tbuckley/cabot-search huggingface dataset:
Poor recovery facilities put patients' lives at risk
Authors: Z. Kmietowicz
Journal: BMJ (2000)

A report into the deaths of patients following surgery has said that many hospitals are operating on patients without adequate recovery facilities, putting their health at risk.

The finding is one of several criticisms of the way that surgery is conducted in England, Wales, and Northern Ireland made by the national confidential enquiry into perioperative deaths (NCEPOD).

The report stated that two fifths of hospitals in which deaths occurred within 30 days of surgery had no high dependency unit. Although this is a substantial improvement on the 19% of hospitals that had a high dependency unit in 1990, the absence of such a facility in an acute surgical hospital is “detrimental to patient care,” stated the report. The inquiry closely examined 10% of deaths that occurred in 30 days after surgery in 1998-9.

In 61 cases (5% of the sample of those who died) the patients were denied access to specialist aftercare because, although the facilities existed, no bed was available.

“An HDU [high dependency unit] should now be at the top of the list of priorities in any hospital that does not already have one,” stated the report.

The report, Then and Now, compares the way surgery was conducted in 1990 with the situation in 1998-9 and found that the rate of change had been “unacceptably slow.”

A major concern is that the proportion of hospital notes about dead patients that are “lost” has increased from 3% to 5—a situation that the inquiry described as “unacceptable.”

Although some doctors had embraced a previous recommendation from the inquiry to conduct audits into perioperative deaths, great disparity existed between specialties. Ophthalmic surgeons and anaesthetists reviewed the lowest proportion of deaths (13% and just under 30%respectively), whereas general surgeons discussed the highest proportion (82%) of cases. According to the inquiry, no death should be “allowed to go unremarked.”

In two further reports, the national inquiry reviewed the outcomes of three procedures—vascular radiology, neurovascular radiology, and angioplasty.

The increasing demand for vascular and neurovascular radiology has not been matched by a similar rise in consultant posts, stated the report. More specialists are needed, along with suitable training programmes.

Most deaths following angioplasty (82%) occurred in patients who had the procedure as an emergency, but the overall death rate was low (0.87%).

As half the patients who died were referred from another hospital, the inquiry recommended that systems for transferring patients be more efficient to prevent patients deteriorating while waiting for the procedure.


Then and Now is available, price £15, from NCEPOD, 35-43 Lincoln's Inn Fields, London WC2A 3PN, or can be downloaded from the inquiry's website (www.ncepod.org.uk).
Remarks on Laryngoscopy
Authors: E. H. Sieveking
Journal: BMJ (1862)

erythemata.Rayer gives one case, indeed, of these in which sanguineous extravasation occurred, and which was consequently almost identical with purpura.It seems quite established that it does not depend on any uniform cause, but rather on a peculiar state of system, of which " debility of the nervous powers" (Eras.Wilson) and fragility of the capillaries must be considered as the chief characteristics.In one form, there is decided fever, and what is called high arterial action, which of course means cardiac excitement with relaxation of the arteries-a condition which paresis of the vagi and
SO-CALLED LEUCOSARCOMA OF THE IRIS.
Authors: E. V. L. BROWN
Journal: JAMA (1906)

It has long been known that most sarcomas of the uveal tract contain more or less pigment, but it remained for Ribbert, 1 in 1897, to first maintain that all so-called leucosarcomas were in reality made up exclusively of pigment-bearing stroma cells and their derivitives.  He conceives of a species of cell reversion, by which the normally pigmented chromatophore recurs to its embryonic prototype, and is then later encountered in tumor formation in its successive stages of development, as, namely, the unpigmented, small round cell, the spindle cell (either pigmented or unpigmented), or as the fully developed, branched and pigmented chromato phore differing in no way from its physiologic predecessor. No other type of cell increase, such as that from ordinary connective tissue, vessel endothelium or perithelium, ever produces uveal sarcoma.  Sweeping as these statements seem on first consideration, various other writers, and notably Tashiro 2 and Schieck, 3 have
Why Not Say It Clearly: A Guide to Scientific Writing
Authors: Hugh H. Hussey
Journal: JAMA (1978)

Lester S. King, MD, has produced the best book on scientific writing I have read (and I think I have read most such books as well as many essays intended to guide would-be writers). The 11 chapters flow easily and readably from first ("The Present Scene") to last ("Setting Up a Course in Medical Writing"). Each chapter can be read profitably as a unit, yet remains part of the whole, valuable alike to teachers, editors, writers, and would-be writers. The fact that the book title lists no illustrations can be misleading. True, there are no drawings, diagrams, or tables, but the text is replete with examples of the way King unravels and reconstructs bad expository writing. Such illustrative editing appears most abundantly in chapter 3 ("Five Treacherous Servants"), a chapter title brought to mind by Kipling's poem, "The Serving Men." King's "treacherous servants" are exemplified by<i>is, of, and, very</i>
The kidney: medical and surgical diseases.
Authors: Conrad L. Pirani
Journal: JAMA (1963)

The second edition of Allen's<i>The Kidney</i>appears 11 years after the first. This has been an exciting period in the field of renal diseases. New biochemical, physiological, clinical, and pathological methods have all greatly contributed to a better understanding of normal and diseased kidneys. One can state truly that a new era has been opened from which even greater progress can be expected and from which one can hope that satisfactory therapeutic approaches might eventually be developed. Allen's books, the only really comprehensive text on renal pathology which appears in the English language, has been rightly considered a major contribution to and a key reference source for all those interested in renal diseases. The new edition is a valiant attempt to bring up-to-date our present knowledge in the light of the many major advances of recent years. Up-dating of the book has required an increase in the number of
A 21-Year-Old Pregnant Woman with Hypertension and Proteinuria
Authors: Andrea Luk, Ronald C. W Ma, Ching Wan Lam, Wing Hung Tam, Anthony W. I Lo, Enders K. W Ng, Alice P. S Kong, Wing Yee So, Chun Chung Chow
Journal: PLoS Medicine (2009)

A 21-year-old pregnant woman, gravida 2 para 1, presented with hypertension and proteinuria at 20 weeks of gestation.She had a history of pre-eclampsia in her first pregnancy one year ago.During that pregnancy, at 39 weeks of gestation, she developed high blood pressure, proteinuria, and deranged liver function.She eventually delivered by emergency caesarean section following failed induction of labour.Blood pressure returned to normal post-partum and she received no further medical follow-up.Family history was remarkable for her mother's diagnosis of hypertension in her fourth decade.Her father and five siblings, including a twin sister, were healthy.She did not smoke nor drink any alcohol.She was not taking any regular medications, health products, or herbs.At 20 weeks of gestation, blood pressure was found to be elevated at 145/100 mmHg during a routine antenatal clinic visit.Aside from a mild headache, she reported no other symptoms.On physical examination, she was tachycardic with heart rate 100 beats per minute.Body mass index was 16.9 kg/m 2 and she had no cushingoid features.Heart sounds were normal, and there were no signs suggestive of congestive heart failure.Radial-femoral pulses were congruent, and there were no audible renal bruits.Baseline laboratory investigations showed normal renal and liver function with normal serum urate concentration.Random glucose was 3.8 mmol/l.Complete blood count revealed microcytic anaemia with haemoglobin level 8.3 g/dl (normal range 11.5-14.3g/dl) and a slightly raised platelet count of 446 × 10 9 /l (normal range 140-380 × 10 9 /l).Iron-deficient state was subsequently confirmed.Quantitation of urine protein indicated mild proteinuria with protein:creatinine ratio of 40.6 mg/mmol (normal range <30 mg/mmol in pregnancy). What Were Our Differential Diagnoses?An important cause of hypertension that occurs during pregnancy is pre-eclampsia.It is a condition unique to the gravid state and is characterised by the onset of raised blood pressure and proteinuria in late pregnancy, at or after 20 weeks of gestation [1].Pre-eclampsia may be associated with hyperuricaemia, deranged liver function, and signs of neurologic irritability such as headaches, hyper-reflexia, and seizures.In our patient, hypertension developed at a relatively early stage of pregnancy than is customarily observed in pre-eclampsia.Although she had proteinuria, it should be remembered that this could also reflect underlying renal damage due to chronic untreated hypertension.Additionally, her electrocardiogram showed left ventricular hypertrophy, which was another indicator of chronicity.While pre-eclampsia might still be a potential cause of hypertension in our case, the possibility of pre-existing hypertension needed to be considered.Box 1 shows the differential diagnoses of chronic hypertension, including
Neuroinflammation and α-Synuclein Dysfunction Potentiate Each Other, Driving Chronic Progression of Neurodegeneration in a Mouse Model of Parkinson’s Disease
Authors: Hui-Ming Gao, Feng Zhang, Hui Zhou, Wayneho Kam, Belinda Wilson, Jau-Shyong Hong
Journal: Environmental Health Perspectives (2011)

BackgroundMechanisms whereby gene–environment interactions mediate chronic, progressive neurodegenerative processes in Parkinson’s disease (PD)—the second most common neurodegenerative disease—remain elusive.ObjectiveWe created a two-hit [neuroinflammation and mutant α-synuclein (α-syn) overexpression] animal model to investigate mechanisms through which mutant α-syn and inflammation work in concert to mediate chronic PD neurodegeneration.MethodsWe used an intraperitoneal injection of the inflammogen lipopolysaccharide (LPS; 3 × 106 EU/kg) to initiate systemic and brain inflammation in wild-type (WT) mice and transgenic (Tg) mice overexpressing human A53T mutant α-syn. We then evaluated nigral dopaminergic neurodegeneration, α-syn pathology, and neuroinflammation.ResultsAfter LPS injection, both WT and Tg mice initially displayed indistinguishable acute neuroinflammation; however, only Tg mice developed persistent neuroinflammation, chronic progressive degeneration of the nigrostriatal dopamine pathway, accumulation of aggregated, nitrated α-syn, and formation of Lewy body-like inclusions in nigral neurons. Further mechanistic studies indicated that 4-week infusion of two inhibitors of inducible nitric oxide synthase and NADPH oxidase, major free radical–generating enzymes in activated microglia, blocked nigral α-syn pathology and neurodegeneration in LPS-injected Tg mice.ConclusionsMicroglia-derived oxidative stress bridged neuroinflammation and α-syn pathogenic alteration in mediating chronic PD progression. Our two-hit animal model involving both a genetic lesion and an environmental trigger reproduced key features of PD and demonstrated synergistic effects of genetic predisposition and environmental exposures in the development of PD. The chronic progressive nature of dopaminergic neurodegeneration, which is absent in most existing PD models, makes this new model invaluable for the study of mechanisms of PD progression.
Parents of Siamese twins appeal against separation
Authors: C. Dyer
Journal: BMJ (2000)

The parents of Siamese twins born in the north of England went to the Court of Appeal this week to try to overturn a High Court judge's ruling giving doctors the go-ahead to operate to separate the twins.

As the BMJ went to press, a surgeon and a paediatric cardiologist from London's Great Ormond Street hospital were travelling to Manchester to examine the twin girls at St Mary's Hospital.

The three appeal court judges had asked for a second opinion on the twins' life expectancy, the dangers of the surgery, the quality of life that the …
Underlying Molecular Genetic Defects in T- B- NK+ Severe Combined Immunodeficiency Disease in Saudi Arabia
Authors: H ALMOUSA, A ALGHONAIM, H ALDHEKRI, S ALMUHSEN, R ARNAOUT, A ALTBAKHI, F ALZAYER, M ALHARBI, H ALSAUD, F ALKAYAL
Journal: Journal of Allergy and Clinical Immunology (2008)
Impairment of Thermoregulatory Control of Skin Sympathetic Nerve Traffic in the Elderly
Authors: Guido Grassi, Gino Seravalle, Carlo Turri, Giovanni Bertinieri, Raffaella Dell’Oro, Giuseppe Mancia
Journal: Circulation (2003)

Human aging is characterized by a marked increase in muscle sympathetic nerve traffic (MSNA). No information exists, however, on the effects of aging on skin sympathetic nerve traffic (SSNA) and on its reflex modulation by thermoregulatory mechanisms.In 13 young, 11 middle-aged, and 12 elderly healthy subjects, we measured arterial blood pressure (Finapres), skin temperature (thermocouples), and resting MSNA and SSNA (microneurography). Measurements also included the SSNA responses to (1) an acute increase and reduction (+/-8 degrees C) in room temperature, each lasting 45 minutes and (2) an acoustic stimulus capable to trigger an emotional arousal. Although resting MSNA was progressively and significantly (P<0.05) increased from young to middle-aged and elderly groups, SSNA was significantly (P<0.05) reduced in the latter compared with the former 2 groups. Cold exposure induced a SSNA increase that was significantly (P<0.01) smaller in the elderly than in young and middle-aged subjects. Conversely, heat exposure induced a SSNA reduction that was significantly (P<0.05) smaller in elderly than in young and middle-aged subjects. Compared with SSNA in young individuals, the SSNA change from cold to warm temperature was reduced by 61% in the elderly group. This was not the case, however, for the SSNA responses to the arousal stimulus, which were superimposable in the 3 groups.These data provide the first demonstration of a dichotomy in the MSNA and SSNA responses to aging. They also show that aging markedly impairs thermoregulatory control of SSNA and that this impairment might participate at the age-related SSNA decrease.
ASSOCIATION OF AORTIC STIFFNESS WITH BIOMARKERS OF MYOCARDIAL WALL STRESS AFTER MYOCARDIAL INFARCTION
Authors: Gert Klug, Hans-Josef Feistritzer, Sebastian J. Reinstadler, Lena Krauter, Agnes Mayr, Johannes Mair, Christian Kremser, Michael Schocke, Wolfgang-Michael Franz, Bernhard Metzler
Journal: Journal of the American College of Cardiology (2014)
919-8 High-speed Coronary Rotational Atherectomy. Are Angiographic Factors Predictive of Failure, Major Complications or Restenosis? A Multivariate Analysis
Authors: Jorge H. Leguizamon, Dionisio F. Chambre, Ernesto M. Torresani, Ricardo G. Nauwerk, Alejandro A. Fernández, Victor Mauro, Carlos M. Barrero
Journal: Journal of the American College of Cardiology (1995)
"Multifocal" Hepatic Nodular Hyperplasia in an Infant
Authors: PACHAGIRI L. SURRESH, MOZAFAREDDIN K. KARIMEDDINI, RICHARD P. SPENCER
Journal: Clinical Nuclear Medicine (1983)

SURESH, PACHAGIRI L. M.D.; KARIMEDDINI, MOZAFAREDDIN K. M.D.; SPENCER, RICHARD P. M.D., Ph.D. Author Information
Current Status of Cardiac Transplantation, 1978
Authors: John Speer Schroeder
Journal: JAMA (1979)

SINCE the first cardiac transplant in man was performed in late 1967, a total of 153 transplants have been carried out at Stanford University Medical Center as of Sept 1, 1978. There are 64 current survivors, and the longest living recipient is alive 8.6 years after the transplant. The initial surge of transplants in 1968 and 1969 reflected the relative ease of the operative procedure (Figure). However, the complexities of diagnosis and control of allograft rejection resulted in high mortality and cessation of the procedure in many centers. Survival has steadily improved, however, and the current 70% one-year survival experience after cardiac transplantation at Stanford compares favorably with the results of cadaver kidney programs. This article reviews the current indications and experience with cardiac transplantation in man and will reflect the experience with this procedure at Stanford University Medical Center, where approximately two thirds of all cardiac transplants have been
The effect of thick fibers and large pores of electrospun poly(ε-caprolactone) vascular grafts on macrophage polarization and arterial regeneration
Authors: Zhihong Wang, Yun Cui, Jianing Wang, Xiaohu Yang, Yifan Wu, Kai Wang, Xuan Gao, Dong Li, Yuejie Li, Xi-Long Zheng, Yan Zhu, Deling Kong, Qiang Zhao
Journal: Biomaterials (2014)
Managing patients who refuse blood transfusions Register of willing consultants exists
Authors: J W A Brace, P D Cooper
Journal: BMJ (1994)

patients with recurrent unexplained falls and syncope, and 82% of this group benefit from intervention.2Simple faints are uncommon in elderly people, partly because of their altered baroreflex sensitivity.Treatment with a vasodilator is the commonest cause of vasovagal syncope, and symptoms may be modified or abolished by a change in treatment.If carotid sinus massage produces an important reproducible asystolic response this is not normal5 and in symptomatic patients requires physiological pacing to abort recurrent syMptoms.4Slowing of the heart rate of greater than 3 seconds during carotid sinus massage does not occur in asymptomatic elderly people.5The carotid sinus syndrome is an underdiagnosed cause of dizziness, falls, and syncope,3 and cardiac pacing will abort syncopal episodes in most cases, although dizziness may persist because ofpersistent hypotensive features.4
Peripheral mercury embolization occurring during arterial blood sampling.
Authors: H. B. Devlin, M. Sudlow
Journal: BMJ (1967)

BRDITSJOU 347antigens, believed by many to be viral, should receive consider- able encouragement from the knowledge that immunity to them exists.In any case, the detailed characterization of these immunological factors themselves, and the possible isolation of specific immunoglobins and their use in future studies, may assist us in finally identifying the causative agent of the Burkitt tumour.I should like to thank the patients for their willing co-operation in these studies, also the expatriate donors of blood.Dr. L. Luzzato assisted with the preparation of the plasma.I am grateful to the various members of the hospital staff whose assistance and co- operation were invaluable.
Subcutaneous cellular neurothekeoma: a pseudosarcomatous tumour
Authors: K. Watanabe, T. Kusakabe, N. Hoshi, T. Suzuki
Journal: British Journal of Dermatology (2001)

Journal Article Subcutaneous cellular neurothekeoma: a pseudosarcomatous tumour Get access K. Watanabe, K. Watanabe Pathology Division, Fukushima Medical University, 1 Hikariga‐oka, Fukushima City 960–1295, JapanE‐mail: w‐kazuo@fmu.ac.jp Search for other works by this author on: Oxford Academic Google Scholar T. Kusakabe, T. Kusakabe Pathology Division, Fukushima Medical University, 1 Hikariga‐oka, Fukushima City 960–1295, JapanE‐mail: w‐kazuo@fmu.ac.jp Search for other works by this author on: Oxford Academic Google Scholar N. Hoshi, N. Hoshi Pathology Division, Fukushima Medical University, 1 Hikariga‐oka, Fukushima City 960–1295, JapanE‐mail: w‐kazuo@fmu.ac.jp Search for other works by this author on: Oxford Academic Google Scholar T. Suzuki T. Suzuki Pathology Division, Fukushima Medical University, 1 Hikariga‐oka, Fukushima City 960–1295, JapanE‐mail: w‐kazuo@fmu.ac.jp Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 144, Issue 6, 1 June 2001, Pages 1273–1274, https://doi.org/10.1046/j.1365-2133.2001.04254.x Published: 01 June 2001
Increased interleukin-1 receptor antagonist in idiopathic pulmonary fibrosis. A compartmental analysis.
Authors: D. R. Smith, S. L. Kunkel, T. J. Standiford, M. W. Rolfe, J. P. Lynch, D. A. Arenberg, C. A. Wilke, M. D. Burdick, F. J. Martinez, J. N. Hampton, R. I. Whyte, M. B. Orringer, R. M. Strieter
Journal: American Journal of Respiratory and Critical Care Medicine (1995)

Idiopathic pulmonary fibrosis (IPF) is a poorly understood interstitial disease that usually proves refractory to therapy and results in irreversible tissue scarring and pulmonary dysfunction. Previous investigations have suggested a number of possible mediators of inflammation and fibrosis that typify IPF. We report increases in lung interleukin-1 receptor antagonist protein (IRAP) content in patients with IPF, as compared with normal control subjects. Importantly, this increase in IRAP was not accompanied by concomitant increases in interleukin-1 beta (IL-1 beta), resulting in a local environment that may be profibrotic. Tissue homogenates and bronchoalveolar lavage fluid from patients with IPF both demonstrate elevated IRAP content compared with that in normal subjects. Immunohistochemical staining and in situ hybridization localize IRAP to hyperplastic type II pneumocytes, macrophages, and local stromal cells. Finally, in vitro studies utilizing fibroblasts isolated from patients with IPF demonstrated no difference in constitutive IRAP production compared with that in normal subjects, but they revealed an exaggerated response to stimulation with transforming growth factor-beta (TGF-beta). These findings suggest that the fibrotic tissue changes of IPF and possibly other chronic interstitial lung diseases may result in part from the local effects of IRAP, and they also demonstrate that pulmonary nonimmune cells may influence local tissue changes through the elaboration of IRAP.
Opiate related collapse in an octogenarian.
Authors: J Rademaker, M Severs
Journal: BMJ (1993)

Queen Alexander Hospital, Ports- mouth) write: We report a case of reversible opiate toxicity to Tylex not previously described.An 86 year old woman with chronic lung disease collapsed and was brought to the casualty department.She was unresponsive, cyanosed with minimal respiratory effort, and hypotensive.She displayed small pupils with no other abnormal neurological signs and had bilateral basal respiratory crackles.Her electrocardiogram and chest radiograph showed nothing abnormal, and blood gas measure- ment confirmed she was acidotic ([H+i 56-6 nmol/l), hypercapnic (Pco2 10 6 kPa), and hypoxic
Personalized Diagnosis and Management of Congenital Cataract by Next-Generation Sequencing
Authors: Rachel L Gillespie, James O'Sullivan, Jane Ashworth, Sanjeev Bhaskar, Simon Williams, Susmito Biswas, Elias Kehdi, Simon C Ramsden, Jill Clayton-Smith, Graeme C Black, I Christopher Lloyd
Journal: Ophthalmology (2014)
Zolpidem and Driving Impairment — Identifying Persons at Risk
Authors: Ronald H. Farkas, Ellis F. Unger, Robert Temple
Journal: New England Journal of Medicine (2013)

Because of new findings about next-day somnolence and sex differences in zolpidem clearance, the FDA has recommended lower doses of the drug, particularly for women, and emphasizes the greater risk of impairment with modified-release than with immediate-release formulations.