tbuckley/cabot-search huggingface dataset:
ERCP after a liquid fatty meal: comment
Authors: M.I. Cremers
Journal: Endoscopy (2006)

I was very interested by the study by Barrie and Klein recently published in Endoscopy [1], as it describes a very simple and apparently innocuous method of improving cannulation in endoscopic retrograde cholangiopancreatography (ERCP). I would, however, like to point out that the authors did not mention the depth of sedation (light, moderate, or anesthesia), or the drugs used to sedate the patients in the study (some drugs used in sedation for ERCP have a potential to cause contraction of the sphincter of Oddi), or whether the sedation was administered by an anesthesiologist. I would also like to point out that the clear liquid meals ingested 2 h before elective procedures requiring general anesthesia, as recommended by the American Society of Anesthesiology, are intended for children, and that the liquid meal used in the study was intentionally a fatty liquid meal and not a clear liquid one.
Primary Pulmonary Hypertension Treated with Oral Phentolamine
Authors: JEREMY N. RUSKIN
Journal: Annals of Internal Medicine (1979)

A patient with symptomatic primary pulmonary artery hypertension underwent therapeutic trials with parenteral and oral phentolamine. Before drug therapy, he manifested marked increases in pulmonary artery pressure and pulmonary arteriolar resistance during exercise. This hypertensive response to exercise was significantly attenuated by parenteral phentolamine. He also manifested sustained hemodynamic improvement with the same degree of attenuation of exercise-induced increases in pulmonary artery pressure and pulmonary arteriolar resistance 7 months after initiation of therapy with oral phentolamine . Twenty months after initiation of therapy, the patient continues to enjoy symptomatic improvement with a marked increase in exercise tolerance.
Fever and rash in a returning traveller
Authors: N. Kumar, D. J. Lewis
Journal: BMJ (2012)

A previously fit and well 26 year old male student of Chinese origin attended the emergency department with a five day history of a febrile illness. He had returned to the United Kingdom from a three week visit to Malaysia and Singapore the day before the illness began. His main symptoms were fever, headache, and nausea. He had also noted a faint widespread rash the day before admission.

On examination his temperature was 39.7°C, his blood pressure was 134/77 mm Hg, and he had a regular heart rate of 75 beats/min. He had a respiratory rate of 14 breaths/min and oxygen saturations of 98% on room air. The only relevant clinical finding was a confluent erythematous macular rash across his chest, back, arms, and legs, with multiple small discrete areas of sparing.

Full blood count showed haemoglobin 163 g/L (120-180), platelets 86×109/L (130-400×109), white cell count (WCC) 3.4×109/L (4.5-11.0×109), neutrophils 1.7×109/L (2.0-7.5×109; 40-75% WCC), lymphocytes 1.4×109/L (1.3-3.5×109; 20-45% WCC), and no eosinophilia (0.04-0.44×109/L; 1-6% WCC). A blood film was negative for malaria parasites and confirmed thrombocytopenia with atypical lymphocytes. Renal function, liver function, and clotting tests were unremarkable and C reactive protein was less than 4 mg/L.



### 1 What are the most likely clinical diagnosis and important differential diagnosis?

#### Short answer

On the basis of the history and clinical picture, the diagnosis is probably dengue infection. Malaria is an important differential diagnosis and should be excluded with serial blood film examination or direct antigen testing (or both).

#### Long answer

Dengue infection classically presents with an abrupt onset of fever, …
A Peptide Conjugate of Vitamin E Succinate Targets Breast Cancer Cells with High ErbB2 Expression
Authors: Xiu-Fang Wang, Marc Birringer, Lan-Feng Dong, Pavel Veprek, Pauline Low, Emma Swettenham, Marina Stantic, Lin-Hong Yuan, Renata Zobalova, Kun Wu, Miroslav Ledvina, Stephen J. Ralph, Jiri Neuzil
Journal: Cancer Research (2007)

Abstract Overexpression of erbB2 is associated with resistance to apoptosis. We explored whether high level of erbB2 expression by cancer cells allows their targeting using an erbB2-binding peptide (LTVSPWY) attached to the proapoptotic α-tocopheryl succinate (α-TOS). Treating erbB2-low or erbB2-high cells with α-TOS induced similar levels of apoptosis, whereas α-TOS-LTVSPWY induced greater levels of apoptosis in erbB2-high cells. α-TOS rapidly accumulated in erbB2-high cells exposed to α-TOS-LTVSPWY. The extent of apoptosis induced in erbB2-high cells by α-TOS-LTVSPWY was suppressed by erbB2 RNA interference as well as by inhibition of either endocytotic or lysosomal function. α-TOS-LTVSPWY reduced erbB2-high breast carcinomas in FVB/N c-neu transgenic mice. We conclude that a conjugate of a peptide targeting α-TOS to erbB2-overexpressing cancer cells induces rapid apoptosis and efficiently suppresses erbB2-positive breast tumors. [Cancer Res 2007;67(7):3337–44]
Presidential Candidate Disability
Authors: Raymond Scalettar
Journal: JAMA (1984)

AS A NEW presidential campaign is about to begin, the health of the presidential candidates should not be ignored. The presence of an ongoing medical problem, intemperate habits such as abuse of alcohol or other drugs, or the development of an acute medical illness during the campaign could easily result in the victory of a candidate elected not necessarily by the will of the people but by default because of an opponent's medical illness. It has now been more than 20 years since the historic presidential campaign of 1960, which resulted in the election of John F. Kennedy. His opponent, the vicepresident of the United States in 1960, Richard M. Nixon, was defeated in an extremely close election. Although the vice-president's political fortune was to decline immediately after this defeat, his presidential victory in 1968 crowned a remarkable political comeback to be followed by his resignation in 1973. The purpose
On the methods calculating mean survival time in <sup>51</sup>Cr‐platelet survival study
Authors: Toshiyasu Tsukada, Toshiro Tango
Journal: American Journal of Hematology (1980)

Abstract The International Committee for Standardization in Hematology recommended three methods for calculating objectively the mean platelet survival time, ie, weighted mean of linear estimate and logarithmic estimate, truncated exponential model, and gamma model. For determining which method is better, data of the survival study were fitted to each of three methods, as well as the Paulus polynomial and exponential polynomial models, and the mean survival time and the mean square error were compared. Mean survival obtained by each method was always longest in healthy controls and shortest in ITP. In 3rd degree of polynomial estimate and 2nd and 3rd degrees of logarithmic estimate, several cases showed practically outlying mean survival time of more than 12 days. In healthy controls, highest mean square error was observed in 1st degree logarithmic estimate, and in cases with short mean survival time the highest one was obtained in 1st degree polynomial estimate. Mean square error in ITP pre‐ and postsplenectomy and in aplastic anemia was smallest in the gamma model. Among nine methods recommended by the International Committee for Standardization in Hematology and by Dr. Paulus, the gamma model so far provides the best method for calculating the mean survival time of 51 Cr‐platelets.
Beta-blockers and Fibrinous Peritonitis
Authors: I. G. Cunningham
Journal: BMJ (1975)

cadaver arm to be achieved.Separate measurements of trabecular bone mass, cortical bone mass, and bone mineral concentration have also been achieved in patients.The results of this study have been presented in March 1975 at the International Symposium on Computer Tomo- graphy in Bermuda and will be further ad- vanced at the European Society of Radiology in Edinburgh in June.It is important to stress that these results were obtained by modification of the E.M.I. brain scanner where the existence of a surrounding water reference makes accurate and absolute re- sults possible.-Weare, etc.,
How might we improve surgical services for rural populations in developing countries?
Authors: R S Ramaiah
Journal: BMJ (1984)

For too long 3rd World governments have concentrated on providing services for urban populations.  One can understand this policy since city dwellers are the most vociferous literate and political.  Any unrest among them may be a bad omen for these governments.  Only in recent years have governments shown any interest in rural populations--especially as regareds health care.  Although I agree with Professor Samiran Nundy (14 July p.71) my worry is that the decisionmakers may choose the wrong priorities.  Instead of concentrating on basic needs they may advocate sophisticated and expensive measures modelled on Western countries.  These measures may be a luxury in 3rd World countries.  There is an acute need to develop an infrastructure in primary health care before establishing secondary services.  In term of achieving common good for large rural populations this is the best way forward.  Unfortunately many of the health care decisionmakers are preoccupied with the glamorous institutions to which Professor Nundy refers.  A drastic change in this attitude is needed to improve the services for the rural populatons.  The main emphasis has to be onrural helath care.  (full text)
Patients' access to personal health information
Authors: I. Cocks
Journal: BMJ (1986)

women with testosterone values exceeding 3 nmol/l (0-87 ttg/ml), which is consistent with hyper- androgenism.Although, as the authors suggest, "hidradenitis suppurativa falls into the same category as acne vulgaris and idiopathic hirsutism as an example of primary cutaneous virilism," it is of interest that dehydroepiandrosterone sulphate values are not raised in patients with hidradenitis suppurativa, in contrast to patients with the other diseases.This suggests that hidradenitis suppurativa may have a distinct hormonal cause.
Prevalence and Predictors of Lipid and Glucose Monitoring in Commercially Insured Patients Treated With Second-Generation Antipsychotic Agents
Authors: Dan W. Haupt, Lisa C. Rosenblatt, Edward Kim, Ross A. Baker, Richard Whitehead, John W. Newcomer
Journal: American Journal of Psychiatry (2009)

The authors sought to quantify plasma lipid and glucose testing rates in patients receiving second-generation antipsychotics before and after guidelines recommending testing were issued in February 2004 by the American Diabetes Association (ADA).In this retrospective cohort analysis using data from a large managed care database (PharMetrics, 2000-2006), patients under age 65 on second-generation antipsychotics were identified and followed from 40 days before to 130 days after the antipsychotic prescription was written. Baseline and 12-week (40 days) lipid and glucose testing rates were determined for pre- and postguideline cohorts. Logistic regression analyses determined predictors of baseline and 12-week lipid and glucose testing while controlling for covariates.A total of 5,787 preguideline patients and 17,832 postguideline patients were identified. Baseline lipid testing rates were 8.4% for the preguideline cohort and 10.5% for the postguideline cohort, and the 12-week testing rates were 6.8% and 9.0%, respectively. Baseline glucose testing rates were 17.3% for the preguideline cohort and 21.8% for the postguideline cohort, and the 12-week testing rates were 14.1% and 17.9%, respectively. All four comparisons were statistically significant. Baseline and 12-week testing rates for lipids and glucose in children were the lowest of all age groups.Despite statistically significant improvements after the ADA guidelines were issued, monitoring for plasma lipids and glucose in this population remains low. Clinicians and administrators responsible for the health of at-risk populations should implement new approaches for effective monitoring of major modifiable risk factors for medical morbidity and mortality in patients taking second-generation antipsychotics.
Commentary: The Role of Percutaneous Coronary Intervention in ST-Segment–Elevation Myocardial Infarction
Authors: Eric R. Bates, Brahmajee K. Nallamothu
Journal: Circulation (2008)

this issue of Circulation, Dr Gregg Stone offers a thorough review of percutaneous coronary intervention (PCI) strategies to treat ST-segment-elevation myocardial infarction (STEMI). 1,2All of the major topics are addressed and comprehensively referenced, and the figures provide a concise summary of much of the evidence base.His ultimate vision is the establishment of STEMI systems of care dedicated to primary PCI.Improving patient outcomes in STEMI is a critical goal, and we agree that continued efforts are needed to expand prehospital and hospital-based emergency medical systems for STEMI patients.However, we also continue to believe that there are currently substantial challenges to delivering primary PCI rapidly and reliably in real-world settings.Given that some of the opinions offered by Stone differ from recommendations made by professional societies, we offer a different perspective on this controversial subject and provide some of the background thinking that led to the development of the 2004 American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Patients With STelevation Myocardial Infarction 3 and the subsequent 2007 focused update. 4Our discussion also is informed by the ACC Door-to-Balloon (D2B) Alliance campaign 5 and the AHA Mission: Lifeline initiative. 6Our goal is not to debate the points made by Stone but to place PCI for STEMI in the broader context of the patient and the healthcare system.We do this by providing additional insights into the development of PCI strategies in STEMI, examining the critical challenges that remain for delivering primary PCI, highlighting the difference between fibrinolytic therapy and a fibrinolytic strategy, and endorsing a new paradigm for reperfusion therapy.
Oxidation of Methionine by Human Polymorphonuclear Leukocytes
Authors: Min-Fu Tsan, Jasmine W. Chen
Journal: Journal of Clinical Investigation (1980)

Studies of the photosensitized oxidation have demonstrated that photodynamic oxidation of methionine is mediated by singlet oxygen (1O2). In this study, we demonstrated that phagocytosing human polymorphonuclear leukocytes (PMN), but not resting PMN, oxidized both intracellular and extracellular methionine to methionine sulfoxide. N-ethylmaleimide, which inhibits phagocytosis and cellular metabolism, inhibited the oxidation of methionine. Neutrophils from patients with chronic granulomatous disease did not oxidize methionine even in the presence of phagocytosis. The oxidation of methionine by phagocytosing normal PMN was inhibited by 1O2 quenchers, (1.4-diazabicyclo-[2,2,2]-octane, tryptophan, NaN3), myeloperoxidase (MPO) inhibitors (NaN3, KCN) and catalase. In contrast, superoxide dismutase, ethanol, and mannitol had no effect. Furthermore, 1O2 quenchers did not interfere with the production of superoxide (O2−) by phagocytosing PMN. The combination of catalase and SOD did not enhance the inhibition of methionine by phagocytosing PMN. On the other hand, deuterium oxide stimulated the oxidation of methionine by PMN almost 200%.
Cancer vaccines: progress reveals new complexities
Authors: Zhiya Yu, Nicholas P. Restifo
Journal: Journal of Clinical Investigation (2002)

The future of vaccine designA decade ago, it seemed clear that our burgeoning knowledge of the molecular identities of tumor-associated antigens and a deeper understanding of basic immunology would point the way to an effective therapeutic cancer vaccine.Significant progress has been made and objective regressions after immune-based treatments are observed in some patients -even in those with bulky, metastatic disease.Notwithstanding this progress, we do not yet have a cancer vaccine in hand that can reliably increase patient survival or induce tumor destruction.The creation of therapeutic cancer vaccines has proven to be an enormous challenge, and many of the strategies learned in the development of highly successful vaccines against infectious agents simply do not apply to cancer vaccines.Issues of antigenic change and immune escape are present in both antitumor and antiviral situations.However, one big difference between antiviral and antitumor vaccines is that the former are preventative whereas the latter are generally expected to be therapeutic.Another problem with the targeting of tumor antigens relates to their poor immunogenicity.Tumor antigens appear to be relatively well tolerated in the host, perhaps because many of these antigens are also expressed in normal tissues.In this context, a successful cancer vaccine raises the specter of autoimmune attack if the vaccines are ultimately powerful enough to eliminate cancer cells.In this review, we highlight new challenges that have been revealed by recent progress in the field of tumor immunology.We then attempt to outline a future plan for cancer immunotherapy.
Cellular Target of Cyclophosphamide Toxicity in the Murine Liver: Role of Glutathione and Site of Metabolic Activation
Authors: L D DeLeve
Journal: Hepatology (1996)

Hepatic venoocclusive disease (HVOD) is caused by the disruption of the microcirculation by an as-yet unknown mechanism. Previous in vitro studies with azathioprine, monocrotaline, and dacarbazine suggested that toxins that cause HVOD initially causing HVOD target sinusoidal endothelial cells (SEC) perhaps via profound glutathione (GSH) depletion. The current study examines cyclophosphamide toxicity in SEC and hepatocytes, as well as the interplay between the two cell types. Cyclophosphamide was not directly toxic to SEC, but in coculture of SEC and hepatocytes, cyclophosphamide was significantly more toxic to SEC. Two cyclophosphamide metabolites, 4-hydroperoxycyclophosphamide and acrolein, were equally toxic to SEC, and toxicity occurred at 20-fold-lower concentrations than in hepatocytes. 4-Hydroperoxycyclophosphamide depleted GSH by greater than 95% before inducing cell death in SEC. When hepatocyte-GSH levels were sustained with supplemental methionine and serine in coculture, toxicity in both cell types was diminished. In coculture, SEC are significantly more susceptible than hepatocytes to cyclophosphamide toxicity, and this is likely caused by acrolein generated by the hepatocyte. As seen with other toxins implicated in HVOD, the profound depletion of SEC GSH precedes the onset of toxicity. The degree of cyclophosphamide toxicity induced in SEC is determined by both metabolic activation and GSH detoxification in the hepatocytes.
NEW METHOD OF BLOOD TRANSFUSION
Authors: Edward G. Waters
Journal: JAMA (1926)

<h3>To the Editor:</h3> —In the August 14 issue ofThe Journalappears "A New Method of Blood Transfusion" by Dr. James J. Donahue of St. Louis. The writer is evidently not acquainted with Brines' paper in the<i>Archives of Surgery</i>(<b>12</b>:124-139 [Jan.] 1926), which describes in some detail the same (and other) modifications of the original Unger machine and technic. In justice to Dr. Brines, the reported method can hardly be called "new."
Factors Influencing the Testing for Driving Under the Influence
Authors: R. Gibson Parrish
Journal: JAMA (1992)

<h3>To the Editor.</h3> —The recent letter by Saylor et al<sup>1</sup>about driving under the influence of drugs (DUID) prompts us to issue a word of caution. As the authors point out, 14% to 81% of impaired drivers with low or negligible blood ethanol levels test positive for other mind- or performance-altering drugs. The wide range observed may be due to several factors. Drug testing for DUID is not uniform. Because of limited resources, police-related toxicology laboratories frequently focus their efforts on the prosecution of offenders and not on complete toxicologic testing. For example, in states where ethanol intoxication is legally defined as a specific concentration of ethanol in blood, a higher concentration in a driver's blood may prompt no further toxicologic testing since the blood ethanol concentration alone is sufficient for prosecution. If a driver's blood ethanol concentration is low or negligible, tests for other intoxicating drugs may be
A review of peripheral nerve blockade as local anaesthesia in the treatment of palmar hyperhidrosis
Authors: M.J. Hayton, J.K. Stanley, N.J. Lowe
Journal: British Journal of Dermatology (2003)

Injection of botulinum toxin type A (BTX-A) is an effective method of controlling palmar hyperhidrosis. It is, however, an uncomfortable procedure without adequate anaesthesia. We outline the techniques used, the reasons for them and potential pitfalls that can be avoided, with an outline of the neural anatomy relevant to the palmar injection of BTX-A. We have been using peripheral nerve blockade as local anaesthesia during BTX-A treatment of palmar hyperhidrosis for the last few years, and have found it an effective method of providing pain relief during the procedure, giving greater anaesthesia than that given by topical anaesthetic cream under occlusion and ice. It has been our experience that patients prefer wrist blockade to topical anaesthesia and ice when receiving BTX-A injections for treatment of palmar hyperhidrosis.
Conclusion: challenges for the future
Authors: D. Warner North
Journal: Environmental Health Perspectives (1993)

The title "Challenges for the Future" implies the challenge to summarize a very complex meeting. Of necessity, I will present a personal impression. My interest is in risk assessment, which I define as a process for summarizing science in support of decision making. Risk assessment is sometimes regarded as arcane numerology, a rigid process of computing risk numbers in which much available science is unused. I am a strong advocate for the broader definition of risk assessment. It is encouraging to learn how much science is becoming available for use in risk assessment for gasoline, its components, and alternative fuels.
Taught a lesson by taut skin
Authors: P. Geoghegan, D. J. Sexton, L. Giblin, A. O'Regan
Journal: BMJ (2012)

A 45 year old man with a history of ulcerative colitis presented to his general practitioner because of Raynaud’s phenomenon and itchy tight skin that had affected his hands and elbows bilaterally over the preceding few months. He was referred to a rheumatologist, who performed a series of immunological tests. The results included a positive antinuclear antibody staining pattern on immunoflourescence, with anti-RNA polymerase III antibodies identified on further testing. Tests for anti-centromere and anti-topoisomerase I (anti-Scl 70) antibodies were negative. The rheumatologist diagnosed a systemic connective tissue disorder. 

When the skin symptoms worsened over the next few weeks the patient started to use over the counter ibuprofen to ease the pain associated with his tight skin. He subsequently presented to the emergency department with fatigue. His blood pressure was found to be 210/120 mm Hg. In addition to the skin abnormalities, bibasal fine inspiratory crepitations were detected on physical examination. Routine laboratory testing showed haemoglobin 75 g/L (reference range 130-180), creatinine 475 µmol/L (80 µmol/L one month previously (80-110), and lactate dehydrogenase 357 U/L (70-250). Electrocardiography showed T wave inversion in the lateral leads. He was excreting 1.15 g of protein in his urine per 24 hours and haematuria was detected on dipstick urinalysis.



### What is the diagnosis?

#### Short answer

Scleroderma renal crisis, which results in a hypertensive emergency.1

#### Long answer

Our patient had diffuse cutaneous scleroderma. Figures 1⇓ and 2⇓ show taut shiny skin on his forearm and hands, with areas of hypopigmentation on the extensor surfaces. The skin was so tight that he developed contractures at the elbows (fig 1 shows the position of maximal …