tbuckley/cabot-search huggingface dataset:
Multiple and recurrent inflammatory fibroid polyps in three generations of a Devon family: a new syndrome.
Authors: P P Anthony, D S Morris, K D Vowles
Journal: Gut (1984)

The recurrence of multiple inflammatory fibroid polyps is reported in three generations of a Devon family. Only one female in each has been affected in a direct line of descent. The grandmother has had nine polyps resected over 11 years, the mother seven over 18 years, and the daughter six over six years. None of the patients or their relatives are known to have any allergies, dietary fads, or gastrointestinal infections. Chromosome studies have been normal in two patients. No cancer risk has been identified. Conventional histology, electron microscopy, and immunohistology suggest that the lesion is a self-limiting proliferation of histiocytes; the initiating event or stimulus remains unknown. A genetic factor is likely to operate in this unique family which is probably polygenic and multifactorial in nature.
Health Benefits of Gastric Bypass Surgery After 6 Years
Authors: Ted D. Adams, Lance E. Davidson, Sheldon E. Litwin, Ronette L. Kolotkin, Michael J. LaMonte, Robert C. Pendleton, Michael B. Strong, Russell Vinik, Nathan A. Wanner, Paul N. Hopkins, Richard E. Gress, James M. Walker, Tom V. Cloward, R. Tom Nuttall, Ahmad Hammoud, Jessica L. J. Greenwood, Ross D. Crosby, Rodrick McKinlay, Steven C. Simper, Sherman C. Smith, Steven C. Hunt
Journal: JAMA (2012)

Extreme obesity is associated with health and cardiovascular disease risks. Although gastric bypass surgery induces rapid weight loss and ameliorates many of these risks in the short term, long-term outcomes are uncertain.To examine the association of Roux-en-Y gastric bypass (RYGB) surgery with weight loss, diabetes mellitus, and other health risks 6 years after surgery.A prospective Utah-based study conducted between July 2000 and June 2011 of 1156 severely obese (body mass index [BMI] ≥ 35) participants aged 18 to 72 years (82% women; mean BMI, 45.9; 95% CI, 31.2-60.6) who sought and received RYGB surgery (n = 418), sought but did not have surgery (n = 417; control group 1), or who were randomly selected from a population-based sample not seeking weight loss surgery (n = 321; control group 2).Weight loss, diabetes, hypertension, dyslipidemia, and health-related quality of life were compared between participants having RYGB surgery and control participants using propensity score adjustment.Six years after surgery, patients who received RYGB surgery (with 92.6% follow-up) lost 27.7% (95% CI, 26.6%-28.9%) of their initial body weight compared with 0.2% (95% CI, -1.1% to 1.4%) gain in control group 1 and 0% (95% CI, -1.2% to 1.2%) in control group 2. Weight loss maintenance was superior in patients who received RYGB surgery, with 94% (95% CI, 92%-96%) and 76% (95% CI, 72%-81%) of patients receiving RYGB surgery maintaining at least 20% weight loss 2 and 6 years after surgery, respectively. Diabetes remission rates 6 years after surgery were 62% (95% CI, 49%-75%) in the RYGB surgery group, 8% (95% CI, 0%-16%) in control group 1, and 6% (95% CI, 0%-13%) in control group 2, with remission odds ratios (ORs) of 16.5 (95% CI, 4.7-57.6; P < .001) vs control group 1 and 21.5 (95% CI, 5.4-85.6; P < .001) vs control group 2. The incidence of diabetes throughout the course of the study was reduced after RYGB surgery (2%; 95% CI, 0%-4%; vs 17%; 95% CI, 10%-24%; OR, 0.11; 95% CI, 0.04-0.34 compared with control group 1 and 15%; 95% CI, 9%-21%; OR, 0.21; 95% CI, 0.06-0.67 compared with control group 2; both P < .001). The numbers of participants with bariatric surgery-related hospitalizations were 33 (7.9%), 13 (3.9%), and 6 (2.0%) for the RYGB surgery group and 2 control groups, respectively.Among severely obese patients, compared with nonsurgical control patients, the use of RYGB surgery was associated with higher rates of diabetes remission and lower risk of cardiovascular and other health outcomes over 6 years.
Relationship between Serum Vitamin D, Disease Severity, and Airway Remodeling in Children with Asthma
Authors: Atul Gupta, Alies Sjoukes, David Richards, Winston Banya, Catherine Hawrylowicz, Andrew Bush, Sejal Saglani
Journal: American Journal of Respiratory and Critical Care Medicine (2011)

Little is known about vitamin D status and its effect on asthma pathophysiology in children with severe, therapy-resistant asthma (STRA).
IMPROVING HEART DISEASE KNOWLEDGE AND RESEARCH PARTICIPATION IN ADULTS WITH CONGENITAL HEART DISEASE (THE HEALTH, EDUCATION AND ACCESS RESEARCH TRIAL: HEART-ACHD)
Authors: Anne Marie Valente, Ann Gianola, Amy J. Harmon, Gary Webb, Jennifer G. Ting, Karen Stout, Alexander Opotowsky, Karen Kuehl, Paul Khairy, Joseph Kay, Michael Earing, Jamil Aboulhosn, Stephen Cook, Craig Broberg, Amy Vers tappen, Michael Landzberg, Michelle Gurvitz
Journal: Journal of the American College of Cardiology (2012)
Antimicrobial therapeutic determinants of outcomes from septic shock among patients with cirrhosis
Authors: Yaseen M. Arabi, Saqib I. Dara, Ziad Memish, Abdulmajeed Al Abdulkareem, Hani M. Tamim, Nehad Al‐Shirawi, Joseph E. Parrillo, Peter Dodek, Stephen Lapinsky, Daniel Feinstein, Gordon Wood, Sandra Dial, Sergio Zanotti, Anand Kumar
Journal: Hepatology (2012)

It is unclear whether practice-related aspects of antimicrobial therapy contribute to the high mortality from septic shock among patients with cirrhosis. We examined the relationship between aspects of initial empiric antimicrobial therapy and mortality in patients with cirrhosis and septic shock. This was a nested cohort study within a large retrospective database of septic shock from 28 medical centers in Canada, the United States, and Saudi Arabia by the Cooperative Antimicrobial Therapy of Septic Shock Database Research Group between 1996 and 2008. We examined the impact of initial empiric antimicrobial therapeutic variables on the hospital mortality of patients with cirrhosis and septic shock. Among 635 patients with cirrhosis and septic shock, the hospital mortality was 75.6%. Inappropriate initial empiric antimicrobial therapy was administered in 155 (24.4%) patients. The median time to appropriate antimicrobial administration was 7.3 hours (interquartile range, 3.2-18.3 hours). The use of inappropriate initial antimicrobials was associated with increased mortality (adjusted odds ratio [aOR], 9.5; 95% confidence interval [CI], 4.3-20.7], as was the delay in appropriate antimicrobials (aOR for each 1 hour increase, 1.1; 95% CI, 1.1-1.2). Among patients with eligible bacterial septic shock, a single rather than two or more appropriate antimicrobials was used in 226 (72.9%) patients and was also associated with higher mortality (aOR, 1.8; 95% CI, 1.0-3.3). These findings were consistent across various clinically relevant subgroups.In patients with cirrhosis and septic shock, inappropriate and delayed appropriate initial empiric antimicrobial therapy is associated with increased mortality. Monotherapy of bacterial septic shock is also associated with increased mortality. The process of selection and implementation of empiric antimicrobial therapy in this high-risk group should be restructured.
Serum vitamin A deficiency and increased intrahepatic expression of cytokeratin antigen in alcoholic liver disease
Authors: Mukunda B. Ray, Charles L. Mendenhall, Samuel W. French, Peter S. Gartside
Journal: Hepatology (1988)

The clinical and histologic significance of cytokeratin antigen expression in various intrahepatic locations was assessed in 57 patients with alcoholic liver disease as part of a large Veterans Administration Cooperative Study of Alcoholic Hepatitis. Cytokeratin antigen was demonstrated in fixed, paraffin-embedded liver tissue by an avidin-biotin peroxidase method using a mixture of two different monoclonal antibodies, AE1 (acidic; 48, 50 and 56.5 kD) and AE3 (basic; 52, 56, 58 and 65 to 67 kD). In contrast to the normal liver, in which only bile duct epithelium was positive, this antibody mixture stained both bile ducts and hepatocytes in pathologic livers. Serum levels of vitamin A showed a significant inverse correlation with the amount of cytokeratin antigen (scale: 0 to 3) in hepatocytes without Mallory bodies (p = 0.001), in Mallory body-containing hepatocytes (p < 0.0001) and in bile ducts (p = 0.0074). Increased amount of cytokeratin antigen in each of these locations, in turn, correlated directly with the histologic severity of the liver disease. Histologic severity (fibrosis, parenchymal degeneration/necrosis, hepatocyte regeneration and inflammation) was significantly higher in patients when either Mallory bodies (p < 0.0001) or cytokeratin antigen (p = 0.0021) was present in hepatocytes. Demonstration of cytokeratin antigen in hepatocytes which contained Mallory bodies correlated positively (p = 0.03) with clinical severity of the liver disease as determined by high serum bilirubin and prolonged prothrombin time (Maddrey's discriminant function). This study suggests that (i) vitamin A deficiency may be a triggering factor in aggregation of cytokeratin filaments, and (ii) the degree of aggregation of cytokeratin may determine the histologic severity and thereby the prognosis of patients with alcoholic liver disease.
Desmopressin‐induced thrombocytopenia in type i platelet discordant von willebrand disease
Authors: Giancarlo Castaman, Francesco Rodeghiero, Antonella Lattuada, Pier Mannuccio Mannucci
Journal: American Journal of Hematology (1993)

Abstract Thrombocytopenia after desmopressin (DDAVP) infusion is usually observed in patients with type IIB von Willebrand disease (vWD). No other subtypes of vWD with thrombocytopenia after DDAVP have been reported so far. We describe here the occurrence of thrombocytopenia after DDAVP in a 39 year old male and his son with phenotypic characteristics of type I vWD, 'platelet discordant subtype.' After DDAVP, the abnormal ristocetin cofactor/von Willebrand factor antigen ratio in plasma was not corrected and the bleeding time remained markedly prolonged. Platelet count dropped 30 min after DDAVP (from 279 to 96 × 10 3 /μL in the propositus and from 298 to 116 × 10 3 /μL in his affected son) and returned to normal at 60 min. Platelet clumping was evident on peripheral blood smears obtained after infusion. These cases indicate that after DDAVP thrombocytopenia can occur in vWD other than type IIB.
Periodicity in Disease
Authors: Hobart A. Reimann
Journal: New England Journal of Medicine (1957)

DURING the past decade, a number of repetitive disorders of unknown cause were assembled tentatively as a syndrome named periodic disease.1 Episodes last a few hours or days and recur in cycles often with striking regularity in seven or multiples of seven days. The disorders occur in both sexes and in all races, begin or end at any age, have remissions, have a hereditary tendency and are not significantly influenced by therapy. The general health is unimpaired except during the episodes. A few deaths have been reported.The periodic disorders at first sight seem to be unrelated entities because of . . .
Serum Cholesterol Levels and Cancer Mortality in 361662 Men Screened for the Multiple Risk Factor Intervention Trial
Authors: Roger W. Sherwin, Deborah N. Wentworth, Jeffrey A. Cutler, Stephen B. Hulley, Lewis H. Kuller, Jeremiah Stamler
Journal: JAMA (1987)

Several prospective studies have demonstrated an association between low serum cholesterol level and subsequent mortality from cancer. This finding was explored in the large cohort (361,662) of men aged 35 to 57 years who were screened for possible randomization to the Multiple Risk Factor Intervention Trial. Mortality follow-up revealed a significant excess of cancer in the lowest decile of serum cholesterol level during the early years of follow-up, which attenuated over time. In contrast, the association between high serum cholesterol and coronary heart disease did not diminish during the average of seven years of follow-up. These findings are consistent with the inference that the association between low serum cholesterol level and cancer is at least in part due to an effect of preclinical cancer on serum cholesterol level. A subset of the cohort (12,866 men) participated in the randomized Multiple Risk Factor Intervention Trial protocol, which called for annual measurements of serum cholesterol level. Among the 150 of these men who died of cancer during the trial, cholesterol level fell 22.7 mg/dL (0.59 mmol/L) more than in the survivors over an equivalent period. These data are consistent with the foregoing inference.
Application of a Highly Sensitive Detection System for Epidermal Growth Factor Receptor Mutations in Plasma DNA
Authors: Tomomi Nakamura, Naoko Sueoka-Aragane, Kentaro Iwanaga, Akemi Sato, Kazutoshi Komiya, Naomi Kobayashi, Shinichiro Hayashi, Toshiya Hosomi, Mitsuharu Hirai, Eisaburo Sueoka, Shinya Kimura
Journal: Journal of Thoracic Oncology (2012)
Carcinoembryonic Antigen
Authors: Robert H. Goslin
Journal: JAMA (1981)

In 85 patients with small cell cancer of the lung, the degree of carcinoembryonic antigen (CEA) elevation correlated with the extent of disease. Normal CEA levels (less than 2.5 ng/mL) occurred in 55% of patients with limited disease compared with 12% of patients with extensive disease. All patients with CEA levels greater than 50 ng/mL had liver involvement. Serial CEA levels were useful in monitoring response to chemotherapy and in predicting relapse. All patients with CEA values greater than 5.0 ng/mL before start of treatment had a fall in CEA level with response to treatment and a rise in CEA level when resistance to chemotherapy developed. In patients with CEA levels of less than 5.0 ng/mL at the start of treatment, rising values reflected the onset of recurrent disease in 10 or 21 patients who had relapses. The CEA levels used in conjunction with standard roentgenograms and organ scanning studies can aid in the initial staging of small cell cancer of the lung, and in monitoring treatment.
Pathogenesis of periodontitis: a major arginine-specific cysteine proteinase from Porphyromonas gingivalis induces vascular permeability enhancement through activation of the kallikrein/kinin pathway.
Authors: T Imamura, R N Pike, J Potempa, J Travis
Journal: Journal of Clinical Investigation (1994)

To elucidate the mechanism of production of an inflammatory exudate, gingival crevicular fluid (GCF), from periodontal pockets in periodontitis, we examined the vascular permeability enhancement (VPE) activity induced by an arginine-specific cysteine proteinase, Arg-gingipain-1 (RGP-1), produced by a major periopathogenic bacterium, Porphyromonas gingivalis. Intradermal injections into guinea pigs of RGP-1 (> 10(-8) M), or human plasma incubated with RGP-1 (> 10(-9) M), induced VPE in a dose- and activity-dependent manner but with different time courses for the two routes of production. VPE activity induced by RGP-1 was augmented by kininase inhibitors, inhibited by a kallikrein inhibitor and unaffected by an antihistamine drug. The VPE activity in human plasma incubated with RGP-1 also correlated closely with generation of bradykinin (BK). RGP-1 induced 30-40% less VPE activity in Hageman factor-deficient plasma and no VPE in plasma deficient in either prekallikrein (PK) or high molecular weight kininogen (HMWK). After incubation with RGP-1, plasma deficient in PK or HMWK, reconstituted with each missing protein, caused VPE, as did a mixture of purified PK and HMWK, but RGP-1 induced no VPE from HMWK. The VPE of extracts of clinically isolated P. gingivalis were reduced to about 10% by anti-RGP-1-IgG, leupeptin, or tosyl-L-lysine chloromethyl ketone, which paralleled effects observed with RGP-1. These results indicate that RGP-1 is the major VPE factor of P. gingivalis, inducing this activity through PK activation and subsequent BK release, resulting in GCF production at sites of periodontitis caused by infection with this organism.
The Community Speaks: Continuous Deep Sedation as Caregiving Versus Physician-Assisted Suicide as Killing
Authors: Carol L. Powers, Paul C. McLean
Journal: The American Journal of Bioethics (2011)

Click to increase image sizeClick to decrease image size Acknowledgments Created under the auspices of Harvard's Ethics Leadership Group and now working with Community Voices in Medical Ethics, Inc., Harvard's Community Ethics Committee was developed to serve as a resource to the ethics committees of the teaching hospitals and health care institutions affiliated with Harvard Medical School. The volunteer members of the Community Ethics Committee are drawn from within the geographic region of the Harvard hospitals and are varied as to socio-economic status, religious affiliations, cultural and language groups, and educational backgrounds. Committee members are Christine Mitchell, Co-Chair, Abdel-Rahman Mohamed, Aka I. Kovacikovs, Ann McNamara, Arnold Messing, Barbara Foot, Herman Blumberg, Julian Willard, Kathy Kaditz, Lori Bruce, Michelle DeBinion de Contreras, Molly Johnson, Uma Deshmukh, Vanea Norris, and Yvonne Joyner.
Intensive Coronary Care — A Practical System for a Small Hospital without House Staff
Authors: Gerard Church, Robert O. Biern
Journal: New England Journal of Medicine (1969)

Abstract In 300 cases of proved infarction treated in a four-bed coronary unit of simple design and low cost in a small hospital without house staff, the death rate was 18 per cent (55 cases). Only 3 per cent of the deaths were due to arrhythmias. The death rate in "mild" cases was 7 per cent, and that of patients who arrived in the first 12 hours of the illness was 17 per cent. Eighteen of 19 patients with primary ventricular fibrillation survived.
Radiology and Diagnosis of Intrathoracic Tuberculosis: The Importance of Radiology in the Diagnosis of Pulmonary Tuberculosis
Authors: H. M. Davies
Journal: BMJ (1927)

IN these days, when our therapeutics is dominated by the surgical treatment of pulmionary tuberculosis and the cvn- servative treatment of non-pulmonary tuberculosis, 'the demarcationi between the respective spheres of the physician and surgeon seems practically obliterated, and' any dis- cuIssion of their interrelation, therefore, an aD ronin,
Evidence for a Specific Seminiferous Tubular Factor Affecting Follicle-Stimulating Hormone Secretion in Man
Authors: David H. Van Thiel, Richard J. Sherins, George H. Myers, Vincent T. De Vita
Journal: Journal of Clinical Investigation (1972)

The interaction of the testis and gonadotropin secretion was studied in 15 men surviving chemotherapy for lymphoma. Azoospermia and complete destruction of all testicular germinal elements were present in 10 of the 15 men; however, Sertoli cells and Leydig cells were present. In these 10 men plasma follicle-stimulating hormone (FSH) levels were fourfold higher than in normal men of similar age whereas luteinizing hormone (LH) levels were normal. In contrast, both FSH and LH were normal in the remaining five men. Three had a full complement of spermatogenic tissue on biopsy and normal sperm concentrations. The other two men were azoospermic; one demonstrated full spermatogenesis in 30% of his tubules; the other had only a few spermatogonia in all tubules. In those patients with lower levels of gonadotropins pituitary insufficiency was excluded by the demonstration of appropriate responsiveness of FSH and LH to clomiphene administration. Similarly, Leydig cell function was normal since plasma testosterone was within the normal range in 13 of the 15 men and only slightly decreased in two. Thus, following chemotherapy, testicular damage was restricted to the germinal tissue, and this in turn was associated with a selective increase in FSH. The source of the FSH inhibitor is either the Sertoli cell or early germinal elements. However, since FSH levels are only half as high as those reported for castrate men, other testicular factors may modify FSH secretion.
The need to protect our colleagues
Authors: B W A Herriot
Journal: BMJ (1996)

Six months ago my mother died at home in her mid-70s. During her last few days I became her doctor. This is a role that I should not have taken as it placed a huge responsibility on me at a time of great emotional stress.

She has suffered from secondary breast cancer for many years but through sheer determination she continued to live life to the full. After a stroke a few years ago she could say little, but with the help of a word processor and her family she recovered well. Interestingly, she could not deal with money after this but was still able to do complicated tapestry, transferring detailed designs on to blank canvas with skill.

A few days before she died I got a telephone call during morning surgery to say that she had collapsed. Her own general practitioner visited her immediately and thought, correctly, that she had had a further cerebrovascular accident. I live seven hours' drive away so arranged to go after evening surgery, leaving my wife, who is also a general practitioner, to run the practice. On arrival in the …
Hepatic Bilirubin UDP-Glucuronyl Transferase Activity in Liver Disease and Gilbert's Syndrome
Authors: Martin Black, Barbara H. Billing
Journal: New England Journal of Medicine (1969)

A recently described method for assaying the specific hepatic enzyme responsible for the conjugation of bilirubin was applied to specimens of liver obtained at laparotomy or by percutaneous needle biopsy. Seventy-nine patients with parenchymatous liver disease, biliary obstruction or Gilbert's syndrome were studied, and the results obtained were compared with those from 11 patients without liver disease. A reduction in enzyme activity was observed in each of the 11 patients with Gilbert's syndrome, and in the four patients with Wilson's disease. Biliary obstruction appeared to cause an increase in the activity of the enzyme.
The Diagnostic Importance of the Normal Finding
Authors: G. Anthony Gorry, Stephen G. Pauker, William B. Schwartz
Journal: New England Journal of Medicine (1978)

When a diagnostic test is reported as normal, the clinician generally uses it only to rule out certain diseases. However, if properly interpreted, the normal value may help to differentiate among diagnoses that yield normal results with different frequencies. A simple method permits the extraction of such information. The physician estimates the probability of various diagnoses and then combines these estimates with the anticipated frequency of negative results for each disease under consideration.