tbuckley/cabot-search huggingface dataset:
TIPS is a useful long-term derivative therapy for patients with Budd-Chiari syndrome uncontrolled by medical therapy
Authors: Antonia Perelló, Juan Carlos García-Pagán, Rosa Gilabert, Yanette Suárez, Eduardo Moitinho, Francisco Cervantes, Juan Carlos Reverter, Angels Escorsell, Jaume Bosch, Juan Rodés
Journal: Hepatology (2002)

Patients with Budd-Chiari syndrome (BCS) may require treatment with portal decompressive surgery or liver transplantation. Transjugular intrahepatic portosystemic shunt (TIPS) represents a new treatment alternative, but its long-term effect on BCS outcome has not been evaluated. Twenty-one patients with BCS consecutively admitted to our unit were evaluated. The mean follow-up was 4 ± 3 years. Seven patients had nonprogressive forms and were successfully controlled with medical therapy; 1 case, with a short-length hepatic vein stenosis was successfully treated by angioplasty. All 8 patients are alive and asymptomatic. The remaining 13 patients, had a TIPS because of clinical deterioration (in one of them, because early TIPS thrombosis a successful side-to-side portacaval shunt [SSPCS] was performed) followed by an improvement in clinical condition. However, a patient with fulminant liver failure before TIPS insertion, died 4 months later and another patient with cirrhosis at diagnosis had liver transplantation 2 years later. The remaining 11 patients are alive and free of ascites. In 3 of these patients TIPS is patent after 3, 6, and 12 months. The remaining 8 patients developed late TIPS dysfunction. In two of these cases, after angioplasty and restenting, TIPS is patent after a follow-up of 9 and 80 months. In 5 other patients, recurring TIPS occlusion was not further corrected because no signs of portal hypertension were present. In conclusion, in patients with BCS uncontrolled with medical therapy, TIPS is a highly effective technique that is associated with long-term survival.
Arend Jan Dunning
Authors: J. Overbeke, L. Offerhaus
Journal: BMJ (2009)

Arend Jan Dunning (“Ad”) was well known as an excellent organiser and manager with unsurpassed skills in human relationships. Moreover, he was an old fashioned intellectual with broad interests who acquired some fame by publishing a number of books with a philosophical background on the relative powerlessness of medicine. Some of these were inspired by his keen …
Randomised clinical trial of ultrasound treatment for pressure ulcers
Authors: G. t. Riet, A. G H Kessels, P. Knipschild
Journal: BMJ (1995)

Toxoplasma retinochoroiditis usually develops in the second and third decades oflife and is generally attributed to congenital infection * Prevention of toxoplasma retinochoroiditis is considered to be a major benefit of prenatal screening as previous studies have suggested that 80% of congenitally infected children would eventually develop retinochoroiditis * This report shows that the incidence of symptomatic toxoplasma retinochoroiditis is nearly 100 times higher in black people born in west Africa than in subjects born in Britain * In subjects born in Britain acute symptomatic toxoplasma retinochoroiditis is much less common than expected, affecting about one fifth of the estimated number of congenitally infected people * These findings suggest that the potential benefits of prenatal screening for toxoplasma infection in Britain are limited lesions and on the proportion of retinochoroiditis attributable to acquired rather than congenital infection.These factors could have led to an underestimate or overestimate, respectively, of the proportion of congenitally infected subjects who develop ocular symptoms in the long term.The benefits of potentially preventing ocular symp- toms in the long term need to be balanced against the risks of repeated testing of all pregnant women, the participation of a large number of women falsely identified as infected and those truly infected in unnecessary invasive investigations and treatment, and unnecessary terminations of pregnancy.9 15 36 37Evidence that symptomatic retinochoroiditis is less common than suggested by previous estimates of the prevalence of retinochoroiditis implies that prenatal screening for toxoplasmosis may be of limited value in Britain.
Clinical Utility of Different Lipid Measures for Prediction of Coronary Heart Disease in Men and Women
Authors: Erik Ingelsson, Ernst J. Schaefer, John H. Contois, Judith R. McNamara, Lisa Sullivan, Michelle J. Keyes, Michael J. Pencina, Christopher Schoonmaker, Peter W. F. Wilson, Ralph B. D’Agostino, Ramachandran S. Vasan
Journal: JAMA (2007)

Evidence is conflicting regarding the performance of apolipoproteins vs traditional lipids for predicting coronary heart disease (CHD) risk.To compare performance of different lipid measures for CHD prediction using discrimination and calibration characteristics and reclassification of risk categories; to assess incremental utility of apolipoproteins over traditional lipids for CHD prediction.Population-based, prospective cohort from, Framingham, Massachusetts. We evaluated serum total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, apolipoprotein (apo) A-I and apo B, and 3 lipid ratios (total cholesterol:HDL-C, LDL-C:HDL-C, and apo B:apo A-I) in 3322 middle-aged white participants who attended the fourth offspring examination cycle (1987-1991) and were without cardiovascular disease. Fifty-three percent of the participants were women.Incidence of first CHD event (recognized or unrecognized myocardial infarction, angina pectoris, coronary insufficiency, or coronary heart disease death).After a median follow-up of 15.0 years, 291 participants, 198 of whom were men, developed CHD. In multivariate models adjusting for nonlipid risk factors, the apo B:apo A-I ratio predicted CHD (hazard ratio [HR] per SD increment, 1.39; 95% confidence interval [CI], 1.23-1.58 in men and HR, 1.40; 95% CI, 1.16-1.67 in women), but risk ratios were similar for total cholesterol:HDL-C (HR, 1.39; 95% CI, 1.22-1.58 in men and HR, 1.39; 95% CI, 1.17-1.66 in women) and for LDL-C:HDL-C (HR, 1.35; 95% CI, 1.18-1.54 in men and HR, 1.36; 95% CI 1.14-1.63 in women). In both sexes, models using the apo B:apo A-I ratio demonstrated performance characteristics comparable with but not better than that for other lipid ratios. The apo B:apo A-I ratio did not predict CHD risk in a model containing all components of the Framingham risk score including total cholesterol:HDL-C (P = .12 in men; P = .58 in women).In this large, population-based cohort, the overall performance of apo B:apo A-I ratio for prediction of CHD was comparable with that of traditional lipid ratios but did not offer incremental utility over total cholesterol:HDL-C. These data do not support measurement of apo B or apo A-I in clinical practice when total cholesterol and HDL-C measurements are available.
Normal hepatocytes correct serum bilirubin after repopulation of Gunn rat liver subjected to irradiation/partial resection
Authors: Chandan Guha, Bhupesh Parashar, Niloy J. Deb, Madhur Garg, Giridhar R. Gorla, Anupam Singh, Namita Roy-Chowdhury, Bhadrasain Vikram, Jayanta Roy-Chowdhury
Journal: Hepatology (2002)

The treatment of inherited metabolic liver diseases by hepatocyte transplantation (HT) would be greatly facilitated if the transplanted normal hepatocytes could be induced to proliferate preferentially over the host liver cells. We hypothesized that preparative hepatic irradiation (HIR) should inhibit host hepatocyte proliferation in response to partial hepatectomy (PH). Normal nonirradiated hepatocytes transplanted in this setting should have a selective growth advantage over the host liver cells and should progressively repopulate the liver. To test this hypothesis, we transplanted 5 million hepatocytes from normal Wistar-Roman High Avoidance (RHA) rats into the livers of congeneic bilirubin-uridine 5’-diphosphoglucuronate glucuronosyltransferase (UGT1A1)-deficient jaundiced Gunn rats by intrasplenic injection after one of the following treatments: (1) 68% PH, (2) HIR (50 Gy), or (3) HIR + PH. In rats receiving either PH or HIR alone before HT, serum bilirubin concentrations declined by 25% to 30% in 28 weeks. In contrast, serum bilirubin levels were normalized completely in rats receiving HIR + PH before HT. Massive repopulation of the Gunn rat liver by the UGT1A1-positive Wistar-RHA hepatocytes was shown by UGT1A1 enzyme assay, immunoblot analysis, and immunohistochemical staining of the recipient liver. High-performance liquid chromatography analysis of the bile collected from Gunn rats 5 months after PH, HIR, and HT showed normalization of the pigment profile, with bilirubin diglucuronide and monoglucuronide as the predominant pigments. In conclusion, a preparative regimen of HIR + PH results in massive repopulation of the liver with functionally normal transplanted hepatocytes, resulting in complete correction of a metabolic deficiency. Noninvasive strategies to replace PH for providing proliferative stimuli to the transplanted cells should make this regimen valuable in augmenting the effects of HT for the treatment of liver diseases.
Where There's Smoke There Are Liars
Authors: Edward N. Squire
Journal: JAMA (1991)

To the Editor.  — With the United States advancing toward a smokeless society, smokers, perhaps fearing stigma, perhaps feeling shame, perhaps simply being deceptive, may increasingly choose not to reveal their smoking to their physicians. We cite a recent example of such a phenomenon.  We examined 52 adults with allergic asthma who were enrolled in a study during which tobacco use was incidentally ascertained. During this protocol, seven (14%, with a 95% confidence interval [CI] of 6% to 26%) of the 52 patients revealed, in confidence, that they smoked, a finding that had gone undetected during their clinical evaluations. Their smoking was therefore not known to the physicians who treated their asthma. Moreover, as vital as this information was, it had not been forthcoming, despite the fact that multiple measures should have elicited it, including new patient evaluation performed by the allergy-immunology service, with specific attention to exacerbating factors; documentation
Doubts raised over cancer vaccine study
Authors: A. Tuffs
Journal: BMJ (2001)

A prizewinning German study claiming to have found a safe and effective vaccine for kidney cancer has been heavily criticised by doctors who say that the research data may have been manipulated and that the treatment could even be dangerous.

Alexander Kugler, a senior registrar in the urology department of Gottingen University Hospital, and Gernot Stuhler, an oncologist from Tubingen University, treated 17 patients with metastasising kidney cancer with a vaccine made from a hybrid of cancer and immune cells. Their study, published in March last year, reported that after …
The cholesterol controversy.
Authors: P. Thomas
Journal: BMJ (1992)

Injuries sustained on "bouncy castles" SIR,-We wish to report the dangers of playing on "bouncy castles."A bouncy castle is an inflatable children's playground, consisting essentially of a rubber matress inflated with air.Three walls generally surround the castle, with the fourth side open to allow entry and exit, but some castles are open on all four sides.They are popular in fairgrounds and recreational halls.During last summer five children and one adult were treated at Northwick Park Hospital for injuries sustained while they were playing on bouncy castles.All injuries were to the arm or neck.Three supracondylar fractures of the humerus occurred.Two of these required open reduction and internal fixation with Kirschner wires.The third was managed with a collar and cuff support.A girl aged 6 sustained a fracture of the mid-shaft of the humerus, which was managed with a hanging cast support.The neck injuries occurred in a 52 year old man and a 12 year old boy.These were both soft tissue injuries caused by flexion and were managed conservatively.
Writing for publication in the<i>BJD</i>: tips for fledglings
Authors: A. Anstey
Journal: British Journal of Dermatology (2015)

And the words slide into the slots ordained by syntax, and glitter as with atmospheric dust with those impurities which we call meaning.1 ‘How many of you read the BJD each month?’ All 120 delegates raised their hands. ‘How many of you have published in the BJD?’ About 20 hands went up (abstracts, items of correspondence and case reports, I surmised). ‘How many of you have published an original article or review in the BJD?’ One hand went up. The scene was set for the next hour, with a talk in London to U.K. dermatology residents. I was delighted to be there, anticipating lively dialogue with potential BJD authors and peer reviewers. What a treat to savour: one hour with the future of British dermatology. So, what tips did I have for this audience who listened so attentively to what I had to say? The following is a summary of the key themes that were covered, based largely on recently published BJD editorials, discussions within the BJD editorial team and my own personal views on how to acquire academic writing skills.
THE SURGICAL TREATMENT OF THE AUTONOMOUS NEUROGENIC BLADDER
Authors: REED M. NESBIT
Journal: JAMA (1941)

The autonomous neurogenic bladder results from destructive lesions of the cauda equina or conus terminalis. The bladder is totally deprived of its essential innervation by the parasympathetic division of the autonomic nervous system. The detrusor becomes hypertonic, but, because of the destruction of the spinal reflex, all reflex contractions are abolished. Bladder sensation is lost and voluntary sphincteric control is destroyed (fig. 1). Sharing in the hypertonicity of the detrusor are those circularly arranged fibers at the vesical neck described as the internal sphincter. The hypertonic internal sphincter acts as a definite obstruction, almost exactly analagous to having contracture of a vesical neck superimposed on the entire picture. As a result, urine does not escape from the bladder until the intravesical pressure exceeds the obstruction in the outlet. Since reflex activity of the bladder is lost, voiding is accomplished only by straining or by continuous overflow dribbling incontinence. As time
Improved Method of Cocain Anesthesia.
Authors: Henry W. Wandless
Journal: JAMA (1897)

Dallas, Texas, Sept. 4, 1897. <h3>To the Editor:</h3> —With the permission of Drs. Anderson and Oaks, I would like to add something in reference to the " Improved Method of Cocain Anesthesia" by Dr. P. L. Anderson. This is not in the nature of criticism, but simply to add my experience to theirs. In 1890 it seemed to be the practice to use a 4 per cent. solution of cocain with a spray for this purpose, but I did not adhere to this, for I soon found that the toxic effects of the drug were alarming and began applying it by means of cotton wrapped on a cotton carrier. I did not at this time (1891) use the preliminary spray, but gradually increased the strength of the solution of cocain until finally a saturated solution was used. From this mode of application I did not notice any special toxic effect, except
Francis Geoffrey Smiddy
Authors: J. MacFie
Journal: BMJ (2003)

Former senior surgeon Leeds General Infirmary (b Kendal 1922; q Leeds 1944; ChM, MD, FRCS), d 8 March 2003.​2003.




Figure 1




Geoff Smiddy joined the Royal Army Medical Corps in 1945 and served three years in India. After various posts at Leeds Infirmary, in 1957 he accepted a fellowship at Harvard Medical School, where he produced some of the earliest research into the significance of enteric bacteria as a cause of mortality in haemorrhagic shock. In 1961 he was appointed consultant surgeon at Leeds General Infirmary. He was elected to the court of examiners for the Royal College of Surgeons of England in 1967, and it was his extensive experience in examining that was the major stimulus to his writing surgical textbooks. Smiddy's first book, Medical Management of the Surgical Patient, was published in 1975 and sold many thousands of copies, running to three editions. Smiddy retired in 1987. He leaves a wife, Penny, two children; and four grandchildren.
Fibrosarcoma of Left Atrium
Authors: F. E. Cayley, H. I. Bijapur
Journal: BMJ (1963)

Dcmo MEDI ORNALurine also as a source of some of the protein content of the amniotic fluid.SUMMARY The erythropoietin content of amniotic fluid from Rh-immunized pregnant women and of cord blood and foetal urine from anaemic erythroblastotic infants has been investigated by use of transfusion-induced poly- cythaemic mice as recipients.High levels of erythro- poietin have been found in the amniotic fluid in pregnancies with severely anaetnic foetuses, and they seem to be correlated with those in cord blood and foetal urine.It is suggested that estimations of the erythropoietin levels in the amniotic fluid may be of help in the prenatal diagnosis of erythroblastosis.
Dose-finding study of interferon alfa-n3 in hepatitis
Authors: J H Hoofnagle, J Everhart
Journal: Hepatology (1997)

Normal Heterozygotes Homozygotes TotalA significant association between genetic hemochromato-A1ATD, liver disease 33 (82.5%) 7 (17.5%)0 (0%) 40 sis (GH) and a 1 -antitrypsin deficiency (A1ATD) has been A1ATD, no liver reported by Rabinovitz et al. 1 in patients with severe liver disease 32 (82.1%) 7 (17.9%)0 (0%) 39 disease.It has been suggested that there is an additive effect Controls 159 (86.9%) 22 (12.0%) 2 (1.1%) 183 of hepatic iron storage and hepatocyte damage from the ab-Published data 5 326 (88.6%) 40 (10.9%) 2 (0.5%) 368normally folded PiZ or PiS protein.There could also be some interaction of the mutant A1ATD gene and the hemochromatosis gene by a previously undescribed mechanism, involving a third gene, resulting in liver disease even before hematolog-There is no difference between the hemochromatosis muical evidence of iron accumulation. 1However, Fargion et al. 2 tation frequency in those A1ATD patients with liver disease reported no relationship between these conditions identi-(17.5%) and without liver disease (17.9%).It is of interest fying GH by hematological indices and liver biopsy in pathat the frequency of heterozygotes in patients with A1ATD tients with and without cirrhosis.(17.7%) is higher than in individuals without A1ATD.How-Ninety percent of patients from Britain with GH are homoever, this difference does not reach statistical significance (% zygous for the C282Y (845G r A) mutation in the hemochrodifference: 5.5%; 95% confidence interval: 7.2%-18.2%).Our matosis (HLA-H) gene.Homozygosity for GH is estimated control heterozygote frequency is higher than that published at up to 5 per 1,000 in Europe, 3 with a carrier frequency of for the U.K. British population and represents local popula-10% to 17%.tion variation.To investigate the possibility of an interaction between the These results show that possession of the hemochromatotwo conditions resulting in chronic liver disease, we used sis mutation is not a risk factor for liver disease in A1ATD.molecular biological techniques to study 79 A1ATD patients in the United Kingdom with the PiZZ or PiSZ mutations Acknowledgment: Supported by grant 179, The Children's confirmed by isoelectric focusing.Forty patients were reappeal, Sheffield, UK (to M.J.S.).The authors thank Dr. S. ferred in childhood because of liver disease, and were found Povey for donation of DNA from A1ATD patients and Dr. D. to have fibrosis or cirrhosis on liver biopsy.Thirty-nine indi-Curtis for her assistance with development of the molecular viduals had no evidence of liver disease into adult life, 21 biology techniques.were clinically normal, and 18 had emphysema.We used the polymerase chain reaction (PCR) and restric-MARK J. SHARRARD, M.R.C.P. tion fragment length polymorphism to investigate these pa-MIRANDA DURKIE, B.SC. tients for the C282Y mutation.A modified PCR was devel-M.
Current ultrasonographic criteria for miscarriage could lead to misdiagnosis, say researchers
Authors: J. Wise
Journal: BMJ (2011)

The current guidance on using ultrasound scans to detect a miscarriage could lead to an incorrect diagnosis and should be changed, according to a series of four studies.

A miscarriage is often confirmed by ultrasonographic identification of a pregnancy sac or embryo in the uterus. Researchers writing in the journal Ultrasound in Obstetrics and Gynaecology say that the cut off values for defining miscarriage might be unsafe and need to be revised (doi:10.1002/uog.10109).

One of the researchers, Tom Bourne from Imperial College London, said: “Currently there is a risk that some women seeking reassurance with pain or bleeding in early pregnancy may be told they have had a miscarriage and choose to undergo surgical or medical treatment when the pregnancy is in fact healthy.”

Guidelines from the Royal College of Obstetricians and Gynaecologists state that on ultrasound an empty gestational …
One day survey by the Mental Health Act Commission of acute adult psychiatric inpatient wards in England and Wales
Authors: R. Ford, G. Durcan, L. Warner, P. Hardy, M. Muijen
Journal: BMJ (1998)

To provide (via the Mental Health Act Commission's "national visit") empirical evidence on ward occupancy levels, use of the Mental Health Act 1983, nurse staffing, and care of female patients on acute adult psychiatric wards.One day survey of a stratified random sample.119/250 (47%) acute adult psychiatric inpatient units in England and Wales.End sample of 263 acute psychiatric inpatient wards.Ward occupancy rates; number of patients detained under the Mental Health Act and proportion "absent without leave"; nurse staffing levels, skill mix, and vacancies;proportion of women with self contained, women-only facilities.Mean ward occupancy was 99% (95% confidence interval 97% to 102%). A ward mean of 30% (28% to 32%) of patients were detained under the Mental Health Act; of all detained patients, 1% (1% to 2%) were absent without leave. A ward mean of 0.3 (0.29 to 0.31) nurses were on duty per patient at the time of the visit. An estimated ward mean of 31% (30% to 32%) of nurse staffing may have been through casual contracts--higher in inner (48% (43% to 53%)) and outer London (45% (41% to 48%)). On 26% (21% to 32%) of wards, there were no nurses interacting with patients. A ward mean of 36% (30% to 41%) of female patients had self contained, women-only facilities.Attention should focus on improving the quality of acute inpatient psychiatric care as well as of community care.
Physiologic Changes in Mitral Stenosis
Authors: Lewis Dexter
Journal: New England Journal of Medicine (1956)

THE effects of mitral stenosis on the heart and lungs are due to an obstructive lesion between the left atrium and ventricle. The bodily response to such an obstruction is initially twofold. Most important is a rise of pressure proximal to the obstruction — that is, in the left atrium, pulmonary veins, pulmonary capillaries, pulmonary artery and right ventricle. The amount of blood passing through the obstructed area — the cardiac output — becomes reduced.The size of the orifice of the normal mitral valve in an adult is about 5 sq. cm. The pressure in the left atrium is . . .