tbuckley/cabot-search huggingface dataset:
Effectiveness of lipid lowering drugs in general practice: Authors' reply
Authors: J. Hippisley-Cox
Journal: BMJ (2003)

Editor—Wang et al, and Kumana and Cheung are concerned by the omission of data on drug dosage. We included an analysis of drug dosage in the original paper submitted to the BMJ and removed it at the request of the editorial board. Of the 1116 patients whose serum cholesterol value was above 5 mmol/l, 209 (18.7%) were receiving maximum doses compared with 96 (7.1%) of the 1353 patients who did achieve the target range. In addition, in those patients receiving the maximum dose only 32% (96) achieved the target cholesterol value.

The table shows the number of patients taking each drug who reached target cholesterol values according to whether the maximum dose recommended in the British National Formulary had been prescribed. However, we have not looked at equivalent doses when these are submaximal for one drug, but maximal for another.



Table 1

Achievement of serum cholesterol value of ≤5 mmol/l and use of maximum dose of individual lipid agents



We did not write the statement “Statins reduce lipid levels better than fibrates”—this appeared in This week in the BMJ rather than in our paper. The text was different from the version we submitted, and we had no opportunity to comment on it before publication.

Kumana and Cheung raise the issue of differences between patients taking different statins. As we described in our paper, we took account of potential confounders by including the following variables in the multivariate analysis: sex, age, obesity, smoking status, pretreatment cholesterol values, comorbidity (ischaemic heart disease, diabetes, hypertension, and stroke), and registered general practices. We discussed the potential effect on the results in our discussion.

We think that the “dispersion” mentioned by Wang et al refers to the 95% confidence intervals (which are not standard deviations), and naturally these are narrower for atorvastain and simvastatin because of the larger sample sizes in those groups.
The “problem” of dreaming in NREM sleep continues to challenge reductionist (two generator) models of dream generation
Authors: Tracey L. Kahan
Journal: Behavioral and Brain Sciences (2000)

The “problem” of dreaming in NREM sleep continues to challenge models that propose a causal relationship between REM mechanisms and the psychological features of dreaming. I suggest that, ultimately, efforts to identify correspondences among multiple levels of analysis will be more productive for dream theory than attempts to reduce dreaming to any one level of analysis. [Hobson et al. ; Nielsen]
Arthroscopy in Acute Trauma of the Knee Joint
Authors: W. Glinz, P. Segantini, P. Kägi
Journal: Endoscopy (1980)

Even in massive hemarthrosis, arthroscopy of the acutely injured knee joint can be performed. The procedure is indicated in all cases where clinical findings and radiography cannot establish a clear diagnosis or a clear indication for operation. Hemarthrosis of unknown origin should be investigated in every case. An additional indication for arthroscopy is planned arthroscopic operation. In a series of 1000 arthroscopies, the examination was performed in 76 patients in the acute stage after trauma. In most knee joints several injuries were found; the most frequent being tears of the menisci, cartilage lesions, ruptures of the anterior cruciate ligament and tears of the joint capsule. 24 cases were treated by arthroscopic operation: 13 partial meniscectomies were performed in acute blocking of the knee and in 8 cases a detached chondral or osteochondral fragment was removed. 29 cases required arthrotomy. Post-operative morbidity of arthroscopic operation is surprisingly low. Patients were not hospitalized for diagnostic or operative arthroscopy.
Reactivation of vasculitis after influenza vaccination.
Authors: J Cannata, V Cuesta, V Peral, I Maisueche, J Herrera
Journal: BMJ (1981)

Despite custodial care he contrived to sniff glue on two further occasions.Both of these episodes were associated with a recurrence of loin pain, haematuria, and proteinuria.Although urea and creatinine concentrations remained normal, microscopic haematuria persisted after six weeks' abstinence from glue.
Synergistic interactions between sorafenib and bortezomib in hepatocellular carcinoma involve PP2A-dependent Akt inactivation
Authors: Kuen-Feng Chen, Hui-Chuan Yu, Tsung-Hao Liu, Shoei-Sheng Lee, Pei-Jer Chen, Ann-Lii Cheng
Journal: Journal of Hepatology (2009)
Tuberous Sclerosis
Authors: Roger C. Duvoisin
Journal: JAMA (1961)

There is a growing awareness of the protean clinical manifestations of Bourneville's disease and of the occurrence of cases lacking one or another component of the classic triad of mental deficiency, epilepsy, and adenoma sebaceum. With a view to emphasizing the oligosymptomatic forms of the disease, three patients are presented who did not have intellectual impairment. One patient had a record of scholastic excellence. The other two achieved average I.Q. scores on psychological testing. Adenoma sebaceum and intracranial calcifications ("brain stones") established the diagnosis in two patients. The third had epilepsy and was found on pneumoencephalography to have the characteristic intraventricular tumefaction of tuberous sclerosis.
Biotechnology Industry Roars Into The Millennium
Authors: Maggie Reh
Journal: JNCI Journal of the National Cancer Institute (1998)

Nearly three decades after two California scientists pioneered recombinant DNA technology, biomedical research is undergoing explosive growth, and the industry fueling that growth is poised to break even financially for the first time ever.Over the last year, the biotechnology industry in the United States has seen a 20% jump in product sales, setting a new industry record.This milestone is due in large part to the accelerated pace at which biologics have gained marketing approval in recent years: almost as many biologically based drugs and devices were approved by the Food and Drug Administration in 1997 as were approved in the entire decade of the 1980s."We are on the brink of a revolution in medicine," summed up David G. Nance, president and chief executive officer ofIntrogen Therapeutics, Inc., in Austin, Texas."The medicines used to treat our parents and keep them comfortable aren't the medicines that will be used to treat us and keep us comfortable."Even President Clinton has joined in the enthusiasm surrounding biomedicine's rapid progress and its potential to develop drugs that could help millions of Americans who suffer from chronic, degenerative, and often fatal diseases including cancer.In his 1998 State of the Union address, Clinton marvelled at how rapidly scientists pinpointed the gene that causes Parkinson's disease."In the 1980s, scientists identified the gene causing cystic fibrosis, it took 9 years," Clinton said."Last year, scientists located the gene that causes Parkinson's disease -in only 9 days!"1324 NEWS
Diagnosis of dementia
Authors: C. Nicholl
Journal: BMJ (2009)

The usefulness of screening tests varies according to the clinical setting

Although dementia is common, with an expected prevalence of 13 in 1000 in people aged 65-69 and 122 in 1000 in those over 80, only about half of those affected are diagnosed.1 Without a diagnosis, patients and carers cannot access the services they need, so earlier diagnosis is a key component of the National Dementia Strategy in the United Kingdom.2 3 However, early diagnosis is not easy and no definitive test exists. In the linked cross sectional study (doi:10.1136/bmj.b2030), Brown and colleagues assess the effectiveness of the “test your memory” cognitive test in detecting Alzheimer’s disease. The test was designed to minimise operator time and to be suitable for non-specialists to use.4 

Cognitive function in established dementia is clearly different from the cognitive changes of normal ageing, but the onset of dementia is gradual. Diagnosis requires consideration of the person’s education, culture, and circumstances; dementia presents when a person’s cognitive abilities are no longer adequate for them to cope with their environment. A high flying executive may experience problems early in the neuropathological process, whereas a resident of a care home may …
Reply to O.R. Colegio et al
Authors: Johan W. de Fijter, Jan Nico Bouwes Bavinck
Journal: Journal of Clinical Oncology (2013)

An editorial by Goodwin et al 1 prioritized ran- domized controlled trials (RCTs) over observational research for demonstrating benefits of treatment.We agree that RCTs remain the gold standard for establishing efficacy of new cancer therapies under controlled conditions.However, we suggest that the editorial undervalued the ability of population-based observational research to investigate effects of new therapies among patients treated in routine practice.We disagree with the editorial statement 1 that RCTs establish both efficacy and effectiveness and propose that population-based studies are necessary and complementary to ensure that results of
Therapeutic endoscopic retrograde cholangiography and cholangioscopy (ERCC) combining a single-balloon enteroscope and an ultraslim endoscope in altered gastrointestinal anatomy
Authors: K. Mönkemüller, J. Toshniwal, M. Zabielski
Journal: Endoscopy (2012)

An 84-year-old man with coronary artery disease, hypertension, diabetes mellitus, and previous Billroth II gastrojejunostomy presented with purulent cholangitis. He underwent endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and placement of a 10-cm 10-Fr double-pigtail stent. During the second ERCP it was not possible to access the afferent limb. Thus we performed single-balloon ERCP using a therapeutic enteroscope (DBE-EN-450T5, 13.5-mm outer diameter, working channel 2.8 mm; TS13140 overtube, outer diameter 13.2 mm, inner diameter 10.8 mm, working length 1350 mm, total length 1450 mm; Fujifilm, Tokyo, Japan). The stabilizing effect of the overtube facilitated the enteroscope to enter into the afferent limb and reach the papilla, from which an exiting double-pigtail stent was seen ([Fig. 1]). The stent was grabbed with a basket (25-mm nitinol basket, Teflon outer coating, with 5-Fr diameter; Fujifilm, Willich, Germany) and retrieved while the overtube was left in place ([Fig. 2]). Then the scope was reinserted through the overtube. The cholangiogram revealed a tortuously dilated common bile duct (CBD) and multiple filling defects, including a large stone and aerobilia. Because direct cholangioscopy using the enteroscope was not possible because of the relatively small papillary opening, a decision to use the ultrathin (transnasal) gastroscope (EVIS EXERA II video gastroscope GIF-XP-180N; 110-cm working length, 5.5-mm outer diameter, 2.0-mm working channel; Olympus, Hamburg, Germany) was taken. Because the ultrathin gastroscope had a total length of 110 cm, it could not be advanced through the longer enteroscopy overtube. Therefore, an approximately 60-cm segment of the overtube was cut, leaving about 20 cm out of the patient's mouth ([Fig. 3]). Then the ultrathin scope was advanced through the overtube into the afferent limb, and the papillary orifice was again recognized and easily intubated. After intubation of the CBD, a large stone was visualized ([Fig. 4]). Scope-guided cholangiography showed a dilated CBD with stones ([Fig. 5]). An over-the-wire balloon (0.025 guide wire, MTW, Wesel, Germany; 12-mm, 5-Fr catheter balloon, MTW, Wesel, Germany) was used to pull the stone into the distal part of the CBD. Here it was grabbed with the basket and retrieved. After stone extraction, a full cholangioscopy was performed using the ultraslim gastroscope ([Fig. 6]).
Water Intoxication and Psychosis
Authors: NORMAN D. OLSON
Journal: Annals of Internal Medicine (1974)

Comments and Corrections1 February 1974Water Intoxication and PsychosisNORMAN D. OLSON, M.D.NORMAN D. OLSON, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-80-2-279_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In The October Issue (Ann Intern Med 79:551-554, 1973) Dubovsky and associates reported the syndrome of inappropriate secretion of antidiuretic hormone associated with an acute psychotic decompensation. As in previous reports it was marked polydipsia that precipitated the water intoxication, and they noted that the psychosis did not improve after correction of the hyponatremia alone.We have observed a 56-year-old man with a childhood history of meningitis, with residual abducens palsy and mild presenile dementia of uncertain duration, who presented twice in 4 months with acute organic psychosis associated with inappropriate secretion of antidiuretic hormone.On his...Reference1. BARTTERSCHWARTZ FW: The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 42:790-806, 1967 CrossrefMedlineGoogle Scholar1. MANDELLMERSOL-SOBBOTMANDELL AIM: Psychological disturbance and water retention. Arch Gen Psychiatry 10:513-518, 1964 CrossrefMedlineGoogle Scholar2. LANGGARDSMITH HW: Self-induced water intoxication without predisposing illness. N Engl J Med 266:378-381, 1962 CrossrefMedlineGoogle Scholar1. SCHRIERBERL RT: Mechanism of the antidiuretic effect associated with interruption of parasympathetic pathways. J Clin Invest 51:2613-2620, 1972 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Minneapolis Veterans Administration Hospital Minneapolis, Minnesota PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByPostmortem diagnosis of hyponatremia: case report and literature reviewLong-term neurologic outcome in psychogenic water drinkers with severe symptomatic hyponatremia: The effect of rapid correctionThe Syndrome of Inappropriate Secretion of Antidiuretic Hormone (Siadh): An Overview 1 February 1974Volume 80, Issue 2Page: 279-282KeywordsAntidiuretic hormoneDementiaHyponatremiaIntoxicationMeningitisParalysis Issue Published: 1 February 1974 PDF DownloadLoading ...
Psoriasis: immunopathogenesis and evolving immunomodulators and systemic therapies; U.S. experiences
Authors: T. Kormeili, N.J. Lowe, P.S. Yamauchi
Journal: British Journal of Dermatology (2004)

Background Psoriasis is a chronic inflammatory skin disorder that is presently without a permanent cure. Up to 40% of patients with psoriasis also develop psoriatic arthritis. The mainstay armamentarium to treat psoriasis systemically includes methotrexate, ciclosporin and oral retinoids, all with significant potential for toxicity and the need for close laboratory supervision. The although the exact mechanism of psoriasis is still unclear, the involvement of T‐cell‐mediated cytokine expression in the aetiology of psoriasis is becoming clearer. The goal of modern treatment is to target such immune responses that lead to the formation of psoriatic plaques and psoriatic arthritis using selective immunomodulating pharmacotherapy. The advantages of these biological agents are less toxic systemic side‐effect profiles that will improve the quality of life in psoriatic patients. Objectives This review article describes current and emerging selective immunotherapies and systemic therapies for the treatment of psoriasis, and will briefly discuss disease immunopathogenesis. Methods Literature review. Results and conclusions Given the role of the inflammatory immune responses in the pathogenesis of psoriasis, the goal of modern medicine and pharmacotherapy lies in the design and use of specific targets in cell‐mediated immune reactions and the modulation of the expression of various inflammatory cytokines. The clinical evidence of efficacy of some of these new biological immunomodulatory agents from several U.S.‐based research studies and clinical experiences is convincing.
The Ruby Trial
Authors: Nathan K. Rickles
Journal: JAMA (1964)

<h3>To the Editor:—</h3> The spectacle of the battle of the experts was once again dramatically portrayed before the world. And once again futility, controversy, and confusion were displayed. Six experts testified and, like adversaries lined up on opposing sides of a giant tug of war, gave conflicting reports. Why is this state of utter confusion permitted to continue? One cannot blame the experts, as their appearance and behavior have become accepted in our American system of justice. I have personally appeared as an expert for both defense and prosecution. I know the expectations of both sides and how these pressures can influence honest judgment. After the histrionics of cross-examination, no matter how dignified or impartial the expert may try to be, the testimony seems open to censure and many times to ridicule. The spectacle of the doctor in court does little to enhance his image. Most certainly, justice is made
Thalidomide for the treatment of histiocytic sarcoma after hematopoietic stem cell transplant
Authors: Muneer H. Abidi, Isaacson Tove, Rami B. Ibrahim, Dan Maria, Edward Peres
Journal: American Journal of Hematology (2007)

Abstract Histiocytic sarcoma (HS) is a rare neoplasm of uncertain etiology. Most recently, the diagnostic criteria for this entity have been revised with inclusion of diagnostic modalities such as immunohistochemical and cytogentic techniques. HS tends to have an aggressive clinical course and presents with systemic symptoms of fever, weight loss, adenopathy, hepatosplenomegly, rash, and pancytopenia. Thalidomide is a promising agent that may exert a therapeutic benefit in HS. We report a case of a 48‐year‐old female with HS who presented with fever, weight loss, fatigue, generalized anasarca, and pancytopenia. She underwent multi‐agent chemotherapy followed by matched unrelated hematopoietic stem cell transplant. Her disease recurred and thalidomide therapy was started, with her overall disease burden significantly reduced as measured radiographically. Am. J. Hematol. 82:932–933, 2007. © 2007 Wiley‐Liss, Inc.
Value of stress myocardial perfusion and delayed enhanced magnetic resonance imaging for noninvasive screening of coronary artery disease before elective repair of aortic aneurysm
Authors: Masaki Ishida, Hajime Sakuma, Noriyuki Kato, Nanaka Ishida, Takatsugu Shimono, Isao Yada, Kan Takeda
Journal: Journal of the American College of Cardiology (2002)
Family Physician Rediscovered
Authors: DAVID E. REED
Journal: Annals of Internal Medicine (1982)

Letters and Corrections1 August 1982Family Physician RediscoveredDAVID E. REED, M.D.DAVID E. REED, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-97-2-280_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Dr. Barbero's discussion (1) of the difficulties encountered by patients making the transition from the care of a pediatrician to that of an internist presents an interesting dilemma and a challenge to our profession to meet the needs of society.In addition to the need for increased communications between the pediatrician and internist, and expanded education programs to aide physicians in dealing with patients entering or leaving their care, I feel we should consider the creation of a new specialty. Semanticists will delight in developing appropriate titles for this new practitioner, (for example, transpediatrician) and wags may...References1. BARBERO G. Leaving the pediatrician for the internist [Editorial]. Ann Intern Med. 1982;96:673-4. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: DAVID E. REED, M.D.Affiliations: University of Pittsburgh Pittsburgh, PA 15232 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 August 1982Volume 97, Issue 2Page: 280-280 ePublished: 1 December 2008 Issue Published: 1 August 1982 PDF downloadLoading ...
Notes on Strophanthus
Authors: K. N. Bahadhurji
Journal: BMJ (1887)

Thank you for your interest in spreading the word about The BMJ.NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Username * Your Email * Send To * You are going to email the following Notes on Strophanthus Your Personal Message CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
F-18 FDG PET Demonstration of Thyroglossal Duct Cyst
Authors: Ba D. Nguyen
Journal: Clinical Nuclear Medicine (2005)

Thyroglossal duct cyst is a congenital cervical abnormality representing a remnant from the development and migration of thyroid tissue from the foramen cecum to the final thyroid fossa. It may contain ectopic thyroid tissue and can be demonstrated on scintigraphic examinations. The author presents such a case with F-18 FDG uptake on PET/CT imaging in a patient previously having thyroid ablation with radioactive iodine for toxic multinodular goiter.
Mortality in Overweight and Underweight Children With Acute Myeloid Leukemia
Authors: Beverly J. Lange
Journal: JAMA (2005)

ContextCurrent treatment for acute myeloid leukemia (AML) in children cures about half the patients. Of the other half, most succumb to leukemia, but 5% to 15% die of treatment-related complications. Overweight children with AML seem to experience excess life-threatening and fatal toxicity. Nothing is known about how weight affects outcomes in pediatric AML.ObjectiveTo compare survival rates in children with AML who at diagnosis are underweight (body mass index [BMI] ≤10th percentile), overweight (BMI ≥95th percentile), or middleweight (BMI = 11th-94th percentiles).Design, Setting, and ParticipantsRetrospective review of BMI and survival in 768 children and young adults aged 1 to 20 years enrolled in Children’s Cancer Group-2961, an international cooperative group phase 3 trial for previously untreated AML conducted August 30, 1996, through December 4, 2002. Data were collected through January 9, 2004, with a median follow-up of 31 months (range, 0-78 months).Main Outcome MeasuresHazard ratios (HRs) for survival and treatment-related mortality.ResultsEighty-four of 768 patients (10.9%) were underweight and 114 (14.8%) were overweight. After adjustment for potentially confounding variables of age, race, leukocyte count, cytogenetics, and bone marrow transplantation, compared with middleweight patients, underweight patients were less likely to survive (HR, 1.85; 95% confidence interval [CI], 1.19-2.87; P = .006) and more likely to experience treatment-related mortality (HR, 2.66; 95% CI, 1.38-5.11; P = .003). Similarly, overweight patients were less likely to survive (HR, 1.88; 95% CI, 1.25-2.83; P = .002) and more likely to have treatment-related mortality (HR, 3.49; 95% CI, 1.99-6.10; P&lt;.001) than middleweight patients. Infections incurred during the first 2 courses of chemotherapy caused most treatment-related deaths.ConclusionTreatment-related complications significantly reduce survival in overweight and underweight children with AML.