tbuckley/cabot-search huggingface dataset:
Consent may not be needed to save life
Authors: P. Hoyte
Journal: BMJ (1997)

Dr McFadzean and colleagues had to wrestle with some difficult problems over consent, but they had not reached a definitive conclusion when they were pre-empted by the patient's sudden death. Three particular strands of consent had to be considered in this case—the patient's competence to make a decision about her treatment, her past rejection of surgery for this condition, and her subsequent inability to give consent to emergency surgery.

A competent adult patient has a fundamental right to give, or withhold, consent to any examination, investigation, or treatment. For the incompetent adult, no mechanism exists in English and Welsh law for any other person, or indeed a court, to authorise or consent to treatment. In Scotland, however, an application may be made to the Court of Session for the appointment of a Tutor Dative who may deal with issues of consent on behalf of an incompetent patient.1

While it is always good practice to involve …
LONG TERM OUTCOMES ASSOCIATED WITH VASCULAR CLOSURE DEVICE USE IN PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION VIA THE FEMORAL APPROACH: A PROPENSITY SCORE ADJUSTED, PROPENSITY SCORE MATCHED ANALYSIS
Authors: Sripal Bangalore, Venkatesan Vidi, Frederick G. Welt, Pinak B. Shah, Frederic Resnic
Journal: Journal of the American College of Cardiology (2010)
New Opportunities in the Changing Landscape of Prevention
Authors: Derek Yach, Chris Calitz
Journal: JAMA (2014)

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
Developmental stage determines estrogen receptor alpha expression and non-genomic mechanisms that control IGF-1 signaling and mammary proliferation in mice
Authors: Jie Tian, Thomas R. Berton, Stephanie H. Shirley, Isabel Lambertz, Irma B. Gimenez-Conti, John DiGiovanni, Kenneth S. Korach, Claudio J. Conti, Robin Fuchs-Young
Journal: Journal of Clinical Investigation (2011)

Insulin like growth factor–1 (IGF-1) stimulates increased proliferation and survival of mammary epithelial cells and also promotes mammary tumorigenesis. To study the effects of IGF-1 on the mammary gland in vivo, we used BK5.IGF-1 transgenic (Tg) mice. In these mice, IGF-1 overexpression is controlled by the bovine keratin 5 promoter and recapitulates the paracrine exposure of breast epithelium to stromal IGF-1 that is seen in women. Studies have shown that BK5.IGF-1 Tg mice are more susceptible to mammary tumorigenesis than wild-type littermates. Investigation of the mechanisms underlying increased mammary cancer risk, reported here, revealed that IGF-1 preferentially activated the PI3K/Akt pathway in glands from prepubertal Tg mice, resulting in increased cyclin D1 expression and hyperplasia. However, in glands from postpubertal Tg mice, a pathway switch occurred and activation of the Ras/Raf/MAPK pathway predominated, without increased cyclin D1 expression or proliferation. We further showed that in prepubertal Tg glands, signaling was mediated by formation of an ERα/IRS-1 complex, which activated IRS-1 and directed signaling via the PI3K/Akt pathway. Conversely, in postpubertal Tg glands, reduced ERα expression failed to stimulate formation of the ERα/IRS-1 complex, allowing signaling to proceed via the alternate Ras/Raf/MAPK pathway. These in vivo data demonstrate that changes in ERα expression at different stages of development direct IGF-1 signaling and the resulting tissue responses. As ERα levels are elevated during the prepubertal and postmenopausal stages, these may represent windows of susceptibility during which increased IGF-1 exposure maximally enhances breast cancer risk.
Acute Exacerbation of Chronic Hepatitis B Virus Infection After Withdrawal of Lamivudine Therapy
Authors: Pieter Honkoop, Robert A. de Man, Hubert G.M. Niesters, Pieter E. Zondervan, Solko W. Schalm
Journal: Hepatology (2000)

Acute exacerbations of chronic hepatitis B virus (HBV) infection occur after withdrawal of lamivudine therapy in approximately 16% of patients and are considered of little clinical significance. We observed "lamivudine withdrawal hepatitis" accompanied by jaundice and incipient liver failure, but also followed by complete recovery and viral clearance. To investigate the incidence, severity, timing, and virologic characteristics of "lamivudine withdrawal hepatitis" we monitored 41 patients for at least 6 months after discontinuation of nucleoside analogue therapy. The incidence of hepatitis flares was estimated to be 7 of 41 (17%); in 2 of 41 cases (5%), hepatitis flares were associated with jaundice and incipient liver failure. A noticeable feature of the "lamivudine withdrawal hepatitis" flares were the high HBV-DNA levels at the time of the alanine transaminase (ALT) peak. All were wild-type HBV, even the one that emerged from a lamivudine-resistant strain during therapy. To minimize the risk of liver failure and to enhance the elimination of HBV following flares, lamivudine therapy was reinstituted in an icteric patient. Clinical and biochemical remission ensued, followed by loss of HBV DNA and hepatitis B e antigen (HBeAg) seroconversion. Such a virologic response did not occur in 5 other patients with a nonicteric "lamivudine withdrawal hepatitis," who were not retreated with lamivudine. Hepatitis after withdrawal of lamivudine resembles acute hepatitis B with a predominance of anicteric flares within a time frame of 6 months. Active management of hepatitis flares following withdrawal of nucleoside analogue therapy should be investigated further.
Extracellular Redox State Regulates Features Associated with Prostate Cancer Cell Invasion
Authors: Luksana Chaiswing, Weixiong Zhong, Joseph J. Cullen, Larry W. Oberley, Terry D. Oberley
Journal: Cancer Research (2008)

Abstract We have examined the possible role of extracellular reduction-oxidation (redox) state in regulation of biological/biochemical features associated with prostate cancer cell invasion. DU145, PC-3, and RWPE1-derived human prostate cancer (WPE1-NB26) cell lines were used for the present in vitro analysis. Increasing levels of nitric oxide using S-nitroso-N-acetylpenicillamine resulted in a decrease in cell invasion ability, whereas increasing levels of extracellular superoxide radical (O2•−) using xanthine/xanthine oxidase resulted in an increase in cell invasion ability in these three cell lines. WPE1-NB26 cells exhibited an increased glutathione/glutathione disulfide ratio in the medium in comparison with RWPE1 cells (immortalized but nonmalignant prostate epithelial cells), suggesting an alteration of extracellular redox state of WPE1-NB26 cells. We hypothesized that O2•− production at or near the plasma membrane or in the adjacent extracellular matrix at least partially regulated prostate cancer cell invasion. Using adenovirus-mediated extracellular superoxide dismutase (EC-SOD) gene transduction to enzymatically decrease O2•− levels, we showed that in the presence of heparin, adenovirus EC-SOD gene transduction resulted in an increase in the expression of EC-SOD outside the cells with resultant inhibition of cell invasion ability. This inhibition correlated with reduced metalloproteinase [matrix metalloproteinase (MMP) 2/membrane type 1-MMP] activities and increased levels of extracellular nitrite. Our results suggest a prominent role of extracellular redox status in regulation of cell invasion, which may provide opportunities for therapeutic interventions. [Cancer Res 2008;68(14):5820–6]
SET OF THREE NEW INSTRUMENTS FOR THE TREATMENT OF CHRONIC ENDOTRACHELITIS.
Authors: DANIEL H. CRAIG
Journal: JAMA (1906)

The length of the three instruments is equal, and is 22 cm. This length was chosen as the shortest which would enable the gynecologist to satisfactorily accomplish the treatment without allowing his hands to come in contact with the patient. This seemed to me important because this method being designed for use at the office or out-patient clinic the thorough sterilization of the hands consumed too much time. With this length of instrument ordinary manual skill and dexterity render such sterilization entirely unnecessary. The cervical forceps (Fig. 1) was designed to grasp the anterior aspect of the portio vaginalis as near as possible to, but not into, the external os. The tissues are here very often so soft as to tear when so grasped by the ordinary tenaculum or tenaculum forceps under the strain to which this grasp is to be subjected. The ordinary grasp with one blade within and
Natural cell-mediated cytotoxicity against various target cells in patients with epidermodysplasia verruciformis
Authors: Slawomir Majewski, Jacek Malejczyk, Stefania Jablonska, Joanna Misiewicz, Lidia Rudnicka, Slawomir Obalek, Gerard Orth
Journal: Journal of the American Academy of Dermatology (1990)
Distribution of macrovascular disease in scleroderma
Authors: L Stafford, H Englert, J Gover, J Bertouch
Journal: Annals of the Rheumatic Diseases (1998)

Macrovascular disease in scleroderma has recently been described in two comparative studies. The aim of this study was to map its anatomical distribution.In a retrospective cohort study of 20 scleroderma patients, the results of Doppler studies of arteries in the limbs, neck, and abdomen were compared with those from 20 cohort negative patients. The latter were matched for age, sex, and the presence/absence of hypertension, hyperlipidaemia, smoking, and diabetes status. Arteries were compared quantitatively using a body surface area adjusted measurement of intraluminal diameter, and qualitatively using descriptive characteristics of the arterial walls. The latter were binomially categorised under three non-exclusive headings--thickening, stenosis, and calcification.The ulnar arteries in scleroderma patients were significantly narrower than those of the negative cohort. The arterial walls were also characterised by smooth thickening along their entire length. The characteristics of the other arteries, including those of the lower limbs, were not significantly different from those of the negative cohort.The ulnar artery seems to be specifically targeted in patients with scleroderma. Assessment of the ulnar artery should be considered in these patients by means of a modified Allen's test or Doppler sonography especially in the presence of digital gangrene.
Influences of pressure surrounding the heart and intracardiac pressure on the diastolic coronary pressure-flow relation in excised canine heart.
Authors: S Satoh, J Watanabe, M Keitoku, N Itoh, Y Maruyama, T Takishima
Journal: Circulation Research (1988)

We investigated the change in the instantaneous diastolic left coronary pressure-flow relation (DPFR) when the pressure surrounding the heart (SHP), right heart pressure (RHP), and left heart pressure (LHP) were systematically varied. Eight excised and maximally vasodilated canine hearts placed in an air-tight chamber were used. To obtain a capacitance-free DPFR, coronary perfusion pressure was slowly decreased (about 2 mm Hg/sec) during a prolonged diastole. The zero-flow pressure (Pf = 0) and the slope of the DPFR were analyzed. The mean values of the slope did not change significantly throughout the interventions. The mean value of Pf = 0 in the control state (SHP = RHP = LHP = 0 mm Hg) was 6.0 +/- 2.0 mm Hg (mean +/- SD, n = 8), significantly higher than the venous outflow pressure, RHP (p less than 0.001), and the other two pressures (p less than 0.001). When SHP was raised to 15 and 30 mm Hg, while the other pressures remained at 0 mm Hg, the mean values of Pf = 0 increased to 20.9 +/- 2.4 and 35.6 +/- 3.1 mm Hg (p less than 0.001 and p less than 0.0005, respectively, vs. control). The mean values of Pf = 0 when only RHP was elevated to 15 and 30 mm Hg were 16.0 +/- 1.5 and 29.3 +/- 1.5 mm Hg (p less than 0.001 and p less than 0.0005 vs. control). On elevation of LHP to 15 and 30 mm Hg, the mean values of Pf = 0 were 12.0 +/- 2.8 and 17.3 +/- 3.6 mm Hg (p less than 0.01 and p less than 0.01 vs. control). When both SHP and LHP were almost evenly elevated to about 15 and 30 mm Hg, the mean values of Pf = 0 were raised to 22.0 +/- 2.9 and 35.3 +/- 3.2 mm Hg, respectively. These mean values were not significantly different from those when only SHP was elevated to the comparable levels. The observation that Pf = 0 exceeded RHP in the control state and that RHP, which was elevated above the preceding Pf = 0, was identical with the present Pf = 0 supports the vascular waterfall mechanism when RHP is low. Furthermore, the evidence that the degree of DPFR shift was almost linearly dependent on the SHP level rather than on the LHP level indicates that the pressure on the epicardial side is one of the factors that determines the pressure at the top of the vascular waterfall.
99mTc-DISIDA Uptake in Liver Lesion and Pulmonary Metastases Shown on SPECT/CT in a Patient With Hepatocellular Carcinoma
Authors: Cristina Emiko Ueda, Wilson André Ichiki, Mariana Ferraz de Campos Mazo Ruiz, Allan Oliveira Santos, Elba Cristina Sá de Camargo Etchebehere
Journal: Clinical Nuclear Medicine (2013)

A 43-year-old man, previously submitted to right hepatectomy, right hepatic artery chemoembolization, and surgical resection of liver lesions, with well-differentiated and moderately differentiated hepatocellular carcinoma (HCC) confirmed by histopathology, underwent cholescintigraphy with Tc diisopropyliminodiacetic acid (Tc-DISIDA) due to recurrent cholangitis. The scintigraphic images and the coregistered CT images showed radiotracer uptake in an area of biliary ectasia near the hepatic surface (which may be associated with recurrent cholangitis), in a hepatic nodule, and in multiple pulmonary metastases.
Efficacy of augmented immunosuppressive therapy for early vasculopathy in heart transplantation
Authors: Rubén Lamich, Manel Ballester, Vicens Martí, Vicens Brossa, Rosa Aymat, Ignasi Carrió, Lluis Bernà, Marta Campreciós, Mireia Puig, Montserrat Estorch, Albert Flotats, Ramón Bordes, Juan Garcia, Josep M Augè, Josep M Padró, Josep M Caralps, Jagat Narula
Journal: Journal of the American College of Cardiology (1998)
How Korotkoff, the Surgeon, Discovered the Auscultatory Method of Measuring Arterial Pressure
Authors: HAROLD N. SEGALL
Journal: Annals of Internal Medicine (1975)

The Korotkoff sounds that measure systolic and diastolic arterial pressure levels were described in a brief communication by N. C. Korotkoff in 1905. He did not state how it happened that he discovered this auscultatory method of measuring "blood" pressure. The search for information on this matter led to studying the thesis for his doctorate published in 1910 on Experiments for Determining the Efficiency of Arterial Collaterals. It seems that when he wanted to be sure that pressure on an artery (digital, or with an Esmarch ligature or a Riva-Rocci cuff) had completely obliterated its lumen, he listened over the artery below the area of pressure. The absence of any sounds meant complete obliteration; a sound appeared with each beat when some flow did occur during partial obliteration of the lumen and when no pulsation could be detected because of the small volume of flow.
THE RELATIONSHIP BETWEEN HEMOCONCENTRATION AND HYPONATREMIA ON CLINICAL OUTCOMES IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE: DATA FROM THE KOREAN HEART FAILURE (KORHF) REGISTRY
Authors: Jaewon Oh, Seok-Min Kang, Namki Hong, Jong-Chan Youn, Sungha Park, Sang-Hak Lee, Yangsoo Jang, Namsik Chung
Journal: Journal of the American College of Cardiology (2014)
Are there any noninvasive markers for diagnosis of viral hepatitis?
Authors: Z. Aydin, K. Demir, A. Okten, S. Kaymakoglu, N. Salmayenli, S. Ozdil, C. Karaca, A. Danalioglu, G. Koroglu, F. Besisik, G. Boztas, Z. Mungan, U. Cevikbas, Y. Cakaloglu
Journal: Journal of Hepatology (2003)
Incidence of adrenal dysfunction in cirrhosis
Authors: James O’Beirne, Andrew K. Burroughs
Journal: Journal of Hepatology (2008)

We thank Professor McCaughan for his interest in our review and his comments regarding the incidence of adrenal dysfunction in cirrhosis. We apologise for not citing his paper but we chose to focus on studies of adrenal insufficiency in the setting of critical illness, as it is in this particular context that data pertaining to adrenal insufficiency may lead to corticotherapy being applied to patients with liver disease. In our review we highlight the fact that although adrenal insufficiency is common in critically ill patients with liver disease and may be associated with a worse outcome, there are currently no randomised controlled trials that show corticotherapy to be beneficial in this patient group [[1]O’ Beirne J. Holmes M. Agarwal B. Bouloux P. Shaw S. Patch D. et al.Adrenal insufficiency in liver disease – What is the Evidence?.J Hepatol. 2007; 47: 418-423Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar]. In fact, as we discussed in the article the haemodynamic response to steroids may be independent of the degree of adrenal insufficiency and therefore may represent a purely pharmacological effect. This is supported by the recent data from the CORTICUS study group which showed that patients with septic shock treated with corticosteroids have faster resolution of shock which is independent of the response to adrenal stimulation but also have an increased incidence of superinfection and new septic shock [[2]Sprung C.L. Annane D. Keh D. Moreno R. Singer M. Freivogel K. et al.Hydrocortisone therapy for patients with septic shock.N Engl J Med. 2008; 358: 111-124Crossref PubMed Scopus (1659) Google Scholar]. Similar to the report by McCaughan et al. we have also found a high incidence (53%) of adrenal insufficiency in cirrhotic patients [3Sigalas A. Xirouchakis E. Manousou P. Corbani A. Calvaruso V. Patch D. et al.Adrenal impairment is frequent finding in stable cirrhosis and is related to disease severity.Hepatology. 2007; 46: S1PubMed Google Scholar, 4McDonald J.A. Handelsman D.J. Dilworth P. Conway A. McCaughan G.W. Hypothalamic–pituitary adrenal function in end stage non-alcoholic liver disease.J Gastroentrol Hepatol. 1993; 8: 247-253Crossref PubMed Scopus (52) Google Scholar]. It is therefore unclear whether the adrenal insufficiency observed in critically ill liver patients is a pre-existing condition or related to the critical illness per se. Given that there appears to be potential for adverse outcome with corticosteroid therapy we agree with Professor McCaughan that controlled clinical trials examining the role of corticosteroid supplementation in cirrhotic patients with critical illness and adrenal insufficiency are urgently needed.
Procainamide‐induced agranulocytosis with reversible myeloid sensitivity
Authors: John C. Nelson, John D. Lutton, Arthur E. Fass
Journal: American Journal of Hematology (1984)

Abstract A 56‐year‐old man developed procainamide‐induced agranulocytosis. Bone marrow aspiration showed the absence of myeloid elements beyond the promyelocyte stage. Procainamide at therapeutic concentrations in vitro depressed bone marrow granulocyte‐macrophage colonies (CFUc) while CFUc growth was normal in the absence of drug. Following the patient's recovery, CFUc growth was no longer suppressed by procainamide in vitro. The observations in this patient showing reversible sensitivity to drug contrast with those on other patients with drug‐induced agranulocytosis that show persistent marrow injury or drug sensitivity despite clinical recovery.
A CASE OF URETHRAL ECTASIA.
Authors: C. C. FITE
Journal: JAMA (1884)

The description of a case of urethral ectasia or vaginal urethrocele by Professor Santesson in the<i>Nordiskt Medicinskt Arkiv</i>, which you reprint in the Aug. 16 number of theJournalprompts me to report a case of the same kind I saw in March of this year. I did not know that the condition was so rare or I would have put it on record at the time. I had been engaged to treat Mollie H. for what she designated "Womb disease," and in making the necessary examination to ascertain the position and condition of the parts, I made the following discovery. In passing the finger a tumor was felt just under the urethral orifice, and she said at once, "There it is, that is the trouble, it don't hurt much to pass it or to have intercourse, but it pains me in walking and when I make water, and
A deadly oil.
Authors: G Ross
Journal: BMJ (1981)

On 1 May 8-year-old Jaime Vaquero, of Torrej on de Ardoz, a Madrid suburb, died after a brief illness characterised by fever and lower respiratory tract symptoms. Two days later five other members of the family and three of their neighbours were in hospital with a similar illness. A week later 100 more had been admitted and four more had died; an epidemic was officially declared. Mainly the younger population was affected, their ages ranging from 5 to 50. All had presented with some or all of the following: a mild-to-moderate fever (38?-40?C), a dry cough, muscular aches and pains, headache, chest pains, dyspnoea, vomiting, diarrhoea, and an itchy rash. No patient had mucous membrane or upper respiratory symptoms or signs.
Can the Relationship between Doctors and Drug Companies Ever Be a Healthy One?
Authors: Emma D'Arcy, Ray Moynihan
Journal: PLoS Medicine (2009)

The financial ties between doctors and drug companies have come under intense scrutiny in recent years. Some commentators—such as Marcia Angell, former editor-in-chief of the New England Journal of Medicine—argue that the mission of doctors is fundamentally different to the mission of drug companies and that the ties between them should be completely cut. “Drug companies are investor owned businesses with a responsibility to maximise profits for their shareholders,” says Angell [1]. “That is quite different from the mission of the medical profession, which is to provide the best care possible for patients.” Other commentators have argued that clinicians and drug companies do have some shared goals in aiming to maximize human health. In this debate, Emma D'Arcy, co-founder of a social networking site that facilitates interactions between doctors and drug companies, argues that it would be valuable to the public if we could establish “authentic alliances” between these professionals. But journalist Ray Moynihan argues that such alliances are prone to the corrupting influence of pharmaceutical industry money, and that disentanglement is a healthier alternative.