tbuckley/cabot-search huggingface dataset:
Voice changes after thyroidectomy: role of the external laryngeal nerve.
Authors: A E Kark, M W Kissin, R Auerbach, M Meikle
Journal: BMJ (1984)

Hitherto voice changes have been regarded as an infrequent complication of thyroidectomy and damage to the recurrent laryngeal nerve has been given as their major cause. Voice function was assessed in 325 patients after thyroidectomy. Permanent changes occurred in 35 (25%) after subtotal thyroidectomy and in 19 (11%) after lobectomy. The commonest cause of voice change appeared to be injury to the external laryngeal nerves on one or both sides. Damage to the recurrent laryngeal nerve, which was routinely identified and protected, was rarely a cause. When the external laryngeal nerves were identified and preserved, permanent voice changes occurred in only 5% of cases; this was similar to the incidence of 3% in controls after endotracheal intubation alone. The course of the external laryngeal nerve is variable, and consequently mass ligation of the vessels at the top of the upper pole will damage it in a high proportion of cases. To minimise this serious complication these nerves should be identified and protected as well as the recurrent nerves and voice function should be assessed early in the postoperative period by laryngoscopy and by a speech therapist.
Health CO-OPs of the Affordable Care Act
Authors: Allan M. Joseph, Eli Y. Adashi
Journal: JAMA (2015)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Treatment of Lupus Nephritis with Prednisone and Combined Prednisone and Azathioprine
Authors: JAMES V. DONADIO
Journal: Annals of Internal Medicine (1972)

The relative effectiveness of high-dose prednisone (group A) was compared with the same regimen plus azathioprine (group B) for the treatment of lupus nephritis of mild or moderate severity over 6 months. Nephritis activity was graded by renal biopsy specimens; biopsies were repeated and rescored at 6 months. There was significant improvement in all patients of both groups. Creatinine clearance, urinary sediment abnormalities, proteinuria, hypocomplementemia, and high titers of antinuclear antibodies showed improvement in most patients, but none correlated completely with the improvement in renal biopsy scores. High doses of corticosteroids are effective in the short-term treatment of mild or moderately severe lupus nephritis; the addition of azathioprine over the short term does not improve the results. Two patients with severe lupus nephritis who were treated with steroids alone died within 2 months, so that a possible beneficial effect of added azathioprine in severe, advanced disease cannot be excluded.
Determinism and Humanism in Modern Medicine
Authors: Eugene D. Robin
Journal: JAMA (1978)

MODERN western medicine grew from two separate philosophical roots—scientific determinism and humanism. The former, based on the doctrine that every experiment done under the same conditions produces the same results, provides the basis of much of modern medicine. It has led to the use of the laboratory, to clinical investigation, and to the development of diagnostic and therapeutic technology. It also determines the manner in which basic and clinical sciences are currently taught in medical schools. <h3>Roots of Modern Medicine</h3> Scientific determinism is indispensable in approaching patient treatment. However, it has important limitations. Many diseases are not well understood. Moreover, there are biologic variations in patients and technical variations in data collection. The second root of modern western medicine, humanism, is based on the principle that the proper concern of man is man. It is a more ancient basis for the physician's role than scientific determinism. Originating early in the
Comparison of Noncontact and Electroanatomic Mapping to Identify Scar and Arrhythmia Late After the Fontan Procedure
Authors: Dominic J. Abrams, Mark J. Earley, Simon C. Sporton, Peter M. Kistler, Michael A. Gatzoulis, Michael J. Mullen, Janice A. Till, Seamus Cullen, Fiona Walker, Martin D. Lowe, John E. Deanfield, Richard J. Schilling
Journal: Circulation (2007)

The right atrium late after the Fontan procedure is characterized by multiple complex arrhythmia circuits. We performed simultaneous electroanatomic and noncontact mapping to assess the accuracy of both systems to identify scar and arrhythmia.Mapping was performed in 26 patients aged 26.8+/-8.9 years, 18.7+/-4.4 years after Fontan surgery. The area and site of abnormal endocardium defined by electroanatomic mapping (bipolar contact electrogram <0.5 mV) were compared with those defined by noncontact mapping during sinus rhythm and by dynamic substrate mapping. Contact and reconstructed unipolar electrograms at a known distance from the multielectrode array, recorded by the noncontact system simultaneously at 452 endocardial sites, were compared for morphological cross correlation, timing difference, and amplitude. Mapping of arrhythmias was performed with both systems when possible. The median patient abnormal endocardium as defined by electroanatomic mapping covered 38.0% (range 16.7% to 97.8%) of the right atrial surface area, as opposed to 60.9% (range 21.3% to 98.5%) defined by noncontact mapping during sinus rhythm and 11.9% (range 0.4% to 67.3%) by dynamic substrate mapping. A significant decrease in electrogram cross correlation (P=0.003), timing (P=0.012), and amplitude (P=0.003) of reconstructed electrograms, but not of contact electrograms (P=0.742), was seen at endocardial sites >40 mm from the multielectrode array. Successful arrhythmia mapping by electroanatomic versus noncontact mapping was superior in 15 patients (58%), the same in 6 (23%), and inferior in 5 (19%; P=0.044).Electroanatomic mapping is the superior modality for arrhythmia mapping late after the Fontan procedure. Noncontact mapping is limited by a significant reduction in reconstructed electrogram correlation, timing, and amplitude >40 mm from the multielectrode array and cannot accurately define areas of scar and low-voltage endocardium.
Nephroblastoma in infants, 1969-75: variations in treatment and survival.
Authors: C A Stiller, E L Lennox
Journal: BMJ (1980)

and conclusions In a series of 79 infants aged under 1 year with nephro- blastoma diagnosed during 1969-75 all the patients underwent nephrectomy, 33 (42%) received a course of radiotherapy, and 49 (62%) received chemotherapy.The overall three-year survival rate for patients who survived at least one week after diagnosis was 65%.The corres- ponding rate for infants with stage I tumours was 76%.The survival rate in children with early-stage tumours was significantly higher in those who were treated by nephrectomy and chemotherapy alone compared with those who also received radiotherapy.In a large proportion of cases nephrectomy and chemo- therapy together constituted sufficient treatment for the cure of infants with nephroblastoma, and in some instances nephrectomy alone proved adequate.There was no general tendency for children under 1 year old to be unable to withstand chemotherapy.
STUDIES IN AGGLUTINATION
Authors: Gerald S. Shibley
Journal: The Journal of Experimental Medicine (1926)

From the foregoing evidence, specific bacterial agglutination may be conceived of as follows: When bacteria are mixed with their homologous agglutinative sera, specific union between organism and agglutinin occurs. This interaction consists of specific coating of the bacteria by globulin. By virtue of the fact, noted by Loeb and illustrated in Fig. 6, that protein film formation gives the coated particle the characteristics of denatured protein, the bacteria now take on the character of particles of denatured globulin. Particles of denatured protein flocculate whenever their charge is reduced by electrolyte to a critical level lying somewhere between 12 and 14 millivolts. This is true even when the salt is strong, as, unlike bacterial particles, their cohesive force is not readily depressed by salt. The sensitized bacteria, now being essentially particles of denatured protein, likewise agglutinate as soon as their charge is reduced by electrolyte to this potential level.
Hypokalaemia, Flaccid Quadruparesis, and Myoglobinuria with Carbenoxolone (Biogastrone)
Authors: S. D. Mohamed, R. S. Chapman, J. Crooks
Journal: BMJ (1966)

for the treatment of chronic gastric ulcer.A number of side-effects have been encountered.Thus both Doll et al. and Horwich and Galloway noted salt and water retention and weight gain, with or with- out hypertension
A Novel Model of Urinary Tract Differentiation, Tissue Regeneration, and Disease: Reprogramming Human Prostate and Bladder Cells into Induced Pluripotent Stem Cells
Authors: Mohammad Moad, Deepali Pal, Anastasia C. Hepburn, Stuart C. Williamson, Laura Wilson, Majlinda Lako, Lyle Armstrong, Simon W. Hayward, Omar E. Franco, Justin M. Cates, Sarah E. Fordham, Stefan Przyborski, Jane Carr-Wilkinson, Craig N. Robson, Rakesh Heer
Journal: European Urology (2013)

Primary culture and animal and cell-line models of prostate and bladder development have limitations in describing human biology, and novel strategies that describe the full spectrum of differentiation from foetal through to ageing tissue are required. Recent advances in biology demonstrate that direct reprogramming of somatic cells into pluripotent embryonic stem cell (ESC)-like cells is possible. These cells, termed induced pluripotent stem cells (iPSCs), could theoretically generate adult prostate and bladder tissue, providing an alternative strategy to study differentiation.To generate human iPSCs derived from normal, ageing, human prostate (Pro-iPSC), and urinary tract (UT-iPSC) tissue and to assess their capacity for lineage-directed differentiation.Prostate and urinary tract stroma were transduced with POU class 5 homeobox 1 (POU5F1; formerly OCT4), SRY (sex determining region Y)-box 2 (SOX2), Kruppel-like factor 4 (gut) (KLF4), and v-myc myelocytomatosis viral oncogene homolog (avian) (MYC, formerly C-MYC) genes to generate iPSCs.The potential for differentiation into prostate and bladder lineages was compared with classical skin-derived iPSCs. The student t test was used.Successful reprogramming of prostate tissue into Pro-iPSCs and bladder and ureter into UT-iPSCs was demonstrated by characteristic ESC morphology, marker expression, and functional pluripotency in generating all three germ-layer lineages. In contrast to conventional skin-derived iPSCs, Pro-iPSCs showed a vastly increased ability to generate prostate epithelial-specific differentiation, as characterised by androgen receptor and prostate-specific antigen induction. Similarly, UT-iPSCs were shown to be more efficient than skin-derived iPSCs in undergoing bladder differentiation as demonstrated by expression of urothelial-specific markers: uroplakins, claudins, and cytokeratin; and stromal smooth muscle markers: α-smooth-muscle actin, calponin, and desmin. These disparities are likely to represent epigenetic differences between individual iPSC lines and highlight the importance of organ-specific iPSCs for tissue-specific studies.IPSCs provide an exciting new model to characterise mechanisms regulating prostate and bladder differentiation and to develop novel approaches to disease modelling. Regeneration of bladder cells also provides an exceptional opportunity for translational tissue engineering.
Genetic variants associated with idiopathic pulmonary fibrosis susceptibility and mortality: a genome-wide association study
Authors: Imre Noth, Yingze Zhang, Shwu-Fan Ma, Carlos Flores, Mathew Barber, Yong Huang, Steven M Broderick, Michael S Wade, Pirro Hysi, Joseph Scuirba, Thomas J Richards, Brenda M Juan-Guardela, Rekha Vij, MeiLan K Han, Fernando J Martinez, Karl Kossen, Scott D Seiwert, Jason D Christie, Dan Nicolae, Naftali Kaminski, Joe GN Garcia
Journal: The Lancet Respiratory Medicine (2013)
Scoliosis management now subject of numerous questions
Authors: Terra Ziporyn
Journal: JAMA (1985)

"Many of you probably thought you'd seen the end of scoliosis," G. Dean MacEwen, MD, of Wilmington, Del, told a roomful of orthopedic surgeons earlier this year. "But today, with school screening sending patients with mild curves into our offices, and patients treated years earlier now turning up as adults, requesting—and in some cases requiring— treatment, all of us have to be to some degree involved in the subject." In fact, however, revived debate at a meeting of the American Academy of Orthopaedic Surgeons in Las Vegas indicates that, for scoliosis, problems supposedly solved by medical science have once again become a mystery. Controversy rages on almost every aspect of scoliosis management. Questions now being asked include: Is scoliosis really a dangerous medical problem? If so, do its chief dangers or complications involve pain, respiratory compromise, or cosmesis? If not, can bracing or surgery be justified? Do curves continue
Transient elastography as a predictor of oesophageal varices, a comparison with other non invasive markers
Authors: E. Reed, A. Stanley, E. Forrest, R. Gillespie, S. Dickson, M. Neilson, S. Barclay
Journal: Gut (2011)

<h3>Introduction</h3> Surveillance for varices is recommended for cirrhotic patients, with endoscopy the gold standard investigation. The authors sought to establish the utility of transient elastography (TE) in predicting the presence of varices, in comparison with other non-invasive markers. <h3>Methods</h3> Patients who had undergone measurement of liver stiffness using TE (Fibroscan) between October 2008 and October 2010 in our institution were identified. Patients with a liver stiffness measurement (LSM) suggestive of cirrhosis (&gt;12 kPa) who had also undergone endoscopy were selected. Laboratory data and patient9s age, were used to calculate AST/ALT ratio, APRI and FIB-4 scores. A LSM of 17.6 kPa, validated in patients with Hepatitis C, was used as the cut off to predict varices. Previously published cut-offs for the other non-invasive markers were also applied and used to calculate sensitivity, specificity and positive and negative predictive values for the prediction of oesophageal varices. <h3>Results</h3> 96 patients met the inclusion criteria (27 HCV, 26 ALD, 7 NAFLD, 7 autoimmune hepatitis, 6 cryptogenic cirrhosis, 6 under investigation, 11 dual pathology, 6 others). 25/96 (26%) of patients had oesophageal varices (12 small, 13 large). The performance characteristics of each test are shown in table 1. Receiver operating curve analysis suggested an optimal liver stiffness cut off of 26 kPa for our cohort. Subgroup analysis of patients with/without hepatitis C as the cause of liver disease showed similar results. <h3>Conclusion</h3> TE is highly sensitive in predicting the presence of oesophageal varices in a cohort of patients with a diverse range of aetiology of liver disease. However a cut off of 17.6 kPa demonstrates low positive predictive power and specificity, and would have wrongly categorised 19.7% of patients with varices. A cut off of 26 kPa would improve the PPV, but misclassify 23.8% of patients with varices. TE may give useful information about the pretest probability of finding varices, however its performance characteristics are not sufficient to obviate the need for endoscopy.
Diabetes-induced functional and structural changes in insulin receptors from rat skeletal muscle.
Authors: C F Burant, M K Treutelaar, M G Buse
Journal: Journal of Clinical Investigation (1986)

The effect of diabetes on the structure and function of insulin receptors was studied in rats 7 d after streptozotocin injection, using solubilized, partially purified receptors from rat hindlimb muscles. Diabetes increased the number of insulin receptors per gram of muscle 60-70% without apparent change in insulin binding affinity. Incubation of receptors at 4 degrees C with [gamma-32P]ATP and insulin resulted in dose-dependent autophosphorylation of the beta-subunit on tyrosine residues; receptors from diabetic rats showed decreased base-line phosphorylation, as well as a decrease in autophosphorylation at maximally stimulating insulin concentrations. These receptors also showed diminished exogenous substrate kinase activity using histone H2b and angiotensin II as phosphoacceptors. The electrophoretic mobility (sodium dodecyl sulfate-polyacrylamide gel electrophoresis) of a subpopulation of beta-subunits derived from diabetics was slightly decreased; differences in electrophoretic mobility between control- and diabetic-derived beta-subunits were enhanced by generating fragments by partial Staphylococcus aureus V8 protease digestion. Endoglycosidase-H or neuraminidase treatment increased the electrophoretic mobility of beta-subunits in both groups, but only neuraminidase appeared to decrease or abolish differences in electrophoretic mobility between controls and diabetics, suggesting that excess sialilation may account, in part, for the altered mobility of diabetic derived beta-subunits. All structural and functional alterations in insulin receptors were prevented by treating diabetic rats with insulin for 60 h. Peripheral insulin resistance associated with insulinopenic diabetes may be related to modifications in insulin receptor structure, resulting in impaired signal transmission.
Elevated serum levels of the eosinophil granule major basic protein in patients with eosinophilia.
Authors: D L Wassom, D A Loegering, G O Solley, S B Moore, R T Schooley, A S Fauci, G J Gleich
Journal: Journal of Clinical Investigation (1981)

A radioimmunoassay was established for the human eosinophil granule major basic protein (MBP). The mean level of MBP in sera from 105 normal control patients was 454 ng/ml, whereas in a sample of 188 patients with various forms of diseases, including the hypereosinophilic syndrome, levels as high as 14,000 ng/ml were measured. Serum levels of MBP did not correlate with eosinophil counts in normal subjects, but a positive correlation was seen in patients with eosinophilia; the patients with eosinophil counts greater than 350/mm3 generally showed increased levels of MBP. Many patients with skin disease and normal eosinophil counts had elevated levels of serum MBP. Monomer MBP has a molecular weight of 9,300, but in sera of patients with eosinophilia, the MBP activity was of high molecular weight, greater than 50,000. Analyses of serum by Sephadex G-200 and by electrofocusing suggest that MBP is not simply polymerized, but rather is bound to a larger carrier molecule. Monomeric MBP can be isolated from serum by reduction of serum with dithiothreitol, alkylation with iodoacetamide, and acidification to pH 2 followed by fractionation on Sephadex G-50 at pH 2. Under these conditions, up to 80% of the MBP emerges in monomeric form. The results indicate that eosinophil granule proteins circulate in blood covalently bound to serum proteins, and that elevated concentrations of serum MBP are present in some diseases associated with eosinophilia.
The Relationship of Lipoprotein Lipase Activity and LDL size Is Dependent on Glucose Metabolism in an Elderly Population
Authors: Griët Bos, Peter G. Scheffer, Delfina Vieira, Jacqueline M. Dekker, Giel Nijpels, Michaela Diamant, Tom Teerlink, Coen D.A. Stehouwer, Lex M. Bouter, Robert J. Heine, Hans Jansen
Journal: Diabetes Care (2004)

Small LDL size is common in patients with type 2 diabetes and is associated with an increased risk of cardiovascular disease (1). LDL size is determined by various constituents of lipoprotein metabolism, such as lipoprotein lipase (LPL) and hepatic lipase (HL) activities, cholesteryl ester transfer protein (CETP), as well as triglyceride concentrations (2–4). Although abnormalities in LPL, HL, and CETP levels are associated with a diabetic lipoprotein profile, a relation to insulin resistance has been found only with lipase activities (5–7) but not with CETP (8,9). In this cross-sectional study, we investigated the relationship of LPL and HL activities and CETP mass with LDL size in 426 subjects with normal and impaired glucose metabolism or type 2 diabetes.

The Hoorn Study is a population-based cohort study of glucose metabolism and cardiovascular risk factors among 2,484 inhabitants of the municipality of Hoorn, which started in 1989. In 2000–2001, a follow-up was conducted in selected subjects then aged 60–87 years, as previously described (10). We invited all surviving subjects with type 2 diabetes ( n = 176) and …
In the Back of the Ambulance
Authors: Robert Marion
Journal: JAMA (1986)

was scheduled to be the Early Bird and so, after trudging sleepily through the cold, predawn morning,  entered the pediatric emergency room just before 6 o'clock. It was the third month of my internship.  was exhausted and felt as if I'd had enough. Jeff Goodman was sitting in an examining booth, finishing off a chart. How was your night?  asked, sitting next to him.  If  live to be a hundred, Jeff answered, I'll never understand why people bring kids to the ER at 5 AM for diaper rashes. He finished the chart and said, Look, it's quiet. I'm going to take a nap in the isolation room, okay?  Sure,  said nervously. You mind if  wake you up if  have a problem?  I expect you to wake me up if you have a problem, he answered. You know where to find me. And
Points from Letters: Descriptive Analogies
Authors: B. Bentley-Phillips
Journal: BMJ (1971)

Analyzer.The conditions remained identical apart from increased concentration of indicator enzymes.3Normal ranges were determined for each system on blood drawn from healthy volunteers.The results are given in the Table .The range for asparate amino- transferase was much narrower with the LKB instrument, the upper limit of normal falling by 8 units.This was due to the standard deviation being virtually halved, since the mean was similar to the previous value.Instrument No.