tbuckley/cabot-search huggingface dataset:
Decreasing Liver Biopsy Complications
Authors: Michael J. Kovacs
Journal: Annals of Internal Medicine (1993)

Letters1 September 1993Decreasing Liver Biopsy ComplicationsMichael J. Kovacs, MD, Michael Keeney, MD, and Ian Chin-Yee, MDMichael J. Kovacs, MDSearch for more papers by this author, Michael Keeney, MDSearch for more papers by this author, and Ian Chin-Yee, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-5-199309010-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Janes and Lindor's [1] criteria for outpatient liver biopsy include a prothrombin time less than 14 seconds. Garcia-Tsao and Boyer [2] cite a prothrombin time prolonged less than 3 seconds and a bleeding time of 10 minutes. No mention was made of the bleeding history, probably the best predictor of postoperative bleeding [3]. Reliance by clinicians on the prothrombin time or bleeding time to predict postbiopsy bleeding is hampered by the difficulty in their use, interpretation, and generalizability.Neither article specified the sensitivity of the reagents (International Sensitivity Index [ISI]), making it impossible to generalize a prothrombin ...References1. Janes CH, Lindor KD. Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med. 1993; 118:96-8. Google Scholar2. Garcia-Tsao G, Boyer JL. Outpatient liver biopsy: how safe is it? Ann Intern Med. 1993; 118:150-3. Google Scholar3. Lind SE. The bleeding time does not predict surgical bleeding. Blood. 1991; 77:2547-52. Google Scholar4. Hirsh J. Oral anticoagulant drugs. N Engl J Med. 1991; 324:1865-75. Google Scholar5. Rodgers RP, Levin J. A critical reappraisal of the bleeding time. Semin Thromb Hemost. 1990; 16:1-20. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 September 1993Volume 119, Issue 5Page: 436-437KeywordsAnticoagulantsAspirinBiopsyHemorrhageInternational normalized ratioLiverOutpatientsPlateletsProthrombin timeSurgery Issue Published: 1 September 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The role of Foxp3+ T cells in long‐term efficacy of prophylactic and therapeutic mucosal tolerance induction in mice
Authors: B. Winkler, K. Hufnagl, A. Spittler, M. Ploder, E. Kállay, S. Vrtala, R. Valenta, M. Kundi, H. Renz, U. Wiedermann
Journal: Allergy (2006)

Background: Mucosal tolerance induction is suggested as treatment strategy for allergic diseases. Using a murine model of birch pollen (BP) allergy we investigated the long‐term efficacy and the underlying mechanisms of mucosal tolerance induction with two structurally different molecules in a prophylactic and in a therapeutic set‐up. Methods: The three‐dimensional major BP allergen Bet v 1 or a nonconformational hypoallergenic fragment thereof was intranasally applied before (prophylaxis) or after sensitization (therapy). Results: In the prophylactic application both the Bet v 1 allergen and the fragment prevented allergic sensitization, and this effect lasted for 1 year. In the therapeutic approach established allergic immune responses were also suppressed after treatment with either of the molecules. However, a long‐lasting curative effect (6 months) was only achieved with the Bet v 1 allergen but not with the Bet v 1 fragment. Real‐time reverse transcriptase polymerase chain reaction (RT‐PCR) analysis of splenocytes revealed that tolerance induction with the Bet v 1 allergen was associated with enhanced expression of transforming growth factor (TGF)‐ β , interleukin (IL)‐10, and Foxp3 mRNA in CD4+ T cells, whereas treatment with the fragment led to the induction of either Foxp3 (prophylaxis) or IL‐10 (therapy) alone. Conclusion: From these data we concluded (i) that the mechanisms underlying peripheral tolerance are linked to the conformation of the antigen, (ii) that mucosal tolerance is mediated by separate regulatory cell subsets, and (iii) that the long‐term efficacy of immunosuppression is associated with the presence of Foxp3+ T cells.
PTU-048 Initial Experience With Radiofrequency Ablation In Gastric Antral Vascular Ectasia And Radiation Proctitis
Authors: SS Siddhi, H Dalziel, EB Henry
Journal: Gut (2014)

<h3>Introduction</h3> Gastric Antral Vascular Ectasia (GAVE) and radiation proctitis can cause chronic GI bleeding and may be severe enough to cause transfusion dependent anaemia. Current standard therapy for both these conditions is endoscopy with argon plasma coagulation. This usually requires multiple endoscopies over time and in many patients may be ineffective. With the development of Radiofrequency Ablation (RFA) in Barrett’s Oesophagus, we extended its use in these two settings. The available literature is small and our study adds to this body of evidence. <h3>Methods</h3> Retrospective case record study. We collected data from all patients who received RFA between December 2012 and November 2013. Data was collected from endoscopy reports and electronic case records. RFA was performed using the Halo 60,90 or through the scope probes at 12j energy (Barxx/Covidien). <h3>Results</h3> Three patients received RFA for GAVE and six patients for Radiation proctitis. GAVE: All patients presented with transfusion dependent anaemia. They needed 0.85 OGD/pt/month, 0.41 APC/pt/month and 6 units of packed cells /pt/month prior to RFA. Between 2–4 sessions of RFA was required. Post RFA, there was a reduction in endoscopies to 0.34/pt/month (P 0.239) In two out of three patients no further transfusions were required. Hence there was a significant reduction in transfusion requirement. (P 0.033). Radiation Proctitis: All patients presented with PR bleeding. One was transfusion dependent. A mean of 0.58 APC sessions were done per patient/month. There was a significant reduction in the number of sigmoidoscopies from 0.87/pt/month to 0.2/pt/month (P 0.007). One patient who was requiring 9 units of packed cells per month stopped transfusions after RFA. Number of RFA sessions was between 1–3 (mean: 1.66). In the NHS, therapeutic sigmoidoscopy with APC costs £704 and therapeutic OGD is £667. A single unit of blood transfusion costs £635. An RFA probe costs £920 and hence an RFA procedure proves cost effective above 2x APC or 2x blood transfusions. Our only complication was one clinically insignificant stricturing but this was after 8xAPC and 3X RFA. Healing is optimum after 3 months. It is better tolerated than APC in terms of comfort. <h3>Conclusion</h3> RFA for GAVE and RP is technically feasible, well tolerated and cost effective. We have demonstrated that there was a significant reduction in blood transfusions in GAVE and requirement for Sigmoidoscopy in RP. We have shown no significant complications and RFA should be considered as a first line treatment in refractory GAVE and in RP where bleeding is significant. We recognise this is a small, retrospective study but future work will include larger numbers, QoL data and establish if this should be considered the first line therapy. <h3>Disclosure of Interest</h3> None Declared.
Gastroenterology: Pathophysiology and Clinical Applications
Authors: Arthur B. French
Journal: JAMA (1983)

In this era of massive, multiauthored, unbelievably expensive specialty texts, there is surely a place for a small, relatively inexpensive yet thorough text on gastroenterology. Harvey Dworken's Gastroenterology: Pathophysiology and Clinical Applications is such a book.  Although there is adequate yet concise discussion of physiological background as it relates to function and to disease, the unique aspect of the book is its presentation of Dworken's perspective on symptoms and disease. Although in many, perhaps most, instances the gross correlations between physiology and disease are firmly based on established facts, many of the details are explained by intuitive assumptions. No two teachers of gastroenterology—or anything else—have identical bodies of intuitive belief. Since Dworken has a critical, independent mind, this book is not only an expression of the fundamentals of gastroenterology, more detailed than that of an internal medicine text, more concise than the massive compendiums of Bockus, of Sleisenger and Fordtran,
Eradicating Helicobacter pylori in patients with duodenal ulcer.
Authors: R. P. Logan, J. H. Baron, J. J. Misiewicz
Journal: BMJ (1992)

requesting permission for HIV antibody testing some life assurance companies rightly ask pro- posers to nominate their general practitioner or another named doctor who should be informed in total confidence in the event of a positive result.This doctor need not be the one who obtained the sample, who may be less well known to the proposer and not necessarily in a position to offer long term support.This makes the procedure more personalised and acceptable to the proposer.My life assurance society does not at present use saliva tests for HIV antibody testing so I have not had to delete references to false positive results in policy holders' documents.In the less likely event of a false positive result of a blood test I would insist that the subsequent negative result was given due prominence.These documents remain strictly confidential to the underwriting team.
The natural history of left ventricular hypertrophy in hypertrophic cardiomyopathy: an electrocardiographic study.
Authors: W J McKenna, M Borggrefe, D England, J Deanfield, C M Oakley, J F Goodwin
Journal: Circulation (1982)

The natural history of electrocardiographic left ventricular hypertrophy was assessed in relation to clinical features, treatment with propranolol and prognosis in 100 patients with hypertrophic cardiomyopathy who were followed 5--20 years (mean 8 years). Seventy-one patients received propranolol, 120--800 mg/day (mean 240 mg). At diagnosis, the voltage measurement from SV1 + RV5 was 37 +/- 20 mm, the R wave in aVL was 12 +/- 6 mm and the mean frontal plane voltage was 15 +/- 10 mm. After 5 years, these values were increased to 43 +/- 22 mm (p less than 0.0002), 14 +/- 6 mm (p less than 0.003) and 17 +/- 10 mm (p less than 0.01), respectively. Neither a left ventricular outflow tract gradient nor propranolol treatment influenced these voltage changes. Twenty patients had an increase of more than 10 mm in SV1 + RV5, which was associated with exertional chest pain (p less than 0.006) and death (p less than 0.02). Four patients had a decrease of more than 10 mm in SV1 + RV5. Two of these received high-dose propranolol, one 720 mg/day for 12 years and another 800 mg/day for 12 years. No other patient received more than 480 mg of propranolol daily. In hypertrophic cardiomyopathy there is electrocardiographic evidence of progressive hypertrophy, which is associated with poor prognosis and is not influenced by treatment with propranolol in moderate dosage. Regression of hypertrophy is rare and may be related to long-term treatment with high-dose propranolol.
Response to H Zeidler's comments on the INFAST study
Authors: Joachim Sieper
Journal: Annals of the Rheumatic Diseases (2014)

In his comments about our Infliximab as First Line Therapy in Patients with Early Axial Spondyloarthritis (INFAST) trial,1 H Zeidler addresses the question whether a separation in patients with predominant axial spondyloarthritis (axSpA) and peripheral SpA manifestations makes sense and whether it reflects reality. Peripheral arthritis is one of the clinical parameters used in the classification criteria for axSpA.2 However, it is not used here as an activity parameter. Thus, is has been explicitly stated for these criteria that peripheral arthritis might be current or in the past. In most of the studies cited by H Zeidler peripheral arthritis1 ,3 was counted as current or in the past and current or past is not always reported in detail. However, this information is available in some of the studies. In the German Spondyloarthritis Inception Cohort (GESPIC) …
Adverse events reporting in English hospital statistics: Authors' reply
Authors: Paul Aylin, Alex Bottle, Shivani Tanna, Brian Jarman
Journal: BMJ (2004)

How variable is the functionally-defined structure of early visual areas in human cortex and how much variability is shared between twins? Here we quantify individual differences in the best understood functionally-defined regions of cortex: V1, V2, V3. The Human Connectome Project 7T Retinotopy Dataset includes retinotopic measurements from 181 subjects (109 female, 72 male), including many twins. We trained four “anatomists” to manually define V1-V3 using retinotopic features. These definitions were more accurate than automated anatomical templates and showed that surface areas for these maps varied more than three-fold across individuals. This three-fold variation was little changed when normalizing visual area size by the surface area of the entire cerebral cortex. In addition to varying in size, we find that visual areas vary in how they sample the visual field. Specifically, the cortical magnification function differed substantially among individuals, with the relative amount of cortex devoted to central vision varying by more than a factor of 2. To complement the variability analysis, we examined the similarity of visual area size and structure across twins. Whereas the twin sample sizes are too small to make precise heritability estimates (50 monozygotic pairs, 34 dizygotic pairs), they nonetheless reveal high correlations, consistent with strong effects of the combination of shared genes and environment on visual area size. Collectively, these results provide the most comprehensive account of individual variability in visual area structure to date, and provide a robust population benchmark against which new individuals and developmental and clinical populations can be compared. <b>SIGNIFICANCE STATEMENT:</b> Areas V1, V2, and V3 are among the best studied functionally-defined regions in human cortex. Using the largest retinotopy dataset to date, we characterized the variability of these regions across individuals and the similarity between twin pairs. We find that the size of visual areas varies dramatically (up to 3.5x) across healthy young adults, far more than the variability of the cerebral cortex size as a whole. Much of this variability appears to arise from inherited factors, as we find very high correlations in visual area size between monozygotic twin-pairs, and lower but still substantial correlations between dizygotic twin pairs. These results provide the most comprehensive assessment of how functionally defined visual cortex varies across the population to date.
A Geriatric Medical Residency Program
Authors: LESLIE S. LIBOW
Journal: Annals of Internal Medicine (1976)

Geriatricians are needed to further improve the health care of elderly Americans. The first formalized geriatric residency program in the United States was developed at the Mount Sinai City Hospital Center in New York, and this has produced a second program at the Jewish Institute for Geriatric Care at Long Island Jewish-Hillside Medical Center, New Hyde Park, New York. The goals of this training are to develop special clinical skills to deal with the medical and psychosocial problems of the elderly, and to achieve the ability to develop health care systems for the elderly. Emphasis is on a multileveled system, including home, outpatient, acute hospital, convalescent unit, and long-term institution care. The training period is 12 to 24 months, after an initial 24 to 36 months of standard internal medicine, thus fulfilling the requirements for board eligibility in internal medicine.
The baby shambles
Authors: Des Spence
Journal: BMJ (2007)

The baby monitors looked mournfully back at me from the bottom of the wheelie bin as I slammed the lid. Then I experienced a series of flashbacks: the crackle of a baby's cry; the whiff of stale vomit on my clothes; pacing the floor at 3 am; the breastfeeding propaganda, and the malign medical insensitivity of the health visitors' “support”—a tick list questionnaire on depression, domestic abuse, and “concerns” about seemingly everything (my wife took to hiding from them in her subsequent pregnancies). Thus we were sucked into the parental collective—mere …
Who's Been Sleeping in Our Bed?
Authors: Alfred M. Bongiovanni
Journal: JAMA (1964)

<h3>To the Editor:—</h3> Apropos the excellent communication, "Role of Insurance Abuse in Hospital-Bed Utilization," by Dr. William R. Hunt (<i>JAMA</i><b>187</b>:934 [March 21] 1964) certain questions remain unanswered. Every physician and citizen should heed Dr. Hunt's words. Indeed there is some abuse involved, but the degree is as yet not susceptible to meaningful analysis. The problem should be studied thoughtfully by the insuring agencies, and the insured, so that realistic and practical measures are taken. Dr. Hunt notes the relatively greater rise in hospital rates as compared with other costs. It is not difficult to recall the days (not so long ago) when hospital employees were universally paid salaries well below subsistence. There has been a necessary and proper amelioration of this injustice, which alone would account for the comparatively greater increase in rates. The major premise, that "patients with a high degree of coverage" had a greater admission
Brentuximab as a Treatment for CD30<sup>+</sup>Mycosis Fungoides and Sézary Syndrome
Authors: Tarun Mehra, Kristian Ikenberg, Rudolf Maria Moos, Rudolf Benz, Gayathri Nair, Urs Schanz, Eugenia Haralambieva, Wolfram Hoetzenecker, Reinhard Dummer, Lars Einar French, Emmanuella Guenova, Antonio Cozzio
Journal: JAMA Dermatology (2014)

The prognosis of advanced cutaneous T-cell lymphoma (CTCL), including Sézary syndrome and mycosis fungoides (MF), is poor. So far, no curative option apart from allogeneic stem cell transplantation is available. Large cell transformation often hallmarks cases with a more aggressive clinical course, and large tumor cells may express CD30. Recently, brentuximab vedotin, a conjugate of an anti-CD30 antibody and monomethylauristatin E, which inhibits the polymerization of microtubuli, has produced promising results in phase 2 trials in CD30+ Hodgkin lymphoma and anaplastic large cell lymphoma.We describe 4 patients with advanced CTCL, 3 with MF and 1 with Sézary syndrome, who were treated with brentuximab. All patients had received multiple previous systemic therapies. In 2 cases of MF, a remission enabling subsequent allogeneic stem cell transplantation was achieved.Brentuximab is a well-tolerated, promising new treatment option for advanced CTCL that can be integrated in an allogeneic stem cell transplantation plan by selectively depleting malignant CD30+ cutaneous lymphoma cells.
Interactions between Glutathione <i>S-</i> Transferase P1, Tumor Necrosis Factor, and Traffic-Related Air Pollution for Development of Childhood Allergic Disease
Authors: Erik Melén, Fredrik Nyberg, Cecilia M. Lindgren, Niklas Berglind, Marco Zucchelli, Emma Nordling, Jenny Hallberg, Magnus Svartengren, Ralf Morgenstern, Juha Kere, Tom Bellander, Magnus Wickman, Göran Pershagen
Journal: Environmental Health Perspectives (2008)

BackgroundAir pollutants may induce airway inflammation and sensitization due to generation of reactive oxygen species. The genetic background to these mechanisms could be important effect modifiers.ObjectiveOur goal was to assess interactions between exposure to air pollution and single nucleotide polymorphisms (SNPs) in the β2-adrenergic receptor (ADRB2), glutathione S-transferase P1 (GSTP1), and tumor necrosis factor (TNF) genes for development of childhood allergic disease.MethodsIn a birth cohort originally of 4,089 children, we assessed air pollution from local traffic using nitrogen oxides (traffic NOx) as an indicator based on emission databases and dispersion modeling and estimated individual exposure through geocoding of home addresses. We measured peak expiratory flow rates and specific IgE for inhalant and food allergens at 4 years of age, and selected children with asthma symptoms up to 4 years of age (n = 542) and controls (n = 542) for genotyping.ResultsInteraction effects on allergic sensitization were indicated between several GSTP1 SNPs and traffic NOx exposure during the first year of life (pnominal < 0.001–0.06). Children with Ile105Val/Val105Val genotypes were at increased risk of sensitization to any allergen when exposed to elevated levels of traffic NOx (for a difference between the 5th and 95th percentile of exposure: odds ratio = 2.4; 95% confidence interval, 1.0–5.3). In children with TNF-308 GA/AA genotypes, the GSTP1–NOx interaction effect was even more pronounced. We observed no conclusive interaction effects for ADRB2.ConclusionThe effect of air pollution from traffic on childhood allergy appears to be modified by GSTP1 and TNF variants, supporting a role of genes controlling the antioxidative system and inflammatory response in allergy.
ACUTE APPENDICITIS IN A CHILD COMMENCING WITH DIARRHOEA AND CONVULSIONS
Authors: B. Myers
Journal: BMJ (1924)

ORA foi her age.Altlhough she couild not speak, like the lesional ap)hasics, she could hum tunes anid tried to sing with words.The third case was a boy (G.B.) aged 2 year s and 10 moniths, who has nievel spokeni.He makes
Activation primes human B lymphocytes to respond to heat shock.
Authors: N L Spector, A S Freedman, G Freeman, J Segil, J F Whitman, W J Welch, L M Nadler
Journal: The Journal of Experimental Medicine (1989)

Crosslinkage of the B cell antigen receptor by anti-mu beads or SAC results in the selective induction of hsp70. We have observed that activated cells, having enhanced expression of hsp70, survive lethal stimuli much better than their unactivated counterparts. These results are in accordance with the proposal that hsp70 is essential for cells to survive lethal environmental stresses. Moreover, the activation event itself primes B cells thereby enabling them to increase the expression of both hsp70 mRNA and protein. This is the first demonstration that triggering of B cells via crosslinkage of sIg is accompanied by the induction of thermotolerance without the need for a prior sublethal heat treatment.