tbuckley/cabot-search huggingface dataset:
Methotrexate Displacement in Man*
Authors: D. G. Johns, J. W. Hollingsworth, A. R. Cashmore, I. H. Plenderleith, J. R. Bertino
Journal: Journal of Clinical Investigation (1964)

In a number of mammalian species, including man, the 4-amino analogs of pteroylglutamate persist in liver and kidney for many months af- ter administration (1-4).In the rat (3) and mouse (4), the binding site appears to be the en- zyme dihydrofolate reductase [also termed folate reductase ( 5) and tetrahydrofolate dehydrogen- ase.1]Studies with partially purified dihydro- folate reductase obtained from several sources (6-8) have shown the affinity of this enzyme for the 4-amino analogs to be extremely high.Recent work with tritium-labeled pteroylglutamate in vivo has shown that, in man, the labeled compound can be displaced from cells several days after its administration, both by unlabeled pteroylglutamate (9, 10) and by other compounds that possess an affinity for the enzyme dihydrofolate reductase (11).If, as animal experiments sug- gest, the 4-amino analogs bind to the same en- zyme, a similar procedure should also bring about the displacement of these compounds.The studies reported here show that, in man, tritiated methotrexate (amethopterin; 4-amino-AN10-methyl- pteroylglutamic acid) can be readily displaced
A 91-Year-Old Woman With Difficult-to-Control Hypertension
Authors: Lewis A. Lipsitz
Journal: JAMA (2013)

Hypertension is common among people older than 65 years, affecting nearly two-thirds of men and three-fourths of women by age 75 years. Treatment goals and medication selection for this population may differ from those for younger patients.To discuss the presentation, pathophysiology, and optimal treatment of hypertension among elderly persons.MEDLINE was searched from 1990 to 2013. A hand search of bibliographies from guidelines and review articles from 2000 to 2013 was also used to identify studies of hypertension treatment in patients older than 65 years.Hypertension in elderly people differs from that in younger people in that (1) hypertension is predominantly systolic because of vascular stiffness; (2) it is associated with reduced baroreflex sensitivity, which increases blood pressure variability and vulnerability to hypotension during common daily activities; (3) it is associated with cognitive and functional decline as well as adverse cardiovascular outcomes; and (4) hypertension may be beneficial in frail people older than 85 years. Treatment of healthy patients up to age 85 years with most antihypertensive medications reduces cardiovascular morbidity and mortality and possibly cognitive and functional decline.Although patients in their 90s have not been studied, any ambulatory and independent patient older than 80 years should have multiple blood pressure measurements taken during their usual daily activities, and if these show persistent hypertension, these patients should be treated judiciously.
Arrhythmia and Diabetes
Authors: Joan Stephenson
Journal: JAMA (2009)

Individuals with type 2 diabetes who also have atrial fibrillation (AF) have a substantially increased risk of cardiovascular events and death, according to an international team of researchers (Du X et al. Eur Heart J. doi: 10.1093/eurheartj/ehp055 [published online March 11, 2009]).
Do High-Deductible Health Plans Threaten Quality of Care?
Authors: Thomas H. Lee, Kinga Zapert
Journal: New England Journal of Medicine (2005)

Interview with James Robinson and Thomas Lee on health savings accounts and high-deductible plans. (09:47)Download Employers struggling with rising health care costs are implementing their strategy for the post–managed-care era — a shift of costs and responsibility to the consumer. As Robinson describes in this issue of the Journal (pages 1199–1202), this shift is likely to be accelerated by the spread of health savings accounts, which are expected to encourage as many as 25 percent of privately insured Americans to enroll in "high-deductible health plans" by the end of the decade. With these insurance products, patients bear a substantial portion of their health care costs ($1,000 or more per year for individuals). Advocates of these . . .
High-Dose Allopurinol Reduces Left Ventricular Mass in Patients With Ischemic Heart Disease
Authors: Sushma Rekhraj, Stephen J. Gandy, Benjamin R. Szwejkowski, M. Adnan Nadir, Awsan Noman, J. Graeme Houston, Chim C. Lang, Jacob George, Allan D. Struthers
Journal: Journal of the American College of Cardiology (2013)
Bone Marrow Necrosis During Chemotherapy for Lymphoma
Authors: Bernard A. Mason
Journal: JAMA (1978)

ANTEMORTEM diagnosis of bone marrow necrosis was recently reported by Kiraly and Wheby.<sup>1</sup>The major underlying diseases associated with bone marrow necrosis are sickle cell anemia and malignant neoplasms.<sup>1,2</sup>Malignant lymphoma has been a particularly uncommon reported cause of bone marrow necrosis.<sup>1,3</sup>Necrosis as a consequence of intensive chemotherapy has been reported less frequently.<sup>1,2</sup>We report the case of a patient with poorly differentiated lymphocytic lymphoma involving the bone marrow, in whom striking bone marrow necrosis developed, verified during life by aspiration and biopsy after one month of intensive chemotherapy. <h3>Report of a Case</h3> A 50-year-old man had severe right leg pain that had been unresponsive to symptomatic treatment. He had lost 10 kg in one month, but did not have fever or night sweats. On admission to George Washington University Medical Center, he appeared chronically ill with right-quadriceps atrophy. No lymphadenopathy, organomegaly, or bony tenderness
Bell's Palsy: Some Problems of Prognosis and Treatment
Authors: G. A. Dalton
Journal: BMJ (1960)

This study is based on a survey of the patients suffering from facial paralysis examined by me in the E.N.T. department of the United Birmingham Hospitals during a two-year period 1954 to 1956.The aims of the investigation were to seek criteria which will give guidance on the probability of spontaneous recovery in idiopathic facial paralysis and to assess the value of present methods of treatment. Material and MethodsOf the 107 patients (54 male, 53 female) examined, 56 were affected on the right, 49 on the left, and 2 bilaterally.Their ages ranged from 5 to 75 years, the highest incidence being in the 30-40 age-group.All the palsies were of lower-motor-neurone type, and so in a sense could be described as cases of Bell's palsy; for in 1821 Bell distinguished between " paralysis which proceeds from the brain, and that affection of the muscles of the face when from a less alarming cause they have lost the controlling influence of the respiratory (i.e., facial) nerve."However, the term Bell's palsy is nowadays reserved for those cases of peripheral facial palsy in which there is no obvious cause such as injury, infection, or new growth (Cawthorne, 1951).Preliminary investigations established pathological causes in 10 patients.They were: (a) chronic mastoid infection (three patients); (b) intratemporal epidermoid of the type described by Jefferson and Smalley (1938) (two patients); (c) fracture involving the temporal bone (two patients); (d) sarcoidosis (one patient with bilateral paralysis); (e) acute middle-ear infection (one patient);(f) brain-stem glioma, which presented originally as a nuclear lesion (one patient).These are listed for completeness and are not discussed further.Bell's Palsy and Ramsay Hunt's Syndrome
Torsion of the Spermatic Cord
Authors: John J. Klingerman
Journal: JAMA (1967)

Historical, physical, and laboratory findings in 36 patients with surgically proven torsion of the spermatic cord or testicular appendages are reviewed. These patients were seen in a large metropolitan hospital during a recent 11-year period. Each year, an average of 3.2 patients with torsion have been seen, or one for each 5,728 hospital admissions. The average yearly census of patients treated by the urological service during the same period was 2,615, an average of one patient with torsion for each 503 admissions. Torsion may occur at any age but certainly predominates during the adolescent years (85% to 90%). The salvage rate of the testicle, in 28 patients with acute torsion, was 25%. Forty-three percent of patients with acute torsion were initially thought to have epididymitis, with loss of the affected testicle in all cases. The treatment is immediate surgical exploration of the affected organ and orchiopexy of the opposite testis.
Pregnancy, Childbirth, and Parenthood
Authors: Louis Keith
Journal: JAMA (1983)

This book is a somewhat unorthodox approach to a traditional subject, one that has interested clinicians and the public since time immemorial. The word<i>unorthodox</i>relates to the editor's statement regarding the genesis of the book—the loss of two full-term children due to abruptio placentae. Each chapter is thoughtfully outlined, and this outline is presented in the table of contents. The authors have attempted to discuss the myriad of problems that affect pregnancy, childbirth, and parenthood from a point of view that relates to the patient and the family. Among the topics covered are pregnancy in modern and traditional society, sexuality during pregnancy, unwantedness, rape and pregnancy, teenage pregnancies, and the process of childbirth per se. In addition, there is a discussion of some of the adverse outcomes of pregnancies, such as emotional illness in the postpartum period, living with newborn death, and perinatal death. Fatherhood is also discussed in
The high incidence of varicella herpes zoster with the use of bortezomib in 10 patients
Authors: Yin Tong, Jie Qian, Ying Li, Hai Meng, Jie Jin
Journal: American Journal of Hematology (2006)

Bortezomib, a proteasome inhibitor, has been used for patients with refractory and relapsed multiple myeloma, lymphoma and leukemia. We used bortezomib in ten refractory or relapsed patients (seven of multiple myeloma, two of lymphoma and one of acute myeloblastic leukemia). Six out of ten (60%) patients developed varicella herpes zoster after the complete of one cycle of bortezomib. The incidence of varicella herpes zoster was higher than reported in the literature. It may be due to immunosuppression caused by the combination of high-dose dexamethasone or other drugs. We considered that prophylactic antiviral medication could be used in predisposed patients to reduce the incidence of varicella herpes zoster.
FDA declines to lift ban on homosexual men as blood donors
Authors: D. Josefson
Journal: BMJ (2000)

Digital healthcare is a rapidly growing healthcare sector. Its importance has been recognised at both national and international level, with the WHO recently publishing its first global strategy for digital health. The use of digital technology within cystic fibrosis (CF) has also increased. CF is a chronic, life-limiting condition, in which the treatment burden is high and treatment regimens are not static. Digital technologies present an opportunity to support the lives of people with CF. We included 59 articles and protocols in this state-of-the-art review, relating to 48 studies from 1999 until 2019. This provides a comprehensive overview of the expansion and evolution of the use of digital technology. Technology has been used with the aim of increasing accessibility to healthcare, earlier detection of pulmonary exacerbations and objective electronic adherence monitoring. It may also be used to promote adherence and self-management through education, treatment management Apps and social media.
Carotid artery stenting versus surgery: adequate comparisons?
Authors: Marco Roffi, Horst Sievert, William A Gray, Christopher J White, Giovanni Torsello, Piergiorgio Cao, Bernhard Reimers, Klaus Mathias, Carlo Setacci, Claudio Schönholz, Daniel G Clair, Martin Schillinger, Iris Grunwald, Marc Bosiers, Alex Abou-Chebl, Issam D Moussa, Harald Mudra, Sriram S Iyer, Dierk Scheinert, Jay S Yadav, Marc R van Sambeek, David R Holmes, Alberto Cremonesi
Journal: The Lancet Neurology (2010)
Relation Between Hospital Primary Angioplasty Volume and Mortality for Patients With Acute MI Treated With Primary Angioplasty vs Thrombolytic Therapy
Authors: David J. Magid
Journal: JAMA (2000)

ContextInstitutional experience with primary angioplasty has been suggested as a factor in selecting a reperfusion strategy for patients with acute myocardial infarction (AMI). However, no large studies have directly compared outcomes of primary angioplasty vs thrombolytic therapy as a function of institutional experience.ObjectiveTo compare outcomes among patients with AMI who were treated with primary angioplasty vs thrombolytic therapy at hospitals with different volumes of primary angioplasty.DesignRetrospective cohort.SettingA total of 446 acute care hospitals with 112 classified as low volume (≤16 procedures), 223 as intermediate volume (17-48 procedures), and 111 as high volume (≥49 procedures) based on their annual primary angioplasty volume.PatientsA total of 62 299 patients with AMI treated with primary angioplasty or thrombolytic therapy from June 1, 1994, through July 31, 1999.Main Outcome MeasureIn-hospital mortality.ResultsMortality was lower among patients who received primary angioplasty compared with those who received thrombolysis at hospitals with intermediate volumes (4.5% vs 5.9%; P<.001) and high volumes (3.4% vs 5.4%; P<.001) of primary angioplasty. At low-volume hospitals, there was no significant difference in mortality between patients treated with primary angioplasty vs those treated with thrombolysis (6.2% vs 5.9%; P = .58). Adjusting for differences in demographic, medical history, clinical presentation, treatment, and hospital characteristics did not significantly alter these findings.ConclusionsIn this study, patients with AMI treated at hospitals with high or intermediate volumes of primary angioplasty had lower mortality with primary angioplasty than with thrombolysis, whereas patients with AMI treated at hospitals with low angioplasty volumes had similar mortality outcomes with primary angioplasty or thrombolysis.
MPs “dismayed” at confusion about electronic patient records
Authors: Zosia Kmietowicz
Journal: BMJ (2007)

Confusion about what information to include in electronic patient records as well as a lack of engagement with frontline NHS staff, particularly doctors, has been blamed for delays in creating the database promised by the government, which would be accessible throughout the health service.

A highly critical report from the cross party health committee says that MPs were dismayed at the lack of clarity about what medical details would be included in the two types of electronic records planned by the NHS IT programme—summary care record and detailed care record—and what they would be used for.

The confusion has led to delays of more than two years in developing and installing new IT systems in some cases. Many NHS staff have lost faith in the new system and are frustrated with having to rely on outdated software.

One example given in the report is iSoft's Lorenzo system for basic administration, which is to be installed in hospitals across the north and the Midlands, but will not be trialed until next year. Until it is in place the uploading of patients' …
Case of Angina Ludovici
Authors: J. A. E. Stuart
Journal: BMJ (1879)

My attempt at lithectasy was, I fear, a poor one.With a proper tent, or a three-bladed dilator, or both, the urethra might possibly have been sufficiently dilated to permit the removal of the stone.At any rate, if I meet such another case, and the stone is of moderate size, I will give this method a fair trial before proceeding to lithotomy.In attempting to crush the stone as I did, I did more harm than good.
Comment on the significance of positive carcinogenicity studies using gavage as the route of exposure.
Authors: F Perera, T Brennan, J R Fouts
Journal: Environmental Health Perspectives (1989)

There is continuing controversy, extending into regulatory matters, over the significance to human health of positive results in carcinogenicity studies in animals using the gavage technique as the route of exposure. Our review of a nonrandom sample of 117 chemicals or chemical processes listed as known or reasonably anticipated to be carcinogenic in the National Toxicology Program's Third Annual Report on Carcinogens provides support for the validity of the gavage route in such studies. Twenty-three chemicals among the 117 substances and processes listed were positive by gavage. Twenty of these 23 chemicals were also appropriately studied by at least one other route of exposure. Thus, we were able to evaluate the extent to which positive gavage results were confirmed by another route of exposure in this sample. Nineteen (or 95%) of the twenty chemicals were positive for carcinogenicity by at least one other nongavage route in carcinogenicity bioassays. Moreover, in each of these 19 cases, positive carcinogenesis results were obtained by a nongavage route in the same species of animal where gavage administration led to the induction of cancer. All of the 23 gavage-positive chemicals induced tumors distal to the site of administration in at least one study, as did all 15 chemicals which were also positive by subcutaneous injection. We emphasize, however, the limited scope of our survey. We have not evaluated all chemicals that have tested positive by gavage and by at least one alternative route, nor have we assessed those chemicals found to be negative by the gavage route.(ABSTRACT TRUNCATED AT 250 WORDS)
Pulmonary Embolism from a Popliteal Vein Aneurysm
Authors: J C LEUNG, MARC COEL, JEHOON KO, JOHN COGAN
Journal: Clinical Nuclear Medicine (1993)

This is the first report of a venous aneurysm detected by radionuclide venography. Aneurysms of the popliteal vein are very rare. Described here is a case of a saccular popliteal venous aneurysm that presented as dyspnea secondary to pulmonary embolism. In this case, there was recurrent PE despite anticoagulant therapy. Almost all such aneurysms are associated with PE, about half of which are recurrent. This report demonstrates another useful aspect of obtaining a simultaneous radionuclide venogram when performing a perfusion lung scan with Tc-99m MAA.
Cutaneous sodium lauryl sulphate irritation potential: age and regional variability
Authors: ANASTASIA B. CUA, K.-P. WILHELM, H.I. MAIBACH
Journal: British Journal of Dermatology (1990)

To investigate differences in response to irritation according to age and site seven young-adult and eight elderly females were exposed to 0.25% sodium lauryl sulphate (SLS) under patch-test occlusion for 24 h. Ten anatomical regions were tested: forehead, upper arm, volar and dorsal forearm, postauricular, palm, abdomen, upper back, thigh, and ankle. The skin responses were evaluated 24 h post-patch removal by visual scoring and by transepidermal water loss measurements (TEWL). Non-treated symmetrical anatomical regions served as controls. SLS induced a mild erythematous reaction on most anatomical regions except the palm and TEWL was significantly increased as compared with controls. The elderly group demonstrated significantly less susceptibility to SLS-induced irritation for most regions of the body as indicated by visual scores and TEWL measurements. In addition, evaluation of the stratum corneum water content following SLS irritation demonstrated lower responses in the old age group for most regions. The thigh had the highest reactivity and the palm the lowest, in both age groups. These data suggest that young adult skin is more sensitive to SLS than old skin and that SLS irritation varies considerably with respect to region. Moreover, objective TEWL measurements seem to be a better indicator of irritant susceptibility, especially in the elderly, than clinical evaluation by visual scoring.
Analysis of tidal breathing parameters in infancy: how variable is TPTEF:TE?
Authors: J Stocks, C A Dezateux, E A Jackson, A F Hoo, K L Costeloe, A M Wade
Journal: American Journal of Respiratory and Critical Care Medicine (1994)

During recent years there has been increasing interest in the measurement of tidal breathing parameters, such as the time to reach peak tidal expiratory flow as a proportion of total expiratory time (TPTEF:TE), and their application to population-based studies of the determinants of early respiratory morbidity. However, little is known about factors influencing the within and between-subject variability of these parameters. This study examines the influence of sedation on TPTEF:TE, estimates the optimal number of breaths and breath epochs required to measure TPTEF:TE, and assesses short-term repeatability of this parameter during the first year of life, taking account of age-related differences. Measurements were made in 266 healthy infants and young children (1 d to 19 mo old). Mean (SD) TPTEF:TE fell from 0.49 (0.11) in the first 2 wk of life to 0.34 (0.09) by 5 to 8 wk, remaining similar thereafter. Sedation with triclofos sodium (75 mg/kg) had no significant effect on TPTEF:TE, which was 0.33 (0.10) in 23 unsedated 6-wk-old infants and 0.32 (0.08) in 49 sedated infants of similar age and weight (95% CI for the difference: -0.05, 0.04). At least 10 breaths in each of two separate epochs from each infant were required to provide a representative estimate of TPTEF:TE. The mean (SD) difference between repeat measurements made 5 to 108 min apart was 0.02 (0.08) in 34 infants younger than 6 wk of age (95% limits of agreement: -0.15, 0.18) and -0.01 (0.04) (95% limits of agreement -0.09, 0.08) in 30 infants 6 wk and older.(ABSTRACT TRUNCATED AT 250 WORDS)
337. Adenoviral Delivery of the RheoSwitch® Therapeutic System to Mouse Brain and Liver
Authors: David W. Potter, Marti A. DiPietro, Jessica L. Seitzer, Anand Katakam, Prasanna Kumar
Journal: Molecular Therapy (2006)

The RheoSwitch® Therapeutic System (RTS) is used to regulate gene expression in response to a systemically administered small molecule ligand, or Activator Drug, and may have utility in human gene therapies that require a specifically regulated level of gene expression, as well as in situations where it is desirable to terminate the therapy either when it is no longer needed, or where continuation of the therapy would be unsafe. The version of RTS used in these studies is comprised of an ecdysone receptor (EcR) fused to a GAL4 DNA binding domain, a chimeric of retinoid X receptor fused to a VP16 activation domain (pVP16-Hs-LmRXR), a reporter gene (such as GFP) placed under the control of a 6xGAL4 response element, and a minimal promoter (p6xGAL4-TATA-SEAP), was constructed into Adenovirus (Ad). The Ad-RTS-GFP has been used to evaluate ligand dependent transgene expression in tissues. Following intravenous injection or direct intracerebral injection of Ad-RTS-GFP in the brain, GFP expression was shown to be dependent on systemic administration of ligand. While ligand had been previously shown to partition efficiently to various organs in the thoracic cavity and leg muscles, its ability to cross the blood brain barrier was an important issue for gene or cell therapies targeted to the brain. In the present studies, mice were given a single intracerebral injection of 108-109 infectious virus particles and GFP expression was induced with an intraperitoneal (IP) injection of Activator Drug A (100 mg/ kg) 2-3 days after viral injection. Brain tissue was removed 3 days after ligand administration and cryostat sections were prepared for assessment of GFP expression. A strong fluorescence signal was observed throughout the brain in mice receiving ligand and infected cells were primarily in the ventricle, midline and outer regions of the brain. In other studies, ligand-dependent GFP expression in brain was observed following administration of ligand by either intramuscular or oral routes. These studies demonstrate that Activator Drug crosses the blood brain barrier and that the RTS system is active in both liver and brain when delivered using an Adenoviral vector.