tbuckley/cabot-search huggingface dataset:
Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed
Authors: Dhiraj Tripathi, James W. Ferguson, Narendra Kochar, Joanna A. Leithead, George Therapondos, Norma C. Mcavoy, Adrian J. Stanley, Ewan H. Forrest, William S. Hislop, Peter R. Mills, Peter C. Hayes
Journal: Hepatology (2009)

Current therapy for preventing the first variceal bleed includes beta-blocker and variceal band ligation (VBL). VBL has lower bleeding rates, with no differences in survival, whereas beta-blocker therapy can be limited by side effects. Carvedilol, a non-cardioselective vasodilating beta-blocker, is more effective in reducing portal pressure than propranolol; however, there have been no clinical studies assessing the efficacy of carvedilol in primary prophylaxis. The goal of this study was to compare carvedilol and VBL for the prevention of the first variceal bleed in a randomized controlled multicenter trial. One hundred fifty-two cirrhotic patients from five different centers with grade II or larger esophageal varices were randomized to either carvedilol 12.5 mg once daily or VBL performed every 2 weeks until eradication using a multibander device. Seventy-seven patients were randomized to carvedilol and 75 to VBL. Baseline characteristics did not differ between the groups (alcoholic liver disease, 73%; median Child-Pugh score, 8; median age, 54 years; median follow-up, 20 months). On intention-to-treat analysis, carvedilol had lower rates of the first variceal bleed (10% versus 23%; relative hazard 0.41; 95% confidence interval 0.19-0.96 [P = 0.04]), with no significant differences in overall mortality (35% versus 37%, P = 0.71), and bleeding-related mortality (3% versus 1%, P = 0.26). Six patients in the VBL group bled as a result of banding ulcers. Per-protocol analysis revealed no significant differences in the outcomes.Carvedilol is effective in preventing the first variceal bleed. Carvedilol is an option for primary prophylaxis in patients with high-risk esophageal varices.
The Analgesic Properties of Numorphan (14-Hydroxy Dihydromorphinone)
Authors: Alexander Coblentz, Howard R. Bierman
Journal: New England Journal of Medicine (1956)

SINCE the discovery of morphine a ceaseless effort has been made to improve its somnifacient and analgesic effects, and at the same time to decrease the undesirable reactions. In the past fifty years many drugs with morphinelike activity have resulted from these efforts. Some of these drugs resemble morphine and are modifications of the naturally occurring alkaloids; others are produced synthetically. Numorphan (14-hydroxy dihydromorphinone hydrochloride),§ a synthetic derivative of the alkaloid morphine (Fig. 1), differs from Dilaudid by the addition of a hydroxyl group at the fourteenth position — a change that is purported to increase its analgesic properties.1 It . . .
An itchy ear that became painful
Authors: D. Mistry, H. Atkinson
Journal: BMJ (2009)

A 23 year old medical student presented with a four week history of an itchy ear that became painful. The patient reported associated hearing loss, and there was scanty offensive smelling otorrhoea. On examination the pinna was red, warm, and mildly tender (fig⇓). The external auditory canal lumen was narrowed owing to oedema and inflammation. As a result, the ear drum could not be seen. ### Short answers
Case of multiple myeloma mimicking an infectious disease with fever, intrahepatic cholestasis, renal failure, and pulmonary insufficiency
Authors: Francesco S. Vella, Barbara Simone, Gianluigi Giannelli, MariaTeresa Pesolo, Giuseppe Ingravallo, Antonia Gentile, Salvatore Antonaci
Journal: American Journal of Hematology (2002)

Abstract We describe a case of multiple myeloma (MM) presenting with high fever, inflammatory chemistry abnormalities, simultaneous acute renal failure, cholestatic hepatitis, and acute lung failure. The extremely aggressive course and pulmonary involvement in the form of pulmonary alveolar proteinosis (PAP) are discussed, stressing the unusual nature of the findings and the variable picture of MM. Am. J. Hematol. 72:38–42, 2003. © 2002 Wiley‐Liss, Inc.
Caffeine and Benign Breast Disease
Authors: Michael F. Jacobson
Journal: JAMA (1986)

<h3>To the Editor.—</h3> The recent study on caffeine and benign breast disease (BBD) requires further comment. Lubin et al<sup>1</sup>conclude that "our findings suggest that there is no association between coffee consumption and BBD." They also state that their results are consistent with two earlier reports by Lawson et al<sup>2</sup>and Marshall et al<sup>3</sup>and refer to their own article and the latter two as "all case-control studies." The authors note, however, that several clinical studies have found an improvement in BBD in women who restrict their intake of methylxanthines. Lubin et al neglected to cite a previous case-control study involving 634 women with fibrocystic disease and 1,066 controls. Boyle et al<sup>4</sup>found a 1.5-fold increase in the risk of BBD for women consuming 31 mg to 250 mg of caffeine per day, and a 2.3-fold risk for women drinking over 500 mg a day. Notably,
Ectopic Expression of Cancer–Testis Antigens in Cutaneous T-cell Lymphoma Patients
Authors: Ivan V. Litvinov, Brendan Cordeiro, Yuanshen Huang, Hanieh Zargham, Kevin Pehr, Marc-André Doré, Martin Gilbert, Youwen Zhou, Thomas S. Kupper, Denis Sasseville
Journal: Clinical Cancer Research (2014)

Abstract Purpose: The pathogenesis of cutaneous T-cell lymphoma (CTCL) remains only partially understood. A number of recent studies attempted to identify novel diagnostic markers and future therapeutic targets. One group of antigens, cancer–testis (CT) antigens, normally present solely in testicular germ cells, can be ectopically expressed in a variety of cancers. Currently, only a few studies attempted to investigate the expression of CT antigens in CTCL. Experimental Design: In the present work, we test the expression of CT genes in a cohort of patients with CTCL, normal skin samples, skin from benign inflammatory dermatoses, and in patient-derived CTCL cells. We correlate such expression with the p53 status and explore molecular mechanisms behind their ectopic expression in these cells. Results: Our findings demonstrate that SYCP1, SYCP3, REC8, SPO11, and GTSF1 genes are heterogeneously expressed in patients with CTCL and patient-derived cell lines, whereas cTAGE1 (cutaneous T-cell lymphoma-associated antigen 1) was found to be robustly expressed in both. Mutated p53 status did not appear to be a requirement for the ectopic expression of CT antigens. While T-cell stimulation resulted in a significant upregulation of STAT3 and JUNB expression, it did not significantly alter the expression of CT antigens. Treatment of CTCL cells in vitro with vorinostat or romidepsin histone deacetylase inhibitors resulted in a significant dose-dependent upregulation of mRNA but not protein. Further expression analysis demonstrated that SYCP1, cTAGE1, and GTSF1 were expressed in CTCL, but not in normal skin or benign inflammatory dermatoses. Conclusions: A number of CT genes are ectopically expressed in patients with CTCL and can be used as biomarkers or novel targets for immunotherapy. Clin Cancer Res; 20(14); 3799–808. ©2014 AACR.
Aortic Dysplasia in Infancy Simulating Anomalous Origin of the Left Coronary Artery
Authors: ALBERT C. PRICE, DIXON A. LEE, KATHLEEN E. KAGAN, WILLIAM P. BAKER
Journal: Circulation (1973)

A case is reported of an infant believed to have had anomalous origin of the left coronary artery. Clinical evaluation and angiography appeared to support the diagnosis. At necropsy, however, the left coronary was seen to arise from the aorta but was totally occluded by dysplastic changes which resulted in myocardial infarction and death of the patient. There was minimal aortic deformity produced by these changes, and no aortic gradient was present. Thus, this very rare case of minimal supravalvular aortic stenosis with left coronary artery occlusion was not recognizable clinically nor angiographically.
Biomedical Ethics: A Multidisciplinary Approach to Moral Issues in Medicine and Biology
Authors: Stephen Workman
Journal: JAMA (2008)

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 Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More 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) 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
Cardiovascular Therapy: A Systematic Approach, vol 1: Circulation
Authors: Irwin R. Callen
Journal: JAMA (1980)

This is the first of a new set of volumes devoted to cardiovascular therapy. It is a relatively large and ambitious undertaking with excellent readable type. The text is profusely illustrated with line drawings on almost every page, and the writing is readable and understandable. Three general topics are discussed. Section 1, on blood pressure, covers hypertension and includes critical and secondary hypertension and hypotension. Section 2, on the arterial system, includes aortic diseases, coronary and cerebral artery diseases, and disorders of the upper and lower extremities. Also included here are diseases of the mesenteric, renal, and genital arterial systems. Section 3 on the venous system covers thrombophlebitis, pulmonary embolism, and venous insufficiency. Four appendices include the treatment protocol for anaphylaxis, suggested standing admission orders for acute myocardial infarction, aspirin-containing compounds, and drug dosages by body weight. The index is extensive, and the references are up to date as far
A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy
Authors: N. Uedo, R. Ishihara, H. Iishi, S. Yamamoto, S. Yamamoto, T. Yamada, K. Imanaka, Y. Takeuchi, K. Higashino, S. Ishiguro, M. Tatsuta
Journal: Endoscopy (2006)

With endoscopy, there is a high rate of interobserver variability in the identification of gastric intestinal metaplasia, and the endoscopic findings correlate poorly with the histological findings. Previous studies by our group investigating the use of a narrow-band imaging system with magnifying endoscopy (NBI-ME) in the gastric mucosa suggested that the appearance of a light blue crest (LBC) on the epithelial surface may be a distinctive endoscopic finding associated with the presence of intestinal metaplasia. The aim of the present study was to clarify the value of NBI-ME for diagnosing gastric intestinal metaplasia.The LBC was defined as a fine, blue-white line on the crests of the epithelial surface/gyri. To investigate the histology underlying the appearance of LBC, 44 biopsy specimens were obtained from regions containing LBC and 44 from non-LBC mucosa in 34 patients with atrophic gastritis. Three endoscopists then carried out NBI-ME in 107 consecutive patients to validate the diagnostic accuracy of the novel endoscopic technique. The degree of correlation between the LBC grading and the histological parameters of intestinal metaplasia was then assessed.The LBC grading correlated with cells that were positive for CD10 ( P = 0.0001) and Alcian blue ( P = 0.036). The appearance of LBC correlated with histological evidence of intestinal metaplasia with a sensitivity of 89 % (95 % CI, 83 - 96 %), a specificity of 93 % (95 % CI, 88 - 97 %), a positive predictive value of 91 % (95 % CI, 85 - 96 %), a negative predictive value of 92 % (95 % CI, 87 - 97 %), and an accuracy of 91 % (95 % CI, 88 - 95 %).In narrow-band imaging with magnifying endoscopy, observation of a light blue crest on the epithelial surface in the gastric mucosa is a highly accurate sign of the presence of histological intestinal metaplasia.
Pressure and frequency dependent linkage between motility and epithelial secretion in human proximal small intestine
Authors: A Mellander
Journal: Gut (2000)

<h3>BACKGROUND</h3> Motor disturbances are sometimes associated with diarrhoea by unknown mechanisms. <h3>AIM</h3> To determine if there is a quantitative link between intestinal motility and epithelial secretion. <h3>SUBJECTS</h3> Experiments were performed in 21 healthy volunteers and three patients with villus atrophy. <h3>METHODS</h3> Duodenal and jejunal motor activities were registered in the fasted state by open tip manometry. Secretion was measured directly by marker perfusion and indirectly by recording transmural potential difference (PD). <h3>RESULTS</h3> A significant correlation was found between “low pass filtered” pressure and PD, but no correlation was found between amplitudes of isolated contractions and PD changes. During repeated phasic contractions (phase III of migrating motor complex), PD increased at a rate that was higher in the duodenum than in the jejunum, and higher in patients with villus atrophy than in healthy controls. After reaching a peak, PD decreased despite continuing phasic motor activity, provided that there was no concomitant increase in mean pressure. Fluid secretion increased roughly in parallel with PD, except at the very end of the cycle. <h3>CONCLUSIONS</h3> To explain these findings, one has to postulate participation of at least two types of receptor: a slowly adapting pressure sensitive receptor and another mechanoreceptor, possibly a mucosal touch receptor, to account for the run down phenomenon. This model predicts that short lasting trains of contractions, so called discrete clusters, will be a particularly potent stimulus for activation of mucosal secretion.
Accuracy of quantitative magnetic resonance imaging in the detection of ex vivo focal cartilage defects
Authors: H Graichen
Journal: Annals of the Rheumatic Diseases (2005)

<b>Background:</b> No established, non-invasive diagnostic procedure for quantifying focal cartilage defects is currently available. <b>Objective:</b> To test the accuracy of quantitative magnetic resonance imaging (qMRI) for reliable determination of cartilage defect size in various compartments of the human knee. <b>Methods:</b> 24 tibial and patellar cartilage plates were harvested during knee arthroplasty. 74 cylindrical defects with diameters of 3, 5, and 8 mm were created with a punch. In 15 specimens (51 defects), the cartilage cylinders (inside the punch) were removed (approach 1), while in 9 specimens (23 defects) the surrounding tissue was removed mechanically and the cartilage cylinder was left in place (approach 2). All plates were imaged with a T<sub>1</sub> weighted water excitation gradient echo sequence at a resolution of 1.5 mm×0.31 mm×0.31 mm. The defect size was computed from the image data after interactive segmentation and compared with the known dimensions of the cylinders. <b>Results:</b> Although there was a significant overestimation of the defect size by qMRI in 3 mm defects (mean (SD) +1.3 (0.58) mm = ±42%; p&lt;0.001), the overestimation was only +1.0 (0.57) mm (±21%; p&lt;0.05) in 5 mm defects and +0.1 (0.39) mm (±4%; p = 0.31) in 8 mm defects (approach 1). Values were similar for approaches 1 and 2 and for patellar and tibial cartilage plates. <b>Conclusions:</b> These findings show that qMRI allows accurate quantification of focal cartilage defects. It may therefore represent a valuable tool in the diagnosis of traumatic cartilage lesions, osteochondrosis dissecans, and osteochondral fractures, and in monitoring their responsiveness to surgical or other treatments.
Deaths from cervical cancer began falling before screening programmes were established
Authors: A E Raffle
Journal: BMJ (1997)

Editor—The contrasting viewpoints in the letters from C Mary Anderson and Amanda Herbert illustrate the dilemma of cervical screening1 2: abnormal results are common, but the disease we are trying to prevent was rare before screening.3 Do the high rates of detection exist because we are averting a new epidemic of 7000 cases,2 or even 7000 deaths,4 each year in England? Or do the vast majority of lesions represent an early and reversible stage in the pathogenesis of cancer?

Screening has been available in Britain since the mid-1960s, but it was not until call and recall programmes were widely …
Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women
Authors: Paul M Ridker, Julie E. Buring, Nader Rifai, Nancy R. Cook
Journal: JAMA (2007)

Despite improved understanding of atherothrombosis, cardiovascular prediction algorithms for women have largely relied on traditional risk factors.To develop and validate cardiovascular risk algorithms for women based on a large panel of traditional and novel risk factors.Thirty-five factors were assessed among 24 558 initially healthy US women 45 years or older who were followed up for a median of 10.2 years (through March 2004) for incident cardiovascular events (an adjudicated composite of myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death). We used data among a random two thirds (derivation cohort, n = 16 400) to develop new risk algorithms that were then tested to compare observed and predicted outcomes in the remaining one third of women (validation cohort, n = 8158).Minimization of the Bayes Information Criterion was used in the derivation cohort to develop the best-fitting parsimonious prediction models. In the validation cohort, we compared predicted vs actual 10-year cardiovascular event rates when the new algorithms were compared with models based on covariates included in the Adult Treatment Panel III risk score.In the derivation cohort, a best-fitting model (model A) and a clinically simplified model (model B, the Reynolds Risk Score) had lower Bayes Information Criterion scores than models based on covariates used in Adult Treatment Panel III. In the validation cohort, all measures of fit, discrimination, and calibration were improved when either model A or B was used. For example, among participants without diabetes with estimated 10-year risks according to the Adult Treatment Panel III of 5% to less than 10% (n = 603) or 10% to less than 20% (n = 156), model A reclassified 379 (50%) into higher- or lower-risk categories that in each instance more accurately matched actual event rates. Similar effects were achieved for clinically simplified model B limited to age, systolic blood pressure, hemoglobin A(1c) if diabetic, smoking, total and high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and parental history of myocardial infarction before age 60 years. Neither new algorithm provided substantive information about women at very low risk based on the published Adult Treatment Panel III score.We developed, validated, and demonstrated highly improved accuracy of 2 clinical algorithms for global cardiovascular risk prediction that reclassified 40% to 50% of women at intermediate risk into higher- or lower-risk categories.
QUANTITATIVE STUDIES ON THE MIXED LYMPHOCYTE INTERACTION IN RATS
Authors: Darcy B. Wilson
Journal: The Journal of Experimental Medicine (1967)

Some of the conditions and parameters of the proliferative response in the mixed lymphocyte interaction have been studied with the use of culture inocula consisting of lymphoid cells from various immunogenetically diverse, isogenic strains of rats. Procedures are described by which consistent culture responses can be obtained which are measurable in terms of incorporation of radioactive thymidine into a trichloroacetic acid precipitable cell fraction. Results of experiments with this "mixed lymphocyte interaction" show that (a) Incorporation of thymidine into the mixed cultures is detectable only during and after the 4th day of incubation. Use of culture inocula derived from the thoracic duct or partially purified suspensions of lymphocytes from the peripheral blood provides further evidence that it is the small lymphocyte which synthesizes DNA in these cultures. The addition of peritoneal exudate cells, presumably containing some macrophages, to the mixed lymphocyte cultures does not alter the kinetics of the response. (b) Proliferative responses occur in mixed cultures of cells only when the donors differ by alleles at the important Ag-B histocompatibility locus. (c) Proliferative reactivity in mixed cultures of lymphocytes from parental and hybrid donors is unidirectional. With the use of chromosomally marked cells from donors of different sexes, it was established that only parental lymphocytes are dividing in mixed cultures of parental and hybrid cells. The results of these experiments strongly support the premise that the proliferative response in mixed cultures of lymphocytes represents a de novo immunologic reaction on the cellular level against histocompatibility antigens.
Women in the Middle Years: Current Knowledge and Directions for Research and Policy
Authors: Virginia Olesen
Journal: JAMA (1983)

As America becomes older, with the majority of its citizens in the category of the "later mature" or elderly, works that inform the health professional about the lives of persons in these categories are increasingly useful. This volume, which presents five essays and an appendix, grew out of a seminar sponsored by the Social Science Research Council, an indication of the growing importance of understanding women's lives and an aging population. The essays treat some of the unknown questions about the lives of adult women, their health, adult development and women's development, work and family roles, women in the German Democratic Republic, and, finally, research and policy questions. Each of the chapters presents a rather broad overview of the topic addressed and each contains useful references. Also commendable is the appendix, which outlines longitudinal and cross-sectional data sources on women in the middle years. Happily, the volume also contains an