tbuckley/cabot-search huggingface dataset:
Pneumocystis carinii in bronchoalveolar lavage fluid and bronchial washings
Authors: S P Matusiewicz, R J Fergusson, A P Greening, G K Crompton, S M Burns
Journal: BMJ (1994)

Secondly, all hospitals should establish clear and coordinated managerial responsibility for the transfusion process.Thirdly, transfusion laboratories should be required to have a procedure for recording all transfusion errors and the corrective action taken and to report regularly to the proposed national scheme.Fourthly, statistics on the number of blood units transfused and the number of patients who receive transfusions should be collected and reported nationally to provide denominators for any reporting scheme.Finally, pilot projects should be set up to identify and report cost effective ways of improving the safety ofthe clinical transfusion process.We thank the organisers of the national external quality assurance scheme in haematology, which distributed the questionnaire and the final report to all hospital transfusion laboratories in Britain.
Immunisation of guinea-pigs with circulating immune complexes from patients with rheumatoid arthritis.
Authors: C.E Hack, H.G Lim, R.C Aalberse
Journal: Annals of the Rheumatic Diseases (1984)

Sixteen guinea-pigs were immunised with immune complexes isolated from serum of nine patients with rheumatoid arthritis. The resulting antisera were analysed by radioimmunoassays. All guinea-pig sera were extensively absorbed with normal human serum. After this absorption eight guinea-pig sera contained antibodies specific for immune complexes isolated from the sera of three patients. One of these antisera reacted not only with immune complexes (and serum) from the corresponding patient but also with immune complexes (and sera) from other patients with rheumatoid arthritis. The antigen(s) to which the guinea-pig antibodies were directed sedimented as IgM, and they bound to IgG Sepharose. Therefore the guinea-pig sera were absorbed with IgM-rheumatoid factors isolated from the serum of the corresponding patient. After this absorption, the guinea-pig sera had lost their reactivity with immune complexes. We conclude that these antisera did not detect an exogenous antigen in immune complexes from patients with rheumatoid arthritis. The positive reactions found were due to antibodies specific for (idiotypic?) antigenic determinants on IgM-rheumatoid factors.
The Spectrum of Coronary Artery Spasm
Authors: Howard D. Kirshenbaum
Journal: JAMA (1981)

Angina from coronary artery spasm is not rare. Because new and effective medical therapy is now available, it is imperative that the physician recognize this syndrome when it occurs. Coronary artery spasm can present clinically as unstable rest angina with reversible ST-segment elevation and bradyarrhythmias and tachyarrhythmias. In this setting, Prinzmetal's variant angina is generally promptly recognized and appropriately treated. The diagnosis is variant angina, however, often is not so obvious. Chest pain may be exertional or seem noncardiac in origin. The chest pain syndrome may be chronic and stable as well as unstable. The ECG may show ST-segment depression, rather than elevation. Five cases of coronary artery spasm that emphasize the variable features of variant angina and offer aid for the prompt diagnosis and treatment of the syndrome are presented here.
Ethnicity and hypertension: not as black and white as NICE makes out
Authors: A. El Turabi, R. Payne
Journal: BMJ (2011)

In human basophils, degranulation stimulated by receptor activation or Ca<sup>++</sup> ionophores is accompanied by an increase in free arachidonic acid (AA) as determined by gas chromatography negative ion chemical ionization mass spectrometry. Previous studies suggested that there was more than one pool of AA generated during stimulation and indirectly suggested that the leukotriene (LTC<sub>4</sub>) generated in these reactions was dependent on only one of these pools of AA. Our studies further examined these issues. Preliminary studies demonstrated discordance in the generation of free AA and LTC<sub>4</sub> release. Treatment of basophils with triacsin C, a reacylation inhibitor, led to a marked increase in N-formyl-l-methionyl-l-leucyl-l-phenylalanine-(fMLP) stimulated free AA generation with no effect on LTC<sub>4</sub>release. Similarly, incubation of basophils with recombinant human secretory phospholipase A<sub>2</sub> (sPLA<sub>2</sub>), before and during fMLP stimulation, led to the generation of extremely high levels of free AA with no effect on LTC<sub>4</sub> release. Pretreatment of basophils with anti-14 kDa phospholipase A<sub>2</sub> monoclonal antibody (mAb 3F10) inhibited fMLP-induced synthesis of LTC<sub>4</sub> but did not attenuate the mass of AA measured nor histamine release. Treating human basophils with zileuton (an inhibitor of 5-lipoxygenase) inhibited the stimulated synthesis of LTC<sub>4</sub> and in combination with triacsin C increased the amount of observable AA by an amount approximately equal to the loss in LTC<sub>4</sub> mass. Monoclonal antibody 3F10 blocked only the enhanced AA production caused by the combination of zileuton and triacsin C. Monoclonal antibody 3F10 did not inhibit the increases in free AA produced by pretreatment with triacsin C alone. These findings were supported by experiments using another relatively specific inhibitor of sPLA<sub>2</sub>, SB 203347. In all respects, SB 203347 mimicked the addition of mAb 3F10. Taken together, these data indicate that not all pools of AA are well used for LTC<sub>4</sub> synthesis. These experiments also suggest that LTC<sub>4</sub> synthesis in human basophils stimulated with fMLP depends on a SB 203347- and monoclonal antibody 3F10-inhibitable deacylation activity, presumably a sPLA<sub>2</sub> acting at or near the cell surface. Furthermore, under normal conditions, this pool of AA is not observable because it is efficiently coupled to 5-lipoxygenase. Other deacylating enzymes, which do not supply AA for 5-lipoxygenase metabolism, also appear to be activated by fMLP and these other enzymes appear responsible for the net free AA normally observed after stimulation.
Variegate Porphyria in New England
Authors: Jan E. Muhlbauer
Journal: JAMA (1982)

Variegate porphyria (VP) is an autosomal dominant disease characterized in adults by mechanical fragility and blistering of sun-exposed skin or acute visceral and neurological manifestations. The laboratory diagnosis of VP depends on a search for high levels of coproporphyrin and protoporphyrin in the feces. Variegate porphyria has been infrequently diagnosed in the United States. In this study of five New England families with VP, there were nine manifest, six latent, and six questionable cases among 40 individuals studied. This report reviews the diagnostic approach to and treatment of affected individuals and their families.
Controversy on drugs affecting ATP sensitive potassium channel in ischaemic heart disease
Authors: G. E Billman
Journal: Cardiovascular Research (1994)

Journal Article Controversy on drugs affecting ATP sensitive potassium channel in ischaemic heart disease Get access George E Billman George E Billman Department of Physiology, The Ohio State University, Columbus, OH 43210, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 28, Issue 1, January 1994, Pages 137–138, https://doi.org/10.1093/cvr/28.1.137 Published: 01 January 1994
Guillaume Dupuytren: A Surgeon in His Place and Time
Authors: Claude E. Welch
Journal: JAMA (1985)

Hannah K. Barsky has prepared the first biography of Dupuytren written in the English language. She has succeeded in a major reevaluation of one of the most complex surgeons of the past two centuries. Heretofore he has been regarded as a brilliant man, so important that his era was termed "The Age of Dupuytren" but so intolerant that he intrigued against his rivals, refused to listen to the repeated entreaties of his estranged wife, and exhibited true affection only for himself and his only daughter. In order to understand his character, Mrs Barsky has approached her subject in a different way. In her hands Dupuytren has become a major actor playing on a stage set in the turbulent years of the French Revolution, where many of his characteristics can be explained by the spirit of the times. To accent the tumult in which he lived, she has gathered an immense
German doctors fear that performance rating websites may be libellous
Authors: Annette Tuffs
Journal: BMJ (2007)

As the number of German websites that try to judge doctors' performances according to patients' opinions rises, the National Association of Statutory Health Insurance Physicians (KBV) has warned doctors to contact the providers of websites that they think may be libelling them.

However, doctors may not be aware of negative comments about them, because the websites are not obliged to inform the respective doctors when the comments appear.

Last week a Munich agency launched a new website (www.jameda.de) listing addresses of about 170 000 doctors and 120 000 other …
Advances in epigenome-wide association studies for common diseases
Authors: Dirk S. Paul, Stephan Beck
Journal: Trends in Molecular Medicine (2014)

Epigenome-wide association studies (EWASs) provide a systematic approach to uncovering epigenetic variants underlying common diseases. Discoveries have shed light on novel molecular mechanisms of disease and enabled the application of epigenetic variants as biomarkers. Here, we highlight the recent advances in this emerging line of research and discuss key challenges for current and future studies.
Steroids in advanced cancer: survey of current practice.
Authors: P. R. Needham, A. G. Daley, R. F. Lennard
Journal: BMJ (1992)

American studies suggest that appropriate measures of abusive behaviours can be achieved.However, pilot studies with in depth interviews at our hospital found several methodological problems.These included the obtaining of informed consent to participate in research on family violence, access to potential respondents, and ethical dilemmas about procedure if abuse is uncovered during research.Further British research will therefore need to address these problems before large scale studies of elder abuse are conducted.We acknowledge the support of Channel 4 and the Office of Population Censuses and Surveys omnibus survey team in undertaking this survey.
Sympathetic modulation of the relation between ventricular repolarization and cycle length.
Authors: A Zaza, G Malfatto, P J Schwartz
Journal: Circulation Research (1991)

Sympathetic influences on ventricular repolarization are not yet fully elucidated, despite their relevance to arrhythmogenesis. The sympathetic control of repolarization, measured from an endocardial monophasic action potential duration (APD) and from the QT interval, was investigated in 24 anesthetized cats. The effects of right and left stellectomy and of subsequent bilateral stellectomy or beta-blockade on the relation between APD (or QT) and cycle length (CL) at steady state, and on the kinetics of adaptation of APD to a sudden change in cycle length were studied separately. Steady-state APD/CL (or QT/CL) relations were obtained by atrial pacing at different cycle lengths. The kinetics of APD adaptation were evaluated for a sudden decrease of approximately 100 msec in pacing cycle length. The steady-state APD/CL (QT/CL) relation was fitted by the hyperbolic function APD = CL/[(a. CL) + b]. From this, two parameters were computed: 1) 1/a, that is, APD (QT) extrapolated at infinite cycle length (APDmax or QTmax) and 2) the cycle length at which 50% of the total change in APD (or QT) occurred (CL50 = b/a). Right stellectomy reduced APDmax and CL50, an effect reversed by subsequent left stellectomy or beta-blockade (propranolol, 0.5 mg/kg). Left stellectomy prolonged APDmax and CL50. Bilateral stellectomy, in both groups, caused a further increase in these variables. Results were similar for the QT/CL relation. The adaptation kinetics of APD to cycle length was described by the sum of two exponentials. The first time constant (tau fast, about three beats) was unchanged by any intervention; the second (tau slow) was shortened by right stellectomy and prolonged by left stellectomy. The further removal of the remaining stellate ganglion had the same effect in both groups, that is, an increase in tau slow. Thus, sympathetic innervation modulates both the steady-state dependence on cycle length and the kinetics of adaptation to sudden rate changes of ventricular repolarization. The effects of sympathetic influence are asymmetrical. Right stellectomy shortens APDmax and QTmax, reduces CL50, and accelerates APD adaptation to a new steady state. Because these effects are reversed by beta-blockade or left stellectomy, they are likely to be due to a reflexly enhanced sympathetic outflow to the ventricles through the left-sided nerves.
PTU-138 Central Obesity and Waist Belt Cause Partial Hiatus Hernia and Short Segment Acid Reflux in Healthy Volunteers
Authors: Y Y Lee, J G Whiting, E V Robertson, M H Derakhshan, A A Wirz, D Morrison, A Weir, D Smith, A Kelman, K E L McColl
Journal: Gut (2013)

<h3>Introduction</h3> Epidemiology demonstrates an association between obesity, hiatus hernia and acid reflux but mechanism is unclear. We have examined the structure and function of the gastro-oesophageal (GO) junction in healthy subjects with and without obesity and the effects of elevating intra-abdominal pressure with belt. <h3>Methods</h3> We recruited 8 subjects with normal ( &lt; 94 cm males &lt; 80 cm females) and 8 with increased ( &gt; 102 cm males &gt; 88 cm females) waist circumference, matched for age and gender. To allow accurate monitoring of location of the GO junction and its proximal movement during TLOSRs, a magnet (2x1 mm) was endoscopically clipped to the SCJ. Combined assembly of locator probe, high-resolution pH catheter and slimline manometer was passed nasally. After a standard meal, recording seated upright was continued for an hour. A waist belt was applied on a separate day throughout the entire recording. The effect of obesity was assessed by comparing obese vs. non-obese, both without belt. The effect of belt was assessed by comparing entire group with and without belt. The effect of belt in obesity was assessed by comparing belt-on vs. off in obese subjects. All results were in mean (SEM). <h3>Results</h3> Location of the SCJ (<i>P</i> = 0.006) and pH step-down (<i>P</i> = 0.01) were displaced proximally in obese vs. non-obese but the diaphragm was not displaced as reflected by peak LOS pressure (pLOS) and pressure inversion point (PIP) (Figure). With belt-on vs. off, there was similarly proximal displacement of SCJ and pH step-down and also of the diaphragm (<i>P</i> = 0.003) and LOS (upper and lower border, <i>P</i> = 0.01 and 0.03 respectively). In obese subjects with belt-on vs. off, there was proximal displacement of SCJ, pH step-down and diaphragm. There was marked proximal migration of SCJ during TLOSRs with its magnitude being less in obese vs. non-obese (4.2 vs. 6.8 cm, <i>P</i> = 0.04) and belt-on vs. off (3.9 vs. 5.5 cm, <i>P</i> = 0.01), consistent with its resting position being already proximally displaced. At traditional site (5 cm above LOS), the mean % time pH &lt; 4 was minimal (0 – 0.5%) in all studied groups, however, acid exposure above the SCJ but below upper border LOS was increased in belt-on vs. off (6.2% vs. 1.6%, <i>P</i> = 0.01) and in obesity with belt-on vs. off (9.7% vs. 3.0%, <i>P</i> = 0.04) but not obese vs. non-obese (<i>P</i> = 0.2). <h3>Conclusion</h3> Our findings indicate that in asymptomatic volunteers, central obesity and waist belt cause partial hiatus herniation and that waist belt also causes short segment reflux. <h3>Disclosure of Interest</h3> None Declared
How many general practitioners for 1433 patients?
Authors: S. A Murray, L. J C Graham, M. J Dlugolecka
Journal: BMJ (1995)

Dumbiedykes, in Lothian, is an inner city council estate of 670 homes in Edinburgh. About half of the residents are registered at the Mackenzie Medical Centre. We ascertained the total number of general practitioners and partnerships with patients living in Dumbiedykes and determined the number of patients registered with each practice.

We obtained from the community health index, which lists all patients registered with general practitioners in Scotland, the 12 postcodes of Dumbiedykes and the name of each resident's general practitioner. We summarised this list of patients according to each patient's general practitioner and grouped the patients into practices using a list of Lothian general practitioners by practice.

In all, 1433 patients were registered in Dumbiedykes in 1993. The population of Dumbiedykes is relatively stable (only 7% of households had moved there in …
Randomised trial of endoscopy with testing for Helicobacter pylori compared with non-invasive H pylori testing alone in the management of dyspepsia
Authors: K E L McColl
Journal: BMJ (2002)

<h3>Abstract</h3> <b>Objective:</b> To compare the efficacy of non-invasive testing for <i>Helicobacter pylori</i> with that of endoscopy (plus <i>H pylori</i> testing) in the management of patients referred for endoscopic investigation of upper gastrointestinal symptoms. <b>Design:</b> Randomised controlled trial with follow up at 12 months. <b>Setting:</b> Hospital gastroenterology unit. <b>Participants:</b> 708 patients aged under 55 referred for endoscopic investigation of dyspepsia, randomised to non-invasive breath test for <i>H pylori</i> or endoscopy plus <i>H pylori</i> testing. <b>Main outcome measure:</b> Glasgow dyspepsia severity score at one year. Use of medical resources, patient oriented outcomes, and safety were also assessed. <b>Results:</b> In 586 patients followed up at 12 months the mean change in dyspepsia score was 4.8 in the non-invasive <i>H pylori</i> test group and 4.6 in the endoscopy group (95% confidence interval for difference −0.7 to 0.5, P=0.69). Only 8.2% of patients followed up who were randomised to breath test alone were referred for subsequent endoscopy. The use of non-endoscopic resources was similar in the two groups. Reassurance value, concern about missed pathology, overall patient satisfaction, and quality of life were similar in the two groups. The patients found the non-invasive breath test procedure less uncomfortable and distressing than endoscopy with or without sedation. No potentially serious pathology requiring treatment other than eradication of <i>H pylori</i> was missed. <b>Conclusion:</b> In this patient group, non-invasive testing for <i>H pylori</i> is as effective and safe as endoscopy and less uncomfortable and distressing for the patient. Non-invasive <i>H pylori</i> testing should be the preferred mode of investigation. <h3>What is already known on this topic</h3> Endoscopy is a commonly used investigation for upper gastrointestinal symptoms, but its effectiveness has been questioned Non-invasive testing for <i>Helicobacter pylori</i> has been shown to predict endoscopic diagnosis in patients with dyspepsia <h3>What this study adds</h3> In patients less than 55 years of age with uncomplicated dyspepsia, non-invasive testing for <i>H pylori</i> is as effective and as safe as endoscopy Non-invasive <i>H pylori</i> testing is as reassuring to the patient as endoscopy and is less uncomfortable and distressing
Positive Epicardial Fat Pad Sign Without Pericardial Effusion
Authors: Robert B. Engle
Journal: JAMA (1982)

<h3>To the Editor.—</h3> In a recent article inThe Journal(1980;244:2762), Carsky et al described the epicardial fat pad sign (EFPS) in the diagnosis of pericardial effusion. In another article<sup>1</sup>they reported that 52% of 100 patients with echocardiographic evidence of pericardial effusion had positive EFPS on plain chest films. They stated that a pericardial line wider than 2 mm is virtually diagnostic of pericardial fluid or thickening. Other authors<sup>2</sup>mention pericardial thickening as a cause for widening of the pericardial line, yet no confirmed case has been reported. In 1955, Kremens<sup>3</sup>reported a case of presumed pericardial thickening owing to fibrinous pericarditis as identified on anteroposterior planigrams of the chest. Echocardiography was not available at that time, and pericardiocentesis was not carried out. We describe a patient showing a positive EFPS with no evidence of pericardial effusion on echocardiography. To our knowledge, this would appear to
Medicine — Profession or Trade?
Authors: John Lister
Journal: New England Journal of Medicine (1966)

AS anticipated, the deferment of the agreed pay increases to the medical profession precipitated the most serious demonstration of discontent among members of the junior hospital staffs that has yet been seen. They claimed that many were working for excessively long hours, that their residential accommodations were often inadequate and that in many hospitals they had to do more than their own fair share of work because of unfilled staff vacancies. They also claimed that modern investigative technics are increasingly demanding their time and that on the grounds of increased productivity alone they should have been granted the pay rise. . . .
European general practice
Authors: M. Boland
Journal: BMJ (1995)

ethnic media, and places of worship.Survivors of myocardial infarction and those who have undergone successful coronary revascularisation should relay their experiences to members of their community.Failure to seek prompt medical advice and delays in diagnosis and treatment among ethnic groups often result from language difficulties,26 and this issue also needs to be addressed.General practitioners with a large proportion of patients from affected ethnic groups could set up "well Asian clinics" to identify subjects at high risk.Awareness of the risks could be increased by informing second generation Asians coming through the British educational system, who could convey the advice to their family and friends, as well as modify their own risk factors while young.An effective campaign of primary prevention requires adequate central funding and planning.The Departnent of Health should consider issuing guidelines and highlighting targets for action.Dietary advice, particularly on restricting carbohydrates, needs to be sensitive.The food industry has a part to play by altering the fat content of food (for example, more monosaturates and n-3 fatty acids) and generally by promoting healthier, lower energy, and yet palatable products.Encouraging Asians to increase regular physical activity may be worth while and should be evaluated.Unless something is done to reduce the risk of heart disease in the Asian population in Britain all indicators suggest that the problem will increase.5Data from Leicester indicate that, by 2008, half its Asian population will be over 50 and, if their risk of coronary death remains 1 4 times that of the rest of the population the number of deaths from coronary heart disease will double.27In other places with large Asian communities this will have a considerable impact on acute medical services.Spending now would make more medical and economic sense than paying later.