tbuckley/cabot-search huggingface dataset:
Binge Drinking in College
Authors: Brian J. Bohlmann
Journal: JAMA (1995)

<h3>To the Editor.</h3> —Dr Wechsler and colleagues<sup>1</sup>provide an excellent assessment of the effects of binge drinking among college students, including "secondary binge effects" on nonbinging or nondrinking students. I propose that similar secondary effects occur among nondrinking students in medical school. When I started medical school in 1983, out of my class of 169, there were no more than five other nondrinkers. As one of the nondrinking students, I came under regular and frequent pressure from many members of the freshman class to drink alcohol when I attended class events. This pressure left me feeling alienated and added unnecessary stress during my freshman year. I regarded this pressure to drink alcohol as significant because I had never experienced similar pressure during high school or college. Even the medical school administration seemed to regard alcohol as an essential part of social interaction within our profession. I have already recounted
Another hazard of gold therapy?
Authors: R A Fulton, R D Sturrock, H Capell
Journal: Annals of the Rheumatic Diseases (1982)

A patient with seropositive rheumatoid developed a bullous eruption localised to the jewellery areas 12 hours after a test dose of sodium aurothiomalate (Myocrisin). Investigation showed that she was allergic to nickel rather than gold. Small quantities of nickel were found in the Myocrisin solution after a short contact with a metal needle, suggesting an explanation for the reaction.
Cofactors Required for TLR7- and TLR9-Dependent Innate Immune Responses
Authors: Chih-yuan Chiang, Alex Engel, Amanda M. Opaluch, Irene Ramos, Ana M. Maestre, Ismael Secundino, Paul D. De Jesus, Quy T. Nguyen, Genevieve Welch, Ghislain M.C. Bonamy, Loren J. Miraglia, Anthony P. Orth, Victor Nizet, Ana Fernandez-Sesma, Yingyao Zhou, Gregory M. Barton, Sumit K. Chanda
Journal: Cell Host & Microbe (2012)
Asymptomatic Hyperinsulinemic Hypoglycemia after Gastric Banding
Authors: Marina Scavini, Antonio E. Pontiroli, Franco Folli
Journal: New England Journal of Medicine (2005)

To the Editor: Service et al. (July 21 issue)1 recently reported on six patients with hyperinsulinemic hypoglycemia and nesidioblastosis after Roux-en-Y gastric bypass surgery. The authors postulated that the rapid presentation of nutrients in the duodenum stimulated excessive secretion of glucagon-like peptide 1, leading to islet-cell hypertrophy, proliferation, and neogenesis. This report prompted us to review the incidence of hyperinsulinemic hypoglycemia after laparoscopic adjustable gastric banding (LAGB), the most common bariatric procedure performed in Europe. This procedure effectively achieves gastric restriction and a durable weight loss in obese patients without permanently altering the intestinal anatomy, improves insulin resistance, and prevents . . .
Academic Physicians' Participation in Organized Medicine
Authors: Arthur H. Herold
Journal: JAMA (1995)

To study the relationship of state medical societies to their medical schools, two cross-sectional surveys were conducted. The first was a survey of the medical society executive directors of the 46 states and US sovereign territories that have medical schools within their borders. Directors were asked to compare academic and community physician participation (membership and member involvement) in the medical society and describe the characteristics of the medical society's medical school unit (eg, how formalized it is and its design, composition, and level of interaction). The unit's characteristics were compared with the amount of academic physician participation. Data about physician membership in state medical societies and the American Medical Association (AMA) were obtained from the AMA Physician Masterfile. Significantly fewer academic physicians than community physicians were members of the state medical society or the AMA (38.1% vs 52.0%,<i>P</i>&lt;.001, and 32.8% vs 41.7%,<i>P</i>&lt;.001, respectively). Academic physician members were less likely than community physician members to be involved in medical society activities. Twenty-eight (60.9%) of 46 medical societies had no formalized structure for the unit that represents academic physicians at the medical society. The unit's characteristics had no significant relationship to academic physician membership or member involvement. This first survey and the AMA data suggest that academic physicians were significantly less likely to participate in medical society activities or join the AMA than community physicians, and the way in which medical schools and medical societies interface did not appear to influence participation. The second survey was carried out at the four academic medical centers in Florida. All academic physicians were surveyed about their attitudes toward organized medicine. Academic physicians reported that the annual dues were not reasonable relative to the benefit derived, but other data in this study suggested that reducing dues would not necessarily increase membership. Academic physicians also reported that their administration did not reward their participation in organized medicine and thought participation was less relevant to academic physicians than community physicians, but admitted a knowledge deficit regarding organized medicine. These findings suggest that reducing dues may not be sufficient to increase academic physician participation in organized medicine, but that changing the reward system within the medical school and increasing academic physicians' awareness of organized medicine's value to them may be ways to influence participation. (<i>JAMA</i>. 1995;274:1727-1732)
Short-Term Effects of Variceal Sclerotherapy on Portal Hypertensive Gastropathy
Authors: H. Boldys, T. Romanczyk, M. Hartleb, A. Nowak
Journal: Endoscopy (1996)

Obliteration of esophageal varices may modify the mucosal perfusion of the stomach. The relationship between short-term injection variceal sclerotherapy (IVS) and the evolution of portal hypertensive gastropathy (PHG) is insufficiently recognized.Forty-one cirrhotic patients were treated with hemostatic or secondary preventive IVS. They underwent sclerotherapy at intervals of four to five days until esophageal ulceration, stricture, or a reduction in variceal size developed. On admission and on completing the IVS schedule, an endoscopy score was calculated using a system assigning 0 points for a normal mucosal image, 1 point for reddened, 2 points for a mosaic-like mucosal pattern, and 3 points for a mosaic-like pattern plus red marks in the stomach. All patients received propranolol after the first sclerotherapy session.The total score before IVS was 45 points (1.1 points per patient). After 188 sclerotherapy sessions (2-8 per patient), the score significantly increased to 73 points (1.8 points per patient, P = 0.04). This effect was particularly marked in Child-Pugh class B patients (mean individual rise from 0.7 to 1.9 points, P = 0.01), and negligible in patients with either less or more advanced cirrhosis (Child-Pugh classes A and C).In patients with cirrhosis, short-term IVS may contribute to the mechanisms of progressive PHG.
Pfizer stops clinical trials of heart drug
Authors: Janice Hopkins Tanne
Journal: BMJ (2006)

Pfizer, the world's largest drug company, suddenly halted phase III clinical trials of torcetrapib on 2 December. Torcetrapib is a new agent that increases concentrations of “good” high density lipoprotein (HDL) cholesterol. 

Only two days earlier, Pfizer executives had said that they hoped to ask the US Food and Drug Administration for approval next year, and the company issued a financial statement: “Company highlights torcetrapib-atorvastatin and cholesteryl ester transfer protein research as most important new development in cardiovascular medicine in years.” 

Pfizer said that “in the interests of patient safety” it was stopping the clinical trials of torcetrapib (called Illuminate) because the independent data safety monitoring board found more deaths and cardiovascular events …
Of Cats, Humans, and Bartonella
Authors: Lucy S. Tompkins
Journal: New England Journal of Medicine (1997)

Bacillary angiomatosis and bacillary peliosis are new opportunistic infections that were first recognized at the beginning of the AIDS epidemic. They are caused by Bartonella henselae and B. quintana, tiny gram-negative bacilli that are difficult to cultivate in the laboratory.1,2 These diseases are characterized by angioproliferative lesions that resemble those of Kaposi's sarcoma (shown in the Image in Clinical Medicine elsewhere in this issue3) in the skin, bone, and many other organs (where the condition is known as bacillary angiomatosis) or the liver and spleen (where it is called peliosis hepatis). At about the same time, the mysterious . . .
COMPARISON OF EST AND ANTIDEPRESSANT DRUGS IN AFFECTIVE DISORDERS
Authors: JANE E. OLTMAN, SAMUEL FRIEDMAN
Journal: American Journal of Psychiatry (1961)

Because of limited temporal factors, it is difficult at present to compare the incidence of "long-term" remissions (2 years or more) in patients treated by EST and those treated with antidepressant drugs. In "psychotic" depressions, treatment relapses, as defined, are certainly not more frequent in drug-treated patients than in the EST group. In "neurotic" depressions, results, with respect to relapses, are definitely more favorable following drug therapy. Premature discontinuation of the drug will lead to a greater incidence of relapses. As a corollary to this, patients treated with drug therapy require more continued follow-up care than those treated by EST. Contrary to our earlier hopes, it is evident that drugs will not affect the recurrent pattern of affective disorders–no more than EST has done. The pattern of repetition of attacks varies greatly from one patient to another.
Radiographic examination of the lumbar spine in a community hospital: an audit of current practice.
Authors: S F Halpin, L Yeoman, D D Dundas
Journal: BMJ (1991)

OBJECTIVE--To assess general practitioners9 decisions to request lumbar spine radiographs according to the guidelines of the Royal College of Radiologists. DESIGN--Prospective questionnaire survey of outpatients attending for lumbar spine radiography. SETTING--London community hospital. SUBJECTS--100 consecutive adult outpatients attending for lumbar spine radiography at their general practitioner9s request. MAIN OUTCOME MEASURES--Patient9s history and clinical signs; radiological diagnosis; change in management of patients with significant radiological abnormality in response to the radiologist9s report. RESULTS--60 patients were aged between 18 and 45, 27 (45%) of whom were women. Five patients were fully examined by their doctor before radiographs were requested, 76 were partially examined, and 19 were not examined. In 37 patients the examinations showed radiologically normal findings; 30 had radiologically significant disc or degenerative disease. Pain score and radiological diagnosis was not correlated (6.43 (range 1-10) for patients with significant disease v 6.14 (range 1-10) for those without, p greater than 0.05). There were no cases of malignancy or infection. One patient with radiologically significant disease was referred to a hospital specialist, and the management of only two such patients was altered by the report. 52 of the examinations should not have been requested if the guidelines had been strictly applied. CONCLUSIONS--There is a need to inform doctors of the efficacy of radiological examinations. An awareness of the college9s guidelines among general practitioners should be actively promoted by radiologists.
Body-Mass Index and Mortality among 1.46 Million White Adults
Authors: Amy Berrington de Gonzalez, Patricia Hartge, James R. Cerhan, Alan J. Flint, Lindsay Hannan, Robert J. MacInnis, Steven C. Moore, Geoffrey S. Tobias, Hoda Anton-Culver, Laura Beane Freeman, W. Lawrence Beeson, Sandra L. Clipp, Dallas R. English, Aaron R. Folsom, D. Michal Freedman, Graham Giles, Niclas Hakansson, Katherine D. Henderson, Judith Hoffman-Bolton, Jane A. Hoppin, Karen L. Koenig, I-Min Lee, Martha S. Linet, Yikyung Park, Gaia Pocobelli, Arthur Schatzkin, Howard D. Sesso, Elisabete Weiderpass, Bradley J. Willcox, Alicja Wolk, Anne Zeleniuch-Jacquotte, Walter C. Willett, Michael J. Thun
Journal: New England Journal of Medicine (2010)

A high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.
Aortic Valvuloplasty — A Valid Alternative?
Authors: Peter C. Block
Journal: New England Journal of Medicine (1988)

The introduction of percutaneous balloon aortic valvuloplasty for the treatment of aortic stenosis has complicated decision making concerning elderly patients with this degenerative cardiac disease. Physicians have been reluctant to refer many elderly patients with aortic stenosis to cardiac surgery because other medical problems, associated coronary disease, or the frailty of the patient seemed to make the operative risk prohibitive. With the introduction of balloon aortic valvuloplasty,1 2 3 there is now a therapeutic alternative to conservative medical therapy or cardiac surgery. Valvuloplasty has been recommended instead of surgical replacement of the valve in patients who are elderly or at high risk. . . .
Cardiac surgery in the elderly.
Authors: A. T. Elder, E. W. Cameron
Journal: BMJ (1989)

ment and only partially restores the sulcal changes a chronic anorexic state has been suggested to cause persisting morphological changes in the brain.'3Although bulimia nervosa was originally described as an ominous variant of anorexia nervosa,"A the short term outcome in the two disorders seems similar5"-but because bulimia nervosa is an episodic condition the short term findings may be misleading.An observation that mortality in bulimia nervosa was as high as in anorexia nervosa gives some support for a pessimistic view of the disorder, but until longer term follow up of persisting eating disturbance is reported this view remains unsubstantiated.7
Maximal bronchoconstriction in humans. Relationship to deep inhalation and airway sensitivity.
Authors: R Pellegrino, B Violante, V Brusasco
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

We hypothesized that maximal bronchoconstriction can be predicted from the bronchomoter effect of deep inhalation (DI) and the degree of airway sensitivity to methacholine (MCh). We studied 26 healthy or mildly asthmatic subjects with limited response to MCh (maximal FEV1 decrease, 23 +/- 9 SD%; Group 1) and 26 subjects with moderate to severe asthma with exaggerated response (maximal FEV1 decrease > 40%, Group 2). The effect of DI was quantified as the linear regression coefficient of the percent decrements of maximal (Vm50) versus partial (Vp50) forced expiratory flow at 50% of FVC over the initial steps of challenge (MP slope). Airway sensitivity was inferred from the MCh doses (PDs) causing Vm50 or Vp50 to decrease by 40% or FEV1 by 15%. The absence of limit to bronchonstriction was predicted by either MP slope or any PD with accuracies between 71 and 81%, but with an accuracy of 87% by a discriminant function including MP slope and PD40Vp50. Within Group 1, the maximal FEV1 decrease correlated linearly with MP slope (r2 = 0.41); but it was better predicted by a multiple regression including MP slope and PD40Vp50 (In mg) (r2 = 0.54). We conclude that the magnitude of the bronchodilator effect of DI during induced bronchoconstriction and airway sensitivity predict the level of maximal bronchoconstriction in vivo. We speculate that these parameters reflect some of the mechanisms modulating the response to bronchoconstrictor stimuli such as airway wall structure, airway-to-parenchymal interdependence, and contractile properties of airway smooth muscle.
Immediate Blood Transfusion in Obstetric Shock
Authors: I. S. Fox
Journal: BMJ (1943)

Immediate Blood Transfusion in Obstetric ShockThe following record shows the value of immediate blood transfusion in a case of obstetric shock with normal labour and without excessive haemorrhage. CASE HISTORYMrs. B., a primipara aged 28, started labour pains in the early hours of July 28, 1943.Uneventful first and second stages of labour resulted in the normal birth of a female child at 9 p.m.
Controlled trial of antituberculous chemotherapy in Crohn's disease: a five year follow up study
Authors: G A O Thomas, G L Swift, J T Green, R G Newcombe, C Braniff-Mathews, J Rhodes, S Wilkinson, G Strohmeyer, G Kreuzpainter
Journal: Gut (1998)

<i>Background</i>—It has been suggested that<i>Mycobacterium paratuberculosis</i> is the cause of Crohn's disease. In a previous report the immediate effect of two years treatment with antituberculous chemotherapy showed no clinical benefit. <i>Aims</i>—To assess both the immediate and longer term effect of treatment on the disease. <i>Methods</i>—Patients were followed for five years from their date of entry to the study. One hundred and thirty patients entered the initial study, and of these 111 (81%) were followed regularly. <i>Results</i>—Overall, there was no evidence of consistent benefit or disadvantage from antituberculous chemotherapy in any of the assessments made, including the number of acute relapses, surgical episodes, hospital admissions, disease activity, blood tests, or medication required for Crohn's disease during the follow up period. <i>Conclusion</i>—The absence of any benefit at the end of the initial two year trial period, and during the three year subsequent follow up, fails to support the hypothesis that mycobacteria play an important part in the pathogenesis of Crohn's disease, or that antituberculous chemotherapy may be of benefit.
Stunned myocardium after rapid correction of acidosis. Increased oxygen cost of contractility and the role of the Na(+)-H+ exchange system.
Authors: K Hata, T Takasago, A Saeki, T Nishioka, Y Goto
Journal: Circulation Research (1994)

Left ventricular (LV) contractile dysfunction during acidosis has been reported to be almost reversible in crystalloid-perfused hearts after correction of acidosis. In contrast, we have found that, in blood-perfused hearts, contractile function is paradoxically depressed after correction of acidosis with a transient overshoot of contractility during the recovery of pH. To clarify the mechanism of this phenomenon, we measured the LV contractility index (Emax) and the relation between myocardial oxygen consumption (VO2) and systolic pressure-volume area (PVA, a measure of the LV total mechanical energy) before and after induction and rapid correction of acidosis by CO2 loading (pH 7.00) and unloading in 13 excised cross-circulated canine hearts. During the rapid correction of acidosis in six control hearts, a severe transient overshoot of Emax (404% of acidosis) occurred. However, after correction of acidosis, Emax and PVA were lower than the preacidosis values by 46% (P &lt; .01) and 44% (P &lt; .01) at the same LV volume. When the preacidosis Emax level was restored by Ca2+ infusion, the VO2 intercept (PVA-independent VO2) of the linear VO2-PVA relation exceeded the control value by 18% (P &lt; .05) with an unchanged slope. In addition, the oxygen cost of contractility, defined as the slope of the relation between PVA-independent VO2 and Emax, increased by 83% (P &lt; .01) after correction of acidosis, indicating that postacidosis myocardium requires higher VO2 for nonmechanical activities for a unit increase in Emax. Then, we hypothesized that these mechanoenergetic disorders after rapid correction of acidosis would result from Ca2+ overload via accelerated Na(+)-Ca2+ exchange due to the heavily operating Na(+)-H+ exchange system at the time of rapid pH recovery. To examine this hypothesis, dimethylamiloride, a selective Na(+)-H+ exchange inhibitor, was administered just before the correction of acidosis in the other seven hearts. The administration of dimethylamiloride completely prevented both the mechanical and energetic disorders after correction of acidosis. We conclude that rapid recovery of pH paradoxically depresses myocardial contractility and increases the oxygen cost of contractility through an activation of the Na(+)-H+ exchange system.
Collective Accountability for Medical Care — Toward Bundled Medicare Payments
Authors: Glenn Hackbarth, Robert Reischauer, Anne Mutti
Journal: New England Journal of Medicine (2008)

Medicare's projected spending growth is unsustainable. The program already strains the resources of beneficiaries and taxpayers alike and will someday crowd out other public- and private-sector priorities, given that Medicare spending as a percentage of the gross domestic product is expected to nearly double in the next 20 years. At the same time, neither beneficiaries nor taxpayers are getting good value from the program. Per-beneficiary spending in high-spending regions of the country exceeds that in low-spending regions by one third, and yet beneficiaries in high-spending regions receive no better quality of care.1 The incentives inherent in the dominant fee-for-service payment . . .
RU 486: The Pill That Could End the Abortion Wars and Why American Women Don't Have It
Authors: Steve Heilig
Journal: JAMA (1991)

The continuing saga of the French-developed antiprogesterone drug RU-486 is already ripe for a full length exploration. Veteran journalist and abortion-rights activist Lawrence Lader has produced the first of what will probably become a long list of such books. While his effort has some shortcomings, it is also a fascinating and valuable contribution to our understanding of this complex sociomedical issue. Although RU-486 has been exhaustively researched in many nations, and over 60 000 women in France have now utilized the drug for obtaining an early nonsurgical abortion, American research of both its proven abortifacient and other promising clinical applications is at a virtual standstill. Lader states his conclusion about this situation early in his book: "RU 486, perhaps more than any drug in our history, will reach the public through votes and political clout rather than through scrutiny for safety and effectiveness." To date, his statement appears to be
Prevention of secondary cases of meningococcal disease in household contacts by vaccination.
Authors: B M Greenwood, M Hassan-King, H C Whittle
Journal: BMJ (1978)

Household contacts of patients with group A meningococcal infection were vaccinated with either meningococcal vaccine or tetanus toxoid. Five of the 523 subjects who received tetanus toxoid developed meningococcal meningitis and another four probably had meningococcal disease. Only one possible case of meningococcal infection occurred among 520 contacts vaccinated with meningococcal vaccine. Vaccination had no effect on nasopharyngeal carriage of meningococci. Vaccination of household contacts of patients with group A meningococcal infections is an effective way of using limited supplies of meningococcal vaccine, though its value would be limited in an epidemic. Secondary cases of meningococcal infection often occur within a few days of the index case, and, although vaccine alone seemed to provide adequate prophylaxis in these Nigerian subjects, additional chemoprophylaxis may be needed to cover this critical period.
The Value of Bronchodilator Administration in Asthmatic Patients Before Lung Imaging
Authors: PAUL J. ROACH, S TED TREVES
Journal: Clinical Nuclear Medicine (1995)

A 17-year-old boy with chest pain and severe bronchospasm underwent lung imaging to exciude pulmonary embolism. This showed widespread nonsegmental defects in both the ventilation and perfusion scans. A repeat study performed Immediately after nebulized bronchodilator administration was normal apart from changes consistent with left lower lobe pneumonia and atelectasis which had subsequently evolved on the chest radiograph. Bronchodilator administration is valuable in improving the accuracy of lung scanning in asthmatic patients by reducing the perfusion and ventilation abnormalities caused by hypoxia-induced vasoconstriction.