tbuckley/cabot-search huggingface dataset:
GP who saw Baby P is found guilty of a series of failings
Authors: C. Dyer
Journal: BMJ (2010)

The GP who failed to spot that battered toddler Peter Connolly was a victim of child abuse was guilty of a “serious breach” of professional duty, a GMC fitness to practise panel has ruled.

Jerome Ikwueke was found guilty of a series of failures during seven consultations at his surgery in north London between May 2006 and July 2007.

Peter was found dead aged 17 months on 3 August 2007 with more than 50 injuries. His mother, Tracy Connolly, her boyfriend, and his brother are serving jail terms for …
Lymphadenopathy Due to Amyloidosis Secondary to Sjögren Syndrome and Systemic Lupus Erythematosus Detected by F-18 FDG PET
Authors: Itsuko Serizawa, Masayuki Inubushi, Kakuko Kanegae, Koichi Morita, Tetsuya Inoue, Tohru Shiga, Tomoo Itoh, Jun Fukae, Takao Koike, Nagara Tamaki
Journal: Clinical Nuclear Medicine (2007)

We report a case showing lymphadenopathy due to amyloidosis secondary to Sjögren syndrome and systemic lupus erythematosus (SLE). The amyloid lymphadenopathy was detected by positron emission tomography (PET) as faint but significant uptake of F-18 fluorodeoxyglucose (FDG). Lymph node amyloidoses after SLE are probably unusual, and those secondary to Sjögren syndrome remain rare. FDG-PET findings of amyloidosis have been exclusively described with pulmonary amyloidomas. When a patient with a connective tissue disease develops significant FDG uptake in the lymph nodes, the possibility of amyloidosis should be considered.
Origin of the third heart sound. I. Studies in dogs.
Authors: Y Ozawa, D Smith, E Craige
Journal: Circulation (1983)

We studied 13 anesthetized dogs in which a third heart sound (S3) was repeatedly induced by hypoxemia plus fluid overload. A miniature accelerometer with a mass of about 1.1 g was applied at three levels--intact chest wall over cardiac apex, in the pericardium and on the epicardium--to record motion of the structures under observation as well as sound. Intraventricular pressure and sound were monitored using a Millar catheter. Application of two accelerometers simultaneously over the epicardium permitted observation of the chronologic sequence of ventricular wall dynamics in early diastole. The S3 at each level occurred simultaneously with the sudden onset of reduced acceleration, or negative jerk. These dynamic phenomena were maximal at or near the cardiac apex. We conclude that the event that triggers the S3 is a sudden intrinsic limitation of longitudinal expansion of the left ventricular wall.
Factitious Hypoglycemia Due to Chlorpropamide
Authors: Garfield G. Duncan
Journal: JAMA (1961)

FACTITIOUS HYPOGLYCEMIA, or hypoglycemia due to surreptitious self-administration of insulin, is an uncommon but recognized entity. 1,2 Conn and Seltzer 3 reported 1 case and Rynearson 4 reported 3 such cases, in one of which 7 exploratory operations and an eventual total pancreatectomy were performed in attempts to remove a suspected functioning islet cell tumor of the pancreas. It has been suggested that factitious hypoglycemia be suspected in patients who are diabetic, in the family of the diabetic, or in medical personnel such as physicians or nurses to whom knowledge of hypoglycemic agents and their actions is readily accessible.  Oral hypoglycemic agents employed in the treatment of diabetes vary in their hypoglycemia-producing properties. Tolbutamide (Orinase) rarely provokes hypoglycemia, whereas unless guarded against, chlorpropamide (Diabinese) is not an infrequent cause of abnormally low concentrations of sugar in the blood.  No reported case of factitious use of chlorpropamide in producing clinical
Relation of pregnancy toxaemia to trophoblastic tumours.
Authors: D. Llewellyn-Jones
Journal: BMJ (1967)

MICALJOURNALfood (Kerr and Kirkaldy-Willis, 1946 ;McWatters, 1945).Rose (1955), discussing the aetiology, mentioned hypermotility and bowel distension as exciting causes.In secondary volvulus there is usually an abnormal congenital or acquired fixation of the intestine.In this case the past history is consistent with attacks of subacute volvulus recurring over seven years.Though no anatomical abnormality was obvious in the mesentery, a volvulus through 720 degrees suggests undue mobility and length of mesentery.This could have been the result of previous subacute attacks of volvulus or it could have predisposed to them.Bulky diets are said to cause an increase in length of bowel and mesentery as well as hypermotility (Dickson, 1950).There was no evidence of unusual dietary habits in this patient.The right inguinal hernia might have anchored a loop of small intestine and produced a secondary volvulus.However, this hernia was said to be easily reducible up to the final attack of strangulation and to have been present for only two years.If it was responsible its repair should have cured the tendency for the bowel to undergo volvulus.The final attack of volvulus appeared to start only after the inguinal hernia had been repaired and the bowel resected.It is possible, though unlikely, that the anastomosis acted like the occasionally reported antimesenteric tumour by partly anchor- ing the bowel and predisposing to volvulus (Aird, 1957).Lulenski (1961) reported cases where volvulus was super- imposed on small-bowel obstruction.In this case the anastomosis appeared widely patent without any evidence that it could have caused mechanical obstruction.After any abdo- minal operation, especially with intestinal resection, there occur transient ileus, gaseous and fluid distension of bowel, and later
Renin-angiotensin II response to the hemodynamic pathology of ovines with ventricular septal defect.
Authors: M M Boucek, R Chang, D P Synhorst
Journal: Circulation Research (1989)

We studied the response of the renin-angiotensin system (RAS) to a surgically created ventricular septal defect (VSD) in immature ovines and also the role of angiotensin II in the pathophysiology of VSD in the chronically instrumented ovine. Plasma renin activity (PRA) was increased from 2.39 +/- 1.1 to 3.78 +/- 1.4 ng/ml/hr (p less than 0.05, n = 17) after VSD but not after sham procedure. The change in PRA was positively correlated with the amount of left-to-right shunt through the VSD (r = 0.74, p less than 0.05). Inhibition of angiotensin II effect with saralasin (10 micrograms/kg/min) or angiotensin II production with captopril (2 mg/kg) lowered systemic resistance (Rs) by 14% and 34%, respectively (p less than 0.05), and raised pulmonary resistance (Rp) by 35% and 77%, respectively (p less than 0.05). Thirty minutes following captopril, the ratio of pulmonary to systemic flow (Qp/Qs) decreased from 3.31 +/- 0.18 to 2.15 +/- 0.18 (p less than 0.05) while total pulmonary flow fell from 7.15 +/- 0.38 to 5.92 +/- 0.34 l/min/M2 (p less than 0.05, n = 11). Systemic flow increased from 2.17 +/- 0.14 to 2.86 +/- 0.33 l/min/M2 (p less than 0.05) despite a reduction in left atrial pressure (17.3 +/- 1.0 vs. 13.0 +/- 1.7, p less than 0.01). Reinfusion of angiotensin II (0.02 micrograms/kg/min) into the central aorta after captopril returned the hemodynamics to baseline including a rise in Rs and fall in Rp. Exogenous angiotensin II alone (0.08 micrograms/kg/min) or a threefold stimulation in PRA with furosemide (2 mg/kg) caused little hemodynamic effect.(ABSTRACT TRUNCATED AT 250 WORDS)
Regular review: Peripheral neuropathy
Authors: R. A C Hughes
Journal: BMJ (2002)

<h3>ABSTRACT</h3> Copper is essential for the activity and stability of cytochrome <i>c</i> oxidase (CcO), the terminal enzyme of the mitochondrial respiratory chain. Loss-of-function mutations in genes required for copper transport to CcO result in fatal human disorders. Despite the fundamental importance of copper in mitochondrial and organismal physiology, systematic characterization of genes that regulate mitochondrial copper homeostasis is lacking. To identify genes required for mitochondrial copper homeostasis, we performed a genome-wide copper-sensitized screen using DNA barcoded yeast deletion library. Our screen recovered a number of genes known to be involved in cellular copper homeostasis while revealing genes previously not linked to mitochondrial copper biology. These newly identified genes include the subunits of the adaptor protein 3 complex (AP-3) and components of the cellular pH-sensing pathway-Rim20 and Rim21, both of which are known to affect vacuolar function. We find that AP-3 and the Rim mutants impact mitochondrial CcO function by maintaining vacuolar acidity. CcO activity of these mutants could be rescued by either restoring vacuolar pH or by supplementing growth media with additional copper. Consistent with these genetic data, pharmacological inhibition of the vacuolar proton pump leads to decreased mitochondrial copper content and a concomitant decrease in CcO abundance and activity. Taken together, our study uncovered a number of novel genetic regulators of mitochondrial copper homeostasis and provided a mechanism by which vacuolar pH impacts mitochondrial respiration through copper homeostasis.
Effects of static and rhythmic twitch contractions on the discharge of group III and IV muscle afferents
Authors: M. P KAUFMAN, T. G WALDROP, K. J RYBICKI, G. A ORDWAY, J. H MITCHELL
Journal: Cardiovascular Research (1984)

Although both static and rhythmic twitch contractions of the hindlimb muscles of anaesthetised cats have been shown to reflexly evoke pressor responses, the increase in arterial pressure evoked by the former type of contraction has been shown to be substantially larger than that evoked by the latter. We have therefore recorded the impulse activity of single group III and IV muscle afferents, whose activation reflexly increases arterial pressure, while we both statically and rhythmically twitch-contracted the triceps surae muscles of anaesthetised cats. We found that group III afferents (n=17) discharged significantly more impulses in response to static contraction than in response to rhythmic contraction. By contrast, group IV afferents (n=18) fired approximately the same number of impulses in response to the two types of contraction. In addition, we found that many of the group III but only a few of the group IV afferents displayed discharge properties suggestive that these afferents were mechanoreceptors. We conclude that the discharge of group III afferents are likely to be responsible for the difference in the magnitudes of the reflex pressor responses evoked by static and rhythmic contraction.
Hypotension and Bradycardia Following Diazoxide and Hydralazine Therapy
Authors: Stephen Mizroch
Journal: JAMA (1977)

<h3>To the Editor.—</h3> We report a case pertinent to the article entitled "Hypotensive Sequelae of Diazoxide and Hydralazine Therapy" (237:264,1977). <h3>Report of a Case.—</h3> A 58-year-old man came to the emergency room with slurred speech, left hemiparesis, and blood pressure of 240/150 mm Hg. Diazoxide, 300 mg intravenously, was given, followed by furosemide (Lasix), 40 mg intravenously, and methyldopa (Aldomet), 500 mg by mouth. There was a decrease in blood pressure to 160/100 mm Hg. When the blood pressure rose to 190/130 mm Hg after three hours, hydralazine hydrochloride, 20 mg, was given intramuscularly. Thirty minutes later, the patient began to complain of nausea, weakness, and disphoresis. At this time his blood pressure was 60 mm Hg systolic; his heart rate, 36 beats per minute; and only femoral pulses could be palpated. Atropine sulfate intravenously and a dopamine hydrochloride drip reversed the situation and the patient made an uneventful recovery.
Variations in Carboxyhaemoglobin Levels in Smokers
Authors: C. M. Castleden, P. V. Cole
Journal: BMJ (1974)

Three experiments on smokers have been performed to determine variations in blood levels of carboxyhaemoglobin (COHb) throughout the day and night and whether a random measurement of COHb gives a true estimation of a smoker9s mean COHb level. In the individual smoker the COHb level does not increase gradually during the day but is kept within relatively narrow limits. Moderately heavy smokers rise in the morning with a substantially raised COHb level because the half life of COHb is significantly longer during sleep than during the day. Women excrete their carbon monoxide faster than men. A random COHb estimation gives a good indication of the mean COHb level of an individual.
Protective effect of gluten-free diet against development of lymphoma in dermatitis herpetiformis
Authors: H.M. LEWIS, T.L. RENAULA, J.J. GARIOCH, J.N. LEONARD, J.S. FRY, P. COLLIN, D. EVANS, L. FRY
Journal: British Journal of Dermatology (1996)

A retrospective study of 487 patients with dermatitis herpetiformis showed that lymphoma developed in eight patients, the expected incidence being 0.21 (standardized registration ratio 3810). All lymphomas occurred in patients whose dermatitis herpetiformis had been controlled without a gluten‐free diet (GFD) or in those who had been treated with a GFD for less than 5 years. The results are suggestive of a protective role for a GFD against lymphoma in dermatitis herpetiformis and give further support for advising patients to adhere to a strict GFD for life.
A 75-year-old female with dyspnoea and chest pain
Authors: M. Tresinie, F. Van De Maele, W. Verhaeghe, B. Van de Maele, R. Venken, K. Hertveldt
Journal: European Respiratory Journal (2005)

CASE HISTORYA 75-yr-old nonsmoking female, with an unremarkable medical history, was admitted to the emergency ward for evaluation of dyspnoea and right-sided thoracic pain.Physical examination revealed tachycardia and decreased breath sounds at the right lower base, with dullness on percussion.Electrocardiography showed atrial fibrillation.A right-sided hemithoracic mass was seen upon chest radiography (fig.1).Computed tomography (CT) of the chest and magnetic resonance (MR) were also performed (figs 2 and 3).Laboratory results were as follows: white blood cells5 13.42610 6 cells?L -1 ; red blood cells5451610 6 cells?L -1 and serum total protein 66 g?L -1 (albumin555.1%,gammaglobu-lin512.1%).Carcinoembryonic antigen, b 2 -microglobulin, afetoprotein and b-human chorionic gonadotropin were all within normal range.Abdominal ultrasound revealed a liver cyst.Bone scintigraphy and CT of the pelvic region were normal.A right-sided posterolateral thoracotomy was performed.A 10-cm large, soft, encapsulated, white mass was found to be attached to the parietal pleura, without any signs of local infiltration or adhesions with the adjacent lung.No pedicle was found.Complete removal was easily performed.The results of the microscopical examination are shown in figures 4-6.
Relative impact of CD4+CD25+ regulatory T cells and tacrolimus on inhibition of T-cell proliferation in patients with atopic dermatitis
Authors: M. Vukmanovic-Stejic, A. McQuaid, K.E. Birch, J.R. Reed, C. Macgregor, M.H.A. Rustin, A.N. Akbar
Journal: British Journal of Dermatology (2005)

Background It has been established recently that CD4+CD25+ regulatory T cells (Tregs) play an important role in controlling various immune responses. Immunosuppressive drugs are often used to treat immune dysregulation but are frequently associated with undesirable side‐effects. Objectives We examined the suppressive capacity of circulating Tregs in patients with atopic dermatitis (AD). Combined effects of Tregs and tacrolimus on the inhibition of T‐cell proliferation in vitro were also assessed. Methods CD4+CD25+ and CD4+CD25– T cells were isolated from peripheral blood mononuclear cells using immunomagnetic beads. CD4+CD25– T cells were stimulated with purified protein derivative (PPD) or house dust mite allergen (Der p1) for 6 or 7 days, respectively. A dose range of tacrolimus and CD4+CD25+ T cells were added separately, or together. Proliferation was measured by 3H‐thymidine incorporation. Results CD4+CD25+ T cells from normal controls and patients with AD are anergic and inhibit the proliferation of CD4+CD25– T cells in response to PPD and Der p1 in vitro in a dose‐dependent manner. Addition of tacrolimus and Tregs together showed significantly stronger inhibition of proliferation than either on their own. This was true for both antigens and both in normal controls and in patients with AD. Conclusions CD4+CD25+ T cells in patients with AD have normal suppressive activity compared with healthy controls. Tregs and tacrolimus have additive effects on the inhibition of proliferation in response to PPD and Der p1.
Management of Foreign Bodies in the Food and Air Passages
Authors: John T. Martin
Journal: JAMA (1968)

Can 2,489 foreign bodies fit together in the same human stomach? Does denture-wearing increase the probability of a foreign body causing acute abdominal pain? "Yes" says Denver surgeon Sawyer as he enriches an extensive review of the literature with his own experiences on retrieving objects that can be inserted, ingested, or aspirated by patients of all ages. The result is a compact, readable, occasionally droll, and always informative treatise that can serve as a text or as an easily referenced avenue to world opinion. Foreign bodies causing endobronchial ball valves, problems faced in retrieving friable intrapulmonary objects, and legal aspects of dental damage caused by endotracheal anesthesia are succinctly presented. Dr. Sawyer offers valuable data about the infant larynx, as carefully as he outlines techniques for bronchoscopy or discusses the use of electronic and magnetic locating equipment. He develops indications for surgical versus endoscopic recovery of foreign matter and emphasizes
P76 Long-term effectiveness of a staged assessment for problematic severe asthma
Authors: J. Sharples, A. Gupta, L. Fleming, C. J. Bossley, M. Bracken, P. Hall, A. Hayward, M. Puckey, I. M. Balfour-Lynn, M. Rosenthal, A. Bush, S. Saglani
Journal: Thorax (2011)

<h3>Background</h3> Children with problematic severe asthma (PA) may have genuine therapy-resistant disease, or may be difficult-to-treat because of unaddressed potentially modifiable factors. <h3>Objectives</h3> Evaluate the long-term efficacy of a structured protocol including a nurse-led assessment1 (Stage 1) in identifying modifiable factors and differentiating difficult asthma (DA) from severe therapy-resistant asthma (STRA) in children with PA. As a secondary aim, we determined whether DA and STRA could be identified without the detailed assessment. <h3>Methods</h3> 78 children, median age 11.8 years (range 5–17 years), that underwent Stage 1 assessment between 2005 and 2008 were included. Lung function, medications, symptoms and exacerbations were obtained at 1 year, 2 years, and up to 6 years (current status) after initial assessment. Children in whom modifiable factors were identified were classified as DA and those that progressed to further investigations (Stages 2 &amp; 3) as STRA. <h3>Results</h3> Median duration of follow-up was 3.9 years (range 2.5–6.1 years). 31/78 (40%) children were classified as DA, and did not proceed to Stages 2 &amp; 3. Children with DA had significantly lower dose inhaled corticosteroids prescribed at follow-up compared to STRA (DA vs STRA: median [IQR] 800 μg [400 μg–1425 μg] vs 1600 μg [800 μg–2400 μg], p&lt;0.05), and significantly fewer oral corticosteroid bursts per year (DA vs STRA: median [IQR] 1 [0–2] vs 4 [1.5–8], p&lt;0.001). DA children had improved lung function at follow-up compared to baseline (median [IQR] FEV<sub>1</sub> % predicted: 91% [86.5%–102.5%] vs 80% [73%–86%], p&lt;0.01) despite lower dose inhaled corticosteroids. DA and STRA had different characteristics at baseline: DA children had a higher FEV<sub>1</sub> % predicted (p&lt;0.01), less bronchodilator reversibility (p&lt;0.05), lower fractional exhaled nitric oxide (p&lt;0.05), and less sensitisation to food and aeroallergens (both p&lt;0.05) compared to STRA. However, there was considerable overlap between the groups and the two could not reliably be distinguished in advance of the detailed Stage 1 assessment. <h3>Conclusion</h3> As a result of our assessment, 40% of children with PA did not undergo invasive investigations and escalation of therapy. Up to 6 years later, children with DA had a significant improvement in lung function and fewer exacerbations despite reduced maintenance medication.
Cross tolerance to salbutamol occurs independently of 2 adrenoceptor genotype-16 in asthmatic patients receiving regular formoterol or salmeterol
Authors: D K C Lee
Journal: Thorax (2004)

The development of tolerance following the use of long acting beta(2) agonists in asthmatic patients with either the homozygous arginine (Arg-16) or glycine (Gly-16) genotypes is poorly documented, especially in relation to the acute reliever response to salbutamol in constricted airways. A study was undertaken to evaluate the Arg-16 and Gly-16 genotypes for the acute salbutamol response following methacholine bronchial challenge between the first and last doses of formoterol (FM) and salmeterol (SM) combination inhalers.Parallel groups of 10 matched homozygous Arg-16 and 10 homozygous Gly-16 patients completed a randomised, double blind, double dummy, crossover study. Following a 1 week washout period, patients received treatment for 2 weeks with either inhaled budesonide (BUD) 200 micro g + FM 6 micro g (two puffs twice daily) or inhaled fluticasone propionate (FP) 250 micro g + SM 50 micro g (one puff twice daily). After washouts and randomised treatments (1 hour after the first and last inhalation) a methacholine challenge was performed followed by salbutamol 200 micro g, with recovery over 30 minutes (the primary outcome).Washout values for forced expiratory volume in 1 second (FEV(1)), methacholine hyperreactivity, and salbutamol recovery were similar for both treatments and genotypes. Pre-challenge FEV(1) values for both genotypes did not differ significantly between the first and last doses of each treatment. Salbutamol recovery as mean (SE) area under the 30 minute time-response curve was significantly delayed (p<0.05) equally in both genotype and treatment groups. There were no differences in salbutamol recovery in either genotype or treatment group.Acute salbutamol recovery in methacholine constricted airways was significantly delayed to a similar degree in both genotypes due to cross tolerance induced by FM or SM.
The linear-ordered collagen scaffold-BDNF complex significantly promotes functional recovery after completely transected spinal cord injury in canine
Authors: Sufang Han, Bin Wang, Wei Jin, Zhifeng Xiao, Xing Li, Wenyong Ding, Meghan Kapur, Bing Chen, Baoyu Yuan, Tiansheng Zhu, Handong Wang, Jing Wang, Qun Dong, Weibang Liang, Jianwu Dai
Journal: Biomaterials (2014)
Hematologic Problems in the Newborn
Authors: Ruth Andrea Seeler
Journal: JAMA (1983)

How does one improve on a classic? To find the answer, read the third edition of<i>Hematologic Problems in the Newborn written</i>by Drs Oski and Naiman. Like the two previous editions, this monograph is a state-of-the-art reference for the person caring for the neonate, whether a pediatric hematologist, neonatologist, or general pediatrician. Chapters have been updated and revised but still cite the classic papers. There is artful integration of the recent biochemical confirmatory studies that explain the classic clinical observations of the pioneers in pediatric hematology and oncology working with neonates. Instead of an all encompassing bibliography at the end of the book, each chapter has its own (and this reviewer thinks more useful) bibliography for each of the given topics. Chapter 1 contains all the needed tables and charts of the normal values during this rapidly changing period of life. The second chapter delineates the maternal-infant interrelationships and