tbuckley/cabot-search huggingface dataset:
Long-term Follow-up after Endoscopic Sphincterotomy (EST)
Authors: E. Seifert
Journal: Endoscopy (1988)

Long-term results after endoscopic sphincterotomy (EST) revealed disappearance or improvement of symptoms in 92.0%. The symptoms remained unchanged in 6.2% and deteriorated in only 1.8%. X-ray follow-up studies showed concrement-free bile ducts in 85.2%, recurrent stones in 11.3%, and a stenosis of EST in 3.5%. Satisfactory long-term results depend on the indication for EST. The results of EST for choledocholithiasis are much better than for papillary stenosis (symptom-free or improved = 91.7%: 83.7%, unchanged = 6.4%: 14.3%, deteriorated = 1.9%: 2.0%). An EST-related stenosis was more than five times more frequent (16.8%: 2.9%) in papillary stenosis than choledocholithiasis. A gallbladder in situ does not seem to be an additional risk factor after EST. Subsequent cholecystectomy was performed in only 16.2% (routinely and elective), and in only 2.0% as an emergency procedure. In approximately 50% of the cases aerobilia and reflux, and in about 100% bacteriocholia, are observed after EST. When the free outflow of bile is ensured, it is not probable that late secondary diseases will develop.
Osteoblastic Reaction in Non-small Cell Lung Carcinoma and its Association to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors Response and Prolonged Survival
Authors: Emilie Pluquet, Jacques Cadranel, Anne Legendre, Michelle Beau Faller, Pierre Jean Souquet, Gerard Zalcman, Maurice Perol, Gislaine Fraboulet, Gerard Oliveiro, Florence De Fraipont, Elisabeth Quoix, Sylvie Lantuejoul, Bernard Milleron, Denis Moro-Sibilot
Journal: Journal of Thoracic Oncology (2010)
Torsion of an Accessory Spleen of the Cecum Presenting as Acute Appendicitis
Authors: Robert T. Bass, See Tao Yao, Robert J. Freeark
Journal: New England Journal of Medicine (1967)

ACCESSORY spleens have been found in many - areas of the abdominal cavity1 and in the scrotal sac2 and have mimicked various surgical conditions.3 Although there have been reports of an accessory spleen simulating acute appendicitis4 there have been no reports of one actually located on the cecum. In the case presented below, a patient with torsion of an accessory spleen of the cecum initially had findings suggesting acute appendicitis.Case ReportL.C. (C.C.H. 65–32356), a 27-year-old Negro, was admitted to Cook County Hospital with an 8-hour history of right-lower-quadrant pain that was constant and became increasingly severe. He denied . . .
Making clinical governance work
Authors: Pieter J Degeling, Sharyn Maxwell, Rick Iedema, David J Hunter
Journal: BMJ (2004)

The current focus on quality and safety means most doctors have negative views about clinical governance.But done properly, clinical governance has the power to improve NHS performance Clinical governance has been described as "by far the most high-profile vehicle for securing culture change in the new NHS." 1 However, the government's past preoccupation with delivery and top down performance management has undermined its developmental potential. 2To be effective, clinical governance should reach every level of a healthcare organisation.It requires structures and processes that integrate financial control, service performance, and clinical quality in ways that will engage clinicians and generate service improvements. 3We strongly endorse this view.Because clinicians are at the core of clinical work, they must be at the heart of clinical governance.Recognition of this fact by clinicians, managers, and policy makers is central to re-establishing "responsible autonomy" as a foundation principle in the performance and organisation of clinical work.We look at problems with the prevailing model of clinical governance and describe an alternative approach. Improving quality from the top down or from the bottom up?Clinical governance was conceived as being local in both its orientation and in its operation (fig 1).As a bottom-up mechanism, it was intended to inspire and enthuse and create a no-blame learning environment characterised by excellent leadership, highly valued staff, and active partnership between staff and patients. 1he reality in most trusts, however, is far removed from these high hopes.The clinical governance arrangements established meet the formal requirements of central bodies such as the Commission for Health Improvement (now the Healthcare Commission).They also reflect the government's past emphasis on inspection and performance management. 5 6Hence, in most trusts the operations of the stand alone "silos" (fig 2) are oriented to ensure that a trust's senior management can satisfy its accountability on centrally determined generic performance measures.Given their focus on abstracted issues such as risk, safety, and quality, the people who staff these silos tend to treat clinical work as an undifferentiated aggregate.This means that they are neither disposed nor equipped to consider the full range of clinical, organisational, and interpersonal processes that are entailed in, for example, treating a fracture or supporting a patient in self managing a chronic disease.
Immunoelectron microscopic localisation of transforming growth factor alpha in rat colon.
Authors: R Perez-Tomas, X Cullere, M Asbert, C Diaz-Ruiz
Journal: Gut (1994)

Transforming growth factor alpha (TGF alpha) is a polypeptide, which binds to the epidermal growth factor receptor to carry out its function related to cell proliferation and differentiation. The ultrastructural localisation of TGF alpha was studied in both the proximal and the distal colon. The columnar cells, lining the surface epithelium of the proximal colon, showed a strong immunoreactivity in the polyribosomes and in the interdigitations of the lateral membrane. The columnar cells of the crypts and the goblet cells in both the proximal and the distal colon showed the immunostaining in the cis and trans cisternae of the Golgi apparatus. TGF alpha seems to be processed differently in the surface columnar cells and in the crypt columnar cells and goblet cells. Moreover, it probably has different roles in proliferation and differentiation.
Incremental Prognostic Value of Myocardial Perfusion Single Photon Emission Computed Tomography for the Prediction of Cardiac Death
Authors: Rory Hachamovitch, Daniel S. Berman, Leslee J. Shaw, Hosen Kiat, Ishac Cohen, J. Arthur Cabico, John Friedman, George A. Diamond
Journal: Circulation (1998)

Background —The incremental prognostic value of stress single photon emission computed tomography (SPECT) for the prediction of cardiac death as an individual end point and the implications for risk stratification are undefined. Methods and Results —We identified 5183 consecutive patients who underwent stress/rest SPECT and were followed up for the occurrence of cardiac death or myocardial infarction. Over a mean follow up of 642±226 days, 119 cardiac deaths and 158 myocardial infarctions occurred (3.0% cardiac death rate, 2.3% myocardial infarction rate). Patients with normal scans were at low risk (≤0.5%/y), and rates of both outcomes increased significantly with worsening scan abnormalities. Patients who underwent exercise stress and had mildly abnormal scans had low rates of cardiac death but higher rates of myocardial infarction (0.7%/y versus 2.6%/y; P &lt;.05). After adjustment for prescan information, scan results provided incremental prognostic value toward the prediction of cardiac death. The identification of patients at intermediate risk of nonfatal myocardial infarction and low risk for cardiac death by SPECT may result in significant cost savings when applied to a clinical testing strategy. Conclusions —Myocardial perfusion SPECT yields incremental prognostic information toward the identification of cardiac death. Patients with mildly abnormal scans after exercise stress are at low risk for cardiac death but intermediate risk for nonfatal myocardial infarction and thus may benefit from a noninvasive strategy and may not require invasive management.
Detrusor hyperactivity with impaired contractile function. An unrecognized but common cause of incontinence in elderly patients
Authors: N. M. Resnick
Journal: JAMA (1987)

Little is known about the causes of urinary incontinence in institutionalized elderly people, despite the fact that $8 billion is annually devoted to diapering those afflicted. We have identified a specific physiological abnormality— detrusor hyperactivity with impaired contractile function (DHIC)—that, although previously unrecognized, is the second most common (33%) cause of incontinence in this setting. Detrusor hyperactivity with impaired contractile function is a distinct physiological subset of detrusor hyperreflexia and presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. This impaired emptying is due to diminished detrusor contractile function and is associated with bladder trabeculation, a slow velocity of bladder contraction, little detrusor reserve power, and a significant amount of residual urine. Aside from its high prevalence, the importance of DHIC is that it may present as urinary retention, may closely mimic prostatic outlet obstruction, may explain why past therapeutic trials for detrusor hyperreflexia have failed, and may necessitate a change in the current nosology of bladder dysfunction. Furthermore, DHIC may represent a more advanced stage in the natural history of detrusor hyperreflexia, a stage characterized by deterioration of detrusor contractile efficiency. Thus, this previously unrecognized cause of incontinence in the elderly is common and raises several important issues. (<i>JAMA</i>1987;257:3076-3081)
Abstract 2080: The role of ErbB2 in regulating survival in matrix-detached inflammatory breast cancer cells
Authors: Cassandra L. Buchheit, Brittany Angarola, Allison Steiner, Zachary Schafer
Journal: Cancer Research (2012)

Abstract Inflammatory breast cancer (IBC) is a rare and highly invasive type of breast cancer, and patients diagnosed with IBC often face a very poor prognosis. IBC is characterized by the lack of primary tumor formation and the rapid accumulation of cancerous epithelial cells in the dermal lymphatic vessels. Given that normal epithelial cells require attachment to the extracellular matrix (ECM) for survival, a comprehensive examination of the molecular mechanisms underlying IBC cell survival in the lymphatic vessels is of paramount importance to our understanding of IBC pathogenesis. Here we demonstrate that in contrast to normal mammary epithelial cells, IBC cells evade ECM-detachment-induced apoptosis (anoikis) and maintain ATP levels following ECM detachment. Exogenous ErbB2 overexpression leads to increased ATP production and soft agar growth in IBC cells that normally lack ErbB2 amplification. Additionally, ErbB2 knockdown in KPL-4 cells, an IBC cell line characterized by high levels of ErbB2, resulted in diminished ATP levels, decreased colony growth, and increased caspase activation following ECM detachment. Further studies reveal that the protection from anoikis in IBC cells is dependent on activation of the ERK-MAPK pathway, but does not depend on modulation of the levels of the pro-apoptotic factor Bim. These results demonstrate that ErbB2 is necessary and sufficient for IBC cell survival in the absence of ECM attachment. Understanding the molecular mechanism utilized by IBC cells to survive in matrix-detached conditions could lead to more specific and effective therapeutics to prevent IBC metastasis from occurring and to treat patients in which metastasis has already occurred. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2080. doi:1538-7445.AM2012-2080
Facing Requests for Physician-Assisted Suicide
Authors: Linda L. Emanuel
Journal: JAMA (1998)

Requests for physician-assisted suicide are not a new phenomenon, and many physicians are likely to face this challenging situation. This article proposes for professionals an 8-step approach to respond to requests for physician-assisted suicide. The approach seeks to identify and treat the root causes of the request and aims to present a plan for consistent application of a set of clinical skills. Justification for the steps requires only 2 noncontentious principles: the patient should be free of unwanted intervention, and the physician is obligated to provide suffering patients with comfort care. Care based on these 2 principles alone does not include physician-assisted suicide. The approach does, however, justify patient refusal of oral intake in specific circumstances. The approach could resolve a majority of requests for physician-assisted suicide and should be tested further for clinical efficacy.
Double-blind clinical trial of the analgesic effects of phenazocine hydrobromide (Narphen) compared with morphine sulphate in patients with acute abdominal pain
Authors: D. Hopton
Journal: Gut (1971)

No significant difference could be detected either by clinical impression or statistical analysis in the relief of pain afforded by 2·5 mg phenazocine hydrobromide (Narphen) and 10 mg morphine sulphate when given by intramuscular injection to patients with acute abdominal pain. Phenazocine does not cause spasm of the sphincter of Oddi and so is recommended for treating biliary or pancreatic pain.
Post-intervention cardiac enzyme elevations: Prognostic significance in IMPACT II
Authors: Barbara E. Tardiff, Robert M. Califf, James E. Tcheng, A.Michael Lincoll, Kristina N. Sigmon, Robert A. Harrington, Kenneth W. Mahaffey, Paul Teirstein, James Heinsimer, Eric J. Topol
Journal: Journal of the American College of Cardiology (1996)
Familial Alzheimer’s disease–associated presenilin-1 alters cerebellar activity and calcium homeostasis
Authors: Diego Sepulveda-Falla, Alvaro Barrera-Ocampo, Christian Hagel, Anne Korwitz, Maria Fernanda Vinueza-Veloz, Kuikui Zhou, Martijn Schonewille, Haibo Zhou, Luis Velazquez-Perez, Roberto Rodriguez-Labrada, Andres Villegas, Isidro Ferrer, Francisco Lopera, Thomas Langer, Chris I. De Zeeuw, Markus Glatzel
Journal: Journal of Clinical Investigation (2014)

Familial Alzheimer’s disease (FAD) is characterized by autosomal dominant heritability and early disease onset. Mutations in the gene encoding presenilin-1 (PS1) are found in approximately 80% of cases of FAD, with some of these patients presenting cerebellar damage with amyloid plaques and ataxia with unclear pathophysiology. A Colombian kindred carrying the PS1-E280A mutation is the largest known cohort of PS1-FAD patients. Here, we investigated PS1-E280A–associated cerebellar dysfunction and found that it occurs early in PS1-E208A carriers, while cerebellar signs are highly prevalent in patients with dementia. Postmortem analysis of cerebella of PS1-E280A carrier revealed greater Purkinje cell (PC) loss and more abnormal mitochondria compared with controls. In PS1-E280A tissue, ER/mitochondria tethering was impaired, Ca2+ channels IP3Rs and CACNA1A were downregulated, and Ca2+-dependent mitochondrial transport proteins MIRO1 and KIF5C were reduced. Accordingly, expression of PS1-E280A in a neuronal cell line altered ER/mitochondria tethering and transport compared with that in cells expressing wild-type PS1. In a murine model of PS1-FAD, animals exhibited mild ataxia and reduced PC simple spike activity prior to cerebellar β-amyloid deposition. Our data suggest that impaired calcium homeostasis and mitochondrial dysfunction in PS1-FAD PCs reduces their activity and contributes to motor coordination deficits prior to Aβ aggregation and dementia. We propose that PS1-E280A affects both Ca2+ homeostasis and Aβ precursor processing, leading to FAD and neurodegeneration.
Specific IgE serum concentration is associated with symptom severity in children with seasonal allergic rhinitis
Authors: C. Rolinck‐Werninghaus, T. Keil, M. Kopp, S. Zielen, U. Schauer, A. Von Berg, U. Wahn, E. Hamelmann
Journal: Allergy (2008)

The impact of allergen-specific and total IgE serum levels before and during the pollen season on symptom severity as well as efficacy of treatment with anti-IgE requires further delineation.Birch and grass pollen allergic patients aged 6-17 years with seasonal allergic rhinitis (SAR) were analyzed for the association of IgE serum concentration with symptom severity and rescue medication use (combination: symptom load, SL) during the grass pollen season. Reference group A (n = 53) received placebo, while group B (n = 54) received Omalizumab (anti-IgE) monotherapy before and during the grass pollen season.Patients on placebo with high baseline specific grass pollen IgE (>50 kU/l) had a significantly higher SL compared with those with low IgE levels (< or =50 kU/l): SL 1.28 vs 0.61, P = 0.015. This association was nonexistent in patients treated with anti-IgE. In contrast, baseline total IgE levels did not correlate with SL in any group. Patients with anti-IgE treatment and high free total IgE levels (>16.7 ng/ml) had a significantly higher SL compared with those with low free total IgE levels (< or =16.7 ng/ml): SL 0.63 vs 0.23, P = 0.031.Baseline specific IgE, but not total IgE, is associated with symptom severity during the pollen season in children with SAR. Likewise, the symptom load in SAR patients with anti-IgE correlates with free total IgE levels. Although further research in larger populations is needed to confirm our findings, our data suggest that specific IgE can be used as a parameter for patient selection for this kind of treatment.
Exertional arrhythmia and nitgroglycerin
Authors: G. E. Gey
Journal: JAMA (1973)

Nitroglycerin improves the exercise performance of patients with coronary heart disease. A retrospective study of data collected while monitoring 103 such patients was focused on the various types of arrhythmia and the effects of nitroglycerin on the frequency of occurrence. After nitroglycerin administration, occurrences were fewer. This applied more to angina patients than to those with healed myocardial infarction.
Thalidomide — A Revival Story
Authors: Noopur Raje, Kenneth Anderson
Journal: New England Journal of Medicine (1999)

One of the most devastating tragedies of modern medicine was set into motion by the over-the-counter marketing of thalidomide in Europe during the late 1950s for the treatment of morning sickness. The drug was withdrawn in the 1960s after the appearance of reports of teratogenicity and phocomelia associated with its use. The recent return of thalidomide stems from the broad spectrum of its pharmacologic and immunologic effects.1 Thalidomide has been approved by the Food and Drug Administration for the treatment of erythema nodosum leprosum, an inflammatory manifestation of leprosy,2 and potential therapeutic applications span a wide spectrum of other diseases. . . .
Reaffirming Professionalism through the Education Community
Authors: P. Preston Reynolds
Journal: Annals of Internal Medicine (1994)

To determine the role of the clinical training environment and a medical education community in reaffirming medical professionalism among physicians-in-training and faculty.Published articles on undergraduate and graduate medical education and sociology works on professionalism were identified through research.Studies were selected that illustrated barriers to professionalism in medical education and patient care and the professional conduct of medical students, residents, and faculty.Factors that undermined the medical education community were the specialization of medicine, the faculty reward systems, and the service demands of residency because of the economics of health care.Establishment of a firm system with a core teaching faculty, creation of mentoring and role modeling programs, implementation of a longitudinal curriculum on medical professionalism, evaluation of physicians on professional conduct, and evaluation of the clinical training environment are suggested as strategies to re-establish an education community and reaffirm professionalism in medicine.
The inadequacy of punch-excised melanocytic lesions: Sampling through the block for the determination of “margins”
Authors: Timothy T. Chang, Stephen C. Somach, Kyle Wagamon, Ally-Khan Somani, Jerome Pomeranz, Christine Jaworsky, Jonathan Bass, Harry L. Winfield, Jessica E. Sigel, Arlene S. Rosenberg
Journal: Journal of the American Academy of Dermatology (2009)
Linear atrophoderma of Moulin: a disease which follows Blaschko's lines
Authors: A. WOLLENBERG, L. BAUMANN, G. PLEWIG
Journal: British Journal of Dermatology (1996)

Linear atrophoderma of Moulin is a distinctive disease pattern characterized by hyperpigmented atrophoderma and described originally in 1992. It follows the lines of Blaschko, and occurs without preceding inflammation, subsequent induration or scleroderma. The lesions usually develop during childhood or adolescence, and the prognosis is good. The differential diagnoses include linear dermatoses, e.g. linear scleroderma, epidermal naevi, inflammatory linear verrucous epidermal naevus, lichen striatus, Blaschkitis acuta, reticulate hyperpigmentation of Iijima and linear lupus erythematosus. Diagnosis is made clinically and histologically. We report a 22-year-old woman with a 17 year history of linear atrophoderma which involved the right arm and trunk.
90. miRNA Shuttles Improve Therapeutic RNAi
Authors: Ryan L. Boudreau, Beverly L. Davidson
Journal: Molecular Therapy (2006)

Top of pageAbstract
Huntington's disease (HD) and Spinocerebellar ataxia type I (SCA1) are dominant neurodegenerative diseases caused by polyglutamine (polyQ) expansion. The mutations produce toxic proteins, with polyQ length predictive of disease onset and severity. There is no therapy for HD or SCA1, supporting the investigation of novel strategies. In other work, we show that gene silencing by RNA interference (RNAi) can be achieved in vitro and in vivo by expressing short hairpin RNAs (shRNAs) which are subsequently processed into small interfering RNAs (siRNAs) specific for ataxin-1 or huntingtin mRNA. Viral delivery of RNAi to disease mouse models resulted in partial recovery of morphological and behavioral phenotypes, suggesting improvements could be explored. To improve our RNAi strategy, we have previously developed an inducible RNAi expression system which exploits microRNAs (miRNAs) as siRNA shuttles. Although previous studies suggest that miRNA shuttles are processed by RNAi machinery more efficiently than shRNAs, the silencing efficiencies of miRNA shuttles and shRNAs have not been adequately compared. To address this, we generated RNAi constructs which express siRNAs specific for unique targets (ataxin-1, huntingtin or eGFP) in the context of either miRNA shuttles or shRNAs. shRNAs were driven by the polIII-based U6 or H1 promoters, while miRNA shuttles were driven by U6 or the polII-based CMV promoter. We assessed the ability of the RNAi constructs to silence Renilla luciferase with 3'UTRs containing target sequences corresponding to either ataxin-1, huntingtin or eGFP. Furthermore, sense and antisense sequences were targeted to determine which RNAi strands (guide or passenger) enter RISC. RNAi and luciferase target constructs were co-transfected into 293 cells and luciferase assays performed 48h later. Preliminary results show that the RNAi constructs direct sequence-specific silencing of the appropriate luciferase target. Furthermore, silencing was more efficient with miRNA shuttles than shRNAs, independent of the targeted sequence. These results suggest that miRNA shuttles may be used to increase the therapeutic efficacy of RNAi in SCA1 and HD mouse models.