tbuckley/cabot-search huggingface dataset:
The Valsalva Maneuver in Diabetic Neuropathy
Authors: Samuel Vaisrub
Journal: JAMA (1974)

Two hundred and seventy years ago Antonio Maria Valsalva ("De Aure Humana," 1704) recommended forced expiration against a closed glottis, for expelling pus from an infected middle ear. This procedure, known thereafter as the Valsalva experiment or maneuver, has been used extensively in the treatment of eustachian tube obstruction. However, its potential for the study of circulatory physiology was not suspected. Nor was this potential appreciated even when, nearly a century and a half later, Eduard Friedrich Weber (1851) found that the Valsalva maneuver caused changes in the volume of the pulse. And only after Flack<sup>1</sup>(1920) modified the maneuver by having patients blow against a column of mercury rather than against a closed glottis did investigations of the complex physiologic changes set in motion by this procedure begin in earnest. Only during the past two decades have the diagnostic implications of these changes become apparent. Normally, an abrupt
Cardiac Blood Pool Visualization by Ga-67 Scintigraphy at 48 Hours in a Patient with Severe Heart Failure
Authors: PHILIP PASPA, ASSAD MOVAHED
Journal: Clinical Nuclear Medicine (1993)

Ga-67 scintigraphy can be useful in the diagnosis of myocarditis and, therefore, can affect the management of patients who have severe congestive heart failure. Because biopsy results can be focal, a biopsy may miss areas affected by the myocardiopathic process. In such an instance, Ga-67 imaging can provide valuable information. Obviously, the results of the scan would affect management decisions drastically. Presented here is a case in which the Ga-67 scan at 48 hours showed cardiac blood pool visualization, indicating severe left ventricular dysfunction and secondary renal failure. This became apparent from additional Ga-67 scintigraphic images obtained at 144 hours.
Geographic variations in the effect of atopy on asthma in the European Community Respiratory Health Study
Authors: Jordi Sunyer, Deborah Jarvis, Juha Pekkanen, Susan Chinn, Christer Janson, Benedicte Leynaert, Christina Luczynska, Raquel Garcia-Esteban, Peter Burney, Josep M. Antó
Journal: Journal of Allergy and Clinical Immunology (2004)
Scarlatina After Operations
Authors: Lawrence J. Severino
Journal: JAMA (1983)

To the Editor.—  The discussion by Bartlett et al of toxic shock syndrome associated with surgical wound infection inThe Journal(1982;247:1448) is an illustration that even in medicine, There is no new thing under the sun (Ecclesiastes 1:9). The advances in medicine change with the times, but the description of disease is constant and varies only with the skill of the observer. I would like to bring to the attention of the authors a description of a report entitled Scarlatina After Operations, which was delivered by James Paget at St Bartholomew's Hospital in 1863.  Mr Paget described ten cases of scarlatina following surgery. His colleagues surmised that these cases were only casual coincidences of scarlatina with surgical diseases, since scarlet fever was prevalent in London at this time. Paget noted that if this were so, he should find a proportionate number of cases among surgical patients not operated on,
The Expert Witness
Authors: Alfred P. French
Journal: JAMA (1985)

To the Editor.—  In a recent letter, Mr Uzych 1 expressed the opinion that litigation by its nature is adversarial.... The expert medical witness may suffer a wrenching experience as a seasoned trial attorney tortures the `truth' in an effort to obtain a good result for the client.  In another letter in the same issue, Oxley 2 makes the following criticism of a recent article by G. W. Kindschi 3 :  makes no mention of the fundamental medical issue.... [He] should be cautious in making unsubstantiated statements about how frozen sections contribute to excessive medical care costs.  Lefer 2 disagrees sharply with  Kindschi's opinions and conclusions.  Kern 2 opines that  traditional view of the frozen section examination unnecessarily restricts useful operating room consultation.  Mawk 2 states that Dr Kindschi... has failed to address three important surgical concerns. I suspect that  Kindschi, in reading this
Transient transmural reduction of myocardial blood flow demonstrated by thallium-201 scintigraphy, as a cause of variant angina.
Authors: A Maseri, O Parodi, S Severi, A Pesola
Journal: Circulation (1976)

In previous studies we demonstrated that variant angina could not be attributed to increased myocardial demands. In order to investigate whether a reduction of regional myocardial blood supply could be responsible for these ischemic episodes, we studied regional myocardial perfusion in six patients admitted to our coronary care unit. Myocardial scintigrams, obtained 5-7 min following i.v. injection of 1 mCi of thallium-201, performed during an episode of ST-segment elevation, showed transmural deficits of tracer uptake in the heart wall corresponding to the leads showing ST-segment elevation. These regional deficits ahd disappeared by 2 hours because of late uptake in previously ischemic myocardium. One week later, following injections performed in the absence of acute ischemia, no deficit was apparent. Tracer uptake in ischemic areas was 60% to 85% of that observed a week later. After adjusting for thallium-201 kinetics and counting geometry promblems., these scintigrams actually represent large underestimations of actual flow reduction. Thus variant angina appears to be caused by massive transmural reduction of myocardial blood supply.
ACC/AHA/AACVPR/AAFP/ANA Concepts for Clinician–Patient Shared Accountability in Performance Measures
Authors: Eric D. Peterson, P. Michael Ho, Mary Barton, Craig Beam, L. Hayley Burgess, Donald E. Casey, Joseph P. Drozda, Gregg C. Fonarow, David Goff, Kathleen L. Grady, Dana E. King, Marjorie L. King, Frederick A. Masoudi, David R. Nielsen, Stephen Stanko
Journal: Journal of the American College of Cardiology (2014)
TRANSCATHETER AORTIC VALVE REPLACEMENT FOR FAILED SURGICAL BIOPROSTHESES. EARLY RESULTS FROM THE PARTNER II VALVE-IN-VALVE REGISTRY
Authors: John Webb, Michael Mack, Todd Dewey, Danny Dvir, Kevin Greason, Howard Herrmann, Samir Kapadia, Jonathan Leipsic, Raj Makkar, D. Craig Miller, Augusto Pichard, Lowell Satler, Rakesh Suri, Mathew Williams, Craig Smith, Martin Leon
Journal: Journal of the American College of Cardiology (2014)
Clonal deletion of postthymic T cells: veto cells kill precursor cytotoxic T lymphocytes.
Authors: K Hiruma, H Nakamura, P A Henkart, R E Gress
Journal: The Journal of Experimental Medicine (1992)

Veto cell-mediated suppression of cytotoxic T lymphocyte (CTL) responses has been proposed as one mechanism by which self-tolerance is maintained in mature T cell populations. We have previously reported that murine bone marrow cells cultured in the presence of high-dose interleukin 2 (IL-2) (activated bone marrow cells [ABM]) mediate strong veto suppressor function. To examine mechanisms by which ABM may suppress precursor CTL (p-CTL) responses, we used p-CTL generated from spleen cells of transgenic mice expressing a T cell receptor specific for H-2 Ld. It was demonstrated that the cytotoxic response by these p-CTL after stimulation with irradiated H-2d/k spleen cells was suppressed by DBA/2 (H-2d) ABM, but not by B10.BR (H-2k) ABM or dm1 (Dd, Ld mutant) ABM. Flow cytometry analysis with propidium iodide staining revealed that these p-CTL were specifically deleted by incubation with H-2d ABM, but not with H-2k ABM. These data indicate that ABM veto cells kill p-CTL with specificity for antigens expressed on the surface of the ABM, and that the mechanism for veto cell activity of ABM is clonal deletion of p-CTL.
791 IMPACT OF ANTIVIRAL TREATMENT ON NON INVASIVE PREDICTORS OF LIVER FIBROSIS IN HIV-HCV CO-INFECTED PATIENTS: THE FIBROVIC 2 STUDY-ANRS HC02
Authors: P. Halfon, F. Carrat, P. Bedossa, J. Lambert, G. Penaranda, C. Perronne, S. Pol, P. Cacoub
Journal: Journal of Hepatology (2008)
Mother knows best
Authors: T. Smith
Journal: BMJ (1996)

This year is the 50th anniversary of the publication of Dr Benjamin Spock's Baby and Child Care, which in successive revised editions has sold over 43 million copies. Single handed, Spock transformed the way that parents brought up their babies, giving them confidence to make their own decisions about feeding, soothing, loving, and training their children.

In the first half of this century advice on the care of babies was dominated by psychologists who asserted—with the confident arrogance of evangelists—that mothers should use the discoveries of behavioural science to condition their babies. They …
Psychoanalysis: Waning or Waxing?-Reply
Authors: Paul W. Mosher
Journal: JAMA (1995)

<h3>In Reply.</h3> —In his response to our letter, Dr Poreh cites data showing that the proportion of psychiatrists and psychologists entering psychoanalytic practice has declined. He offers this fact as a rebuttal to our pointing out that claims of some sort of decline in psychoanalysis are false. If the number of psychiatrists and psychologists in the United States had been static during the two decades under consideration, Poreh's point would have merit. Instead, of course, both fields have undergone significant growth as new nonpsychoanalytic treatment modalities have been developed. These new biological and psychological treatment modalities have made it possible to treat conditions that are not amenable to psychoanalysis. However, at the same time, as we showed, the absolute number of psychoanalytic practitioners in the United States has increased significantly. In addition, Poreh accepts and then dismisses the data we supplied indicating the large increase in the absolute number of
Effects of sustained low-flow ischemia on myocardial function and calcium-regulating proteins in adult and senescent rat hearts
Authors: Patrick Assayag, Danièle Charlemagne, Isabelle Marty, Joël de Leiris, Anne Marie Lompré, François Boucher, Paul-Etienne Valère, Sylviane Lortet, Bernard Swynghedauw, Sophie Besse
Journal: Cardiovascular Research (1998)

Objective: Both aging and myocardial ischemia are associated with alterations of calcium-regulating proteins. We investigated the effects of graded levels of low-flow ischemia on myocardial function and on SR Ca2+-ATPase (SERCA2), Na+-Ca2+ exchanger (NCx) and ryanodine receptor (RyR2), at mRNA and protein levels in both adult and senescent myocardium. Methods: Isolated hearts from 4 and 24 month old (mo) rats were retrogradely perfused during 180 min at 100% (100% CF, n=11 and n=11 respectively), 30% (30% CF, n=10 and n=12) or 15% (15% CF, n=13 and n=8) of their initial coronary flow, and active tension and coronary resistance (in % of their baseline value) were recorded. After 180 min of perfusion, NCx, RyR2 and SERCA2 mRNAs (in % of age-matched 100% CF group value) and protein levels were quantitated in the left ventricles by slot blot and Western blot analysis, respectively. Results: In 24 mo hearts, low-flow ischemia induced a greater fall in active tension (−65±7% vs. −40±4% in 4 mo 30% CF, p<0.01 and −82±2% vs. −60±5% in 4 mo 15% CF groups, p<0.05 after 15 min of ischemia) and a greater increase in coronary resistance (+357±44% vs. +196±39% in 4 mo 30% CF, p<0.05 and +807±158% vs. +292±61% in 4 mo 15% CF groups, p<0.001 after 15 min of ischemia). An increased accumulation of SERCA2 (+36%) and NCx (+46%) transcripts, but not RyR2, already occurred in 24 mo 30% CF group while the 3 transcripts accumulated in 24 mo 15% CF group. In 4 mo rats SERCA2 (+26%), NCx (+35%) and RyR2 (+81%) mRNA levels only increased in the 15% CF group. Corresponding calcium-regulating protein levels were unaltered whatever the degree of flow reduction in both 4 mo and 24 mo hearts. Conclusion: Low-flow ischemia does not induce calcium-regulating protein loss in both adult and senescent hearts. The increase in mRNAs coding for calcium-handling proteins and the impairment of myocardial function which occur at a lesser degree of coronary flow reduction in senescent hearts, indicate a higher vulnerability to low-flow ischemia during aging.
Student elective in Papua New Guinea
Authors: G. A Parsons
Journal: BMJ (1982)

prenatal life.Psalm 139 speaks of God's care and concern for the developing embryo.5It is clear that the unborn child is regarded in scripture as a unique and specific individual from the earliest days of pregnancy.6-There are no grounds, biological or biblical, for a careless or shallow view of the value of human life or the contention that the zygote is not a human being.A leading article in a recent Christian Medical Fellowship quarterly newsletter con- cludes: "We should be constantly affirming God's abiding principles for man as stewards of His creation.Christians are rightly in the forefront of science.Man was ordained to control and replenish the earth.We can adequately discharge this responsibility only through constant reference to the Creator's objectives and His principles by which man is to relate to man....The ability to perform is not license to do.Each test-tube test must itself be tested by those laws which on Judgment Day will inexorably test every man." 9
Harry Goldblatt: 1891-1977
Authors: Leonard B. Berman
Journal: JAMA (1977)

The recent death of Harry Goldblatt bids us to pause and reflect on the affairs of men. The Nobel Prize committee is likely to continue its policy of not asking me for suggestions but I, unabashed, offer Dr Goldblatt's name. The experiment that gave rise to the eponymic kidney is well known, but his reasons for clamping the renal artery and the unexpected consequences may bear a brief retelling. Goldblatt's passion was to find the cause of essential hypertension. As a young pathologist, he was greatly taken with the thought that nephrosclerosis is a primary disease that leads to hypertension. His problem was that the experimental production of nephrosclerosis in a normotensive animal is impossible, but there might be an analogy between the kidney with nephrosclerosis and a kidney with a tiny clamp on each afferent arteriole. He wondered if partially occluding both main renal arteries with large clamps would
Food fortification cuts cases of spina bifida in Canada
Authors: Robert Short
Journal: BMJ (2004)

The fortification of a nation's food with folic acid dramatically reduces the incidence of spina bifida and other neural tube defects. This benefit occurs without masking vitamin B-12 deficiency in elderly people, a theoretical risk of fortifying food with folic acid.

These were the findings of Canadian researchers who studied the population in Newfoundland, an area with historically high rates of neural tube defects ( BMC Pregnancy and Childbirth 2004;4:20). They found that the rate of such defects was 78% lower after fortification. They conclude that fortifying food with folic acid at the …
Non-medical use of ketamine: Author's reply
Authors: K. L R Jansen
Journal: BMJ (1993)

standard that centres could embellish as they wished.This advanced life support course was piloted in 1992 and is now available to centres that conform with the requirements.Advertisements often state that courses conform to the guide- lines of the European and British Resuscitation Councils.However, some centres fail to satisfy the standards laid down for the new advanced life support course.The Resuscitation Council (UK) has therefore agreed to approve on request every course that satisfies the advanced life support requirements.These courses will be given a number that can be checked with the coordinator at our London office and successful participants on the courses will be entitled to receive a certificate from the Resuscitation Council.
Insulin-like growth factor I gene expression in isolated rat renal collecting duct is stimulated by epidermal growth factor.
Authors: S A Rogers, S B Miller, M R Hammerman
Journal: Journal of Clinical Investigation (1991)

The renal collecting duct is a site of insulin-like growth factor I (IGF I) synthesis. Epidermal growth factor (EGF) is also synthesized within the kidney in the thick ascending limb of Henle's loop and the distal tubule. EGF has been shown to regulate IGF I expression in nonrenal tissues. To shed light upon a role of EGF in intrarenal regulation of IGF I gene expression, plasma membranes prepared from collecting ducts isolated from rat kidney and collecting ducts themselves were incubated in the presence and absence of recombinant human EGF (hEGF). hEGF enhanced phospholipase C activity in collecting duct plasma membranes establishing the potential for EGF signal transduction at this site. Inclusion of hEGF in suspensions of collecting ducts increased production of immunoreactive IGF I in a concentration-dependent manner. Production was stimulated significantly by addition of 10(-8) or 10(-6) M hEGF to suspensions for 2 h. Levels of IGF I mRNA in collecting ducts were increased 2.8-fold after incubation with 10(-6) M hEGF in vitro. Our findings demonstrate a direct action of hEGF to enhance collecting duct IGF I gene expression in vitro. Such enhancement is likely to reflect an effect of EGF to stimulate IGF I production in the collecting duct of the intact kidney. Since EGF is produced in kidney, our findings are consistent with intrarenal paracrine regulation of IGF I gene expression by EGF.
Comparison of Plasmapheresis and Intravenous Immunoglobulin as Maintenance Therapies for Juvenile Myasthenia Gravis
Authors: Wendy K. M. Liew, Christine A. Powell, Steven R. Sloan, Robert C. Shamberger, Christopher B. Weldon, Basil T. Darras, Peter B. Kang
Journal: JAMA Neurology (2014)

Juvenile myasthenia gravis (MG) is a relatively rare autoimmune disorder. The comparative efficacy of plasmapheresis (PLEX) vs immunoglobulin as maintenance therapy is unclear for this childhood disease.To determine whether PLEX or intravenous immunoglobulin (IVIG) therapy is more effective as maintenance therapy in this disease.This retrospective analysis over a 33-year period involved 54 children and adolescents with juvenile MG at a specialized neuromuscular clinic and electromyography laboratory at a tertiary care academic pediatric hospital.Plasmapheresis and IVIG.Response to treatment was measured by both improvement in objective physical examination findings and the patients’ reported improvement in symptoms and functional abilities.Subjective and objective outcomes correlated well. Both PLEX and IVIG had high response rates. Of the 27 patients with generalized juvenile MG receiving PLEX, IVIG, or both treatments, 7 of 7 patients treated with PLEX alone responded, 5 of 10 patients treated with IVIG alone responded, and 9 of 10 patients who received both responded. There was a significant difference in response rates between patients who received PLEX vs IVIG (P = .04). The youngest age at which PLEX was initiated via peripheral venous access was 9 years, while the youngest child who received IVIG was 9 months old. Thymectomy was performed in 17 children, of whom 11 experienced significant postoperative improvement.This study provides class III evidence that PLEX and IVIG both have high response rates as maintenance therapies and are reasonable therapeutic options for juvenile MG. Plasmapheresis may have a more consistent response rate than IVIG in this setting. These findings will provide some guidance regarding the approach to therapy for juvenile MG, especially as the results differ somewhat from those of studies focusing on adult MG.
A64: Patient-Reported Side Effects with Weekly Injections of Methotrexate in Tertiary Care Rheumatology Clinic
Authors: Melanie Bechard, Julie Lemieux, Johannes Roth, Karen Watanabe Duffy, Ciaran M. Duffy, Mary Aglipay, Nick Barrowman, Roman Jurencak
Journal: Arthritis & Rheumatology (2014)

Background/Purpose: Methotrexate is frequently used to treat a variety of paediatric rheumatologic conditions. We explored patient‐reported frequency of side effects and coping strategies for weekly injections of subcutaneous methotrexate. Methods: A prospective observational cohort study was conducted from June 2013 through August 2013. All patients with clinic appointments in rheumatology during this period were screened for eligibility. Patients aged 4–17 years who were currently receiving weekly subcutaneous methotrexate injections for at least 4 weeks were invited to participate in the study. A focused interview with the patient and family members, conducted by one interviewer, investigated their experiences with subcutaneous methotrexate. The interview consisted of 18 questions and required approximately 10 minutes to complete. Results: 42 patients met inclusion criteria and 41 consented to participate in the study. The mean age was 11.2 years (SD = 3.9 yrs) and 68% of participants were female. Most of these patients were diagnosed with juvenile idiopathic arthritis (73%). Mean duration of therapy with subcutaneous injections of methotrexate was 2.5 years (SD = 2.1 yrs) and the dosing range was 0.3\N1 mg/kg/week (maximum 25 mg/week). Almost all patients (95%) reported excellent adherence to the treatment regimen, missing less than one dose per month. The two most commonly reported side effects were nausea and vomiting (56% and 34% of patients, respectively). Less frequently reported side effects included fatigue (29%), anorexia (24%), headache (15%), and recurrent oral ulcers (10%). Of patients who experienced nausea, 74% used dimenhydrinate while 48% used ondansetron to manage their symptoms. Similarly, many patients who experienced vomiting tried to alleviate their symptoms with dimenhydrinate (64%) or ondansetron (50%). While dimenhydrinate effectively treated nausea in only 42% of patients, most patients reported good efficacy of ondansetron (83%). A similar effect was observed for treatment of vomiting (efficacy of dimenhydrinate 12% versus ondansetron 75%). None of the patients tried ginger to alleviate nausea/vomiting. Except for oral ulcers, clinical side effects resolved within 24 hours in 88% of patients. Of patients who had used oral methotrexate in the past, only 26% felt that the oral form was better tolerated. Conclusion: More than half of the patients reported at least one side effect that could be attributed to methotrexate injections; the most frequent ones were nausea and vomiting. Importantly, most side effects resolved within 24hours and patients reported excellent compliance. In general, patients did not have a preference for oral methotrexate.
Pitfalls in Vein Surgery
Authors: Karl A. Lofgren
Journal: JAMA (1964)

Varicose veins and their complications often present a problem in satisfactory management. Three major pitfalls are responsible for unsatisfactory results of vein surgery: (1) inaccurate diagnosis, (2) incomplete surgery, and (3) inadequate follow-up. Each one must be recognized and then carefully avoided if effective treatment of this chronic, widespread disorder is to be achieved.
Sickle Cell Disease and Viral Hepatitis
Authors: ELIZABETH BARRETT-CONNOR
Journal: Annals of Internal Medicine (1968)

A review of patients with hepatitis who were hospitalized over a 7-year period revealed 6 cases with predominantly S hemoglobin and 10 with sickle cell trait. The clinical, laboratory, and liver biopsy pictures in these patients were comparable with findings in patients without sickle cell hemoglobinopathy, whether or not anemia was present. The only significant difference was severe hyperbilirubinemia in patients with sickle cell anemia. The bilirubinemia appears to represent the increased load of red cell breakdown products on an acutely damaged liver and is not an effect of anemia per se or a reflection of underlying liver disease. Biopsy specimens failed to demonstrate intrahepatic sickling as the cause of the acute illness or as a complicating factor. The liver disease of sickle cell anemia, frequently attributed to intrahepatic sickling, may also reflect unrecognized viral hepatitis or its sequels.