tbuckley/cabot-search huggingface dataset:
Resuscitation Strategies in Trauma
Authors: Ronald V. Maier
Journal: JAMA (2013)

The Prospective, Observational, Multicenter, Major Trauma Transfusion (PROMMTT) Study: Comparative Effectiveness of a Time-Varying Treatment With Competing RisksJohn B. Holcomb, MD; Deborah J. del Junco, PhD; Erin E. Fox, PhD; Charles E. Wade, PhD; Mitchell J. Cohen, MD; Martin A. Schreiber, MD; Louis H. Alarcon, MD; Yu Bai, MD, PhD; Karen J. Brasel, MD, MPH; Eileen M. Bulger, MD; Bryan A. Cotton, MD, MPH; Nena Matijevic, PhD; Peter Muskat, MD; John G. Myers, MD; Herb A. Phelan, MD, MSCS; Christopher E. White, MD; Jiajie Zhang, PhD; Mohammad H. Rahbar, PhD; for the PROMMTT Study GroupObjective: To relate in-hospital mortality to early transfusion of plasma and/or platelets and to time-varying plasma:red blood cell (RBC) and platelet:RBC ratios.Design: Prospective cohort study documenting the timing of transfusions during active resuscitation and patient outcomes. Data were analyzed using time-dependent proportional hazards models.Setting: Ten US level I trauma centers.Patients: Adult trauma patients surviving for 30 minutes after admission who received a transfusion of at least 1 unit of RBCs within 6 hours of admission (n = 1245, the original study group) and at least 3 total units (of RBCs, plasma, or platelets) within 24 hours (n = 905, the analysis group).Main Outcome Measure: In-hospital mortality.Results: Plasma:RBC and platelet:RBC ratios were not constant during the first 24 hours (P &lt; .001 for both). In a multivariable time-dependent Cox model, increased ratios of plasma:RBCs (adjusted hazard ratio = 0.31; 95% CI, 0.16-0.58) and platelets:RBCs (adjusted hazard ratio = 0.55; 95% CI, 0.31-0.98) were independently associated with decreased 6-hour mortality, when hemorrhagic death predominated. In the first 6 hours, patients with ratios less than 1:2 were 3 to 4 times more likely to die than patients with ratios of 1:1 or higher. After 24 hours, plasma and platelet ratios were unassociated with mortality, when competing risks from nonhemorrhagic causes prevailed.Conclusions: Higher plasma and platelet ratios early in resuscitation were associated with decreased mortality in patients who received transfusions of at least 3 units of blood products during the first 24 hours after admission. Among survivors at 24 hours, the subsequent risk of death by day 30 was not associated with plasma or platelet ratios.JAMA Surg. 2013; 148(2):127-136.doi:10.1001/2013.jamasurg.387
Plasma cortisol and the use of hydrocortisone in the treatment of status asthmaticus
Authors: R. M. Cayton, P. Howard
Journal: Thorax (1973)

<b>Cayton, R. M., and Howard, P. (1973).</b><i>Thorax</i>, <b>28</b>, 567-573. <b>Plasma cortisol and the use of hydrocortisone in the treatment of status asthmaticus.</b> Plasma cortisol, intravenous synacthen tests of adrenal function, arterial blood gases, and spirometric tests of respiratory function were measured in patients with bronchial asthma during clinically stable periods and during status asthmaticus. Intravenous hydrocortisone was given in a predetermined manner in an attempt to measure the effective dose for treatment. The presence of adrenal suppression did not influence the severity of the attack nor the amount of hydrocortisone required for treatment. Clinical signs, arterial oxygen tension, forced expiratory volume, forced vital capacity, pulse rate, and blood pressure gave no indication as to which patients would respond to a single injection of aminophylline or require repeated hydrocortisone for days or weeks. The results are discussed in relation to the mechanism of bronchial asthma.
Enhancement of Metastatic Potential of Murine and Human Melanoma Cells by Laminin Receptor Peptide G: Attachment of Cancer Cells to Subendothelial Matrix as a Pathway for Hematogenous Metastasis
Authors: G. Taraboletti, D. Belotti, R. Giavazzi, M. E. Sobel, V. Castronovo
Journal: JNCI Journal of the National Cancer Institute (1993)

Background : Stable anchorage of circulating cancer cells to the vasculature is a critical step in the formation of hematogenous metastases. Although the basement membrane glycoprotein laminin clearly plays a crucial role in this event, the exact interactive pathways among cancer cells, laminin, and the vessel wall have not been elucidated. In a previous study, we identified synthetic peptide G, which contains the laminin-binding domain of the 67-kd laminin receptor and which inhibits tumor cell adhesion to endothelial cells. Purpose : To assess the role of the interaction between laminin and the 67-kd laminin receptor in hematogenous metastasis formation, we studied the effect of peptide G on melanoma cell behavior in vivo and in vitro. Methods : The effect of peptide G and control peptides was studied in vivo on lung retention and colonizing potential of murine (B16BL6) and human (A2058) melanoma cells injected intravenously in C57BL/6 and nude mice, respectively. In addition, their effect on cell adhesion and chemotaxis to laminin and on binding of iodine 125-labeled laminin to cells was studied in vitro. Results : In vivo, pretreatment of cells with peptide G resulted in a two- to 10-fold significant increase in the number of experimental lung metastases. A significant relative increase in lung retention of peptide G-treated tumor cells was observed 48 hours after injection, although after 4 hours a partial reduction was observed. In vitro, peptide G significantly increased laminin binding and cancer cell adhesion to laminin and subendothelial matrix, whereas chemotaxis to laminin was significantly inhibited. Conclusions : Peptide G differentially affected the biological response of cancer cells to laminin. In vitro, it increased laminin binding and cell adhesion to laminin and subendothelial matrix, whereas it inhibited cell chemotaxis to laminin. In vivo, the overall effect of peptide G was an augmentation of lung metastasis. Implications : Our findings suggest that direct adhesion of tumor cells to the subendothelial matrix is a main pathway for hematogenous metastases and that tumor cell-matrix interaction may be more relevant than tumor cell-endothelial cell attachment in this process. [J Natl Cancer Inst 85: 235–240, 1993]
Efficacy, safety and effectiveness of image-guided percutaneous microwave ablation in cystic renal lesions Bosniak III or IV after 24 months follow up
Authors: Gianpaolo Carrafiello, Gianlorenzo Dionigi, Anna Maria Ierardi, Mario Petrillo, Federico Fontana, Chiara Floridi, Luigi Boni, Francesca Rovera, Stefano Rausei, Alberto Mangano, Sebastiano Spampatti, Alberto Marconi, Giulio Carcano, Renzo Dionigi
Journal: International Journal of Surgery (2013)
Sulphonylurea Drugs in Pregnancy
Authors: J. M. Malins, A. M. Cooke, D. A. Pyke, M. G. Fitzgerald
Journal: BMJ (1964)

accurate list of these questions and I cannot agree with Professor Kekwick that 90% have been clinical.Indeed, I would put the true figure as at most 30%.But I would not be in the least surprised to know that the pro- fessor has some peculiarly personal definition of the word " clinical."Would he regard the following sample question, which was one recently asked, as clinical or as a sadistic joke at the candidate's expense, and not to be taken seriously ?Which of the following is correct?Kala-azar is black man's disease Kwashiorkor is red dog disease
Should We Be Measuring Blood Cholesterol Levels in Young Adults?
Authors: Stephen B. Hulley
Journal: JAMA (1993)

Should we measure blood cholesterol levels in all adults, or only in those at high risk of coronary heart disease (CHD)? Most men under the age of 35 years and women under the age of 45 years--roughly half the adult population--are at very low short-term risk of CHD. One consequence is that drug treatment to lower high blood cholesterol levels in the average young adult is an extremely expensive means of prolonging life; the estimated $1 million to $10 million per year of life is 100 to 1000 times the cost of other approaches. Individualized dietary treatment is somewhat cheaper but relatively ineffective. Another consequence of the low CHD risk in young adults is the greater likelihood that intervention may have harmful effects that outweight the benefits. Meta-analysis of primary prevention trials in middle-aged men reveal an increase in non-CHD deaths among those randomized to cholesterol interventions, an unexpected finding that is more substantial than the decrease in CHD deaths. This raises the possibility that one or more of the cholesterol interventions could have very serious adverse effects among young adults, whose risk of non-CHD death is normally 100 times their risk of CHD death. We conclude that the policy of screening and treating high blood cholesterol levels in young adults is neither cost-effective, nor does it satisfy ethical standards requiring strong evidence that preventive interventions do more good than harm. Fortunately, cholesterol screening in young adults is also not necessary: most CHD events associated with high blood cholesterol levels in this population will not occur for decades and can be prevented by treatment that is begun in middle age. Cholesterol screening and treatment in young adults should be limited to individuals with known coronary disease or other unusual factors that place them at high short-term risk of CHD death.
The views of singlehanded general practitioners: a qualitative study.
Authors: J M Green
Journal: BMJ (1993)

OBJECTIVES--To examine the concerns of singlehanded general practitioners working in an inner London area and to compare the views of general practitioners in partnerships. DESIGN--Qualitative analysis of semistructured interviews with a random sample of singlehanded general practitioners and a sample of general practitioners from partnerships matched for age and sex. SETTING--The area covered by Lambeth, Southwark, and Lewisham Family Health Services Authority. RESULTS--The singlehanded general practitioners were more likely to be older, male, and first qualified abroad than general practitioners in partnerships. Their major concerns were inadequate premises, maintaining their singlehanded status, and coping with recent changes to their contract. Most were very satisfied with their solo status and did not see the provision of 24 hour care as stressful. CONCLUSION--Singlehanded general practitioners saw themselves as providing a unique service for patients, and their status as an alternative for general practitioners who were unhappy in partnerships. Such practices are unlikely to wither away as a pattern of provision. Any comprehensive development of primary care must take their needs into account.
Mechanism of Repetitive Monomorphic Ventricular Tachycardia
Authors: Bruce B. Lerman, Kenneth Stein, Erica D. Engelstein, David S. Battleman, Neal Lippman, Dong Bei, Daniel Catanzaro
Journal: Circulation (1995)

Background The most common form of idiopathic ventricular tachycardia (VT) is repetitive monomorphic VT (RMVT), which is characterized by frequent ventricular ectopy and salvos of nonsustained VT with intervening sinus rhythm. Unlike most other forms of idiopathic VT, this tachycardia typically occurs at rest and is nonsustained. The mechanism of RMVT is undefined. Because of a common site of origin, the right ventricular outflow tract (RVOT), we hypothesized that RMVT is mechanistically related to paroxysmal sustained, exercise-induced VT, which has been shown to be consistent with cAMP-mediated triggered activity. Therefore, in this study, we sought to identify (1) the mechanism of RMVT at the cellular level by using electropharmacological probes known to activate either stimulatory or inhibitory G proteins and thereby modify intracellular cAMP levels, (2) potential autonomic triggers of RMVT through analysis of heart rate variability, and (3) whether well-characterized somatic activating mutations in the stimulatory G protein, Gα s , underlie RMVT. Methods and Results Twelve patients with RMVT underwent electrophysiological study. Sustained monomorphic VT was reproducibly initiated and terminated with programmed stimulation and/or isoproterenol infusion in 11 of the 12 patients (the other patient had incessant RMVT). Induction of VT demonstrated cycle length dependence and was facilitated by rapid atrial or ventricular pacing. Termination of VT occurred in response to interventions that either lowered stimulated levels of intracellular cAMP (and thus decreased intracellular Ca 2+ )—ie, adenosine (12 of 12), vagal maneuvers or edrophonium (8 of 9), and β-blockade (3 of 5)—or directly decreased the slow-inward calcium current—ie, verapamil (10 of 12). Analysis of heart rate variability during 24-hour ambulatory monitoring in 7 patients showed that the sinus heart rate is increased and accelerates before nonsustained VT ( P &lt;.05), whereas high-frequency heart rate variability is unchanged. These findings are consistent with transient increases in sympathetic tone preceding nonsustained VT. Finally, myocardial biopsy samples were obtained from the site of origin of the VT (typically the RVOT) and from the right ventricular apex from 9 patients. Genomic DNA was extracted from each biopsy sample, and three exons of Gα s in which activating mutations have previously been described were amplified by polymerase chain reaction. All sequences from these regions were found to be identical to that of control. Conclusions Although the arrhythmia occurs at rest, the constellation of findings in idiopathic VT that is characterized by RMVT is consistent with the mechanism of cAMP-mediated triggered activity. Therefore, the spectrum of VT resulting from this mechanism includes not only paroxysmal exercise-induced VT but also RMVT.
Low diacylglycerol values in colonic adenomas and colorectal cancer.
Authors: G Sauter, A Nerlich, U Spengler, R Kopp, A Pfeiffer
Journal: Gut (1990)

The biochemical events that make colonic epithelial cells proceed along the adenoma-carcinoma sequence are not well understood. The phosphoinositol signal transduction pathway is involved in the regulation of cell growth and differentiation. To determine its role in colonic neoplasias we performed mass measurements of its second messenger sn-1,2-diacylglycerol in biopsy specimens from normal mucosa and neoplasias of the colon. Normal colonic mucosa was also investigated in patients without colonic abnormalities (n = 10). Compared with pooled diacylglycerol values from five colonic sites (100%), values in patients with a normal colon were highest in the ascending colon (120 (5)%, p less than 0.05) and lowest in the rectum (81 (5)%, p less than 0.01). Absolute diacylglycerol values in patients with normal colons (2.62 (0.16) nmol/mg protein) were not significantly different from those found in the normal mucosa of patients with colorectal neoplasias (2.45 (0.17) nmol/mg protein). Both colonic adenomas (n = 15) and colorectal carcinomas (n = 14) showed significantly decreased diacylglycerol values compared with the adjacent normal mucosa of each patient (72 (4)%, p less than 0.001, and 71 (4)%, p less than 0.001 respectively). The appreciable decrease in mass diacylglycerol values clearly distinguishes adenomas and carcinomas of the colon from the surrounding normal mucosa. This finding suggests that profound metabolic changes of the phosphoinositol signal transduction pathway occur early in the adenoma-carcinoma sequence and may be important in colonic carcinogenesis.
The Apex Cardiogram in Left Ventricular Outflow Tract Obstruction
Authors: EMILIO TAFURR, LAWRENCE S. COHEN, HAROLD D. LEVINE
Journal: Circulation (1964)

The use of the apex cardiogram offers a simple yet valuable aid in the diagnosis of obstruction of the left ventricular outflow tract. Characteristic changes in the ejection component of the apex cardiogram distinguish obstruction due to hypertrophic subaortic stenosis from obstruction due to valvular aortic stenosis. A second systolic wave is inscribed in the mid-ejection period of the apex cardiogram in hypertrophic subaortic stenosis. This wave reflects the development of the obstruction of the outflow tract of the left ventricle by the hypertrophied septum. This obstruction is not apparent in the apex cardiogram at the onset of ejection but becomes manifest as contraction progresses. Although the apex cardiogram in patients with subaortic stenosis may appear normal at rest, isoproterenol may act as a provocative agent inducing the characteristic changes of this condition. In valvular stenosis obstruction is reflected in the apex cardiogram from the very onset of ejection and is manifest throughout the total ejection phase as a sustained gradual sloping plateau.
Searching for Medical Certainty: Medical Chemistry to Molecular Medicine
Authors: Robert L. Martensen
Journal: JAMA (1997)

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
Heaviest Recorded Brain
Authors: J. Morris
Journal: BMJ (1872)

THE BRITISH MJEDICAL 7OURNAL.465 vagina to be syringed out with Condy's fluid, two drachms to one pint of water, with good effect.From this time she slowly improved, al- though much reduced from the long continuance of discharged san- guineous fluid ; and she gradually attained her usual health and mo;i- toint, under a course of quinine and iron and full diet.REMARKS.-I have occasionally been told by medical friends that they had a case of uterine hydatids, inferring that they were the same as found in the liver and other parts of the body.It is probably known to all present, that hydatid-like bodies have been discharged from the uterus; and the resemblance between these bodies and hydatid cysts formed in other parts of the body, was sufficient to induce the older observers to consider the two identical.Later inquiries lhave proved that these bodies discharged from the uterus are not true hydatids, but that they are the product of conception, and have, indeed, nothing in comnmon with true hydatids further than a slight external re- semblance.The tenidency of all modern research has been to demon- strate that the genuine mole cannot occur, except as the result of impregnation and the degeneration of the true ovum.Cruveilhier first conclusively demonstrated its non-hydatid character,
A study of general practitioners' reasons for changing their prescribing behaviour
Authors: D. Armstrong, H. Reyburn, R. Jones
Journal: BMJ (1996)

<h3>Abstract</h3> <b>Objectives</b>: To explore general practitioners9 reasons for recent changes in their prescribing behaviour. <b>Design</b>: Qualitative analysis of semistructured interviews. <b>Setting</b>: General practice in south east London. <b>Subjects</b>: A heterogeneous sample of 18 general practitioners. <b>Results</b>: Interviewees were able to identify between two and five specific changes that had occurred in their prescribing in the preceding six months. The most frequently mentioned changes related to fluoxetine, angiotensin converting enzyme inhibitors, and the antibiotic treatment of Helicobacter pylori. Three models of change were identified: an accumulation model, in which the volume and authority of evidence were important; a challenge model, in which behaviour change followed a dramatic or conflictual clinical event; and a continuity model, in which change took place against a background of willingness to change, modulated by other factors such as cost pressures and the comprehensible therapeutic action of a drug. Behaviour change was reinforced and sustained by experiences with individual patients. <b>Conclusions</b>: Multiple factors are involved in general practitioners9 decisions to change their prescribing habits. Three models of change can be identified which have important implications for the design and evaluation of interventions aimed at behaviour change. <h3>Key messages</h3> Key messages General practitioners respond to different types of cue to change their prescribing Many change agents seem to have their power through surprise or conflict and it may be possible to simulate therapeutic challenges together with appropriate educational support The traditional agencies of change—clinical meetings, journal editorials, and so on—cannot be expected to bring about change on a large scale; at best they can help prepare the ground Change is initially precarious and needs reinforcement if it is to be maintained
Fewer than half of patients with fatigue get explanation for their symptoms within a year, study shows
Authors: D. Spurgeon
Journal: BMJ (2009)

Of 571 patients who presented with fatigue, in a primary care study in 147 general practices throughout the Netherlands, at least half in a one year follow-up did not receive a diagnosis that could possibly explain their complaint, and only a minority were diagnosed as having serious pathology ( CMAJ 2009 Oct 26, doi:10.1503/cmaj.090647).

Nevertheless, the authors concluded that because fatigue is seen in 5% to 10% of patients and …
Renal Resistance to Parathyroid Hormone with Osteitis Fibrosa "Hypo-Hyperparathyroidism."
Authors: Charles Hanson
Journal: Annals of Internal Medicine (1970)

Meeting Abstracts1 May 1970Renal Resistance to Parathyroid Hormone with Osteitis Fibrosa "Hypo-Hyperparathyroidism."Authors: Charles Hanson, M.D., Boy Frame, M.D., F.A.C.P., Harold Frost, M.D., Melvin Block, M.D., and A. Robert Arnstein, M.D., F.A.C.P.Author, Article, & Disclosure InformationPublication: Annals of Internal MedicineVolume 72, Number 5https://doi.org/10.7326/0003-4819-72-5-788_1 Get AccessSubmit a CommentContributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.Name (if multiple authors, separate names by comma)Name field is requiredComment TitleTitle field is requiredAffiliation & Institution (max characters: 200)Affiliations field is requiredCommentComment field is requiredPlease disclose any conflicts of interest or leave the box unchecked if you have noneDisclosure of Any Conflicts of InterestCancelSubmit
A 66-Year-Old Man With an Abdominal Aortic Aneurysm
Authors: Marc Schermerhorn
Journal: JAMA (2009)

Ruptured abdominal aortic aneurysm (AAA) is a common cause of death. Abdominal aortic aneurysms tend to be asymptomatic until the time of rupture, which has a mortality rate of greater than 80%. Therefore, elective repair prior to rupture is preferred if life expectancy is reasonable and the risk of rupture outweighs the risk of repair. Mr F, a 66-year-old man with a 5.2-cm AAA, illustrates the issues surrounding monitoring and treating AAA. Risk factors for AAA include older age, male sex, smoking history, and a family history of AAA. Screening for AAA with ultrasound has been shown to prevent rupture, prevent AAA-related death, and be cost-effective. Risk factors for rupture include larger diameter, female sex, and smoking history. Endovascular repair has lower operative mortality and complications and has replaced standard open surgery in more than half of patients. However, long-term survival is similar after endovascular and open surgical repair. Those at risk of AAA who would benefit from repair should undergo screening.