tbuckley/cabot-search huggingface dataset:
Optimal Dosage of Insulin and Glucose in Glucose-Insulin-Potassium Treatment of Acute Myocardial Infarction Remains to Be Established
Authors: Rolf Svedjeholm, Erik Håkanson, Zoltan Szabo
Journal: Circulation (1999)

To the Editor:The dosage of insulin and glucose plays an important role for the efficacy of GIK (glucose-insulin-potassium) treatment.Until the ECLA study, only 4 trials in acute myocardial infarction (AMI) had used the GIK therapy required to achieve adequate suppression of plasma free fatty acids (FFAs). 1 Pooled data from these trials demonstrated a 48% reduction in mortality.In the ECLA study, a significant survival advantage relative to the control group was only found in the "high-dose GIK group." 2 In spite of these encouraging results, we do not yet know the optimal dosage of insulin and glucose in AMI.To establish appropriate metabolic interventions, these should preferably be evaluated in the relevant clinical settings.Surprisingly little is known about the metabolic consequences of myocardial infarction in humans or the impact of metabolic interventions in this setting.In stable coronary artery disease, an infusion of 30 g of glucose, 50 IU of regular insulin, and 80 mmol of KCl per liter at 1.5 mL/kg body weight reduced myocardial FFA uptake and myocardial oxygen demand, whereas the uptake of glucose and lactate increased. 3In AMI, it was demonstrated that this regimen reduced the level of plasma FFAs substantially. 4 However, its impact on myocardial metabolism in this setting remains obscure.The neuroendocrine stress response, for instance, may be expected to influence myocardial metabolism and attenuate the effect of GIK due to insulin resistance.In coronary surgery, where systematic studies on GIK and its effects on systemic and myocardial metabolism have been done by Dr Rolf Ekroth and colleagues at Sahlgrenska University Hospital in Go ¨teborg, Sweden, it has been shown that insulin resistance can be severe early after the operation.Furthermore, substantially higher doses of insulin are required to achieve full metabolic effects than to achieve suppression of plasma FFAs. 5 Hence, before large-scale prospective, randomized studies on GIK in AMI are undertaken, further studies of myocardial metabolism in AMI and the impact of different GIK regimens may be advisable.
Malignant Lymphoma Presenting as Necrotizing Eosinophilic Granulomatosis
Authors: Aaron Lupovitch
Journal: JAMA (1965)

Necrotizing eosinophilic granulomatosis is a disease related to the allergic vasculitides and granulomatoses. In one patient, symptoms originally thought to be necrotizing eosinophilic granulomatosis on the basis of lymph node biopsy eventuated in an obvious lymphoma with leukemic dissemination. One similar case has been reported. These raise a question regarding the prognosis and course inferred by this diagnosis.
Two Further Cases of Curling's Ulcer in Major Burns in Children
Authors: M. Choudhury
Journal: BMJ (1963)

DICAL JOURNAL possible to be more precise than to classify the thera- peutic effect of a drug as satisfactory, fair, or poor. SummaryThe relative therapeutic value of orphenadrine and UK.738 was studied by means of a double-blind trial.Orphenadrine 100 mg.thrice daily produced satisfactory results in 15 out of 24 patients, and thus was much more effective than UK.738 4 mg.thrice daily.Simple quantitative data were collected relating to strength of grip, range of active and passive movement of the neck, and the ability to write.It was shown that such quantitative tests and other objective evidence can be of value in assessing the therapeutic value of drugs used in Parkinsonism.It was shown that after oral administration of orphenadrine peak activity occurred in about two hours whereas peak activity due to benzhexol occurred in two to three hours.It was not possible to demonstrate clearly a similar peak of activity for UK.738.It follows that when the relative merits of drugs are being determined by objective testing due regard should be paid to the phase of maximal activity, otherwise the findings will not be comparable.Fallacious results are also attributable to failure to appreciate the far-reaching effects of emotional upsets in these patients; and their lack of practice in experimental procedures also makes for unreliable data.I am indebted to Prmfessor S. Alstead for allowing me to study patients under his care, for his guidance, and for his helpful criticism of the manuscript.My thanks are due to Dr. J. C. Brocklehurst, who was closely associated with me in this work, for his help and advice.I am also indebted to Sister E. Biggin and Sister M. Quigley and their staff for their willing co-operation; to the pharmacists for supervising the issue of the drugs in accordance with the scheme for a double-blind clinical trial; to Mr. P. Waldie
ABC of Breast Diseases: Metastatic breast cancer
Authors: R C F Leonard, A Rodger, J M Dixon
Journal: BMJ (1994)

Few other cancers when they metastasise have such a variable natural Xt $ course and effect on survival as breast cancer.Patients with hormone sensitive cancers may live for several years without any intervention 19 other than various sequential hormonal manipulations.In contrast, 15 patients with disease that is not hormone sensitive have a much shorter interval free of disease and shorter survival, reflecting the more 10 o aggressive biology of hormone independent cancers.The average 8 period of survival after diagnosis of metastatic disease is 18-24 months, but this varies widely between patients.Clinical patterns of relapse predict future behaviour.Patients with a long interval without disease (more than two years) after primary ~~~~d iagnosis and favourable sites of recurrence (such as local lymph nodes i. a0, '~.~~.,..~and chest wall) survive longer than patients with either a short interval .~~~~~~~~without disease or recurrence at other sites.Patients with visceral Median time of survival associated with sites of disease have the poorest outlook; these patients tend to have a short metastasis in patients with breast cancer.interval without disease and have cancers that are biologically more aggressive. Treatment of metastatic diseaseHormonal treatment of metastatic breast cancer Premenopausal women A patient may present with metastatic * Oophorectomy breast carcinoma or develop a systemic * Radiation menopause recurrence after treatment for an apparently * Gonadotrophin releasing hormone analogues localised breast cancer.The aim of treatment * Other treatments as for postmenopausal women is to produce effective control of symptoms with minimal side effects.In terms of drug Postmenopausal women treatment this ideal is only achieved by * Tamoxifen (or pure antioestrogen when available) hormonal treaunent in the 30% of patients * Aromatase inhibitors (such as aminoglutethimide and whose cancers respond to such drugs.There 4-hydroxyandrostenedione is no evidence that treating patients with * New oral aromatase inhibitors (currently in clinical trials) asymptomatic metastases improves overall * Progestogens (such as medroxyprogesterone acetate and megestrol survival, and chemotherapy should be given acetate) routinely only to symptomatic patients.Antioestrogens, aromatase inhibitors, and progestogens may be used in virtually any sequence in responsive patients.Radiographs showing metastatic lesions in humerus (left) and changes after course of hormonal treatment with consequent reduction in bone pain (right).
Autoantibodies in childhood scleroderma.
Authors: R M Bernstein, R S Pereira, A J Holden, C M Black, A Howard, B M Ansell
Journal: Annals of the Rheumatic Diseases (1985)

The clinical presentation of scleroderma in childhood is even more varied than in adult life. This study of 19 children shows that antinuclear antibodies (ANA) detected on the HEp2 cell substrate are just as common as in the adult disorders. All seven children with diffuse scleroderma or acrosclerosis were ANA positive, as were eight of the 12 with more localised disease. Antinucleolar antibodies were particularly frequent (58% overall), but anticentromere antibody was not observed. Enzyme-linked immunosorbent assays (ELISAs) for antibodies to collagen types I-V, in contrast to adult scleroderma, gave normal results in all childhood cases.
Quantitation of size of relative myocardial perfusion defect by single-photon emission computed tomography.
Authors: J H Caldwell, D L Williams, G D Harp, J R Stratton, J L Ritchie
Journal: Circulation (1984)

The purpose of this study was to validate a semiautomatic method for quantitating the size of relative myocardial perfusion defects from single-photon emission computed tomographic (SPECT) images. We compared the size of the image defect in vivo, expressed as percent of involved left ventricle, as determined by this method with the anatomic size of the defect in vitro in 19 dogs. To test the method under optimal conditions, we first labeled the left ventricular myocardium in nine dogs by left atrial injection of 99mTc-labeled macroaggregated albumin particles after acute occlusion of one coronary artery. The "defect volume" was defined as the volume of the left ventricular myocardium for which counts fell 2 or more SDs below the distribution of counts in the myocardium supplied by a normal coronary artery in a series of animals. The relative in vivo defect volume by SPECT occupied 26.46 +/- 12.7% of the left ventricular volume (mean +/- SD), compared with a relative defect size in vitro of 33.3 +/- 13.7% (p = NS) of left ventricular volume as determined by well counting of myocardial samples. There was a close correlation between the two measurements (r = .92). However, myocardial relative defect volumes involving less than 5% of myocardium were not identified by SPECT. The defect volume weighted for the relative reduction in flow within the defect zone or the relative "reduced perfusion volume" was also determined. The correlation between the estimates by SPECT and those made in vitro for relative reduced perfusion volume was also high (r = .94).(ABSTRACT TRUNCATED AT 250 WORDS)
'Alternate channel' approaches seek to limit myocardial damage
Authors: John Henahan
Journal: JAMA (1984)

Coronary veins are being used as alternate channels in new techniques that seek to limit myocardial damage from coronary occlusions or in connection with cardiac surgery. Some of these new techniques still are undergoing preclinical study. Others already have entered the operating room. Many were discussed in Vienna recently at the First International Symposium on Protection of the Myocardium via the Coronary Sinus. These new approaches through the coronary sinus also might increase the efficacy of pharmacologic agents such as streptokinase, the prostaglandins, mannitol, and antiarrhythmic drugs, several participants indicated. The emphasis on the coronary system reflects a rejuvenation of interest in work carried out by Claude Beck, MD, more than 40 years ago. He attempted to treat myocardial ischemia by creating a shunt between the aorta and the coronary sinus. Although short-term improvements in heart function were seen in about 60% of the 200 patients who underwent Beck's operation,
CD18-independent neutrophil and mononuclear leukocyte emigration into the peritoneum of rabbits.
Authors: R K Winn, J M Harlan
Journal: Journal of Clinical Investigation (1993)

The CD18 mAb 60.3 and the CD49d mAb HP1/2 were given at the time of intraperitoneal instillation of either protease peptone or live Escherichia coli bacteria and at 12 h. Leukocyte emigration was evaluated at 4 and 24 h. PMN emigration 4 h after protease peptone instillation and injection of both mAbs was 10% of that in saline treatment. It was 15% of that in saline treatment after mAb 60.3 alone and unchanged by mAb HP1/2. At 24 h PMN emigration in response to protease peptone was not prevented by either CD18 or CD49d mAbs, however, when given together emigration was 10% of saline-treated animals. Mononuclear cell emigration to protease peptone was enhanced at 4 h by both CD18 and CD49d mAbs. The CD18 mAb did not augment mononuclear emigration in response to live bacteria. At 24 h, neither the CD18 nor the CD49d mAb alone blocked emigration of mononuclear cells, but the combination of the two did. These studies demonstrate that: (a) early (4 h) PMN emigration is CD11/CD18 dependent; (b) late (24 h) PMN emigration is CD11/CD18 independent; and (c) mononuclear cells utilize the integrins CD18 and CD49d.
Progressive immunoglobulin gene mutations in chronic lymphocytic leukemia: evidence for antigen-driven intraclonal diversification
Authors: Alicia D. Volkheimer, J. Brice Weinberg, Bethany E. Beasley, John F. Whitesides, Jon P. Gockerman, Joseph O. Moore, Garnett Kelsoe, Barbara K. Goodman, Marc C. Levesque
Journal: Blood (2006)
Should pregnant doctors work in termination of pregnancy clinics?
Authors: M. Millward
Journal: BMJ (2010)

I found clinic days as a foundation year 2 (F2) doctor strangely satisfying. After three months of on-calls in obstetrics and gynaecology, running between emergency department and labour ward, I was ready for some clinic time. I was also seven months pregnant and getting round, heavy, and tired. Imagine my confusion when I was assigned to repeated sessions of the weekly termination of pregnancy (TOP) clinic. On questioning the rota coordinator on the appropriateness of this decision (imagining that someone may have overlooked my rapidly swelling gravid uterus), I was told that as most of the other doctors had conscientiously objected I was the only junior doctor available for those weeks.

Discussions with doctors in other fields and with non-medical friends and family only heightened my unease about being a pregnant doctor consulting on and certifying terminations. In my experience most junior doctors don’t want to get involved …
STUDIES ON PNEUMONIA VIRUS OF MICE (PVM)
Authors: Edward C. Curnen, Frank L. Horsfall
Journal: The Journal of Experimental Medicine (1946)

1. The cause for the phenomenon of hemagglutination with heated PVM suspensions has been sought. 2. Evidence in wide variety indicates that the component responsible for hemagglutination is the virus particle itself. 3. The virus is capable of combining with a substance present in lung tissue of certain mammalian host species susceptible to infection by PVM. The occurrence of such combination accounts for a number of unusual properties manifested by this pneumotropic virus.
BS2-2: Nuclear Receptor Coactivators: Physiology and Disease.
Authors: BW O'Malley
Journal: Cancer Research (2011)

Abstract Nuclear receptors control gene expression by recruiting transcriptional coactivators (or corepressors). The coactivators are ‘master regulators’ that activate genes to control physiologies such as reproduction, growth and metabolism. Consequently, they are major players in the development of many inherited and acquired endocrine-related pathologies such as fertility/endometriosis, cancers, and disorders of carbohydrate, lipid and protein metabolism. The coactivator proteins provide important insights to polygenic diseases and represent a new class of drug targets for therapeutic interventions. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr BS2-2.
Mediastinal Histoplasmosis: F-18 FDG PET and CT Findings Simulating Malignant Disease
Authors: Gavin C. Mackie, Judith M. Pohlen
Journal: Clinical Nuclear Medicine (2005)

We describe the computed tomography and F-18 FDG PET findings of a patient with extensive mediastinal nodal enlargement resulting from histoplasmosis. This patient with known metastatic melanoma presenting for restaging was initially considered to have widespread mediastinal and cervical metastases on the basis of the imaging findings. Bronchoalveolar lavage fluid and transbronchial lymph node biopsy were consistent with histoplasmosis. The imaging findings improved after treatment with antifungal medication. A relatively small area of pulmonary involvement proved to be the clue in the imaging studies that the disease was inflammatory rather than neoplastic.
Mean velocity of circumferential fiber shortening in prolapsed mitral leaflet syndrome.
Authors: D Pisano, S D Cha, A S Gooch, V Maranhao, H Goldberg
Journal: Circulation (1977)

In 26 patients with mitral valve prolapse, ventricular function was evaluated by mean velocity of circumferential fiber shortening (MVCF) as measured along the basilar, middle and apical axes. Significantly increased rates of MVCF were found in patients with mitral prolapse along the basilar axis (1.75 +/- 0.23 circ/sec) and middle axis (2.09 +/- 0.34 cir/sec) (P less than 0.025 and P less than 0.05, respectively). Patients with mitral valve prolapse and regurgitation demonstrated a significant increase in MVCF along the basilar axes (1.72 +/- 0.15 cir/sec) (P less than 0.05). Asynergy apperars to have a negative effect on the MVCF along the middle axis. The MVCF was found not to be related to clinical findings, symptoms or electrocardiographic changes. The mechanism for the increase in MVCF in patients with mitral valve prolapse remains unsettled.
Genetic differences in drug metabolism associated with ocular toxicity.
Authors: H Shichi, D W Nebert
Journal: Environmental Health Perspectives (1982)

The tissue localization and subcellular distribution of drug-metabolizing enzymes in the eye are described. With the use of inbred strains of mice, the [Ah] complex is shown to be an important experimental system for probing genetic differences in drug metabolism and related drug toxicities. Although the genetic system described in detail here involves mice, there is ample evidence that the same system operates in man. Genetic differences in acetaminophen- and naphthalene-induced cataract formation and and other ocular degeneration are shown to be related to the [Ah] complex. Because this toxicity appears similar to senile cataracts, we propose that certain types of drug-induced cataracts might exist among clinical populations of senile cataracts but that any cause-and-effect relationship would be very difficult to determine because of underlying interindividual differences in genetic predisposition. It is therefore suggested that genetic differences in drug metabolism be an important consideration in the clinical assessment of ocular toxicity caused by drugs and other environmental pollutants.
Lymphadenography: Its Uses in Haematology
Authors: B. Malamos, S. D. Moulopoulos, A. Sarkas
Journal: BMJ (1959)

LEUKAEMIAM,BJOURXAL malignant properties and will grow progressively in a proportion of the hamsters into which they have been implanted.Electron-microscopy of Infected Cells Electron-microscopic studies have been made of tissue-culture cells infected with virus from a number of different sources: from the hamster kidney tumour, from one of the induced mouse mammary carcinomas, and from a (Gross) virus-induced leukaemia in a C3H mouse.Cells fr&n cultures which showed typical cytopathic changes were collected after trypsinization, fixed with osmic acid, embedded in methacrylate, and sectioned in the usual way.The controls comprised uninfected cultures subsequently treated in the same way.Independent of the source of the agent, the nuclei of the infected cells were found to contain particles ranging in size from 30 m,t to 40 m,u, round or slightly oval in
Narcosis for Chronic Tension
Authors: M. A. Harper
Journal: BMJ (1967)

sHu^375 servation as inpatients for periods varying from 14 weeks to 38 years (mean 12.6 years) before treatment.One improved in gait and arm after seven days of treatment, but another showed no improvement until after two months, when walking improved, but not until four and a half months later was improvement seen in the spasticity of the arm.'
Clinical Findings in Amebic and Pyogenic Liver Abscess.
Authors: Galen L. Barbour
Journal: Annals of Internal Medicine (1970)

Meeting Abstracts1 May 1970Clinical Findings in Amebic and Pyogenic Liver Abscess.Galen L. Barbour, M.D., Kerrison Juniper Jr., M.D., F.A.C.P.Galen L. Barbour, M.D.Search for more papers by this author, Kerrison Juniper Jr., M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-72-5-791_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThirty-three amebic and 33 pyogenic liver abscesses have been seen at 3 Little Rock hospitals since 1940. This paper compared the clinical findings in these two diseases from the standpoint of differential diagnosis and treatment. Pyogenic abscesses were due to coliform bacteria from the biliary tract in 30% of cases; the abscesses were more frequently multiple and involved both lobes of the liver. Secondary bacterial infection was found in only one of the amebic abscesses. Both types of abscess were found most often in patients in their fifties and sixties, but only amebic abscesses showed a race-sex predilection for negro... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Galen L. Barbour, M.D.; Kerrison JuniperJr., M.D., F.A.C.P.Affiliations: Little Rock, Ark. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1970Volume 72, Issue 5Page: 791-791KeywordsAbscessesAmebiasisBacteriaBiliary systemLiver ePublished: 1 December 2008 Issue Published: 1 May 1970 PDF downloadLoading ...
Systematic review of spinal manipulation: A biased report
Authors: B J Lewis
Journal: Journal of the Royal Society of Medicine (2006)

As Fellows of The Royal Society of Medicine, and also currently the President and Immediate Past President of the British Chiropractic Association, we wish to comment on the paper by Ernst and Canter (April 2006, JRSM1).

The authors clearly demonstrate bias in the very carefully selected studies included in their review. It appears to us that these researchers wished to examine a number of rather obscure areas of investigation (infantile colic, asthma, dysmenorrhoea, etc.) that cannot fairly reflect the efficacy or efficiency of manipulation—and there are many good quality primary research papers available for critique that deal adequately with the major focus of mainstream manipulation.2,3 It would, of course, have been a more accurate and impartial review if they had concentrated on those elements where the outcomes are well documented—namely, low back pain syndromes.4,5

Indeed, this recent review included four `reviews of reviews' by the main author; this in itself would surely perpetuate any author bias, whether intentional or not. In fact, the Centre for Reviews and Dissemination at the University of York concluded that it was difficult to assess the methodological robustness of the reviews utilized or the quality or the results of the primary studies. It is obvious that the CRD will not be alone in their conclusion. However, our own profession will continue to strive for the highest standards in research, education and practice, where patients' best interests will always remain paramount.

At the end of the day, no matter how robust the methodology of a critical review, the authors are inclined to their own bias: to conduct a review of reviews of one's own opinions, adds little to a meaningful literature base.