tbuckley/cabot-search huggingface dataset:
Even Common Diseases Can Be Complex
Authors: William R. Barclay
Journal: JAMA (1977)

Frequently we lose sight of the fact that illness is not a matter of just an infection, an injury, a neoplasm, or a metabolic disorder, but of a combination of factors, not the least important of which may be life-style or behavior. Unless the multiple factors underlying an illness are recognized, the diagnosis may be missed or the treatment fail. Such a situation is described in the CLINICAL NOTE in this issue ofThe Journal(p 2718). Fiumara's account of diagnosing gonococcal proctitis in a married woman illustrates once more that the practice of medicine is as much an art as it is a science, and that the securing of a complete and detailed history is an important part of that art. The time constraints of medical practice frequently pressure us into making a hurried diagnosis or instituting a routine form of treatment. Although this approach may suffice for most,
Suicidal behaviour syndrome with low CSF 5-HIAA.
Authors: B Cronholm, M Asberg, S Montgomery, D Schalling
Journal: BMJ (1977)

<h3>Objective</h3> Few studies have assessed immunophenotypic abnormalities on lymphocyte subsets in patients with antiphospholipid syndrome (APS).We performed an extended immunological study to define alterations of distinct T, B, and natural killer (NK) cell subsets in obstetric patients with APS and their relationship with APS–associated complications. <h3>Methods</h3> Patients and controls: 36 women with APS [Sydney criteria, Group A1 without thrombosis (n = 26), Group A2 with thrombosis (n = 10)]; and 36 age matched women with recurrent abortion without antiphospholipid antibodies (disease controls; Group B), 36 healthy parous women (healthy controls; Group C), and 36 healthy nonparous women (healthy controls; Group D). Thrombotic events occurred after history of abortions in all A2 women. Three-color whole-blood flow cytometry was used to characterize the distinct immunophenotypes. <h3>Results</h3> A1 patients had significantly higher percentages of CD4+CD45RA–CCR7+ central memory cells (A1 vs D), higher percentages of activated CD4+CD25+ T cells (A1 vs D), and lower percentages and absolute counts of CD4+CD45RA–CCR7– effector memory cells (A1 vs D). GroupA2 patients had higher percentages and absolute numbers of CD19+CD27–IgD+ naive B cells (A2 vs A1 vs all controls), lower percentages and absolute numbers of CD3–CD56+CD16+ NK cells (A2 vs all controls), and higher percentages of activated CD4+DR+ (A2 vs all controls), CD8+DR+ (A2 vs A1 vs C vs D), CD4+CD38+DR+ (A2 vs D), and CD4+CD25+DR+ T cells (A2 vs all controls). Increased percentages of CD8+DR+ T cells [relative risk (RR) 2.43, 95% CI 1.09–5.44, p = 0.02] and of naive B cells (RR 3.05, 95% CI 1.30–7.11, p = 0.009) were associated with development of thrombosis. <h3>Conclusion</h3> In obstetric patients with APS we documented significant changes in T, B, and NK cell homeostasis. Increased levels of CD8+DR+ and CD19+CD27–IgD+ cells might identify obstetric patients with APS at risk of having thrombosis.
Cardiac Studies Reveal Clues Into Asthma and Decreased Lung Function
Authors: Tracy Hampton
Journal: JAMA (2008)

TORONTO—New data from a 20-year observational cohort study of more than 5000 young adults provide important insights into the development of asthma and low lung function. The findings from the Coronary Artery Risk Development in Young Adults (CARDIA) study (http://www.nhlbi.nih.gov /resources/deca/descriptions/cardia .htm) could lead to better diagnosis and treatment of these conditions, according to study investigators who presented their findings at the American Thoracic Society’s 2008 International Conference held here in May. CARDIA’s goal was really to identify the natural history of coronary artery disease, but people with chronic obstructive pulmonary disease die mostly of cardiac disease, not lung disease, said Ravi Kalhan, MD, of the Northwestern University Feinberg School of Medicine in Chicago. Because lung function measurements are being taken during the study, pulmonologists are able to investigate the development of lung disease among participants.
Twenty Years Experience With the Gastroepiploic Artery Graft for CABG
Authors: Hisayoshi Suma, Hiroaki Tanabe, Akihito Takahashi, Taiko Horii, Tadashi Isomura, Hitoshi Hirose, Atsushi Amano
Journal: Circulation (2007)

Background— To improve the longterm outcome after CABG, several strategies have been used using arterial conduits. Our 20 years experience with the right gastroepiploic artery (GEA) graft was evaluated. Methods and Results— In 1352 patients having CABG with the GEA graft, (1092 men, mean 63 years, 99% multivessel disease, and mean EF 0.51), internal thoracic artery, saphenous vein, and radial artery grafts were concomitantly used in 1312 (97%), 783 (58%), and 128 (8%) patients, respectively. The mean number of distal anastomoses was 3.1, and 2.4 coronary arteries were bypassed with arterial grafts. The sites for GEA grafting were 70 anterior descending, 268 circumflex, and 1089 right coronary arteries. The operative mortality was 1.26%. In 1118 follow-up patients (82.6%), 5, 10, and 15 years survival rates were 91.7%, 81.4%, and 71.3%, and the cardiac death-free survival rates were 95.8%, 91.7%, and 88.6%, respectively. The cumulative patency rate of the GEA graft was 97.1% at 1 month, 92.3% at 1 year, 85.5% at 5 years, and 66.5% at 10 years, respectively. In 172 skeletonized GEA grafts with 233 distal anastomoses, the patency rate at immediate, 1, and 4 years after surgery was 97.6%, 92.9%, and 86.4%, respectively. In 124 patients with late (5 to 17 years) restudy, patency rate was 96% (114/119) in the left internal thoracic artery, 87% (108/124) in GEA, and 68% (67/98) in saphenous vein grafts. New stenosis was uncommon in GEA. Conclusion— The GEA graft is a safe and effective arterial conduit for CABG.
Demonstration of Increased FDG Activity in Rosai-Dorfman Disease on Positron Emission Tomography
Authors: Jian Q. Yu, Hongming Zhuang, Yan Xiu, Erin Talati, Abass Alavi
Journal: Clinical Nuclear Medicine (2004)

Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy, is a rare benign disease of unknown etiology that most commonly involves the cervical lymph nodes. Imaging with F-18 positron emission tomography (FDG-PET) has been widely accepted as an important diagnostic modality in the evaluation of patients with possible cancers. However, FDG is not a tumor-specific tracer, and numerous nonmalignant processes can result in increased FDG accumulation. We report the detection of Rosai-Dorfman disease by FDG-PET in a patient with suspected metastatic breast cancer.
Community care for patients with schizophrenia one year after hospital discharge.
Authors: D Melzer, A S Hale, S J Malik, G A Hogman, S Wood
Journal: BMJ (1991)

To document the circumstances and care of patients with schizophrenia who had recently been discharged from local psychiatric inpatient services, and to establish the extent to which misgivings about community care might be justified.Cross sectional surveys with review of case notes. Follow up interviews with questionnaires administered one year after discharge.Two inner London districts (West Lambeth and Lewisham) with high levels of social deprivation and at different stages of developing community services.90 and 50 patients in the two services respectively, aged 18 to 65, who satisfied the Research Diagnostic Criteria for schizophrenia and who were discharged from inpatient services.Diagnosis elicited by present state examination, global social disability rating, use of services during the three months before interview.89 of the 140 patients (64%) had been ill for five or more years, yet few were former long stay inpatients. 55% (50/91; 95% confidence interval 45% to 65%) of those interviewed had current psychotic mental states and 22% (27/124; 16% to 31%) were functioning socially at very poor or severely maladjusted levels. 86% (107/124) were unemployed. The majority of patients had seen a mental health or social service professional, yet only 16% (20/124) were in specialised accomodation (excluding hospitals) and only 23% (17/73) of those eligible had used day care. Small numbers of people had experienced homelessness (two) or imprisonment (four over six months).Many schizophrenic patients leaving local psychiatric inpatient care have active symptomatology and profound social disabilities. Community care was characterised by high rates of contact with service professionals but little supported accommodation or day activity. This group of clients may require dedicated provision, which would actively encourage them to use services protected from the demands of those with less severe illness.
Renal Function After Pituitary Ablation for Diabetic Retinopathy
Authors: Marian Isaacs
Journal: JAMA (1969)

Renal function was evaluated in 18 patients before and after pituitary ablation for diabetic retinopathy. Prior to therapy, blood urea nitrogen levels were below 20 mg/100 ml in 11 and above 25 mg/100 ml in only 1 of the 18. Glomerular filtration rate was low in 16 of these patients, and renal plasma flow was reduced in nine of the 11 patients measured. After ablation, glomerular filtration rate or renal plasma flow, or both, were further decreased in 16. Control total exchangeable potassium (TEK) was normal in 15 of 22 patients. After therapy, the TEK decreased in 16 of 20 patients. Percutaneous renal biopsy specimens were obtained in six patients before therapy, all six specimens revealed nodular glomerulosclerosis and arteriolar sclerosis. No additional changes or regression of lesions were noted in any postablation renal biopsy specimen.
Worksite Health Promotion and Health Care Costs and Utilization
Authors: Lewis H. Kuller
Journal: JAMA (1987)

<h3>To the Editor.—</h3> The article entitled "Impact of Worksite Health Promotion on Health Care Cost and Utilization"<sup>1</sup>is seriously flawed. The conclusions are very misleading. It is hard to believe that any statistical method can adjust for the very large differences in the characteristics of groups that were not selected at random. Twelve percent of the control employees lived in New Jersey compared with 67% of group 1 and 83% of group 2. New Jersey introduced diagnosis related groups and an all-payer system during the period of the study. There were substantial educational and socioeconomic differences between the groups. One of the most important determinants of health is education and level of income. The analysis at a minimum should have presented the data separately for the salaried and wage populations. Furthermore, adjusting for the cost by state of residence by using the total reported state health care cost is
SUBSTITUTE FOR FRACTURE BED IN CASES OF FRACTURE WITH LARGE CASTS
Authors: R. C. Webb
Journal: JAMA (1923)

When a patient is placed in a large cast, such as a double spica, there are certain difficulties which occur in the nursing, and various frames and special types of beds have been devised to aid in the care of the patient. A recent case occurring in my practice was that of an electrical engineer with a subtrochanteric fracture of the femur. A Lane plate was applied and the patient placed in a double spica cast extending from the nipples to the toes on the side involved, and to the knee on the other side. He was then placed on a "fracture bed" with a mechanical contrivance for lifting the frame on which he lay. The bars of the frame were not wide enough; it caused him some discomfort, and additional nurses were required to manipulate the apparatus. This, with the mechanical inconsistencies from an engineering standpoint, added to the
Ventricular Arrhythmias in Ischemic Heart Disease
Authors: James N. Weiss, Koonlawee Nademanee, William G. Stevenson, Bramah Singh
Journal: Annals of Internal Medicine (1991)

Ventricular arrhythmias remain the leading cause of death from coronary artery disease. This review summarizes current thinking in several areas relating to the pathophysiology, prognosis, and therapy of ventricular arrhythmias associated with acute and chronic coronary artery disease syndromes. The experimental basis of arrhythmias in the setting of acute myocardial ischemia and chronic myocardial infarction is described, stressing the important pathophysiologic differences between these two conditions. The effects of the autonomic nervous system as a key modulator of ischemic arrhythmogenesis are discussed. Insights, derived from endocardial mapping studies, into the nature of ventricular tachycardia in humans with chronic myocardial infarction are described, including implications for risk stratification and therapy to prevent arrhythmia recurrence. Current therapeutic principles are discussed in the management of ventricular arrhythmias associated with coronary artery disease, including pharmacologic approaches, surgical and catheter ablation, and automatic implantable cardioverting and defibrillating devices.
Long‐term treatment with aspirin desensitization: a prospective clinical trial comparing 100 and 300 mg aspirin daily
Authors: A. Rozsasi, D. Polzehl, T. Deutschle, E. Smith, K. Wiesmiller, H. Riechelmann, T. Keck
Journal: Allergy (2008)

Background: The daily dose of aspirin in desensitization in aspirin‐sensitive asthmatics with nasal polyps is still a matter of debate. Aims of the study: To compare two doses of aspirin during the first year of desensitization and to evaluate long‐term effects on nasal/pulmonary symptoms. Methods: Patients with positive aspirin provocation test were treated with either 100 or 300 mg aspirin daily. Results: In all patients taking 100 mg aspirin ( n = 7) recurrent nasal polyps were observed. No patient experienced reduction of asthma medication or improvement of pulmonary function. In the 300 mg group no recurrent nasal polyps were seen. Asthma medication could be reduced in three patients, pulmonary function was improved in five patients. Thirty‐nine consecutively desensitized patients, taking 300 mg aspirin, showed significant improvement of olfaction and polyp‐free nasal passages during the first year of therapy. After a median follow‐up of 27 months no sinus revision surgery was necessary. Conclusions: Aspirin desensitization followed by 300 mg aspirin daily is efficacious and results in polyp‐free nasal airways, improvement of sense of smell, and reduction of the need for sinus revision surgery for recurrent nasal polyps. Aspirin in a dose of 100 mg daily is not sufficient to effectively reduce nasal and bronchial or pulmonary symptoms and to prevent recurrent nasal polyps by at least the first 12 months of treatment.
A Phase I Trial Of Zileuton In Sickle Cell Disease
Authors: Marthe-Sandrine Eiymo Mwa Mpollo, Maa-Ohui Quarmyne, Omar Rayes, Caryn S. Gonsalves, Laurie Vanderah, Christina Canter, Johnson Haynes, Claudia Fernanda Clavijio, Christians Uwe, Karen Kalinyak, Clinton H. Joiner, Alexander A. Vinks, Punam Malik
Journal: Blood (2013)
Protective Ventilation for Patients with Acute Respiratory Distress Syndrome
Authors: Leonard D. Hudson
Journal: New England Journal of Medicine (1998)

Acute respiratory distress syndrome (ARDS) consists of the sudden development of diffuse lung injury in critically ill patients. Initial inflammation, edema, and atelectasis rapidly progress to fibrosis in many patients. The syndrome has been frustratingly resistant to treatment, and no specific therapy has proved beneficial. Although recent case series suggest some decrease in mortality over the past decade, the death rate remains about 40 percent.13 Recently, the view that new strategies of ventilator management might improve patient outcomes has gained currency.4 This view is based largely on an impressive body of data from studies in animals indicating that mechanical . . .
Heroin substitute treatment should not be time limited, says report commissioned by government
Authors: I. Torjesen
Journal: BMJ (2014)

No time limit should be imposed on drug users’ access to heroin substitute treatment, a report by the Advisory Council on the Misuse of Drugs recommends,1 because doing so could increase the possibility of relapse and drive up crime.

The council was commissioned in June 2014 by the then minister for crime prevention, Norman Baker, to advise the Inter-Ministerial Group on Drugs on whether access to opioid substitution therapy should be time limited and how to optimise outcomes from use of this therapy.

In its report, published on 6 November, the council said …
Prophylactic immunization with Bubble liposomes and ultrasound-treated dendritic cells provided a four-fold decrease in the frequency of melanoma lung metastasis
Authors: Yusuke Oda, Ryo Suzuki, Shota Otake, Norihito Nishiie, Keiichi Hirata, Risa Koshima, Tetsuya Nomura, Naoki Utoguchi, Nobuki Kudo, Katsuro Tachibana, Kazuo Maruyama
Journal: Journal of Controlled Release (2011)
Medical Audit JCAH-Style: A Positive View
Authors: Russell N. Anderson
Journal: JAMA (1977)

<h3>To the Editor.—</h3> Having been a Field Representative of the JCAH for the past three years, it may be considered that I have a somewhat biased point of view. However, I believe any bias would be balanced by 21 years of private practice and an appreciation of the problems of the medical staff in fulfilling their responsibility for patient care evaluation. Dr Rosenberg would favor a process audit rather than an outcome audit for patient care evaluation. It would be difficult, if not impossible, for physicians to agree on the step-by-step process that would define good medical care. There would be much resistance and resentment to the cookbook medicine approach. Process audit may put an imposing load on data retrieval personnel. Outcome audit is based on the assumption that if optimal care is rendered, there should be outcome that is commensurate with that care. The methodology, therefore, evaluates the quality
Costs of unnecessary tests: nonsense urines.
Authors: J G Cruickshank, A H Gawler, R J Hart
Journal: BMJ (1980)

with self-care).4Impaired mobility was the main reason for disability and difficulty with feeding or dressing for dependence.The frequency of dependence increased with age, 33 of the dependent patients being over 60 years.The table shows the aids considered necessary and those supplied as a result of the assessment; the difference represents aids already provided.Aids to bathing were most often considered necessary, and most of these and virtually all the feeding aids had to be supplied.Toilet aids were needed by a few patients, and many miscellaneous aids were supplied to a few patients.Bath aids were considered useful by virtually all of those to whom they were supplied, as were the feeding aids except for the suction egg cup.Aids needed and supplied No (0) of aids Aids supplied after No* (') Cost per item needed assessment useful (f) Bath aids: Rail 46 31 (67) 28/29 (97) 4-25 Mat 38 23 (61) 21/21 (100)
Computed Tomographic Assessment of Atherosclerosis in Ancient Egyptian Mummies
Authors: Adel H. Allam
Journal: JAMA (2009)

To the Editor: The current epidemic of atherosclerosis is commonly ascribed to risk factors associated with the modern human lifestyle. Computed x-ray tomographic (CT) imaging can visualize calcium hydroxyapatite in vessel walls and is widely regarded as pathognomonic of atherosclerosis.1
TCT-490 Frequency And Impact Of Nuisance Bleeding On Adverse Events After Percutaneous Coronary Intervention: 2-Year Results From The Patterns Of Non-Adherence To Antiplatelet Regimens In Stented Patients (PARIS) Registry
Authors: Usman Baber, Samantha Sartori, Jennifer Yu, David Cohen, David J. Moliterno, George Dangas, Annapoorna Kini, Alaide Chieffo, Roxana Mehran
Journal: Journal of the American College of Cardiology (2014)
Inflammatory potential of neutrophils detected in sickle cell disease
Authors: Aaron F.H. Lum, Ted Wun, Donald Staunton, Scott I. Simon
Journal: American Journal of Hematology (2004)

Abstract An early event in the inflammatory response is neutrophil recruitment to endothelium in response to chemotactic stimulation, which in turn activates CD18‐integrin, which anchors neutrophils to the vessel wall under the shear force of blood flow. Activated neutrophils circulating in sickle cell disease (SCD) patients may significantly contribute to vascular occlusions (VOC) as neutrophils adherent to inflamed endothelium recruit sickle red blood cells inducing VOC. To elucidate the mechanisms by which neutrophils may participate in VOC in SCD, CD18‐integrin expression and function in fresh blood samples of non‐crisis patients were measured by flow cytometry. CD11b/CD18 membrane expression was ∼70% higher on unstimulated SCD neutrophils than controls, which correlated with a 1‐fold higher rate of adhesion to ligand. Unstimulated SCD neutrophils expressed ∼30,000 active CD18 per cell, while controls expressed ∼6,000. Stimulation with a low concentration of IL‐8 (0.1 nM) upregulated 100% more active CD18 and induced 60% more adhesion of SCD than control neutrophils. These data demonstrate that neutrophils from SCD patients constitutively express active CD18 in blood and respond with enhanced sensitivity to chemokine activation of adhesion, thus increasing their propensity for exuberant adhesion. Am. J. Hematol. 76:126–133, 2004. © 2004 Wiley‐Liss, Inc.
Relative Inaccuracy of the A1cNow in Children With Type 1 Diabetes
Authors: Larry Fox, Mariya Dontchev, Katrina Ruedy, Roy Beck, Craig Kollman, Laurel Messer, Julie Coffey, Darrell Wilson, Elizabeth Doyle, William Tamborlane, Michael Steffes
Journal: Diabetes Care (2006)

The Diabetes Control and Complications Trial (DCCT) confirmed the importance of tight glucose control in limiting the development of microvascular complications and established a standard for measuring A1C levels using high-performance liquid chromatography (HPLC) (1). Several studies demonstrated the benefit of rapid A1C testing in the clinic while face-to-face with the patient/family (2–4). The DCA2000 Analyzer (Bayer, Tarrytown, NY) uses an immunoassay method certified by the National Glycohemoglobin Standardization Program (NGSP) (5). It is frequently used to provide a rapid (6 min) A1C result, enhancing the ability to optimize therapy in a timely fashion. We recently reported that the DCA2000 was highly correlated with an HPLC reference (the DCCT standard) ( r = 0.94, P < 0.001), although there was a slight bias with DCA2000 values being, on average, 0.2% higher than laboratory values (6).

The A1cNow (Metrika, Sunnyvale, CA) was developed as a single-use, disposable test for measuring A1C at home. It is small, about the size of a pager, requires one drop of blood, and uses an immunoassay. Results are displayed in ∼8 min. However, there has been only one published study (7) to date assessing …
THE FORMATION OF VESICAL CALCULI
Authors: BENJAMIN H. HAGER
Journal: JAMA (1928)

Stones are formed within the urinary tract under a variety of conditions, and no single mechanism suffices to explain the process. It is difficult to distinguish the actual cause from the predisposing factors, and impossible to distinguish it from those factors which may be regarded as secondary. Cystine and uric acid stones cannot be explained on any other basis than faulty metabolism. The experimental production of oxamide calculi by feeding large quantities of oxalate can probably be explained on a physiochemical basis. That a foreign body, regardless of its structure or composition, acts as a nucleus for the deposition of urinary salts is well established, so that the part played by mechanical factors and obstruction cannot be ignored. It is apparent that the chemical substances which go to make up urinary calculi vary under different conditions, and are dependent in part on the etiologic factor. During the last decade, bacteria