tbuckley/cabot-search huggingface dataset:
Transmission of Infection during Withdrawal of Blood
Authors: K. Mendelssohn, L. J. Witts
Journal: BMJ (1945)

From the Nuffield Department of Clinical Medicine, Oxford) It is now generally realized that jaundice may be transmitted by syringes used for intravenous therapy if the syringes are merely rinsed with sterile water, between,cases and not sterilized by heat.Bigger (1943) showed that t is extremely difficult.to
TREATMENT OF CHRONIC SUPPURATIVE DACRYOCYSTITIS.
Authors: A. E. PRINCE
Journal: JAMA (1898)

In response to an invitation from the Secretary of the Ophthalmologic Section of theAmerican Medical Association, I send the following brief paper, the purpose of which is to present the method I employ for obliterating the lachrymal sac. During the earlier years of my practice I tried medication, irrigation and large probes, but the percentage of relapses was so great that I finally discontinued endeavoring to preserve the patency and restore drainage in all cases of chronic suppurative dacryocystitis. For the benefit of those who conclude, in any given case, to obliterate the lachrymal sac, rather than to attempt any of the various plans offered for the preservation of drainage, I here offer a very simple, and at the same time a very satisfactory method of dealing with this question, which has not disappointed me in its results for several years. My procedure is as follows: Introduce a probe
Assessing change through audit
Authors: F Margison
Journal: BMJ (1994)

EDITOR, - In his commentary1 on the multicentre criterion based audit of the management of induced abortion in Scotland2 Ken MacRae makes a telling point about the risk of double standards in the assessment of audit rather than research papers. He is right to challenge the view expressed in “Editor's choice” that without such double standards “the BMJ would rarely have published any papers on audit.” The methodology of research needs to fit its purpose, and the current accepted gold …
Ventilator-Associated Pneumonia—The Wrong Quality Measure for Benchmarking
Authors: Michael Klompas, Richard Platt
Journal: Annals of Internal Medicine (2007)

Legislators, payers, and quality-of-care advocates across the United States are considering requiring hospitals to report ventilator-associated pneumonia rates as a way to benchmark and reward quality of care. Accurate diagnosis of ventilator-associated pneumonia, however, is notoriously difficult because several common complications of critical care can mimic the clinical appearance of ventilator-associated pneumonia. The challenge is compounded by substantial subjectivity inherent in the current surveillance definition. These sources of variability make ventilator-associated pneumonia rates difficult to acquire, interpret, and compare both within and among institutions. Ventilator-associated pneumonia should be excluded from compulsory reporting initiatives until we develop and validate more objective outcome measures that meaningfully reflect quality of care for ventilated patients.
Centrilobular Hepatic Fibrosis Following Acetaminophen-Induced Hepatic Necrosis in an Alcoholic
Authors: James Robert O'Dell, Rowen K Zetterman, D. A. Burnett
Journal: JAMA (1986)

ACETAMINOPHEN ingested acutely in amounts of 10 g or more can cause centrilobular hepatic necrosis, which may be fatal.<sup>1</sup>Chronic liver disease secondary to acetaminophen has been described (three cases) and is said to be histologically similar to chronic active hepatitis.<sup>2-4</sup>Alcoholics seem unusually sensitive to acute acetaminophen liver injury and can develop hepatic necrosis at lower doses of acetaminophen.<sup>5-7</sup>We describe a patient who, while consuming alcohol, experienced repeated episodes of acute centrilobular necrosis secondary to doses of acetaminophen usually not considered to produce toxic reactions. An unusual aspect of this case is the development, over a short period of time, of extensive fibrosis in the areas of acetaminophen-induced centrilobular necrosis. We speculate that while alcohol may have potentiated acetaminophen hepatotoxicity, the combination of acetaminophen-induced centrilobular necrosis and alcohol may have caused the development of centrilobular fibrosis. <h3>Report of a Case</h3> A 38-year-old woman was admitted
Case 36-1969
Authors: William F. McNeely, David L. Page, Robert H. Ackerman
Journal: New England Journal of Medicine (1969)

Presentation of Case First admission. A fifty-nine-year-old man was admitted to the hospital because of pain in the flank.Two years previously he began to experience episodic retrosternal discomfort radiating to the left arm; the discomfort was provoked by exercise or by eating a large meal and was relieved by rest and responded rapidly to nitroglycerin. There was no exertional dyspnea, edema, orthopnea or cough. A year before admission he had a brief episode of rapid, irregular heart action. During exertion he experienced pain in the calves, which diminished with rest. On physical examination the blood pressure was 128 systolic, . . .
Traumatic Rupture of Superior Vena Cava
Authors: S. Oram
Journal: BMJ (1944)

about 14-inches proximal to the splenic flexure, where the size of the colon became diminutive.The entire descending and pelvic colons were very small.The lumen of the affected segment of gut was quite patent, but was reduced in diameter.There was no evidence of any form of organic obstruction at the junction of the normal colon and microcolon or elsewhere.It is a feature of particular interest that the segment of colon involved was that deriving its blood supply from the inferior mesenteric artery and corresponding embryologically to the hind-gut.
The Use of Nonsteroidal Anti-inflammatory Agents
Authors: Robert F. Willkens
Journal: JAMA (1978)

NONSTEROIDAL anti-inflammatory agents take their origin in antiquity, and despite their extensive proliferation, they remain empirical forms of therapy. The inflammatory reaction, once remembered by students of pathophysiology as a tetrad of Greek terms, is now defined as a series of interacting biochemical pathways that include inflammatory mediators, the complement cascade, the coagulation intermediates, and fixed and migrating reactive cells. The aim of treatment with anti-inflammatory agents as such is to control rather than eliminate the inflammatory response. Where the stimulus, or provocation, is recognized, it becomes relatively easy to turn off this reaction. Similarly, when a specific mediator or cell can be identified, such as histamine or the mast cell, agents directed at these elements of inflammation can intercept and modify the harmful effects of this reaction. Unfortunately, most of the disorders for which anti-inflammatory agents are useful have undefined causes, and treatment is directed at the overall response
Uncontrollable bleeding under tourniquet.
Authors: T D Bunker, A H Ratliff
Journal: BMJ (1984)

Arterial calcification and joint degeneration are common in the elderly, and thus arterial calcification is often seen in the radiographs of patients undergoing joint replacement.The rigidity imparted to the femoral arterial tree by this calcification may be so great as to make the vessel incompressible by the tourniquet, which then acts as a venous obstruction and increases the amount of bleeding at operation.We report a case of uncontrollable bleeding under tourniquet and a review of the published reports.
Searching for Dr Condom
Authors: Wendy Moore
Journal: BMJ (2008)

Although it is one of medicine’s longest surviving, most popular, and most effective advances, we know tantalisingly little about the origins of the condom.

Throughout history the likes of Bartolomeo Eustachio, James Parkinson, and Thomas Hodgkin have fallen over each other in the scramble to attach their names to parts of our anatomy or our ailments. Yet the identity of Dr Condom—if indeed such a medic ever existed—has remained, appropriately, sheathed in mystery.

Suggested references to early condoms in prehistoric cave paintings, ancient Egyptian tomb art, and Greek mythology probably owe more to researchers’ overly fertile imaginations than to hard evidence. Historians are on firmer ground with …
Infarction Without Coronary Artery Disease
Authors: William Cabeen
Journal: JAMA (1974)

<h3>To the Editor.—</h3> In your Aug 12 issue (229:811, 1974), a case of transmural myocardial infarction without demonstrable coronary artery disease was described. Possible causes—coronary artery spasm, embolism, anatomic variation, and small vascular disease—were briefly discussed. It would seem more plausible that the first electrocardiographic finding of ventricular fibrillation was the causative factor, ie, that the arrhythmia was primary (perhaps from electrocution, as the patient was working under his house when he was stricken, where inadvertent contact with a high voltage is quite possible). The resultant lack of adequate coronary perfusion during ventricular fibrillation, and the direct myocardial trauma and possible coronary artery compression during external cardiac massage, could have resulted in myocardial infarction. The patient's subsequent normal cardiac catheterization and coronary angiography and exercise stress test confirm the adequacy of his coronary vasculature during an<i>adequate</i>rhythm. Of course, a combination of decreased perfusion in ventricular fibrillation and one
Criteria in the Choice of a Computer System
Authors: Samuel Raymond
Journal: JAMA (1974)

THIS article reviews current laboratory computer systems from one user's viewpoint, and suggests a new criterion for evaluating them. The personal opinions expressed here are based on six years of intensive experience in designing and implementing a computer system for our laboratory; they derive whatever interest they possess from these facts: (1) our system has been operating successfully for the past four years, (2) it has won complete acceptance among the professional staff it serves, (3) it saves our hospital considerably more in actual dollars than it costs, and (4) it is ready for use in other hospitals.  It will be seen that these opinions do not agree with important, commonly held opinions about computer systems, their design, their objectives, and especially the way computer technology is now applied. Computer systems, in my opinion, exist to facilitate the care of the patient, rather than to exhibit the technical accomplishments of
The option of HBIG-free prophylaxis against recurrent HBV
Authors: Alyson N. Fox, Norah A. Terrault
Journal: Journal of Hepatology (2012)

Since the early 1990's, hepatitis B immune globulin (HBIG) has been central to the prevention of hepatitis B virus (HBV) recurrence after liver transplantation. When used in combination with oral nucleos(t)ide analogues, HBIG prevents reinfection with HBV in ⩾90% of transplant recipients. While HBIG is highly efficacious, its use is undermined by its high cost. Because of this limitation, there have been many studies of alternative regimens seeking to minimize the dose or duration of HBIG without sacrificing low HBV recurrence rates. Toward that goal, lower dose intramuscular HBIG in combination with oral nucleos(t)ide analogues has been shown to be highly efficacious in preventing disease recurrence and represents a significant cost savings when compared with high dose intravenous administration. The withdrawal of HBIG after a defined course of combination HBIG and oral antivirals has also been shown to be effective, particularly if combination antiviral therapy is used. The ability to achieve undetectable HBV DNA levels pre-transplantation in the majority of patients may contribute to the high efficacy of these HBIG "light" regimens. Additionally, the success of antiviral rescue therapy for those patients who fail prophylaxis and develop recurrent HBV infection post-transplant has provided the impetus to move increasingly towards HBIG-free approaches. New techniques to detect occult HBV in hepatic and extrahepatic sites may allow clinicians to define a subgroup of patients in whom withdrawal of HBIG or all prophylaxis may be applicable.
Staphylococcus aureus Isolates From Patients With Nonmenstrual Toxic Shock Syndrome
Authors: Paul L. Garbe
Journal: JAMA (1985)

Although toxic shock syndrome toxin-1 (TSST-1) has been proposed as the toxin responsible for toxic shock syndrome, its role in this disease has not been proved. To study this question, we examined Staphylococcus aureus strains isolated from normally sterile sites in patients with nonmenstrual toxic shock syndrome for the presence of TSST-1 production. Only 20 (62.5%) of 32 produced TSST-1, compared with 41 (93%) of 44 vaginal isolates from patients with menstrual toxic shock syndrome. Of strains of S aureus from patients with nonmenstrual toxic shock syndrome, TSST-1-negative isolates were more likely to be associated with a fatal outcome and to not be phage group 1 than TSST-1-positive isolates. Seven of the TSST-1-negative strains were evaluated in a rabbit subcutaneous chamber model of toxic shock syndrome. Fifteen (60%) of 25 rabbits developed a toxic shock syndrome-like illness and nine died. Clinical signs and histopathologic findings in the rabbits were similar to those seen in rabbits inoculated with TSST-1-positive S aureus isolates. These results suggest that other, as yet unrecognized, toxins play a role in toxic shock syndrome, and that TSST-1 production may not be essential to the pathogenesis of toxic shock syndrome.
Giant Rhabdomyosarcoma with Necrosis Visualized with TI-201 Chloride
Authors: HATICE DURAK, ÖMER UGUR, FIGEN ÖZGUR
Journal: Clinical Nuclear Medicine (1991)

A 15-year-old girl with a giant rhabdomyosarcoma at the occipital region had a bone scan with Tc-99m MDP and tumor imaging with T1–201 chloride. There was Tc-99m MDP uptake of the lesion. T1–201 chloride scan clearly delineated the rhabdomyosarcoma, showing multiple areas of decreased uptake that corresponded to the hypo-dense areas of tissue necrosis on CT.
Clinical relevance of immunological dissection in T‐ALL: A report on 20 cases with stem cell (CD7+, CD4‐, CD8‐, CD1‐) phenotype
Authors: Felicetto Ferrara, Renato Cimino, Iolanda Antinolfi, Carlo de Rosa, Giuseppina Mele, Vincenzo Mettivier, Caterina Fusco, Luigi Del Vecchio
Journal: American Journal of Hematology (1992)

Abstract In a prospective study on 44 cases of T‐cell origin acute lymphoblastic leukemia, 20 patients were found to display an immature immunophenotype (CD7+, CD4‐, CD8‐, CD1‐) and were classified as T‐stem cell leukemia (T‐SCL). Twenty‐four patients expressed CD4 and/or CD8 antigens on their blast cells, designated T acute lymphoblastic leukemia (T‐ALL). The T‐SCL subset showed a significantly higher median age, a more frequent incidence of extramedullary leukemia, a morphology L1 in most cases, and a poor response to treatment in terms of either complete remission rate or median survival duration. In addition, significant differences between the two groups were found in evaluating the number of days of blast disappearance from peripheral blood, of CR achievement, and of neutrophils and platelets recovery. We conclude that T‐SCL represents a distinct clinical entity, characterized by a poor response to ALL conventional chemotherapy. Alternative therapeutic approaches should be developed for patients suffering from this form of leukemia, to modify its severe prognosis. © 1992 Wiley‐Liss, Inc.
Screening and Management of Adult Hearing Loss in Primary Care
Authors: Sidney T. Bogardus, Bevan Yueh, Paul G. Shekelle
Journal: JAMA (2003)

Hearing loss is one of the most common chronic health conditions and has important implications for patient quality of life. However, hearing loss is substantially underdetected and undertreated. We present clinical cases to illustrate common situations in which primary care physicians may be called on to identify or to manage hearing loss. With the data reported in the companion scientific review as a guide, we present potential answers to important questions pertaining to hearing loss and suggest ways in which primary care physicians can improve the detection, evaluation, and treatment of hearing loss. The cases focus on screening for chronic hearing loss, evaluation of hearing loss, and treatment of patients with presbycusis.
Variable pulsed light is less painful than light-emitting diodes for topical photodynamic therapy of actinic keratosis: a prospective randomized controlled trial
Authors: P. Babilas, R. Knobler, S. Hummel, C. Gottschaller, T. Maisch, M. Koller, M. Landthaler, R.-M. Szeimies
Journal: British Journal of Dermatology (2007)

Photodynamic therapy (PDT) of actinic keratosis (AK) using methylaminolaevulinate (MAL) is an effective and safe treatment option, but the procedure is painful.To evaluate the efficacy and pain associated with variable pulsed light (VPL), a prospective, randomized, controlled split-face study was performed.Topical MAL-PDT was conducted in 25 patients with AK (n = 238) who were suitable for two-sided comparison. After incubation with MAL, irradiation was performed with a light-emitting diode (LED) (50 mW cm(-2); 37 J cm(-2)) vs. VPL (80 J cm(-2), double pulsed at 40 J cm(-2), pulse train of 15 impulses each with a duration of 5 ms, 610-950 nm filtered hand piece) followed by re-evaluation up to 3 months.The pain during and after therapy was significantly lower with VPL irradiation [t (d.f. = 24) = 4.42, P < 0.001]. The overall mean +/- SD infiltration and keratosis score at 3 months after treatment was 0.86 +/- 0.71 (LED system) vs. 1.05 +/- 0.74 (VPL device) (no statistically significant difference; P = 0.292). Patient satisfaction following both treatment modalities did not significantly differ at the 3-month follow up (P = 0.425).VPL used for MAL-PDT is an efficient alternative for the treatment of AK that results in complete remission and cosmesis equivalent to LED irradiation but causes significantly less pain.
Management of the Patient with Severe Angina Pectoris
Authors: JOHN J. SAMPSON, KENNETH H. HYATT
Journal: Circulation (1972)

Severe angina pectoris may be reduced to tolerable levels by suppressing below the pain threshold those factors elevating systolic blood pressure and heart rate and prolonging systolic ejection period. Their product parallels myocardial oxygen consumption (MVO 2 ) as noted in several excellent reviews. The level of this product associated with angina, the "angina index," defines the individual threshold for onset of angina. Prevention of angina-inducing physical and psychic stress is desirable, but often impractical, and the use of nitroglycerin preceding or following stress may lead to years of acceptable life. Prolonged, spontaneous, or readily induced angina, especially with a change in pattern, may be due to an acute coronary occlusive episode, whether defined as a prodromal period or an actual myocardial infarct. This form of attack requires close observation and appropriate care. The psychic stress-prone patient may repeatedly present a benign duplicate of such pain production, producing a diagnostic challenge. Routine protection of the angina patient, especially against arrhythmias, is discussed. Different therapeutic modalities for control of intractable angina are presented, many with promise, but those currently giving the best results are: (1) elimination of precipitating conditions, i.e. (a) brady- and tachyarrhythmias, (b) hypertension, (c) hyperthyroidism, (d) mechanical obstruction of ventricular outflow, and (e) heart failure (2) beta-adrenergic blocking agents, i.e. propranolol, with or without nitrates or nitroglycerin; and (3) surgical revascularization preceded by selective coronary angiography. The aortocoronary saphenous vein bypass has been effective in prompt relief of angina in patients with viable myocardium and potentially good flow in the distal artery, with acceptably low operative mortality from skilled teams. Mechanical efficiency and thus congestive failure may improve, and there is hope for increased longevity. Contraindications are poorly defined, especially as related to its performance in recent infarction of varying magnitude. With only 3 years' experience in determining long-term benefits, it seems rational to repeatedly redefine indications for surgery, but currently not to operate on every patient with "significant" coronary disease.
Book Review Tobacco Control in Developing Countries Edited by Prabhat Jha and Frank J. Chaloupka. 512 pp., illustrated. New York, Oxford University Press, 2000. $114 (cloth); $49.95 (paper). 0-19-263250-7 (cloth); 0-19-263246-9 (paper).
Authors: Luis G. Escobedo
Journal: New England Journal of Medicine (2001)
Prevention and medical management of Clostridium difficile infection
Authors: J Shannon-Lowe, N J Matheson, F J Cooke, S H Aliyu
Journal: BMJ (2010)

#### Summary points

The incidence of Clostridium difficile infection in the United Kingdom has increased since the late 1990s.1 High profile outbreaks in the United States, Canada, and northern Europe have been associated with a previously uncommon but highly virulent strain known as ribotype 027. A recent review in the BMJ examined the role of surgery in treating C difficile colitis.2 This review focuses on the prevention and medical management of C difficile infection. Because few randomised controlled trials (RCTs) exist on this subject, our recommendations are based mainly on non-RCT studies and clinical governance reports.

#### Sources and selection criteria

We searched PubMed and Google Scholar for articles published from 2006 to 2009 on the treatment and prevention of Clostridium difficile infection and screened the reference lists of retrieved publications. We also consulted the Cochrane Library and the recent best practice guidance from the Health Protection Agency . 1

C difficile can be cultured from the stool of 3% of healthy adults and as many as 35% of hospital inpatients.3 Lower rates of nosocomial colonisation are seen in some studies, and may be dependent on patient population, length of hospital stay, and local infection control procedures.w1 w2 Most colonised people remain asymptomatic. Clinical disease develops when the normal gut flora is disrupted, usually by antibiotic exposure, thereby creating conditions that favour C difficile proliferation within the colon. Although C difficile infections in England have …
Self-complementary AAV Vectors; Advances and Applications
Authors: Douglas M McCarty
Journal: Molecular Therapy (2008)

Numerous preclinical studies have demonstrated the efficacy of recombinant adeno-associated virus (rAAV) gene delivery vectors, and recent clinical trials have shown promising results. However, the efficiency of these vectors, in terms of the number of genome-containing particles required for transduction, is hindered by the need to convert the single-stranded DNA (ssDNA) genome into double-stranded DNA (dsDNA) prior to expression. This step can be entirely circumvented through the use of self-complementary vectors, which package an inverted repeat genome that can fold into dsDNA without the requirement for DNA synthesis or base-pairing between multiple vector genomes. The important trade-off for this efficiency is the loss of half the coding capacity of the vector, though small protein-coding genes (up to 55 kd), and any currently available RNA-based therapy, can be accommodated. The increases in efficiency gained with self-complementary AAV (scAAV) vectors have ranged from modest to stunning, depending on the tissue, cell type, and route of administration. Along with the construction and physical properties of self-complementary vectors, the basis of the varying responses in multiple tissues including liver, muscle, and central nervous system (CNS) will be explored in this review.