tbuckley/cabot-search huggingface dataset:
Factitious Hypoglycemia and the Multiple Personality Disorder
Authors: Ellen L. Toth
Journal: Annals of Internal Medicine (1990)

Letters and Corrections1 January 1990Factitious Hypoglycemia and the Multiple Personality DisorderEllen L. Toth, MDEllen L. Toth, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-1-76_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor: Factitious hypoglycemia due to self-induction with insulin (1) is not an uncommon form of the Munchausen syndrome (2). It is recommended that patients with this diagnosis be confronted; however, in the following case, confrontation was initially unrewarding.An obese female was hospitalized with hypoglycemia disproportionate to the insulin dose she stated she had taken for pre-existing insulin-requiring type II diabetes (random C-peptide, 3.7 µG/L). During hypoglycemia suppressed C-peptide levels (< 0.3 µG/L) with high total insulin values (> 240 µmol/L) were found, suggesting insulin abuse (1). On confrontation she vehemently denied this and discharged herself.Her psychotherapist...References1. Service F and Moore G. Factitial and autoimmune hypoglycemias. In: Service FJ, ed. Hypoglycemic Disorders: Pathogenesis, Diagnosis and Treatment. Boston: GK Hall; 1983:129-41. Google Scholar2. Hyler S and Sussman N. Chronic factitious disorder with physical symptoms (the Munchausen syndrome). Psychiatr Clin North Am. 1981;4:365-77. CrossrefMedlineGoogle Scholar3. Coons P, Bowman E, and Milstein V. Multiple personality disorder: a clinical investigation of 50 cases. J Nerv Ment Dis. 1988;176:519-27. CrossrefMedlineGoogle Scholar4. Menninger K. Polysurgery and polysurgical addiction. Psychoanal Q. 1934;3:173-99. CrossrefGoogle Scholar5. Grunberger G, Weiner J, Silverman R, Taylor S, and Gorden P. Factitious hypoglycemia due to surreptitious administration of insulin. Diagnosis, treatment, and long-term follow-up. Ann Intern Med. 1988;108:252-7. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Ellen L. Toth, MDAffiliations: The University of Alberta Edmonton, Alberta T6G 2G3 Canada PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCoexistence of Munchausen’s Syndrome and Multiple Personality Disorder: Detailed Report of a Case and Theoretical Discussion 1 January 1990Volume 112, Issue 1Page: 76-76KeywordsHypoglycemiaInsulinOverweightPersonality disordersPsychotherapyType 2 diabetes ePublished: 1 December 2008 Issue Published: 1 January 1990 PDF downloadLoading ...
Bisphosphonates: mechanisms of action.
Authors: G A Rodan, H A Fleisch
Journal: Journal of Clinical Investigation (1996)

Because of its failure to act when given orally and its rapid hydrolysis when given parenterally, pyrophosphate was used therapeutically only in scintigraphy and against dental calculus. This prompted us to search for analogs that showed similar physicochemical activity but resisted enzymatic hydrolysis and, therefore, would not be degraded metabolically. The bisphosphonates fulfilled these conditions. This review will deal with the mechanisms of action of these compounds. In vitro results, as well as results both in animals and humans, will be integrated in an attempt to deduce the current state of the art. Various reviews have been published recently on bisphosphonates and may be consulted also for information on other aspects (8 ‐14). Since the literature in this field is plentiful, selective citation was necessary. Priority is given to papers dealing with the mechanisms of action. Since many papers often deal with the same finding, in most cases only the first ones are quoted. Subsequent papers are quoted only if they convey new knowledge.
CCCTC-binding factor controls the homeostatic maintenance and migration of Langerhans cells
Authors: Tae-Gyun Kim, Mikyoung Kim, Jong-Joo Lee, Sung Hee Kim, Jeong Hwan Je, Yangsin Lee, Min-Ji Song, Yeeun Choi, Youn Wook Chung, Chae Gyu Park, Jin Won Cho, Min-Geol Lee, Yeon-Su Lee, Hyoung-Pyo Kim
Journal: Journal of Allergy and Clinical Immunology (2015)
Ventricular Defibrillation
Authors: Lloyd D. MacLean
Journal: JAMA (1961)

In an experiment on defibrillation of the myocardium in dogs, a distinct advantage of large electrodes (7.3 cm.) over small (5 cm.) was demonstrated. A survey of defibrillation equipment in use in 26 hospitals revealed that in 13 hospitals only electrodes 5 cm. or less in diameter were available for human use. During defibrillation, marked heating of the myocardium to over 65° C. occurred when voltages exceeding 170 were used. The use of 100 to 170 volts was safe with shocks of alternating current of 0.15- to 0.30-sec. duration repeated up to 10 times in 10 sec. Single shocks of 0.15 sec. were safe up to 380 volts if large paddles (8 to 12 cm.) were used. To avoid thermal injury and to effect prompt defibrillation, a heart-shaped electrode measuring 8 by 12 cm. is recommended when intrathoracic defibrillation is practiced.
Two Cases of Subcutaneous Rupture of Jejunum: Recovery
Authors: J. R. M. Whigham, D. B. Handelman
Journal: BMJ (1944)

MEDICAL MEMORANDAMED:CAL JOURNAt 813 intramuscular injection of 20 c.cm. of convalescent herpes zoster serum on the day after the case arose; the other 6 were used as controls.(Case D. R., with no previous history of varicella, was admitted to the ward in error on June 21.He was given 20 c.cm. of the serum intramuscularly next day.)The results of the experiment are set out in the Table.Table of Results
THE CLINICAL APPLICATION OF THE GLYCOGELATIN PATCH TEST
Authors: W. FRAIN-BELL, T. M. MACLEOD
Journal: British Journal of Dermatology (1967)

We are grateful to Dr. J. Rogers for allowing us to investigate patients under his care. We would like to acknowledge also the help we have received from Mrs. H. Henderson, nurse in charge of the contact clinic, Mr. T. King, Senior Medical Photographer, Dundee Royal Infirmary, and in particular Mr. W. Kay and Mr. A. Pratt of the Medical Workshop Eastern Regional Hospital Hoard Physics Department.
Therapy of Diabetes Mellitus with Combinations of Drugs Given Orally
Authors: Samuel B. Beaser
Journal: New England Journal of Medicine (1958)

THE advances in biochemistry of the past decade have revealed that the defects in carbohydrate metabolism in diabetes involve several distinct areas in hepatic metabolism, together with a defect in transport of glucose into peripheral muscle.1 This has prepared for the possibility of correction of one or more of these, separately or together, by pharmacologic agents simpler in structure than insulin and capable of absorption by the gastrointestinal tract.The recently introduced hypoglycemic agents for oral administration fit this description. They are of two classes, the sulfonylureas (tolbutamide† and chlorpropamide‡)1 , 2 and the diguanides (phenethyldiguanide§).1 , 3 The sulfonylureas stimulate the . . .
Selling Science: How the Press Covers Science and Technology
Authors: David H. Mark
Journal: JAMA (1995)

For a medical researcher or scientist, being contacted by journalists for a story or an opinion brings on a rush of conflicting sensations. Easily starstruck do we become with ourselves for our 15 minutes or 3-column inches. This is often followed quickly by paranoia, fear, and resentment as we perceive our work distorted and exaggerated. "They didn't get it right, they don't understand the implications, the public will panic!" Based on repeated observations of this phenomenon in her studies of public attitudes toward science and technology, Professor Nelkin decided to study the relationship between scientists and the media and to describe the world of science journalists. This book constitutes a revised edition of the one originally published in 1987, updated to include her observations of recent changes in the way science is reported in the news. The author first examines image making in science reporting, where the use of certain
Bilateral Adrenal Uptake of Gallium-67 Citrate in a Patient with Congenital Adrenal Hyperplasia
Authors: MORDECHAI LORBERBOYM, SAUL D. SARKAR, PHYLLIS SPEISER, GRACE TANNEN, MARIA I. NEW
Journal: Clinical Nuclear Medicine (1990)

Ga-67 scintigraphy in a 25-year-old white woman with virilizing congenital adrenal hyperplasia due to 21-hydroxylase deficiency showed bilateral adrenal uptake of radiotracer. CT scanning performed 1 year earlier showed moderate bilateral adrenal enlargement without adenoma(s). The presence of lymphoma, malignant pheochromocytoma, tuberculosis, or sarcoidosis was ruled out on the basis of radiographic and laboratory tests and by clinical follow-up.
GMC agrees new structure
Authors: M. Hunter
Journal: BMJ (2001)

A compromise seems to have been reached on the vexed question of self regulation of the medical profession in the United Kingdom.

At a meeting in London at the end of July, the General Medical Council agreed to reduce membership of its ruling body from the current 104 members to just 35. Of these, 14 will be lay members, bringing the lay proportion of the council up to 40%

The move treads a fine line between the demands of the professional bodies, which had been calling for a council no smaller than 51 members, and …
Unawareness and undertreatment of asthma: follow‐up in a different geographic area in Denmark
Authors: V. Backer, H. Nolte, L. Pedersen, N. Dam, H. Harving
Journal: Allergy (2009)

Background: Early detection and treatment of asthma is important to minimize morbidity and healthcare costs. The objective of this study was to investigate asthma awareness and management in a western society. Methods: In a random sample of 10 400 subjects aged 14–44 years, 686 (6.6%) reported symptoms of asthma in a standardized screening questionnaire. All 686 were evaluated by respiratory specialists and diagnosed by history, symptoms, lung function tests, bronchial challenges and allergy testing. Of these 686 participants, 69 (10%) had asthma alone, 205 (30%) had rhinitis alone and 217 (32%) had both asthma and rhinitis; 195 (28%) had nonasthmatic respiratory reports. Results: Awareness of asthma was found among 163 (57%) of the 286 asthmatics, and 204 (95%) had doctor‐diagnosed rhinitis as well. In a multivariate regression analysis, comorbidity with rhinitis (β = 0.489, P &lt; 0.001), smoking (β = −0.116, P &lt; 0.01), doctor‐diagnosed bronchitis (β = 0.086, P &lt; 0.05), and earlier emergency visits at hospital (β = 0.147, P &lt; 0.001) was significantly associated with awareness. A difference in awareness was found between those who had asthma and rhinitis (62.2%) and those who had asthma alone (40.6%) ( P &lt; 0.01). Inhaled corticosteroids (ICS) were used by 27% of those with asthma, including 12% who used both ICS and long‐acting beta‐agonist. Conclusions: More than half of the persons with asthma were aware of their disorder; and the awareness was more likely in those with comorbidity of rhinitis. In general, asthma management was inadequate.
Regionalization of Care for Acute Coronary Syndromes
Authors: Saif S. Rathore, Andrew J. Epstein, Kevin G. M. Volpp, Harlan M. Krumholz
Journal: JAMA (2005)

There is a growing movement advocating the treatment of patients with acute coronary syndromes (ACS) at regional centers with dedicated facilities.1, 2 Proponents contend that regionalized ACS care will save lives by improving access to new technologies, specialist physicians, and higher quality care not available at other centers.1, 2 The state of Maryland has already begun planning for regionalized care for patients with ACS.3 Recent enthusiasm for this movement has focused on its potential benefits. We present concerns about the rationale for regionalized ACS care, and outline some potential unintended consequences.
Tc-99m MIBI Scan in Atypical Chest Pain Exclusion of Myocardial Ischemia and Acute Cholecystitis
Authors: STEPHEN M. SCHLICHT, NOURIA SALEHI, DAVID BINNS, NATHAN BETTER
Journal: Clinical Nuclear Medicine (1997)

A 33-year-old woman with known cholelithiasis had fever and right upper quadrant pain. A clinical diagnosis of acute cholecystitis was made. Before cholecystectomy, she complained of atypical chest pain. To exclude the possibility of myocardial ischemia, the patient was injected with Tc-99m sestamibi at the time of chest pain. SPECT images were performed 1 hour after injection. These showed normal myocardial perfusion and therefore ischemia was excluded. On planar images the gall bladder was visualized confirming a patent cystic duct; thus, the diagnosis of acute cholecystitis was also discounted. Surgery was deferred, and elective cholecystectomy 1 month later confirmed chronic cholecystitis. In this case, Tc-99m sestamibi not only excluded myocardial ischemia, but also excluded acute cholecystitis.
The Prolactin Response to Thyrotropin-Releasing Hormone Differentiates Isolated Gonadotropin Deficiency from Delayed Puberty
Authors: Irving M. Spitz, Harry J. Hirsch, Stefan Trestian
Journal: New England Journal of Medicine (1983)

It is currently believed that hypogonadotropic hypogonadism (or isolated gonadotropin deficiency) is secondary to lack of delivery of endogenous luteinizing hormone-releasing hormone to the pituitary gonadotrope, whereas delayed puberty is related to retarded activation of the hypothalamic-pituitary axis.1 , 2 The distinction between the two conditions poses one of the most difficult diagnostic problems in endocrinology.2 , 3 When isolated gonadotropin deficiency is associated with anosmia or other congenital anomalies, it is easily differentiated from physiologic delayed puberty.4 However, many patients present without any somatic abnormalities. In such cases, the usual course is to procrastinate. However, prolonged delay in treatment causes severe social embarrassment . . .
Evidence-Based Medicine Meets Cost-effectiveness Analysis
Authors: Carolyn M. Clancy
Journal: JAMA (1996)

Accumulated public and private frustrations regarding escalating costs and substantial evidence of variation in medical practice have stimulated several parallel movements to narrow the gap between evidence and practice. Beginning with the work of the Canadian Task Force on the Periodic Health Examination<sup>1</sup>and the US Preventive Services Task Force<sup>2</sup>and followed by intense interest in the development and dissemination of clinical practice guidelines through a recent movement toward evidence-based medicine,<sup>3</sup>there has been a proliferation of tools and methods to assess the value of medical interventions and translate those findings into practice. Once the province of a small group of social scientists, meta-analysis, decision sciences, and other methods are now familiar to an expanding cadre of clinician scientists struggling to apply scientific methods to improve routine practice. The opportunities for improvement are immense and fully worthy of the collective effort.<sup>4</sup> See also p 285. The
Clinical and biological implications of driver mutations in myelodysplastic syndromes
Authors: Elli Papaemmanuil, Moritz Gerstung, Luca Malcovati, Sudhir Tauro, Gunes Gundem, Peter Van Loo, Chris J. Yoon, Peter Ellis, David C. Wedge, Andrea Pellagatti, Adam Shlien, Michael John Groves, Simon A. Forbes, Keiran Raine, Jon Hinton, Laura J. Mudie, Stuart McLaren, Claire Hardy, Calli Latimer, Matteo G. Della Porta, Sarah O’Meara, Ilaria Ambaglio, Anna Galli, Adam P. Butler, Gunilla Walldin, Jon W. Teague, Lynn Quek, Alex Sternberg, Carlo Gambacorti-Passerini, Nicholas C. P. Cross, Anthony R. Green, Jacqueline Boultwood, Paresh Vyas, Eva Hellstrom-Lindberg, David Bowen, Mario Cazzola, Michael R. Stratton, Peter J. Campbell
Journal: Blood (2013)
Blood Coagulability and Oral Contraception
Authors: L. O. Pilgeram
Journal: BMJ (1964)

The relationship between therapy with the oral contraceptive Enovid (norethynodrel plus ethinylestradiol-3-methyl ether) and blood coagulability was investigated.  Plasma samples were obtained from 9 young women (mean age 24.7 years) who had received 5 mg of norethynodrel plus .075 mg of ethinyl estradiol-3-methyl ether daily for at least 11 days prior to blood donation and from 9 female controls (mean  age 22.4 years).  The Enovid subjects had been treated with cyclical contraceptives for more than 5 months preceeding the investigation.  The plasma samples were defibrinated and antithrombin was assayed.  Plasma of the Enovid subjects showed an increase in activity of plasma antithrombin by 24.1 percent (P less than .012) when assayed by the clotting time method and by 20.7 percent (P less than .007) when analyzed by the tosylarginine methyl  ester technique.
The Adaptation of Clinical Methods to the Practicing Physician.
Authors: Elmer L. Kenyon
Journal: JAMA (1907)

Chicago, April 24, 1907. <h3>To the Editor:</h3> —Some years ago I was desirous of studying clinically surgical work on a certain anatomic region of the body. Living in Chicago, where clinics in abundance in this department of practice, as in others, are accessible, the project seemed a very simple one. I tried, and to my surprise, found the plan impracticable. At the clinics attended for this one purpose there was presented a great variety of cases, which, not appealing to me then, merely served to consume my time. Thus I wasted hour on hour in order to get at even one case I wished to see. I gave up the idea then and I should have to give up such a project to-day. It was not at that time and is not now practicable to expect a clinician to keep a score of men in mind and telephone them of
A post-classical theory of enamel biomineralization… and why we need one
Authors: James P Simmer, Amelia S Richardson, Yuan-Yuan Hu, Charles E Smith, Jan Ching-Chun Hu
Journal: International Journal of Oral Science (2012)

Enamel crystals are unique in shape, orientation and organization. They are hundreds of thousands times longer than they are wide, run parallel to each other, are oriented with respect to the ameloblast membrane at the mineralization front and are organized into rod or interrod enamel. The classical theory of amelogenesis postulates that extracellular matrix proteins shape crystallites by specifically inhibiting ion deposition on the crystal sides, orient them by binding multiple crystallites and establish higher levels of crystal organization. Elements of the classical theory are supported in principle by in vitro studies; however, the classical theory does not explain how enamel forms in vivo. In this review, we describe how amelogenesis is highly integrated with ameloblast cell activities and how the shape, orientation and organization of enamel mineral ribbons are established by a mineralization front apparatus along the secretory surface of the ameloblast cell membrane.
Reviews and Notes: The Faith Factor
Authors: Henry Schneiderman
Journal: Annals of Internal Medicine (1996)

Literature of Medicine1 November 1996Reviews and Notes: The Faith FactorHenry Schneiderman, MDHenry Schneiderman, MDHebrew Home and Hospital, West Hartford, CT 06117.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-9-199611010-00033 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Produced by DA Matthews. 50-minute videotape.Rockville, MD: National Institute for Healthcare Research; 1995. $20.00. Order phone; telephone, 301-984-7162.Spirituality is critically important to clinical medicine, and yet it is addressed only rarely and obliquely in much of modern medicine, including medical teaching. Matthews strives to put religion back into the thought and bedside repertoire of physicians. He has used various teaching techniques, including a lecture presented at numerous medical schools around the United States. A videotape of that lecture constitutes the bulk of the longer and more scholarly of these publications, which are manifestly designed to widen the audience ... Author, Article, and Disclosure InformationAffiliations: Hebrew Home and Hospital, West Hartford, CT 06117. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1996Volume 125, Issue 9Page: 783KeywordsAlcoholsHealth services research ePublished: 15 August 2000 Issue Published: 1 November 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Entecavir treatment for chronic hepatitis B: Adaptation is not needed for the majority of naïve patients with a partial virological response
Authors: Roeland Zoutendijk, Jurriën G. P. Reijnders, Ashley Brown, Fabien Zoulim, David Mutimer, Katja Deterding, Jörg Petersen, Wolf Peter Hofmann, Maria Buti, Teresa Santantonio, Florian van Bömmel, Pierre Pradat, Ye Oo, Marc Luetgehetmann, Thomas Berg, Bettina E. Hansen, Heiner Wedemeyer, Harry L. A. Janssen
Journal: Hepatology (2011)

Entecavir (ETV) is a potent inhibitor of viral replication in nucleos(t)ide analogue (NA)-naïve chronic hepatitis B (CHB) patients. The aim of this study was to investigate the long term efficacy and safety of ETV in NA-naïve CHB patients, particularly in those with detectable hepatitis B virus (HBV) DNA after 48 weeks, in whom treatment adaptation is suggested by current guidelines. In a multicenter cohort study, we investigated 333 CHB patients treated with entecavir monotherapy. The NA-naïve population consisted of 243 patients, whereas 90 were NA-experienced. Virological response (VR) (HBV DNA<80 IU/mL) was achieved in 48%, 76%, and 90% of hepatitis B e antigen (HBeAg)-positive and in 89%, 98%, and 99% of HBeAg-negative NA-naïve patients at weeks 48, 96, and 144, respectively. Thirty-six of 175 (21%) NA-naïve patients with at least 48 weeks of follow-up had a detectable load at week 48 (partial virological response [PVR]). Twenty-nine (81%) patients with PVR reached VR during prolonged ETV monotherapy, and none of them developed ETV-resistance. Among 22 patients with HBV DNA<1,000 IU/mL at week 48, VR was achieved in 21 (95%) patients, compared with eight of 14 (57%) patients with HBV DNA≥1,000 IU/mL. Continuous HBV DNA decline was observed in most patients without VR during follow-up, and in three patients adherence was suboptimal according to the treating physician. ETV was safe and did not affect renal function or cause lactic acidosis.ETV monotherapy can be continued in NA-naïve patients with detectable HBV DNA at week 48, particularly in those with a low viral load because long-term ETV leads to a virological response in the vast majority of patients.