tbuckley/cabot-search huggingface dataset:
Antithymocyte Globulin Hypersensitivity in Bone Marrow Failure Patients
Authors: Leonard Bielory
Journal: JAMA (1988)

We evaluated the predictive value of immediate epicutaneous (prick) skin testing in 36 patients receiving a heterologous protein of equine origin, antithymocyte globulin (ATG), for bone marrow failure. Three of the 36 patients had positive epicutaneous test results. Two of these three received ATG treatment; one died of anaphylaxis while the other was desensitized successfully. Intradermal skin tests revealed positive wheal-flare reactions to progressively increasing dilutions of ATG in 96% of patients tested. None of these patients suffered any anaphylactic symptoms during treatment. Nine patients who had received ATG were evaluated subsequently for the possible development of immediate epicutaneous reactions three to 12 months after treatment; one of the nine patients developed a positive epicutaneous skin test reaction. We recommend that all patients who are to be treated or re-treated with heterologous antisera should be tested using the epicutaneous technique and that patients with positive reactions should be desensitized.
PTU-118 Baclofen As An Adjunct Pharmacotherapy For The Maintenance Of Abstinence In Alcohol Dependent Patients With Liver Disease
Authors: L Owens, P Richardson, M Pirmohamed, A Rose
Journal: Gut (2014)

<h3>Introduction</h3> Alcohol induced liver disease is the predominant cause of alcohol-related mortality in the UK. Therefore abstinence-based treatments are essential. Upto 70% of patients receiving alcohol treatment relapse within 6 months,<sup>1</sup> NICE attribute much of this failure of treatment to underutilisation of pharmacotherapy and recommend this be made available.<sup>2</sup> However, current licensed pharmacotherapies are contraindicated for patients with ALD. Baclofen has shown efficacy in the promotion of abstinence in patients with severe alcohol dependence<sup>3,4</sup> including those with ALD,<sup>5</sup> without exhibiting any of the complications or side effects elicited by current pharmacotherapies. Therefore the primary aim of this study was to measure the effectiveness of Baclofen in maintaining abstinence in this difficult to treat group. <h3>Methods</h3> An observational prospective clinical audit was performed. Patients with liver disease and concomitant alcohol use were commenced on Baclofen at 10 mg three times daily (TDS), and titrated according to tolerability and response up to 30 mg TDS. Primary outcome measures were severity of physical dependence, as determined by SADQ score, and weekly alcohol consumption. These were compared at baseline, and 6 months. <b>Setting</b> Acute Hospital Trust <h3>Participants</h3> 149 patients referred to Hepatology for investigation of abnormal liver function and heavy drinking <h3>Results</h3> Of the 149 patients commenced on Baclofen 100 (67.1%) remained engaged in treatment for 6 months. There was a significant reduction in alcohol consumption (P &lt; 0.0001 95% CI for difference 18 to 20) with 81 of the 149 patients (54.3%) maintaining total abstinence, 20 (13.4%) continued to drink and 48 (32.2%) were lost to follow-up and assumed to have returned to drinking. There was a significant reduction in the presence of physical dependence (c<sup>2</sup> = 77.4 P &lt; 0.0001) as categorised by SADQ, and a non-significant improvement of liver biochemistry. <h3>Conclusion</h3> Baclofen has a positive impact on alcohol consumption in this very difficult to treat, high risk patient group. A RCT is needed to confirm the benefit of baclofen in this patient group. <h3>References</h3> Raistrick, D. 2006, NTA NICE, <i>Alcohol Use Disorders: CG115</i>, 2011 Addolorato, G. 2012 Muzyk, A. 2012 Leggio, L. 2010 <h3>Disclosure of Interest</h3> None Declared.
Shock in polytrauma
Authors: P. E Pepe
Journal: BMJ (2003)

Needs better definition and perhaps more selective treatment 

By 2020 bodily injuries are predicted to outpace infectious diseases worldwide in terms of years of productive life lost.1 2 Evolving experience has shown that treatment plans for serious injuries require discrimination between the mechanism of injuries, their anatomic involvement, and their “staging.”2 Yet traditionally, many emergency medical services developed more simplified treatment algorithms without such discriminations, leading to mis-interpretations and invalid conclusions from studies.2 Also deployment configurations may account for conflicting data regarding certain interventions and unrecognised confounders (for example, overzealous ventilation or fluid resuscitation in severe haemorrhagic states) may obscure the benefits of other treatment.2 3 4 5 Finally prospective clinical trials to either validate or refute interventions currently used are lacking.3

With these perspectives in mind traditional recommendations for managing shock in polytrauma are being questioned as being universally applicable, particularly in the preoperative phases of resuscitation.4 5 6 Specifically the strategy of universally providing rapid infusions of crystalloid or colloid …
HIGH GLUCOSE CONDITION INDUCED JAGGED–1 OVEREXPRESSION AND NOTCH INHIBITION, RESULTING IN THE ABERRANT ENDOTHELIAL TUBE FORMATION: A NOVEL MECHANISM OF DIABETIC MICROVASCULOPATHY IN A MODEL OF HUMAN ANGIOGENESIS
Authors: Chang–Hwan Yoon, Young–Eun Choi, Hyo–Soo Kim
Journal: Journal of the American College of Cardiology (2013)
Pesticides. Relation to environmental quality
Authors: F. H. Tschirley
Journal: JAMA (1973)

There are a number of definitions for environmental quality. In the following discussion of pesticides and their relation to environmental quality, I shall consider the environment to be the total world in which we live—its physical, chemical, and biological components, including man. Exclusion of man from the environment is artificial; it ignores the component that has greatest potential for affecting the remaining components of an amazingly complex and interdependent system. <h3>Toxicity and Transportability</h3> A primary consideration for all pesticides is toxicity—to the target organism, to the associated fauna and flora, and to man. In that regard, we must recognize that all pesticides are toxic to a greater or lesser degree. Thus, the controlling variables in determining the use of a product are the manner and degree of use rather than relative toxicity per se. Pesticides in use today range from values for lethal dose from 50% survival of group (LD
Endoscopic sutured closure of a gastric natural orifice transluminal endoscopic surgery access gastrotomy compared with open surgical closure in a porcine model. A randomized, multicenter controlled trial
Authors: P. Park, M. Bergström, R. Rothstein, P. Swain, I. Ahmed, G. Gomez, G. Raju
Journal: Endoscopy (2010)

See also: Commentaire de travail de P. O. Park et al., pp. 311Endoscopy 2010; 42(04): 349-349DOI: 10.1055/s-0031-1291845
Anaplastic Large-Cell Lymphoma Presenting As an Endobronchial Polypoid Tumor
Authors: Shuo-Chueh Chen, Chuen-Ming Shih, Jen-Liang Su, Su-Peng Yeh, Chia-Hung Chen, Guan-Chin Tseng, Wu-Huei Hsu, Wei-Erh Cheng, Yu-Sheng Lin, Yu-Lin Tsai
Journal: Journal of Clinical Oncology (2008)

AST and ALT of 72 U/L and 92 U/L, respectively (normal, 3 to 48 U/L and 30 to 65 U/L).These were normal 4 months earlier.Abdominal computed tomography scan revealed an abnormal "straight-border" 1 -attenuation of the liver along the trajectory of radiation beam used previously-representing radiation-induced liver disease (RILD; Fig 1A, arrows).RILD, previously termed radiation hepatitis, manifests 4 to 8 weeks after radiation exposure. [2]3][4][5] Significant RILD develops in 6% to 66% of patients exposed to an excess of 30 to 35 Gy of radiation, depending on irradiated liver volume and hepatic functional reserve. 3,5 Patients may present with a triad of ascites, hepatomegaly, and elevated liver enzymes. 2 The majority of patients recover completely in 3 to 5 months, while a minority progress towards a chronic stage, with worsening liver fibrosis and failure, only rarely developing fulminant hepatic failure. 3,5 The term "radiation hepatitis" is a misnomer, since pathologic evaluation fails to reveal inflammation, instead showing nonspecific veno-occlusive disease. [3]][5] Radiation-induced endothelial damage exposes the subendothelial basement membrane, leading to platelet activation and aggregation, and stimulation of dormant hepatic stellate cells.Fibrin thrombus causes venous occlusion, panlobular congestion, diffuse hemorrhagic and necrotic foci, and distention of hepatic sinusoids. [3]4][5] Prolonged obstruction and activation of hepatic stellate cells results in hepatocyte loss and fibrosis mediated by transforming growth factor-␤1 release. [3]4][5] Radiologically, RILD presents with a "straight-border" sign, which is defined as any hepatic attenuation difference bordered by straight lines. 1 Fatty infiltration, fibrosis, and vascular abnormalities can all present similarly. 1RILD presents as demarcated areas of hypoor hyperattenuation in a nonanatomic distribution, contrasting with vascular lesions. 1 Our patient developed RILD following hepatic radiation exposure during irradiation of right chest wall/axilla 6 weeks earlier.Subsequent tests after 4 months and later imaging showed complete normalization of liver enzymes and hepatic appearance (Fig 1B).As of May 2008, our patient was free of recurrent disease.
Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland
Authors: E Vartiainen, P Puska, J Pekkanen, J Toumilehto, P Jousilahti
Journal: BMJ (1994)

<h3>Abstract</h3> <b>Objectives</b>: To estimate the extent to which changes in the main coronary risk factors (serum cholesterol concentration, blood pressure, and smoking) explain the decline in mortality from ischaemic heart disease and to evaluate the relative importance of change in each of these risk factors. <b>Design</b>: Predicted changes in ischaemic heart disease mortality were calculated by a ligistic regression model using the risk factor levels assessed by cross sectional population surveys, in 1972, 1977, 1982, 1987, and 1992. These predicted changes were compared with observed changes in mortality statistics. <b>Setting</b>: North Karelia and Kuopio provinces, Finland. <b>Subjects</b>: 14 257 men and 14 786 women aged 30–59 randomly selected from the national population register. <b>Main outcome measures</b>: Levels of the risk factors and predicted and observed changes in mortality from ischaemic heart disease. Results — The observed changes in the risk factors in the population from 1972 to 1992 predicted a decline in mortality from ischaemic heart disease of 44% (95% confidence interval 37% to 50%) in men and 49% (37% to 59%) in women. The observed decline was 55% (51% to 58%) and 68% (61 to 74) respectively. <b>Conclusion</b>: An assessment of the data on the risk factors for ischaemic heart disease and mortality suggests that most of the decline in mortality from ischaemic heart disease can be explained by changes in the three main coronary risk factors.
THE TREATMENT OF CERTAIN DISEASES IN REFERENCE TO THEIR PRESENT CHARACTER AND TYPE
Authors: C. M. Durrant
Journal: BMJ (1853)

JULY 15, than is yet commonly practised; as this, like the early free incision in diffusive inflammation of the cellular membrane, will prevent the destructive ravages of tissue, as well as the fatal constitutional symptoms which follow the unchecked and protracted course of the disease.As an illustration of the effects of the dressing here described, I will relate two or three cases.CASE I.About the end of last year, a gentleman, aged 68, was convalescent after a dangerous attack of bronchitis, which hadl conifined him to bed and to his room for six weeks.At the end of this timc, he was regaining the healthy powers of his system; his digestive organs were vigorous; the strength which he had lost was gradually returning; anid my attendance upon him had so far declined that he only required a call every third or fourth day, in order to watch his progress.OIn one of these occasions, in answer to an inquiry how he had been, he said, smilingly, that he was goinlg on very well, but had lost sleep from a troublesome boil; yet, entertainiIng a b)elief in the humoral doctrinie, that boils had a healthy indication, he supposed that he must wait patienltly until it passed away.Ilis countenaance, neither on this nor the next visit, denoted any injurious efllects from pain or irritation; but, on calling a third tinme, I discovered that he was losing the ground which he had gained; his appetite had greatly lessened; and he confessed that he had had little or no sleep for a week, having found iio relief in any position from the pain plates the whole and open domain of medicine with greater wonder, than the well known varied and inconsistent character of those diseases which we call epidemic.It is not so much that they reflect and depend upon different condi-
Neurasthenia and Its Treatment.
Authors: W. Blair Stewart
Journal: JAMA (1899)

Atlantic City, N. J., Feb. 15, 1899. <h3>To the Editor:</h3> —An article on "Neurasthenia and Its Treatment" (videJournal, Jan. 14, 1899, p. 72) refers to the frequent mistake in advising patients to go to Atlantic City, N. J., and further says: "Such places are fit only for well people, and in no way adapted to the sick." As a practitioner in this city, I can not allow this statement to go unchallenged. It is true that many cases of neurasthenia are referred to Atlantic City with instructions to throw away medicines and allow the sea air, sea baths and hot baths to do the rest. Many such cases come to Atlantic City every year, never consult a physician, attend balls and all kinds of amusements and sports, eat every variety of hotel mixtures, take baths indiscriminately and run a race with their healthy neighbors, and then go home physical
Crisp-padhiar syndrome
Authors: TA Crisp, JB King, O Chan, N Padhiar
Journal: British Journal of Sports Medicine (2011)

Introduction The common cause of medial midfoot pain following acute trauma usually, either pronatory or inversion sprain is due to tibialis posterior tendon dysfunction, tibialis posterior tendinopathy, Os naviculare syndrome, stress fracture of the navicular and Lisfranc ligament injury. These are disabling conditions which are often treated in isolation. Crisp-Padhiar syndrome We present a case history which highlights the complexity of the problem and discuss the findings of subsequent series of 42 patients who presented with post-traumatic medial midfoot pain. In Crisp-Padhiar syndrome patients present with combination of the following: (1) trauma, (2) presence of Os naviculare, (3) tibialis posterior tendinopathy, (4) tibialis posterior dysfunction, (5) acquired flatfoot, (6) Os naviculare synchondrosis and (7) anomalous tibialis posterior tendon attachment of Os naviculare. The treatment of choice in the initial stage is to stabilise the medial structures in Aircast Posterior Tibial Tendon Dysfunction brace for 6 weeks, followed by intensive physiotherapy and dependent on reduction of symptoms and degree of flat footedness, consider fluoroscopy guided tendon distension injection and introduction of customised carbon fibre foot orthoses. Surgery was performed only in two patients who did not respond to conservative management.
Response from BNF for Children
Authors: G. Rylance, S. Wagle
Journal: BMJ (2009)

The high rate of medication errors reported in children is concerning,1 although the majority result in “no harm” or ”low harm.”2

Doses in the BNF for Children ( BNFC ) are standardised according to weight, body surface area, or age, and reflect the available evidence and clinical experience of their safety and efficacy. Although …
Free Psychotherapy: The Therapist&amp;rsquo;s and the Patient&amp;rsquo;s View
Authors: Nikolas Manos
Journal: Psychotherapy and Psychosomatics (1982)

In a free psychotherapy clinic, 28 patients and 8 therapists in training were inquired on the influence nonpayment of a fee had on the treatment process and the therapist himself. The results indicate that though some of the negative effects described by previous authors were also present in this study, overall, both patients and therapists felt that nonpayment of a fee had no influence on the treatment or the therapist and that it even had some positive aspects.
THE MENTAL AND PHYSICAL HEALTH OF SCHOOLCHILDREN
Authors: SANGER BROWN
Journal: JAMA (1923)

While knowledge of the subject of the mental and physical health of schoolchildren is steadily increasing, there is still much to be learned in these directions, particularly in the field of mental hygiene in the schools.  It is true that the great majority of children do reasonably well in the schools of today, both public and private, but the fact remains that a certain percentage get along indifferently, or not at all. Of this small group, some are physically below par, some acquire slowly, some are remarkably brilliant and some have the makings of genius in them. The remarks in the following pages apply particularly, though not exclusively, to the small group. Granting both the limitations and the potentialities of these children, special education has as yet failed to meet their entire needs. Education, medicine, mental hygiene and social hygiene should unite to solve the problem.  The observations discussed here
Absorption of Enteric-Coated Aspirin-Reply
Authors: John H. Bland
Journal: JAMA (1983)

In Reply.—  I stand by my statement there remains doubt that entericcoated aspirin absorbs with enough predictability to make it worthwhile to use. In Dr Baum's study comparing plain aspirin and Ecotrin, five of 21 patients had anti-inflammatory concentrations of salicylate in the serum samples (20 to 30 mg/dL)— 25% of the patients examined. For Enseals, seven of 21 patients had effective serum levels, ie, one third. Thus, 75% of those taking aspirin and Ecotrin and 66% of those taking Enseals had insufficient concentrations for rheumatoid arthritis management. The conclusions drawn on the basis of 21 patients examined and a single salicylate level after seven days of therapy were not impressive; the investment in time and effort to determine which patient has an effective salicylate concentration is inappropriate.  In a Health, Education, and Welfare-sponsored demonstration program at the University of Vermont, Burlington, from 1965 to 1972 (Bland JH, Steffenhagen RA:
NK cells impede glioblastoma virotherapy through NKp30 and NKp46 natural cytotoxicity receptors
Authors: Christopher A Alvarez-Breckenridge, Jianhua Yu, Richard Price, Jeffrey Wojton, Jason Pradarelli, Hsiaoyin Mao, Min Wei, Yan Wang, Shun He, Jayson Hardcastle, Soledad A Fernandez, Balveen Kaur, Sean E Lawler, Eric Vivier, Ofer Mandelboim, Alessandro Moretta, Michael A Caligiuri, E Antonio Chiocca
Journal: Nature Medicine (2012)
Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk
Authors: Masahiro Kikuya, Tine W. Hansen, Lutgarde Thijs, Kristina Björklund-Bodegård, Tatiana Kuznetsova, Takayoshi Ohkubo, Tom Richart, Christian Torp-Pedersen, Lars Lind, Hans Ibsen, Yutaka Imai, Jan A. Staessen
Journal: Circulation (2007)

Current diagnostic thresholds for ambulatory blood pressure (ABP) mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for ABP measurement.We performed 24-hour ABP monitoring in 5682 participants (mean age 59.0 years; 43.3% women) enrolled in prospective population studies in Copenhagen, Denmark; Noorderkempen, Belgium; Ohasama, Japan; and Uppsala, Sweden. In multivariate analyses, we determined ABP thresholds, which yielded 10-year cardiovascular risks similar to those associated with optimal (120/80 mm Hg), normal (130/85 mm Hg), and high (140/90 mm Hg) blood pressure on office measurement. Over 9.7 years (median), 814 cardiovascular end points occurred, including 377 strokes and 435 cardiac events. Systolic/diastolic thresholds for optimal ABP were 116.8/74.2 mm Hg for 24 hours, 121.6/78.9 mm Hg for daytime, and 100.9/65.3 mm Hg for nighttime. Corresponding thresholds for normal ABP were 123.9/76.8, 129.9/82.6, and 110.2/68.1 mm Hg, respectively, and those for ambulatory hypertension were 131.0/79.4, 138.2/86.4, and 119.5/70.8 mm Hg. After rounding, approximate thresholds for optimal ABP amounted to 115/75 mm Hg for 24 hours, 120/80 mm Hg for daytime, and 100/65 mm Hg for nighttime. Rounded thresholds for normal ABP were 125/75, 130/85, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80, 140/85, and 120/70 mm Hg.Population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines.
Relationship Between Stressfulness of Claiming for Injury Compensation and Long-term Recovery
Authors: Genevieve M. Grant, Meaghan L. O’Donnell, Matthew J. Spittal, Mark Creamer, David M. Studdert
Journal: JAMA Psychiatry (2014)

IMPORTANCE Each year, millions of persons worldwide seek compensation for transport accident and workplace injuries.Previous research suggests that these claimants have worse long-term health outcomes than persons whose injuries fall outside compensation schemes.However, existing studies have substantial methodological weaknesses and have not identified which aspects of the claiming experience may drive these effects.OBJECTIVE To determine aspects of claims processes that claimants to transport accident and workers' compensation schemes find stressful and whether such stressful experiences are associated with poorer long-term recovery. DESIGN, SETTING, AND PARTICIPANTSProspective cohort study of a random sample of 1010 patients hospitalized in 3 Australian states for injuries from 2004 through 2006.At 6-year follow-up, we interviewed 332 participants who had claimed compensation from transport accident and workers' compensation schemes ("claimants") to determine which aspects of the claiming experience they found stressful.We used multivariable regression analysis to test for associations between compensation-related stress and health status at 6 years, adjusting for baseline determinants of long-term health status and predisposition to stressful experiences (via propensity scores).MAIN OUTCOMES AND MEASURES Disability, quality of life, anxiety, and depression.RESULTS Among claimants, 33.9% reported high levels of stress associated with understanding what they needed to do for their claim; 30.4%, with claim delays; 26.9%, with the number of medical assessments; and 26.1%, with the amount of compensation they received.Six years after their injury, claimants who reported high levels of stress had significantly higher levels of disability (+6.94 points, World Health Organization Disability Assessment Schedule sum score), anxiety and depression (+1.89 points and +2.61 points, respectively, Hospital Anxiety and Depression Scale), and lower quality of life (-0.73 points, World Health Organization Quality of Life instrument, overall item), compared with other claimants.Adjusting for claimants' vulnerability to stress attenuated the strength of these associations, but most remained strong and statistically significant.CONCLUSIONS AND RELEVANCE Many claimants experience high levels of stress from engaging with injury compensation schemes, and this experience is positively correlated with poor long-term recovery.Intervening early to boost resilience among those at risk of stressful claims experiences and redesigning compensation processes to reduce their stressfulness may improve recovery and save money.