tbuckley/cabot-search huggingface dataset:
Megavitamin Therapy-Reply
Authors: Philip L. White
Journal: JAMA (1975)

In Reply.—  The thrust of my editorial written in support of Dr Juke's comment had to do with the promotion of undesirable laws to restrict the authority of the FDA to regulate over-the-counter sale of vitamin and mineral supplements, the general distortion of the value of vitamins, and the safety of massive doses of vitamins and minerals. The arguments in support of Senator Proxmire's bills have been provided by those who stand to gain the most financially from the unrestricted sale of vitamins. Dr Pauling has been a spokesman for one of those groups.  The legislative issues have little to do with vitamin C and the common cold or with orthomolecular psychiatry. Vitamin C would be taken as a single vitamin and the megavitamins ordered by a psychiatrist would probably be prescription items. Neither single vitamins nor prescription drugs are included in the Proxmire bill.  Dr Sackler pleads for service
Non-specific beneficial effect of measles immunisation: analysis of mortality studies from developing countries
Authors: P. Aaby, B. Samb, F. Simondon, A. M. C. Seck, K. Knudsen, H. Whittle
Journal: BMJ (1995)

<h3>Abstract</h3> <b>Objective</b>: To examine whether the reduction in mortality after standard titre measles immunisation in developing countries can be explained simply by the prevention of acute measles and its long term consequences. <b>Design</b>: An analysis of all studies comparing mortality of unimmunised children and children immunised with standard titre measles vaccine in developing countries. <b>Studies</b>: 10 cohort and two case-control studies from Bangladesh, Benin, Burundi, Guinea-Bissau, Haiti, Senegal, and Zaire. <b>Main outcome measures</b>: Protective efficacy of standard titre measles immunisation against all cause mortality. Extent to which difference in mortality between immunised and unimmunised children could be explained by prevention of measles disease. <b>Results</b>: Protective efficacy against death after measles immunisation ranged from 30% to 86%. Efficacy was highest in the studies with short follow up and when children were immunised in infancy (range 44-100%). Vaccine efficacy against death was much greater than the proportion of deaths attributed to acute measles disease. In four studies from Guinea-Bissau, Senegal, and Burundi vaccine efficacy against death remained almost unchanged when cases of measles were excluded from the analysis. Diphtheria-tetanus-pertussis and polio vaccinations were not associated with reduction in mortality. <b>Conclusion</b>: These observations suggest that standard titre measles vaccine may confer a beneficial effect which is unrelated to the specific protection against measles disease.
Anaesthesia in the dark.
Authors: J D Whitby
Journal: BMJ (1969)

or hypertension or both."There is no way of knowing which of these patients were actually suffering from pre-eclampsia as opposed to essential hypertension or chronic renal disease.McCartney' has shown by electron microscopic study of renal biopsies that the clinical diagnosis of pre-eclampsia is incorrect in primigravidae in 30% and in multiparae in 86% of cases.Drs. Wardle and Menon refer to cryo- fibrinogen as ". . . the early breakdown pro- duct of fibrinogen."Although the identity of this substance is not entirely clear, it is more likely to represent an aggregation of fibrin monomer, perhaps in association with molecular fragments of fibrinogen, and as such represents critical evidence of the action of thrombin on fibrinogen.They also state that " toxaemia is increased when there is uterine distension ... [for example, in] acci- dental haemorrhage."Undoubtedly they in- tend to imply that toxaemia is increased in incidence rather than severity.However, an association of "toxaemia" and accidental haemorrhage is seriously questioned.Hibbard,'for example, has produced figures to show that accidental haemorrhage is no more fre- quent in pregnancies complicated by hyper- tensive disorders than in normal pregnancies.However, accidental haemorrhage frequently produces severe disseminated intravascular coagulation, often with proteinuria, and, in the absence of hypotension, can resemble pre-eclampsia.
Context, connection, and coordination: The need to switch
Authors: Robert D. Oades, Bernd Röpcke, Ljubov Oknina
Journal: Behavioral and Brain Sciences (2003)

Abstract Context, connection, and coordination (CCC) describe well where the problems that apply to thought-disordered patients with schizophrenia lie. But they may be part of the experience of those with other symptom constellations. Switching is an important mechanism to allow context to be applied appropriately to changing circumstances. In some cases, NMDA-voltage modulations may be central, but gain and shift are also functions that monoaminergic systems express in CCC.
Health Care Costs
Authors: Paul Griner
Journal: Annals of Internal Medicine (2005)

Letters6 December 2005Health Care CostsPaul Griner, MDPaul Griner, MDFrom University of Rochester School of Medicine & Dentistry (retired), Washington, DC 20016.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-143-11-200512060-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In his article describing how health care providers contribute to high and rising health care costs in the United States, Bodenheimer (1) notes that the quantity of services is associated with the supply of resources. Strategies to control supply, such as placing hospitals at risk for increased spending, could be effective in controlling costs. Such an approach was used successfully in Rochester, New York, in the 1980s (2, 3). From 1980 to 1989, the 9 hospitals in the Rochester area operated under an all-payer prospective payments system. This system, which featured local administration and control, represented the ...References1. Bodenheimer T. High and rising health care costs. Part 3: the role of health care providers. Ann Intern Med. 2005;142:996-1002. [PMID: 15968014] LinkGoogle Scholar2. Block JA, Regenstreif DI, Griner PF. A community hospital payment experiment outperforms national experience. The Hospital Experimental Payment program in Rochester, NY. JAMA. 1987;257:193-7. [PMID: 3540325] CrossrefMedlineGoogle Scholar3. Hall WJ, Griner PF. Cost-effective health care: the Rochester experience. Health Aff (Millwood). 1993;12:58-69. [PMID: 8509031] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Paul Griner, MDAffiliations: From University of Rochester School of Medicine & Dentistry (retired), Washington, DC 20016.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoHigh and Rising Health Care Costs. Part 1: Seeking an Explanation Thomas Bodenheimer Health Care Costs William L. Berger Metrics 6 December 2005Volume 143, Issue 11Page: 844KeywordsConflicts of interestForecastingHealth careHealth care providersHealth care quality ePublished: 6 December 2005 Issue Published: 6 December 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The VA and Medicare HMOs — Complementary or Redundant?
Authors: Eric J. Hester, Deborah J. Cook, Laurence J. Robbins
Journal: New England Journal of Medicine (2005)

tients stated that they had received less care from the VA after their HMO enrollment.Redundant primary care might lead to confusion among providers and patients, and the dispensing of medications from both systems might lead to serious drug toxicity and interactions.Despite having received capitated payments from the Centers for Medicare and Medicaid Services, Medicare HMOs had not provided any services in the past year for 25 percent of the HMO-enrolled veterans in our study.Currently, the VA and Medicare health care systems remain isolated and independent sources of care for veterans.Providers and policymakers might consider whether enhancement of collaboration and elimination of redundancies might offer important cost savings and improved safety for dually eligible veterans under these two federally funded health care programs.
Suppression of transcription factor early growth response 1 reduces herpes simplex virus lethality in mice
Authors: Shih-Heng Chen, Hui-Wen Yao, I-Te Chen, Biehuoy Shieh, Ching Li, Shun-Hua Chen
Journal: Journal of Clinical Investigation (2008)

Herpes simplex virus type 1 (HSV-1) infection is the most common cause of sporadic, fatal encephalitis, but current understanding of how the virus interacts with cellular factors to regulate disease progression is limited. Here, we show that HSV-1 infection induced the expression of the cellular transcription factor early growth response 1 (Egr-1) in a human neuronal cell line. Egr-1 increased viral replication by activating promoters of viral productive cycle genes through binding to its corresponding sequences in the viral promoters. Mouse studies confirmed that Egr-1 expression was enhanced in HSV-1–infected brains and that Egr-1 functions to promote viral replication in embryonic fibroblasts. Furthermore, Egr-1 deficiency or knockdown of Egr-1 by a DNA-based enzyme greatly reduced the mortality of HSV-1–infected mice by decreasing viral loads in tissues. This study provides what we believe is the first evidence that Egr-1 increases the mortality of HSV-1 encephalitis by enhancing viral replication. Moreover, blocking this cellular machinery exploited by the virus could prevent host mortality.
Prescribing and monitoring lithium therapy: summary of a safety report from the National Patient Safety Agency
Authors: D. Gerrett, T. Lamont, C. Paton, T. R. E. Barnes, A. Shah
Journal: BMJ (2010)

Lithium is a commonly prescribed drug for treating bipolar disorder and unipolar (refractory) depression. Over 800 000 prescriptions for lithium salts were dispensed in England in 2008.1

Lithium has a narrow therapeutic range and may be affected by changes in renal function and fluid balance (for example, when a person is dehydrated or pregnant).2 Its tolerability profile also provides challenges for prescribing, as adverse effects such as fine tremor may be confused with the coarse tremor seen in toxicity. Lithium treatment increases the risk of clinical hypothyroidism and renal insufficiency (both acute and chronic). Thus tailoring doses for individual patients, with careful monitoring of lithium concentrations, estimated glomerular filtration rate, and thyroid stimulating hormone, is essential. 

Treatment is usually started by a psychiatrist, with longer term care and monitoring by a general practitioner, who can be guided by the relevant quality outcome framework (QOF) target for lithium monitoring in the general practitioner contract. The 2006 guidelines from the National Institute for Health and Clinical Excellence (NICE) set out clear standards for lithium monitoring, including measurement of serum lithium concentrations every three months and assessment of thyroid and renal function every six months.3 These guidelines are more stringent than the current quality outcome framework targets for England.

A quality improvement programme showed that mental health trusts often do not have electronic systems that reliably communicate test results between the laboratory and the clinical team or between primary and secondary care.4 It also showed the shortcomings in the monitoring …
Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review
Authors: L. M Bachmann
Journal: BMJ (2003)

To summarise the evidence on accuracy of the Ottawa ankle rules, a decision aid for excluding fractures of the ankle and mid-foot.Systematic review.Electronic databases, reference lists of included studies, and experts.Data were extracted on the study population, the type of Ottawa ankle rules used, and methods. Sensitivities, but not specificities, were pooled using the bootstrap after inspection of the receiver operating characteristics plot. Negative likelihood ratios were pooled for several subgroups, correcting for four main methodological threats to validity.32 studies met the inclusion criteria and 27 studies reporting on 15 581 patients were used for meta-analysis. The pooled negative likelihood ratios for the ankle and mid-foot were 0.08 (95% confidence interval 0.03 to 0.18) and 0.08 (0.03 to 0.20), respectively. The pooled negative likelihood ratio for both regions in children was 0.07 (0.03 to 0.18). Applying these ratios to a 15% prevalence of fracture gave a less than 1.4% probability of actual fracture in these subgroups.Evidence supports the Ottawa ankle rules as an accurate instrument for excluding fractures of the ankle and mid-foot. The instrument has a sensitivity of almost 100% and a modest specificity, and its use should reduce the number of unnecessary radiographs by 30-40%.
320-MULTIDETECTOR COMPUTED TOMOGRAPHY ANGIOGRAPHY IS ASSOCIATED WITH SIGNIFICANT REDUCTION IN RADIATION EXPOSURE, COMPARED TO 64-MULTISLICE TECHNOLOGY
Authors: Ayesha F. Shaukat, Idean B. Marvasty, Lori Meyers, Allison Drew, Sarah Rinehart, Gustavo Vazquez, Zhen Qian, Parag Joshi, Eric Krivitsky, Szilard Voros
Journal: Journal of the American College of Cardiology (2010)
Community-acquired methicillin-resistant <i>Staphylococcus aureus</i> : different populations, different results
Authors: K. Sardana, V. Manchanda, V.K. Garg
Journal: British Journal of Dermatology (2006)

Journal Article Community‐acquired methicillin‐resistant Staphylococcus aureus: different populations, different results Get access K. Sardana, K. Sardana Department of Dermatology, Maulana Azad Medical College, Delhi, India *Department of Microbiology, Chacha Nehru Children's Hospital, Delhi, India E‐mail: kabir_sardana1@rediffmail.com Search for other works by this author on: Oxford Academic Google Scholar V. Manchanda, V. Manchanda Department of Dermatology, Maulana Azad Medical College, Delhi, India *Department of Microbiology, Chacha Nehru Children's Hospital, Delhi, India E‐mail: kabir_sardana1@rediffmail.com Search for other works by this author on: Oxford Academic Google Scholar V.K. Garg V.K. Garg Department of Dermatology, Maulana Azad Medical College, Delhi, India *Department of Microbiology, Chacha Nehru Children's Hospital, Delhi, India E‐mail: kabir_sardana1@rediffmail.com Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 155, Issue 6, 1 December 2006, Pages 1298–1299, https://doi.org/10.1111/j.1365-2133.2006.07543.x Published: 01 December 2006
Pulmonary function analysis in the rabbit following bronchochallenge to causative agents and mediators of the acute byssinotic response.
Authors: M P Bishop, P A Pilia, W J Moorman, S K Ainsworth
Journal: Environmental Health Perspectives (1986)

New Zealand White rabbits were acutely bronchochallenged for 5 min to ascertain airway responsiveness with six potential byssinogenic agents and mediators: 0.1 g/mL cotton dust extract (CDE), 0.1 g/mL cotton bract extract (CBE), 1 mg/mL endotoxin, 1 mg/mL n-formyl methionyl peptide (n-fMet), 10 mg/mL 5-hydroxytryptamine (5-HT), and 1 mg/mL prostaglandin F2 alpha (PGF2 alpha). Methacholine (MC), 10 mg/mL, was used as a control bronchoconstrictor. Clinically objective criteria were established using increases in resistance values compared to those obtained with saline controls. Animals were classified as: mild responders (Mi) = 125-149%; moderate responders (Mo) = 150-199%; or severe responders (S) = greater than 200%. Three of five (2Mo, 1S) rabbits showed increased pulmonary resistance to CDE bronchochallenge, 3/5 (1Mi, 1Mo, 1S) to CBE, 1/5 (Mo) to purified endotoxin, 4/5 (1Mo, 3S) to n-fMet, 3/5 (1Mi, 1Mo, 1S) to 5-HT, and 2/5 (1Mo, 1S) to PGF2 alpha. All five rabbits (1Mo, 4S) responded to MC bronchochallenge. Rabbits responded minimally to saline, the common solvent of all test agents; however, when challenged with methacholine, a known bronchoconstrictor, rabbits showed significant overt symptoms of acute respiratory distress with immediate and substantial increases in resistance over saline controls. CDE, CBE, and n-fMet inhalation challenge resulted in a majority or all animals showing increased resistance. 5-HT contained in CDE and CBE, exhibited similar resistance increases; however, endotoxin, also found in cotton dust, showed little airway reactivity. The rabbit is useful for characterizing changes in pulmonary function parameters seen in the acute byssinotic reaction. This study has demonstrated that bronchochallenge in the rabbit with potential byssinogenic agents (CDE, CBE, endotoxin, and n-fMet) and mediators (5-HT and PGF2 alpha) result in measurable changes in airway function, particularly increased resistance. Since bronchoconstriction is the major clinical manifestation of the acute byssinotic reaction in man and animals, it is likely that bronchoconstriction observed in cotton mill workers may be in part or totally the result of inherent dust constrictor substances or secondarily released mediators.
Perineural Spread of Melanoma Demonstrated by F-18 FDG PET With MRI and Pathologic Correlation
Authors: Theodore J. Lee, Christine M. Glastonbury, Anne F. Buckley, David W. Eisele, Randall A. Hawkins
Journal: Clinical Nuclear Medicine (2008)

F-18 FDG-PET is generally considered insensitive for the detection of perineural tumor spread. A case is presented of abnormal linear tracer uptake corresponding to the body of the right mandible on a PET scan in a patient with a history of lip melanoma. MRI correlation showed abnormal enlargement and enhancement of the intramandibular portion of the right inferior alveolar nerve. Surgical resection with pathologic analysis confirmed perineural spread of spindle cell melanoma of the lip. Perineural tumor should be considered when asymmetric linear radiotracer uptake is seen on PET scans of the head and neck that does not correspond to the anatomic course of muscular structures.
Serum IgD and IgE concentrations in immunodeficiency diseases.
Authors: R H Buckley, S A Fiscus
Journal: Journal of Clinical Investigation (1975)

Concentrations of IgD and IgE were measured in sera from 165 patients with well-defined immunodeficiency in an effort to find information possibly relevant to the roles of antibodies of these classes in host defense. Values for both immunoglobulins were generally quite low in patients who had marked deficiencies of all three major immunoglobulins, although occasional normal or high normal values for IgD were seen in hypogammaglobulinemic patients. Group mean IgD concentrations were also depressed in patients with Wiskott-Aldrich syndrome and in those with selective IgA deficiency; IgE concentrations were depressed in patients with X-linked immunodeficiency with hyper-IgM and in those with ataxia telangiectasia. IgD and IgE were both significantly elevated in patients with extreme hyperimmunoglobulinemia E and undue susceptibility to infection and in a patient with the Nezelof syndrome; none of these patients had histories suggestive of atopy. In addition, the mean IgE concentration was significantly elevated in patients with selective IgA deficiency, many of whom were atopic, and in those with the Wiskott-Aldrich syndrome. The highest IgD concentration (163 mg/100 ml) was found in serum from a boy with variable immunodeficiency who had a lifelong history of severe recurrent pharyngeal infections, primarily streptococcal in etiology. Recurrent staphylococcal infection was a feature common to many but not all patients with elevated serum IgE concentration. These data may prove useful in the future delineation of biologic roles for antibodies in these two immunoglobulin classes.
SURGICAL CLINIC IN GYNECOLOGY AT THE POST-GRADUATE SCHOOL OF CHICAGO, MARCH 7, 1898.
Authors: FRANKLIN H. MARTIN
Journal: JAMA (1898)

[Stenographic report.]  Case 1.  —The first case I have to present is one diagnosed fibro-myoma of the uterus. The patient is 45 years of age. She has borne no children. For several years there has been a menorrhagia developing, which lately has become excessive. Two suspicious symptoms about the case is the disproportionate loss of flesh in the last six months compared to the blood loss, and the almost universal fixation of the lower part of the tumor as I palpate it through the abdominal walls. It extends to just beneath the umbilicus. I should estimate the size of the tumor, including the uterus of which it seems a part, as eight inches in its long diameter, corresponding to the long diameter of the patient, and the transverse diameter at the largest portion at four inches.  Exploratory Laparotomy.  —I will make an exploratory laparotomy with the idea of removing the
THE SYMPTOMS AND NATURE OF ERYTHEMA MULTIFORME.
Authors: LOUIS A. DUHRING
Journal: JAMA (1898)

By the term erythema multiforme I understand a disease characterized by certain tolerably well-defined erythematous lesions upon the skin, which undergo a variable evolution with a tendency to run an acute course and to recover spontaneously. The lesions are chiefly erythematous in type and are superficial, their seat being in the corium, especially in the papillary layer. They are not hyperemic but are distinctly exudative in character. They consist of macules, maculo-papules, papules, papulo-vesicles, vesicles and blebs. They manifest a disposition for one form to pass into another, thus frequently, but not always, constituting a multiform eruption, hence the name erythema multiforme, originally proposed for the disease by F. Hebra. While therefore a notable variety of lesions frequently, but not always, characterize the disease, it must not be supposed that every exudative erythema is necessarily an erythema multiforme. There are certain polymorphous erythemata which are to be classed as erythema
ABC of diseases of liver, pancreas, and biliary system: Transplantation of the liver and pancreas
Authors: K R Prasad
Journal: BMJ (2001)

Liver transplantation is carried out for many chronic liver diseases and for fulminant hepatic failure. The United Kingdom has seven liver transplantation units, which perform 600–700 transplantations a year. Activity is limited by availability of donor organs, and there are around 200 patients waiting for a liver transplant at any one time. Transplantation of the pancreas is less well established. The pancreas is usually transplanted together with a kidney in patients with end stage diabetes mellitus and renal failure. Worldwide, around 1000 patients (mainly in the United States) receive a pancreatic transplant each year. Only 20–30 a year are transplanted in the United Kingdom.

### Indications and contraindications

Hepatocellular carcinoma complicates many chronic liver diseases, and a small tumour is not a contraindication to transplantaton because tumour recurrence is uncommon in these patients. However, most patients with large (>5 cm) or multiple hepatomas or most other types of cancer are not considered for transplantation as tumours recur rapidly. Patients with certain rare tumours, such as liver metastases from neuroendocrine disease and sarcomas, can do well for several years. Contraindications to liver transplantation include extrahepatic malignancy, severe cardiopulmonary disease, systemic sepsis, and an inability to comply with regular drug treatment.

#### Common indications for liver transplantation

### Timing and selection of patients for transplantation

The preoperative status of the patient is one of the most important factors predicting the outcome after transplantation. Patients with chronic liver disease and signs of decompensation should be assessed for transplantation before they become critically ill. In certain diseases, such as primary biliary cirrhosis, quality of life issues may form the basis for indication for transplantation. For example, chronic lack of energy can be debilitating in patients …