tbuckley/cabot-search huggingface dataset:
PTU-118 A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment
Authors: M R S Siddiqui, H Ashrafian, P Tozer, N Daulatzai, D Burling, A Hart, T Athanasiou, R K Phillips
Journal: Gut (2012)

<h3>Introduction</h3> Imaging modalities such as endoanal ultrasound or MRI can be useful preoperative adjuncts prior to the appropriate surgical intervention for perianal fistulas. We present a systematic review of published literature comparing endoanal ultrasound with MRI for the assessment of idiopathic and Crohn9s perianal fistulas. <h3>Methods</h3> A meta-analysis was performed to obtain pooled values for specificity and sensitivity. Electronic databases were searched from January 1970 to October 2010 for published studies. <h3>Results</h3> Four studies were used in our analysis. There were 241 fistulas in the ultrasound group and 240 in the magnetic resonance group. The combined sensitivity and specificity of magnetic resonance for fistula detection were 0.87 (95% CI 0.63 to 0.96) and 0.69 (95% CI 0.51 to 0.82). There was a high degree of heterogeneity between studies reporting on MRI sensitivity (df=3, I<sup>2</sup>=93%). This compares to a sensitivity and specificity for endoanal ultrasound of 0.87 (95% CI 0.70 to 0.95) and 0.43 (95% CI 0.21 to 0.69) respectively. There was a high degree of heterogeneity between studies reporting on EAUS sensitivity (df=3, I<sup>2</sup>=92%). <h3>Conclusion</h3> From the available literature, the summarised performance characteristics for MRI and EAUS demonstrate comparable sensitivities at detecting perianal fistulas, although the specificity for MRI was higher than that for EAUS. Both specificity values are however considered to be diagnostically poor. The high degree of data heterogeneity and the shortage of applicable studies precludes any firm conclusions being made for clinical practice. Future trials with improved study design (including prospective data collection and consideration of verification bias) may help to further clarify the role of MRI in the assessment and treatment response monitoring of perianal fistulas (particularly in patients with Crohn9s disease). <h3>Competing interests</h3> None declared.
Australian doctors report high rates of job satisfaction
Authors: M. Sweet
Journal: BMJ (2011)

More than 80% of Australian doctors are moderately or very satisfied with their jobs, a national survey has found.

Doctors who had a good support network, whose household had a high income, and who believed that their patients had realistic expectations were most likely to report high satisfaction.

Other factors associated with professional satisfaction were being able to take time off, being younger or close to retirement, and having good self reported health.

However, the researchers noted that “the direction of causality in these relationships is unknown.”

The survey findings, published in the 3 January edition of the Medical Journal of Australia (2011;194:30-3, www.mja.com.au/public/issues/194\_01\_030111/joy11511_fm.html), come from an ongoing longitudinal study by researchers from Melbourne and Monash Universities that is investigating …
Do You Believe in Miracles?
Authors: Joseph E. Hardison
Journal: JAMA (1983)

I want to tell you a story. A story I believe and hope you will too. It's a story about a young man, a poor family, and a giant, wild turkey. First, I will tell you about the young man as an old man. His name is Mr Bogar and he is 83 years old. He discovered the central scotoma in his right eye when sighting his rifle at a snake about to make a meal of his precious Purple Martin chicks. When he closed his left eye, the snake, climbing the pole to the Purple Martin house, disappeared. He shifted the rifle to his left shoulder, aimed with his left eye, and shot the snake just in time. The ophthalmologist confirmed the scotoma in the right eye, which was caused by a degenerative retinal disease.  In 1925, Mr Bogar was 25 years old, living with his wife on a
"HERMAN RUBIN AND CITROPHAN"
Authors: Albert S. Hyman
Journal: JAMA (1924)

To the Editor:  —After reading your splendid article exposing the alleged claims for the fat-reducing proprietary Citrophan (The Journal, March 1. p. 734), there are a few additional comments I should like to make, as the name of the Beth David Hospital has been used by Dr. Herman H. Rubin in his advertising literature.  The statement to the effect that Dr. Rubin is or was the chief medical clinician to the Beth David Hospital is, of course, absolutely untrue. The records of the institution show that the only connection which Dr. Rubin has ever had with the Beth David Hospital was during the latter part of 1920, at which time he held a very minor part as one of the assistants in the first medical clinic of the dispensary. The records further show that Dr. Rubin was asked to resign by the Dispensary Committee for two reasons: (1) conduct unbecoming
THE RENAL LESION OF EXPERIMENTAL CANTHARIDIN POISONING
Authors: Richard M. Pearce
Journal: The Journal of Experimental Medicine (1913)

Although the study of experimental nephritis by physiological methods shows that the most striking effect of cantharidin is injury of the blood vessels, the great abundance of mitotic figures in the tubular epithelium in the stage of repair points to an equally widespread and severe epithelial injury. Caution must therefore be observed in ascribing the physiological disturbances of kidney function caused by cantharidin as due exclusively to a vascular injury, and in regarding cantharidin nephritis as a pure type of vascular nephritis.
Splenectomy Done during Hematologic Remission To Prevent Relapse in Patients with Thrombotic Thrombocytopenic Purpura
Authors: Mark A. Crowther
Journal: Annals of Internal Medicine (1996)

To assess whether splenectomy done during hematologic remission reduces the relapse rate in patients with relapsing thrombotic thrombocytopenic purpura.Consecutive case series.Tertiary care teaching hospital.6 consecutive patients seen during a 10-year period who had had one or more relapses of thrombotic thrombocytopenic purpura.All patients had elective splenectomy while in hematologic remission and were followed after surgery for as long as 8.0 years.Attack rates (events per year) were calculated for each patient from time of presentation to time of splenectomy and from time of splenectomy to January 1996.A total of 26 episodes of thrombotic thrombocytopenic purpura occurred over 22.3 patient-years before splenectomy. After splenectomy, 3 acute episodes occurred over 22.7 patient-years. The attack rate (+/-1 SD) decreased from 2.3 +/- 2.0 events per year to 0.1 +/- 0.1 events per year.In patients who have had one or more relapses of thrombotic thrombocytopenic purpura, splenectomy done during hematologic remission reduces the frequency of acute relapse and the resulting need for medical therapy.
Only 30% of Americans with HIV have virus in check, finds report
Authors: M. McCarthy
Journal: BMJ (2014)

Only three in 10 Americans with HIV have their virus under control, says a report released by the US Centers for Disease Control and Prevention (CDC) on 25 November.1

Achieving low viral concentrations is a key goal in the fight against HIV, because not only do people infected with HIV who achieve very low levels of the virus have a near normal life expectancy, they also have a very low risk of transmitting the virus to others.

The new study says, however, that of the 1.2 million Americans estimated to …
Genetic Variants of von Willebrand's Disease
Authors: L. Holmberg, I. M. Nilsson
Journal: BMJ (1972)

A specific antiserum against an antihaemophilic factor (AHF)-related plasma protein was raised in rabbits. A quantitative immunochemical method was used to determine the amount of this protein present in the plasma of 33 patients with haemophilia A and 70 patients with von Willebrand9s disease. The protein probably consisted of AHF residing in or complexed with the von Willebrand factor. The patients with von Willebrand9s disease were shown to fall into two separate genetic groups, one with decreased and one with normal amounts of the AHF-related protein. The patients with haemophilia A had normal amounts of the protein in their plasma.
Atrx deficiency induces telomere dysfunction, endocrine defects, and reduced life span
Authors: L. Ashley Watson, Lauren A. Solomon, Jennifer Ruizhe Li, Yan Jiang, Matthew Edwards, Kazuo Shin-ya, Frank Beier, Nathalie G. Bérubé
Journal: Journal of Clinical Investigation (2013)

Human ATRX mutations are associated with cognitive deficits, developmental abnormalities, and cancer. We show that the Atrx-null embryonic mouse brain accumulates replicative damage at telomeres and pericentromeric heterochromatin, which is exacerbated by loss of p53 and linked to ATM activation. ATRX-deficient neuroprogenitors exhibited higher incidence of telomere fusions and increased sensitivity to replication stress–inducing drugs. Treatment of Atrx-null neuroprogenitors with the G-quadruplex (G4) ligand telomestatin increased DNA damage, indicating that ATRX likely aids in the replication of telomeric G4-DNA structures. Unexpectedly, mutant mice displayed reduced growth, shortened life span, lordokyphosis, cataracts, heart enlargement, and hypoglycemia, as well as reduction of mineral bone density, trabecular bone content, and subcutaneous fat. We show that a subset of these defects can be attributed to loss of ATRX in the embryonic anterior pituitary that resulted in low circulating levels of thyroxine and IGF-1. Our findings suggest that loss of ATRX increases DNA damage locally in the forebrain and anterior pituitary and causes tissue attrition and other systemic defects similar to those seen in aging.
A genome-wide association study of plasma total IgE concentrations in the Framingham Heart Study
Authors: Mark Granada, Jemma B. Wilk, Marina Tuzova, David P. Strachan, Stephan Weidinger, Eva Albrecht, Christian Gieger, Joachim Heinrich, Blanca E. Himes, Gary M. Hunninghake, Juan C. Celedón, Scott T. Weiss, William W. Cruikshank, Lindsay A. Farrer, David M. Center, George T. O'Connor
Journal: Journal of Allergy and Clinical Immunology (2011)
THE EFFECT OF CHEMICAL CARCINOGENS ON VIRUS-INDUCED RABBIT PAPILLOMAS
Authors: Peyton Rous, William F. Friedewald
Journal: The Journal of Experimental Medicine (1944)

The application of methylcholanthrene and tar to virus-induced papillomas of the domestic rabbit caused them to become carcinomatous with great rapidity, and the malignant changes were frequently multiple. In bringing on the cancers the chemical agents acted in their specific capacity as carcinogens, not as ordinary stimulants of cell proliferation. The cancers derived from the virus-infected cells and were of the same types as arise from these elements spontaneously after a much longer time. The evidence would seem to indicate that the chemical carcinogens acted by way of the virus.
Postexertional hypotension: a valuable physical sign.
Authors: B I Hoffbrand
Journal: BMJ (1982)

Case 2-A 56-year-old man suffered severe unstable angina three months after an inferior myocardial infarction.Treatment with propranolol 160 mg/day and isocardide dinitrate 60 mg/day was ineffective, and nifedipine 40 mg/day was added to the regimen.Three days later severe muscle cramps occurred in both legs and hands.The pain occurred only at night, the patient being asymptomatic during the day.The drug was discontinued and the cramps resolved.After a week the drug was readministered and the pain reappeared within 24 hours.The drug was again discontinued and the patient referred for surgery.Case 3-A 73-year-old man with severe ischaemic heart disease and old myocardial infarction was referred to the outpatient clinic with severe stable angina.Treatment with isocardide dinitrate 80 mg/day and propranolol
Obstetric and Gynecologic Milestones IIIustrated
Authors: Bernard A. Eskin
Journal: JAMA (1997)

Here is the opportunity to understand why we associate a person with a medical event, syndrome, procedure, or anatomic part. After all our complaining about the abuse of eponyms, those awkward expressions finally become meaningful, at least for reproductive medicine.<i>Obstetric and Gynecologic Milestones Illustrated</i>is an encyclopedic tome that contains the biographies of the best-known practitioners and paragons of reproductive science who left their names for posterity. Many of their advances are now obsolete and familiar only to the history-oriented among us. However, there is vitality to these stories, which reverberate from the halls of medical colleges worldwide— including Harvard, Johns Hopkins, and Albany, where Sampson persisted in studying the endometrial cells flying through the fallopian tubes and resting on the surrounding pelvic peritoneum as an ipso facto cause of the still unknown endometriosis. Anatomical discoveries were responsible for cataloging tissue and providing landmarks for the gynecologic surgeon. Such
Catheter ablation of the atrioventricular junction with radiofrequency energy.
Authors: J J Langberg, M C Chin, M Rosenqvist, J Cockrell, N Dullet, G Van Hare, J C Griffin, M M Scheinman
Journal: Circulation (1989)

Catheter ablation of the atrioventricular junction using direct-current defibrillator discharges requires general anesthesia and may have serious side effects. Sixteen patients with drug-refractory supraventricular tachycardia underwent catheter ablation of the atrioventricular junction using radiofrequency energy. A standard 7F quadripolar electrode catheter was positioned to record the largest unipolar His potential (580 +/- 640 microV) from the distal electrode. An electrocoagulator (Microvasive Bicap 4005) supplied continuous, unmodulated energy at 550 kHz. One to 14 applications of radiofrequency current were delivered between the distal electrode and a large-diameter chest wall electrode. Transient, mild chest discomfort was reported by seven of 16 patients. None had significant arrhythmias or blood pressure changes during radiofrequency ablation. Complete atrioventricular block was produced in nine of 16 patients and high-grade second-degree atrioventricular block was produced in one patient with radiofrequency current. Attenuated His bundle electrograms could still be recorded in the remaining six patients, four of whom underwent successful atrioventricular junctional ablation using direct-current shock during the same session. Atrioventricular block persisted in all 10 patients successfully treated with radiofrequency ablation during a mean follow-up of 4.2 months. Compared with a group of historic control subjects treated with direct-current shock ablation, the 10 patients successfully treated with radiofrequency current had significantly less creatine kinase-MB isoenzyme release (5.7 +/- 5.1 vs. 22 +/- 13 IU, p = 0.006). A junctional escape rhythm was present in all patients after radiofrequency-induced atrioventricular block. In contrast, three of 10 control patients had an idioventricular escape after direct current shock ablation, and four patients had no escape rhythm at all.(ABSTRACT TRUNCATED AT 250 WORDS)
In vivo real-time endocytoscopic visualization of blood flow in rectal microvasculature
Authors: B. Yan, J. Van Dam
Journal: Endoscopy (2008)

Endocytoscopy (ECS) is a new technology that enables endoscopists to visualize gastrointestinal mucosa at the cellular level. This reported case demonstrates the ability to visualize real-time blood flow utilizing ECS. Methylene blue dye was sprayed onto normal rectal mucosa during a routine screening colonoscopy of an asymptomatic patient. High-magnification views of colonic mucosa revealed normal mucosal cellular structure and microvasculature with normal flow of red blood cells. Individual red blood cells were seen circulating through the arterioles. Epithelial colonocytes appeared to be organized in a hexagonal pattern around crypts with borders demarcated by microvasculature. ECS can provide high-magnification views of the gastrointestinal mucosa including microvasculature in real time. This establishes possibilities for future in vivo research in areas such as cancer biology, angiogenesis, and inflammatory bowel disease.
Efficacy of Sequential Double Tracer Subtraction and SPECT Parathyroid Imaging in the Precise Localization of a Low Mediastinal Parathyroid Adenoma Successfully Removed Surgically
Authors: Domenico Rubello, Costantino Pagetta, Andrea Piotto, Dario Casara, Gian Carlo Zonzin, Pier Carlo Muzzio, Maria Rosa Pelizzo
Journal: Clinical Nuclear Medicine (2004)

The case of a 58-year-old female patient with primary hyperparathyroidism (serum calcium levels = 12.3 mg/dL, serum PTH levels = 254 pg/mL) resulting from a rare case of solitary parathyroid adenoma located in the low mediastinum is described. The sequential acquisition of planar Tc-99m pertechnetate-MIBI subtraction scan and SPECT imaging precisely localized an intrathymic parathyroid adenoma located in the lower portion of the mediastinum anteriorly close to the body of the sternum. High-resolution 10-MHz neck ultrasonography and neck–mediastinum spiral computed tomography scan did not reveal parathyroid enlargement. A 14-mm sized intrathymic parathyroid adenoma was successfully removed through a 4-cm median cervicotomy by pulling up and excising the thymus. Thus, in this patient, the accurate preoperative scintigraphic localization of the parathyroid adenoma allowed the surgeon to avoid a sternotomy as is usually required in these cases. Intraoperative, rapid PTH levels fell to the normal range and serum calcium levels remained in the normal range in the subsequent 15-month follow up.
Thwarting thrombogenesis on artificial surfaces
Authors: Phil Gunby
Journal: JAMA (1982)

The usefulness of heart-lung machines, synthetic vascular grafts, and other cardiovascular replacement or support devices is undisputed, but they share a common disadvantage: Thrombi may form on the artificial surfaces, interfering with the device itself or eventually lodging in one of the patient's organs. The problems begin, says Edwin W. Salzman, MD, professor of surgery at Harvard Medical School and Beth Israel Hospital, Boston, when "certain proteins carried in the plasma—fibrinogen is one of the most important—are selectively deposited on a surface in a thin coat. "It is this thin film of protein," he told a recent American Heart Association seminar, "not the surface of the artificial material, that influences other blood proteins and platelets to find the surface attractive or unattractive and thus thrombogenic or thromboresistant." There are two possible ways to cope with this, and Salzman's group is studying both. One is to develop artificial surfaces that are
Impaired Coronary Microvascular Functions in Patients With Behçet Disease
Authors: Hakan Gullu, Mustafa Caliskan, Dogan Erdogan, Sema Yilmaz, Recep Dursun, Ozgur Ciftci, Eftal Yucel, Haldun Muderrisoglu
Journal: Journal of the American College of Cardiology (2006)
Basal cell carcinoma: are early appointments justifiable?
Authors: P.M. Gordon, N.H. Cox, W.D. Paterson, C.M. Lawrence
Journal: British Journal of Dermatology (2000)

In the U.K., patients with suspected skin tumours are usually referred from a general practitioner to a hospital-based dermatologist for treatment. The urgency of such referrals is currently a topic of political importance. We have studied case record data from 162 patients with basal cell carcinoma (BCC) to establish the relevance of referrals routinely being considered urgent. At presentation, mean tumour size (maximum dimension) was 7. 4 mm (median 10) and mean duration of BCC was 20.5 months (median 12). There was no correlation (all P > 0.05) between tumour size and patient age (r = 0.1325), tumour size and duration (r = 0.4433), or tumour size and interval between referral and hospital consultation (r = 0.0695). If the slow growth rate of the average BCC is assumed to be linear, a reduction in referral interval from the mean value of 10.7 weeks in our patients down to the U.K. government target of 2 weeks would equate to a size difference in BCC of 0.7 mm, which is not therapeutically significant. Individual BCCs with rapid growth or other features of concern may require urgent referral, but evidence from our patients and from other studies is that this is not routinely necessary.
Randomized Study Comparing Radiofrequency Ablation With Cryoablation for the Treatment of Atrial Flutter With Emphasis on Pain Perception
Authors: Carl Timmermans, Gregory M. Ayers, Harry J.G.M. Crijns, Luz-Maria Rodriguez
Journal: Circulation (2003)

Radiofrequency ablation (RF) of atrial flutter (AFL) has a high procedural efficacy, a low recurrence rate, and reports of procedure-related pain. The aim of the present study was to compare RF with cryoablation (cryo) for the treatment of AFL, with emphasis on pain perception during application of energy.Fourteen patients (55+/-11 years, 11 males) with AFL were randomized to receive ablation of the cavotricuspid isthmus (CTI) by either RF or cryo. Cryothermia was delivered with the CryoCor Cryoablation System (10F, 6-mm tip), and radiofrequency energy was delivered with the use of an 8-mm-tip catheter. Pain was evaluated according to a visual analogue scale (VAS; 0 to 100). All patients in the cryo group were successfully ablated with a mean of 18 applications (9 sites), and RF was successful in 6 of 7 patients (not significant) with 13 applications (not significant). The mean temperature was -82 degrees C and 55 degrees C for cryo and RF, respectively. One patient in the cryo group perceived pain, versus all 7 patients in the RF group (P<0.05). The proportion of painful applications averaged 75.3% in the RF group and 2.0% in the cryo group (P<0.05), whereas the corresponding VAS for pain was 38.3+/-25.3 and 0.32+/-0.86, respectively (P<0.05). At 6-month follow-up, there were no recurrences of atrial flutter.Cryo, as compared with RF, produces significantly less pain during application. Although in the present study there was no significant difference in efficacy, larger studies will be needed to definitively compare efficacy.
Racial Differences in Hemodynamic Responses to Environmental Thermal Stress Among Adolescents
Authors: Robert M. Kelsey, Bruce S. Alpert, Stephen M. Patterson, Marie Barnard
Journal: Circulation (2000)

Background —Previous studies by our laboratory and others have shown that blood pressure (BP) responses to many short-term laboratory stressors are greater in black than in white children. We sought to determine the cardiac and vascular contributions to these differences in BP reactivity and whether racial differences in vascular reactivity involve excessive vasoconstriction or deficient vasodilation. Methods and Results —We evaluated BP, heart rate, and impedance cardiographic measures of preejection period (PEP) and total peripheral resistance (TPR) in healthy black (n=76) and white (n=60) adolescents (mean age, 14.8 years) during passive exposure to a vasoconstrictive cold chamber (8°C to 10°C) and a vasodilatory heat chamber (40°C to 42°C). Results indicated greater decreases in PEP and increases in TPR in blacks than whites during cold exposure ( P &lt;0.05) but no group differences during heat exposure. Covariance analyses indicated that the racial differences during cold exposure probably reflected greater β-adrenergic cardiac reactivity and α-adrenergic vasoconstrictive reactivity in blacks than whites. Conclusions —Blacks and whites exhibited comparable myocardial and vasodilatory responses to heat stress, but blacks exhibited heightened myocardial and vasoconstrictive reactivity to cold stress. These results suggest that the locus of racial differences in vascular reactivity involves vasoconstrictive rather than vasodilatory function. The pattern of racial differences during cold stress raises the possibility that both myocardial and vasoconstrictive mechanisms may contribute to the increased risk of hypertension in blacks.