tbuckley/cabot-search huggingface dataset:
Reducing Suppressive Therapy in Patients with a History of Thyroid Cancer
Authors: Manfred Blum
Journal: Annals of Internal Medicine (1995)

Letters15 November 1995Reducing Suppressive Therapy in Patients with a History of Thyroid CancerManfred Blum, MD and Surekha Perlman, MDManfred Blum, MDNew York University Medical Center; New York, NY 10016Search for more papers by this author and Surekha Perlman, MDNew York University Medical Center; New York, NY 10016Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-10-199511150-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:It is now recommended that levothyroxine doses be reduced when the drug is used to suppress thyroid-stimulating hormone (TSH), so that a thyrotoxicosis-induced increased risk for osteoporosis is minimized in patients with a history of thyroid cancer who have been apparently tumor-free for many years [1-5]. However, no data address whether low but detectable TSH levels can achieve the clinical benefit that was seen when TSH was extinguished. Furthermore, a tumor-free state is difficult to definitively ascertain.We are concerned that some patients with a history of thyroid cancer may be harmed when TSH is unclamped unless ...References1. Paul TL, Kerrigan J, Kelly AM, Braverman LE, Baran DT. Long-term L-thyroxine therapy is associated with decreased hip bone density in premenopausal women. JAMA. 1988; 259:3137-41. Google Scholar2. Solomon BL, Wartofsky L, Burman KD. Prevalence of fractures in postmenopausal women with thyroid disease. Thyroid. 1993; 3:17-23. Google Scholar3. Spencer CA, Lai-Rosenfeld AO, Guttler RB, LoPresti J, Marcus AO, Nimalasuriya A, et al. Thyrotropin secretion in thyrotoxic and thyroxine-treated patients: assessment by a sensitive immunoenzymonemetric assay. J Clin Endocrinol Metab. 1986; 63:349-55. Google Scholar4. Spencer CA. Clinical utility of sensitive TSH assays. Thyroid Today. 1986; 9. Google Scholar5. Cooper DS. Thyroid hormone and the skeleton: a bone of contention. JAMA. 1988; 259:3175. Google Scholar Author, Article, and Disclosure InformationAuthors: Manfred Blum, MD; Surekha Perlman, MDAffiliations: New York University Medical Center; New York, NY 10016 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byUltrasonic Imaging of the Neck in Patients with Thyroid CancerUltrasonic Imaging and Identification of Metastases in Cervical Lymph Nodes 15 November 1995Volume 123, Issue 10Page: 808-809KeywordsHypothyroidismLung and intrathoracic tumorsMagnetic resonance imagingOsteoporosisThoraxThyroglobulinThyroidThyroid carcinomaThyroid-stimulating hormoneThyroxine ePublished: 15 August 2000 Issue Published: 15 November 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Recurrence of Biliary Drug Lithiasis Due to Dipyridamole
Authors: D. Sautereau, C. Moesch, J.-C. Letard, F. Cessot, A. Gainant, B. Pillegand
Journal: Endoscopy (1997)

The occurrence of drug-containing gallstones is not often observed. To our knowledge, three drugs have so far been incriminated-ceftriaxone, glaphenine, and dipyridamole. This report presents the case of an 85-year-old woman who developed a recurrent drug-containing gallstone caused by dipyridamole eighteen months after a previous stone had been removed endoscopically.
Prospects for Advancing Tuberculosis Control Efforts through Novel Therapies
Authors: Joshua A Salomon, James O Lloyd-Smith, Wayne M Getz, Stephen Resch, María S Sánchez, Travis C Porco, Martien W Borgdorff
Journal: PLoS Medicine (2006)

Development of new, effective, and affordable tuberculosis (TB) therapies has been identified as a critical priority for global TB control. As new candidates emerge from the global TB drug pipeline, the potential impacts of novel, shorter regimens on TB incidence and mortality have not yet been examined.We used a mathematical model of TB to evaluate the expected benefits of shortening the duration of effective chemotherapy for active pulmonary TB. First, we considered general relationships between treatment duration and TB dynamics. Next, as a specific example, we calibrated the model to reflect the current situation in the South-East Asia region. We found that even with continued and rapid progress in scaling up the World Health Organization's DOTS strategy of directly observed, short-course chemotherapy, the benefits of reducing treatment duration would be substantial. Compared to a baseline of continuing DOTS coverage at current levels, and with currently available tools, a 2-mo regimen introduced by 2012 could prevent around 20% (range 13%-28%) of new cases and 25% (range 19%-29%) of TB deaths in South-East Asia between 2012 and 2030. If effective treatment with existing drugs expands rapidly, overall incremental benefits of shorter regimens would be lower, but would remain considerable (13% [range 8%-19%] and 19% [range 15%-23%] reductions in incidence and mortality, respectively, between 2012 and 2030). A ten-year delay in the introduction of new drugs would erase nearly three-fourths of the total expected benefits in this region through 2030.The introduction of new, shorter treatment regimens could dramatically accelerate the reductions in TB incidence and mortality that are expected under current regimens-with up to 2- or 3-fold increases in rates of decline if shorter regimens are accompanied by enhanced case detection. Continued progress in reducing the global TB burden will require a balanced approach to pursuing new technologies while promoting wider implementation of proven strategies.
Dopamine for Cardiogenic Shock
Authors: Joel S. Karliner
Journal: JAMA (1973)

Dopamine (3,4 dihydroxy phenylethylamine) is a naturally occurring catecholamine that has been employed both experimentally and clinically for the therapy of various forms of shock. Dopamine possesses a variety of useful pharmacologic properties. It functions as an a-adrenergic agonist, causing vasoconstriction of peripheral capacitance and resistance vessels; it also is a β-adrenergic agonist, producing an increase in cardiac rate and an augmentation of myocardial contractility. In these respects, dopamine is not different from norepinephrine. However, dopamine possesses another property that is unique: it dilates renal and mesenteric vascular beds directly. Recent evidence indicates that dopamine inhibits renal tubular reabsorption of sodium. Thus, dopamine can be used to increase systemic arterial pressure by stimulating the myocardium, without compromising renal blood flow and urine output. Although dopamine, like other pressor agents, has been utilized in a variety of forms of shock, its most successful application has been in patients with cardiogenic shock.
Hemodynamics after endoscopic submucosal injection of epinephrine in patients with nonvariceal upper gastrointestinal bleeding: a matter of concern
Authors: S. von Delius, P. Thies, A. Umgelter, C. Prinz, R. Schmid, W. Huber
Journal: Endoscopy (2006)

We report about detailed hemodynamic changes and one major cardiac complication occurring after submucosal injection of epinephrine (1 : 10 000) for management of upper gastrointestinal bleeding in a series of four consecutive patients. Cardiac contractility and afterload, determined by the cardiac index and the systemic vascular resistence index (SVRI), were assessed by transpulmonary thermodilution using the Pulse Contour Cardiac Output monitoring system (PiCCO; Pulsion Medical Systems, Munich, Germany), and the mean arterial pressure and heart rate were recorded. We observed a distinct rise in both mean arterial pressure and heart rate, and this effect was pronounced in the three patients with esophageal lesions. The increase in the mean arterial pressure was caused by an elevation of the cardiac index in two patients, a rise in both cardiac index and SVRI in one patient, and a rise in the SVRI only in the fourth patient. One patient, who had received 30 ml epinephrine for treatment of a bleeding Mallory-Weiss tear, developed an acute myocardial infarction during the postprocedural follow-up period. In conclusion, submucosal injection of epinephrine may cause significant hemodynamic changes that can potentially lead to adverse cardiac events. Close cardiac monitoring during and after submucosal application of epinephrine therefore seems a prudent precaution. In the treatment of esophageal lesions, the total amount of epinephrine injected should be carefully titrated, so that the lowest possible volume that achieves adequate hemostasis is used.
Points from letters: Early detection of bronchial carcinoma
Authors: J C Roberts
Journal: BMJ (1975)

<h3></h3> In Huntington’s disease (HD), symptoms occur late in life. However, an earlier neurodevelopmental and pre-manifest period exists in juvenile and ultra-juvenile HD (and other neuro-diseases). In order to deliver the missing knowledge about defective brain formation, we used juvenile HD and control iPSC and established 2-months old 3D fused brain organoids of dorsal and ventral forebrain identity. We confirmed their specification into various distinct regions such as PAX6+ ventricular zone and TBR1+ subventricular zone, NKX2.1+ and DLX2+ medial ganglionic eminence (MGE), GSX2+ lateral ganglionic eminence (LGE), and TTR+ choroid plexus. By conducting qPCR experiments, we demonstrate that the transcriptomics of several neuronal and glial markers is altered in juvenile HD organoids. Detecting early neurodevelopmental cellular phenotypes in cell composition during development in organoids that are not as specified as the human brain requires single-cell RNA-seq and a special high-resolution bioinformatics pipeline. Therefore we constructed a unique JSEQ® pipeline and performed the scRNA-seq analysis of HD71Q and HD77Q vs. control 17Q and 21Q organoids to determine early alterations in HD cells during brain formation. The JSEQ® bioinformatics pipeline performs all entry steps in single-cell sequencing analyses and subsequently determines high-resolution cell composition by the combinatorial CSSG algorithm. Combining the scRNA-seq and JSEQ pipeline, we identified several cell populations particularly vulnerable in juvenile HD. Overall, we present the formation of fused brain organoids and early transcriptomic changes in juvenile HD neurodevelopment.
Chronic caregiver stress and IgE expression, allergen-induced proliferation, and cytokine profiles in a birth cohort predisposed to atopy
Authors: Rosalind J. Wright, Patricia Finn, Johanna Paola Contreras, Sheldon Cohen, Robert O. Wright, John Staudenmayer, Matthew Wand, David Perkins, Scott T. Weiss, Diane R. Gold
Journal: Journal of Allergy and Clinical Immunology (2004)
Intrahepatic CD8+ T-cell failure during chronic hepatitis C virus infection
Authors: Hans Christian Spangenberg, Sergei Viazov, Nadine Kersting, Christoph Neumann-Haefelin, Denise McKinney, Michael Roggendorf, Fritz von Weizsäcker, Hubert E. Blum, Robert Thimme
Journal: Hepatology (2005)

Abstract The precise mechanisms responsible for the failure of intrahepatic hepatitis C virus (HCV)-specific CD8+ T cells to control the virus during persistent infection have not been fully defined. We therefore studied the CD8+ T-cell response in 27 HLA-A2–positive patients using four previously well-defined HLA-A2–restricted HCV epitopes. The corresponding HCV sequences were determined in several patients and compared with the intrahepatic HCV-specific CD8+ T-cell response. The results of the study indicate: (1) intrahepatic HCV-specific CD8+ T cells are present in the majority of patients with chronic HCV infection and overlap significantly with the response present in the peripheral blood. (2) A large fraction of intrahepatic HCV-specific CD8+ T cells are impaired in their ability to secrete interferon γ (IFN-γ). This dysfunction is specific for HCV-specific CD8+ T cells, since intrahepatic Flu-specific CD8+ T cells readily secrete this cytokine. (3) T-cell selection of epitope variants may have occurred in some patients. However, it is not an inevitable consequence of a functional virus-specific CD8+ T-cell response, since several patients with IFN-γ–producing CD8+ T-cell responses harbored HCV sequences identical or cross-reactive with the prototype sequence. (4) The failure of intrahepatic virus–specific CD8+ T cells to sufficiently control the virus occurs despite the presence of virus-specific CD4+ T cells at the site of disease. In conclusion , different mechanisms contribute to the failure of intrahepatic CD8+ T cells to eliminate HCV infection, despite their persistence and accumulation in the liver. (Hepatology 2005;42:828–837.)
Pneumocystis carinii Pneumonia
Authors: Stanley A. Plotkin
Journal: JAMA (1978)

To the Editor.—  The article by Rao et al reporting  Pneumocystis carinii Pneumonia: Occurrence in a Healthy American Infant was extremely interesting, considering the scarcity of similar reports and the current belief by most workers in the field that Pneumocystis occurs symptomatically only in the immunosuppressed.  Since physicians may be led by this report to treat blindly with trimethoprim in occult pneumonias of infancy, I think it is proper to raise some questions: How many parasites were seen? Were photographs taken? Was a control section of known positive Pneumocystis infection stained at the same time? Were precipitin antibodies to Pneumocystis demonstrated? Was pneumocystis antigenemia confirmed in this child?  Having this information would certainly influence my evaluation of this reported case and others that I might see in the future.
Acyclovir in Lymphomatoid Papulosis and Mycosis Fungoides
Authors: Günter Burg
Journal: JAMA (1986)

<h3>To the Editor.—</h3> Over two years ago Resnick and colleagues<sup>1</sup>reported on the remission of tumor-stage mycosis fungoides (MF) following intravenously administered acyclovir in a 58-year-old woman with a seven-year history. Mahrle and colleagues,<sup>2</sup>using the same treatment, saw no effect in their two patients with MF. By contacting over 20 experts in the field of cutaneous lymphomas worldwide we gathered nine more cases of MF in which acyclovir had been administered. In only two of these patients had a partial response been achieved. In none of our own five patients with cutaneous T-cell lymphomas (four with plague-stage MF and one with pleomorphic T-cell lymphoma) could any response be seen. Thus, in three of the 17 cases gathered so far an antiproliferative effect of acyclovir had been observed. We asked the following question: if acyclovir is effective in some patients with lymphoproliferative diseases, what could be the possible
ABC of palliative care: Principles of palliative care and pain control
Authors: B. O'Neill, M. Fallon
Journal: BMJ (1997)

Principles of palliative careThe World Health Organisation defines palliative care as "the active total care of patients whose disease is not responsive to curative treatment.Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount.The goal of palliative care is achievement of the best quality of life for patients and their families."Palliative care is necessarily multidisciplinary.It is unrealistic to expect one profession or individual to have the skills to make the necessary assessment, institute the necessary interventions, and provide ongoing monitoring. Development of palliative careModern palliative care originated in the development of St Christopher's Hospice in London in 1967.Recognising the unmet needs of dying patients in hospital, Dame Cecily Saunders established the hospice and, with others, conceived of a comprehensive approach to dealing with the variety of symptoms and suffering often experienced by patients with progressive debilitating disease.Careful observation of the use and effects of morphine and similar drugs also originated at the hospice.Traditionally, hospice care was reserved for those with incurable cancer.Increasingly, care is provided for other patients such as those with AIDS and neurological disorders, including motor neurone disease and multiple sclerosis.When palliative medicine was accorded specialist standing in the United Kingdom, in 1987, the agreed definition was "the study and management of patients with active, progressive, far-advanced disease, for whom the prognosis is limited and the focus of care is the quality of life."In the past hospices provided only inpatient care, and they were isolated from mainstream care.Most units now combine inpatient and home care services, and many independent home care teams also exist, working closely with general practitioners and other workers in primary care.Similarly, many acute hospital and teaching centres now have consultative, hospital based teams.While hospices will always be needed to care for some patients, the philosophy of care and knowledge gained must be integrated into other specialties.After appropriate assessment, the various methods of symptom control described in this series can be applied at any stage of many illnesses.Symptoms can be relieved while awaiting a response to curative treatment.
Leukocyte trafficking in a mouse model for leukocyte adhesion deficiency II/congenital disorder of glycosylation IIc
Authors: Sviatlana Yakubenia, David Frommhold, Dirk Schölch, Christina C. Hellbusch, Christian Körner, Björn Petri, Claire Jones, Ute Ipe, M. Gabriele Bixel, Robert Krempien, Markus Sperandio, Martin K. Wild
Journal: Blood (2008)
Triple mode of action of flecainide in catecholaminergic polymorphic ventricular tachycardia
Authors: D. S. Steele, H.-S. Hwang, B. C. Knollmann
Journal: Cardiovascular Research (2013)

There has been a resurgence of interest in the class I C antiarrhythmic agent flecainide fuelled by recent work identifying the drug as an effective treatment for catecholaminergic polymorphic ventricular tachycardia (CPVT).1–3 CPVT is caused by mutations in the sarcoplasmic reticulum (SR) Ca2+ release channel (RyR2), or the associated proteins calsequestrin-2 or triadin, which lead to an increased propensity for spontaneous SR Ca2+ waves during exercise or stress. These in turn induce a transient inward current due to Ca2+ extrusion via the Na/Ca exchanger (NCX), delayed afterdepolarizations (DADs) and triggered action potentials. While it is increasingly accepted that flecainide is an effective treatment for CPVT, a degree of controversy has emerged regarding its mechanism of action.

Watanabe et al . provided the first evidence that, in addition to known inhibitory effects on the Na+ current ( I Na), flecainide also acts directly on RyR2 to prevent pro-arrhythmic SR release, thereby providing a dual mode of action.1 Subsequent work demonstrated that flecainide only inhibits RyR2 gating when the channel is in the open state.4 The functional consequence of this effect on RyR2 is that the Ca2+ flux associated with each diastolic Ca2+ spark is reduced, while event frequency increases, such that there is no change in the SR Ca2+ leak, SR Ca2+ content, or systolic Ca2+ release. On the basis of these findings, we proposed a new, primary antiarrhythmic mechanism, whereby the flecainide-induced decrease in the spark mass reduces the probability that Ca2+ sparks will undergo salutatory propagation between junctional Ca2+ release sites, which is the basis of pro-arrhythmic Ca2+ waves.4

The importance of flecainide's action on …
Severe Nonfatal Histoplasmosis
Authors: Harry Rubin, Patrick H. Lehan, Michael L. Furcolow
Journal: New England Journal of Medicine (1957)

IN recent years histoplasmosis has been recognized as a common disease throughout the central United States. Although this fungus produces a wide variety of illnesses, the majority of reports in the literature deal with its rare and unusual manifestations. The present case is presented to point up the manifestations of a common form of the disease, severe nonfatal histoplasmosis. Several pertinent but not widely known facts about the roentgenographic picture, skin tests and serology will be discussed. Comments regarding management and the possible role of a recently described antibiotic, amphotericin B,¶ as a therapeutic agent are set forth.Case Report . . .
Learning to Live Together: Preventing Hatred and Violence in Child and Adolescent Development
Authors: Ruth Freeman
Journal: BMJ (2004)

A nyone living in a violent community can gain hope from this book, written for educationalists, parents, and community workers. The book provides a theoretical basis and educational strategies to enable individuals, groups, and nations to coexist peacefully. Starting from biological and evolutionary perspectives, the authors postulate how violence has been inculcated into society; while violent behaviour was once appropriate for survival, it is not relevant to today's society. To enable people to coexist, aggression must be contained. This has implications …
Ronald James Howd
Authors: L. Le Dune
Journal: BMJ (2003)

Former general practitioner Birtley, County Durham (b Benfieldside, County Durham, 1928; q Durham 1951), d 1 March 2003.

After qualifying, Ronald Howd joined the Royal Naval Volunteer Reserve. He was appointed surgeon lieutenant in the reserve in 1958. He entered general practice in Birtley in 1955, retiring in 1988. A private man, he was direct and forthright in manner. The compassionate side of his nature was most apparent in the way in which he related to children in his work. They were frequently beguiled and distracted by the stories that he told them. He was a natural sportsman and played football, cricket, and golf. He leaves a wife and three daughters.
Lower Esophageal Sphincter Response to Gastric Alkalinization
Authors: DONALD O. CASTELL
Journal: Annals of Internal Medicine (1971)

Recent studies have shown that the hormone gastrin has a profound effect on lower esophageal sphincter pressure. The present study was performed to evaluate the effect of different gastric alkalinizing agents. Sphincter pressure was monitored continuously in a group of normal subjects, using fluid-filled catheters. Instillation of 0.1 N hydrochloric acid into the stomachs of these subjects resulted in consistent decreases in lower esophageal sphincter pressure. The subsequent instillation of 0.1 N sodium bicarbonate resulted in striking increases in sphincter pressure to values much greater than basal levels. Similar results were obtained when 0.1 N sodium hydroxide or a commercial antacid preparation was placed into the stomach. Alkalinization of the stomach by various agents results in marked increases in lower esophageal sphincter pressure. The proposed mechanism of action is through release of endogenous gastrin from the antrum. Treatment of heartburn with alkali appears to have a dual effect—neutralization of gastric acid and an increase in the lower esophageal sphincter pressure barrier.
Nine patients are killed as hospital is caught in cross fire in Sri Lankan war zone
Authors: B. Bland
Journal: BMJ (2009)

At least nine people were killed and many more wounded when a hospital in Sri Lanka’s northern war zone was hit by artillery fire, international aid agencies have reported.

The International Committee of the Red Cross and the United Nations have said that on Sunday 1 February several artillery barrages hit Puthukkudiyirippu Hospital, which is caught in the middle of a fierce battle between the Sri Lankan army and the separatist Tamil Tiger rebels.

The aid agencies said that it was not immediately clear which …