tbuckley/cabot-search huggingface dataset:
THE USE OF GLYCERINE AND ICHTHYOL IN THE TREATMENT OF SEPTIC WOUNDS
Authors: T. W. A. Daman
Journal: BMJ (1916)

MDICAL JOUR1IAIIntestinies.-Theappendices epiploicae of the transverse colon were swollen and haemorrhagic.The mesentery contained suany calcareous masses as large as small haricot beans.The lymphatic glands were not enlarged.The presacral haemolymph glands were enlarged.Kidneus.-Weighed 7 oz.each.On section they were pale in colour and in the pyramidal portion of each kidney were two pale-green areas about the size of a large pea.The other .abdominalorgans were apparentlv normal.*Marrow.-The shaft of the tibia contained marrow of a pale yellow colour with complete absence of any red coloration; that in the head of the tibia was pale yellow.The marrow of the ribs and sternum was greyish-brown in colour. MIicroscopic Examiiinationt.IHeart.-The spaces between the muscular bundles were in- filtrated with leucocytes of the myeloblastic type.Liver.-The periphery of the lobules was packed with cells ,with the appearance of myeloblasts.Much free browni-coloured pigment was presenit towards the periphery of the lobules.Iidney.-A section through one of the pale-green areas men- tioned above revealed a mass of cells resembling myeloblasts closely packed together, with atrophy of the uriniferous tu'bules.Other portions of the kidney were almost entirely free from blood cells.Spleen.-The Malpighian bodies were apparently normal.In the pulp were many myeloblasts and much free brown pigment.
Genes and the Response to Drugs
Authors: Yoseph Caraco
Journal: New England Journal of Medicine (2004)

The response to many drugs in common use varies greatly among patients. After the intake of identical doses of a given agent, some patients may have clinically significant adverse effects, whereas others may have no therapeutic response. Some of this diversity in rates of response can be ascribed to differences in the rate of drug metabolism, particularly by the cytochrome P-450 superfamily of enzymes. Ten isoforms of cytochrome P-450 are responsible for the oxidative metabolism of most drugs, each having selective yet overlapping substrate specificity. Variability among patients in the activity of these enzymes reflects a complex interaction between environmental . . .
Could hospitals do more to encourage breast feeding?
Authors: T Waterston, J Davies
Journal: BMJ (1993)

care) implicitly as a proxy for outcome confuses two separate and quite distinct dimensions of health care.7'8The use of crude measures of activity implies that more care is synonymous with better health and ignores the fact that few health care interventions have been adequately evaluatedboth from a medical and from an economic standpoint.9Undertaking more activity regardless of its medical or economic effectiveness can no longer be justified as an objective of the health service.The mechanistic application of a measure of efficiency that relates inputs (money) to process (crude measure of activity) seems at odds with such welcome recent innovations as the launch of the research and development strategy, the creation of the clearing house on outcomes, and departmental support for the Effective Health Care Bulletins.Hard pressed districts are now forced to meet conflicting objectives.How can they continue to ensure that they purchase more activity, however inappropriate, while being asked to focus on health gain, outcomes, and the multiagency work needed to implement the Health ofthe Nation?Although efficiency is difficult to define and measure in the public sector, recognising some key concepts could result in the development of a more reliable index.Firstly, efficiency should be considered only in a disaggregated form-for example, a service, department, or procedure-rather than at district level, where an average value is impossible to interpret.Secondly, output measures should take account of case mix (age, severity, and comorbidity of the patients), which directly affects costs.Lastly, measures of outcome should be incorporated into the index.We urge the NHS Management Executive to make clear that it expects purchasers to focus on the purchase of effective health care, either abandoning its current efficiency index or revising it to incorporate an adjustment for quality.The goal should be the efficient production of effective health care.In turn this will require purchasers to examine the evidence for various interventions and purchase on the basis of medical and economic effectiveness.9Only when we have substantially improved our knowledge of these can we turn our attention to global measures of efficiency.
Claims for Negligence
Authors: W. E. Hick
Journal: BMJ (1953)

<h3>Objectives</h3> Vancomycin is a glycopeptide antibiotic commonly used in neonatal intensive care units (NICUs) to treat late onset sepsis. It is recommended that vancomycin trough levels at steady state following intermittent dosing regimen be maintained at 10–20 mg/L, which is largely dependent on the type of infection. Our objective is to assess the ability of initial vancomycin dosing regimens to obtain target trough levels and to assess the percentage and risk factors associated with the development of acute kidney injury (AKI) while on vancomycin. <h3>Methods</h3> This is a retrospective review of all NICU patients admitted between January 2016 and December 2017 who received vancomycin according to the NeoFax at either 10 mg/kg/dose (low-dose group, LDG) or 15 mg/kg/dose (high-dose group, HDG), with a frequency based on the postmenstrual age (PMA) and postnatal age (PNA). Both regimens were compared by their ability to attain target trough levels and the episodes of vancomycin-induced AKI. Other outcomes included identification of risk factors associated with the development of vancomycin-induced nephrotoxicity. <h3>Results</h3> Of 182 patients evaluated, 44 (24%) were in the LDG and 138 patients (76%) were in the HDG. Ninety-one patients (50%) attained target trough levels of 10–20 mg/L. Among these and according to patients’ PMA, 48% in the HDG versus 7% in the LDG in PMA ≤29 weeks and 69% in the HDG versus 18% in the LDG in PMA 30–36 weeks attained target trough levels (p=0.006 and p&lt;0.001, respectively). According to PNA, 47% in the HDG versus none in the LDG in patients &lt;7 days old and 61% in the HDG versus 10% in the LDG in patients aged 8–14 days attained target trough levels (p=0.025 and p=0.016, respectively). A total of 14% developed AKI in the LDG vs 7% in the HDG (p=0.225). Only PMA ≤29 weeks (OR, 4.5, 95% CI 1.5 to 13), vancomycin trough levels &gt;20 mg/L (OR 5.1, 95% CI 1.5 to 17), hypotension (OR 11.02, 95% CI 3.5 to 34) and furosemide (OR 4.4, 95% CI 1.4 to 13.5) were significantly associated with vancomycin-induced AKI in our NICU. <h3>Conclusion</h3> Vancomycin dosing in neonates according to the NeoFax did not provide sufficient attainment of target trough levels (10–20 mg/L). However, using the higher dosing range at 15 mg/kg/dose was more likely to reach target levels, with no measured increased risk of nephrotoxicity. Extreme premature neonates, supratherapeutic vancomycin trough levels, hypotension and furosemide use are associated with an increased incidence of vancomycin-induced nephrotoxicity.
Early recovery of left ventricular function after thrombolytic therapy for acute myocardial infarction: An important determinant of survival
Authors: Florence H. Sheehan, Rolf Doerr, Wolfgang G. Schmidt, Edward L. Bolson, Rainer Uebis, Rainer von Essen, Sven Effert, Harold T. Dodge
Journal: Journal of the American College of Cardiology (1988)
Natural family planning: Trial doesn't support natural methods
Authors: M S King
Journal: BMJ (1993)

condoms that are said to have burst were in fact never worn, and after panic headlines in the media packets of contraceptive pills may be impulsively thrown away.I believe that natural methods of family planning should be seen as one of many choices, with accurate teaching available from health professionals working in any family planning clinic or general practice.The sooner that natural methods stop being associated with the teaching of the Catholic church the better.
Failure of salt to increase starch digestibility and glycaemic response
Authors: L. J D O'Donnell, P. M Emmett, K. W Heaton
Journal: BMJ (1988)

Cholesterol embolism in a renal graft after treatment with streptokinaseThe clinical features of cholesterol embolism in the kidney have been well delineated.'We report a case of acute renal graft failure due to cholesterol emboli.We further suggest that fibrinolytic treatment caused the disease and draw attention to this potential complication of an increasingly popular treatment of myocardial infarction.2 3 Case report A 56 year old man was admitted to hospital with chest pain that had lasted four hours.Nineteen years earlier he had received a cadaver kidney transplant after a 20 year history of chronic glomerulonephritis with hypertension.No rejection occurred.Serum creatinine concentration was stable at 150 [smol/l.
Monoclonal antibodies to LFA-1 and to CD4 inhibit the mixed leukocyte reaction after the antigen-dependent clustering of dendritic cells and T lymphocytes.
Authors: K Inaba, R M Steinman
Journal: The Journal of Experimental Medicine (1987)

T cell proliferation in response to many stimuli is known to occur in discrete clusters of dendritic cells (DC) and CD4+ helper lymphocytes. The role of lymphocyte function-associated antigen (LFA-1) and CD4 in the formation and function of these clusters has been evaluated in the mixed leukocyte reaction (MLR). By day 1 of the control MLR, most of the DC and responsive T cells are associated in discrete aggregates. Addition of anti-LFA-1 and CD4 reagents does not block DC-T aggregation but reduces the subsequent proliferative response by 80-90%. Anti-LFA-1 disassembles newly formed DC-T cell aggregates, whereas anti-CD4 inhibits blastogenesis without disrupting the cluster. Binding of DC to sensitized, antigen-specific CD4+ cells has been studied using lymphoblasts isolated at day 4 of the MLR. It has been shown previously that greater than 80% blasts rebind to DC in an antigen-specific fashion in rapid (10 min) binding assays. Antigen-dependent DC-T binding is blocked by anti-Ia but not by mAb to LFA-1 or CD4. However, the bound anti-CD4-coated lymphocytes are unable to release IL-2. Anti-LFA-1-coated T cells release IL-2 but are easily disaggregated after binding to DC. These findings lead to two conclusions. LFA-1 and CD4 are not involved in the initial steps whereby DC bind to T cells but exert an independent and subsequent role. LFA-1 acts to stabilize the DC-T cluster, while CD4 contributes to lymphocyte blastogenesis and IL-2 release. Because DC but not other presenting cells cluster unprimed lymphocytes, it seems likely that an antigen-independent mechanism distinct from LFA-1 and CD4 mediates aggregate formation at the onset of cell-mediated immunity.
Psychological Impact of Genetic Counseling for Familial Cancer: A Systematic Review and Meta-analysis
Authors: D. Braithwaite, J. Emery, F. Walter, A. T. Prevost, S. Sutton
Journal: JNCI Journal of the National Cancer Institute (2004)

Background: Identification of a genetic basis underlying certain types of cancer has led to an increase in demand for genetic counseling about individual risks of the disease. We conducted a systematic review of the literature to determine the quality and strength of evidence relating to psychological outcomes of genetic counseling for familial cancer. Methods: Six electronic databases were searched to identify controlled trials and prospective studies that examined the effect of genetic counseling on risk perception, knowledge, anxiety, cancer-specific worry, depression, and cancer surveillance. Twenty-one studies from 25 papers met inclusion criteria, including five controlled trials and 16 prospective studies. Analysis of each outcome was stratified by short-term (≤1 month) and long-term (≥3 months) follow-up. Trial evidence was assessed with standardized differences of the means at follow-up between intervention and comparison groups, and these data were pooled by use of random-effects meta-analysis. Results: Meta-analysis of controlled trials showed that genetic counseling improved knowledge of cancer genetics (pooled short-term difference = 0.70 U, 95% confidence interval [CI] = 0.15 to 1.26 U) but did not alter the level of perceived risk (pooled short-term difference = –0.10 U, 95% CI = –0.23 to 0.04 U). Prospective studies reported improvements in the accuracy of perceived risk. No effect was observed in controlled trials on general anxiety (pooled long-term effect = 0.05 U, 95% CI = –0.21 to 0.31 U) or cancer-specific worry (pooled long-term difference = –0.14 U, 95% CI = –0.35 to 0.06 U), although several prospective studies demonstrated short-term reductions in these outcomes. Few studies examined cancer surveillance behaviors, and no studies attempted to measure informed choice. Conclusions: Genetic counseling for familial cancer is associated with improvement in knowledge but does not have an adverse effect on affective outcomes. We urge further investigation of these findings through well-designed, well-reported, randomized controlled trials with suitable comparison groups and additional outcome measures. [J Natl Cancer Inst 2004;96:122–33]
Lymphadenopathy Induced by Diphenylhydantoin
Authors: Hugh H. Hussey
Journal: JAMA (1975)

There are so many drugs and so many adverse reactions to them that a single physician can hardly be expected to know all of them. In the current issue of Archives of Otolaryngology (101:446-448, 1975), Greene reports a case of localized cervical lymphadenopathy resulting from the administration of diphenylhydantoin sodium—a rather rare complication according to the author as well as standard references, such as the second edition of<i>AMA Drug Evaluations</i>and<i>Physicians' Desk Reference</i>. Indeed, as Greene notes, the development of a discrete cervical mass as an adverse reaction to hydantoin analogs is rare enough that many patients have been subjected to prolonged hospitalizations, radiotherapy, chemotherapy, and surgery when all that was needed was withdrawal of the offending drug. Greene reports the case of a 25-year-old woman who had been taking diphenylhydantoin sodium, 100 mg four times daily, during a four-week period before she was admitted to the US
STUDIES ON THE MODE OF SPREAD OF B. ENTERITIDIS MOUSE TYPHOID INFECTION
Authors: Leslie T. Webster, Ida W. Pritchett
Journal: The Journal of Experimental Medicine (1927)

Thirteen batches of mice from nine different sources were tested for the presence of mouse typhoid bacilli. Individuals from nine of the groups were found to be infected with the B. enteritidis type, four with the paratyphoid B, one with both, and one with neither type. With two exceptions, smooth type colonies alone were found. These results are in conformity with similar observations as reported by others and confirm the general belief that smooth colony types of paratyphoid-enteritidis bacilli prevail throughout the various stages of rodent typhoid infection.
Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects.
Authors: M T Epstein, E A Espiner, R A Donald, H Hughes
Journal: BMJ (1977)

The effect of confectionery liquorice on electrolyte status and the renin-angiotensin-aldosterone (RAA) axis was studied in 14 healthy volunteers. They ate liquorice in daily doses of 100 g or 200 g (equivalent to 0-7-1-4 g glycyrrhizinic acid) for one to four weeks. Plasma potassium concentrations fell by over 0-3 mmol/l in 11 people, including four who had to be withdrawn from the study because of hypokalaemia. One or more values of the RAA axis, especially plasma renin activity and urinary aldosterone concentrations, were considerably depressed in all subjects. These results show that potentially serious metabolic effects may occur in some people who eat modest amounts of liquorice daily for less than a week.
What counts as the evidence for three-dimensional and four-dimensional spatial representations?
Authors: Ranxiao Frances Wang, Whitney N. Street
Journal: Behavioral and Brain Sciences (2013)

Abstract The dimension of spatial representations can be assessed by above-chance performance in novel shortcut or spatial reasoning tasks independent of accuracy levels, systematic biases, mosaic/segmentation across space, separate coding of individual dimensions, and reference frames. Based on this criterion, humans and some other animals exhibited sufficient evidence for the existence of three-dimensional and/or four-dimensional spatial representations.
Reply to Dr. Cremers
Authors: Q. Cai
Journal: Endoscopy (2006)

We are grateful to Dr. Cremers for his interest in our article. We routinely give patients conscious sedation for all endoscopic procedures, including endoscopic retrograde cholangiopancreatography (ERCP), in our endoscopic suite. The medications that we use for conscious sedation are meperidine and midazolam. In addition, for some patients, promethazine may be used. All of these medications are administered intravenously before and during the procedure. For some patients who cannot be consciously sedated, we conduct the procedure with the patients under general anesthesia. The ERCP study only included patients with conscious sedation. I agree that the fatty meal may be retained in the gastric lumen longer than some other clear liquids. However, the volume of fatty meal we use is very small (about 9 ml in each patient). On the basis of our experience, it is safe to administer meals with these small volumes shortly before the procedure, as we have not encountered any aspiration problems.
Is gestural communication more sophisticated than vocal communication in wild chimpanzees?
Authors: Adam Clark Arcadi
Journal: Behavioral and Brain Sciences (2003)

The communicative behavior of chimpanzees has been cited in support of the hypothesis that language evolved from gesture. In this commentary, I compare gestural and vocal communication in wild chimpanzees. Because the use of gesture in wild chimpanzees is limited, whereas their vocal behavior is relatively complex, I argue that wild chimpanzee behavior fails to support the gestural origins hypothesis.
General Internist and Family Practitioner
Authors: Martin F. Stein, Anthony E. Maniscalco
Journal: Annals of Internal Medicine (1974)

Comments1 November 1974General Internist and Family PractitionerMARTIN F. STEIN JR., M.D., ANTHONY E. MANISCALCO, M.D.MARTIN F. STEIN JR., M.D.Search for more papers by this author, ANTHONY E. MANISCALCO, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-81-5-713_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Doctor Alvin R. Tarlov's letter (Ann Intern Med80:780-781, 1974) has accurately outlined some important problems with educational programs in internal medicine. The fragmentation of internal medicine, particularly as it relates to the clinic patient population, is disturbing. Many patients are shifted from one specialty clinic to another, receiving uncoordinated care in as many as eight clinics. Too often each specialist is only interested in his small sphere of medicine. No one bothers to look at the patient as a whole or in the context of his family unit. Fragmented medical care also often exists in separate... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byChanges in patient perceptions toward a family practice 1 November 1974Volume 81, Issue 5Page: 713-714 ePublished: 1 December 2008 Issue Published: 1 November 1974 PDF downloadLoading ...
Delays in abortion referrals limit women's choices, says report
Authors: Debashis Singh
Journal: BMJ (2004)

Women in some parts of England have to wait up to two months from first seeking advice about an abortion to having the procedure, says a survey. The delays in referral mean that many women are presenting to services later than nine weeks pregnant and cannot be considered for early medical termination using the abortion pill, mifepristone, despite this being a popular option among women.

The survey, from the All-Party Parliamentary Pro-Choice and Sexual Health Group, shows that only 52% of the primary care trusts (PCTs) that have …
Maintaining excellence: the preservation and development of specialised services.
Authors: L. J. Donaldson
Journal: BMJ (1992)

The advent of the Tomlinson inquiry draws attention to the need to strike a balance between market led and planned approaches to health care delivery. This is important not just for hospital rationalisation but also for the preservation and development of services which are provided in a smaller number of hospitals. Specialised services are often in the forefront of raising standards of care and introducing new developments and innovations. They are the only option for a small number of patients with serious illnesses. In the internal market for health care provision created by the 1990 NHS reforms more sophisticated and flexible mechanisms must be found to provide stability for specialised services while at the same time enabling the benefits of purchaser choice and provider competition to be realised.
Response to Comment on Little et al. Recovery of Hypoglycemia Awareness in Long-standing Type 1 Diabetes: A Multicenter 2 × 2 Factorial Randomized Controlled Trial Comparing Insulin Pump With Multiple Daily Injections and Continuous With Conventional Glucose Self-monitoring (HypoCOMPaSS). Diabetes Care 2014;37:2114–2122
Authors: Stuart A. Little, Lalantha Leelarathna, Emma Walkinshaw, Horng Kai Tan, Olivia Chapple, Alexandra Lubina-Solomon, Thomas J. Chadwick, Shalleen Barendse, Deborah D. Stocken, Catherine Brennand, Sally M. Marshall, Ruth Wood, Jane Speight, David Kerr, Daniel Flanagan, Simon R. Heller, Mark L. Evans, James A.M. Shaw
Journal: Diabetes Care (2014)

We agree with Edelman (1) that the HypoCOMPaSS protocol (2) does not reflect current routine clinical practice. It was not our intention to replicate existing suboptimal clinical practice with regard to conventional multiple daily injection (MDI) therapy and self-monitoring of blood glucose (SMBG). Rather, the premise of our study focused on achievability within routine care. We do not agree that education, weekly telephone contact, and monthly visits (as part of a targeted 6-month intervention for those with impaired awareness of hypoglycemia [IAH]) should be dismissed as unachievable. We have shown the potential for a >10-fold reduction in severe hypoglycemia (SH)—including in those patients not receiving more costly technological interventions …
Differentiating Paragangliomas From Other Somatostatin Receptor Bearing Head and Neck Tumors on 111In-Pentetreotide Scintigraphy
Authors: G G. Tronco, K J. Nichols, M B. Tomas, C J. Palestro
Journal: Clinical Nuclear Medicine (2005)

Greater New York and New England Chapters, the Society of Nuclear Medicine 18th Annual Northeast Regional Scientific Session Abstracts October 22–October 24, 2004—Stamford, Connecticut: PDF Only
Variation of the Spleen-Liver Activity Ratio Due to a Change in Position
Authors: P TODD MAKLER, HAROLD A. GOLDSTEIN, MICHAEL G. VELCHIK, MITCHELL SANDLER, ABASS ALAVI
Journal: Clinical Nuclear Medicine (1984)

The ratio of splenic to hepatic activity in the posterior view of a Tc-99m SC liver-spleen scan has been used as an indicator of parenchymal disease. Analysis of liver-spleen scans from a series of patients acquired in both the supine and erect positions revealed that the spleen-liver ratio varied considerably with a change in the patient position. Qualitatively there was a shift of colloid from the liver to the spleen in five of 18 supine views and ten of 18 erect views. Quantitative analysis of 37 cases showed that the median erect spleen-liver ratio was 20% greater than the spleen-liver ratio observed in supine patients. Criteria for an abnormal spleen-liver ratio need to be established in each position.