tbuckley/cabot-search huggingface dataset:
Teaching of Physical Diagnosis
Authors: STANLEY L. WIENER
Journal: Annals of Internal Medicine (1974)

Letters1 June 1974Teaching of Physical DiagnosisSTANLEY L. WIENER, M.D.STANLEY L. WIENER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-80-6-772 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: At Stony Brook Medical School, the teaching of medical interviewing and physical diagnosis is begun during the first week of training and is taught weekly, for one full day each week, for 6 months. This gives the students approximately 250 hours of instruction in these disciplines during the first half of the first year and it prepares them for systems teaching.At the end of the 6-month training period, the students are given a monitored examination, in which they individually do an interview and physical examination of a patient unknown to them. For this exercise they are... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: STANLEY L. WIENER, M.D.Affiliations: Long Island Jewish-Hillside Medical Center New Hyde Park, New York 11040 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Reliability of Clinical Methods, Data and Judgments 1 June 1974Volume 80, Issue 6Page: 772-772KeywordsExercise ePublished: 1 December 2008 Issue Published: 1 June 1974 PDF downloadLoading ...
Identification of genetic differences in drug metabolism: Prediction of individual risk of toxicity or cancer
Authors: Daniel W. Nebert
Journal: Hepatology (1991)

These two reports describe recombinant DNA tests that can identify individuals having a defect in the cytochrome P450IID6 ( CYP2D6 )-mediated oxidative metabolism of debrisoquine and more than two dozen other drugs that are commonly prescribed. The poor metabolizer (PM), representing 5% to 10% of the northern European white population is homozygous for an autosomal recessive trait. Compared with the extensive metabolizer (EM) phenotype, the PM individual is more prone to toxicity caused by some of these drugs. Curiously, the PM phenotype appears to be associated with a lower risk of lung and bladder cancer. Gough and coworkers propose that the primary gene defect associated with the CYP2D6 polymorphism appears to be a G to A transition mutation affecting the splice junction of intron 3/exon 4 of the CYP2D6 gene. They offer a polymerase chain reaction (PCR) amplification method for diagnosing three variant alleles and claim to have predicted the phenotype of all normal and 34 of 42 (81%) PM individuals. Based on the known frequencies of those variant alleles detectable by this method, however, the assay would be expected to predict less than 60% of PM patients. Heim and Meyer, on the other hand, have combined allelespecific PCR with restriction fragment length polymorphism (RFLP) patterns to identify more than 95% of all mutant alleles, suggesting that their assay would accurately predict more than 90% of all PM individuals. Using this latter assay or a similar test with further improvements, especially in combination with family studies, it should soon be possible for the physician to determine the CYP2D6 phenotype of the patient, thereby avoiding toxic drug overdoses.
Airway Inflammation, Exhaled Nitric Oxide, and Severity of Asthma in Patients with Western Red Cedar Asthma
Authors: MOIRA CHAN-YEUNG, HIDETO OBATA, MICHELLE DITTRICK, HENRY CHAN, RAJA ABBOUD
Journal: American Journal of Respiratory and Critical Care Medicine (1999)

Examination of induced sputum and measurement of exhaled NO have been advocated as noninvasive methods of assessing the degree of airway inflammation. In this study, we performed follow-up evaluation on 71 subjects with asthma caused by exposure to Western red cedar; 50 subjects had left exposure, whereas the rest continued to work in the same job. Spirometry, methacholine challenge tests, exhaled nitric oxide, and sputum induction were carried out. Of the 50 subjects who left exposure, 12 had no respiratory impairment according to the American Throacic Society guidelines for assessing respiratory impairment in patients with asthma, 17 belonged to Class 1, 12 to Class 2, five to Class 3, and four to Class 4. The percentage of eosinophils in induced sputum showed a significant inverse relationship with FEV1 (r = − 0.46, p < 0.001), and a significant positive correlation with levels of exhaled NO (r = 0.42, p < 0.001) and with the class of respiratory impairment (r = 0.52, p < 0.001). Mean percent eosinophils were 1.5 for impairment Class 0, 2.2 for Class 1, 1.7 for Class 2, 6.8 for Class 3, and 16.3 for Class 4. No relationship was found between the levels of exhaled NO and the functional parameters as well as the impairment class. NO levels in ppb were 21 for impairment Class 0, 30 for Class 1, 22 for Class 2, 26 for Class 3, and 49 for Class 4. This study also provides objective evidence that airway inflammation, as indicated by induced sputum, corroborates the rating of respiratory impairment in patients with asthma.
Xenobiotic incorporation into pyruvate dehydrogenase complex can occur via the exogenous lipoylation pathway
Authors: Hannah R. Walden, John A. Kirby, Stephen J. Yeaman, Joe Gray, David E. Jones, Jeremy M. Palmer
Journal: Hepatology (2008)

Lipoylated enzymes such as the E2 component of pyruvate dehydrogenase complex (PDC-E2) are targets for autoreactive immune responses in primary biliary cirrhosis, with lipoic acid itself forming a component of the dominant auto-epitopes. A candidate mechanism for the initiation of tolerance breakdown in this disease is immune recognition of neo-antigens formed by xenobiotic substitution of normal proteins. Importantly, sensitization with proteins artificially substituted with the lipoic acid analogue xenobiotic 6-bromohexanoic acid (6BH) can induce an immune response that cross-reacts with PDC-E2. This study investigated the potential of recombinant lipoylation enzymes lipoate activating enzyme and lipoyl-AMP(GMP):N-lysine lipoyl transferase to aberrantly incorporate xenobiotics into PDC-E2. It was found that these enzymes could incorporate lipoic acid analogues including octanoic and hexanoic acids and the xenobiotic 6BH into PDC-E2. The efficiency of incorporation of these analogues showed a variable dependence on activation by adenosine triphosphate (ATP) or guanosine triphosphate (GTP), with ATP favoring the incorporation of hexanoic acid and 6BH whereas GTP enhanced substitution by octanoic acid. Importantly, competition studies showed that the relative incorporation of both 6BH and lipoic acid could be regulated by the balance between ATP and GTP, with the formation of 6BH-substituted PDC-E2 predominating in an ATP-rich environment.Using a well-defined system in vitro we have shown that an important xenobiotic can be incorporated into PDC in place of lipoic acid by the exogenous lipoylation system; the relative levels of lipoic acid and xenobiotic incorporation may be determined by the balance between ATP and GTP. These observations suggest a clear mechanism for the generation of an auto-immunogenic neo-antigen of relevance for the pathogenesis of primary biliary cirrhosis.
GW25-e3407 Relationship of C-Reactive Protein with the Index of Microcirculatory Resistance Measured After Primary Percutaneous Coronary Intervention
Authors: Tai Shi, Liang Tang, Zhen-Fei Fang, Jian-Jun Tang, Qi-Ming Liu, Sheng-Hua Zhou, Xinqun Hu
Journal: Journal of the American College of Cardiology (2014)
Sulphanilamide for Acute Disseminated Lupus Erythematosus
Authors: J. E. G. Pearson
Journal: BMJ (1943)

cause of the heightened threshold in certain types of cases was raised.Assuming that the diminished motor activity associated with depression is due to increased cerebral inhibition, in contrast with that which occurs in schizophrenic disorders, a heightened electrical convulsion threshold might reasonably be expected to result from this inhibition.Now, it is shown by this investigation that cases of depression generally have a. higher threshold than cases of other disorders.Investigation also showed that the threshold increased with age, and as depression itself is more commonly found in older age groups there are two possibilities: (a) that certain forms of depression raised the threshold per se, or (b) that age alone has this result.It is impossible to say definitely which factor operates the more strongly, or, indeed, whether the age factor is not really the determinant of the psychosis.Amphetaminae sulphas, being a known cortical stimulant, was utilized in an attempt to lower the electrical convulsion threshold; in this it was found to be effective, and smaller strengths of electricity could be used.As regards the mode of action, considerations were discussed showing the likelihood that it exerts its effect centrally rather than by any accompanying peripheral changes, such as the heightened blood pressure.The possibility of the achievement of the central action by a process of " substrate competition," as suggested by Gaddum in the case of ephedrine, was advanced.In two cases there was some post-convulsion excitement.This was never very great, and may not have been due to the drug, since such excitement has been present after the con- vulsion when the drug was not employed.No other undesir- able effects were observed from the use of the drug: even in the patient with a blood pressure of 210/120 no harm appeared to result with the doses given.
Antiarrhythmic drug combinations in the treatment of ventricular tachycardia.
Authors: D L Ross, D Y Sze, D L Keefe, C D Swerdlow, D S Echt, J C Griffin, R A Winkle, J W Mason
Journal: Circulation (1982)

Combinations of antiarrhythmic drugs are frequently used to treat refractory ventricular tachycardia (VT), but few scientific data support this practice. We examined the efficacy and electrophysiology of 110 antiarrhythmic drug combination trials at electrophysiologic study in 74 patients with recurrent ventricular tachycardia. Lidocaine was combined with quinidine in 33 trials, procainamide in 22 and encainide in 20. Propranolol was combined with quinidine in 17 trials, procainamide in 12 and encainide in six. All individual drugs tested (except propranolol, which was usually not tested individually) had failed at electrophysiologic study or clinically in the presence of usually accepted plasma concentrations. Lidocaine in combination with quinidine was effective in 3% of the trials, with procanamide in 5% and with encainide in none of the trials. Propranolol in combination with quinidine was effective in 18% of the trials, with procainamide in 17% and with encainide in none of the trials. The electrophysiologic effects of the tested drug combinations were dominated by the individual effects of the type 1 antiarrhythmic agents. We conclude that the tested antiarrhythmic drug combinations are infrequently effective in preventing VT induction at electrophysiologic study when each agent has failed individually. The addition of lidocaine or propranolol to quinidine, procainamide or encainide does not produce significant synergistic or new effects on the electrophysiologic variables analyzed.
Family Decision Making on Trial
Authors: B Lo, F Rouse, L Dornbrand
Journal: New England Journal of Medicine (1990)

The highest courts in New York State and Missouri have made it more difficult to withhold life-sustaining treatment from incompetent patients. In the case of Mary O'Connor, the New York court ruled in October 1988 that such treatment must be given unless there is unequivocal evidence that the patient would have chosen to refuse it.1 This decision set a standard of proof so strict that few patients are likely to satisfy it. In the case of Nancy Cruzan, the Missouri court declared the following month that the state had an "unqualified" interest in prolonging life.2 These rulings rejected a medical, . . .
Satellite DNA repeat sequence variation is low in three species of burying beetles in the genus Nicrophorus (Coleoptera: Silphidae)
Authors: L. M. King, M. P. Cummings
Journal: Molecular Biology and Evolution (1997)

Three satellite DNA families were identified in three species of burying beetles, Nicrophorus orbicollis, N. marginatus, and N. americanus. Southern hybridization and nucleotide sequence analysis of individual randomly cloned repeats shows that these satellite DNA families are highly abundant in the genome, are composed of unique repeats, and are species-specific. The repeats do not have identifiable core elements or substructures that are similar in all three families, and most interspecific sequence similarity is confined to homopolymeric runs of A and T. Satellite DNA from N. marginatus and N. americanus show single-base-pair indels among repeats, but single-nucleotide substitutions characterize most of the repeat variability. Although the repeat units are of similar lengths (342, 350, and 354 bp) and A + T composition (65%, 71%, and 71%, respectively), the average nucleotide divergence among sequenced repeats is very low (0.18%, 1.22%, and 0.71%, respectively). Transition/transversion ratios from the consensus sequence are 0.20, 0.69, and 0.70, respectively.
Elevated Serum DDE and Risk for Alzheimer Disease
Authors: Alfred Bernard
Journal: JAMA Neurology (2014)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Neurology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Neurology journal
A TYPE-SPECIFIC PROTEIN FROM PNEUMOCOCCUS
Authors: Robert Austrian, Colin M. MacLeod
Journal: The Journal of Experimental Medicine (1949)

The isolation and characterization of a type-specific M protein from pneumococcus are described. This protein is similar chemically in all respects studied to the M proteins of group A streptococci. No immunological crossreactions have been observed, however, between M proteins of the two species. Strains of capsular type I pneumococcus have been encountered which contain different M proteins. The same is true for capsular type II pneumococcus. It is apparent, therefore, that the capsular polysaccharides and M proteins can vary independently of each other.
Renal Papillary Necrosis in Patients With IDDM
Authors: Leif Groop, Leena Laasonen, Johan Edgren
Journal: Diabetes Care (1989)

Although diabetes mellitus is reported in 29% of patients with renal papillary necrosis (RPN), the frequency of RPN among patients with insulin-dependent diabetes mellitus (IDDM) has from autopsy studies been estimated to be only 4.4%. In vivo data on the prevalence of RPN in patients with IDDM have been lacking. We therefore studied the prevalence of RPN in 76 patients with long-standing IDDM and in 34 age-matched control subjects by intravenous urography. None of the control subjects showed radiographic signs of papillary necrosis. RPN was observed in 18 patients (23.7%); 15 were women (83.3%). Age and duration of diabetes was not different between patients with and without papillary necrosis, and there was no significant difference between the two groups regarding the prevalence of microangiopathic complications, i.e., proliferative retinopathy and diabetic nephropathy. Microscopic hematuria was three times more frequent in patients with than without RPN (44 vs. 16% P &amp;lt; .02). In addition, pyuria was reported in 40% of patients with papillary necrosis, and 61% of them gave a positive history of urinary tract infection compared to 16% (P &amp;lt; 05) and 32% (P &amp;lt; .02), respectively, in patients without papillary necrosis. It is concluded that RPN is a more frequent complication of long-standing IDDM than appreciated from autopsy studies, and being female and having a history of urinary tract infection are associated with an increased risk of RPN.
Ultrastructural findings in endomyocardial biopsy of patients with Kearns-Sayre syndrome
Authors: Bodo Schwartzkopff, Hartmut Frenzel, Günter Breithardt, Martina Deckert, Benno Lösse, Klaus V. Toyka, Martin Borggrefe, Waldemar Hort
Journal: Journal of the American College of Cardiology (1988)
The Application of Romanowsky's Stain in Malaria
Authors: W. B. Leishman
Journal: BMJ (1901)

ROMANOWSKY'S STAIN -IN MALARIA.[ Tw 63Sall our efforts to diminution of suffering until such time as the patient succumbs to sheer exhaustion, or dies from some concomitant complaint.It has been my lot to have such a case under almost daily observation for two and a-half years -from the first diagnosis of the disease to its fatal termination-and the course of the case under the treatment adopted seems to me worth recording, and the treatment itself worth remarking upon.The problem I wish to draw attention to is this: Given a ease of cancer where surgical treatment is impossible, what treatment offers the best means of making the patient's life bearable as long as it lasts?Thie case I refer to was as follows:Mrs. M., widow, aged 7r, consulted me in May, I898, for symptoms poiniting to commencing cancer of the cervix.HISTORY.As usual, a slight hwnmorrhage was the first thing complained of Slhortly afterwards an offensive discharge set in.A microscopic examinat ion of a scraping fr;)m the cervix revealed the characteristic cell growth.The patient went to London with a view to being operated upon, and was seen by several surgeonis in consultation.After careful consideration, however, it was decided that on account of the age (and other reasons) comiiplete removal of the disease by suirgical interference was inadvisable, and she returned homiie to the country.While in London-a period of .sonictwo mnonths-pain began to require relief, and wlhen she returned to iiiy care wvas becoining severe.The pain increased rapidly in severity, and for a time the patient got imiuch worse; then, under the treatment to be described imiimediately, she improved much in general health, and lived in coinparative ease until October, I9oo, wlhen she had fainting fits on several successive days, and died from exhaustion.TREATMENT.(A) Hternorrhage.-Thiswas always controlled by ergot internally, and on the few occasions when severe flooding occurred, by subcutaneous in- jection of ergotin.
A Case of Cicatrix of the Pyloric end of the Stomach Causing Death
Authors: M. A. Wood
Journal: BMJ (1874)

death occurring to a country practitioner, and another accident with nearly fatal syncope in his own dispensary practice.Dr. Young (Edinburgh) narrated, a few years ago, two deaths from this cause, which occurred in his father's practice.Fatal hoemorrhages have also been reported by Taynton, Anderson, Whitworth, Des Forges, and Nicol, and in only one of these cases was there supposed to be any special hoemorrhagic tendency.Further scrutiny of these cases shows, as we might expect, that nearly all these deaths were reported under somewhat exceptional circum- stances; so that many more disasters have, doubtless, occurred and have
THE TREATMENT OF ANOXEMIA IN PNEUMONIA IN AN OXYGEN CHAMBER
Authors: William C. Stadie
Journal: The Journal of Experimental Medicine (1922)

1. The use of an oxygen chamber in the treatment of pneumonia patients makes it possible to administer this gas for long periods of time under exactly known conditions. The medical and nursing care of the patient is greatly facilitated. 2. Prolonged inhalation of oxygen varying from 40 to 60 per cent appears to be without harm. 3. Oxygen administered to intensely anoxemic patients almost immediately clears up this anoxemia. Cyanosis disappears with the anoxemia. 4. The removal of patients from the high oxygen while they are still sick and while examination shows that there are still extensive edema and infiltration of the lung results in a return of the intense anoxemia. 5. It is sometimes impossible to clear up the anoxemia, even when as high as 60 per cent of oxygen is given, especially when there are considerable edema and infiltration of the lungs. 6. Five cases in which the prognosis was grave recovered. Three cases, one of tuberculosis, one with a Pneumococcus Type III infection, and a third with a pneumonia superimposed on a chronic pulmonary condition, died. 7. In all cases there appeared to be an improvement in the patient's condition. In one case, particularly, with an intense degree of anoxemia, the patient became moribund and pulseless. Following the administration of 60 per cent of oxygen there was a lowering of the heart rate from 160 to 120, the return of the pulse to the radial artery, the color became bright pink, and there was a remarkable change in the clinical condition. 8. The anoxemia of pneumonia is due, in large measure, to an impairment of the respiratory surface of the lungs. The greater the lung involvement the greater the anoxemia. Especially is this so when the pneumonic process extends throughout the lungs so that there are many patches of bronchopneumonia, with accompanying bronchitis and edema, as evidenced by the presence of râles throughout the lungs. 9. Rapid and shallow breathing of the degree observed in pneumonia is, as far as present evidence shows, of less importance in the production of anoxemia.
Incentives help vulnerable patients to stay well
Authors: Sue Collinson
Journal: BMJ (2007)

In the head to head debate, Shaw says that to pay patients to take medication would create perverse incentives, but in her discussion she dismisses a particularly complex group of patients, with tuberculosis, despite the public health issues involved.1 2 This is a group of patients for whom payment, or other forms of incentive, are of critical importance, at both the individual and …
Drug Therapy in Reproductive Endocrinology
Authors: H. G Burger
Journal: BMJ (1996)

Ed Jean Ginsburg Arnold, £45, pp 416 ISBN 0 340 61385 8

The discipline of reproductive endocrinology spans a broad range of medical practice. General practitioners are often quite at home with the management options—and their practicalities—for the perimenopausal or postmenopausal woman or the girl with dysmenorrhoea.They are also likely to be well informed about endocrine contraception but unlikely to involve themselves in the induction of ovulation or the hormonal management of women with reproductive tract malignancies. Specialist gynaecologists would, in 1996, be expected to be au fait with the main endocrine aspects of the specialty, while urologists …
Patterns of long-term survival following Ipilimumab (Ipi): the Memorial Sloan Kettering Cancer Center 10-year metastatic melanoma (MM) experience
Authors: David B Page, Jarushka Naidoo, Parisa Momtaz, Kita Bogatch, Deborah Kuk, Katherine Panageas, Jianda Yuan, Jedd D Wolchok, Michael Postow
Journal: Journal for ImmunoTherapy of Cancer (2014)

Meeting abstracts In two Phase III randomized trials in MM, Ipi improved median overall survival (OS) [[1][1], [2][2]]. Here, we evaluate OS and characterize post-Ipi treatment patterns among long-term survivors from a single-institution cohort of patients (pts) treated with Ipi. Through a search