tbuckley/cabot-search huggingface dataset:
Tuberculous Meningitis After Intrathecally Administered Methylprednisolone Acetate
Authors: Melville Roberts
Journal: JAMA (1967)

THE INTRATHECAL USE of methylprednisolone acetate in the treatment of sciatica and arachnitis was introduced in 1961 by Gardner and associates.<sup>1</sup>In reporting 3 1/2 years of experience with the intrathecal use of methylprednisolone acetate, Sehgal and Gardner<sup>2</sup>noted the complete absence of serious complications. More recently, Shealy<sup>3</sup>described the case of a patient with sciatic pain, treated with methylprednisolone acetate given intrathecally, in whom<i>Cryptococcus neoformans</i>meningitis later developed. He emphasized the need for careful evaluation of patients before the intrathecal use of drugs. During the past 14 months, 53 patients on the neurosurgical service have been treated with methylprednisolone acetate given intrathecally for low back and lower-extremity pain after myelography. Tuberculous meningitis subsequently developed in one of the patients. The relationship between the use of systemic steroids and the development and dissemination of pulmonary tuberculosis has been known for some time. The appearance of tuberculous
Phenobarbital regulates nuclear expression of HNF-4α in mouse and rat hepatocytes independent of CAR and PXR
Authors: Aaron W. Bell, George K. Michalopoulos
Journal: Hepatology (2006)

Phenobarbital is a lipophilic molecule used as a sedative and antiepileptic drug that elicits a multitude of effects in the liver, including gross liver enlargement, hepatocyte hypertrophy, and induced expression of drug-metabolizing enzymes and other liver-specific genes. The constitutive androstane receptor (CAR; NR1I3) and to a lesser extent the pregnane X receptor (PXR; NR1I2) are responsible for mediating induction of many phenobarbital-responsive genes. However, CAR-mediated transcriptional control of some genes is critically dependent on hepatocyte nuclear factor 4 alpha (HNF-4α; NR2A1), which itself regulates multiple liver-specific genes involved in hepatic growth, metabolism, and differentiation. We studied the effects of phenobarbital on HNF-4α expression in hepatocytes and provide evidence that HNF-4α nuclear expression is regulated in response to phenobarbital. Real-time polymerase chain reaction analyses revealed that HNF-4α mRNA is modestly up-regulated by phenobarbital. In addition, nuclear expression of HNF-4α protein is significantly elevated 3 hours after the administration of phenobarbital in wild-type, CAR−/−, and CAR−/−/PXR−/− mice. In vitro analysis revealed that phenobarbital-induced HNF-4α expression is both time- and dose dependent. In addition, the phosphatase inhibitor okadaic acid and the Ca2+/calmodulin-dependent protein kinase II inhibitor KN62 block nuclear induction of HNF-4α by phenobarbital. Furthermore, HNF-4α nuclear expression is enhanced by inhibition of cyclic AMP–dependent protein kinase A. In conclusion, induced nuclear expression of HNF-4α and CAR is an integral part of the phenobarbital response, aimed at coordinated regulation of genes involved in drug metabolism and detoxification as well as maintenance of liver function. (HEPATOLOGY 2006;44:186–194.)
A plea for broader perspectives on health
Authors: F. Godlee
Journal: BMJ (2008)

Many factors influence health and are influenced by it. What does this mean for how we decide which interventions to invest in? In an editorial this week (doi:10.1136/bmj.a1204), Michael Drummond and colleagues say we must do what the textbooks tell us: consider all costs and benefits, no matter whether it’s the health service or other sectors that pick up the bill.

The National Institute for Health and Clinical Excellence gives “mixed messages” on this at the moment, says the editorial. When it appraises drugs and procedures, NICE takes the narrow health service view. When it appraises public health interventions it …
Basal, sham feed and pentagastrin stimulated gastric acid, pepsin and electrolytes after omeprazole 20 mg and 40 mg daily.
Authors: J N Thompson, J A Barr, N Collier, J Spencer, A Bush, L Cope, R J Gribble, J H Baron
Journal: Gut (1985)

Gastric secretion was measured in nine patients with duodenal ulcer before, and after treatment for four weeks with omeprazole 20 mg or 40 mg daily. Basal acidity and acid output were affected variably by 20 mg, but inhibited totally by 40 mg daily. Sham feed stimulated acid output was reduced by 20 mg daily and completely inhibited by 40 mg daily. Maximal pentagastrin stimulated acid output was halved by 20 mg omeprazole daily and 84% inhibited by 40 mg daily. The reduction in acidity was always greater than the reduction of volume. Pepsin output after pentagastrin was little altered but with the reduced secretory volume pepsin concentrations were increased by both doses. The major cause of reduced aspirate acid output after omeprazole is decreased secretion of the primary acid component of the parietal cell by the proton pump H+K+ ATPase. Duodenogastric alkaline reflux is, however, markedly increased after omeprazole and is an additional factor in the resultant hypoacidity or even anacidity after this drug.
Asymptomatic Enlargement of the Parotid Glands
Authors: L. Katsilambros
Journal: JAMA (1961)

DURING World War II, and precisely from 1941 to 1944, when Greece was under enemy occupation, a painless and feverless enlargement of the parotid glands which lasted for several months was observed in undernourished persons. This enlargement appeared in an epidemic form, particularly during the winter season, and we discovered more than 3,000 cases in a research at schools and factories. This enlargement gradually disappeared from the vast majority of patients with the first hot days in spring. Various investigations were performed in order to elucidate the etiology of this syndrome. It was not a bacterial or virus infection, because fever or blood reactions were not observed. Since the first cases appeared in patients with epidemic louse-borne typhus fever, the rickettsial nature of the syndrome was excluded. Chronic virus parotitis was rejected because most patients already had had the infection, and orchitis as a complication during or after the syndrome
Malignant Peripheral Nerve Sheath Tumor of the Thyroid: A Clinicopathological and Ultrastructural Study of One Case
Authors: Judit Pallares, Luis Perez-Ruiz, Susana Ros, Ma Jose Panades, Javier Pardo-Mindan, Josep Lloreta, Xavier Matias-Guiu
Journal: Endocrine Pathology (2004)
Elevated serum concentrations of IgE antibodies to environmental antigens in HIV-seropositive male homosexuals
Authors: Sally Sample, David N. Chernoff, Gail A. Lenahan, Maria H. Serwonska, Setu Rangi, Jeffrey W. Sherman, Charles D. Sooy, Harry Hollander, Edward J. Goetzl
Journal: Journal of Allergy and Clinical Immunology (1990)
Active oral regimen for elderly adults with newly diagnosed acute myelogenous leukemia: a preclinical and phase 1 trial of the farnesyltransferase inhibitor tipifarnib (R115777, Zarnestra) combined with etoposide
Authors: Judith E. Karp, Karen Flatten, Eric J. Feldman, Jacqueline M. Greer, David A. Loegering, Rebecca M. Ricklis, Lawrence E. Morris, Ellen Ritchie, B. Douglas Smith, Valerie Ironside, Timothy Talbott, Gail Roboz, Son B. Le, Xue Wei Meng, Paula A. Schneider, Nga T. Dai, Alex A. Adjei, Steven D. Gore, Mark J. Levis, John J. Wright, Elizabeth Garrett-Mayer, Scott H. Kaufmann
Journal: Blood (2008)
Involution of Threshold Retinopathy of Prematurity after Diode Laser Photocoagulation: Author reply
Authors: David K. Coats, Aaron M. Miller, Kathryn M. Brady-McCreery, Eric R. Holz, Evelyn A. Paysse
Journal: Ophthalmology (2005)

We appreciate Drs Hartnett and McColm’s interest in our article. We reemphasize a point that we made in the article and a point with which Drs Hartnett and McColm seem to concur. There is a need to develop better guidelines regarding when to intervene surgically for eyes that are at risk for progressive stage 4 retinopathy of prematurity. We do not feel that the present treatment paradigm for retinopathy of prematurity will stand the test of time. Eventually, we believe that nonsurgical treatments will become available to prevent or treat retinopathy of prematurity. Until then, it is our opinion that there will be a trend away from extensive ablative treatment of eyes with intermediate risk of progression in favor of ablative therapy only for those eyes at highest risk, combined with strategies designed to intervene surgically for eyes at highest risk for developing a progressive retinal detachment (RD) after ablative treatment. Such a strategy, if successful, would maximize the number of eyes salvaged, while minimizing the number of eyes treated. Identification of eyes at highest risk of developing an RD and after treatment with careful evaluation of novel strategies to target specifically this group of high-risk eyes for additional intervention, we believe, is of utmost importance. We agree with Drs Hartnett and McColm’s comments that plus disease can recur. We have seen this periodically, even in eyes where the neovascularization initially completely resolved, only to recur again later. This has usually, but not always, been seen in association with skip areas in the ablative pattern. Regarding risk factors predictive of progressive RD, a subsequent publication from our group will address this issue in the near future. Diode Laser for ROPOphthalmologyVol. 112Issue 9PreviewWe read with interest Coats et al’s article on involution of threshold retinopathy of prematurity (ROP) after diode laser photocoagulation.1 We agree that there is a need for guidelines as to when to intervene surgically for eyes that are at risk for progressive stage 4 ROP. We addressed this issue earlier this year.2 Full-Text PDF
Vitamin D analogues and psoriasis
Authors: J. BERTH-JONES, P.E. HUTCHINSON
Journal: British Journal of Dermatology (1992)

Topical vitamin D analogues offer a new, effective, more convenient and generally well-tolerated option for the treatment of psoriasis. Only psoriasis vulgaris has been intensively studied, but other forms of the disease may also respond. Both calcitriol and calcipotriol have been shown to be effective in numerous clinical trials, and the latter has compared well with betamethasone valerate and short-contact dithranol in controlled studies. Their mechanism of action is not yet fully understood and may prove complex. The most important effect may be a direct regulation of keratinocyte proliferation and differentiation. However, these compounds also have potent immunological properties, and may act by inhibition of cytokine production by keratinocytes or lymphocytes. Topical application of vitamin D analogues appears generally to be remarkably safe, but hypercalcaemia and hypercalciuria may develop if large quantities are used.
Variation in number of women being recalled after breast cancer screening needs to be looked into
Authors: Roger Dobson
Journal: BMJ (2008)

The percentage of positive results from breast cancer screening has risen in the United Kingdom, but almost a quarter of screening centres are recalling more than one in 10 women for further assessment, often because the initial results were unclear.

Researchers from the Institute of Cancer Research say that variation among individual screening units, especially in the number of women being recalled, should be investigated, as the extra workload for units that recall a high proportion of women will add to other pressures facing the programme.

Pressure of work means that many centres are failing to meet the target of 90% of women being …
Failure of superoxide dismutase to limit size of myocardial infarction after 40 minutes of ischemia and 4 days of reperfusion in dogs.
Authors: A Uraizee, K A Reimer, C E Murry, R B Jennings
Journal: Circulation (1987)

Reactive oxygen species such as the superoxide anion (.O2-) have recently been implicated as important agents involved in causing cell death in the setting of myocardial ischemia and reperfusion. When superoxide anion is involved in ischemic injury the administration of superoxide dismutase (SOD) may limit infarct size by reducing the level of superoxide anions in the myocardium. The study described herein was done to determine whether SOD could limit myocardial infarct size when infarcts were produced in dogs by a 40 min occlusion of the circumflex coronary artery followed by 4 days of reperfusion. The animals in the SOD treatment group received a 1 hr intra-atrial infusion of SOD, at a rate of 250 U/kg/min starting 15 min after occlusion and ending 35 min after reperfusion; control dogs received a saline infusion over the same time frame. Infarct size was determined histologically and expressed as a percentage of the anatomic area at risk (AAR). Infarct size was similar in the two groups, averaging 26.2 +/- 2.5% in the control group (n = 10) and 21.1 +/- 4.8% in the SOD group (n = 11) (p = .40). Hemodynamic variables were not statistically different in the two groups during the occlusion. The transmural mean collateral blood flow at 10 min into the 40 min occlusion was 0.13 +/- 0.02 ml/min/g in the controls and 0.17 +/- 0.03 ml/min/g in the SOD group (p = NS); moreover, SOD did not alter collateral blood flow. In control dogs, infarct size was inversely related to collateral blood flow; analysis of covariance showed that SOD did not shift this relationship. Thus, SOD did not limit infarct size in this study. The results of the current study are consistent with our previous study in which allopurinol, a xanthine oxidase inhibitor, did not limit infarct size in this same experimental preparation. The results suggest that superoxide anions that are accessible to the infused SOD are not a major cause of myocyte death caused by 40 min of severe ischemia followed by reperfusion.
Normale und Pathologische Anatomie der Haut I
Authors: Thomas P. Kugelman
Journal: JAMA (1969)

This latest addition to the monumental new Jadassohn<i>Handbuch</i>again rates the highest accolades. Readers loath to do battle with the German language will rejoice at finding a third of this book written in English. Unfortunately, English is not a happy alternative for all the non-German authors—the chapter on blood vessels written by G. Moretti, an Italian, is barely intelligible. The histology and histochemistry of normal skin, organized by functional anatomic units, are followed by interesting and useful chapters on comparative histology, embryology, aging, and postmortem changes. The two concluding sections on the general pathology of subcutaneous fat and "deposit" diseases seem out of place and should have been included in the succeeding volume—in which are two misplaced chapters on anatomy. Most of the contributors are acknowledged authorities; familiar names include Strauss and Pochi on the sebaceous gland, Ellis on the eccrine gland, Pinkus on embryology, and Brody on the
Decision Making in Advanced Heart Failure
Authors: Larry A. Allen, Lynne W. Stevenson, Kathleen L. Grady, Nathan E. Goldstein, Daniel D. Matlock, Robert M. Arnold, Nancy R. Cook, G. Michael Felker, Gary S. Francis, Paul J. Hauptman, Edward P. Havranek, Harlan M. Krumholz, Donna Mancini, Barbara Riegel, John A. Spertus
Journal: Circulation (2012)

S hared decision making for advanced heart failure has become both more challenging and more crucial as duration of disease and treatment options have increased.High-quality decisions are chosen from medically reasonable options and are aligned with values, goals, and preferences of an informed patient.The top 10 things to know about decision making in advanced heart failure care are listed in Table 1. Why Shared Decision Making?Providers have an ethical and legal mandate to involve patients in medical decisions.Shared decision making recognizes that there are complex trade-offs in the choice of medical care. 1 Shared decision making also addresses the ethical need to fully inform patients about the risks and benefits of treatments. 2 In the setting of multiple reasonable options for medical care, shared decision making involves clinicians working with patients to ensure that patients' values, goals, and preferences guide informed decisions that are right for each individual patient.Grounded in the ethical principle of autonomy, 3 judicial decisions (eg, Cruzan v Missouri Department of Health 4 ) and legislative actions (eg, the Patient Self-Determination Act 5 ) have repeatedly affirmed the rights of patients or duly appointed surrogates to choose their medical therapy from among reasonable options. 6The formal process of informed consent before procedural interventions is an embodiment of this concept in that it underscores the clinician's obligation to ensure that the patient has the opportunity to be informed. 3An informed patient is one who is aware of the diagnosis and prognosis, the nature of the proposed intervention, the risks and benefits of that intervention, and all reasonable alternatives and their associated risks and benefits. 7A major purpose of a high-functioning healthcare system is to provide the resources with which an activated, informed patient can engage in productive discussions with a proactive, prepared healthcare team. 8hared decision making moves beyond informed consent.It asks that clinicians and patients share information with each other and work toward patient-centered decisions aboutThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel.Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.
Incentives in Health
Authors: George Loewenstein, Kevin G. Volpp, David A. Asch
Journal: JAMA (2012)

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Reforming the Core Clerkship in Internal Medicine: The SGIM/CDIM Project
Authors: Allan H. Goroll, Gail Morrison, Eric B. Bass, Robert Jablonover, Dionne Blackman, Roger Platt, Alison Whelan, Francine P. Hekelman
Journal: Annals of Internal Medicine (2001)

Dramatic changes in health care have stimulated reform of undergraduate medical education. In an effort to improve the teaching of generalist competencies and encourage learning in the outpatient setting, the Society of General Internal Medicine joined with the Clerkship Directors in Internal Medicine in a federally sponsored initiative to develop a new curriculum for the internal medicine core clerkship. Using a broad-based advisory committee and working closely with key stakeholders (especially clerkship directors), the project collaborators helped forge a new national consensus on the learning agenda for the clerkship (a prioritized set of basic generalist competencies) and on the proportion of time that should be devoted to outpatient care (at least one third of the clerkship). From this consensus emerged a new curricular model that served as the basis for production of a curriculum guide and faculty resource package. The guide features the prioritized set of basic generalist competencies and specifies the requisite knowledge, skills, and attitudes/values needed to master them, as well as a list of suggested training problems. It also includes recommended training experiences, schedules, and approaches to faculty development, precepting, and student evaluation. Demand for the guide has been strong and led to production of a second edition, which includes additional materials, an electronic version, and a pocket guide for students and faculty. A follow-up survey of clerkship directors administered soon after completion of the first edition revealed widespread use of the curricular guide but also important barriers to full implementation of the new curriculum. Although this collaborative effort appears to have initiated clerkship reform, long-term success will require an enhanced educational infrastructure to support teaching in the outpatient setting.
Consequences of Ongoing Civil Conflict in Somalia: Evidence for Public Health Responses
Authors: Debarati Guha-Sapir, Ruwan Ratnayake
Journal: PLoS Medicine (2009)

Debarati Guha-Sapir and Ruwan Ratnayake use field data to demonstrate the severe vulnerability faced by much of the Somalian population due to ongoing conflict, and call for concerted public health interventions and access to food aid especially in southern Somalia.
The Messenger under Attack — Intimidation of Researchers by Special-Interest Groups
Authors: Richard A. Deyo, Bruce M. Psaty, Gregory Simon, Edward H. Wagner, Gilbert S. Omenn
Journal: New England Journal of Medicine (1997)

Attacks on health researchers are not new. Pierre Louis, for example, was vilified nearly two centuries ago for suggesting that bloodletting was an ineffectual therapy.1 In an open society such as ours, controversy is common and often socially useful. The fact that scientists are sometimes challenged by special-interest groups should be no surprise. However, with widening media coverage of health research, growing public interest in health hazards, and expanding research on the outcomes of clinical care, such attacks may become more frequent and acrimonious. The huge financial implications of many research studies invite vigorous attack.In Marcia Angell's recent Shattuck . . .