tbuckley/cabot-search huggingface dataset:
Dipyridamole thallium-201 scintigraphy as a preoperative screening test. A reexamination of its predictive potential. Study of Perioperative Ischemia Research Group.
Authors: D T Mangano, M J London, J F Tubau, W S Browner, M Hollenberg, W Krupski, E L Layug, B Massie
Journal: Circulation (1991)

BACKGROUND We examined the value of dipyridamole thallium-201 (201Tl) scintigraphy as a preoperative screening test for perioperative myocardial ischemia and infarction. METHODS AND RESULTS We prospectively studied 60 patients undergoing elective vascular surgery. We performed 201Tl scintigraphy preoperatively and blinded all treating physicians to the results. Historical, clinical, laboratory, and physiological data were gathered throughout hospitalization. Myocardial ischemia was assessed during the intraoperative period using continuous 12-lead electrocardiography (ECG) and transesophageal echocardiography (TEE) and during the postoperative period using continuous two-lead ambulatory ECG. Adverse cardiac outcomes (cardiac death, myocardial infarction, unstable angina, severe ischemia, or congestive heart failure) were assessed daily throughout hospitalization. Twenty-two patients (37%) had defects that improved or reversed on delayed scintigrams (redistribution defects), 18 (30%) had persistent defects, and 20 (33%) had no defects on 201Tl scintigraphy. There was no association between redistribution defects and adverse cardiac outcomes: 54% (seven of 13) of adverse outcomes occurred in patients without redistribution defects, and the risk of an adverse outcome was not significantly increased in patients with redistribution defects (relative risk 1.5, 95% confidence interval 0.6-3.9, p = 0.43). Consistent with these findings, there was also no association between redistribution defects and perioperative ischemia: 54% (19 of all 35) of perioperative ECG and TEE ischemic episodes and 58% (14 of 24) of severe ischemic episodes occurred in patients without redistribution defects. The sensitivity of 201Tl scintigraphy for perioperative ischemia and adverse outcomes ranged from 40% to 54%, specificity from 65% to 71%, positive predictive value from 27% to 47% and negative predictive value from 61% to 82%. CONCLUSIONS These results differ from those of previous studies and suggest that the routine use of 201Tl scintigraphy for preoperative screening of patients undergoing vascular surgery may not be warranted.
A Clinical Lecture on the Analgesic Action of Methyl-Acetanilide or Exalgine
Authors: T. R. Fraser
Journal: BMJ (1890)

GENTLEMEN,-I intend to-day to depart a little from-the kind of subject-matter which supplies the main topics for discussion in this lecture room.At the same time, the subject I propose to deal with is one that is obviously and intimately related to our studies in clinical medicine.We cannot, I think, too frequently be reminded that the chief object of these studies is to increase our therapeutic resources; and I do not know that there is any result of disease that more imperatively demands the attention of the physician than the relief or removal of pain.The success with which this can be accomplished may, on the whole, be regarded with complacency, for that success has proved one of the most powerful causes in establishing confidence in the art of medicine, and it has been associated with some of the greatest triumphs in the history of that art.Restricting attention to pharmacological agents, you are aware that the most important of them are opium and several of its alkaloidal principles, belladonna, stramonium, and other plants yielding atropine-like bodies-aconite, cocaine, bromides, and volatile oils; as well as chloroform, ether, chloral,'and other general
THE MANAGEMENT OF FRACTURES INVOLVING THE PARANASAL SINUSES
Authors: JOHN J. SHEA
Journal: JAMA (1931)

The management of fractures involving the paranasal sinuses is similar to the surgical procedures followed in radical sinus surgery. In fact, the most common complication of these fractures is sinusitis. The rhinologist is best prepared to handle these fractures, and by obtaining good results he can convince the general surgeon that these cases belong to his specialty. Today an increasing proportion of hospital emergency cases are head injuries, the results of accidents during rapid transportation, industrial injuries and those obtained from bodily violence. The majority of the fractures of the facial bones exclusive of the simple nasal bone fractures, extend into the maxillary, frontal or ethmoidal sinus. The sinus involved fills with blood, which readily becomes infected. The basis of treatment is the replacement of the bony fragments, and the drainage of the sinus entered. This will restore the features. <h3>MAXILLARY SINUS</h3> "The superior maxillae are the largest bones of
From genes to genome biology: a new era in Helicobacter pylori research
Authors: N DORRELL, B W WREN
Journal: Gut (1998)

In August 1997 the complete annotated genome sequence of Helicobacter pylori was published,1 just 15 years after the organism was first cultured.2 This is an important milestone in gastroenterology research as H pylori is the first enteropathogen to be fully sequenced. The availability of a complete genetic data set heralds a new era in H pylori research as it will provide a framework for global studies of virulence and other aspects of the organism’s biology. In this article we outline the genomics approaches that can now be applied and highlight the potential practical benefits of this research in terms of eradication therapy and disease prevention. Scientists at The Institute for Genomic Research (TIGR) (http://www.tigr.org) have determined the order of the 1 667 867 nucleotides that constitute the circular chromosomal content of H pylori strain ACTC 26695.1 Initial computer analysis suggests the presence of 1590 open reading frames (ORFs or genes), of which nearly 70% can be matched to genes encoding proteins of known function. This immense achievement gives us unequalled opportunities to relate gene sequence to biology and will provide insight into many aspects of the organism’s biology, such as replication, DNA repair, metabolism, ion and protein transport, cell wall structure, and virulence. The most intriguing findings are as follows:
Nifedipine and Fasting Glycemia
Authors: ANTONELLI DANTE
Journal: Annals of Internal Medicine (1986)

Letters and Corrections1 January 1986Nifedipine and Fasting GlycemiaANTONELLI DANTE, M.D.ANTONELLI DANTE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-104-1-125_3 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: It has been reported that nifedipine has diabetogenic properties and that the plasma glucose concentration must be monitored in patients receiving this drug (1, 2).We checked the fasting plasma glucose, glucagon, and insulin levels before and after 1 month of nifedipine treatment (10 mg three times daily) in 12 patients with angina pectoris. No patient had evidence of endocrinopathy; therapy with other drugs was continued and their dosage was not changed during the study period. In the test after 1 month of treatment, the blood was sampled 2 hours after the morning dose of nifedipine. The...References1. GIUGLIANOTORELLACACCIAPUOTIGENTILEVERZAVERRIECHO DRFSMM. Impairment of insulin secretion in man by nifedipine. Eur J Clin Pharmacol. 1980;18:395-8. CrossrefMedlineGoogle Scholar2. CHARLESKETELSLEGERSBUYSSCHAERTLAMBERT SJMA. Hyperglycaemic effect of nifedipine. Br Med J. 1981;283:19-20. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Central Emek Hospital Afula 18101 Israel PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDrug Interactions with Agents Used to Treat Endocrine DisordersNifedipine and bendrofluazide in the treatment of hypertension in non-insulin-dependent diabeticsDiabetogenic Effect of Nifedipine 1 January 1986Volume 104, Issue 1Page: 125-125KeywordsAnginaAttentionBlood plasmaDrug therapyDrugsGlucagonGlucoseHematologic testsInsulin Issue Published: 1 January 1986 PDF downloadLoading ...
Left Ventricular Concentric Remodeling Rather Than Left Ventricular Hypertrophy Is Related to the Insulin Resistance Syndrome in Elderly Men
Authors: Johan Sundström, Lars Lind, Niklas Nyström, Björn Zethelius, Bertil Andrén, C. Nicholas Hales, Hans O. Lithell
Journal: Circulation (2000)

Background —Associations between left ventricular (LV) geometry and the insulin resistance syndrome have been found, mostly in small studies of middle-aged hypertensives. The purpose of this study was to elucidate these associations through the use of a large sample of elderly men. Methods and Results —We investigated 475 men (157 hypertensives) 71 years of age who were attending a population-based health survey in Uppsala County with echocardiography, oral glucose tolerance test (OGTT), hyperinsulinemic euglycemic clamp, and lipid and 24-hour ambulatory blood pressure monitoring. LV relative wall thickness was significantly related to clamp insulin sensitivity index ( r =−0.14), fasting insulin, 32-33 split proinsulin, triglycerides, nonesterified fatty acids, OGTT glucose and insulin levels, waist-to-hip ratio, body mass index, 24-hour blood pressure, and heart rate ( r =0.10 to 0.22). Only 24-hour systolic pressure ( r =0.15), OGTT 2-hour insulin ( r =−0.10), and heart rate ( r =−0.14) were significantly related to LV mass index. Comparing subjects with various LV geometry (normal, concentric remodeling and concentric and eccentric hypertrophy) showed that 24-hour heart rate, OGTT glucose and insulin levels, waist-to-hip ratio, and body mass index were significantly higher ( P &lt;0.001 to 0.05) and clamp insulin sensitivity index was significantly lower ( P &lt;0.01) in the concentric remodeling geometry group than in the normal LV geometry group. The 24-hour blood pressure was significantly higher in the concentric hypertrophy group than in the normal LV geometry group ( P &lt;0.001). Conclusions —Several components of the insulin resistance syndrome were related to thick LV walls and concentric remodeling but less to LV hypertrophy in this population-based sample of elderly men.
Gallium-67 Pulmonary Uptake in Eosinophilic Pneumonia
Authors: JACQUES MORAIS, LUCIE CARRIER, GILLES GARI??PY, LISA LE BEL, RAYMONDE CHARTRAND, DANIEL PICARD
Journal: Clinical Nuclear Medicine (1988)

Eosinophilic pneumonia is usually diagnosed based on the findings on chest x-ray, white blood count, and transbronchial biopsy. After reporting a case of Ga-67 lung uptake in eosinophilic pneumonia, its histopathology is discussed and the mechanisms of Ga-67 uptake by inflammatory lesions are reviewed.
A trial to extend breast cancer screening may be unethical
Authors: M. McCartney
Journal: BMJ (2014)

Anti-phosphocholine (PC)-keyhole limpet hemacyanin hybridomas representative of a memory response that express the lambda 1 L chain isotype have a high reactivity to PC-protein. A common feature of these hybridomas possessing high affinity for PC-protein is the occurrence of somatic mutations resulting in replacement changes in three CDR2 positions of the lambda 1 L chain. The influence of each of these three positions on the Ag binding properties of these antibodies was examined by site-specific mutagenesis and expression of recombinant antibody molecules by transfected cells. Affinity measurements and fine specificity profile determinations demonstrated the importance of the three lambda 1 CDR2 positions in Ag binding. Compared to antibodies expressing germline lambda 1, including one with an additional junctional serine that is not encoded by V or J, those antibodies possessing critical changes in CDR2 would have a strong selective advantage based on affinity differences for Ag. Sequence analysis of a group of clonally related hybridomas expressing mutated lambda 1 genes allowed construction of a hypothetical genealogic tree that suggests selection based on changes in CDR2 of lambda 1 in the absence of H chain mutations. The results are consistent with stepwise acquisition of mutations and selection based on affinity constraints.
Long-term Efficacy of BCG Vaccine in American Indians and Alaska Natives
Authors: Naomi E. Aronson, Mathuram Santosham, George W. Comstock, Robin S. Howard, Lawrence H. Moulton, Everett R. Rhoades, Lee H. Harrison
Journal: JAMA (2004)

The duration of protection from tuberculosis of BCG vaccines is not known.To determine the long-term duration of protection of a BCG vaccine that was previously found to be efficacious.Retrospective record review using Indian Health Service records, tuberculosis registries, death certificates, and supplemental interviews with trial participants.Follow-up for the period 1948-1998 among American Indians and Alaska Natives who participated in a placebo-controlled BCG vaccine trial during 1935-1938 and who were still at risk of developing tuberculosis. Data from 1483 participants in the BCG vaccine group and 1309 in the placebo group were analyzed.Efficacy of BCG vaccine, calculated for each 10-year interval using a Cox regression model with time-dependent variables based on tuberculosis events occurring after December 31, 1947 (end of prospective case finding).The overall incidence of tuberculosis was 66 and 138 cases per 100 000 person-years in the BCG vaccine and placebo groups, respectively, for an estimate of vaccine efficacy of 52% (95% confidence interval, 27%-69%). Adjustments for age at vaccination, tribe, subsequent BCG vaccination, chronic medical illness, isoniazid use, and bacille Calmette-Guérin strain did not substantially affect vaccine efficacy. There was slight but not statistically significant waning of the efficacy of BCG vaccination over time, greater among men than women.In this trial, BCG vaccine efficacy persisted for 50 to 60 years, suggesting that a single dose of an effective BCG vaccine can have a long duration of protection.
Genetic Counseling in Oncology--Reply
Authors: N. Tung
Journal: JAMA (2011)

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Prognostic features in acute megakaryoblastic leukemia in children without Down syndrome: a report from the AML02 multicenter trial and the Children’s Oncology Group Study POG 9421
Authors: M M O'Brien, X Cao, S Pounds, G V Dahl, S C Raimondi, N J Lacayo, J Taub, M Chang, H J Weinstein, Y Ravindranath, H Inaba, D Campana, C H Pui, J E Rubnitz
Journal: Leukemia (2012)
Count the harms
Authors: Fiona Godlee
Journal: BMJ (2006)

Count the harmsHippocrates may not have foreseen the complexities of modern medicine, but 24 centuries ago he (or whoever wrote the Hippocratic Oath) set down a fundamental rule for all clinicians and researchers-"first do no harm."This rule has special resonance this week as we explore over-diagnosis in breast cancer screening, and the evolving clinical trial nightmare at Northwick Park.Three weeks ago an editorial in the BMJ concluded that despite limitations, breast cancer screening does save lives (BMJ 2006;332:499-500).But in the same issue of the journal we published an analysis by Karsten Juhl Jørgensen and Peter Gøtzsche of the letters inviting women for screening (BMJ 2006;332:538-541).None of the letters mentioned the major harms of screening, and the authors concluded that organisers of screening programmes have a serious conflict of interest in wanting high uptake, which compromises their ability to provide balanced information about benefits and harms.That same week we also published "online first" Sophia Zackrisson and colleagues' 15 year follow-up from the Malmö trial of screening for breast cancer, which concluded that 10% of cancers detected by screening in women aged 55-69 are over-diagnosed.This week we pull these strands together, along with letters selected from among the rapid responses to all three pieces (p 727).The total picture is far from reassuring.As Zackrisson et al explain (p 689), their 10% figure is a conservative estimate, since some of the women in the control group also had mammography.In a letter, Gilbert Welch and colleagues suggest that the more relevant figure is 24% since, based on the Malmö data, this is the chance that a screen detected cancer represents over-diagnosis (p 727).Their higher figure is more in line with Gøtzsche's estimate of 30% (p 727).Whatever the figure, or the reasons for it (pp 678, 691 and 727), there seems little doubt among our contributors that over-diagnosis is real and substantial.As Michael Baum relates, his unaddressed concerns about the UK's screening programme, which he helped to set up, led him to resign from the programme committee (p 728).He and Hazel Thornton (p 728) endorse Gøtzsche's concerns about conflicts of interest and the "fobbing off " of women with unbalanced, insufficient information.Lack of proper information may prove to be at the heart of events that have left six young men seriously ill in hospital after the "first in man" trial of the monoclonal antibody TGN1412 (p 683).Michael Goodyear asks what lessons can be learned from this catastrophe (p 677), and Kate Mandeville describes her own experiences as a clinical trial volunteer (p 735).Questions are mounting about the trial, and they need answering.An inquiry by the UK's Medicines and Healthcare Products Regulatory Agency (MHRA) will not be enough, since this body may itself be implicated in mistakes that were made.There must be a full public inquiry if we are to prevent something like this happening again.
Trial against epilepsy drug manufacturer collapses after legal aid is withdrawn
Authors: C. Dyer
Journal: BMJ (2010)

A High Court action against the multinational drug company Sanofi-Aventis over birth defects in children whose mothers took its anticonvulsant drug sodium valproate (marketed as Epilim) during pregnancy has collapsed just days before trial after legal aid was withdrawn.

The Legal Services Commission for England and Wales is thought to have spent around £3m (€3.5m; $4.8m) over six years funding the case, brought by around 80 families, but has refused funding for the trial, which was due to start on 15 November …
Formaldehyde Exposure and Asthma in Children: A Systematic Review
Authors: Gerald McGwin, Jeffrey Lienert, John I. Kennedy
Journal: Environmental Health Perspectives (2009)

Despite multiple published studies regarding the association between formaldehyde exposure and childhood asthma, a consistent association has not been identified. Here we report the results of a systematic review of published literature in order to provide a more comprehensive picture of this relationship.After a comprehensive literature search, we identified seven peer-reviewed studies providing quantitative results regarding the association between formaldehyde exposure and asthma in children. Studies were heterogeneous with respect to the definition of asthma (e.g., self-report, physician diagnosis). Most of the studies were cross-sectional.For each study, an odds ratio (OR) and 95% confidence interval (CI) for asthma were either abstracted from published results or calculated based on the data provided. Characteristics regarding the study design and population were also abstracted.We used fixed- and random-effects models to calculate pooled ORs and 95% CIs; measures of heterogeneity were also calculated. A fixed-effects model produced an OR of 1.03 (95% CI, 1.021.04), and random effects model produced an OR of 1.17 (95% CI, 1.011.36), both reflecting an increase of 10 microg/m3 of formaldehyde. Both the Q and I2 statistics indicated a moderate amount of heterogeneity.Results indicate a significant positive association between formaldehyde exposure and childhood asthma. Given the largely cross-sectional nature of the studies underlying this meta-analysis, further well-designed prospective epidemiologic studies are needed.
Inverse association between farm animal contact and respiratory allergies in adulthood: protection, underreporting or selection?
Authors: K. Radon, A. Schulze, D. Nowak
Journal: Allergy (2006)

Background: It has been argued that the inverse association between exposure to farm animals and nasal allergies observed in children and adults might be because of self‐selection. Aims: We aimed to assess the health‐based selection out of farming in adults. Material and methods: A cross‐sectional study was carried out in a rural region. Overall, 4053 inhabitants (63%) aged 18–44 years responded to a questionnaire on respiratory diseases, life‐time exposure to farming environments and potential confounders. For 2678 of these, specific immunoglobulin E to common allergens was available. The outcome was: (i) sensitization and symptoms of nasal allergies (symptomatic sensitization); (ii) sensitization without symptoms of nasal allergies (asymptomatic sensitization). Results: Farm animal contact in childhood was associated with a decreased risk of symptomatic and asymptomatic sensitization. Continued exposure to farm animals in adulthood further decreased the odds ratio of symptomatic (odds ratio 0.2; 95% confidence interval 0.1, 0.4) but not asymptomatic sensitization (0.7; 0.4, 1.1). Starting farm animal contact in adulthood even increased the odds ratio of asymptomatic sensitization (2.4; 1.1, 5.2). Conclusions: The preventive effect of childhood contact to farm animals against sensitization continues into adulthood. However, in adulthood self‐selection based on symptoms and underreporting of symptoms might also play a role.