tbuckley/cabot-search huggingface dataset:
The contrasting effects of dobutamine and dopamine on gastric mucosal perfusion in septic patients.
Authors: R Nevière, D Mathieu, J L Chagnon, N Lebleu, F Wattel
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

To test the hypothesis whether or not dobutamine or dopamine infusion increases gastric mucosal perfusion, a prospective randomized crossover trial was conducted on 10 septic patients in the intensive care unit of a university hospital. Systemic hemodynamic, oxygen transport, and gastric perfusion assessed by gastric intramucosal pH and laser Doppler flowmetry were measured at baseline and after administration of dobutamine or dopamine (5 micrograms/kg/min). Both increased oxygen transport. In response to dobutamine, gastric mucosal blood flow increased (+32 +/- 14% from baseline; p < 0.05), gastric tonometered PCO2 and gastric arterial PCO2 difference decreased (58 +/- 7 versus 52 +/- 7 mm Hg; p < 0.05; 16.8 +/- 7.0 versus 10.5 +/- 7.2 mm Hg; p < 0.05), and intramucosal pH increased (7.23 +/- 0.05 versus 7.29 +/- 0.06; p < 0.05). In response to dopamine, gastric mucosal blood flow decreased (-28 +/- 8% from baseline; p < 0.05), gastric tonometered PCO2, gastric-arterial PCO2 difference, and calculated intramucosal pH were unchanged (58 +/- 7 versus 61 +/- 9 mm Hg, ns; 16.8 +/- 7.0 versus 18.9 +/- 8.4 mm Hg, ns; 7.24 +/- 0.05 versus 7.21 +/- 0.06, ns). We speculated that despite an oxygen transport increase, dobutamine and dopamine have affected differently gastric mucosal perfusion in septic patients.
Atherosclerosis Imaging and the Future of Lipid Management
Authors: Scott M. Grundy
Journal: Circulation (2004)

owering low-density lipoproteins (LDL) by statin therapy to reduce the risk for major clinical events in patients with established atherosclerotic cardiovascular disease (ASCVD) represents a therapeutic triumph of modern medicine.With standard doses of statins, the risk for CVD events falls by approximately one third. 1Additional risk reduction occurs by adding other therapeutic modalities to statin therapy-antiplatelet drugs, antihypertensive agents, smoking cessation, and healthy lifestyle changes. 2 Most of the benefit from these combined treatments appears to result from the stabilization of vulnerable plaques in patients who have advanced atherosclerotic disease; in other words, they reduce the likelihood of plaque ruptures that cause acute cardiovascular syndromes.
The obesity epidemic: too much food for thought?
Authors: R C Davey
Journal: British Journal of Sports Medicine (2004)

Traditional treatment strategies and public health interventions aimed at reducing the incidence of obesity are proving inadequate at controlling the global epidemic of this condition. The main focus of any intervention should be on preventing small excesses of weight, which lead to large weight gain over time, as once a large amount of excess weight is gained, it is very difficult to lose. The only effective approach is for governments to implement radical policy change, to regulate food consumption and control the food industry in a similar way to that of the tobacco industry, by banning the advertising of selected produce, taxing certain foods, and rationing the purchase of others.
Availability of computed tomography for the management of head injuries in England and Wales.
Authors: I A Baker
Journal: BMJ (1982)

Senior neuroradiologists or radiologists of 42 hospitals with computed tomography available for NHS patients in England and Wales were contacted by postal questionnaire about the use of this facility in the management of patients with acute head injuries. Replies were obtained from 39 hospitals. Requests for computed tomography from general surgeons or physicians and staff of accident and emergency departments received positive responses for scanning with only half to three-quarters the frequency of responses to requests from neurosurgeons. Continuous computed tomography facilities were available generally to neurosurgeons. The combined effect of partial responses to requests and the availability of the computed tomography service meant that only 44% of hospitals gave a continuous service for general surgeons or physicians. The percentage of hospitals giving a continuous service to accident and emergency departments was 54%. It appeared that computed tomography scanning was being used most often as a diagnostic/management instrument after clinical selection among patients with head injuries rather than as an instrument to be used in primary assessment.
Human Health and the Environment: Are Physician Educators Lagging Behind?
Authors: E. F. Merritt
Journal: JAMA (1999)

IN THE PAST 2 DECADES, NUMEROUS HOUSEHOLD AND INDUStrial products have been conclusively linked to human disease. Lead, carbon monoxide, and asbestos are the best known environmental toxins. Research has also established associations of in utero exposure to polychlorinated biphenyls with intelligence quotient deficits in children; mercury in interior latex paint with neurologic disorders; pollutants in drinking water with malignancies of the skin, lymph, and bone marrow. Most recently, dieldrin, an organochlorine used in pesticides, has been associated with a significantly increased, dose-related risk of breast cancer. In response to these accumulating data, 2 national organizations have taken steps to establish a permanent foothold for environmental medicine in US medical education. The National Institute of Environmental Health Sciences (NIEHS) has awarded over $13 million to US medical schools for the inclusion of environmental medicine in traditional academic curricula. And, the Institute of Medicine has recommended that all medical students acquire basic skills in eliciting an “exposure history” and a knowledge of the risk factors for environmental diseases.
Gastric emptying in patients with insulin dependent diabetes mellitus.
Authors: D L Dumitrascu
Journal: Gut (1996)

Our recent paper4 focused primarily on describing the histological features of microscopic colitis syndrome in our first 30 well defined cases.We have previously, however, studied different aetiological aspects in both lymphocytic5 and collagenous colitis.6The importance of factor(s) in the faecal stream has also been discussed by others.7
A nonsynonymous substitution of cystatin A, a cysteine protease inhibitor of house dust mite protease, leads to decreased mRNA stability and shows a significant association with atopic dermatitis
Authors: Y. Vasilopoulos, M. J. Cork, D. Teare, I. Marinou, S. J. Ward, G. W. Duff, R. Tazi‐Ahnini
Journal: Allergy (2007)

Background: Cystatin A ( CSTA ) is a strong candidate for atopic dermatitis (AD) because it maps to AD susceptibility locus on chromosome 3q21 and it does inhibit Der p 1 and Der f 1, major house dust mite cysteine proteases and environmental triggers for AD and asthma. Objective: To examine any association between polymorphisms in CSTA and AD and study the effect on the CSTA mRNA expression level. Methods: We identified three polymorphisms and characterized the linkage disequilibrium mapping of the CSTA gene. All three CSTA polymorphisms were genotyped in 100 AD patients and 203 matched controls. Subsequently, we performed transfection‐based RNA stability assays. Results: We found a significant association between the CSTA +344C variant and AD [odds ratio (OR) = 1.91; P = 0.024]. When further 61 control samples were genotyped. The association with CSTA +344C allele was enhanced OR = 2.13; P = 0.006. To test whether the CSTA +344 affected the CSTA transcriptional activity, the decay rates of RNAs transcribed from the CSTA +344C and CSTA +344T variants were investigated. COS‐7 cells were transfected with a pcDNA3.1−CSTA+344C or a pcDNA3.1−CSTA+344T construct and cultured in the presence or absence of actinomycin D. Real‐time RT‐PCR revealed that CSTA +344C mRNA is more than two times less stable than the CSTA +344T mRNA ( P &lt; 0.001). Conclusion: These results suggest that the CSTA +344C allele associated with unstable mRNA could result in failing to protect the skin barrier in AD patients from both exogenous and endogenous proteases
LONG-TERM CLINICAL OUTCOME AFTER IMPLANTATION OF SIROLIMUS-ELUTING AND PACLITAXEL-ELUTING STENTS IN PATIENTS WITH AND WITHOUT DIABETES MELLITUS - A PREDEFINED SORT OUT II SUBSTUDY
Authors: Michael Maeng, Niels Bligaard, Lisette O. Jensen, Henning Kelbaek, Jens F. Lassen, Peter R. Hansen, Per Thayssen, Leif Thuesen, Jan S. Jensen, Steen Z. Abildstrøm, Anders M. Galloe, None The SORT OUT II Investigators
Journal: Journal of the American College of Cardiology (2010)
Particle size selection device for use with the Turbohaler.
Authors: M. L. Everard, S. G. Devadason, P. N. Le Souef
Journal: Thorax (1996)

Drug deposited within the upper airways of patients using dry powder inhalers does not contribute to the therapeutic effect but can result in unwanted local side effects and, when swallowed, may contribute to systemic effects. A chamber has been devised which uses the centrifugal force generated by the Turbohaler to remove large "non-respirable" particles with a view to minimising deposition in the upper airway. An in vitro study was performed to determine whether such a chamber could reduce the dose contained in coarse particles without having a significant effect on the "respirable dose".The mouthpiece of a 200 micrograms Turbohaler was modified to allow a small volume chamber to be attached. The particle size distribution generated by the Turbohaler was assessed using a multi-stage liquid impinger with a flow rate of 60 l/min. The quantity of drug on each stage was quantified using an ultraviolet spectrophotometric technique. For each experiment 10 actuations were used to ensure adequate quantities of drug on each stage. Particles depositing on stages 3 + 4 have a diameter of < 6.8 microns and are arbitrarily referred to as the "respirable dose". The particle size distribution obtained using the Turbohaler (n = 10) was compared with that from the Turbohaler+ chamber (n = 11).The addition of the chamber resulted in the mean (SD) dose contained in larger "non-respirable" particles depositing on stages 1 + 2 being reduced from 52.2 (12.3) to 29.6 (6.9) micrograms per actuation. However, the chamber did not affect the "respirable" dose. The dose contained in particles with a diameter of < 6.8 microns from the standard Turbohaler was 91.1 (8.9) micrograms compared with 82.4 (18.6) micrograms when used with the chamber.These results indicate that it is possible to devise an effective particle size selection device for the Turbohaler. It may be possible to produce such devices for other dry powder inhalers, although the design would need to be tailored to each particular device.
On the Treatment of Bronchiectasis
Authors: T. G. Stewart
Journal: BMJ (1893)

TREATMENT OF BRONCHIECTASIS.[E"IA JRNAL 1147 secretion, which is even more important than its external one, there cannot be a doubt now.It is, therefore, quite natural that many practitioners have tried the pancreatic liquid extract against diabetes, and especially that peculiar form of it which has long ago been shown by Lancereaux to depend on a disease of the pancreas.What theory indicated has proved correct in a good measur6; injections of the pancreatic liquid have been use- ful, but no case of cure, to my knowledge, has been recorded.In a case of Dr. R&mond, the azoturia (which is excessive, as well shown by Hddon in cases of absence of the pancreatic internal secretion), became very much better under the in- fluence of injections of the liquid e-xtract of pancreas.Another organic liquid has gone further, and some cures have been ob- tained, the first of all in the case of a Calcutta Hindu who came to me, and whom I sent to my friend Dr. W. D. Water- house, of West Hampstead.That other organic extract is the orchitic liquid, which has considerably more power against any form of diabetes than the pancreatic liquid.I have for some time already recommenced the simultaneous use of those two liquids in all cases of glycosuria.VI.The Liver po88e88e8 also an Internal Secretion, and the Hepatic Liquid Extract might be sometzmes Used with Profit.-The well-known physiological facts relating to the production of sugar, and stin more of glycogen, positively show already that that gland has an internal secretion.But has it any other, and especially does it give to the blood principles the absence of which, when the liver is considerably disorganised, produces serious and peculiar symptoms ?There are very good reasons to think so, and it is most likely that in many cases of diffuse organic disease of the liver a number of the symptoms depend on the lack of the internal secretion.Un- fortunately in mammals there is no conclusion to be drawn relating to that point when we take away the liver or only tie all its blood vesselq.In frogs, however, experiments I made long ago, repeated lately by Dr. H. Roger, show that the taking away of the liver is a rapid cause of death after tonic or clonic convulsions.This clearly shows the impor- tance of the internal secretion of the gland.Certainly it-would be well to make use of the hepatic liquid in cases of extensive organic disease of the liver, whether it causes jaundice or not.
Haemorrhage as a Complication of Extracorporeal Pig Liver Perfusion: Studies on Mechanism and Prevention
Authors: J. Winch, J. Kolthammer, R. Hague, R. Fleisher, K. B. Shilkin, R. Williams
Journal: BMJ (1972)

The use of extracorporeal pig liver perfusion for temporary liver support has been followed not infrequently by major bleeding with a fall in coagulation factors and platelets, rather than a rise as hoped. In 18 experimental perfusions in which (125)I-labelled fibrinogen was used as a marker there was in every instance a significant loss of the fibrinogen into the fluid supporting the liver in the perfusion chamber. Further, in 11 of the perfusions there was an additional loss into liver substance, this being associated with a very rapid fall in (125)I fibrinogen and platelets content of the perfusion fluid. Damage to the sinusoids from ischaemic damage incurred during removal of the liver could explain both the direct loss of fibrinogen and, as a result of intravascular coagulation, the associated loss within the perfused liver. No correlation could be found with biochemical function, but it proved possible to assess haematological safety before connexion of the patient to the perfusion by a shortened (125)I fibrinogen test. This was done in three patients treated by five perfusions and in none was the thrombocytopenia or coagulation disturbance adversely affected.
173 RIGTH ATRIAL PRESSURE IS NOT ADEQUATE TO CALCULATE THE PORTAL PRESSURE GRADIENT IN CIRRHOSIS. A CLINICAL-HEMODYNAMIC CORRELATION STUDY
Authors: V. La Mura, J.G. Abraldes, A. Berzigotti, E. Erice, A. Flores-Arroyo, J.C. García-Pagán, J. Bosch
Journal: Journal of Hepatology (2010)
An unusual death in the community
Authors: C. Johnson, S. Koria, D. Fattah
Journal: BMJ (2013)

A 45 year old white man was found dead at home. The coroner was informed and requested an autopsy because the cause of death was not apparent. The patient had recently been under review by the respiratory team for poor respiratory function and patchy fibronodular lung changes. His history included osteomyelitis of the elbow, congenital kyphoscoliosis, and testicular seminoma, which had been treated with orchidectomy and chemotherapy. 

At postmortem examination, the abdominal cavity contained copious pus covering the serosal aspect of the small bowel. There was an obvious perforation at the level of the mid-ileum, as well as three ulcers on the mucosal aspect of the ileum, one of which had perforated.

Widespread pale nodules measuring up to 5 mm each were noted throughout the parenchyma of both lungs and a small pale lesion was present in the left kidney. No abnormalities were seen in the cardiovascular, endocrine, or central nervous systems.

Histological sections of the small bowel (fig 1⇓), lungs, liver, and kidney were taken for further analysis.



Fig 1 Histological section of the small bowel; original magnification ×4





### 1 Describe the histological features of the section of the small bowel

#### Short answer 

The histological section shows widespread granulomatous inflammation within the submucosa and muscularis propria of the bowel. A Langhans giant cell can also be seen.

#### Long answer 

The small bowel villi are not easily visible in this histological section of postmortem bowel because of autolysis as a result of decomposition. Inflammation can be seen within the submucosa and the muscularis propria. Caseous …
Training More Generalists
Authors: Marc L. Rivo
Journal: Annals of Internal Medicine (1994)

Letters1 January 1994Training More GeneralistsMarc L. Rivo, MD, MPHMarc L. Rivo, MD, MPHBureau of Health Professions; Health Resources and Services Administration; Rockville, MD 20857Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-1-199401010-00033 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:I agree with Dr. Lowther that the foremost strategy to produce more generalist physicians is to narrow the generalist-to-specialist reimbursement gap and to reduce regulatory, administrative, and malpractice burdens. Dr. Robinson is correct; I do not believe that these changes in the health care marketplace will produce the appropriate supply and specialty mix of graduating residents in a timely and predictable fashion. A general consensus exists that disincentives in the medical education marketplace, particularly the Medicare financing policy for graduate medical education, will also require changes to produce more generalists and fewer specialists [1].I respectfully disagree with ...References1. Rivo ML, Jackson DM, Clare FL. Comparing physician workforce recommendations. JAMA. 1993; 270:1083-4. Google Scholar2. Fox PD, Wasserman J. Academic medical centers and managed care: uneasy partners. Health Affairs. 1993; (Spring):85-93. Google Scholar3. Schappert SM. National Ambulatory Medical Care Survey: 1990. Vital and Health Statistics of the National Center for Health Statistics. April 1992. Google Scholar4. Corrigan JM, Thompson LM. Contractual arrangements between residency programs and HMOs. J Fam Pract. 1992; 25:543-7. Google Scholar5. Anderson RM, Lyttle CS, Kohrman CH, Levey GS, Clements MM. National study of internal medicine manpower: XIX. Trends in internal medicine residency training programs. Ann Intern Med. 1992; 117:243-50. Google Scholar Author, Article, and Disclosure InformationAffiliations: Bureau of Health Professions; Health Resources and Services Administration; Rockville, MD 20857 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 1994Volume 120, Issue 1Page: 92-93KeywordsGraduate medical educationHealth care sectorHealth maintenance organizationsHospital medicineMedical educationMedicareMotivationResidency ePublished: 15 August 2000 Issue Published: 1 January 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Effect of oral D-penicillamine treatment on experimental arthritis and associated immune responses in rabbits. III: Reduction of the monoarticular arthritis.
Authors: I M Hunneyball, G A Stewart, D R Stanworth
Journal: Annals of the Rheumatic Diseases (1979)

Treatment of rabbits with D-penicillamine at doses up to 30 mg/kg, beginning either before or after the onset of antigen-induced experimental arthritis, diminished the severity of the inflammatory synovitis in a considerable proportion of animals as judged by both external joint measurements and terminal histopathological assessment. D-penicillamine treatment had no effect on serum haptoglobin concentration, haemoglobin concentration, or platelet count. The venous blood white cell count was raised when D-penicillamine treatment was started before immunisation but not when treatment began after the onset of arthritis. A transient loss of appetite was observed in animals starting D-penicillamine treatment.
Development of drug-resistant herpes simplex virus infection after haploidentical hematopoietic progenitor cell transplantation
Authors: Amelia A. Langston, Istvan Redei, Angela M. Caliendo, Jyoti Somani, Don Hutcherson, Sagar Lonial, Silvana Bucur, Judy Cherry, Andrew Allen, Edmund K. Waller
Journal: Blood (2002)
Stomach rupture complicating traumatic diaphragmatic hernia.
Authors: G. Csapo, J. Patkay
Journal: BMJ (1969)

doctors are possibly unaware that an estimate of 10%°, of all admissions to general wards have had an alcohol-dependency.Alcoholism is excluded from the curricula of medical schools.Few doctors therefore understand anything about alcoholism.Workers with alcoholics learn about the illness from the patients themselves.If a true conception of illness is accepted there is no need for shame to be attached to alcoholism.Recovered alcoholics are fortunate people.Recovered medical alcoholics can greatly help by revealing their identity and assisting in information about this disease by enlightening their colleagues and making themselves available for consultation to sufferers from the disease.I hope my personal experiences can be turned to good effect.-Iam, etc., NEIL PANTON.Southampton, Hants.Porphyrinuria SIR,-In Dr. Norman Gitlin's recent communication (11 January, p. 96), the most significant positive finding is the "strongly positive porphobilinogen."Also significant, in a negative sense, is the very modest abnormality in urinary uroporphyrin excretion.This would argue against any "acquired porphyria."On the other hand, it is hard to attach much significance to elevated urinary coproporphyrin in a patient with obvious alcoholic liver disease.Can we be sure that the patient's pain and even the hyperlipaemia' are due to " Zieve's syndrome" and not to acute intermittent or variegate porphyria (possibly precipitated by an alcoholic bout and/or inanition) ?What is badly needed in this case to put these factors in proper perspective is quanrtitation of urinary porphobilinogen (elevated in both acute intermittent and variegate) and faecal protoporphyrin (elevated in variegate).-Iam, etc.,
Effects of an Immunostimulating Agent on Acute Exacerbations and Hospitalizations in Patients with Chronic Obstructive Pulmonary Disease
Authors: J. P. COLLET, S. SHAPIRO, P. ERNST, P. RENZI, T. DUCRUET, A. ROBINSON
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

The PARI-IS Study is a double-blind placebo-controlled randomized clinical trial to study the effect of an immunostimulating agent to prevent acute respiratory exacerbation in patients with COPD. Three hundred eighty-one ambulatory patients (190 placebo and 191 immunostimulant) were followed at home for 6 mo by experienced research nurses. The risk of having at least one episode of acute exacerbation (primary outcome) was similar in the two groups (p = 0.872). In contrast, the total number of days of hospitalization for a respiratory problem was 55% less in the group treated with OM-85 BV (287 d) than in the group treated with placebo (642 d). Patients treated with OM-85 BV spent an average of 1.5 d in hospital compared with 3.4 d for patients treated with placebo (p = 0.037). The risk of being hospitalized for a respiratory problem was 30% lower in the treated group (16.2%) than in the placebo group (23.2%); p = 0.089. Eight deaths were observed: two in patients treated with OM-85 BV and six in patients treated with placebo (p = 0.153). During the course of the study dyspnea improved slightly in patients treated with OM-85 BV, whereas it deteriorated slightly in patients receiving placebo (p = 0.028). These results suggest that this immunostimulating agent may be beneficial for patients with COPD by reducing the likelihood of severe respiratory events leading to hospitalization.