tbuckley/cabot-search huggingface dataset:
Analysis and modelling of cholesterol and high-density lipoprotein cholesterol changes across the range of C-reactive protein levels in clinical practice as an aid to better understanding of inflammation–lipid interactions
Authors: Hanna Johnsson, Maurizio Panarelli, Allan Cameron, Naveed Sattar
Journal: Annals of the Rheumatic Diseases (2013)

Raised total cholesterol (TC) and reduced high-density lipoprotein (HDL) cholesterol levels are established cardiovascular disease (CVD) risk factors. However, in autoimmune conditions the lipid-CVD association appears paradoxical, with inflammation as a potential confounding factor. We therefore sought to model the relationship between systemic inflammatory illness and lipid levels using C-reactive protein (CRP) as the prototypical marker of inflammation. Our hypothesis was that there would be an inverse association between raised CRP levels and both TC and HDL-cholesterol levels.Results from samples analysed simultaneously for CRP and lipids in a 6-month period were collected retrospectively from a large city hospital laboratory database that collates results from both primary and secondary care. The relationships between CRP and lipids were determined using graphical techniques and empirical, non-parametric, best fit models.A total of 11 437 blood samples was included. We identified a significant (p<0.001) biphasic relationship between TC and CRP: TC increased within the healthy CRP range of less than 5 mg/l, but decreased with CRP levels above 10 mg/l. The two effects approximately cancelled each other out in the intermediate CRP range of 5-10 mg/l. There was an inverse relationship between HDL-cholesterol and CRP.Lipid levels change significantly during inflammatory illness in a population with both acute and chronic conditions. These results provide a strong epidemiological basis for the better understanding of lipid changes in inflammatory conditions and with anti-inflammatory therapies.
Value of physical signs in the diagnosis of ventricular tachycardia.
Authors: C J Garratt, M J Griffith, G Young, N Curzen, S Brecker, A F Rickards, A J Camm
Journal: Circulation (1994)

Although the use of physical signs for the diagnosis of ventricular tachycardia (VT) was described in the early 1900s, their value in this role has never been systematically assessed.Using a blinded, randomized protocol, we examined the ability of 26 clinicians to detect ventriculoatrial (VA) dissociation during cardiac pacing in 21 patients with both atrial and ventricular pacing wires in situ after successful ablation of accessory pathways. In protocol 1 (10 patients), pacing was randomized to either ventricular pacing alone (simulating VT) or to atrioventricular sequential pacing (simulating supraventricular tachycardia or VT with intact VA conduction) at rates of 150 or 180 beats per minute. Each patients was examined by four clinicians blinded to the pacing mode. Clinicians were asked to make a diagnosis of "VA association" or "VA dissociation" after examining the patient for variability of the arterial pulse, jugular venous pulse (JVP), and first heart sound. In protocol 2 (11 patients), randomization of pacing mode was performed between examination of each of the three physical signs so that the value of each sign was assessed individually. In protocol 1, a diagnosis of VA dissociation (VT) was made in 21 of 40 observations, with a specificity of 75%, sensitivity of 70%, and a positive predictive value (PPV) of 71%. In protocol 2, from a total of 132 observations (44 for each sign), the sensitivity, specificity, and PPV for a diagnosis of VT were as follows: arterial pulse, 61%, 71%, 70%; JVP, 96%, 75%, 82%; and first heart sound, 58%, 100%, 100%.It is concluded that, in patients with a regular tachycardia of uncertain origin, clinically detectable variations in the first heart sound and JVP are highly specific and sensitive indicators, respectively, of a diagnosis of VT. Assessment of the arterial pulse is of little value in this role.
The prognostic value of neurologic function in astrocytic spinal cord glioma
Authors: Hoon K. Lee, Eric L. Chang, Gregory N. Fuller, Kenneth D. Aldape, George J. Atkinson, Lawrence B. Levy, Ian E. McCutcheon, Moshe H. Maor
Journal: Neuro-Oncology (2003)

To assess the prognostic value of neurologic function (NF) in patients with astrocytic spinal cord glioma, we conducted a retrospective study of 25 patients who were treated at our institution between January 1970 and December 1999. The median age was 40 years, and the median follow-up was 54 months. Nineteen patients had a biopsy, 5 had a subtotal resection, and 1 had a gross total resection. Twenty-two patients received postoperative radiotherapy to a median dose of 45 Gy. NF ratings of 1 and 2 were considered favorable, and 3 and 4 were considered unfavorable, based on a scale of 1 to 4. Dual neuropathologic review confirmed the tumor to be low, intermediate, or high grade, based on the WHO grades I-II, III, or IV, respectively. Actuarial rates of local control (LC), progression-free survival (PFS), and overall survival (OS) were analyzed. Our study results revealed that an improved 5-year OS rate was associated with favorable NF at diagnosis (73% vs. 22% for patients with unfavorable NF; P = 0.04) and favorable NF before radiation therapy (89% vs. 28% for patients with unfavorable NF; P = 0.049). There was a significant difference in OS based on tumor grade ( P < 0.001) and age (risk ratio, 1.04; P = 0.027). PFS and LC were significantly better for young patients and those with lower tumor grade ( P < 0.05). A multivariate analysis of age, NF at diagnosis, and postoperative NF for all patients showed postoperative NF and age to be independent prognostic factors for OS. We conclude that favorable NF may be associated with improved outcome in patients with astrocytic spinal cord glioma.
Long-Term Treatment of the Syndrome of Inappropriate Antidiuretic Hormone Secretion with Phenytoin
Authors: AMIR TANAY
Journal: Annals of Internal Medicine (1979)

A 68-year-old patient with the syndrome of inappropriate antidiuretic hormone secretion secondary to basilary skull fracture was treated successfully with demeclocycline and phenytoin. Phenytoin, which was considered in the past only as a useful diagnostic tool, was given to the patient on a long-term basis. The drug reversed the patient's symptoms and abnormal laboratory values to normal limits without adverse reactions during a treatment period of 8 months.
<i>In Vivo</i> Lipid Peroxidation and Platelet Activation in Cystic Fibrosis
Authors: GIOVANNI CIABATTONI, GIOVANNI DAVÌ, MIRELLA COLLURA, LUCIANA IAPICHINO, FRANCESCA PARDO, ANTONINA GANCI, ROSSANA ROMAGNOLI, JACQUES MACLOUF, CARLO PATRONO
Journal: American Journal of Respiratory and Critical Care Medicine (2000)

F2-isoprostanes are bioactive peroxidation products of arachidonic acid whose urinary excretion provides an index of lipid peroxidation in vivo. We tested the hypothesis that formation of F2-isoprostanes is altered in patients with cystic fibrosis and contributes to platelet activation and pulmonary dysfunction in this set-ting. The urinary excretion of immunoreactive 8-iso-prostaglandin F2 α (PGF2 α) was significantly (p = 0.0001) higher in 36 patients with cystic fibrosis than in 36 age-matched healthy subjects: 618 ± 406 versus 168 ± 48 pg/mg creatinine. The urinary excretion of immunoreactive 11-dehydro-thromboxane B2 (TXB2), an index of in vivo platelet activation, was also significantly (p = 0.0001) higher in patients than in control subjects: 2,440 ± 1,453 versus 325 ± 184 pg/mg creatinine. The excretion rate of 8-iso-PGF2 α was correlated with that of 11-dehydro-TXB2 (rho = 0.51; p = 0.0026) and inversely related to FEV1 (rho = − 0.40; p = 0.0195). Urinary 8-iso-PGF2 α excretion was largely unaffected during cyclooxygenase inhibition with low-dose aspirin, nimesulide, or ibuprofen, consistent with a noncyclooxygenase mechanism of F2-isoprostane formation in cystic fibrosis. Increased vitamin E supplementation (from 200 to 600 mg/d) was associated with statistically significant (p = 0.005) reductions in urinary 8-iso-PGF2 α and 11-dehydro-TXB2 excretion, by 42% and 29%, respectively. We conclude that enhanced lipid peroxidation is an important feature of cystic fibrosis and may contribute to persistent platelet activation and pulmonary dysfunction via generation of bioactive isoeicosanoids. Our results provide a rationale for reassessing the adequacy of vitamin E supplementation in this setting.
Lesson of the week: long term sequelae of missed tendon injuries at the ankle
Authors: N S Thompson, S A Henderson
Journal: BMJ (1997)

Lacerations of the hand and wrist may affect underlying tendons.1 Although lacerations of the ankle are uncommon, injury to underlying structures is still possible. We report on four patients who presented an average of 23 years after injury to the ankle with the consequences of undetected tendon injuries.

Case 1 —A 43 year old man presented with a painful left flat foot. At 6 years of age he had sustained a laceration with glass below his left medial malleolus. At the time his family did not seek medical attention. Subsequently the inside sole of his left shoe was seen to be wearing out. At 13 years of age he was referred to an orthopaedic clinic and underwent an unsuccessful tendon repair. Inspection showed a 1 cm transverse laceration below his medial malleolus and a fixed pes planus deformity. His hindfoot was in 10° of fixed valgus (figure) and the ankle in 5° of fixed equinus. The patient's ankle-hindfoot and midfoot scores were 22 and 16 respectively with the scoring system of the American Orthopedic Foot and Ankle Society for grading the functional status of the foot and ankle. The maximum score is 100 and lower scores reflect increasing severity of symptoms and disability.2 An x ray film showed degenerative changes of the ankle and hindfoot joints, and ultrasonography of the ankle showed a discontinuity of the tibialis posterior tendon.

Case 2 —A 35 year old woman …
Anatomical mapping of Merkel cells in normal human adult epidermis
Authors: J.P. LACOUR, D. DUBOIS, A. PISANI, J.P. ORTONNE
Journal: British Journal of Dermatology (1991)

The distribution of Merkel cells (MCs) in normal human skin and mucosa was studied using the mouse monoclonal antibody Troma-1, reacting specifically with component 8 of the Moll cytokeratin catalogue. The specificity of this antibody for MCs in human skin was assessed by double indirect immunofluorescence (IIF) and immunoelectron microscopy. Two-hundred and thirty 6-mm punch biopsies were obtained from 44 different sites from six human cadavers within 48 h post-mortem. IIF was performed with Troma-1 on EDTA-split epithelial sheets and the MCs were counted and the mean values per mm2 calculated for each site. Regions with greater than 50 MC/mm2 were the lips, hard palate, palms, finger pads, proximal nail fold, and dorsum of the feet. Three different patterns were observed in the epidermis or mucosa: MCs grouped in clumps, linear and arciform arrangements, and scattered MCs. In the hair follicles grouped MCs were observed in the bulb and scattered MCs were seen in the outer root sheath.
Binding of immunoglobulin G aggregates and immune complexes in human sera to Staphylococci containing protein A.
Authors: J S McDougal, P B Redecha, R D Inman, C L Christian
Journal: Journal of Clinical Investigation (1979)

Using the Cowan I strain of Staphylococcus aureus, we compared the binding properties of human monomeric immunoglobulin (Ig)G and oligomeric or complexed IgG. Heat-aggregated IgG served as a model for complexed IgG and heat-killed, formalin-fixed S. aureus (StaphA) as a cellular receptor for IgG, in determining the parameters for oligomeric and monomeric binding. Because of its capacity for multipoint attachment, complexed IgG binding was favored over monomeric IgG binding, and this preferential binding was demonstrated kinetically in equivalent forward rates of binding but in a much slower rate of release from StaphA receptors. From binding studies, we determined which conditions maximize complexes IgG binding and minimized monomeric IgG binding and applied them to the development of an assay for aggregated IgG and immune complexes in human sera. The StaphA binding assay that was devised is quantitative, sensitive, and not complement dependent. It is relatively unaffected by factors such as heparin, complement fixation, native antibodies, and immunoglobulin concentrations, but is affected by the presence of rheumatoid factors. It compares favorably with two other complement-dependent assays of immune complexes, the 125I-Clq binding assay and the Raji cell assay, in terms of sensitivity and the size of immune complexes detected. Studies on the potential of the assay for detecting, isolating, and characterizing immune complexes in biological fluids are presented.
Phasic Vagal Influence on the Rate and Timing of Reflex Swallowing
Authors: Fumiko Yamamoto, Takashi Nishino
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

We investigated the effects of sudden changes in ventilation induced by voluntary hyperpnea and breath-holding on repetitive reflex swallowing elicited by continuous infusion of distilled water into the pharynx in 13 healthy subjects. Ventilation was monitored using a pneumotachograph, and swallowing was identified by submental electromyography with interruption of airflow. We found that voluntary hyperpnea decreased the swallowing frequency whether end-tidal CO2 tension was maintained at normocapnia or allowed to be hypocapnic. Also, the frequency of swallowing immediately increased with the start of breath-holding, but there was a sudden decrease in swallowing frequency during the hyperpnea observed immediately after the resumption of ventilation (post–breath-holding hyperpnea). The preponderant coupling of swallows with the expiratory phase was lost during voluntary hyperpnea but was maintained during post–breath-holding hyperpnea. These observations may suggest that vagally mediated reflexes are operative in normal physiologic situations and play an important role in the control of swallowing rate as well as in the timing of swallowing in reference to the respiratory cycle.
Pseudoinsulinoma Syndrome from Inadvertent Tolazamide Ingestion
Authors: DAVID A. AHLQUIST
Journal: Annals of Internal Medicine (1980)

A 70-year-old woman with rheumatoid arthritis presented with fasting hypoglycemia, inappropriately elevated insulin and C-peptide levels, and negative insulin antibodies, all compatible with the diagnosis of an insulinoma. However, results of a 72-hour fast were subsequently negative. Medication identification revealed that the patient had been taking tolazamide (Tolinase; The Upjohn Company, Kalamazoo, Michigan) instead of tolmetin (Tolectin; McNeil Laboratories, Inc., Fort Washington, Pennsylvania).
Candida paropsilosis Endophthalmitis
Authors: JOHN W. SIXBEY
Journal: Annals of Internal Medicine (1978)

Letters and Corrections1 December 1978Candida paropsilosis EndophthalmitisJOHN W. SIXBEY, M.D., ELLIS S. CAPLAN, M.D.JOHN W. SIXBEY, M.D.Search for more papers by this author, ELLIS S. CAPLAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-89-6-1010_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In their review of the manifestations of disseminated candidiasis, Edwards and colleagues (1) noted that Candida albicans has a greater propensity for ocular involvement than non-albicans species of Candida. Using a rabbit model of hematogenous candidal endophthalmitis, Edwards and associates were unable to infect either vitreous or chorioretina with Candida paropsilosis and Candida krusei with the inoculum size used (2). We wish to report a case of hematogenous candidal endophthalmitis due to C. paropsilosis.A previously healthy 62-year-old man admitted for a subarachnoid hemorrhage underwent a craniotomy on 28 July 1977 for a posterior communicating artery aneurysm....References1. EDWARDSLEHRERSTIEHMFISCHERYOUNG JRETL: Severe candidal infections. Clinical perspective, immune defense mechanisms, and current concepts of therapy. Ann Intern Med 89:91-106, 1978 LinkGoogle Scholar2. EDWARDSMONTGOMERIEISHIDAMORRISONGUZE JJKJL: Experimental hematogenous endophthalmitis due to Candida: species variation in ocular pathogenicity. J Infect Dis 135:294-297, 1977 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of Maryland School of Medicine Baltimore, MD 21201 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byFungal Infections in the Compromised HostCandidal Suppurative Peripheral Thrombophlebitis Recognition, Prevention, and ManagementEpidemic Postsurgical Candida Parapsilosis EndophthalmitisHospital-acquired fungemia 1 December 1978Volume 89, Issue 6Page: 1010-1011KeywordsAneurysmsArteriesCandidaCandida albicansCandidiasisRabbitsSubarachnoid hemorrhage Issue Published: 1 December 1978 PDF downloadLoading ...
All the world's knowledge
Authors: Wendy Moore
Journal: BMJ (2011)

Years spent buried in medical textbooks have taught doctors the value of libraries. Yet few appreciate that the Western medical tradition owes its survival entirely to history’s greatest ever library—the Bayt al-Hikma.

The fall of the Roman empire was not just bad news for decent roads and central heating. The principles of scientific inquiry and learning in medicine, championed by Hippocrates and Galen, were similarly enveloped in the dark ages. It took an enlightened Islamic empire to dispel the gloom.

The Bayt al-Hikma, or House of Wisdom, was founded in Baghdad, the capital of the Islamic empire, in 832, under …
Septic Bursitis in the Prepatellar and Olecranon Bursae
Authors: GEORGE HO
Journal: Annals of Internal Medicine (1978)

Five cases of septic prepatellar and 20 cases of septic olecranon bursitis are reported. All were men, with a mean age of 47 years. Seventeen had a history of recent trauma to the affected limb or sustained pressure on knees or elbows, or both, required by certain occupations. Septic bursitis was not associated with septic arthritis and could be easily distinguished from it by the characteristic bursal swelling and joint examination. Septic bursitis was misdiagnosed as nonseptic bursitis in eight cases despite characterstic bursal fluid leukocytosis (greater than 1000 cells/mm3) and recovery of bacteria on culture. Staphylococcus aureus was identified in 22 cases; 76% were resistant to penicillin. Intravenous antibiotics and bursal fluid drainage were uniformly succesful. Oral antibiotic ttherapy was also successful unless the infection was extensive or there was underlying bursal disease. Early recognition, prompt therapy, and preventive measures are necessary to reduce the morbidity of septic bursitis.
Is it in your Genes? The Influence of Genes on Common Disorders and Diseases that affect you and your Family
Authors: Alastair Kent
Journal: Journal of the Royal Society of Medicine (2004)

Though Dr Reilly's book is targeted at scientifically literate laymen, I think it will be of greatest value to non-geneticist clinicians who occasionally face difficult questions about conditions that seem to run in a patient's family. An accompanying website promises to keep the information up to date and, if this commitment is sustained, this will be a really useful resource. As one might expect from a book from Cold Spring Harbor Laboratories, the examples provided are geared to healthcare delivery in the US. The British reader might have appreciated a list of contact numbers for NHS regional genetics centres who can be consulted by those in need of further guidance: such a list is obtainable from the British Society for Human Genetics [www.bshg.org.uk].

For the general public, I suspect this will be a work to consult rather than purchase. Those who do dip into it— and find information on the genetics of conditions ranging from homosexuality (2–3 times the background risk if you have a gay brother) and male pattern baldness to cancers and heart disease—will quickly realize that the deterministic view of genetics that is often conveyed by the media, with announcements of 'a gene for x or y' where these are complex behaviours or multifactorial diseases, is a gross oversimplification. If that message can be lodged in the reader's mind then the author will have done everyone a favour.

For clinicians, the impact of genetics on clinical practice outside the specialist area of the rare single gene disorders (or the Mendelian subsets of some of the common ones) has so far been small, but this will soon start to change and they will have to master the complexities of genetic and environmental interactions. Whilst Reilly's book is no substitute for proper professional development programmes, its clarity and its easy and accessible style will help them meet this challenge and provide sensible advice.
A COIN-CATCHER FOR REMOVING COINS FROM THE ESOPHAGUS
Authors: J. R. Gilbert
Journal: JAMA (1913)

large number of frames were available, a method of adjusting the ordinary gas-pipe frame was devised.Although very simple and inexpensive, it has been found most convenient and has done away with the annoyance of having to wait until a frame could be made, as well as the expense and inconvenience of having a large number of frames constantly on hand.The following description is presented in the hope that an adjustable frame, which can easily be made to fit any average child under 15 years of age, may be of value to others.
Immunosuppression in acutely decompensated cirrhosis is mediated by prostaglandin E2
Authors: Alastair J O'Brien, James N Fullerton, Karen A Massey, Grace Auld, Gavin Sewell, Sarah James, Justine Newson, Effie Karra, Alison Winstanley, William Alazawi, Rita Garcia-Martinez, Joan Cordoba, Anna Nicolaou, Derek W Gilroy
Journal: Nature Medicine (2014)
The Effects of Intranasal Budesonide on Allergen-induced Production of Interleukin-5 and Eotaxin, Airways, Blood, and Bone Marrow Eosinophilia, and Eosinophil Progenitor Expansion in Sensitized Mice
Authors: Huahao Shen, Paul M. O'Byrne, Russ Ellis, Jennifer Wattie, Chibing Tang, Mark D. Inman
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

We have previously demonstrated that allergen inhalation induces expansion of bone marrow eosinophil progenitors in sensitized mice and subjects with asthma and that the inhaled corticosteroid, budesonide, reduced baseline but not allergen-induced increase in bone marrow eosinophil/basophil progenitors (EoB-CFU) in subjects with asthma. Here, we evaluated the effects of intranasal budesonide on allergen-induced increases in interleukin (IL)-5 and eotaxin in the airway and peripheral blood, expansion of bone marrow Eo-CFU and eosinophilia in bone marrow, peripheral blood and airway, as well as airway hyperresponsiveness, in ovalbumin (OVA)-sensitized mice. Budesonide treatment attenuated allergen-induced eosinophilia in bone marrow, peripheral blood, and airways as well as allergen-induced increases in bone marrow eosinophil progenitors but not allergen-induced increases in IL-5 or eotaxin 12 h following the second of two daily exposures to allergen; at later time points treatment was associated with attenuation of IL-5, eosinophilia, Eo-CFU, and airway hyperresponsiveness. These results suggest that a component of the mechanism by which corticosteroid treatment attenuates allergen-induced airway inflammation is through suppression of bone marrow eosinophilopoiesis, and that this is likely not mediated simply through the blocking of IL-5 production at the airway.