tbuckley/cabot-search huggingface dataset:
No time to train the surgeons
Authors: Joanna Chikwe, Anthony C de Souza, John R Pepper
Journal: BMJ (2004)

More and more reforms result in less and less time for training 

Surgical training in the United Kingdom is beset by fundamental problems raising what has been described as “considerable disquiet amongst trainees and trainers.”1 Basic and higher surgical trainees progress through a system comprehensively reformed five years ago to emphasise structured training, supervision, and regular assessment. So why are senior house officers' skill levels regarded by trainees and trainers as “very shallow”?2 Why is there insufficient capacity in the system to train surgeons in the way that their trainers want?3 And why is it that, in a recent poll of consultant surgeons, two thirds would not wish to be operated on by a Calman trained consultant colleague?4

In 1993 Sir Kenneth Calman proposed reforms of the registrar grades to bring the United Kingdominto line with a European Union directive on medical training. It was hoped that encouraging structured learning and supervision would compensate for reducing training time. The European Working Time …
IN VITRO EFFECTS OF HEPARIN ADMINISTRATION ON FREE THYROXINE CONCENTRATIONS
Authors: Kathleen M. Giacomini, Monika F. Bayer, John C. Giacomini, Sharon L. Youmans, I. Ross McDougall
Journal: Clinical Nuclear Medicine (1984)

We have demonstrated previously that heparin produces an increase in serum free thyroxine (FT4) measured by 2 step radio-immunoassay or equilibrium dialysis in some patients. The mechanism by which heparin administration acts to increase serum concentrations of FT4 was investigated in 12 patients. Blood was collected from each patient before and after an intravenous dose of heparin. Each sample was divided into 2 portions. Paraoxon, an inhibitor of lipase activity, was added to 1 portion. FT4 and non-esterified fatty acids were analyzed. FT4 was 1.4±0.2 (Mean±SD) and 1.4±0.3 ng/dl in the samples before heparin administration with and without paraoxon, respectively. After heparin administration, FT4 was 1.8±0.7 ng/dl in the samples not containing paraoxon (p < 0.01) and 1.5±0.2 ng/dl in the samples containing paraoxon (NS). Non-esterlfied fatty acid concentrations increased 10 fold on the average after heparin administration in the samples without paraoxon (p < 0.01). In the samples containing paraoxon, there was no Increase in non-esterified fatty acid concentrations after heparin administration. There was significant correlation between FT4 and non-esterified fatty acid concentrations (r = 0.93, p <0.01) In serum after heparin administration which did not contain paraoxon. There was a significant correlation between plasma triglyceride concentrations and non-esterified fatty acid concentrations after heparin administration in the samples not containing paraoxon. The effect of heparin administration on non-esterified fatty acids occurs primarily in vitro after blood withdrawal by continued hydrolysis of plasma triglycerides. The resultant elevated non-esterified fatty acids in turn appear to displace thyroxine from its binding sites on plasma proteins. Caution should be exercised in the interpretation of FT4 after administration of heparin.
Prospective study of periostitis and finger clubbing in primary biliary cirrhosis and other forms of chronic liver disease.
Authors: O Epstein, R Dick, S Sherlock
Journal: Gut (1981)

The association of finger clubbing and periostitis has been reported in primary biliary cirrhosis and, more rarely, in other forms of chronic liver disease. The prevalence of periostitis and its relationship to finger clubbing is unknown. In this prospective study, we have determined the prevalence of periostitis and finger clubbing in 74 patients with primary biliary cirrhosis and 54 with other forms of chronic liver disease. Clubbing was present in 24% of patients with primary biliary cirrhosis, 29% with HBsAg negative chronic active hepatitis, and 23% in the group of miscellaneous liver diseases. Symmetrical periostitis affecting the tibiae and fibulae occurred in 35% of patients with primary biliary cirrhosis, 29% with chronic, active hepatitis and 40% of patients in the miscellaneous group. The distal radii and ulnae were affected in only eight patients (6%). In primary biliary cirrhosis, the presence of finger clubbing was strongly associated with periostitis (P less than 0.01), but this association was uncommon in other forms of chronic liver disease. In all forms of chronic liver disease periostitis commonly occurs in the absence of finger clubbing. Marked tenderness over the distal leg bones is a reliable sign of underlying periostitis, but this sign is present in only a third of affected patients. This study indicates that periostitis affecting the lower leg bones is common in patients with chronic liver disease, and its presence should be sought whether or not the patient has finger clubbing.
Treatment of Presumed Cerebral Toxoplasmosis with Azithromycin
Authors: Eliot W. Godofsky
Journal: New England Journal of Medicine (1994)

To the Editor: A 28-year-old man with AIDS was hospitalized because of nausea, vomiting, and dizziness. Human immunodeficiency virus (HIV) infection had been diagnosed in 1991. He had had several o...
The Treatment of Obstinate Vomiting in Pregnancy
Authors: E. Copeman
Journal: BMJ (1875)

<h3>Background</h3> Evidence of an increased risk to develop haematological malignancy, especially non-Hodgkin’s lymphoma (NHL) in autoimmune diseases, has been gathered since the 1970s. In the last decade studies from SLE cohorts have consistently shown a markedly increased risk of NHL. <h3>Objectives</h3> To analyze clinical and disease characteristics in SLE patients who developed a lymphoma during follow-up, as well as to define characteristics of the lymphoma and its evolution. <h3>Methods</h3> Retrospective observational, longitudinal study conducted in a tertiary hospital. Medical records of 362 patients with ≥4 SLICC classification criteria of SLE were reviewed, including those with lymphoma diagnosis. Demographic and clinical data, comorbidities, SLE manifestations and therapy, data related to lymphoma and outcome were collected. Descriptive statistic analysis with measures of central tendency and measures of variability was performed. <h3>Results</h3> Of the 362 SLE patients, 9 (2.5%) were diagnosed of lymphoma, of which 100% female. Mean age at SLE diagnosis was 34 y.o (SD 11) and average duration from SLE diagnosis to lymphoma was 17 years (SD 14). 7 patients were Caucasian and 2 Hispanic. Observed comorbidities were hypertension (67%), diabetes (22%), dyslipidemia (33%), HBV infection (11%) and active smoking (66%). No malignancy history was detected. Most frequent SLE features were haematological (100%), joint (56%) and skin (56%) involvement. The serious ones were: 3 patients with haemolytic anaemia (1 of them, platelets &lt;20000), 2 epilepsia (1 with CNS vasculitis), 1 glomerulonephritis, 1 pulmonary hypertension and 1 hemophagocytic syndrome. Only 1 patient had overlap with Sjögren’s syndrome. At the time of lymphoma diagnosis, 7 patients were on steroids, 4 on immunosuppressants (2 mycophenolate, 1 azathioprine, 1 rituximab) and 3 on antimalarials (table 1). Mean age at lymphoma diagnosis was 51 y.o (SD 10). 5 patients (56%) had diffuse large B-cell lymphoma (DLBCL); 1, NHL; 1, Hodgkin’s lymphoma; 1, mantle B-cell lymphoma and; 1, MALT. Only 1 patient, of 4 with available data, had EBV positive in the tissue. 7 patients received chemotherapy and 2 patients completed treatment with autologous peripheral stem-cell transplantation. Three patients died, 2 due to lymphoma and one due to other causes (severe flaccid paralysis). Overall survival after lymphoma diagnosis was 8 years (SD 6). <h3>Conclusion</h3> In our patients, unlike that reported in the literature, lymphoma diagnosis was in SLE with longer duration of the disease, and all cases were female. Most frequent subtype was NHL, and all patients had previous haematological manifestations. Regarding previous SLE treatments, 5 patients had been exposed to immunosuppressants.
Syntaxin-4 is localized to the apical plasma membrane of rat renal collecting duct cells: possible role in aquaporin-2 trafficking.
Authors: B Mandon, C L Chou, S Nielsen, M A Knepper
Journal: Journal of Clinical Investigation (1996)

To evaluate the possible role of a putative vesicle-targeting protein, syntaxin-4, in vasopressin-regulated trafficking of aquaporin-2 water channel vesicles to the apical plasma membrane of renal collecting duct cells, we have carried out immunoblotting, immunocytochemistry, and reverse transcription (RT)-PCR experiments in rat kidney. Immunochemical studies used an affinity-purified, peptide-directed polyclonal antibody to rat syntaxin-4. Immunoblots using membrane fractions from inner medullary collecting duct (IMCD) cell suspensions revealed a solitary protein of 36 kD, the expected molecular mass of syntaxin-4. This protein was enriched in a plasma membrane-enriched membrane fraction from IMCD cells. Immunoperoxidase immunocytochemistry in 0.85-microm cryosections from rat inner medulla revealed discrete labeling of the apical plasma membrane of IMCD cells. RT-PCR demonstrated the presence of syntaxin-4 mRNA in microdissected IMCD segments, confirmed by direct sequencing of the PCR product. In addition, RT-PCR experiments demonstrated syntaxin-4 mRNA in glomeruli, vasa recta, connecting tubules, and thin descending limbs of Henle's loops. The demonstrated localization of syntaxin-4 in the apical plasma membrane of collecting duct principal cells, coupled with previous demonstration of syntaxin-4's putative cognate receptor VAMP2 in aquaporin-2-containing vesicles, supports the view that these proteins could play a role of aquaporin-2 vesicle targeting to the apical plasma membrane.
ACUTE UNILATERAL ASCENDING PARALYSIS.
Authors: CARL D. CAMP
Journal: JAMA (1907)

The case of ascending unilateral paralysis, which it is my privilege to report by the kind permission of Dr. James Hendrie Lloyd, merits attention because of the rarity of such symptoms when not caused by gross cerebral disease, and also because of the difficulties in making a satisfactory diagnosis of the pathologic condition present: <h3>Patient.</h3> —B. D., a laborer, aged 60, was admitted to the nervous wards of the Philadelphia General Hospital in the service of Dr. James Hendrie Lloyd on April 6, 1905, complaining of weakness in his left leg. <h3>History.</h3> —His family history was negative. He denied having had venereal diseases, but he had been drinking to excess for fifteen years. On his admission to the hospital, he said that about three weeks before he had fallen and injured several ribs. He was then taken to the Pennsylvania Hospital, where he remained until April 1. After he left
A RETROSPECTIVE ANALYSIS OF LOW FLOW, LOW GRADIENT SEVERE AORTIC STENOSIS WITH NORMAL EJECTION FRACTION: MORTALITY AND NEED FOR VALVE REPLACEMENT, A SINGLE CENTER STUDY
Authors: Jorge Romero, Patricia Chavez, Faraj Kargoli, Anjani Golive, Carlos Manrique, Florentino Lupercio, Francisco Medrano Corado, Mario Garcia, Daniel Spevack
Journal: Journal of the American College of Cardiology (2014)
Compliance and long-term effect of azathioprine in 65 rheumatoid arthritis cases.
Authors: P van Wanghe, J Dequeker
Journal: Annals of the Rheumatic Diseases (1982)

Azathioprine has been used in our unit as a third line disease modifying drug (DMD) since 1969. In 65 patients with severe rheumatoid arthritis (RA), [45 females and 20 males, mean age 55.2 years (32 to 76), mean duration of disease 14 years (1 to 41)], azathioprine was given in an average dose of 1.5 mg/kg body weight/day for a mean duration of 33.4 months (range 1 to 108). The mean follow-up was five years. One hundred and eighty-four patient years of treatment with azathioprine were observed. After three months9 treatment, significant subjective and objective improvement was observed in 65% of the cases. This improvement remained in 29 cases who received continuous treatment for two years. In 12 of the 20 seropositive RA cases, a reduction of at least three dilutions in the rheumatoid factor titre was noted. In the 24 patients who were corticosteroid dependent, the dosage of steroids could be reduced by 35% and in four steroids could be stopped completely. Compliance after two years (n = 54) was still 67%. Azathioprine treatment had to be stopped in 23 patients because of ineffectiveness in nine and adverse effects in 14. In three cases (4.6%) a malignant tumour occurred: one lymphoma and two adenocarcinomata. Low dose azathioprine therapy was shown to be useful as a third line disease modifying drug in RA without an increase in oncogenic risk. Compliance for azathioprine was found to be very satisfactory compared to other drugs.
A SICCA SYNDROME IN HIV INFECTION: ASSOCIATION WITH HLA-DR5 AND CD8 LYMPHOCYTOSIS
Authors: Silviu Itescu, LenoreJ Brancato, Robert Winchester
Journal: The Lancet (1989)

A sicca syndrome with parotid enlargement, pulmonary insufficiency, and lymphadenopathy was seen in 12 patients infected with human immunodeficiency virus (HIV), only 1 of whom has had an opportunistic infection during 304 patient months of study. There was a striking increase in numbers of circulating CD8 lymphocytes and the prevalence of HLA-DR5 was greatly increased. In patients with this diffuse infiltrative lymphocytosis syndrome (DILS) the CD8 lymphocytosis, which probably depends on histo-compatibility antigen status, may influence disease progression in HIV infection.
Detection of Cancer of the Cervix
Authors: Walter R. Burt
Journal: JAMA (1961)

<h3>To the Editor:—</h3> It seems that the ridiculous attack upon me by Dr. Bean, published in the Aug. 19, 1961, issue ofThe Journal(Letters to the Journal column<b>177</b>:529) was undignified and uncalled for. He should appreciate that I was asking for information so that in some way a greater number of women could benefit from early detection of cancer of the cervix. At least 65,000 women die of this malignancy in the United States each year, related in part to the reluctance of many women to have any procedure or examination performed on these organs. Why should Dr. Bean be unwilling to support any procedure or technique that would reduce the mortality of this dread disease? No one denies that the best smear will be obtained upon direct visualization of the cervix. This was reflected in Dr. E. Stewart Taylor's opinion in answer to my question about
Characteristics of lipid substances activating the ileal brake in the rat.
Authors: N J Brown, N W Read, A Richardson, R D Rumsey, C Bogentoft
Journal: Gut (1990)

Studies were carried out in 36 adult male rats to determine the characteristics of lipid substances which, after infusion into the ileum, slow the stomach to caecum transit time of the head of a bean meal in the rat. Stomach to caecum transit time was measured by environmental hydrogen analysis. Ileal infusion of a range of free fatty acids including petroselinic, oleic, myristoleic, erucic, linoleic, and linolenic all significantly slowed stomach to caecum transit time, as did the detergents (sodium bis (2-ethyl hexyl) sulphosuccinate and sodium linoleyl sulphate), the triglyceride corn oil, and the phospholipid lecithin. Although the lipid soluble deconjugated bile acid deoxycholic acid slowed stomach to caecum transit time, the water soluble conjugated bile acid taurocholic acid accelerated it. Infusion of the lipid alcohol oleyl alcohol and the calcium chelating agent disodium edetate (EDTA) into the ileum did not delay the passage of the meal through the stomach and small intestine. The diversity of lipid substances activating the ileal brake suggest a nonspecific effect by lipid soluble substances that can penetrate cell membranes. The lack of effect of EDTA suggested that calcium binding was not important.
Forced change of language
Authors: Brennan Wilson
Journal: Journal of the Royal Society of Medicine (2007)

Mr Cayton has made the very useful contribution of reminding us that language, however simple, always gives away our attitudes.1 Much research has shown that most of these attitudes are both communicated and received unconsciously.

I recently reviewed the unconscious attitudes portrayed in information leaflets given to patients attending departments of radiology in two teaching hospitals for day-case or outpatient procedures, using standard techniques in functional grammatical analysis. The leaflets were extremely courteous, as Mr Cayton recommends, but they consisted almost entirely of instructions: the patients were repeatedly put under social pressure to conform to the wishes and requirements of the radiology staff. On the other hand, there was no documentation of any requirement to respond to the patients' wishes and the staff themselves appeared to have an extremely authoritative position. Most surprising of all, the only route of communication of anything other than demographic details mentioned for the patients was by means of a formal complaint to the Trust authorities. This was all in spite of the fact that at least some of these leaflets had been approved by the central Trust information committee.

In this case, an obvious plea in mitigation is that patients have to be examined in a routine manner in order to produce reliable results, and I am not necessarily advocating a major change in our practice. What has surprised me is that, when these results were presented to them, none of the professional people involved realized that such attitudes could be communicated like this.

Thus, Mr Cayton's proposal of forced change of language will not usually affect underlying attitudes, as many health professionals do not always have insight into their own attitudes and their own use of language. Changing underlying attitudes, of course, will be much more difficult.
INCORPORATION OF SULFATE BY THE MOUSE THYMUS: ITS RELATION TO SECRETION BY MEDULLARY EPITHELIAL CELLS AND TO THYMIC LYMPHOPOIESIS
Authors: Sam L. Clark
Journal: The Journal of Experimental Medicine (1968)

The thymus was examined in suckling mice during normal development and the involution and regeneration produced by injection of cortisol, in experiments designed to test the hypothesis that medullary epithelial cells secrete a ymphopoietic hormone responsible for controlling the magnitude of thymic lymphopoiesis. Cellular events were observed by light and electron microscopy. Lymphopoiesis was assessed, after injection of thymidine-(3)H, by counting the proportion of lymphocytes labeled in radioautographs of thymus. Cortical lymphopoiesis was distributed heterogeneously, being concentrated in the subcapsular region, but medullary lymphopoiesis was statistically homogeneous in distribution and similar in magnitude to the average level of cortical lymphopoiesis in suckling mice. Therefore counts of the labeling index in the medulla were used to estimate the size of the proliferating population of lymphocytes. Epithelial secretory activity was estimated by measuring the incorporation of (36)sulfate by the thymus, using gel filtration chromatography to isolate soluble macromolecular (35)sulfate-presumed on radioautographic evidence to represent the mucoid epithelial secretory product. Incorporated (35)sulfate accumulated rapidly for 4 hr, reached a peak at 12 hr, and had fallen to half that level by 24 hr after a single injection-as would be expected of a secretory product. During normal postnatal development the size of the proliferating population of lymphocytes and the magnitude of (35)sulfate incorporation increased in parallel. During acute involution induced by cortisol both parameters diminished greatly but rose to high levels during subsequent regeneration. Accordingly, lymphopoiesis and sulfate incorporation -as defined and measured in these experiments-correlated linearly over a wide range of variation, providing circumstantial evidence to support the hypothesis that medullary epithelial cells secrete a sulfated mucoid lymphopoietic hormone. This conclusion is discussed in terms of the roles of thymus and adrenal cortex in development of the lymphoid system and maturation of immunological competence.
Efficacy and systemic absorption of topical tacrolimus used in pyoderma gangrenosum
Authors: P-D. Ghislain, I. De Decker, L. Marot, J-M. Lachapelle
Journal: British Journal of Dermatology (2004)

Sir, We report a case of a patient with pyoderma gangrenosum (PG) successfully treated with ciclosporin and topical tacrolimus. An increase in serum creatinine forced us to decrease the doses. The plasma level of tacrolimus was high. The patient was a 77‐year‐old man, with recent surgery for left total hip prosthesis. One week after surgery, an ulceration appeared around the suture area and progressed rapidly, with severe local pain and general malaise. A biopsy at the margin of the lesion showed a sharply demarcated ulceration, in which haemorrhage, necrosis and massive infiltration of polymorphonuclear neutrophils were present. Infection of the prosthesis was excluded. The diagnosis of PG was made, based on clinical and histopathological grounds. Several investigations did not disclose any associated disorder. Systemic treatment with ciclosporin (5 mg kg–1 day–1) was started, without any clinical benefit after 15 days (the lesion continued to increase in size). Tacrolimus (0·1% ointment) was then applied to the margins of the PG ulceration (18 × 12 cm) once daily (± 7·5 g day–1). The result was highly beneficial, with a quick response: no further extension, regression of the inflammatory border and pain relief. Plasma renal parameters 19 days after starting ciclosporin (4 days for tacrolimus) were normal. The day after, serum creatinine was 1·5 (normal 0·6–1·4) mg dL–1 and increased progressively within 3 days, to 2·2 mg dL–1. Creatinine clearance was 30 mL min–1. Serum tacrolimus concentration was 10·2 ng mL–1. Ciclosporin concentration was 307 ng mL–1 (therapeutic values 75–350). Thus, systemic ciclosporin was tapered to 2 mg kg–1 day–1 and tacrolimus 0·03% ointment was used instead of 0·1%. Creatinine levels returned to normal and tacrolimus absorption was not detectable any more. Complete healing of PG was obtained after 6 weeks, with classical cribriform scars.
Chlamydia pneumoniae--a new causative agent of reactive arthritis and undifferentiated oligoarthritis.
Authors: J Braun, S Laitko, J Treharne, U Eggens, P Wu, A Distler, J Sieper
Journal: Annals of the Rheumatic Diseases (1994)

To examine whether reactive arthritis (ReA) known to occur after a urogenital infection with Chlamydia trachomatis can also follow an infection with Chlamydia pneumoniae, a recently described species of Chlamydiae that is a common cause of respiratory tract infections.Specific antibodies (microimmunofluorescence test) and lymphocyte proliferation to C trachomatis and C pneumoniae in paired samples of peripheral blood and synovial fluid were investigated in 70 patients with either reactive arthritis (ReA) or undifferentiated oligoarthritis (UOA).Five patients with acute ReA after an infection with C pneumoniae are reported. Three had a symptomatic preceding upper respiratory tract infection and two had no such symptoms. In all patients a C pneumoniae-specific lymphocyte proliferation in synovial fluid and a high specific antibody titre suggesting an acute infection was found.C pneumoniae needs to be considered a new important cause of reactive arthritis.
TCTAP A-054 Long-term Clinical Outcomes After Transcatheter Closure of Atrial Septal Defect in Adult: Influence of Age Procedure
Authors: Yoichi Takaya, Teiji Akagi, Yasufumi Kijima, Koji Nakagawa, Shunji Sano, Hiroshi Ito
Journal: Journal of the American College of Cardiology (2014)