tbuckley/cabot-search huggingface dataset:
US moves to tighten law on health supplements
Authors: Deborah Josefson
Journal: BMJ (2001)

US lawmakers are looking into imposing tighter regulations on the dietary supplement market in an attempt to prevent false claims being made by manufacturers about the safety or efficacy of a product.

They are considering overturning the 1994 Dietary Health and Supplement Act, which removed herbal remedies and nutritional supplements from the jurisdiction of the Food and Drug Administration. Under the existing act, manufacturers of supplements are not required to prove that their products are safe and effective before putting them on the market. Also, …
Developing primary palliative care
Authors: Paul A Fox
Journal: BMJ (2005)

Developing primary palliative care Continuity of care is paramount but needs to be tailored individuallyEditor-Riley suggests that completion of a form detailing palliative care management should be mandatory for general practitioners. 1 I have spent a great deal of time promoting palliative medicine in primary care, with variable success.Much depends on the individual practitioner's experience and interest, which probably accounts for the variable success of handover forms to communicate with out of hours services.Making this a compulsory part of general practice might bring all practice to the same level.But the initial answer to the question, "Would I be surprised if my patient died in the next 12 months?"would then make the difference.Cynical practitioners would probably answer no for nearly all of their patients, for the longer you practise the less often you are surprised.But, in truth, for many patients in general practice the answer to this question would be no: many elderly patients who live in nursing or residential homes, nearly all patients with chronic disease, including heart disease, chronic obstructive pulmonary disease, neurological disease, and so on.The workload in handing these patients over to the out of hours service would be huge, more so for the out of hours service than the individual practice.Continuity of care for patients who most need it is paramount, including all those with chronic disease.However, more sophisticated systems are needed to meet patient needs: perhaps different systems for different diseases, possibly different systems for each stage of a disease.Whatever the system, it must meet the needs of the individual patient.This entails dialogue between primary care (including out of hours), secondary care, and tertiary care to thrash out the detail.
Selective Deficiency of 1,25-Dihydroxycholecalciferol
Authors: Metz Sa, Baylink Dj, Hughes Mr, Haussler Mr, Robertson Rp
Journal: New England Journal of Medicine (1977)

To investigate the role of vitamin D metabolites in the pathogenesis of pseudohypoparathyroidism, we studied an elderly man with a unique variant of the disease, which was characterized by hypocalcemia, elevated serum parathyroid hormone (513 +/- 13 pg per milliliter, mean +/- S.E.M., normal, less than 450) but normal renal responses (phosphate and cyclic AMP) to exogenous parathyroid extract. Treatment with parathyroid extract did not produce a calcemic effect, suggesting an isolated skeletal hyporesponsiveness to parathyroid hormone. Although 25-hydroxyvitamin D levels were not reduced, levels of 1,25-dihydroxycholecalciferol were extremely low (0.52 ng per deciliter; normal 3.3 +/- 0.06, S.D.). Treatment with 1,25-dihydroxycholecalciferol (1 microgram by mouth per day for four days) increased circulating levels to normal (4.60 ng per deciliter) and restored to normal the calcemic response to parathyroid (change in calcium 3.0 mg per deciliter). These data suggest that 1,25-dihydroxycholecalciferol deficiency may explain the skeletal resistance, but not the renal resistance, often present in classic pseudohypoparathyroidism.
CHRONIC ADHESIVE SCLEROSING PERITONITIS, OR PLASTIC PERITONEAL SCLEROSIS.
Authors: HORACE G. WETHERILL
Journal: JAMA (1904)

The "chronic adhesive sclerosing peritonitis" of the Germans is a rare disease, and, so far as I can determine, has escaped recognition and description in most of our American text-books. One or two articles in the current medical journals of the last ten years describe conditions resembling true chronic adhesive sclerosing peritonitis, but the disease is nowhere accurately described as a distinct pathologic entity. This is all the more remarkable, as it appears to be well known in Germany, Virchow having alluded to it as long ago as 1853, and Riedel has recently considered the subject comprehensively. In the new edition of the "Handbuch der Practischen Chirurgie" by von Bergmann, von Bruns and von Mikulicz (Vol. 3, p. 85), a detailed description of the disease is to be found and the pathologic picture is so closely similar to the findings at the operation and necropsy in the case here reported
Tracheotomy — Its Complications and Their Management
Authors: James W. Meade
Journal: New England Journal of Medicine (1961)

THE following comment, written forty years ago, is, unfortunately, still applicable:The operation of tracheotomy antedates medical writing. Though one of the oldest operations in surgery, it is the one most frequently done improperly, and oftenest mismanaged in the aftercare.1 There is little emphasis in medical or nursing instruction on the proper postoperative management of tracheotomy or the formidable complications that may attend it. The purpose of this paper is to discuss these problems.A study of 212 consecutive, unselected tracheotomies performed by the House Staff of the Boston City Hospital (January, 1957, through June, 1959) is presented. The patients . . .
Prenatal Diagnosis of Tay-Sachs Genotypes
Authors: R. Navon, B. Padeh
Journal: BMJ (1971)

Hexosaminidase activity was determined in cultured and uncultured amniotic fluid cells taken from seven pregnant women who had previously given birth to infants with Tay-Sachs disease. Complete deficiency of hexosaminidase A was found in one case, indicating a Tay-Sachs fetus. The diagnosis was confirmed on examination of various tissues after therapeutic abortion. Of the other six cases three were considered heterozygous and three homozygous normal. These diagnoses were confirmed postnatally on examination of cord blood leucocytes, peripheral leucocytes, and urine. The activity of hexosaminidase A is appreciably decreased in dead cells and hence in uncultured amniotic fluid cells. Hence reliable identification in utero of the three genotypes may be achieved only by examining the cultured living amniotic cells.
Knowledge about tests for HIV antibodies among pregnant women
Authors: N Desmond, H Morgan, P Kell
Journal: BMJ (1994)

EDITOR, - Angus Nicoll and colleagues highlight the increasing prevalence of HIV infection in pregnant women in London.1 We recently investigated patients' understanding of antenatal testing for antibodies to HIV at an inner London obstetric unit. Anonymous self completion questionnaires were issued to 238 women attending the antenatal clinic over three months; 16 women refused to complete them, giving a response rate of 93.3%. All the women had previously seen a doctor and a midwife during the pregnancy. Anonymous, unlinked tests for HIV antibodies were being carried out in …
Laënnec vs. Laennec
Authors: Lazarus Faller
Journal: JAMA (1961)

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Jejunogastric Intussusception, an Acute Exacerbation Diagnosed by Gastroscopy
Authors: K. Ertresvaag, J.F.W. Haffner
Journal: Endoscopy (1981)

A case of acute jejunogastric intussusception is reported. The patient had suffered intermittent attacks for 7 years, and had an acute fulminating attack prior to the present admission. Chronic recurrent jejunogastric intussusception should be considered a possible cause of pain and vomiting in patients who have had gastrojejunostomy or gastric resection.
How doctors' anonymity in family courts is under threat
Authors: Jonathan Gornall
Journal: BMJ (2006)

How doctors' anonymity in family courts is under threat Gornall is way out of dateEditor-Gornall is embarrassingly out of date in his detailed analysis of the B case (which was dealt with by the family courts nearly three years ago), and its relevance to proposed changes in the law to make the English family court system more transparent. 1 Since then, notwithstanding the ever increasingly exaggerated claims from some quarters that opening the family courts would harm children and deter court experts, the courts themselves are acknowledging the need for English family courts to do their business in the more transparent way that courts in Canada, Australia, and of course Scotland have done without apparent difficulty for years.Several High Court judgments have recorded judicial support for more openness to increase public confidence, and Gornall fails to mention that the president and many of his senior judges are in favour of change in this direction.In a landmark case which was decided on 3 November, Munby J agreed that an ongoing case where parents dispute expert evidence that they injured their child should be open to the media.The local authority concerned issued a "position statement" to the press and the reporting in the Times, Guardian, and the Mail on Sunday set out both sides' cases, as did the broadcasting media.A BBC "Real Story" programme on the case allowed a senior official from the local authority ample time to put their case.No vilification of any experts involved was reported.It is likely that more judges will follow Munby J's example and more public interest cases will be opened to the media pending any change in the law.Will the skies fall in?I doubt it, but your readers can judge for themselves.Hopefully they will understand that in complex childcare cases where expert evidence may be tenuous and the stakes for children are very high, public debate can stimulate awareness of the problems faced by all professionals involved in child protection.It's difficult getting the balance right, but doing it in secret doesn't help.
An Unusual Ventilation Perfusion Scintigram in a Case of Immunologic Pulmonary Edema Clinically Simulating Pulmonary Embolism
Authors: RICHARD J. CAMPEAU, JOHN M. FAUST, SAFEER AHMAD
Journal: Clinical Nuclear Medicine (1987)

A case of immunologic pulmonary edema secondary to hydrochlorthiazide allergy developed in a 55-year-old woman that clinically simulated pulmonary embolism. The patient had abnormal washin images with normal washout images on an Xe-133 ventilation study. On the perfusion study, large bilateral central and posterior perfusion defects were present that showed an unusual “mirror image” pattern on the lateral and posterior oblique views. Resolution of radiographic and scintigraphic abnormalities occurred over a 3-day period in conjunction with corticosteroid therapy.
Does ACE genotype influence the development of left ventricular hypertrophy in untreated hypertension
Authors: Jamil Mayet, Kevin P.J. O'Kane, Manjit Shahi, Mick A. Ozkor, Heather A. Johnstone, Neil R. Poulter, Peter S. Sever, Rodney A. Foale, David J. Webb, Simon A. McG. Thom
Journal: Journal of the American College of Cardiology (1996)
Prospective associations between objective measures of physical activity and fat mass in 12-14 year old children: the Avon Longitudinal Study of Parents and Children (ALSPAC)
Authors: C. J Riddoch, S. D Leary, A. R Ness, S. N Blair, K. Deere, C. Mattocks, A. Griffiths, G. Davey Smith, K. Tilling
Journal: BMJ (2009)

<b>Objective</b> To investigate associations between physical activity at age 12 and subsequent adiposity at age 14. <b>Design</b> Prospective birth cohort study with data collected between 2003 and 2007. <b>Setting</b> Original recruitment in 1991-2 of 14 541 pregnant women living in the former County of Avon (United Kingdom). <b>Participants</b> At age 12, 11 952 children were invited to attend the research clinic. Of these, 7159 attended, and 4150 (1964 boys, 2186 girls) provided sufficient data on exposure, outcome, and confounding variables. <b>Main outcome measure</b> Fat mass at age 14, measured by dual emission x ray absorptiometry, associated with physical activity at age 12, measured by accelerometry. <b>Results</b> Prospective associations of fat mass at age 14 (outcome) with physical activity at age 12 (exposure) were strong for both total activity (accelerometer counts/min) and for daily amount of moderate-vigorous physical activity (min/day). An extra 15 minutes of moderate-vigorous physical activity per day at age 12 was associated with lower fat mass at age 14 in boys (by 11.9% (95% confidence interval 9.5% to 14.3%)) and girls (by 9.8% (6.7% to 12.8%)). The proportion of physical activity due to moderate-vigorous physical activity was between 20% and 30% in boys and girls at the two ages. <b>Conclusions</b> Higher levels of physical activity, in particular activity of moderate to higher intensities, are prospectively associated with lower levels of fat mass in early adolescence. Interventions to raise levels of physical activity in children are likely to be important in the fight against obesity.
Book Review Neurological Disorders in Famous Artists, Part 2 (Frontiers of Neurology and Neuroscience. Vol. 22.) Edited by Julien Bogousslavsky and Michael G. Hennerici. 240 pp., illustrated. Basel, Switzerland, Karger, 2007. $112. 978-3-8055-8265-0
Authors: Stephen Jacyna
Journal: New England Journal of Medicine (2007)
Time variation of mitral regurgitant flow in patients with dilated cardiomyopathy.
Authors: G Keren, T H LeJemtel, A A Zelcer, J S Meisner, A Bier, E L Yellin
Journal: Circulation (1986)

Angiographic results in patients with mitral regurgitation suggest that up to 50% of the regurgitant volume occurs during the preejection period. This contrasts markedly with the electromagnetic measurements of mitral regurgitant flow in anesthetized dogs, which suggest that only 5% of mitral regurgitant flow occurs during the preejection period. Therefore, we used two-dimensional and Doppler echocardiography to quantify mitral regurgitation during aortic ejection and in the preejection and postejection periods in eight patients with severe heart failure. Mitral regurgitant volume (RV) was calculated as the difference between total stroke volume (by two-dimensional echocardiography) and forward aortic flow (by pulsed Doppler). Regurgitant velocity (V) and time (RT) were measured by continuous-wave Doppler, and the mean regurgitant area (RAm) was calculated from the RT and mean regurgitant velocity (Vm): RAm = (RV/RT)/Vm. As a first approximation, the RA was assumed to be constant during systole, and the regurgitant volume during aortic ejection and during the preejection and postejection periods was calculated from: RVi = (Vmi) (RTi) (TAm), where Ti represents the duration of the appropriate period. Percentages of total regurgitant volume occurring during the preejection, ejection, and postejection periods were 13 +/- 4%, 79 +/- 5%, and 8 +/- 5%, respectively. Thus, in contrast to previously reported angiographic studies, mitral regurgitation occurs predominantly during the aortic ejection period. These results were not substantially changed by assuming a 20% reduction in effective regurgitant orifice area between the preejection and ejection periods and are consistent with data from chronically instrumented dogs with mitral regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)
Current Sedation and Monitoring Practice for Colonoscopy: An International Observational Study (EPAGE)
Authors: F. Froehlich, J. Harris, V. Wietlisbach, B. Burnand, J.-P. Vader, J.-J. Gonvers
Journal: Endoscopy (2006)

Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice in endoscopy centers internationally.This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient.6004 patients were included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood pressure monitoring in 34 %, and electrocardiography in 24 %. Pulse oximetry was most commonly used for moderately sedated patients, while blood pressure monitoring and electrocardiography were used predominantly for deeply sedated patients. Sedation and monitoring use ranged from 0 % to 100 % between centers. Oxygen desaturation (</= 85 %) occurred in 5 % of patients, of whom 80 % were moderately sedated. On average, three staff members were involved in procedures. An anesthesiologist was present during 27 % of colonoscopies, and during 85 % of colonoscopies using deep sedation.Internationally, sedation and monitoring practice during colonoscopy varied widely. Moderate sedation was the most common sedation method used and electronic monitoring was used in three-quarters of patients. Deep sedation tended to be more resource-intensive, implying a greater use of staff and monitoring.
Empyema due to Klebsiella pneumoniae
Authors: J. M. Reid, R. S. Barclay, J. G. Stevenson, T. M. Welsh, N. McSwan
Journal: Thorax (1967)

Three cases of post-pneumonic empyema due to infection with <i>Klebsiella pneumoniae</i> are reported. All were men considerably debilitated by complicating factors. The presence of persistent fistulae and of lung necrosis makes eradication of this infection very difficult and tedious, and in the management of these cases the objective is to secure adequate removal of necrotic tissue, effective drainage, and finally a satisfactory deroofing procedure to obliterate the empyema cavity.
Renal adenylate cyclase and the interrelationship between parathyroid hormone and vitamin D in the regulation of urinary phosphate and adenosine cyclic 3',5'-monophosphate excretion.
Authors: L R Forte, G A Nickols, C S Anast
Journal: Journal of Clinical Investigation (1976)

This study examined the role of cyclic AMP in the phosphaturic response to parathyroid hormone in vitamin D-deficient rats. Infusion of purified bovine parathyroid hormone (13.3 mug/h) into control, D-fed, or D-deficient, thyroparathyroidectomized rats produced a sixfold increase in renal phosphate and cyclic AMP excretion in D-fed rats, but only a two- to threefold increase in both parameters in D-deficient animals. Intravenous injection of parathyroid hormone over the dosage range from 1-50 mug/kg resulted in a dose-dependent increase in phosphate and cyclic AMP excretion with both D-fed and D-deficient thyroparathyroidectomized rats. However, the D-deficient rats responded to these injections of parathyroid hormone with a two- to threefold increase in both renal phosphate and cyclic AMP excretion at the highest dose of 50 mug/kg, whereas the D-fed animals' response was 35-fold and 11-fold over control excretion levels of phosphate and cyclic AMP, respectively. To directly examine the role of the renal cortical adenylate cyclase system in the blunted phosphaturic and urinary cyclic AMP responses to parathyroid hormone in D-deficient rats, we prepared a plasma membrane fraction enriched in this enzyme activity from the renal cortex of D-fed and D-deficient thyroparathyroidectomized rats. The renal cortical adenylate cyclase of D-deficient rats showed significantly (P less than 0.001) less activation by parathyroid hormone over the hormone concentration range from 0.3 to 7.0 mug/ml than was observed with the enzyme prepared from D-fed animals. Basal adenylate cyclase activity and the fluoride-stimulated enzyme activity were not altered by the state of D-deficiency. These experiments demonstrate that the blunted phosphaturic response to parathyroid hormone observed in D-deficient rats is associated with the reduced responsiveness of the renal cortical adenylate cyclase to the hormone. Moreover, the defect in the renal membrane adenylate cyclase system appears to be localized at the level of PTH binding to membrane receptors or, alternatively, at the level of transmission of the hormone-receptor binding signal to the catalytic moiety of this membrane enzyme.
Aging and Hypothalamic-Pituitary-Adrenal Response to Challenge in Humans*
Authors: TERESA E. SEEMAN, RICHARD J. ROBBINS
Journal: Endocrine Reviews (1994)

AGING is a multifactorial process that results in heterogeneous patterns of progressive morbidity and disability (1–3). This complex process is influenced by multiple internal homeostatic mechanisms which are, in turn, influenced by the external stimuli or stressors. One of the best characterized homeostatic response systems is the hypothalamic-pituitary-adrenal (HPA) axis which coordinates multiple neuroendocrine and metabolic response to stressors. Interest in possible age-related changes in homeostatic regulation, and in HPA functioning in particular, has been stimulated by the fact that men and women who are 65 and over represent one of the fastest growing segments of the population (4). Estimates for the United States alone project that by the year 2000 there will be more than 35 million people aged 65 and over and more than 51 million by the year 2020 (5). The needs of this population in terms of healthcare resources have focused attention on identifying the factors that influence their patterns of disease and disability.