tbuckley/cabot-search huggingface dataset:
Intravenous Immune Globulin Therapy for Neurologic Diseases
Authors: Marinos C. Dalakas
Journal: Annals of Internal Medicine (1997)

High-dose intravenous immune globulin (IVIg) has emerged as an important therapy for various neurologic diseases. Different interpretations of clinical trial results; the expected benefit of IVIg compared with that of alternate therapies; and issues about IVIg's safety, cost, and mechanisms of action have raised concern and uncertainty among practitioners. To clarify these areas, this paper examines the clinical, serologic, and immunologic data on more than 110 patients with various autoimmune neurologic diseases who received IVIg during the past 6 years at the National Institute of Neurological Disorders and Stroke. It also reviews work by other investigators on the efficacy, risks, benefits, and mechanisms of the action of IVIg in these diseases. In controlled clinical trials, IVIg has been effective in treating the Guillain-Barre syndrome, multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, and dermatomyositis. In other controlled or open-label trials and case reports, IVIg produced improvement in several patients with the Lambert-Eaton myasthenic syndrome and myasthenia gravis but had a variable, mild, or unsubstantiated benefit in some patients with inclusion-body myositis, paraproteinemic IgM demyelinating polyneuropathy, certain intractable childhood epilepsies, polymyositis, multiple sclerosis, optic neuritis, and the stiff-man syndrome. The primary adverse reaction was headache; aseptic meningitis, skin reactions, thromboembolic events, and renal tubular necrosis occurred rarely. The most relevant immunomodulatory actions of IVIg, operating alone or in combination, are inhibition of complement deposition, neutralization of cytokines, modulation of Fc-receptor-mediated phagocytosis, and down-regulation of autoantibody production. Therapy with IVIg is effective for certain autoimmune neurologic diseases, but its spectrum of efficacy has not been fully established. Additional controlled clinical trials are needed.
Recent developments: Renal transplantation
Authors: P. A Andrews
Journal: BMJ (2002)

Since the first successful transplant of a kidney from one twin to another in 1954, renal transplantation has moved from being at the cutting edge to being a mature technology. Registry data show that the current survival rates for grafts from cadavers are around 88% and 60% at one and 10 years after transplantation, respectively, while comparable rates for grafts from living donors are in excess of 95% and 70% (fig ​(fig11).1,3 These rates have shown steady improvements over the past 10 years, with the one year survival rates for grafts from cadavers and living donors improving by around 5% in that time.1,3 One year patient survival after transplantation is steady at 95%, with 87% alive at five years. In the medium term (one to three years) after transplantation, clinical outcomes are now so good that it is difficult to improve the survival of the patients or the grafts. Rejection rates have fallen over the years, and rejection is now an uncommon cause of early loss of a graft.
Bleeding Colonic Diverticulum
Authors: Sripathi R Kethu, Harlan G Rich
Journal: New England Journal of Medicine (2003)

A 73-year-old man presented with acute lower gastrointestinal bleeding. He was hemodynamically stable, and nasogastric-tube lavage revealed bile with no blood, suggesting a lower gastrointestinal source for the bleeding. Urgent colonoscopy, performed after a rapid colonic purge, revealed a profusely bleeding diverticulum in the sigmoid colon; at the neck of the diverticulum, a bleeding vessel was identified (arrow in Panel A). Hemostasis was achieved by injecting epinephrine (dilution, 1:10,000) around the diverticulum (Panel B). The patient was discharged two days later, without any further bleeding or complications. Diverticula develop where vasa recta (intramural branches of the marginal artery supplying the . . .
The Role of Early Life Environmental Risk Factors in Parkinson Disease: What Is the Evidence?
Authors: Giancarlo Logroscino
Journal: Environmental Health Perspectives (2005)

Parkinson disease (PD) is of unknown but presumably multifactorial etiology. Neuropathologic studies and animal models show that exposure to environmental neurotoxicants can determine progressive damage in the substantia nigra many years before the onset of clinical parkinsonism. Therefore, PD, like other neurologic diseases related to aging, may be determined by exposures present in the environment early during the life span or even during pregnancy. Recent epidemiologic studies have focused on the possible role of environmental risk factors present during adult life or aging. Smoking and coffee drinking have consistently been identified to have protective associations, whereas roles of other risk factors such as pesticide and infections have been reported in some studies but not replicated in others. Both genetic inheritance and sharing of common environment in the same family explain the increased risk of PD of relatives of PD cases compared with relatives of controls in familial aggregation studies. Much evidence indicates that risk factors that have a long latency or a slow effect could be important for late-onset PD. Further epidemiologic studies are warranted in this area.
The Clinical Importance of the Rh Blood Type
Authors: Louis K. Diamond
Journal: New England Journal of Medicine (1945)

Rh Incompatibility in PregnancyIn contrast to the type of mild or only moderate transfusion reactions described above in men and in nongravid women, it has been recognized for several years that during pregnancy, or shortly thereafter, women may have severe transfusion reactions when given presumably compatible blood during a first transfusion. In 1939, Levine and Stetson40 reported a case of intragroup agglutination in a pregnant woman in which they demonstrated an abnormal agglutinin; they suggested that this had resulted from sensitization of the mother to some agent present in the fetus, inherited from the father. They did not give . . .
Hyperpolarized 13C Spectroscopic Imaging Informs on Hypoxia-Inducible Factor-1 and Myc Activity Downstream of Platelet-Derived Growth Factor Receptor
Authors: Hagit Dafni, Peder E.Z. Larson, Simon Hu, Hikari A.I. Yoshihara, Christopher S. Ward, Humsa S. Venkatesh, Chunsheng Wang, Xiaoliang Zhang, Daniel B. Vigneron, Sabrina M. Ronen
Journal: Cancer Research (2010)

Abstract The recent development of hyperpolarized 13C magnetic resonance spectroscopic imaging provides a novel method for in vivo metabolic imaging with potential applications for detection of cancer and response to treatment. Chemotherapy-induced apoptosis was shown to decrease the flux of hyperpolarized 13C label from pyruvate to lactate due to depletion of NADH, the coenzyme of lactate dehydrogenase. In contrast, we show here that in PC-3MM2 tumors, inhibition of platelet-derived growth factor receptor with imatinib reduces the conversion of hyperpolarized pyruvate to lactate by lowering the expression of lactate dehydrogenase itself. This was accompanied by reduced expression of vascular endothelial growth factor and glutaminase, and is likely mediated by reduced expression of their transcriptional factors hypoxia-inducible factor-1 and c-Myc. Our results indicate that hyperpolarized 13C MRSI could potentially detect the molecular effect of various cell signaling inhibitors, thus providing a radiation-free method to predict tumor response. Cancer Res; 70(19); 7400–10. ©2010 AACR.
Accumulating Evidence for Statins in Primary Prevention
Authors: Jennifer G. Robinson
Journal: JAMA (2013)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
An Address on the Investigation of the Causes of Cancer
Authors: H. T. Butlin
Journal: BMJ (1885)

188q: TTS,'WISH-MIDA -JOUJW,)f.ti *inbciatinii the quantity of' ugar taken should be rdduced to X ,minimum, and the patients should partake freely of 'fresh fruits and' 'veketables, while such aTticlees of food as, potat6es'and rhubArb should 'be avoided.As to the !use of sfim"ulants, no definite statement can be made; eachase must, be judged of on its own Ierits.In old per-.sons, or in patients, with; a feeble circuilationh alcoholic stimulants are of service; and pro6bbly thiere is no better one than *hisky i small quantities, twice'a day;i adrated water.'Tobaced-smokinig -is posi-' tivIy injurious tiallf cases of chronic .catarrh.The only otheriparticiulars which I have now to consider' are some of the external influences or -internal conditions upon.which the catarrh may depend.The fomrer I mentioned when considering 'the etiology of the disease'; it is not necessary, therefore, for me to allude 'to them now, further than to say that, as -soon as the immediate cause of the affection is discovered, the removal of the patient from dxposure to it is the first thing called for.There are, however, some constitutional conditions with which the' various forms of chronic catarrh are associated,' which demand your sttention, and amongst these I may mention struma, gout, rheuma.tism, certain nervous afleetions, and eardiac diseases, -which, by in- ducing congestion of the mucous membrane, keep up the symptoms of catarrh.Aneemia -alo0 is frequently associated with chronic catarrh of the latynx 6r'phrynx.' 'These conditions must, in all 'cases, be looked for, and when de- tected, they should be treated according to their requirements.In the great majority bf ases, tonics are called for;, and iron, especially its astringent preparatink, is of great value, particularly when com- bined With qiiti `nd.i4stychnia.Cases of dry catarrh are frequently associatedl with gout, a disease we very seldom see in Glasgow; and in such instances, the greatest possible good is said to be derived from the administration of colchicum and alkalies; whereas, in cases where the quantity of mucus secreted is large, you will find that the patient will derive considerable relief from the use of lozenges containing half a grain of cubebs, one to be taken every three or four hours.
Competency in Interpretation of 12-Lead Electrocardiograms: A Summary and Appraisal of Published Evidence
Authors: Stephen M. Salerno, Patrick C. Alguire, Herbert S. Waxman
Journal: Annals of Internal Medicine (2003)

Background: There have been many proposals for objective standards designed to optimize training, testing, and maintaining competency in interpretation of electrocardiograms (ECGs). However, most of these recommendations are consensus based and are not derived from clinical trials that include patient outcomes. Purpose: To critically review the available data on training, accuracy, and outcomes of computer and physician interpretation of 12-lead resting ECGs. Data Sources: English-language articles were retrieved by searching MEDLINE (1966 to 2002), EMBASE (1974 to 2002), and the Cochrane Controlled Trials Register (19752002). The references in articles selected for analysis were also reviewed for relevance. Study Selection: All articles on training, accuracy, and outcomes of ECG interpretations were analyzed. Data Extraction: Study design and results were summarized in evidence tables. Information on physician interpretation compared to a gold standard, typically a consensus panel of expert electrocardiographers, was extracted. The clinical context of and outcomes related to the ECG interpretation were obtained whenever possible. Data Synthesis: Physicians of all specialties and levels of training, as well as computer software for interpreting ECGs, frequently made errors in interpreting ECGs when compared to expert electrocardiographers. There was also substantial disagreement on interpretations among cardiologists. Adverse patient outcomes occurred infrequently when ECGs were incorrectly interpreted. Conclusions: There is no evidence-based minimum number of ECG interpretations that is ideal for attaining or maintaining competency in ECG interpretation skills. Further research is needed to clarify the optimal way to build and maintain ECG interpretation skills based on patient outcomes. Deceased.
Pure red-cell aplasia requiring cytotoxic chemotherapy: Presence of clonal T-lymphocytes without characteristics of chronic lymphocytic leukemia
Authors: Masahiko Nezu, Eiichiro Kawano, Hideshi Ishii, Miki Nishimura, Akira Hirasawa, Shinichiro Hashimoto, Satoko Morio, Nobuyuki Aotsuka, Hirotoshi Nakamura, Takayoshi Asai, Yasushi Saito, Hakumei Oh
Journal: American Journal of Hematology (1996)

To the Editor: The clinical management of acute leukemia during pregnancy is difficult due to concerns regarding both teratogenic effects of chemotherapy and pregnancy complications related to myelosuppression [ 11.Despite this, there is evidence that successful outcomes for mother and child may occur using standard chemotherapeutic agents, particularly in the second and third trimester.Acute promyelocytic leukemia (APL) occurs in women of childbearing age, and has been described in pregnant women.During the last decade, management of APL has changed and includes the use of all-trans retinoic acid (ATRA).ATRA is contraindicated during pregnancy due to the known teratogenic effects of retinoid compounds on the developing fetus.There have been a few case reports of pregnant women receiving ATRA during the second and third trimesters of pregnancy, and successful outcomes have occurred [2-61.This case report describes a woman who was carrying a fetus with Potter's syndrome (oligohydramnios and bilateral renal agenesis) and who developed APL in the last trimester of pregnancy.This case differs from those reported previously because the initiation of ATRA therapy resulted in the onset of labor.The patient was a 29-year-old white female who was noted to have oligohydramnios during her first trimester.The fetus was diagnosed with Potter's syndrome, and the patient refused termination of the pregnancy on religious grounds.She presented in week 29 of pregnancy with vaginal bleeding and was noted to have marked pancytopenia.Bone marrow exam was performed and showed the characteristic morphology of APL.Because the fetus was nonviable, the initial plan was to induce labor with pitocin in an attempt to avoid possible peripartum complications during later stages of her leukemia treatment.Induction of labor was not attempted, however, because the patient's cervical 0s was closed, and there was no evidence of effacement.After receiving informed consent, she was started on ATRA 45 mg/m2/ day and within 24-36 hr began having regular contractions, 3-5 min apart.At this time, her cervix was 3 cm dilated and she was 80-90% effaced.Within the next 6 hr she was fully dilated and the fetus and placenta were delivered without any hemorrhagic complications.As expected, the baby died within 30 min of delivery.The patient had not been started on other medications or had other interventions.The patient remained hospitalized
PREDICTORS OF COLECTOMY IN HOSPITALISED PATIENTS WITH ACUTE SEVERE COLITIS
Authors: D J Gibson, N Rafter, D Keegan, K Byrne, S Martin, P R O'Connell, D C Winter, J M Hyland, H E Mulcahy, G Cullen, G A Doherty
Journal: Gut (2013)

<h3>Introduction</h3> 20–30% of patients with ulcerative colitis (UC) will have a colectomy during their disease course. This percentage increases to 40% in patients admitted with acute colitis. <h3>Aims/Background</h3> To assess if clinical or laboratory parameters on admission can identify patients who will require colectomy on that hospital admission. <h3>Method</h3> This was a retrospective review of all patients admitted with a principle diagnosis of UC in a tertiary referral centre between January 2010-November 2011. Patients admitted electively either for endoscopy or UC related surgery were excluded. <h3>Results</h3> 91 patients were identified with a principal discharge diagnosis of UC; 39 patients were excluded (elective admission for surgery or endoscopy). 52 patients hospitalised with acute severe colitis were considered eligible for further study. The majority were male; M:F ratio=36:16. Median age was 47. 13 of 52 patients required colectomy during that admission(25%). 17 patients had thrombocytosis (platelets &gt;400) on admission. 25 patients were anaemic (males Hb &lt;13, females Hb &lt;11.5) on admission and 22 patients had albumin level &lt;30 on admission. Neither thrombocytosis (p=0.42) nor anaemia (p=0.56) were predictive of need for surgery. However, in patients who were significantly hypoalbuminaemic (albumin &lt;30) on admission, colectomy was more likely (p=0.026), by Fisher9s exact test. Mean CRP on admission was statistically higher in those requiring surgery(103.1 vs 46.9 p=0.03). 2/3 patients who had a CRP&gt;50 combined with albumin &lt;30 at admission required colectomy. <h3>Conclusion</h3> In our cohort, raised CRP and significant hypoalbuminaemia on admission were associated with need for colectomy on the same hospital admission. These markers help to categorise patients into high risk who warrant early surgical assessment.
Environmental effects of increased coal utilization: ecological effects of gaseous emissions from coal combustion.
Authors: N R Glass
Journal: Environmental Health Perspectives (1979)

This report is limited to an evaluation of the ecological and environmental effects of gaseous emissions and aerosols of various types which result from coal combustion. It deals with NOx, SOx, fine particulate, photochemical oxidant and acid precipitation as these pollutants affect natural and managed resources and ecosystems. Also, synergistic effects involving two or more pollutants are evaluated as well as ecosystem level effects of gaseous pollutants. There is a brief summary of the effects on materials and atmospheric visibility of increased coal combustion. The economic implications of ecological effects are identified to the extent they can be determined within acceptable limits. Aquatic and terrestrial effects are distinguished where the pollutants in question are clearly problems in both media. At present, acid precipitation is most abundant in the north central and northeastern states. Total SOx and NOx emissions are projected to remain high in these regions while increasing relatively more in the western than in the eastern regions of the country. A variety of ecological processes are affected and altered by air pollution. Such processes include community succession and retrogression, nutrient biogeochemical cycling, photosynthetic activity, primary and secondary productivity, species diversity and community stability. Estimates of the non health-related cost of air pollutants range from several hundred million dollars to $1.7 billion dollars per year. In general, these estimates include only those relatively easily measured considerations such as the known losses to cultivate crops from acute air pollution episodes or the cost of frequent repainting required as a result of air pollution. No substantial nationwide estimates of losses to forest productivity, natural ecosystem productivity which is tapped by domestic grazing animals and wildlife, and other significant dollar losses are available.
AAAS Conference Explores Ethical Aspects of Large Pedigree Genetic Research
Authors: Richard M. Glass
Journal: JAMA (1992)

JAMES D. WATSON, PhD, codiscoverer of the DNA double helix and director of the Human Genome Project, has characterized the genome project as "a 'public good' in the best sense" because its principal goal is "to assist biomedical researchers in their assault on disease" (<i>JAMA</i>. 1990;263:3322). However, the plan to map and sequence the human genome has also raised a number of ethical concerns about such issues as the potential for a revival of eugenics (<i>JAMA</i>. 1992;267:1715-1716) and genetic discrimination in employment and insurance (<i>JAMA</i>. 1991;266:1835-1836). Recognizing the need to address such issues, the National Center for Human Genome Research, National Institutes of Health, Bethesda, Md, included an Ethical, Legal, and Social Implications (ELSI) Program as part of the funding for the project. As one aspect of its activities, the ELSI Program funded a project on the ethical and legal implications of genetic testing, organized by the American Association for
New uses for existing treatments
Authors: F. Godlee
Journal: BMJ (2011)

Two months on from widespread media reports that aspirin reduces deaths from common cancers, are you encouraging your middle aged and older patients to take a daily aspirin? Are you taking one yourself? The reports were based on an impressive meta-analysis published in the Lancet by Peter Rothwell and colleagues ( Lancet 2010;376:1741-50). They looked at individual patient data from randomised trials of daily aspirin versus control and found about a 20% reduction in deaths from cancer at five and 20 years.

You may remember that the BMJ ’s editorial on the paper was more circumspect ( BMJ 2011;342:5-6). In it, Paul Moayyedi …