tbuckley/cabot-search huggingface dataset:
An unusual cause of myocardial infarction
Authors: E. Rashidghamat, S. M. Gregory, P. Lim
Journal: BMJ (2010)

A 47 year old woman presented to a local hospital with chest pain, palpitations, sweating, nausea, and vomiting after a hot shower. Her electrocardiogram on admission showed intermittent broad complex ventricular tachycardia, and serial electrocardiograms showed ST elevation in the inferior limb leads. After being given thrombolytic treatment with tenecteplase, she was started on an amiodarone infusion. She was subsequently transferred to our tertiary cardiac centre for further management because of continuing chest pain and hypotension. On arrival she was found to be in cardiogenic shock, with severe lactic acidosis and pulmonary oedema requiring intubation, assisted ventilation, and inotropic support. She had extensive lower body and limb livedo reticularis. An emergency coronary angiogram was performed and this showed widely patent coronary arteries. A left ventricular angiogram showed severe left ventricular systolic dysfunction with generalised hypokinesia, which was relatively worse in the mid-segments than in the apical and basal left ventricular segments. She also had severe mitral valve regurgitation and high left ventricular diastolic filling pressure. An intra-aortic balloon pump was inserted for haemodynamic stabilisation. She had experienced a similar but less severe event three years before, when she presented with an inferior ST elevation myocardial infarction, which was treated with thrombolysis, and she was subsequently discharged after a normal coronary angiogram. The next day she was extubated and transferred from the cardiac intensive care unit to the coronary care unit. An abdominal ultrasound was requested because she had developed deranged liver function tests, with a predominantly hepatitic picture. The ultrasound showed a right adrenal mass (fig 1⇓). Fig 1 Abdominal ultrasound showing a mass adjacent to the upper pole of the right kidney
479 LIVER TRANSPLANTATION FOR ALPHA-1 ANTITRYPSIN DEFICIENCY: HEPATOCELLULAR CARCINOMA IS COMMON AND DETERIORATES SURVIVAL
Authors: K. Kok, R.J. Porte, R. Adam, A. van den Berg, R. Scheenstra, H. Metselaar, B. van Hoek, M.G. van Oijen, J.P. Drenth
Journal: Journal of Hepatology (2010)
Improved Procedural Results of Coronary Angioplasty With Intravascular Ultrasound–Guided Balloon Sizing
Authors: Gregg W. Stone, John M. Hodgson, Frederick G. St Goar, Axel Frey, Harald Mudra, Helen Sheehan, Thomas J. Linnemeier
Journal: Circulation (1997)

Background Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty (PTCA). We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion (the Glagov phenomenon) at and adjacent to PTCA target lesions would safely accommodate oversized balloons in selected patients undergoing PTCA with intravascular ultrasound (IVUS) guidance. Methods and Results After angiographically guided PTCA of 104 lesions in 102 patients, IVUS was performed, and if atheromatous remodeling was present, PTCA was repeated with larger balloons sized halfway between the lumen and external elastic membrane. Plaque occupied a mean of 51±15% of the angiographically “normal” reference segments. Further balloon upsizing by 0.25 to 1.25 mm was therefore performed in 76 lesions (73%), increasing the nominal balloon-to-artery ratio from 1.12±0.15 after standard PTCA to 1.30±0.17 after IVUS-guided PTCA ( P &lt;.0001). As a result, the angiographic minimal luminal diameter further increased from 1.95±0.49 to 2.21±0.47 mm, the % diameter stenosis fell from 28±15% to 18±14%, and the IVUS lumen area rose from 3.16±1.04 to 4.52±1.14 mm 2 (all P &lt;.0001). The incidence of angiographic dissection was not increased after IVUS-guided balloon upsizing (37% versus 40%, P =.67), and major complications occurred in only 2 patients (1.9%). Conclusions The demonstration by IVUS of atheromatous remodeling permits the safe use of balloons traditionally considered oversized, resulting in significantly improved luminal dimensions without increased rates of dissection or ischemic complications.
86% of English patients are satisfied with GPs, but fewer are happy with out of hours care
Authors: G. Iacobucci
Journal: BMJ (2014)

Patients continue to report a positive overall experience of general practice in England, despite falling satisfaction with opening times and the provision of out of hours care.

The latest results from the national GP Patient Survey 2013-14 show that 85.7% of patients described the overall experience of their GP surgery as good.1 This was just one percentage point less than last year’s results published in June 2013.

Three quarters (74.6%) of patients rated …
Controversies in Coronary Artery Disease
Authors: Milton Mendlowitz
Journal: JAMA (1983)

This book is recommended for reading by internists and general practitioners as well as by cardiologists. It represents the state of the art in coronary cardiology at the present time. "Frontiers" rather than "controversies" would have been more appropriate in the title, since there is no controversial discussion among adversaries. Like all such multiauthored books, some chapters are better written and more acceptable than others, and, because of rapid development in the field, some chapters are already out of date. For example, diltiazem hydrochloride, now generally available, is not discussed along with the other calcium blockers. In my opinion, the book is also out of balance and underemphasizes prevention. The one chapter on prevention deals largely with cholesterol and lipids, skimpily with hypertension, and not at all with exercise and behavioral modification. The chapters on noninvasive screening are superb, and those on intravascular thrombolysis as well as balloon dilatation are
First report of a B cell lymphoproliferative disorder arising in a patient treated with immune suppressants for severe aplastic anemia
Authors: Vicki Dorr, Gary Doolittle, Janet Woodroof
Journal: American Journal of Hematology (1996)

Aplastic anemia is a disorder characterized by pancytopenia and bone marrow hypocellularity. There is some evidence that aplastic anemia may be due to suppression of hematopoiesis by activated T-suppressor cells. Thus, immunosuppressive agents have been used as an alternative to bone marrow transplantation for treatment. We report on a unique case of a patient with aplastic anemia who was treated with a course of immunosuppression including cyclosporine (CSA), anti-thymocyte globulin (ATG), and prednisone. Five months after this treatment, the patient developed a B cell lymphoproliferative disorder which was successfully treated with radiation therapy. Prior reports of CSA-associated lymphoproliferative disorders have appeared in the literature as potential side effects of immunosuppression following transplantation. This is the first report of a lymphoproliferative disorder associated with immunosuppressive treatment of aplastic anemia in a nontransplant setting. Thus, when presenting options for treatment of aplastic anemia, lymphoproliferative disorders should be included as a rare complication of immunosuppressive therapy.
Mitochondrial coupling factor 6 as a potent endogenous vasoconstrictor
Authors: Tomohiro Osanai, Makoto Tanaka, Takaatsu Kamada, Takao Nakano, Koki Takahashi, Satoko Okada, Kenichi Sirato, Koji Magota, Shiho Kodama, Ken Okumura
Journal: Journal of Clinical Investigation (2001)

We demonstrated recently that coupling factor 6, an essential component of the energy-transducing stalk of mitochondrial ATP synthase, suppresses the synthesis of prostacyclin in vascular endothelial cells. Here, we tested the hypothesis that coupling factor 6 is present on the cell surface and is involved in the regulation of systemic circulation. This peptide is present on the surface of CRL-2222 vascular endothelial cells and is released by these cells into the medium. In vivo, the peptide circulates in the vascular system of the rat, and its gene expression and plasma concentration are higher in spontaneously hypertensive rats (SHRs) than in normotensive controls. Elevation of blood pressure with norepinephrine did not affect the plasma concentration of coupling factor 6. Intravenous injection of recombinant peptide increased blood pressure, apparently by suppressing prostacyclin synthesis, whereas a specific Ab to coupling factor 6 decreased systemic blood pressure concomitantly with an increase in plasma prostacyclin. Interestingly, the antibody's hypotensive effect could be abolished by treating with the cyclooxygenase inhibitor indomethacin. These findings indicate that mitochondrial coupling factor 6 functions as a potent endogenous vasoconstrictor in the fashion of a circulating hormone and may suggest a new mechanism for hypertension.
P265 Maxillomandibular Advancement Surgery in the Management of Obstructive Sleep Apnoea: Abstract P265 Table 1
Authors: Meera Patel, B Gurney, D Daley, K Marshall, W McAllister, P Haers
Journal: Thorax (2012)

<h3>Introduction</h3> Obstructive sleep apnoea (OSA) is a clinical condition in which there is intermittent and repeated upper airway collapse during sleep. Maxillomandibular advancement (MMA) has been shown to enlarge the pharyngeal and hypopharyngeal airway by physically expanding the facial skeletal framework. It has also been shown that advancement of the maxillomandibular complex increases tissue tension, and is a valid surgical treatment option for those patients unable or unwilling to tolerate long term continuous positive pressure ventilation (CPAP). <h3>Method</h3> We present a series of 10 patients who underwent MMA and genioplasty surgery for OSA, operated by one surgeon, with an average age of 47 years and an average BMI of 27. The minimum advancement of the mandible was 15mm with the maxilla advancing between 12–15 mm. Diagnosis of OSA was based on: clinical history, Epworth Sleepiness Scale (ESS) questionnaire, and formal sleep study parameters via ambulatory sleep study. Lateral cepalometric radiographs were taken pre- and post-operatively to assess widening of the posterior airway space (PAS). The patients were reassessed using the same criteria 6 months post surgery, with annual follow up. <h3>Results</h3> All 10 patients reported an improved ESS with the average reduction of 70.3%. The PAS increased by 48.4% (5.11mm), on average, with the biggest increase recorded as 11.8mm. The average apnoea hypopnoea index and oxygen desaturation events decreased by 74% and 69% respectively. <h3>Conclusion</h3> The outcome of MMA advancement has previously been reported, with success rates in the literature varying from 57% to 100%. There are no long term studies indicating success. The outcomes of our series of patients support MMA advancement as an effective surgical treatment for OSA and show sustained improvement up to 5 years postoperatively. Careful patient selection and a multidisciplinary approach to management are key to achieving success. Although CPAP remains the standard treatment for most patients with OSA, MMA provides an alternative for selected OSA patients who cannot use CPAP or who wish a curative treatment without life-long dependency on these devices.
Variation in dermatologist beliefs about the safety and effectiveness of treatments for moderate to severe psoriasis
Authors: Katrina Abuabara, Joy Wan, Andrea B. Troxel, Daniel B. Shin, Abby S. Van Voorhees, Bruce F. Bebo, Gerald G. Krueger, Kristina Callis Duffin, Joel M. Gelfand
Journal: Journal of the American Academy of Dermatology (2012)
Regional Ileitis Presenting as Recurrent Intestinal Haemorrhage
Authors: P. Freedman
Journal: BMJ (1952)

_~~~~~~~~~~~~M EDICAL JOURNAL supposed to explain why heavy deposits are found where the horny layer is particularly thick (palms and soles) and where sweating is most marked (palms, soles, forehead, nasolabial folds, axilla, and groin).The striking involvement of the soft palate in this case is difficult to reconcile with that theory.Other observers have pointed out that children seem more prone to develop carotinoderma than do adults (Urbach, 1946), that sunlight is sometimes necessary to produce the cutaneous manifestations (Hess and Myers, 1919; Klose, 1919), and that vegetarians are rarely affected.It seems, therefore, that, apart from the constant finding of excessive intake of carotene-containing foods, there is a marked individual variation in the tendency to develop this pigmentation.
Distribution of dominant T cell receptor beta chains in human intestinal mucosa.
Authors: G G Gross, V L Schwartz, C Stevens, E C Ebert, R S Blumberg, S P Balk
Journal: The Journal of Experimental Medicine (1994)

The majority of human intestinal intraepithelial lymphocytes (iIELs) are CD8+ T cells that use the T cell receptor (TCR)-alpha/beta. Previous studies have shown that iIELs isolated from segments of small intestine or colon contain one or several dominant alpha/beta T cell clones. It is not known whether these clones expand only locally in response to a particular antigen or whether they are widely distributed throughout the intestine. To address this question, iIELs were purified from near the proximal and distal margins in a series of intestinal resections for noninflammatory diseases. TCR-beta expression was then assessed by semiquantitative polymerase chain reaction amplification, analysis of N-region length, and DNA sequencing. The previously described oligoclonal expansion of iIELs was confirmed in each sample. Identical dominant clones were identified in the proximal and distal samples from most cases, including samples taken from sites as distant as the transverse and sigmoid colon or rectum. Distinct clones were found in only one case with samples from the terminal ileum and transverse colon. These results demonstrate that a relatively small number of widely dispersed T cell clones comprise the majority of cells in the human intestinal mucosa.
P4-07-09: Automated Quantitative Assessment of HER2 Expression of Circulating Tumor Cells (CTC) in Metastatic Breast Cancer (IC 2006–04 Study).
Authors: F-C Bidard, ST Ligthart, C Decraene, T Bachelot, S Delaloge, E Brain, M Campone, J-Y Pierga, LWMM Terstappen
Journal: Cancer Research (2011)

Abstract Background Beyond quantitative CTC analysis for outcome assessment, their qualitative analysis could predict drug response and resistance. Classification of CTC and quantification of treatment targets on CTC can be subjective as they are morphologically heterogeneous. Current HER2 fluorescence assessment methods rely on a visual comparison between CTC images and external controls (cells lines) and are poorly reproducible. We report an automated classification and quantification of HER2 expression on CTC in a large cohort of metastatic breast cancer (MBC) patients (pts). Materials and Methods: CTC enumeration and HER2 assessment was performed with the CellSearch® system in pts with MBC included in the prospective IC 2006–04 study (Pierga, Ann Oncol 2011), before first line chemotherapy. The FITC conjugated antibody CB11 was used to identify HER2. For quantitative assessment of HER2 the breast cancer lines SKBR3 and MCF7 with known HER2 status were spiked in blood of normal donors and processed with the CellSearch system. Digital images of Cytokeratin-PE, DAPI, CD45-APC, and HER2−FITC from these samples were stored. An algorithm, previously developed in prostate cancer (Ligthart, AACR 2011), was applied on these images to automate identification of CTC. The fluorescence of the HER2 FITC channel for each CTC as well as the CD45+, DAPI+ leukocytes contained within each sample were also quantified using this algorithm. HER2 fluorescence levels of CTC were compared to HER2 status of status of pts. Results: Among 267 pts included in this study, 103 had at least 1 CTC/7.5 ml and HER2 fluorescence assessment. In these pts, correlation analysis between automated (aCTC) and manual (mCTC) CTC counts showed an excellent correlation (R2 =0.978). HER2 fluorescence of CTC, varied greatly within and between pts, whereas leukocyte fluorescence was more homogeneous. The vast majority of CTC exhibited less fluorescence than SKBR3 cells, even in HER2+ pts. Primary tumor was HER2+ and HER2− in 36 and 58 pts respectively. Percentage of HER2+ CTC was higher in pts with primary HER2+ status. Although a rare event, the presence within a sample of at least 1 CTC whose HER2 expression is superior to SKBR3 cells was also strongly associated with HER2+ primary tumor (N=15/36 vs. 3/58; p&amp;lt;0.001). Conclusion: This study is the first to assess HER2 staining intensity in each CTC isolated from a large number of MBC pts. This was made possible by the aCTC count that was highly correlated with the mCTC count in our cohort and permitted HER2 quantification. Our study shows that HER2 staining is highly heterogeneous among CTC within each pt. These findings demonstrate the feasibility of real time quantitative assessment of treatment targets on CTC and opens a path towards personalized treatment. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-07-09.
SMILE A WHILE
Authors: Harry A. Wilmer
Journal: JAMA (1968)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Mitochondrial superoxide dismutase and glutathione peroxidase in idiosyncratic drug-induced liver injury
Authors: Isabel M. Lucena, Elena García-Martín, Raúl J. Andrade, Carmen Martínez, Camilla Stephens, Jhon D. Ruiz, Eugenia Ulzurrun, Carmen M. Fernandez, Manuel Romero-Gomez, Augustin Castiella, Ramon Planas, José Antonio Durán, Ana Melcón De Dios, Carlos Guarner, German Soriano, Yolanda Borraz, José A. G. Agundez
Journal: Hepatology (2010)

Drug-induced liver injury (DILI) susceptibility has a potential genetic basis. We have evaluated possible associations between the risk of developing DILI and common genetic variants of the manganese superoxide dismutase ( SOD2 Val16Ala) and glutathione peroxidase ( GPX1 Pro200Leu) genes, which are involved in mitochondrial oxidative stress management. Genomic DNA from 185 DILI patients assessed by the Council for International Organizations of Medical Science scale and 270 sex- and age-matched controls were analyzed. The SOD2 and GPX1 genotyping was performed using polymerase chain reaction restriction fragment length polymorphism and TaqMan probed quantitative polymerase chain reaction, respectively. The statistical power to detect the effect of variant alleles with the observed odds ratio (OR) was 98.2% and 99.7% for bilateral association of SOD2 and GPX1 , respectively. The SOD2 Ala/Ala genotype was associated with cholestatic/mixed damage (OR = 2.3; 95% confidence interval [CI] = 1.4-3.8; corrected P [ Pc ] = 0.0058), whereas the GPX1 Leu/Leu genotype was associated with cholestatic injury (OR = 5.1; 95%CI = 1.6-16.0; Pc = 0.0112). The presence of two or more combined risk alleles ( SOD2 Ala and GPX1 Leu) was more frequent in DILI patients (OR = 2.1; 95%CI = 1.4-3.0; Pc = 0.0006). Patients with cholestatic/mixed injury induced by mitochondria hazardous drugs were more prone to have the SOD2 Ala/Ala genotype (OR = 3.6; 95%CI = 1.4-9.3; Pc = 0.02). This genotype was also more frequent in cholestatic/mixed DILI induced by pharmaceuticals producing quinone-like or epoxide metabolites (OR = 3.0; 95%CI = 1.7-5.5; Pc = 0.0008) and S-oxides, diazines, nitroanion radicals, or iminium ions (OR = 16.0; 95%CI = 1.8-146.1; Pc = 0.009). Conclusion: Patients homozygous for the SOD2 Ala allele and the GPX1 Leu allele are at higher risk of developing cholestatic DILI. SOD2 Ala homozygotes may be more prone to suffer DILI from drugs that are mitochondria hazardous or produce reactive intermediates. (Hepatology 2010)
Sulfasalazine and Folate Deficiency
Authors: Jorge Goldberg
Journal: JAMA (1983)

To the Editor.—  The findings that sulfasalazine inhibits folate transport,1inhibits the hydrolysis of polyglutamyl folate, and decreases the absorption of both polyglutamyl and monoglutamyl folates suggest, as recently reported by Halstead et al,2that folate deficiency may be prevented by increasing folate intake while the patient receives sulfasalazine.  We would like to describe a patient with ulcerative colitis while receiving sulfasalazine in whom severe anemia secondary to folate deficiency and aggravated by an immunohemolytic process was identified and later treated with the use of folic acid.  Report of a Case.—  A 39-year-old woman was initially seen at an emergency room because of weakness, dyspnea, and fatigue of three weeks' duration.  She had a ten-year history of verified ulcerative colitis treated with sulfasalazine, 4 g/day. Her disease had been quiescent; she denied experiencing fever, nausea, vomiting, abdominal pain, diarrhea, hematochezia, or weight loss. The patient did not smoke,
PATTERNS OF EARLY THIENOPYRIDINE USE AMONG CONTEMPORARY STEMI AND NSTEMI PATIENTS IN THE US: INSIGHTS FROM ACTION REGISTRY-GET WITH THE GUIDELINES
Authors: Matthew William Sherwood, Tracy Wang, Matthew Roe, Pankaj Madan, Szu-Po Peng, James de Lemos, Eric Peterson, Stephen Wiviott
Journal: Journal of the American College of Cardiology (2012)
"VACCINES IN INFLUENZA"
Authors: Herbert Fox
Journal: JAMA (1918)

<h3>To the Editor:</h3> —The current comment in your issue of October 19 prompts me to call attention to the efforts of this laboratory and base hospital to do something specific for influenza. It was obvious from the first that the virus was an overwhelming one, and it was noteworthy that uncomplicated influenza was associated with leukopenia and that the complicating pneumonia raised the leukocytes very little, seemingly inadequately. In casting about for a simple, efficient and safe means to raise the leukocytes, antiserum from recovered patients was used with some profit but without a great leukocyte reaction. We then prepared a serobacterin, using the serum of patients recovered from simple influenza and from influenza complicated by pneumonia. The bacteria used were two strains of influenza bacilli, one strain each of pneumococcus Type I and Type IV, one strain of hemolytic streptococci and one strain of nonhemolytic streptococci, all recovered from