tbuckley/cabot-search huggingface dataset:
Black and blue . . . and unconscious
Authors: M. v. Onna, T. v. Bemmel, E. v. Wensen, C. Schaar, H. Slis, P. E Spronk
Journal: BMJ (2009)

A comatose 29 year old male was brought to the emergency department of our hospital. The patient was an international truck driver, and he and his co-driver had slept the night before in their truck at a car park near the motorway. The next morning, the co-driver found the patient in a comatose state in the sleep cabin of their truck. The attending neurologist observed a Glasgow coma score of four (E1-M2-V1) with fixed dilated pupils and no cornea and ocular cephalic brainstem reflexes. Furthermore, the patient had multiple petechiae on the left side of the throat and symmetrical bruises on the anterior medial side of both upper legs. Otherwise, physical investigation was unremarkable. ### Short answers
Effect of estradiol upon serum enzymes in primary biliary cirrhosis
Authors: Joseph M. Guattery, William W. Faloon
Journal: Hepatology (1987)

The repeated observation of a fall in serum enzymes at midmenstrual cycle in an untreated patient with primary biliary cirrhosis stimulated a study of estrogen administration in five patients with primary biliary cirrhosis. One patient was premenopausal, one patient was postmenopausal and three had had oophorectomy. After 2 weeks of ethinyl estradiol, AST was under 100 IU per dl in all and had decreased by 50% or more in 4 of 5 patients. γ-glutamyltransferase and alkaline phosphatase fell by 50 and 30% or more, respectively, in all patients. The decreases in serum enzymes were statistically significant in all patients for γ-glutamyltransferase, in 4 of 5 for AST and in 3 of 5 for alkaline phosphatase. One patient developed increased icterus leading to withdrawal of estradiol. Withdrawal of estradiol was followed by return toward control values over variable periods, usually 1 to 4 weeks. Repeated courses of estradiol reproduced these enzyme changes. These observations indicate that estradiol in the doses used (0.05 mg per day) reversibly lowers serum enzyme values in biliary cirrhosis. The mechanism of the effect is unexplained, but an immune system alteration may be responsible.
Outcomes of Tamoxifen Chemoprevention for Breast Cancer in Very High-Risk Women: A Cost-Effectiveness Analysis
Authors: Dawn Hershman, Vijaya Sundararajan, Judith S. Jacobson, Daniel F. Heitjan, Alfred I. Neugut, Victor R. Grann
Journal: Journal of Clinical Oncology (2002)

PURPOSE: To estimate the effects on survival, quality-adjusted survival, and health care costs of using tamoxifen for primary prevention in subgroups of women at very high risk for breast cancer. PATIENTS AND METHODS: A decision analysis was performed using a hypothetical cohort of women that included subgroups with atypical hyperplasia, Gail risk greater than 5, lobular carcinoma-in-situ, or two or more first-degree relatives with breast cancer. Data sources were the Breast Cancer Prevention Trial, the Surveillance, Epidemiology, and End-Results program, time trade-off preference ratings, the Group Health Cooperative of Puget Sound, and the United States Health Care Financing Administration. RESULTS: Our model predicted that tamoxifen would prolong the average survival of cohort members initiating use at ages 35, 50, and 60 years by 70, 42, and 27 days, respectively. It would prolong survival even more for those in the higher-risk groups, especially those with atypical hyperplasia (202, 89, and 45 days). Tamoxifen use was also projected to extend quality-adjusted survival by 158, 80, and 50 days in the atypical hyperplasia group. For younger women in the highest risk groups, chemoprevention with tamoxifen was estimated to have cost savings or be cost-effective, both with and without quality adjustments. CONCLUSION: Chemoprevention with tamoxifen may be particularly beneficial to women with atypical hyperplasia, 5-year Gail model risk greater than 5%, lobular carcinoma-in-situ, or two or more first-degree relatives with breast cancer. The benefits may be greater if tamoxifen is initiated before age 50 years rather than after and if the breast cancer risk reduction conferred by tamoxifen lasts longer than 5 years. For women with a very high risk of invasive breast cancer, chemoprevention with tamoxifen seems to be cost-effective.
Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis
Authors: Paul Angulo, Jill C. Keach, Kenneth P. Batts, Keith D. Lindor
Journal: Hepatology (1999)

Nonalcoholic steatohepatitis (NASH) may present with increased hepatic fibrosis progressing to end-stage liver disease. No factors that determine increasing fibrosis and histologically advanced disease have been recognized, thus, liver biopsy is recommended in all patients for diagnosis and prognosis. Our aim was to identify independent predictors of severe hepatic fibrosis in patients with NASH. One hundred and forty-four patients were studied. All patients underwent liver biopsy. Clinical and biochemical variables were examined with univariate and multivariate analysis. Thirty-seven (26%) patients had no abnormal fibrosis, 53 (37%) had mild fibrosis, 15 (10%) had moderate fibrosis, 14 (10%) had bridging fibrosis, and 25 (17%) had cirrhosis. In multivariate analysis, older age (P =. 001), obesity (P =.002), diabetes mellitus (P =.009), and aspartate transaminase/alanine transaminase (AST/ALT) ratio greater than 1 (P =.03) were significant predictors of severe liver fibrosis (bridging/cirrhosis). Body mass index (P =.003) was the only independent predictor of the degree of fat infiltration. Increased transferrin saturation correlated positively with the severity of fibrosis (P =.02) in univariate analysis, and there was a trend for more female patients among those with more advanced fibrosis (P =. 09). However, iron studies or gender were not significant when controlled for age, obesity, diabetes, and AST/ALT ratio. In conclusion, older age, obesity, and presence of diabetes mellitus help identify those NASH patients who might have severe liver fibrosis. This is the subgroup of patients with NASH who would be expected to derive the most benefit from having a liver biopsy and considering investigational therapies.
Testing Knowledge — Doctors and the Drug Industry — Difficult Post
Authors: John Lister
Journal: New England Journal of Medicine (1971)

DR. John Stokes, who has made a study of the various examination systems available for testing the knowledge of medical undergraduates and also of postgraduates, recently gave a local medical society the benefit of his views. He believed that in spite of all the disadvantages of examinations, they were bound to continue in some form or other both because man can be a lazy animal and because he wants to know where he stands in relation to his fellows. He thought, however, that there was much to be said for continuous assessment schemes and favored the system whereby students are . . .
Assessing cost‐effectiveness in asthma care: building an economic model to study the impact of alternative intervention strategies
Authors: S.D. Sullivan, K.B. Weiss
Journal: Allergy (1993)

Expenditures for medical care services continue to rise as a proportion of the total Gross Domestic Product (GDP) in most countries. Because a large share of resources are increasingly being spent on medical care services, there is a need to more closely examine the quality, cost and efficiency of all aspects of health care delivery. One method for assessing efficiency is cost‐effectiveness analysis. Many of the elements of a basic cost‐effectiveness model for asthma care are available, including accepted relevant studies on societal cost‐of‐illness, accepted health outcomes relevant to good clinical care, and a selection of potential intervention strategies, both for prevention and control. The purpose of this paper is to illustrate how an economic approach to decision‐making can be used to assess the potential impact of alternative intervention strategies for asthma care. Two case studies are developed including a new management strategy for the chronic care of stable moderate asthma and a management strategy for the early detection and prevention of childhood asthma. It is proposed that economic modeling of possible intervention strategies can serve as a useful method for determining the potential impact (in terms of cost‐effectiveness) of a proposed intervention strategy well in advance of any ernpiric clinical trials. Analysis such as these may prove valuable in protecting researchers from developing intervention strategies that are clinically efficacious but cost‐ineffective and, therefore, are unlikely to be adopted by providers/payers I of medical care services for asthmatics.
Medical Science and Medical Industry: The Formation of the American Pharmaceutical Industry
Authors: Norman Gevitz
Journal: JAMA (1988)

This volume examines the American pharmaceutical industry between 1890 and 1930, when, the author argues, it developed the outline of its modern organizational form. Centering his study on Philadelphia, one of the capitals of drug manufacture, Liebenau concerns himself with how science and technology transformed the operations of existing firms and launched newly structured businesses to meet the changing environment. One of the virtues of this study is that the author grounds his analysis of this particular economic sector in the context of what was taking place within American industry generally. Thus, Liebenau allows us to see which structural alterations in the drug companies he studied are due more to developments specific to the industry itself and which are more macroeconomic in nature. Certainly, all manufacturing in this era was marked by a greater rationalization of work, changes in the processes of production and distribution, improvements in communication and transportation,
Cost-effective Treatment of Depression-Reply
Authors: Roland Sturm
Journal: JAMA (1995)

<h3>In Reply.</h3> —Can quality improvement interventions raise the value of care for depression in 1995? Dr Solomon suggests that much of the quality improvement needed to increase the value of care has already occurred because recent studies and the publicity surrounding newer antidepressant medications have raised physician awareness of depression. We doubt that quality of care has improved so much since the late 1980s that it invalidates our studies because treatment rates were extremely low. For example, only one fifth of the most seriously depressed patients in general medical practices received appropriate antidepressant medications. Even a doubling of this rate remains substantially below the level we modeled for quality improvement. Such a doubling is unlikely to have occurred because it would require that almost all detected cases receive appropriate antidepressant medication. In the MOS, we identified excess use of minor tranquilizers as one source of inefficient care. Some clinicians have
Immunological, cytochemical and ultrastructural studies in lymphomatoid papulosis
Authors: R. WILLEMZE, E. SCHEFFER, D.J. RUITER, W.A. VLOTEN, C.J.L.M. MEIJER
Journal: British Journal of Dermatology (1983)

Journal Article Immunological, cytochemical and ultrastructural studies in lymphomatoid papulosis Get access R. WILLEMZE, R. WILLEMZE R.Willemze, Department of Dermatology, University Hospital, Rijnsburgerweg 10, 2333 AA Leiden, The Netherlands. Search for other works by this author on: Oxford Academic Google Scholar E. SCHEFFER, E. SCHEFFER Departments of Dermatology and Pathology, University Medical Centre, Leiden, The Netherlands Search for other works by this author on: Oxford Academic Google Scholar D.J. RUITER, D.J. RUITER Departments of Dermatology and Pathology, University Medical Centre, Leiden, The Netherlands Search for other works by this author on: Oxford Academic Google Scholar W.A. VAN VLOTEN, W.A. VAN VLOTEN Departments of Dermatology and Pathology, University Medical Centre, Leiden, The Netherlands Search for other works by this author on: Oxford Academic Google Scholar C.J.L.M. MEIJER C.J.L.M. MEIJER Departments of Dermatology and Pathology, University Medical Centre, Leiden, The NetherlandsDepartment of Pathology, S.S.D.Z., Delft, The Netherlands Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 108, Issue 4, 1 April 1983, Pages 381–394, https://doi.org/10.1111/j.1365-2133.1983.tb04591.x Published: 01 April 1983 Article history Accepted: 03 November 1982 Published: 01 April 1983
BRAIN NATRIURETIC PEPTIDE AS A PREDICTOR OF CLINICAL ADVERSE EVENTS IN CARDIAC SURGERY: A SINGLE-CENTER PROSPECTIVE STUDY
Authors: Jamil Murad, Mauricio Machado, Thais Helena Pereira Martins, Lilia Nigro Maia, Marcelo Arruda Nakazone
Journal: Journal of the American College of Cardiology (2012)
Language is shaped for social interactions, as well as by the brain
Authors: Mikkel Wallentin, Chris D. Frith
Journal: Behavioral and Brain Sciences (2008)

Abstract Language learning is not primarily driven by a motivation to describe invariant features of the world, but rather by a strong force to be a part of the social group, which by definition is not invariant. It is not sufficient for language to be fit for the speaker's perceptual motor system. It must also be fit for social interactions.
A multicenter randomized controlled dose study of ursodeoxycholic acid for chronic hepatitis C
Authors: Susumu Takano, Yoshimi Ito, Osamu Yokosuka, Masao Ohto, Katsuo Uchiumi, Katsutaro Hirota, Masao Omata
Journal: Hepatology (1994)

The effect of ursodeoxycholic acid on liver function tests and on bile acid metabolism was investigated in a multi-center randomized controlled dose study for chronic hepatitis C. Twenty, 18 and 19 patients were administered 150, 600 and 900 mg/day, respectively of ursodeoxycholic acid every day for 16 wk. Serum liver parameters and bile acid composition in the treatment groups were compared with 17 control patients. A similarly significant decrease of serum alanine aminotransferase and serum gamma-glutamyltransferase was observed in patients administered 600 and 900 mg of ursodeoxycholic acid. Serum bile acid composition was determined by high-performance liquid chromatography. At entry, the relative proportions of major bile acids were similar to those observed in normal individuals. Maximal concentrations of total ursodeoxycholic acid were 0.30 mumol/L, 5.59 mumol/L, 21.42 mumol/L and 14.73 mumol/L in the control, 150, 600 and 900 mg/day groups, respectively. The fraction of the total ursodeoxycholic acid increased in a dose-dependent manner, and it was significantly higher than in controls (p < 0.001). The hydrophobicity index of bile acids was calculated by the method of Heuman, and its correlation with serum parameter levels was analyzed. In the 600 and 900 mg/day dose groups, serum alanine aminotransferase decreased in the cases in which hydrophobicity index significantly decreased during treatment. The same correlation was observed between the hydrophobicity index and serum gamma = glutamyltransferase in these two groups. There was no correlation between these parameters in the control and 150-mg groups. There was no correlation between reduction rate of serum alanine aminotransferase and initial liver histology.(ABSTRACT TRUNCATED AT 250 WORDS)
Methicillin-Resistant Staphylococcus aureus: Introduction and Spread Within a Hospital
Authors: JAMES E. PEACOCK
Journal: Annals of Internal Medicine (1980)

In March 1978, a strain of methicillin-resistant Staphylococcus aureus was introduced from the community into a university hospital. Within 6 months of admission of the index case, methicillin-resistant 5. aureus was isolated from 30 additional patients, 22 of whom were epidemiologically linked by a common phage type (6/47/54/75/83A) and roommate-to-roommate spread. Sixteen of 31 cases were infected, six with bacteremia. Patients with infections received cephalosporins more frequently before infection than did control subjects (p < 0.05). Patients acquiring methicillin-resistant S. aureus in the intensive care unit had a longer mean stay, had higher overall mortality, and received nafcillin and aminoglycosides more frequently than did cohorted control subjects. By mid-1979, methicillin-resistant S. aureus accounted for 38%, 31%, and 24% of all nosocomial S. aureus postoperative wound, pulmonary, and bloodstream infections, respectively. In hospitals with significant methicillin-resistant 5. aureus isolation rates, initial empiric therapy of presumed S. aureus infection with vancomycin seems warranted.
A Once-Weekly R207910-containing Regimen Exceeds Activity of the Standard Daily Regimen in Murine Tuberculosis
Authors: Nicolas Veziris, Murad Ibrahim, Nacer Lounis, Aurelie Chauffour, Chantal Truffot-Pernot, Koen Andries, Vincent Jarlier
Journal: American Journal of Respiratory and Critical Care Medicine (2008)

R207910 (TMC207 or J) is a member of the diarylquinolines, a new family of antituberculous drugs with high bactericidal activity when given daily in the murine model of tuberculosis. R207910 exhibits a long half-life and thus is a good candidate for once-weekly therapy of tuberculosis.To study the activity of once-weekly R207910 monotherapy and combinations of R207910 with other antituberculous agents (isoniazid, rifapentine, moxifloxacin, and pyrazinamide).The established infection model of murine tuberculosis was used. Colony counts were determined in the lungs.Eight weeks of monotherapy reduced the bacillary load by 3 to 4 log(10) for rifapentine and by 5 to 6 log(10) for R207910 (P < 0.05). The addition of rifapentine and isoniazid or moxifloxacin did not improve the bactericidal activity of R207910 monotherapy. In contrast, the triple combination of R207910 plus rifapentine plus pyrazinamide given once weekly for 2 months (i.e., a total of only eight administrations), was significantly (P < 0.05) more active than R207910 monotherapy or other R207910 combinations, and led to lung culture negativity in 9 of 10 mice, whereas all lungs were culture positive in the groups treated with other drug combinations. Moreover, R207910 plus rifapentine plus pyrazinamide given once weekly was more active than the current standard regimen of rifampin plus isoniazid plus pyrazinamide given five times per week.The unprecedented activity of the triple combination of R207910 plus rifapentine plus pyrazinamide suggests that it may be feasible to develop a fully intermittent once-weekly regimen.
Protective effect of exogenous fructose-1,6-diphosphate in cardiogenic shock
Authors: J-N ZHANG, F-M ZHANG, W-S MA, T FORRESTER
Journal: Cardiovascular Research (1988)

Journal Article Protective effect of exogenous fructose-1,6-diphosphate in cardiogenic shock Get access J-N ZHANG, J-N ZHANG Search for other works by this author on: Oxford Academic PubMed Google Scholar F-M ZHANG, F-M ZHANG Search for other works by this author on: Oxford Academic PubMed Google Scholar W-S MA, W-S MA Search for other works by this author on: Oxford Academic PubMed Google Scholar T FORRESTER T FORRESTER **From the Department of Physiology, St. Louis University Medical Center, St Louis, Missouri, USA Search for other works by this author on: Oxford Academic PubMed Google Scholar Cardiovascular Research, Volume 22, Issue 12, December 1988, Pages 927–932, https://doi.org/10.1093/cvr/22.12.927 Published: 01 December 1988 Article history Accepted: 18 July 1988 Published: 01 December 1988
On the Use of Codeine to Relieve Pain in Abdominal Disease
Authors: T. L. Brunton
Journal: BMJ (1888)

THE BRITISH MEDICAL JOUIRNAL 1213 other case the tumour eventually inflamed and sloughed in parts, and caused death by exhaustion.The cases are of interest as showing to what enormous size tumours developed in connection with the side of the face or neck may eventually attain.P'resumably they were originally formed over the parotid (or, perhaps, the submaxillary), and were in part cartilaginous and in part fibro-cellular.I cannot in either give any details as to their nature or precise relations to the glands.Some years ago, in a communication to this JOURNAL, I drew attention to the important clinical fact that the growth of tumours, innocent as well as malignant, often illustrates the law of increase of population.It is rapid in ratio with size attained, or, in other words, in ratio with the number of tlhe cell elements.Thus a tumour which for many years may have grown so slowly that the patient was led to hope that it mighlt never much incom- mode him, increases its rate of growth every year, and finally develops with dangerous rapidity.This had been remarkably thle fact in these two patients.The knowledge of this law may often induce us to urge the timely removal of innocent tumnours which as yet cause no inconvenience.
Drug-induced pulmonary fibrosis.
Authors: I Y Adamson
Journal: Environmental Health Perspectives (1984)

The lung is a primary target of cell injury in patients receiving cytotoxic drugs, and in many cases the reaction is severe enough to produce diffuse pulmonary fibrosis. Although many different agents may damage the lung, the patterns of cellular injury and repair are relatively constant. Using bleomycin toxicity as an example, it has been shown that, after IV injection, the selective site of lung injury is the vascular endothelium; this is followed by the accumulation of interstitial edema and later by necrosis of Type I epithelial cells. In normal repair, rapid proliferation of Type II cells, followed by differentiation to Type I, restores the epithelial surface without fibrosis. However, after bleomycin, Type II cell proliferation is frequently followed by abnormal differentiation to a metaplastic form of epithelium. Fibroblast proliferation accompanies this abnormal epithelial response which is related either to selective retention of bleomycin by epithelial cells or to the toxic effects of administering more drug at the time of Type II cell division. It is concluded that diffuse interstitial fibrosis results from prolonged disturbance of the normal epithelial-mesenchymal interrelationships at the alveolar wall. Disruption of the fibroblastic control system by extensive epithelial necrosis or by delayed or inappropriate repair may be the key factor in instigating fibroblast proliferation and subsequent deposition of collagen. This mechanism may account for the development of diffuse fibrosis or fibrosing alveolitis in response to a variety of pulmonary toxins.
Randomized, multicenter, double-blind, placebo-controlled evaluation of amlodipine in patients with mild-to-moderate heart failure
Authors: Milton Packer, Pascal Nicod, Bijoy R. Khandheria, Dennis L. Costello, Alan G. Wasserman, Marvin A. Konstam, Robert J. Weiss, Richard R. Moyer, David J. Pinaky, Meyer H. Abittan, Joseph F. Souhrada
Journal: Journal of the American College of Cardiology (1991)