tbuckley/cabot-search huggingface dataset:
Cimetidine and Mental Confusion
Authors: Charles A. Wood, Michael L. Isaacson, Margaret S. Hibbs
Journal: JAMA (1978)

<h3>To the Editor.—</h3> In the last year several cases of mental confusion associated with cimetidine therapy have been reported in the literature,<sup>1-3</sup>yet this side effect is not widely known. In fact, this side effect is not reported in the product literature. In the cases reported, these mental changes occurred after accidental overdosage or in patients with suspected renal impairment. Cimetidine is excreted primarily unchanged by the kidney, but neither the literature nor the manufacturer furnish definitive guidelines for the use of cimetidine in patients with renal failure. We would like to report a possible case of drug-induced encephalopathy associated with the administration of normal doses of cimetidine to a patient with a moderate degree of renal failure. <h3>Report of a Case.—</h3> A 53-year-old woman was transferred to our service from the coronary care unit with multiple medical problems. At the time of transfer, her severe problem was a
Functional Disorders of Menstruation in Adolescence
Authors: Janet W. McArthur
Journal: New England Journal of Medicine (1953)

THE purpose of this report is to review certain of the physiologic data that have been found of value in understanding and treating the functional disorders of menstruation in adolescent girls. Additional general information concerning this subject has recently been set forth elsewhere.1 , 2 Menstrual and Reproductive Performance of the Adolescent GirlSo common is erratic menstruation in the years immediately after the menarche that disturbances of menstrual function approach the status of a normal adolescent characteristic. There are, to be sure, cases in which a menstrual disorder connotes the presence of significant reproductive or constitutional disease. However, in most cases . . .
LONG-TERM EVALUATION OF MECHANICAL HEART VALVES
Authors: P.A. Lewis, E.G. Butchart, DouglasG. Altman, A.M.H.P. Van Den Besselaar, C.E.E. Kuntze, T. Ebels, A. Eijgelaar, J.N. Homan Van Der Heide
Journal: The Lancet (1989)
Calcium, the Control of Smooth Muscle Function and Bronchial Hyperreactivity
Authors: D. J. Triggle
Journal: Allergy (1983)

The Ca2+ requirements for excitation-contraction coupling in smooth muscle may be satisfied from both intracellular and extracellular sources, the relative extent of use of which is both tissue- and stimulant-dependent. Extracellular Ca2+ is apparently mobilized through two separate pathways, receptor operated (ROC) and potential dependent (PDC) Ca2+ channels. The latter process is sensitive to the Ca2+-channel antagonists, a heterogeneous group of compounds including verapamil, nifedipine and diltiazem. Ca2+ mobilization in respiratory smooth muscle is reviewed. The available evidence for this multiple stimulant-sensitive system indicates that both intra- and extracellular sources of Ca2+ are used. Data from bovine, canine and guinea pig tracheal muscle indicate, from studies of Ca2+-dependence of response and Ca2+ channel antagonist sensitivity, that the extent of use of extracellular Ca2+ lies in the order K+ greater than histamine greater than or equal to 5-hydroxytryptamine greater than acetylcholine. The bronchodilator activity of the Ca2+ channel antagonists is noted. Bronchial hyperreactivity is characterized by an increased sensitivity to a variety of stimulants including cold air, exercise, histamine and acetylcholine. The possible origins of this defect are noted. It is suggested that a defect in Ca2+ mobilization or in the receptor - Ca2+ mobilization coupling process at the level of the smooth muscle may constitute an important underlying cause of bronchial hyperreactivity. Potential analogies to reactivity changes seen in hypertensive vascular smooth muscle are noted.
Why portal hypertensive varices bleed and bleed: a hypothesis.
Authors: P A McCormick, S A Jenkins, N McIntyre, A K Burroughs
Journal: Gut (1995)

Continued bleeding or early rebleeding is associated with a poor prognosis in patients with variceal haemorrhage. It is not clear why bleeding stops in some patients and continues or restarts in others. It is suggested that secondary haemodynamic changes in the splanchnic circulation after a bleed may contribute to the risk of further bleeding. These changes include the effects of hypotension on portocollateral resistance, the effects of blood in the gut on splanchnic blood flow, and the effects of blood volume expansion on portal venous pressure during resuscitation. These factors, working in concert, cause a secondary rise in portal venous pressure, which may precipitate further bleeding. Treatment aimed at preventing these secondary haemodynamic changes may be beneficial. It is probable that somatostatin and octreotide could act in this way, which may explain their therapeutic efficacy.
Intra-abdominal Adhesions as a Manifestation of a Fibrotic Diathesis
Authors: E. C. Ashby
Journal: BMJ (1969)

In 81 patients with fibrous intra-abdominal adhesions there was a high incidence of other lesions in which there was a substantial element of fibrosis. These included chronic peptic ulceration, ovarian cysts, fibrous stenotic lesions, and thickened scars. It is suggested that in some patients a generalized fibrotic tendency as well as local factors may play a part in the pathogenesis of adhesions.
Right ventricular function in children with tetralogy of Fallot before and after aortic-to-pulmonary shunt.
Authors: J M Jarmakani, M Nakazawa, J Isabel-Jones, R A Marks
Journal: Circulation (1976)

Right and left ventricular volume variables were obtained in 43 tetralogy patients undergoing diagnostic cardiac catheterization. The patient population consisted of 25 preoperative patients (group 1) and 18 patients who had undergone aortic-to-pulmonary shunt procedure (group 2). Volumes were calculated from biplane cineangiocardiograms using Simpson's rule method for the right ventricle (RV) and the area-length methods for the left ventricle (LV). In group 1, RV end-diastolic volume (RVEDV) was not different from normal in the total group and averaged 93 +/- 4% (SEM) of normal. In patients with hemoglobin (Hgb) greater than or equal to 16 g%, however, this variable was significantly (P = 0.044) less than normal. Right ventricular ejection fraction was normal and RV systolic index was significantly (P less than 0.001) reduced, averaging 3.35 +/- 0.18 (SEM) L/min/m2. Left ventricular volume variables in this group were not significantly different from RV volume variables. In group 2, RVEDV in patients with Hgb greater than or equal to 16 g% was significantly (P = 0.037) less than normal, but was normal in patients with Hgb less than 16 g%. Right ventricular ejection fraction averaged 0.52 +/- 0.03 in this group and was significantly (P less than 0.001) less than normal. Right ventricular systolic index (RVSI) averaged 3.51 +/- 0.24 L/min/m2 and was significantly (P = 0.009) less than normal. RVSI in patients with Hgb less than 16 g% averaged 3.90 +/- 0.31 and was not different from normal. In contrast, this variable in patients with Hgb greater than or equal to 16 g% averaged 3.21 +/- 0.34 and was significantly (P = 0.005) less than normal. Left ventricular end-diastolic volume (LVEDV) and LV systolic output in group 2 were significantly higher than RVEDV and RV systolic output. Right ventricular and LV ejection fractions in group 2 were not different. The relatively decreased ejection fraction fraction in tetralogy patients, as compared with patients with valvular pulmonic stenosis and similar volumes and pressures, suggests that the decreased ejection fraction was not due to decreased preload or increased afterload and might be due to impaired ventricular function secondary to chronic hypoxia. Early corrective surgery in these patients might reverse this process. However, patients with severe tetralogy who have small ventricular volume and reduced output might benefit from shunt procedure rather than complete correction.
The Psychiatric Manifestations of Cerebral Malaria
Authors: W. WEBSTER BLOCKER, ALBERT J. KASTL, ROBERT B. DAROFF
Journal: American Journal of Psychiatry (1968)

During a ten-month period 1,200 U. S. soldiers were admitted to an Army hospital in South Viet Nam with falciparum malaria. Nineteen developed "cerebral malaria," and three of these showed dramatic personality changes manifested as apparent "functional" psychoses. Further evaluation including psychological testing, however, led to the impression that the symptoms had a definite organic basis secondary to cerebral involvement. The authors stress the prognostic implications of differential diagnosis.
Transcatheter Valve Replacement in Patients With Severe Mitral Valve Disease and Annular Calcification
Authors: Dominique Himbert, Claire Bouleti, Bernard Iung, Mohammed Nejjari, Eric Brochet, Jean-Pol Depoix, Walid Ghodbane, Amir-Ali Fassa, Patrick Nataf, Alec Vahanian
Journal: Journal of the American College of Cardiology (2014)
The health burden and economic costs of cutaneous melanoma mortality by race/ethnicity–United States, 2000 to 2006
Authors: Donatus U. Ekwueme, Gery P. Guy, Chunyu Li, Sun Hee Rim, Pratibha Parelkar, Suephy C. Chen
Journal: Journal of the American Academy of Dermatology (2011)

Cutaneous melanoma is the most deadly form of skin cancer with more than 8000 deaths per year in the United States. The health burden and economic costs associated with melanoma mortality by race/ethnicity have not been appropriately addressed.We sought to quantify the health burden and economic costs associated with melanoma mortality among racial/ethnic groups in the United States.We used 2000 to 2006 national mortality data and US life tables to estimate the number of deaths, and years of potential life lost (YPLL). Further, we estimated the economic costs of melanoma mortality in terms of productivity losses. All the estimates were stratified by race/ethnicity and sex.From 2000 to 2006, we estimated an increase of 13,349 (8.7%) YPLL because of melanoma mortality compared with a 2.8% increase among all malignant cancers across all race/ethnicity. On average, an individual in the United States loses 20.4 years of potential life during their lifetime as a result of melanoma mortality compared with 16.6 years for all malignant cancers. The estimated annual productivity loss attributed to melanoma mortality was $3.5 billion. Our estimates suggest that an individual who died from melanoma in 2000 through 2006 would lose an average of $413,370 in forgone lifetime earnings. YPLL rates and total productivity losses are much higher among non-Hispanic whites as compared with non-Hispanic blacks and Hispanics.The estimated economic costs did not include treatment, morbidity, and intangible costs.We estimated substantial YPLL and productivity losses as a result of melanoma mortality during an individual's lifetime. By examining the burden by race/ethnicity, this study provides useful information to assist policy-makers in making informed resource allocation decisions regarding cutaneous melanoma mortality.
Subacute Delirious State due to "Preludin" Addiction
Authors: M. Silverman
Journal: BMJ (1959)

MEDICAL JOURNALdosage of amethocaine; moreover, it was administered through a nasal catheter-a very dangerous method, as pointed out by Steinhaus (1952).Case 3 was probably a case of toxicity to the same drug.No history regarding previous sensitization to local analgesics was available in any of the cases.None of these patients had suffered from any obvious allergic disorder, except Case 4. Summary Five cases of hypersensitivity and/or toxicity to amethocaine and lignocaine during bronchoscopy and bronchography are reported.I thank Drs. J. V. Davies, H. D. Palmer, and N. Whittaker for allowing me to publish these cases.
Should the Hemoglobin A<sub>1c</sub>Diagnostic Cutoff Differ Between Blacks and Whites?
Authors: Yusuke Tsugawa, Kenneth J. Mukamal, Roger B. Davis, William C. Taylor, Christina C. Wee
Journal: Annals of Internal Medicine (2012)

Background: Hemoglobin A1c (HbA1c) levels are known to be consistently higher in black persons than in white persons at any given glycemic level. Whether the optimal diagnostic threshold of HbA1c should differ between blacks and whites is unclear. Objective: To compare the relationships between HbA1c level and the prevalence of retinopathy in black and white U.S. adults. Design: Cross-sectional study. Setting: A nationally representative sample of the National Health and Nutrition Examination Survey from 2005 through 2008. Patients: 2804 white persons and 1008 black persons aged 40 years or older in the United States. Measurements: Prevalence of retinopathy. Logistic regression models and restricted cubic spline models were constructed separately for white and black populations to test the HbA1c levels at which risk for retinopathy begins to increase. Results: After adjustment for age, sex, hypertension, body mass index, family history of diabetes, and use of antidiabetes medications or insulin, the lowest HbA1c category for which the prevalence of retinopathy was significantly higher than the reference category (<5.5%) was 6.0% to 6.4% for white persons (risk difference, 4.8% [95% CI, 0.5% to 9.1%]) and 5.5% to 5.9% for black persons (risk difference, 5.3% [CI, 1.0% to 9.5%]). The restricted cubic spline models indicated that the risk for retinopathy increased at lower HbA1c levels in black persons than in white persons. Limitation: The cross-sectional design of the study precluded examining the effect of the duration at each HbA1c level. Conclusion: The prevalence of retinopathy begins to increase at a lower HbA1c level in black Americans than in white Americans. The findings do not support increasing the diagnostic threshold of HbA1c in black persons. Primary Funding Source: None.
PATHOLOGICAL CONDITIONS FOUND IN MEAT INSPECTION.
Authors: D. E. SALMON
Journal: JAMA (1900)

The more common and important pathological conditions found in meat inspection are no doubt subjects of considerable interest to the members of this Association. These conditions may affect the public health to a certain extent, and they are unquestionably worthy of careful study by the sanitarian as well as the pathologist. The federal meat-inspection service having been in operation about nine years, has now reached a stage of development and an approach to uniformity of procedure which justifies the expectation that some thought may hereafter be given to the utilization for scientific purposes of its records and of some of the material which is found. While we have not in the past entirely neglected the collection and study of the pathological material, the imperative necessity of organization and of the investigation and control of the more destructive animal plagues has prevented us from using this material to any great extent
Extra-articular features in early rheumatoid disease.
Authors: A Fleming, S Dodman, J M Crown, M Corbett
Journal: BMJ (1976)

One hundred and two patients who presented with rheumatoid disease within the first year of onset were studied prospectively every four months for a mean 4.5 years to assess the incidence of extra-articular features. The features that seemed to be common in the early stages included hand-muscle wasting, carpal tunnel syndrome, lymphadenopathy, non-specific ankle swelling, and rheumatoid nodules, and to a lesser extent hepatomegaly, being underweight, conjunctivitis, skin transparency, and a palpable thyroid gland. Those features which seldom occurred early included scleromalacia, temporal artery inolvement, salivary gland enlargement, distal-motor neuropathy, splenomegaly, digital vasculitis, and pulmonary and cardiac complications. Being underweight indicated a significantly more severe outcome.
Hunt promises crackdown on foreigners who misuse NHS, despite GPs' objections to checking entitlement
Authors: N. Hawkes
Journal: BMJ (2013)

<h3>Objectives</h3> To explore the process of implementation of an online health information web-based portal and referral system (HealthPathways) using implementation science theory: the Consolidated Framework for Implementation Research (CFIR). <h3>Setting</h3> Southern Health Region of New Zealand (Otago and Southland). <h3>Participants</h3> Key Informants (providers and planners of healthcare) (n=10) who were either involved in the process of implementing HealthPathways or who were intended end-users of HealthPathways. <h3>Methods</h3> Semistructured interviews were undertaken. A deductive thematic analysis using CFIR was conducted using the framework method. <h3>Results</h3> CFIR postulates that for an intervention to be implemented successfully, account must be taken of the intervention’s core components and the adaptable periphery. The core component of HealthPathways—the web portal and referral system that contains a large number of localised clinical care pathways—had been addressed well by the product developers. Little attention had, however, been paid to addressing the adaptable periphery (adaptable elements, structures and systems related to HealthPathways and the organisation into which it was being implemented); it was seen as sufficient just to deliver the web portal and referral system and the set of clinical care pathways as developed to effect successful implementation. In terms of CFIR’s ‘inner setting’ corporate and professional cultures, the implementation climate and readiness for implementation were not properly addressed during implementation. There were also multiple failures of the implementation process (eg, lack of planning and engagement with clinicians). As a consequence, implementation of HealthPathways was highly problematic. <h3>Conclusions</h3> The use of CFIR has furthered our understanding of the factors needed for the successful implementation of a complex health intervention (HealthPathways) in the New Zealand health system. Those charged with implementing complex health interventions should always consider the local context within which they will be implemented and tailor their implementation strategy to address these.
Beneficial Hemodynamic Effects of Oral Levodopa in Heart Failure
Authors: Sol I. Rajfer, Aaron H. Anton, James D. Rossen, Leon I. Goldberg
Journal: New England Journal of Medicine (1984)

Among the positive inotropic drugs available to improve myocardial contractility in congestive heart failure, only digitalis glycosides are suitable for oral administration. In this study, we administered oral levodopa (1.5 to 2.0 g), which is decarboxylated to form dopamine, to 10 patients with severe congestive heart failure. Peak hemodynamic responses occurred one hour after the ingestion of levodopa, with the mean (±S.E.M.) cardiac index increasing from 1.8±0.1 to 2.4 ± 0.2 liters per minute per square meter of body-surface area (P<0.01) and systemic vascular resistance declining from 1905±112 to 1513±121 dyn • sec · cm-5 (P<0.01). These effects persisted for four to six hours. Left ventricular filling pressure, heart rate, and mean arterial pressure were unchanged. Plasma concentrations of dopamine rose to a peak level of 34±5 ng per milliliter one hour after drug ingestion and decreased toward base line over the ensuing five hours. A significant correlation was observed between plasma dopamine levels and changes in cardiac index (r = 0.8; P<0.02). Five patients enrolled in a trial to evaluate the effectiveness of long-term therapy with levodopa had similar hemodynamic responses to the drug after 6.8±1.7 months of treatment. Thus, oral administration of levodopa to patients with severe heart failure produced a sustained improvement in cardiac function. The hemodynamic responses observed can be attributed to the activation of beta1-adrenergic, dopamine1, and dopamine2 receptors by dopamine derived from levodopa. (N Engl J Med 1984; 310:1357–62.)
Failure to incriminate hepatitis B, hepatitis C, and hepatitis E viruses in the aetiology of fulminant non-A non-B hepatitis.
Authors: D Mutimer, J Shaw, J Neuberger, S Skidmore, B Martin, S Hubscher, P McMaster, E Elias
Journal: Gut (1995)

Sporadic non-A, non-B hepatitis is the most common indication for liver transplantation in patients presenting with fulminant and subacute liver failure. This study used serological, histological, and molecular biological techniques to examine specimens from 23 consecutive patients transplanted for sporadic non-A, non-B hepatitis. No evidence was found of hepatitis C virus, hepatitis E virus, or 9cryptic9 hepatitis B virus infection.
Stimulation of Prostaglandin Biosynthesis by Adenine Nucleotides
Authors: PHILIP NEEDLEMAN, MARK S. MINKES, JAMES R. DOUGLAS
Journal: Circulation Research (1974)

Prostaglandin release from various isolated perfused organs is characteristically dependent on the stimulus; thus, certain stimuli caused prostaglandin release in some organs and not in others. Adenosine triphosphate and adenosine diphosphate were potent stimulators of prostaglandin biosynthesis in the kidney, spleen, spleen fat pad, heart, liver and lung; adenosine monophosphate and adenosine were inactive. Epinephrine caused prostaglandin release from the kidney, spleen, and liver, whereas, angiotensin was agonistic in the kidney, spleen, spleen fat pad, and liver. Indomethacin abolished the release (biosynthesis) of prostaglandins from all organs by each agonist.
Recent advances in paediatrics: II childhood and adolescence
Authors: J. Pearn
Journal: BMJ (1997)

Infants die from prematurity, congenital malformations, and infectious diseases; over 90% of those who succumb do so in the less affluent countries of the world.Infection with HIV and malaria are afflicting an increasing number of children and teenagers in tropical countries, and everywhere children who survive infancy become exposed to trauma and neoplasms.Prevention of child trauma, 1 2 drug resistant malaria, 3 and violence to and exploitation of children [4][5][6] remain the topics central to the professional life of all doctors, irrespective of their nationality.Bicycle helmets have been shown to reduce road deaths and injuries