tbuckley/cabot-search huggingface dataset:
Older people and the “patient centred” NHS:Proactive support in primary care can avert admissions
Authors: Moyez Jiwa
Journal: BMJ (2004)

We report the case of a 61 yr old male, who developed a severe right-to-left shunt through a patent foramen ovale, in the absence of elevated right-sided heart pressures, two months after a left-sided pneumonectomy. This is considered to be a rare complication after pneumonectomy. However, taking into account the approximately 20% incidence of patent foramen ovale in the general population, we suggest that right-to-left shunting through an unsuspected foramen ovale or atrial septum defect should always be considered as a possible cause of otherwise unexplained hypoxaemia.
Tracheal Aspirate as a Substrate for Polymerase Chain Reaction Detection of Viral Genome in Childhood Pneumonia and Myocarditis
Authors: Noorullah Akhtar, Jiyuan Ni, Daniel Stromberg, Geoffrey L. Rosenthal, Neil E. Bowles, Jeffrey A. Towbin
Journal: Circulation (1999)

Background —Infectious respiratory disorders are important causes of childhood morbidity and mortality. Viral causes are common and may lead to rapid deterioration, requiring mechanical ventilation; myocardial dysfunction may accompany respiratory decompensation. The etiologic viral diagnosis may be difficult with classic methods. The purpose of this study was to evaluate polymerase chain reaction (PCR) as a diagnostic method for identification of causative agents. Methods and Results —PCR was used to amplify sequences of viruses known to cause childhood viral pneumonia and myocarditis. Oligonucleotide primers were designed to amplify specific sequences of DNA virus (adenovirus, cytomegalovirus, herpes simplex virus, and Epstein-Barr virus) and RNA virus (enterovirus, respiratory syncytial virus, influenza A, and influenza B) genomes. Tracheal aspirate samples were obtained from 32 intubated patients and nucleic acid extracted before PCR. PCR results were compared with results of culture, serology, and antigen detection methods when available. In cases of myocarditis (n=7), endomyocardial biopsy samples were analyzed by PCR and compared with tracheal aspirate studies. PCR amplification of viral genome occurred in 18 of 32 samples (56%), with 3 samples PCR positive for 2 viral genomes. Amplified viral sequences included RSV (n=3), enterovirus (n=5), cytomegalovirus (n=4), adenovirus (n=3), herpes simplex virus (n=2), Epstein-Barr virus (n=1), influenza A (n=2), and influenza B (n=1). All 7 cases of myocarditis amplified the same viral genome from heart as found by tracheal aspirate. Conclusions —PCR is a rapid and sensitive diagnostic tool in cases of viral pneumonia with or without myocarditis, and tracheal aspirate appears to be excellent for analysis.
Tuberculin Skin Testing and the HIV Epidemic
Authors: Robin E. Huebner
Journal: JAMA (1992)

Tuberculosis (TB) cases in the United States have steadily increased in number since 1985. Much of this increase appears attributable to the human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) epidemic, with TB occurring both in those HIV-infected persons with latent as well as recently acquired TB infection.<sup>1</sup>Infection with HIV now is recognized as the most important risk factor for progression from tuberculous infection to active disease. The annual risk of disease in persons dually infected with TB and HIV is 7% to 10%, considerably greater than the 10% lifetime risk in HIV-uninfected tuberculin reactors.<sup>1,2</sup> See also p 369. As a result of the increasing TB morbidity associated with HIV, screening for tuberculous infection now is recommended practice for all patients with HIV infection as well as patients in drug treatment centers, sexually transmitted disease clinics, and HIV/AIDS clinics.<sup>1</sup>Treatment of TB-infected persons with isoniazid can
Asymptomatic Airway Hyperresponsiveness: A Three-year Follow-up
Authors: CATHERINE LAPRISE, LOUIS-PHILIPPE BOULET
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

The physiopathology and significance of asymptomatic airway hyperresponsiveness (AHR) are still to be defined. Over a 3-yr period, we compared clinical, immunologic, and physiologic features of 30 subjects who had asymptomatic AHR with those of 30 symptomatic asthmatic subjects and 30 normoresponder subjects (age: 31.9 ± 1.4 yr [mean ± SEM]; n = 90). Each subject completed a respiratory questionnaire and underwent spirometry, measurement of bronchodilator response and peak expiratory flows, an allergy skin-prick test, blood eosinophil count, assay for total serum IgE level, and methacholine challenge. These tests were repeated annually, at the same period of the year, for 3 yr. Subjects with asymptomatic AHR had greater bronchodilator responses (p = 0.001), variability of peak expiratory flow rate (PEFR) (p = 0.02), and prevalence of atopy (p = 0.02) than did the normoreactive subjects. Compared with asthmatic subjects, subjects with asymptomatic AHR had a lower blood eosinophil count (p = 0.004), higher mean FEV1 (p = 0.006), and weaker bronchodilator response (p = 0.02), but an even greater perception of bronchoconstriction (p < 0.001). After 3 yr, the concentration of methacholine provoking a 20% decrease in FEV1 (PC20) had decreased significantly in the asymptomatic AHR subjects (p < 0.0001) as compared with the other two groups, and of the 28 subjects studied at this time, four (14.3%) had developed asthma symptoms. These last four subjects were atopic and exposed to animals when they developed asthma, had a familial history of asthma, and had an increased baseline AHR as compared with the subjects who did not develop symptoms. In conclusion, this study shows that over a 3-yr period, subjects with asymptomatic AHR had a greater increase in airway responsiveness and frequency of development of asthma symptoms than did normoresponsive subjects. Allergen exposure in sensitized subjects at the time of the study, and genetic predisposition, seemed the main risk factors for the development of symptomatic asthma in this population.
CLINICAL APPLICATION OF A SIMPLE METHOD FOR ESTIMATING “GAMMA GLOBULIN” 1
Authors: B. V. Jager, Margaret Nickerson
Journal: Journal of Clinical Investigation (1948)

The electrophoretic technique offers the most accurate method for serum fractionation.This permits a quantitative separation of serum into albumin and into three major globulin fractions which are designated as alpha, beta and gamma components.In recent years electrophoretic anal- *yses of serum proteins have been performed by many investigators in a variety of diseases.The
Concepts in Anesthesiology
Authors: David A. Sherman
Journal: JAMA (1963)

<h3>To the Editor:</h3> —Dr. Vincent J. Collins' recent address to the Section on Anesthesiology of the American Medical Association [published<i>JAMA</i><b>182:</b>105] is worthy of some comment and criticism. The over-all picture defining the scope and ever-increasing responsibilities of the anesthesiologist has been well covered. Another item mentioned but perhaps not stressed sufficiently concerned operating time. There is a great misconception, prevalent in surgical spheres, that with modern anesthesia the patient is not harmed by prolonged manipulations in the operating room. This is not true. Every extra minute geometrically increases the hazard. The death of a patient who suffers a cardiac standstill after an operation of three hours, which could have been equally well done in two, is preventable. The truth of the well-known statement by Dr. John Gillies, referring to anesthetic management as "physiological trespass" cannot be denied. Whatever skill and experience we possess is dedicated to the
Bronchoalveolar lavage during neutropenic episodes: diagnostic yield and cellular pattern
Authors: C Cordonnier, E Escudier, F Verra, L Brochard, JF Bernaudin, J Fleury-Feith
Journal: European Respiratory Journal (1994)

Few data are available concerning the relationship between alveolar and blood cell populations during neutropenia. We wanted to compare the value of pulmonary endoscopic procedures with lavage in neutropenic (polymorphonuclear (PMN) count < or = 1,000.mm-3) and non-neutropenic settings. We therefore, retrospectively, reviewed the results of 118 investigations for pneumonia in patients with malignant haematological diseases. All had bronchoalveolar lavage (BAL), and some had additional studies with protected bacteriological samples. Each BAL specimen was studied after cytocentrifugation by cytological examination for opportunistic infections, haemorrhage, virus, legionellae, and bacteriological cultures. The diagnostic yield of all endoscopic procedures (BAL, telescoping plugged catheter and protected specimen brush) was 53% in neutropenic (Group 1) and 61% in non-neutropenic (Group 2) patients. The aetiological pattern of pneumonia was nearly the same in the two groups, except for more alveolar proteinosis in Group 1 and more cytomegalovirus (CMV) in Group 2. The absolute number of alveolar cells recovered through BAL (total number, macrophages, lymphocytes and PMNs) was significantly lower in neutropenic patients. We conclude that: 1) neutropenic patients with pneumonia require the same investigative approach as non-neutropenic patients; 2) profound neutropenia may be concomitant with a decreased cellularity of alveoli, which may reflect the consequences of marrow aplasia on the pulmonary cell population and/or direct effect of chemotherapy on the lung.
Detection of Preclinical Alzheimer's Disease
Authors: Ingmar Skoog
Journal: New England Journal of Medicine (2000)

Alzheimer's disease is a chronic disorder with a gradual onset and slowly progressive course that is characterized by an inevitable deterioration in cognitive function. To develop new methods to prevent and treat Alzheimer's disease, we must be able to diagnose the preclinical stage of the disease, before the brain damage becomes irreversible. The presymptomatic phase of Alzheimer's disease has therefore been the focus of intense research.The brains of patients with Alzheimer's disease show extensive neuronal loss, the accumulation of β-amyloid, and extracellular senile plaques and intracellular neurofibrillary tangles in the hippocampus and frontal and temporal cortexes. Minor pathological changes . . .
Cytokine Working Group Study of Lymphodepleting Chemotherapy, Interleukin-2, and Granulocyte-Macrophage Colony-Stimulating Factor in Patients With Metastatic Melanoma: Clinical Outcomes and Peripheral-Blood Cell Recovery
Authors: Krishna S. Gunturu, Kenneth R. Meehan, Todd A. Mackenzie, Todd S. Crocenzi, David McDermott, Edward J. Usherwood, Kim A. Margolin, Nancy A. Crosby, Michael B. Atkins, Mary Jo Turk, Cory Ahonen, Shinichiro Fuse, Joseph I. Clark, Jan L. Fisher, Randolph J. Noelle, Marc S. Ernstoff
Journal: Journal of Clinical Oncology (2010)

Purpose Recovery of lymphocyte populations after lymphocyte depletion is implicated in therapeutic immune pathways in animal models and in patients with cancer. We sought to evaluate the effects of chemotherapy-induced lymphodepletion followed by granulocyte-macrophage colony-stimulating factor (GM-CSF) and high-dose interleukin-2 (IL-2) therapy on clinical response and the recovery of lymphocyte subcompartments in patients with metastatic melanoma. Patients and Methods This was a two-stage phase II trial design. Patients with measurable metastatic melanoma were treated with intravenous cyclophosphamide (60 mg/kg, days 1 and 2) and fludarabine (25 mg/m 2 , day 3 through 7) followed by two 5-day courses of intravenous high-dose bolus IL-2 (600,000 U/kg; days 8 through 12 and 21 through 25). GM-CSF (250 μg/m 2 /d beginning day 8) was given until granulocyte recovery. Lymphocyte recovery profiles were determined by flow cytometric phenotyping at regular intervals, and clinical outcome was assessed by Response Evaluation Criteria in Solid Tumors (RECIST). Results The trial was stopped at the end of stage 1 with four of 18 objective responses noted. Twelve patients had detailed lymphocyte subcompartments evaluated. After lymphodepletion, we observed an induction of regulatory cells (CD4+ T regulatory cells; CD8+ T suppressor cells) and of T memory cells (CD8+ T central memory cells; T effector memory RA+ cells). Expansion of circulating melanoma-specific CD8 + cells was observed in one of four HLA-A2-positive patients. Conclusion Chemotherapy-induced lymphodepletion modulates the homeostatic repopulation of the lymphocyte compartment and influences recovering lymphocyte subpopulations. Clinical activity seems similar to standard high-dose aldesleukin alone.
Aspergillus osteomyelitis: Epidemiology, clinical manifestations, management, and outcome
Authors: Maria N. Gamaletsou, Blandine Rammaert, Marimelle A. Bueno, Brad Moriyama, Nikolaos V. Sipsas, Dimitrios P. Kontoyiannis, Emmanuel Roilides, Valerie Zeller, Roberta Prinapori, Saad J. Taj-Aldeen, Barry Brause, Olivier Lortholary, Thomas J. Walsh
Journal: Journal of Infection (2014)
Psychiatry, postmodernism and postnormal science
Authors: R. Laugharne, J. Laugharne
Journal: Journal of the Royal Society of Medicine (2002)

Mental health care is a complex activity. Those involved include patients, carers, clinicians, purchasers and the public, and these groups have different perspectives and viewpoints on mental healthcare. These viewpoints can be conflicting, and an understanding of their differences is vital for planning. One example is the contrast between the ideas behind evidence-based medicine and user empowerment, which can reflect the differences between a modern and a postmodern view of the world1. Here we discuss the potential impact of postmodern philosophical and cultural change.
ALCOHOL AND THE FATS IN THE TREATMENT OF PHTHISIS.
Authors: J. K. SUTTON
Journal: JAMA (1884)

[From a Clinical Lecture by P H. Cronin, Ph.B.,A.M., M.D., one of the attending Physicians of Cook County Hospital.] It has been said by a well-known authority on the subject of phthisis, that there is nothing in the whole range of medical science, which the student ought to study more carefully than the cachexia, or special form of ill health, associated with the occurrence of tubercle and general scrofulous affections. Indeed, it may be said that in every phase of his professional career, a knowledge of the pathology of scrofula, in its general or special aspect, is an absolute necessity. Experience has fully demonstrated that not to causes within the province of the medical man, solely, can the origin of tubercle or the scrofulous diathesis be traced. Yet it must be acknowledged that by the confidence naturally acquired by him, as the trusted friend of the most exclusive families,
The effect of free fatty acids on myocardial oxygen consumption during atrial pacing and catecholamine infusion in man.
Authors: S Simonsen, J K Kjekshus
Journal: Circulation (1978)

The effect of myocardial uptake of free fatty acids (FFAu) on myocardial oxygen consumption (MVO2) in relation to increased heart rate and inotropic stimulation was determined in patients with coronary artery disease. Submaximal atrial pacing and isoproterenol stimulation increased MVO2 by 66% and 142%, respectively, at similar heart rates. Inhibition of lipolysis with beta-pyridyl carbinol almost abolished FFAu and reduced MVO2 significantly. Increased heart rate contributed 47% and FFAu 50% of the raised MVO2 attributed to inotropic stimulation was 30%. Augmentation of FFAu by triglyceride/heparin infusion increased MVO2 significantly above control levels, both during pacing and isoproterenol infusion. We conclude that MVO2 is closely correlated to FFAu, catecholamines sensitize the heart to FFA, and increased FFAu account for a major part of the increased MVO2 during catecholamine stimulation. The importance of reducing heart rate and lipolysis to reduce myocardial oxygen requirements is emphasized.
GW25-e5395 The Association of miR-146a, miR-125a, and miR-34b/c Polymorphisms With Coronary Artery Disease and Acute Myocardial Infarction Risk
Authors: Dong Zhou, Juan Zhou, Zhaofei Wan, Yan Fan, Feng Lian, Zuyi Yuan
Journal: Journal of the American College of Cardiology (2014)
Should heroin be prescribed to heroin misusers? No
Authors: Neil McKeganey
Journal: BMJ (2008)

Some heroin addicts are very difficult to treat. <b>Jürgen Rehm</b> and <b>Benedikt Fischer</b> believe that maintenance with heroin is the way forward for this group, but <b>Neil McKeganey </b>argues that it is treating the effects of misuse not the addiction
Book: The Royal College of Paediatrics and Child Health at the Millennium
Authors: D. Brewster
Journal: BMJ (2000)

J Osborne BMJ Books, £50 ISBN 0 7279 1434 0 Rating:![Graphic][1]</img>![Graphic][2]</img>![Graphic][3]</img> The British Paediatric Association was founded in 1928 by a Canadian, Donald Patterson. The aim of the association was the advancement of the study of paediatrics and the promotion of friendship among paediatricians. Only six of the 24 invited paediatricians attended the inaugural meeting, and the association had very little influence on political decisions in its early days. Despite this inauspicious beginning, the association has had a distinguished history. This book … [1]: /embed/inline-graphic-1.gif [2]: /embed/inline-graphic-2.gif [3]: /embed/inline-graphic-3.gif
Oral Hygiene With Chlorhexidine in Critically Ill Patients—Reply
Authors: Michael Klompas, Sean M. Berenholtz
Journal: JAMA Internal Medicine (2015)

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Return to Work: Experiences of a Hospital Rehabilitation Officer
Authors: D. A. Brewerton, J. W. Daniel
Journal: BMJ (1969)

Successful return to work after illness or injury often depends on an efficient exchange of information between doctor and employer. Rehabilitation officers with experience in industry have been employed by the Royal National Orthopaedic Hospital, Stanmore, for several years and have established their value in acting as direct links between hospital and industry.
Filaggrin-2 variation is associated with more persistent atopic dermatitis in African American subjects
Authors: David J. Margolis, Jayanta Gupta, Andrea J. Apter, Tapan Ganguly, Ole Hoffstad, Maryte Papadopoulos, Tim R. Rebbeck, Nandita Mitra
Journal: Journal of Allergy and Clinical Immunology (2013)
Addiction to Poppy-heads in England
Authors: M. M. Glatt, M. M. Hossain
Journal: BMJ (1963)

rather than of folic acid.Absorption of vitamin B12 was at the lower limit of normal and was improved by intrinsic factor.However, the absorption was higher than that found in pernicious anaemia, and the presence of free acid in the gastric juice and the normal appearance of the gastric mucosa do not confirm this diagnosis.The marginal absorption of vitamin B12 was probably a factor in the development of deficiency of this vitamin rather than of folic acid.The serum vitamin B 12 level of 120 it~tg./ml. is signi- ficantly low, but it is higher than that usually found in cases with megaloblastic erythropoiesis due to vitamin B12 deficiency.It seems probable that the depletion of vitamin B.2 was greater in the bone marrow than in the serum, and that this was due to increased utilization of the vitamin in the marrow by proliferating myeloma cells.
The Legal Status of Consent to Withhold Treatment
Authors: Giles R. Scofield
Journal: JAMA (1987)

<h3>To the Editor.—</h3> Judith Areen's<sup>1</sup>article on treatment withdrawal raised two issues of general concern. First, the vagueness plaguing various living will statutes can be avoided if those individuals executing living wills include both general and specific instructions concerning their desire not to receive certain types of treatment. A patient who does not want to receive artificial feeding should expressly say so, regardless of what the state statute permits. More ominous is appearance of legislation (such as that recently passed in Oklahoma) that greatly restricts the circumstances under which a physician need honor any individual's request that nutrition/hydration not be provided. As Ms Areen notes, the right to refuse such treatment is protected in some states under common law or constitutional law. Legislation that limits a physician's discretion and is antagonistic to an individual's right to refuse treatment raises the specter of a constitutional challenge through prolonged court litigation,
High Nuclear Expression of CXCR4 Is Associated with Metastases and Decreased Survival in Hormone Sensitive Breast Cancer.
Authors: P. Cronin, F. O'Connell, J. Wang, H. Redmond
Journal: Cancer Research (2009)

Abstract Introduction: CXCR4 chemokine receptor and its specific ligand SDF-1alpha are thought to play an important role in breast cancer metastases. High levels of SDF-1alpha in the common destination organs of metastasis are thought to attract CXCR4-positive tumour cells.Aim: The aim of the study was to test whether CXCR4 expression in the primary tumour can indicate breast cancer with high likelihood of metastasising.Methods: Tissue slides were prepared from the paraffin embedded primary tumours of breast cancer patients. CXCR4 expression was detected using immunohistochemistry assessed by a pathologist. Disseminated tumour cells (DTC's) were detected in the bone marrow samples of patients taken at the time of surgery using anti-HEA/FITC-conjugated antibody and flow cytometry. All other clinicopathological features of the patients were also compiled.Results: CXCR4 expression was assessed in one hundred and ten patients. They had a mean age of 57.18 years and a median follow up of 84 months (range 4 – 108). 72.6% of patients had a T2 or a T3 tumour. The majority were hormone sensitive, 80.9% and Her2/neu negative, 76.1%. Disseminated tumour cells were found in the majority of patients, 85.5%, but 57.2% had greater that 1000 DTC's/100,000. There was no correlation found between cytoplasmic staining for CXCR4 and the clinicopathological features of the tumours including DTC's. High nuclear staining was associated significantly with decreased overall and disease free survival, p&amp;lt;0.041 and p&amp;lt;0.025. Tumours with high nuclear staining were significantly more likely to be hormone sensitive, tubulo-lobular tumours [p&amp;lt;0.008, p&amp;lt;0.0349], from older, post-menopausal women [p&amp;lt;0.081, p&amp;lt;0.018]. There was no correlation between her2/neu and CXCR4 expression. Disseminated tumour cells and lymph node metastases were not associated with nuclear staining but these tumours were more likely to develop distant metastases, p&amp;lt;0.034.Conclusion: High nuclear expression of CXCR4 was significantly associated with hormone sensitive breast cancers and development of distant metastases. These patients had decreased overall and disease free survival. Our results show CXCR4 has an important role in breast cancer metastases and has both prognostic and therapeutic potential. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3037.