tbuckley/cabot-search huggingface dataset:
Transumbilical flexible endoscopic cholecystectomy in humans: first feasibility study using a hybrid technique
Authors: C. Palanivelu, P. Rajan, M. Rangarajan, R. Parthasarathi, P. Senthilnathan, P. Praveenraj
Journal: Endoscopy (2008)

Natural-orifice transluminal endoscopic surgery (NOTES) procedures have been tested using numerous approaches, mainly in animals. In humans, only cholecystectomy has been assessed, using a combined transvaginal and transumbilical approach. We present another variant of a hybrid technique for cholecystectomy, namely the combination of a flexible transumbilical double-channel endoscope and a 3-mm rigid transcutaneous trocar placed in the left hypochondrium for liver retraction.The procedure was attempted in 10 well-selected young patients (M : F = 4 : 6, mean age 29.5 years). Instruments used through the two working channels of the endoscope were either a grasping forceps or snare for grasping and pulling and a hot-biopsy forceps for cold and hot preparation and dissection. Endoclips were used for cystic duct and artery closure. Postoperative analgesia consisted of one intravenous dose of analgesic, followed by oral administration for one further day. Follow-up visits were scheduled at 7 days, 30 days, 90 days, and 6 months.In 4 of the 10 cases the operation had to be converted to conventional laparoscopic cholecystectomy due to difficulty in dissection (in 2 cases) or uncontrollable hemorrhage (2 cases). The mean operating time was 148 minutes. Of the 6 cases in which the procedure was finished by the new approach, cystic artery bleeding occurred in 1 and was successfully clipped. One further patient had a postoperative cystic duct leak with a bilioma, successfully treated by endoscopic retrograde cholangiopancreatography with stenting. Five of the six patients reported themselves as satisfied at 3- or 6-month follow-up.So far, our endoscope-based transumbilical cholecystectomy technique has not yielded satisfactory results in humans. Further instrument and accessory improvements may increase both success rate and acceptance. Scarless surgery without the inherent risks of a transluminal approach may then become feasible.
1265 Serum and biliary cytokeratin fragment CYFRA 21-1, CEA, and CA 19.9 as tumor markers for cholangiocarcinoma
Authors: G BADRA, H GHANEM, H TAHA, S SEIF, I WAKED
Journal: Hepatology (2003)

To discriminate adenocarcinoma metastases originating from either colon or ovary, a panel of immunohistochemical markers was evaluated. For this purpose, paraffin sections from 157 primary and metastatic colonic and ovarian carcinomas were immunostained. These cases were divided into a learning group of 46 colonic and 54 ovarian carcinomas and a test group of 29 colonic and 28 ovarian carcinomas, including all metastatic tumors, among which were five with unknown primary site at the time of testing. The sections were immunostained with antibodies against carcinoembryonic antigen (CFA), cytokeratin 7 (CK7), cytokeratin 20 (CK20), CA 125, vimentin, and CA 19.9. Staining results were expressed as the product of staining intensity and percentage of positive tumor cells. Stepwise discriminant analysis was applied on the learning set to obtain a classification function for both tumors. The validity of the classification function was evaluated using the test set. There was considerable overlap in immunostaining for both tumor types, but colonic carcinomas were typically positive for CEA and CK20 and negative for CK7 and CA125. Ovarian carcinomas were typically positive for CK7 and CA125 and negative for CEA and CK20. In discriminant analysis, the best combination of markers appeared to be CK7 and CFA. Only one sample of the test group (2%) was misclassified. Taking learning and test groups together, 136 of the 157 samples (87%) were correctly classified with high posterior probability (PP > .8). However, from the 28 mucinous ovarian carcinomas, only 19 (68%) could correctly be classified with high PP. When excluding the nonmnucinous ovarian carcinomas from the analysis, overall 87 of 103 (84.5%) of the samples were correctly classified (PP > .8) with a combination of CEA, CK7, and also vimentin. From the 28 mucinous ovarian carcinomas, only two (7%) were misclassified, and four could not be classified with sufficient certainty. In neither analysis did CK20, CA125, or CA19.9 emerge as discriminatory parameters. Based on the same data, an intuitive flow chart was constructed with which 129 of 157 cases could be classified (only one falsely) without further statistical analysis. The five metastases with an at first unknown primary could, according to the follow-up, all be classified correctly with high PP. Most ovarian carcinomas, including the mucinous ones, can be discriminated with high probability from colonic carcinomas using a panel of three antibodies directed against CEA, cytokeratin 7, and vimentin.
Activated macrophages depress the contractility of rabbit carotids via an L-arginine/nitric oxide-dependent effector mechanism. Connection with amplified cytokine release.
Authors: C Bernard, B Szekely, I Philip, E Wollman, D Payen, A Tedgui
Journal: Journal of Clinical Investigation (1992)

Inflammatory mediators released by macrophages (M phi) are believed to be involved in septic vasoplegia. To investigate the effect of M phi on vascular reactivity, excised rabbit carotids were exposed intraluminally either to peritoneal rabbit M phi, activated by 18 h of incubation with 1 microgram/ml lipopolysaccharide, or to the supernatants (SPN) derived from them. The contractile responses to phenylephrine (PE, 10(-6) M) were determined by measuring changes in diameter using an ultrasonic microdimensiometer 1, 2, and 3 h after the first control contraction. In control arteries (n = 12), PE-induced contractions were, respectively, 102.9 +/- 3.3%, 95.2 +/- 4.1%, and 89.7 +/- 3.8% of the first contraction, after 1, 2, and 3 h. Activated M phi significantly reduced PE-stimulated contractions after as little as 1 h of carotid exposure (percentage of controls at 1, 2, or 3 h: 74.1 +/- 5.6, 57.2 +/- 5.2, and 34.2 +/- 5.6, n = 10, P less than 0.001). The activated macrophage-derived SPN took longer to diminish carotid contractility than the M phi themselves, and became significant only after 2 h. The greater effect of M phi might be due to cooperation between M phi and vascular cells, as suggested by the amplified interleukin-1 release observed after M phi infusion. The presence of the endothelium partially protected carotid contractility from depression by activated M phi. Extraluminal addition of NG-monomethyl-L-arginine, an inhibitor of nitric oxide synthesis prevented this depression in arteries with or without endothelium. No products of the oxidative pathway of L-arginine were detected in rabbit activated M phi. These results suggest that activation of this pathway in smooth muscle cells seems to be involved in vascular hypocontractility.
Insertion/Deletion Polymorphism of the Angiotensin I-Converting Enzyme Gene Is Associated With Coronary Artery Plaque Calcification As Assessed by Intravascular Ultrasound
Authors: Martin Pfohl, Anastasios Athanasiadis, Matthias Koch, Pia Clemens, Norbert Benda, Hans U Häring, Karl R Karsch
Journal: Journal of the American College of Cardiology (1998)
The City Initiative for Newborn Health
Authors: Armida Fernandez, David Osrin
Journal: PLoS Medicine (2006)

This article describes the critical first steps taken to revitalize the vast public health system of Mumbai City through the active participation of personnel from within the system. It focuses on one of two components of an ambitious action-research project aimed at improving the survival and health of newborn infants and mothers living in slum communities in Mumbai.
Diagnosis of Legionnaires' Disease from Transtracheal Aspirate by Direct Fluorescent-Antibody Staining and Isolation of the Bacterium
Authors: Gary L. Lattimer, Cindy McCrone, John Galgon
Journal: New England Journal of Medicine (1978)

LEGIONNAIRES' disease, an acute infection caused by a newly described gram-negative bacterium, is most commonly recognized as severe pneumonia associated with a high mortality rate.1 Diagnosis is difficult during the acute illness because clinical findings are similar to those of other atypical pneumonias,2 the organism is difficult to isolate and serum antibody titers may not be diagnostic until after the third week of illness.3 Furthermore, the indirect fluorescent-antibody test, which is the standard serologic method for diagnosis, has shown lack of specificity. Fourfold rises in antibody titers against the agent of Legionnaires' disease have been found in cases of plague, . . .
An unusual cause of massive pleural effusion in pregnancy.
Authors: C A Wolfe, M W Peterson
Journal: Thorax (1988)

A 40 year old woman at 30 weeks of her eighth pregnancy presented with acute onset of dyspnoea and a large left pleural effusion after the onset of premature labour. A barium enema showed diaphragmatic rupture with intestinal contents in the thorax. Repair was accomplished through simultaneous left subcostal and thoracic incisions.
Cerebral Blood Flow After 25 Years
Authors: JAMES F. TOOLE
Journal: Annals of Internal Medicine (1973)

Editorial Notes1 November 1973Cerebral Blood Flow After 25 YearsJAMES F. TOOLE, M.D.JAMES F. TOOLE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-79-5-744 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA quarter of a century ago Seymour Kety and Carl F. Schmidt of the University of Pennsylvania devised a method of measuring cerebral blood flow in man (1, 2). Their system, based on the Fick principle, was safe enough for use both in normal volunteers and in patients. As a consequence, it broadened the study of man's brain from bedside and autopsy-table observations to the physiologist's laboratory.Kety and Schmidt were joined by Dr. Louis Sokoloff (3) who contributed much with his studies of cerebral blood flow and metabolism. Their studies showed that the arterioles controlling brain blood flow are...References1. KETYSCHMIDT SC: The determination of cerebral blood flow in man by the use of nitrous oxide in low concentrations. Am J Physiol 143:53-66, 1945 CrossrefGoogle Scholar2. KETYSCHMIDT SC: The nitrous oxide method for quantitative determination of cerebral blood flow in man: theory, procedure, and normal values. J Clin Invest 27:476-483, 1948 CrossrefMedlineGoogle Scholar3. SOKOLOFF L: Metabolism of the central nervous system in vivo. Handbook of Physiology—Neurophysiology, sec. 1, vols. 2 and 3, edited by FIELD J, MAGOUN HW. Washington, D.C., American Physiological Society, 1960, pp. 1843-1864 Google Scholar4. MCHENRY L: Cerebral blood flow. N Engl J Med 274:82-91, 1966 CrossrefMedlineGoogle Scholar5. OBRISTTHOMPSONKING WHC: Determination of regional cerebral blood flow by inhalation of 133-Xenon. Circ Res 20:124-135, 1967 CrossrefMedlineGoogle Scholar6. Symposium Abstracts: Cerebral circulation and metabolism. Sixth International CBF Symposium, Philadelphia. Stroke 4:321-379, 1973 CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Neurology Bowman Gray School of Medicine Wake Forest University Winston-Salem, North Carolina PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1973Volume 79, Issue 5Page: 744-745KeywordsArteriolesBlood flowBrainResearch laboratories Issue Published: 1 November 1973 PDF DownloadLoading ...
A Physician's Hamlet
Authors: John F. Burnum
Journal: Annals of Internal Medicine (1997)

Medical Writings1 March 1997A Physician's HamletJohn F. Burnum, MDJohn F. Burnum, MDTuscaloosa, AL 35401Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-5-199703010-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail As a young man, I thought of Hamlet as a reflective, vibrant fellow student-and sometimes fearless swordsman-tragically victimized by circumstances. Returning to the play these years later, I feel that I must give some answer to a troubling question: Why does my erstwhile hero delay in killing the seemingly guilty Claudius for the murder of Hamlet's father, the former king, when prompt action might have preserved Hamlet's father's dynasty and saved seven of eight persons from death? Given my viewpoint as a physician, my answer comes from thinking about the play as a work that centers on problem solving and ...References1. Wilson JD. What Happens in Hamlet. Cambridge, UK: Cambridge Univ Pr; 1956:200-1. Google Scholar2. Bynum WF, Neve M. Hamlet on the couch. In: Bynum WF, Porter R, Shepherd M, eds. The Anatomy of Madness: Essays in the History of Psychiatry. New York: Tavistock Publications; 1985:289-304. Google Scholar3. Levin H. Interrogation, doubt, irony: thesis, antithesis, synthesis. In: Bevington D, ed. Twentieth Century Interpretations of Hamlet: A Collection of Critical Essays. Englewood Cliffs, NJ: Prentice-Hall; 1968:73. Google Scholar4. Braddy H. Hamlet's Wounded Name. 2d ed. Amsterdam: Rodopi NV; 1974:1-5. Google Scholar5. Gottschalk P. The Meanings of Hamlet. Modes of Literary Interpretation since Bradley. Albuquerque, NM: Univ of New Mexico Pr; 1972:25. Google Scholar6. Wilson JD. What Happens in Hamlet. Cambridge, UK: Cambridge Univ Pr; 1956:49. Google Scholar7. Gottschalk P. The Meanings of Hamlet. Modes of Literary Interpretation since Bradley. Albuquerque, NM: Univ of New Mexico Pr; 1972:142-8. Google Scholar8. Shakespeare W. The Tragedy of Hamlet Prince of Denmark. Boston: Ginn; 1939:204. Google Scholar9. Bertram J. The theme. In: Bevington D, ed. Twentieth Century Interpretations of Hamlet: A Collection of Critical Essays. Englewood Cliffs, NJ: Prentice-Hall; 1968:93-103. Google Scholar Author, Article, and Disclosure InformationAffiliations: Tuscaloosa, AL 35401Corresponding Author: John F. Burnum, MD, 400-C Bryant Drive E, Tuscaloosa, AL 35401. Previousarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 March 1997Volume 126, Issue 5Page: 412-414KeywordsConflicts of interestDecision makingEmotionsFallsFearHearingHomicideProblem solvingVisionWine Issue Published: 1 March 1997 CopyrightCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
The Enzymatic Defect in Porphyria Cutanea Tarda
Authors: James P. Kushner
Journal: New England Journal of Medicine (1982)

The porphyrias are a group of disorders resulting from specific enzymatic defects in the heme biosynthetic pathway. The compound excreted in excess in the various porphyric syndromes is generally the substrate of the defective enzyme. The inherited nature of a specific enzymatic defect has been established in all forms of porphyria with the exception of porphyria cutanea tarda (PCT).Because of its association with alcoholic liver disease and hepatic siderosis, PCT used to be considered an acquired form of porphyria. The accumulation of uroporphyrin and partially decarboxylated porphyrins in the liver and the excretion of these compounds in the urine . . .
Abstract 904: Biomarkers of Myocardial Stress and Systemic Inflammation are Lower in Patients Who Engage in Heart Failure Self-Care Management
Authors: Christopher S Lee, Debra K Moser, Terry A Lennie, Nancy C Tkacs, Kenneth B Margulies, Barbara Riegel
Journal: Circulation (2009)

Background: Self-care is believed to improve outcomes; but, proposed mechanisms through which self-care may influence outcomes in the heart failure (HF) population remain untested. The purpose of t...
PEGylated PLGA-based nanoparticles targeting M cells for oral vaccination
Authors: Marie Garinot, Virginie Fiévez, Vincent Pourcelle, François Stoffelbach, Anne des Rieux, Laurence Plapied, Ivan Theate, Hélène Freichels, Christine Jérôme, Jacqueline Marchand-Brynaert, Yves-Jacques Schneider, Véronique Préat
Journal: Journal of Controlled Release (2007)
Soluble interleukin-2 receptor in Sezary syndrome: its origin and clinical application
Authors: M.G. BERNENGO, M.T. FIERRO, M. NOVELLI, E. LISA, A. APPINO
Journal: British Journal of Dermatology (1993)

Soluble interIeukin‐2 receptor (sIL‐2R) serum levels were evaluated in Sézary syndrome (SS). mycosis fungoides. non‐epidermotropic T‐cell lymphomas. inflammatory skin diseases (eczema, psoriasis and lichen planus) and benign erythroderma. All groups displayed mean values significantly higher than controls, and values in SS were also significantly higher than those in the other diseases investigated. Follow‐up of 17 SS patients showed that serum SIL‐2R correlated with the clinical course of the disease and with other haematologicai parameters (ahsolute numher of circulating Sézary cells, lactic dehydrogenase). Culture experiments demonstrated that, in contrast with other haematoiogical disorders, highly enriched resting Sézary cells were unahle to release sII‐2R. and failed to release normal amounts even after mitogen stimulation. Nevertheless, the leukaemic burden, together with the activation and consequent CD25 expression of leukaemic lymphocytes infiltrating the skin, may justify the hypothesis of a neoplastie sIL‐2R source. To further support this hypothesis, the highest sIT.‐2R values were found in patients with advanced disease, in which normal reactive lymphocytes were dramatically reduced.
Competency to Give an Informed Consent
Authors: James F. Drane
Journal: JAMA (1984)

A patient's decision must be informed and free, and he/she must be competent either to consent to or refuse treatment. Rather than selecting a single standard of competency, a sliding scale is suggested that requires an increasingly more stringent standard as the consequences of the patient's decision embody more risk. The standard of competency to consent to or to refuse treatment depends on the dangerousness of the treatment decision. Three different standards are correlated with the psychiatric abnormalities that are most likely to undermine them. A model with guidelines for use is provided to aid the physician who is called on to make a determination of competency. (<i>JAMA</i>1984;252:925-927)
Survival after Lung Volume Reduction in Chronic Obstructive Pulmonary Disease
Authors: James C. Hogg, Fanny S. F. Chu, Wan C. Tan, Don D. Sin, Sanjay A. Patel, Peter D. Pare, Fernando J. Martinez, Robert M. Rogers, Barry J. Make, Gerard J. Criner, Reuben M. Cherniack, Amir Sharafkhaneh, James D. Luketich, Harvey O. Coxson, W. Mark Elliott, Frank C. Sciurba
Journal: American Journal of Respiratory and Critical Care Medicine (2007)

Rationale: COPD is associated with reduced life expectancy.Objectives: To determine the association between small airway pathology and long-term survival after lung volume reduction in chronic obstructive pulmonary disease (COPD) and the effect of corticosteroids on this pathology.Methods: Patients with severe (GOLD-3) and very severe (GOLD-4) COPD (n = 101) were studied after lung volume reduction surgery. Respiratory symptoms, quality of life, pulmonary function, exercise tolerance, chest radiology, and corticosteroid treatment status were assessed preoperatively. The severity of luminal occlusion, wall thickening, and the presence of small airways containing lymphoid follicles were determined in resected lung tissue. Kaplan-Meier survival analysis and Cox proportional hazards models were used to determine the relationship between survival and small airway pathology. The effect of corticosteroids on this pathology was assessed by comparing treated and untreated groups.Measurements and Main Results: The quartile of subjects with the greatest luminal occlusion, adjusted for covariates, died earlier than subjects who had the least occlusion (hazard ratio, 3.28; 95% confidence interval, 1.55–6.92; P = 0.002). There was a trend toward a reduction in the number of airways containing lymphoid follicles (P = 0.051) in those receiving corticosteroids, with a statistically significant difference between the control and oral ± inhaled corticosteroid–treated groups (P = 0.019). However, corticosteroid treatment had no effect on airway wall thickening or luminal occlusion.Conclusions: Occlusion of the small airways by inflammatory exudates containing mucus is associated with early death in patients with severe emphysema treated by lung volume reduction surgery. Corticosteroid treatment dampens the host immune response in these airways by reducing lymphoid follicles without changing wall thickening and luminal occlusion.
Qualitative and quantitative evaluation of internal anal sphincter function in the newborn
Authors: V. E. Boston, S. Cywes, M. R. Q. Davies
Journal: Gut (1977)

One-hundred-and-one normal neonates were examined manometrically in the first day of life to assess anorectal function. In order to overcome some of the difficulties in subjective interpretation of results, the stimuli used and the response pattern seen in the anal canal were measured. In the unstimulated state, all subjects demonstrated rhythmical changes in anal canal tone. Mean maximal intraluminal pressure in the anal canal decreased significantly after 10 hours of age and after the first meconium stool. Only five out of the 101 examined on the first day of life had an abnormal manometric response. It is significant that none of these had passed meconium at the time of examination, and that all had a normal response pattern at the age of 28 hours. In 20 of these babies the sensitivity of the rectoanal reflex was measured and found to be significantly increased on the third day of life compared with the first. The quantitative changes in anorectal reflex function in the newborn, are thought to be related to the state of physiological `constipation' which exists in utero and in the early neonatal period. The results indicate that a normal response pattern can be obtained in healthy babies after the first day of life. Consequently, anorectal manometry will be meaningful as a diagnostic method thereafter in the neonatal period. Further, it is suggested that measurement of the stimulus and the response will add useful information and reduce subjective error in interpretation of results.
A View from the Periphery — Health Care in Rural America
Authors: Roger A. Rosenblatt
Journal: New England Journal of Medicine (2004)

Urban Americans tend to view the rural United States as a larder, a playground, or a place to retire. But although agriculture now employs less than 3 percent of the nation's workforce, more than 50 million people — 20 percent of our population — live in places defined as rural by the 2000 Census. Inhabitants of rural areas are generally older, poorer, and less likely to have health insurance than inhabitants of urban areas. Enormous regional variation masks the fact that rural America contains pockets of deep poverty; of the nation's 500 poorest counties, 459 are in rural areas.1 Rural . . .