tbuckley/cabot-search huggingface dataset:
Chronotropic Response to Exercise
Authors: Peter M. Okin, Michael S. Lauer, Paul Kligfield
Journal: Circulation (1996)

Heart rate (HR) response to exercise plays an important role in the diagnosis of coronary artery disease (CAD). Adjustment of ST-segment depression for the change in HR with exercise increases the accuracy of the exercise ECG in the detection of CAD. In addition, an attenuated HR response to exercise, a manifestation of chronotropic incompetence, may have independent diagnostic value for CAD.The diagnostic value of adjusting the magnitude of ST-segment depression, the ST-segment (ST)/HR index, and the ST/HR slope for chronotropic response to exercise was assessed in 283 control subjects and 337 patients with CAD by dividing each ST measurement by the fraction of HR reserve achieved. At a matched specificity of 96%, ST-segment depression of > 160 microV identified CAD with a sensitivity of 52%, an ST/HR index of > 1.69 microV/bpm identified CAD with a sensitivity of 90%, and an ST/HR slope of > 2.96 microV/bpm identified CAD with a sensitivity of 88%. Adjustment for HR reserve improved the sensitivity of each method: adjusted ST-segment depression of > 176 had a sensitivity of 87% (P < .0001), an adjusted ST/HR index of > 2.14 had a sensitivity of 94% (P = .005), and an adjusted ST/HR slope of > 3.47 had a sensitivity of 93% (P = .0001). In addition, the 94% and 93% sensitivities of the adjusted ST/HR index and ST/HR slope were significantly greater than the 87% sensitivity of adjusted ST-segment depression (P < .0001).Correction for an attenuated HR response to exercise improves performance of the simple and HR-adjusted ST-segment depression criteria for the identification of CAD. These findings support assessment of the degree of chronotropic reserve in routine evaluation of the exercise ECG.
Antifibrinolytics: ischemia may offset control
Authors: William A. Check
Journal: JAMA (1984)

Administering a compound that prevents dissolution of blood clots to a patient who has had a subarachnoid hemorrhage substantially reduces the risk of rebleeding. But the reduction in mortality from rebleeding is almost exactly offset by deaths from ischemia and cerebral infarctions. These frustrating findings have been verified in two independent studies using two different antifibrinolytic agents. Both studies were reported at the Ninth International Joint Conference on Stroke and Cerebral Circulation in Tampa, Fla. The findings received a mixed reaction from conference participants, some of whom wondered whether fluid restriction might alter the outcomes. <h3>Retrospective Data Discouraging</h3> Neal F. Kassell, MD, who at the time was professor of surgery at the University of Iowa College of Medicine in Iowa City and is now professor of neurosurgery at the University of Virginia School of Medicine in Charlottesville, described results from an uncontrolled retrospective survey of patients enrolled in the Cooperative
Beyond the Coombs Test
Authors: John P. Leddy
Journal: New England Journal of Medicine (1971)

The antiglobulin (Coombs) test, first applied to acquired hemolytic anemia in 1946,1 has amply proved its usefulness in helping to distinguish immune from nonimmune hemolytic disorders. This fact and the test's highly respected sensitivity may have contributed to the notion that a negative direct antiglobulin reaction in a patient with hemolytic anemia effectively rules out an immune process.That this is not so has long been appreciated by immunohematologists who have been confronted from time to time with clear-cut hemolytic transfusion reactions or with cases of hemolytic anemia having all the earmarks of acquired immune hemolytic anemia (AIHA), but with . . .
Blood pressures that fall on rechecking
Authors: W S Peart, W E Miall
Journal: BMJ (1982)

the investigation of all aged demented patients since the yield of "potentially reversible" causes will certainly be low and the yield of "actually reversible" causes even lower.There are patients of all ages (including aged demented patients) in whom computed tomo- graphy is a valuable procedure, but they will all have to wait a very long time for their scans if we all follow what appears to be Professor Millard's advice and seek computed tomo- graphy scans for all our aged demented patients.
Improved safety factor for triphasic defibrillator waveforms.
Authors: J L Jones, R E Jones
Journal: Circulation Research (1989)

Newly developed biphasic waveforms improve defibrillation efficacy both by reduction of defibrillation threshold and by amelioration of shock-induced dysfunction depending on the relative shape of the first and second pulses. Each of these independent effects improves the waveform's safety factor, the ratio between the shock intensity that produces a specific degree of postshock dysfunction and the shock intensity that produces defibrillation (or cellular excitation). Symmetrical waveforms reduce defibrillation threshold to about 60% that of the corresponding monophasic waveform, probably by reduction of excitation threshold for ischemic cells, but increase postshock arrhythmias. Biphasic waveforms with 10% "tails" reduce postshock arrhythmias. This study tests the hypothesis that these independent mechanisms for improvement of defibrillation efficacy can be combined into a single triphasic waveform that will have a higher safety factor than either of the two biphasic waveforms of which it is composed. Cultured myocardial cells were subjected to high-intensity electric-field stimulation with a control monophasic rectangular waveform, a symmetrical biphasic waveform, and a triphasic waveform consisting of the biphasic waveform with an added 10% "tail." Each waveform portion was 5 msec in duration. Photocell mechanograms monitored contractile activity. We found that the duration of postshock arrest of spontaneous contractile activity increased with stimulus intensity for all waveforms. The voltage gradient producing a 4-second arrest after the biphasic waveform shock was 80.6 +/- 1.3% that of the control waveform (100%), while the voltage gradient for the triphasic waveforms was 87.1 +/- 0.73% of control. The difference between biphasic and triphasic waveforms was significant (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
A Closer Look at Radiocontrast-Induced Nephropathy
Authors: Mayer Brezis, Franklin H. Epstein
Journal: New England Journal of Medicine (1989)

Despite innovations in techniques of body imaging such as computerized radiography, ultrasonography, and magnetic resonance, the use of radiocontrast material is increasing, largely because of the need for angiography in connection with surgery or angioplasty on the coronary arteries, heart, and great vessels. The price exacted for the use of radiocontrast agents is the occasional and seemingly unpredictable occurrence of severe oliguric or nonoliguric acute renal failure. Even with optimal dialytic support, acute renal failure still involves substantial morbidity and mortality, for which prevention is more desirable (and more feasible) than the best therapy.1 In this issue of the Journal . . .
THE PREVENTION OF DEFORMITY.
Authors: WISNER R. TOWNSEND
Journal: JAMA (1902)

While the entire medical profession of this generation are earnestly striving to better the condition of the human race by the prevention of disease, it seems an opportune time also to enlist their efforts toward the prevention of the many deformities of the body which surgeons are called upon to treat. That great results have followed the establishment of proper quarantine regulations is admitted by all, and the wonderful change in the conditions of Havana and other Cuban cities since the American military surgeons have been placed in control of sanitary affairs, is a matter of sincere congratulation and the good effects will be far-reaching. In many other directions preventive medicine is attracting the attention of the entire world, and no subject is more thoroughly discussed to-day than the prevention of tuberculosis. While authorities may differ as to how the result can be best and most speedily accomplished, all agree
THE EPIDEMIOLOGY OF OPEN TIBIAL SHAFT FRACTURES IN SPORTS
Authors: Adeel Akhtar Muhammad, Stuart Goudie, Court Brown Charles
Journal: British Journal of Sports Medicine (2013)

Background Tibial shaft fracture is a common sports injury in young athletic population. Open fractures can result in significant morbidity. Our aim was to study the epidemiology, severity and soft tissue coverage of sports related open tibial shaft fractures in the southeast of Scotland over the last 22 years. Methods We identified 502 patients from our prospective trauma database between 1988 and 2010 with open tibial shaft fractures and 33 patients (6.5%) had sports related fractures. Demographic details were recorded along with sports played, severity of injuries by using injury severity score, severity of fractures by using Gustillo Anderson classification system and requirement of soft tissue coverage procedures. Results The mean age was 30 years (range- 15–67). 29 (88%) were male and four female (12%). The most common sport played was football in 20 patients (61%) followed by rugby in three patients (9%) skiing, quad bike and horse riding in two patients each (6%) and golf, squash, cycling and sledging in one patient (3%) each. The mean injury severity score was 10.8 (range 10–16). Eleven patients (33%) had grade 1, fifteen patients (46%) had grade 2, five patients (15%) had grade 3a and two patients (6%) had grade 3b injuries according to Gustillo Anderson classification system of open fractures. Eight patients (24%) required soft tissue coverage for the treatment of these fractures. The types of flaps used were fasciocutaneous flap in four patients, split skin graft in three patients and adipofascial flap in four patients. Discussion We looked at the epidemiology of open tibia shaft fractures in the southeast of Scotland in last 22 years and found that football was the most common sport (61%) associated with these fractures. 88% patients were male. 21% patients had severe (grade 3) injuries and 24% patients required soft tissue coverage for the treatment of these fractures. This information can help sports physicians in planning orthopaedic and plastic services for the treatment of sports related open tibial shaft fractures.
Multifocal Osteogenic Sarcoma in the Seventh Decade
Authors: JOHN A. VENTO, ROBERT EDKIN, JAMES D. SLAVIN, RICHARD P. SPENCER
Journal: Clinical Nuclear Medicine (1986)

A 64-year-old man with right knee pain had uptake of Tc-99m MDP in the area as well as in the greater trochanter. Both sites were shown to contain osteogenic sarcoma. There was resection of the bone. Eight months later, radiogallium uptake was avid in the nearby soft tissue, indicating tumor spread.
The Refraction of the Eye. A Manual for Students
Authors: Gustavus Hartridge
Journal: JAMA (1900)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Ventricular septal defect in infancy: a combined vectorgraphic and echocardiographic study.
Authors: T Riggs, S Mehta, S Hirschfeld, G Borkat, J Liebman
Journal: Circulation (1979)

Echocardiograms (echo) and vectorcardiograms (VCG) from 40 infants with ventricular septal defects (VSD) were compared with cardiac catheterization data to assess noninvasively the hemodynamics of VSD. The specific aim was to use VCG parameters of right ventricular hypertrophy and echo parameters which reflect pulmonary artery pressure to identify all patients with a nonrestrictive VSD. The configuration of the QRS vector in the horizontal plane was more reliable than individual voltages in assessing right ventricular systolic pressure. Among patients older than 2 months with a clockwise or anterior two-main-vector horizontal loop, 73% (eight of 11) had a nonrestrictive VSD. However, a counterclockwise or posterior two-main-vector loop was also frequently found (43%, six of 14) in infants with a nonrestrictive VSD. The most useful echo parameter was the ratio of right ventricular preejection period-to-right ventricular ejection time (RPEP/RVET), which closely (r = 0.74) reflected the pulmonary artery diastolic pressure. An elevated RPEP/RVET to greater than 0.30 was always associated with a nonrestrictive VSD, although many patients (36%, five of 14) with a nonrestrictive VSD had a normal ratio. By combining both echo and VCG parameters, a nonrestrictive VSD was correctly identified in all patients, while a restrictive VSD was correctly identified in 81% (21 of 26).
Impact and modulation of nasal obstruction
Authors: F. Horak
Journal: Allergy (2002)

Nasal obstruction, the leading symptom of allergic rhinitis, results from the combined activity of early‐ and late‐phase allergic reactions. Desloratadine inhibits both early‐ and late‐phase inflammatory mediators in vitro . Thus, double‐blind, placebo‐controlled, randomized, crossover trials were conducted to assess the efficacy of desloratadine against nasal obstruction, measured objectively and subjectively, during controlled exposure of patients with seasonal allergic rhinitis to allergen. Positive results were obtained in three single‐dose studies; desloratadine 5 mg resulted in a greater improvement from baseline than did placebo in the total symptom score and the nasal obstruction symptom score ( P ≤ 0.02). Desloratadine was more effective than placebo in a multiple‐dose study; desloratadine 5 mg was given once daily for 7 days, and a 6‐h allergen challenge was administered at the end of treatment compared with placebo. Desloratadine treatment was associated with less deterioration from baseline in the mean nasal airflow ( P &lt; 0.05) and in the mean severity score for the symptom of nasal obstruction ( P &lt; 0.03). Desloratadine significantly reduces the severity of nasal obstruction in patients with seasonal allergic rhinitis.
Oxygen supply and oxygen demand in the isolated working rabbit heart perfused with asanguineous crystalloid solution
Authors: T Murashita, R D Kempsford, D J Hearse
Journal: Cardiovascular Research (1991)

Study objective – It has been suggested that oxygenation of the isolated, crystalloid perfused, Langendorff rabbit heart is inadequate and that consequent hypoxia limits mechanical performance. The isolated working rabbit heart, which has a higher oxygen requirement than the Langendorff preparation, was used to investigate the relationships between the ability of the heart to perform external work, myocardial oxygen consumption, and tissue high energy phosphate content. Design – Hearts from adult rabbits (1.5-2.2 kg), paced at 200 beats·min−1, were perfused in the working mode with bicarbonate buffer (1.8 mmol·litre−1 Ca2+; Po2 >85 kPa, 630 mm Hg). Measurements and main results – The effects of (a) increasing preload (10,14,18, 22, 26 cm H2O) at fixed afterload (80 cm H2O) and (b) increasing afterload (60, 80,100,120 cm H2O) at fixed preload (18 cm H2O) on left ventricular power and myocardial oxygen consumption were determined. Increasing preload (from 10 to 26 cm H2O) resulted in linear increases in left ventricular power [from 1.36(SEM 0.06) to 2.81(0.19) J·min−1] and myocardial oxygen consumption [from 554(37) to 801(59) μl·g dry wt−1·min−1]; this was made possible by increased oxygen supply secondary to increased coronary flow. Increasing afterload (from 60 to 120 cm H2O) also increased . left ventricular power [from 1.76(0.05) to 2.16(0.09) J·min−1] and myocardial oxygen consumption [from 617(48) to 903(30) μl·g dry wt−1·min−1]. For a given increase in left ventricular power, the increase in myocardial oxygen consumption was greater if the increased workload was due to an increased afterload than if it was due to an increased preload, suggesting that increasing afterload resulted in a reduced external mechanical efficiency. Prolonged perfusion under conditions of low and high workload (80 and 120 cm H2O afterload for 60 min) was associated with comparable myocardial contents of adenosine triphosphate [22.5(1.4) and 21.7(0.4),μmol·g dry wt−1] and creatine phosphate [21.8(4.5) and 23.7(1.9) μmol·g dry wt−1] and comparable rates of lactate efflux [34.7(13.0) and 36.7(12.5) μmol·g dry wt−1·60 min−1]. Conclusion – Our observation of increased myocardial oxygen consumption and comparable contents of high energy phosphates with increased workload would suggest that the crystalloid perfused working rabbit heart is adequately oxygenated.
Eruptive satellite vascular malformations after removal of a melanocytic naevus
Authors: M. DEROO, I. EECKHOUT, J‐M. NAEYAERT
Journal: British Journal of Dermatology (1997)

The development of satellite lesions after removal of a pyogenic granuloma is well known. However, it is unusual to see this complication after the removal of a non‐angiomatous lesion. We describe a patient who developed multiple small vascular lesions after excision of a dermal melanocytic naevus on her back; new lesions continued to appear over the next 20 years. Little is known about the pathogenesis of eruptive lesions developing after excision of a primary tumour. Several hypotheses, such as the influence of mechanical forces, abnormalities in the vascular system and the existence of a circulating stimulatory factor, have been suggested.
Intraoperative High-Density Global Mapping in Adult-Repaired Tetralogy of Fallot
Authors: Kumaraswamy Nanthakumar, Stéphane Massé, Kwaku Poku, Candice K. Silversides, Vijay S. Chauhan, Justin A. Mariani, Gopal Sivagangabalan, Erwin N. Oechslin, Eugene Downar, Louise Harris
Journal: Journal of the American College of Cardiology (2010)
Mental Health Service Use Among Adult Cancer Survivors: Analyses of the National Health Interview Survey
Authors: Maria Hewitt, Julia H. Rowland
Journal: Journal of Clinical Oncology (2002)

PURPOSE: Analyses were conducted to obtain national estimates of mental health service use, unmet need for such services, and the prevalence of mental health problems among individuals reporting a cancer history. METHODS: Of a nationally representative sample of 95,615 adults in the United States interviewed as part of the 1998, 1999, and 2000 National Health Interview Survey, 4,878 reported a history of cancer (excluding superficial skin cancer). Analyses assessed whether cancer survivors relative to those without a self-reported history of cancer had increased use of mental health services and had increased reports of unmet need for such services. Analyses were also conducted to ascertain demographic and health characteristics associated with service use and unmet need. RESULTS: Compared with individuals without a cancer history, cancer survivors reported significantly greater contact in the past year with a mental health provider (7.2% v 5.7%). Cancer survivors were more likely to have used mental health services (odds ratio, 1.60 among those without other chronic illnesses and 3.04 among those with other chronic illnesses), and mental health service use was significantly greater among those who were under age 65 and diagnosed at younger ages, were formerly married, or had other comorbid chronic conditions. If all cancer survivors with mental health problems or who needed but could not access mental health services due to cost had received such care, mental health service use would have increased from 7.2% to 11.7%, a 62% increase in use. CONCLUSION: Cancer seems to be one of several chronic illnesses that precipitates the need for and use of mental health services. Improvements are needed in recognizing mental health problems among cancer survivors and reducing barriers to psychosocial service use.
Proceedings of the Fifth International Congress on Nephrology, vol 1: Morphology and Pathology, vol 2: Physiology, vol 3: Clinic
Authors: Leonard B. Berman
Journal: JAMA (1974)

Proceedings of international congresses can only be announced rather than reviewed. Nephrologists hold theirs every three years, and these volumes are from the proceedings in Mexico City in 1972. The proceedings furnish the reader with a series of brief and interesting papers arranged in three volumes. Taken together, the volumes provide a convenient and rapid overview of current nephrological interests. The first (<i>Morphology and Pathology</i>) deals mainly with glomerular diseases and it is clear that the 20th century French have inherited the 19th century German passion for nosology as a thing of beauty. Volume two (<i>Physiology</i>) reviews sodium transport, including the related problems of energy needs. Volume three (<i>Clinic</i>) deals with various aspects of proteinuria, uremia, hypertension, and therapeutics. The Australians have an unquenchable enthusiasm for heparin, but there is some difficulty in transporting their good results safely across the ocean. Finally, I am once again puzzled by the absence