tbuckley/cabot-search huggingface dataset:
Questionnaire study and audit of use of angiotensin converting enzyme inhibitor and monitoring in general practice: the need for guidelines to prevent renal failure
Authors: P A Kalra, M Kumwenda, P MacDowall, M O Roland
Journal: BMJ (1999)

<h3>Abstract</h3> <b>Objectives</b>: To determine the current pattern of use of angiotensin converting enzyme inhibitor and monitoring of renal function in general practice and to audit all admissions to a regional renal unit for uraemia related to use of these drugs. <b>Design</b>: Postal questionnaire sent to 400general practitioners; audit of clinical notes of all patients receiving these drugs in one large general practice; audit of all cases of uraemia (creatinine concentration &gt;500µmol/l) related to treatment presenting to hospital renal services over 12months. <b>Setting</b>: General practices in the North Wales health authority and one in central Manchester. Regional renal unit in Salford. <b>Main outcome measures</b>: Proportion of general practitioners who regularly monitored renal function before and after initiation of angiotensin converting enzyme inhibitors. Indications for treatment and details of monitoring of renal function in patients receiving these drugs. Incidence of related uraemia and evidence of comorbid disease, other aetiological factors, delayed detection, and patient outcome. <b>Results</b>: 277 (69%) general practitioners replied; 235(85%) checked renal function before but only 93(34%) after the start of treatment, and 42(15%) never checked renal function. Angiotensin converting enzyme inhibitors were prescribed for 162patients from a total of 3625aged &gt;35 years (mean age 66.4(SD 15.9) years). Monitoring of renal function occurred before treatment in 55(45%) and after start of treatment in 35(29%) of the 122patients treated in general practice. Angiotensin converting enzyme inhibitors could be causally implicated in 9(7%) of 135admissions for uraemia (mean age 74.2(7.2) <i>v</i> 62.1(2.1) years; P&lt;0.01). 3patients had renovascular disease and 6had congestive cardiac failure with another intercurrent illness. Renal function had not been checked in any patient after the start of treatment; mean duration of illness before admission was 10.5(3.2) days. Mean length of hospital stay was 20.9(10.4) days; there were 8survivors. <b>Conclusion</b>: Cases of uraemia related to treatment with angiotensin converting enzyme inhibitors are still encountered and are often detected late because of lack of judicious monitoring of renal function in vulnerable, often elderly, patients, especially at times of intercurrent illness. Guidelines for appropriate monitoring of renal function may help to minimise the problem.
Validation of a regional drug misuse database: implications for policy and surveillance of problem drug use in the uk
Authors: M. Hickman, H. Sutcliffe, A. Sondhi, G. V Stimson
Journal: BMJ (1997)

The eight regional drug misuse databases constitute the largest investment (about £100 000 each annually) in drugs surveillance in England. Along with databases in Scotland and Wales, they provide the main intelligence on problem drug takers, including monitoring government targets.1 They were established because of the lack of information on clients of drug agencies2 but have attracted criticism for not properly informing policymakers of the extent of drug use and not accurately assessing client volume.3 We performed a study in North Thames to assess the level of underreporting of “episodes” (new clients or clients who reattend after an absence of six months4) to the regional database and the relation between episodes and the number of clients and prevalent drug takers attending agencies in a year.

Over …
Low fetal morbidity in pregnancy associated with acute and chronic idiopathic thrombocytopenic purpura
Authors: R Sharon, I Tatarsky
Journal: American Journal of Hematology (1994)

Forty-six mothers with immune thrombocytopenic purpura (ITP) gave birth to 72 babies. Sixty-two babies were delivered vaginally and 10 babies by cesarean section. There was no mortality among mothers or babies. Eighteen infants were born thrombocytopenic (PLT < 100 x 10(9)/l). Eleven infants had a platelet count of less than 50 x 10(9)/l. All the severely thrombocytopenic babies (except 1) were born to post splenectomy thrombocytopenic mothers, regardless of steroid treatment during pregnancy. Five babies had clinical manifestations of bleeding; 3 had mild purpura, 1 severe gastrointestinal bleeding, and 1 intracranial bleeding. The latter 2 babies were born prematurely to the same mother who was severely thrombocytopenic despite splenectomy in childhood. In view of very low morbidity in babies of ITP mothers, we suggest that they be delivered vaginally. Cesarean delivery should be performed in selected cases where the mother is severely thrombocytopenic despite splenectomy or where prematurity or obstetrical complications are encountered.
Diet and Plasma Cholesterol in 99 Bank Men
Authors: J. N. Morris, J. W. Marr, J. A. Heady, G. L. Mills, T. R. E. Pilkington
Journal: BMJ (1963)

NEONATAL TETANUS BRITpH 571.~~~~~~~~~~~~~~~~~~~EIA ORA flow resistance, could be reduced.Assistance could be given to muscles labouring to ventilate lungs reduced in compliance by consolidation' and collapse.Improved ventilation may even help to overcome infection.This was common in the underventilated infant and much less frequent once adequate ventilation was ensured.When it did occur, survival appeared to be prolonged beyond what might have been expected from the gross post-mortem findings.Summary A series of infants with tetanus neonatorum were treated with relaxants and I.P.P.R., with disappointing results.In fatal cases the clinical, electrocardiographic, and pathological changes closely resembled those previously ascribed to overwhelming tetanus intoxica- tion.No improvement followed investigations and treatment based on concepts of tetanus intoxication of the brain-stem or myocardium, nor from lowering the I wish to thank the registrars for all their help, particularly Dr. W. Wittmann for his help during the early difficult period; the E.N.T. surgeons, particularly Dr. P. Maytham and Dr. J. Marais
Acute Myoglobinuria Associated With Heroin Addiction
Authors: Ralph W. Richter
Journal: JAMA (1971)

Acute rhabdomyolysis was observed as a new complication of intravenous heroin-adulterant injections in four men. Clinical features included generalized muscle tenderness, edema, and profound weakness. Myoglobinuria was detected by a specific immunological method which measured levels up to 3.25 mg/ml. Serum myoglobin levels as high as 0.310 mg/ml were found, with serum creatine phosphokinase levels up to 14,000 units. Needle electromyography showed myopathic motor unit potentials in all muscles tested, most marked proximally. Histologic examination demonstrated acute myolysis, and in one case an unusual picture consistent with tubular aggregates. Renal failure occurred in two patients, one of whom survived. Resolution of weakness varied from two to six weeks. The process recurred in one patient following a subsequent heroin injection.
Rising complaints against doctors due to changed patient expectations, researchers say
Authors: T. Moberly
Journal: BMJ (2014)

Numbers of complaints against doctors have risen as a result of broad cultural changes in society, including changing expectations, nostalgia for a “golden age” of healthcare, and a desire to raise grievances altruistically, researchers have said.

A study funded by the General Medical Council looked into the factors behind the increase in inquiries it received from members of the public about doctors’ fitness to practice.1 The number rose from 3615 in 2007 to 6154 in 2012.

A team of researchers led by Julian Archer, senior clinical lecturer at Plymouth University, concluded that …
Insulin signaling in the transcriptional and posttranscriptional regulation of CYP2E1 expression
Authors: Kimberley J. Woodcroft, Mikehl S. Hafner, Raymond F. Novak
Journal: Hepatology (2002)

Diabetes has been reported to increase the expression of cytochrome P450 (CYP) 2E1 messenger RNA (mRNA) and protein several-fold, and enhanced expression has been associated with elevated ketone bodies. Primary cultured rat hepatocytes were used to explore ketone body and insulin regulation of CYP2E1 expression. Hydroxybutyrate and acetoacetate (AC), alone or in combination, either failed to affect or decreased CYP2E1 mRNA levels by up to 90% relative to untreated hepatocytes. Insulin produced a concentration-dependent decrease in CYP2E1 mRNA levels, and insulin receptor immunoprecipitation showed a correspondence between receptor phosphorylation and the decrease in CYP2E1 mRNA levels at physiologic levels of insulin. Phosphatase inhibitors decreased CYP2E1 mRNA levels by greater than 95%. The phosphatidylinositol 3-kinase (PI3-kinase) inhibitors wortmannin or LY294002 and rapamycin, an inhibitor of p70 S6 kinase phosphorylation, ameliorated the insulin-mediated decrease in CYP2E1 mRNA levels. Geldanamycin, which inhibits Src kinase, also abrogated the insulin-mediated decrease in CYP2E1 mRNA levels. In contrast, the protein kinase C (PKC) inhibitor bisindolylmaleimide, the mitogen-activated protein kinase kinase (MEK) inhibitor PD98059, and the p38 mitogen-activated protein (MAP) kinase inhibitor SB202190 did not affect the insulin-mediated decrease in CYP2E1. CYP2E1 mRNA half-life decreased from ˜48 hours in the absence of insulin to ˜15 hours at 10 nmol/L insulin, and this decrease was prevented by wortmannin. The half-life of CYP2B mRNA was increased by insulin, whereas that of CYP3A was unaffected. Analysis of CYP2E1 gene transcription using heterogeneous nuclear RNA (hnRNA) showed that insulin suppressed CYP2E1 transcription. In conclusion, these data show involvement of transcriptional and posttranscriptional mechanisms in the insulin-mediated regulation of CYP2E1 and implicate PI3-kinase, p70 S6 kinase, and Src kinase in mediating these effects.)
Moderate expansion of a normally biallelic trinucleotide repeat in spinocerebellar ataxia type 2
Authors: Stefan-M. Pulst, Alex Nechiporuk, Tamilla Nechiporuk, Suzana Gispert, Xiao-Ning Chen, Iscia Lopes-Cendes, Susan Pearlman, Sidney Starkman, Guillermo Orozco-Diaz, Astrid Lunkes, Pieter DeJong, Guy A. Rouleau, Georg Auburger, Julie R. Korenberg, Carla Figueroa, Soodabeh Sahba
Journal: Nature Genetics (1996)
189 CIRRHOTIC CARDIOMYOPATHY: ABNORMAL VENTRICULAR FILLING OR ACTUAL MYOCARDIAL DYSFUNCTION?
Authors: E. Solà, A. Nazar, M. Sitges, M. Guevara, C. Guigou, S. Poyatos, G.H. Pereira, C. Fagundes, V. Arroyo, P. Ginès
Journal: Journal of Hepatology (2011)
Oxytocic Drugs in Fourth Stage of Labor
Authors: William F. Howard, Philip R. McFadden, William C. Keettel
Journal: JAMA (1964)

A group of 1,459 parturient women were the subjects of a controlled double-blind study assessing the effects of oxytocin, methylergonovine maleate, and a placebo upon the fourth stage of labor. Although patients in the placebo group had a higher incidence of hemorrhage and more often required additional treatment in the form of an oxytocic agent, 88% of this group had no difficulty. Methylergonovine maleate was the agent most effective in preventing postpartum hemorrhage. Postpartum blood pressure rises occurred in all three groups, most frequently following methylergonovine maleate and least often following a placebo. In patients with toxemia of pregnancy, methylergonovine maleate was associated with a high incidence of severe pressor responses. In patients with toxemia, if an oxytocic agent is required, oxytocin is the drug of choice.
Centenary of first successful human transplant
Authors: Martin Terplan
Journal: BMJ (2005)

This year, 7 December will mark the 100th anniversary of the first successful human transplantation. On that day Eduard Zirm (1863-1944), a Viennese born and trained ophthalmologist, performed bilateral corneal transplants in what was then Olmuetz, Austria-Hungary (today's Olomuoc in the Czech Republic). The patient was a 43 year old labourer who had been blinded three months earlier when some lye he was slacking squirted into his eyes. By December, his corneas were completely opaque. The donor cornea …
Subaortic Stenosis and Parathyroid Adenoma
Authors: DAVID SHANDER
Journal: Annals of Internal Medicine (1978)

Letters and Corrections1 May 1978Subaortic Stenosis and Parathyroid AdenomaDAVID SHANDER, M.D., F.A.C.P., FRED H. KATZ, M.D., F.A.C.P.DAVID SHANDER, M.D., F.A.C.P.Search for more papers by this author, FRED H. KATZ, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-88-5-719_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: With reference to the brief report by McFarland and coworkers (Ann Intern Med 88:57-58, 1978) on hypercalcemia with muscular subaortic stenosis, we wish to report a case in which the evidence for muscular subaortic stenosis has subsided after removal of a parathyroid adenoma.The patient is a 63-year-old female Russian immigrant who was first seen on 5 March 1977, with complaints of substernal chest pain, increasing shortness of breath, and one episode of syncope for approximately 15 min on the morning of admission. The patient related a history of coronary artery disease with angina and possible congestive... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Rose Medical Center Denver, CO 80220 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByCardiac hypertrophy, hypertrophic cardiomyopathy, and hyperparathyroidism--an association. 1 May 1978Volume 88, Issue 5Page: 719-719KeywordsAnginaDyspneaHypercalcemiaIschemiaParathyroid tumorsStable coronary artery diseaseStenosisSyncope Issue Published: 1 May 1978 PDF DownloadLoading ...
SUPRARENAL HEMORRHAGE IN THE NEW-BORN
Authors: WILLIAM J. CORCORAN
Journal: JAMA (1924)

Medical literature contains the reports of about 100 cases of extensive suprarenal hemorrhage in the new-born, but no record has been found of another case in which operation has been performed, with recovery. Possibly this is because the course of the disease is too rapid to allow the development of symptoms referable to the gland itself. Clinically, the condition resembles a progressing internal hemorrhage, though in certain cases there are signs of pressure on adjacent organs. This was true in the case reported here, in which the compression signs were so definite as to constitute a typical picture of hemorrhage in, or about, the left suprarenal capsule. Following the publication of Mattei's<sup>1</sup>statistics of necropsies on fetuses and the new-born, suprarenal hemorrhage was no longer considered an uncommon disease. In more recent years, other investigators have shown that microscopically demonstrable hemorrhages in the suprarenal gland are an almost constant
Assisted dying versus assisted living
Authors: T. Koch
Journal: BMJ (2011)

The aim of the present study was to clarify the clinical characteristics and prognosis of patients with interstitial lung disease (ILD) associated with amyopathic dermatomyositis (ILD-ADM). The study consisted of 14 consecutive patients with ILD-ADM. Patients were classified into two categories, acute/subacute and chronic forms, according to the clinical presentation of ILD. The clinical features, responsiveness to therapy, and prognosis between the two forms were compared. Nine ILD-ADM patients were categorised as the acute/subacute form, and five as the chronic form. Arterial oxygen tension was significantly lower in the acute/subacute ILD than chronic ILD patients. On high-resolution computed tomography, ground-glass opacities were frequently found in the two forms, but consolidation was more common in acute/subacute ILD than chronic ILD. Bronchoalveolar lavage analysis showed higher numbers of total cells and lymphocytes in acute/subacute ILD than chronic ILD. Histologically, the most common finding was nonspecific interstitial pneumonia in the two forms, while diffuse alveolar damage was only found in acute/subacute ILD. Acute/subacute ILD was generally resistant to therapy, while chronic ILD responded well. Notably, the mortality of acute/subacute ILD was much higher than that of chronic ILD (67 <i>versus</i> 0%, respectively). In conclusion, interstitial lung disease associated with amyopathic dermatomyositis includes two different forms, the acute/subacute and chronic forms, with distinct prognoses.
Hospital Medicine Essentials for PDA. Version 5.0
Authors: J. Marc Overhage, Paul Dexter
Journal: Annals of Internal Medicine (2003)

Medical Writings: Book and Software Notes18 March 2003Hospital Medicine Essentials for PDA. Version 5.0J. Marc Overhage, MD, PhD and Paul Dexter, MDJ. Marc Overhage, MD, PhDRegenstrief Institute and the Indiana University School of Medicine, Indianapolis, Indiana.Search for more papers by this author and Paul Dexter, MDRegenstrief Institute and the Indiana University School of Medicine, Indianapolis, Indiana.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-138-6-200303180-00033 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hospital Medicine Essentials for PDA. Version 5.0Wachter RM, Goldman L, Hollander H, and Baudendistel T, eds. Philadelphia: Lippincott Williams & Wilkins; 2002. $49.95. ISBN 0781736021. Order at www.lww.com.Field of medicine: Hospital medicine.Format: CD-ROM or download.System requirements: Handheld devices with Palm OS (requires 1.2 MB), Windows CE, or Windows Pocket PC operating system (requires 1.6 MB).Audience: Practitioners, residents, and medical students.Purpose: To provide a quick reference. Content is not intended to be in-depth.Content:Hospital Medicine Essentials for PDA is a source of quick answers to more than 210 clinical problems that a clinician confronts on ... Author, Article, and Disclosure InformationAffiliations: Regenstrief Institute and the Indiana University School of Medicine, Indianapolis, Indiana. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 March 2003Volume 138, Issue 6Page: 524KeywordsHospital medicineHospitalizationsInformation technologyInpatientsPatent ductus arteriosusResearch laboratoriesSigns and symptomsSoftware toolsStaphylococcal infection ePublished: 18 March 2003 Issue Published: 18 March 2003 Copyright & PermissionsCopyright © 2003 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Assessment of renal concentrating ability.
Authors: J R Curtis, B A Donovan
Journal: BMJ (1979)

Maximum urine osmolality was measured during a 24-hour control period in normal ambulant and working subjects and hospital inpatients and compared with that achieved after intramuscular injection of 4 microgram desamino-cys-1-8-D-arginine vasopressin (DDAVP). Most of the normal subjects passed maximally concentrated urine at some time during the control period. The results suggest that in less active subjects or hospital inpatients the DDAVP test is a suitable method of assessing renal concentrating ability.
P1-207: Concurrent chemoradiotherapy with irinotecan/cisplatin followed by consolidation chemotherapy with irinotecan/cisplatin in patients with limited-disease small cell lung cancer
Authors: Kyu Chan Lee, Seok Ho Lee, Soo Jin Choi, Yuna Lee, Sang Hoon Han, Se Hoon Park, Jinny Park, Eun Kyung Cho, Dong Bok Shin, Jae Hoon Lee
Journal: Journal of Thoracic Oncology (2007)
Disintegration and cancer immunotherapy efficacy of a squalane-in-water delivery system emulsified by bioresorbable poly(ethylene glycol)-block-polylactide
Authors: Wei-Lin Chen, Shih-Jen Liu, Chih-Hsiang Leng, Hsin-Wei Chen, Pele Chong, Ming-Hsi Huang
Journal: Biomaterials (2013)

Vaccine adjuvant is conferred on the substance that helps to enhance antigen-specific immune response. Here we investigated the disintegration characteristics and immunotherapy potency of an emulsified delivery system comprising bioresorbable polymer poly(ethylene glycol)–polylactide (PEG–PLA), phosphate buffer saline (PBS), and metabolizable oil squalane. PEG–PLA-stabilized oil-in-water emulsions show good stability at 4 °C and at room temperature. At 37 °C, squalane/PEG–PLA/PBS emulsion with oil/aqueous weight ratio of 7/3 (denominated PELA73) was stable for 6 weeks without phase separation. As PEG–PLA being degraded, 30% of free oil at the surface layer and 10% of water at the bottom disassociated from the PELA73 emulsion were found after 3 months. A MALDI-TOF MS study directly on the DIOS plate enables us to identify low molecular weight components released during degradation. Our results confirm the loss of PLA moiety of the emulsifier PEG–PLA directly affected the stability of PEG–PLA-stabilized emulsion, leading to emulsion disintegration and squalane/water phase separation. As adjuvant for cancer immunotherapeutic use, an HPV16 E7 peptide antigen formulated with PELA73 plus immunostimulatory CpG molecules could strongly enhance antigen-specific T-cell responses as well as anti-tumor ability with respected to non-formulated or Alum-formulated peptide. Accordingly, these advances may be a potential immunoregulatory strategy in manipulating the immune responses induced by tumor-associated antigens.
Bacterial glutaminase in treatment of acute leukaemia.
Authors: A S Spiers, H E Wade
Journal: BMJ (1976)

A glutaminase-asparaginase enzyme from Achromobacter sp has antitumour activity in vitro and in animals. Glutaminase was administered in doses of 3500-20 000 IU/m2 body surface area/day to six patients with acute lymphoblastic leukaemia (ALL) and three patients with acute myeloid leukaemia (AML). The enzyme had a blood half life of 80 minutes but depletion of blood glutamine persisted for 12 hours after single doses. Seven patients, including four (two with AML and two with ALL) resistant to asparaginase, received repeated doses of glutaminase. Antileukaemic effects were observed in all seven; one elderly patient developed metabolic acidosis. Study of this new antileukaemic agent in patients with acute leukaemia at an earlier stage of their disease is now justified.
Reply to Yiping Zhu and Dingwei Ye’s Letter to the Editor re: Beat Roth, Frédéric D. Birkhäuser, Pascal Zehnder, et al. Readaptation of the Peritoneum Following Extended Pelvic Lymphadenectomy and Cystectomy Has a Significant Beneficial Impact on Early Postoperative Recovery and Complications: Results of a Prospective Randomized Trial. Eur Urol 2011;59:204–10
Authors: Urs E. Studer
Journal: European Urology (2011)