tbuckley/cabot-search huggingface dataset:
Weaning Patients from Mechanical Ventilation Using Gastric pH
Authors: Dudley F. Rochester
Journal: Annals of Internal Medicine (1994)

Letters1 March 1994Weaning Patients from Mechanical Ventilation Using Gastric pHDudley F. Rochester, MDDudley F. Rochester, MDUniversity of Virginia Health Schiences Center; Charlottesville, VA 22908Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-5-199403010-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Mohsenifar and colleagues [1] reported that tissue acidosis, as reflected by a very low gastric intramural pH, accurately predicted failure to wean patients from mechanical ventilation.The authors used the HCO3, PCO2, and pH from arterial blood gas analysis plus gastric PCO2 (PgCO2) and the PCO2 factor in the Henderson-Hasselbach equation to calculate gastric intramural pH [1]. Substitution and rearrangement permit cancellation of the HCO3 and PCO2 factor terms. The simpler revised formula is: gastric intramural pH = arterial pH − log(Pg CO2/PaCO2).Both before and during weaning, arterial pH and PaCO2 were virtually identical in the ...References1. Mohsenifar Z, Hay A, Hay J, Lewis MI, Koerner SK. Gastric intramural pH as a predictor of success or failure in weaning patients from mechanical ventilation. Ann Intern Med. 1993; 119:794-8. Google Scholar2. Viires N, Sillye S, Aubier M, Rasidakis A, Roussos C. Regional blood flow distribution in dog during induced hypotension and low cardiac output. Spontaneous breathing versus artificial ventilation. J Clin Invest. 1983; 72:935-47. Google Scholar3. Magder S, Lockhat D, Luo BJ, Roussos C. Respiratory muscle and organ blood flow with inspiratory elastic loading and shock. J Appl Physiol. 1985; 58:1148-56. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Virginia Health Schiences Center; Charlottesville, VA 22908 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByRenal Tubular Acidosis 1 March 1994Volume 120, Issue 5Page: 438-439KeywordsBlood flowCardiac musclesCardiac outputFactor analysisGas analysisHypotensionMusclesShockVentilatorsWeaning Issue Published: 1 March 1994 CopyrightCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Painful enlargement of left subtrapezoid lymph nodes in Graves's disease.
Authors: J E Mahaux, J Chamla-Soumenkoff, R Delcourt, S Levin
Journal: BMJ (1971)

It has been known for a long time that in Graves's disease hyperplasia of the cervical nodes which drain thyroid lymph may occur. “Enlargement of the lymphatic glands, moderate in degree and not progressive, may develop rapidly and slowly subside” (Gowers, 1888). In particular the left subtrapezoid or pretrapezoid chain appears to be involved (Gueneau de Mussy, 1881). As this sign has been almost forgotten in recent years and may be useful in diagnosis where other signs and symptoms are atypical, a further case is presented below. © 1971, British Medical Journal Publishing Group. All rights reserved.
Regional blood flow distribution in dog during induced hypotension and low cardiac output. Spontaneous breathing versus artificial ventilation.
Authors: N Viires, G Sillye, M Aubier, A Rassidakis, C Roussos
Journal: Journal of Clinical Investigation (1983)

Respiratory muscle blood flow and organ blood flow was studied in two groups of dogs with radioactively labeled microspheres to assess the influence of the working respiratory muscles on the regional distribution of blood flow when arterial pressure and cardiac output were lowered by pericardial tamponade. In one group (n = 6), the dogs were paralyzed and mechanically ventilated (Mv), while in the other (n = 6), they were left to breathe spontaneously (Sb). Cardiac output fell to 30% of control values during tamponade in both groups and was maintained constant. None of the dogs was hypoxic. Ventilation in the Sb group peaked after 50 min of hypotension, but remained unchanged in the Mv group. Duplicate measurements of blood flow were made during a control period and after 50 min of tamponade (corresponding to the peak ventilation in Sb). Blood flow to the respiratory muscles increased significantly (P less than 0.001) during tamponade in Sb (diaphragmatic flow increased to 361% of control values), while it decreased in Mv. Although the arterial blood pressure and cardiac output were comparable in the two groups, blood flow distribution during tamponade was different. In Sb, the respiratory muscles received 21% of the cardiac output, compared with only 3% in the Mv group. Thus, by muscle paralysis and Mv, a large fraction of the cardiac output used by the working respiratory muscles can be made available for perfusion of other organs during low cardiac output state: blood flows to the liver, brain, and quadriceps muscles were significantly higher during tamponade in the Mv group compared with the Sb group. Similarly, blood lactate at all times after the induction of low cardiac output and hypotension was significantly lower in the Mv animals (P less than 0.005).
Entero-Vesical Fistula Treated by Laparo-Enterectomy
Authors: F. T. Heuston
Journal: BMJ (1894)

JOURDcaLNL 405 fungi that, judging from analogous plant diseases, it is very probable several species have to be dealt with.Amongst the ascomycetes some botanists place the so-called sprouting or yeast fungi (saccharomyces), one member of which, OGdium albicans, is so well known to us.The parasitic ascomycetes include the fungi which cause the peach blister-" bladder " or " pocket plums "-the vine and the hop mildew, the larch disease, the canker of apple trees, and the caterpillar *phmria.To the same group belongs the fungus which fur- nishes us with ergot.The interesting family of lichens in which the parasite and its host are mutually beneficial to one another was also described.The basiomycetes, like the other groups, contain both saphrophytic and parasitic species.Amongst the last named the Uredineae and their associates, the Ustilaginese stand prominent in causing the rust and onildew in wheat, as well as smut and bunt, diseases of economic importance, and not mere scientific curiosities.7he large family known as the hymenomycetes was the sub- ject of the last lecture, of which the mushroom is the best known and certainly the most highly appreciated member in this country, but which also contains such harmful species as the dry rot fungus and various tree-destroying parasites.After describing the gasteromycetes, the puffballs, the Nidulariese, the curious phalloidei, the course concluded with an account of the remarkable life-history of the myxomycetes, which presents so many analogies to the animal kingdom that some botanists have gone so far as to rechristen them the mycetozoa.
Reversible leg ischaemia due to diuretics.
Authors: D A O'Rourke, J E Hede
Journal: BMJ (1978)

pulmonary shunt effect and decrease right-to-left shunting through the ductus arteriosus, thus increasing arterial oxygenation.The mechanisms influencing pulmonary vascular resistance in the face of hypoxia, hypercarbia, and acidosis are complex and we suggest that an agent such as sodium nitroprusside, which acts directly on blood vessels,4 is more likely to achieve effective pulmonary vasodilatation than one which acts by blocking autonomic receptor sites.This view is supported by two facts.Firstly, cases of idiopathic respiratory distress syndrome treated with phenoxybenzamine,5 while showing a decrease in acidosis, have a much delayed rise in arterial oxygenation compared with the instantaneous effect of sodium nitroprusside seen in our case.Secondly, the systemic blood pressure rose in response to sodium nitroprusside.We suggest that sodium nitroprusside has a place in the management of patients with idiopathic respiratory distress syndrome who continue to deteriorate despite orthodox intensive care.
Multidrug release based on microneedle arrays filled with pH-responsive PLGA hollow microspheres
Authors: Cherng-Jyh Ke, Yi-Jou Lin, Yi-Chen Hu, Wei-Lun Chiang, Ko-Jie Chen, Wen-Cheng Yang, Hao-Li Liu, Chien-Chung Fu, Hsing-Wen Sung
Journal: Biomaterials (2012)
Role of Androgens in Abiraterone Resistance
Authors: Giuseppe Colloca
Journal: Journal of Clinical Oncology (2012)

We thank Castillo and Beltran 1 for their comments regarding our work 2 and are pleased to have this opportunity to address their interest in the evaluation of the adult-T cell leukemia/lymphoma (ATL) prognostic index (PI) separately for patients with acute-type versus lymphoma-type ATL.In their correspondence, Castillo et al 1 described the clinical, genetic, and pathophysiologic differences between acute-and lymphoma-type ATL.We completely agree with their descriptions.Combination therapy with interferon alfa and zidovudine, which is one of the standard treatments outside of Japan, has been reported to be more effective against acute-type ATL than conventional chemotherapy, but ineffective against lymphoma-type ATL. 3 Moreover, a recent study 4 reported that the genetic differences between acute-and lymphoma-type ATL are acquired by clonal evolution in the lymph nodes.It remains to be determined whether the genetic alterations that have been observed in ATL cells have significant influence on the clinical outcomes of patients with ATL, or whether these alterations should be taken into consideration when tailoring therapy to individual patients.In our study, 2 we attempted to establish an ATL-PI that is applicable to both acute-and lymphoma-type ATL, given that the subtypes have not been considered separately when determining therapeutic options in Japan, and also to make a simple PI that can be applied easily in clinics.Consistent with previous reports, 5-7 in our study, patients with acute-type ATL (n ϭ 564) showed worse median overall survival time than patients with lymphoma-type ATL (n ϭ 243): 6.9 months (95% CI, 6.2 to 7.8 months) and 9.9 months (95% CI, 8.1 to 11.3 months), respectively (P Ͻ .001).Application of the ATL-PI to each subtype revealed median overall survival times for acute-type ATL of 4.3 (95% CI, 3.3 to 5.1), 7.3 (95% CI, 6.5 to 8.4), and 15.7 (95% CI, 13.9 to 23.2) months for patients at high, intermediate, and low risk, respectively, whereas those for lymphoma-type ATL were 3.6 (95% CI, 1.5 to 4.7), 9.0 (95% CI, 7.4 to 11.1), and 14.0 (95% CI, 12.4 to 17.2) months, respectively.The three risk groups according to the ATL-PI were thus effectively prognostic both in acute-type (P Ͻ .001by log-rank test with 2 df) and lymphoma-type (P Ͻ .001by log-rank test with 2 df) ATL.In conclusion, ATL-PI is a PI for patients with aggressive ATL, and it is applicable for both acute and lymphoma types separately.We believe ATL-PI is a promising tool for risk stratification.We hope that it will be validated internationally in studies that include patients treated with a combination of interferon alfa and zidovudine.
Effect of Amiodarone and Sotalol on Ventricular Defibrillation Threshold
Authors: Stefan H. Hohnloser, Paul Dorian, Robin Roberts, Michael Gent, Carsten W. Israel, Eric Fain, Jean Champagne, Stuart J. Connolly
Journal: Circulation (2006)

Background— Many patients with implanted cardioverter defibrillators (ICDs) receive adjunctive antiarrhythmic drug therapy, most commonly amiodarone or sotalol. The effects of these drugs on defibrillation energy requirements have not been previously assessed in a randomized controlled trial. Methods and Results— The Optimal Pharmacological Therapy in Cardioverter Defibrillator Patients (OPTIC) trial was a randomized clinical trial evaluating the efficacy of amiodarone plus β-blocker and sotalol versus β-blocker alone for reduction of ICD shocks. Within OPTIC, a prospectively designed substudy evaluated the effects of the 3 treatment arms on defibrillation energy requirements. Defibrillation thresholds (DFTs) were measured (binary step-down protocol) at baseline and again after 8 to 12 weeks of therapy in 94 patients, of whom 29 were randomized to receive β-blocker therapy (control group), 35 to amiodarone plus β-blocker, and 30 to sotalol. In the control group, the mean DFT decreased from 8.77±5.15 J at baseline to 7.13±3.43 J ( P =0.027); in the amiodarone group, DFT increased from 8.53±4.29 to 9.82±5.84 J ( P =0.091). In the sotalol group, DFT decreased from 8.09±4.81 to 7.20±5.30 J ( P =0.21). DFT changes in the β-blocker and the amiodarone group were significantly different ( P =0.006). In all patients, adequate safety margins for defibrillation were maintained. No clinical variable predicted baseline DFT or changes in DFT on therapy. Conclusion— Although amiodarone increased DFT, the effect size with modern ICD systems is very small. Therefore, DFT reassessment after the institution of antiarrhythmic drug therapy with amiodarone or sotalol is not routinely required.
MRI monitoring of immunomodulation in relapse-onset multiple sclerosis trials
Authors: Frederik Barkhof, Jack H. Simon, Franz Fazekas, Marco Rovaris, Ludwig Kappos, Nicola de Stefano, Chris H. Polman, John Petkau, Ernst W. Radue, Maria P. Sormani, David K. Li, Paul O'Connor, Xavier Montalban, David H. Miller, Massimo Filippi
Journal: Nature Reviews Neurology (2011)
Modulation of Atrial Repolarization by Site of Pacing in the Isolated Rabbit Heart
Authors: Mark A. Wood, Robert A. Mangano, Richard M. Schieken, Clive M. Baumgarten, Pippa M. Simpson, Kenneth A. Ellenbogen
Journal: Circulation (1996)

Background Single-site or multisite atrial pacing may reduce the incidence of atrial fibrillation in humans. The therapeutic mechanisms may include synchronization of atrial repolarization (repolarization “memory”) and/or decreased dispersion of atrial repolarization. These responses have not been well documented in intact atria. Methods and Results Monophasic action potential recordings were made from six atrial epicardial sites in 39 isolated perfused rabbit heart preparations during 3 hours of continuous right atrial, left atrial, or biatrial pacing. Action potential recordings obtained at times 0, 45, 90, 135, and 180 minutes were computer analyzed for activation time (AT) and 90% action potential duration (APD) at each site. No consistent relationship could be demonstrated between APD and AT at any time during atrial pacing (all P &gt;.05). On average, left atrial APDs were longer than right atrial APDs by up to 6.3 ms at all times, regardless of the site of pacing ( P ≤.05). At all times, dispersion of atrial repolarization was minimized by left atrial pacing compared with right atrial pacing (21.6±9.1 versus 32.4±15.1 ms, respectively, at time 0; P &lt;.05). Biatrial pacing provided no further reduction in dispersion of repolarization compared with left atrial pacing (all P &gt;.05). Conclusions No relationship can be demonstrated between atrial AT and APD in the isolated rabbit heart preparation. This differs from ventricular repolarization “memory,” which is demonstrable under the same conditions. Left atrial APD is, on average, longer than right atrial APD, suggesting spatial heterogeneity in repolarization. Dispersion of atrial repolarization is minimized by left atrial pacing in this preparation with no further advantage to biatrial pacing.
Oxidative Damage to DNA and Lipids as Biomarkers of Exposure to Air Pollution
Authors: Peter Møller, Steffen Loft
Journal: Environmental Health Perspectives (2010)

Air pollution is thought to exert health effects through oxidative stress, which causes damage to DNA and lipids.We determined whether levels of oxidatively damaged DNA and lipid peroxidation products in cells or bodily fluids from humans are useful biomarkers of biologically effective dose in studies of the health effects of exposure to particulate matter (PM) from combustion processes.We identified publications that reported estimated associations between environmental exposure to PM and oxidative damage to DNA and lipids in PubMed and EMBASE. We also identified publications from reference lists and articles cited in the Web of Science.For each study, we obtained information on the estimated effect size to calculate the standardized mean difference (unitless) and determined the potential for errors in exposure assessment and analysis of each of the biomarkers, for total and stratified formal meta-analyses.In the meta-analysis, the standardized mean differences (95% confidence interval) between exposed and unexposed subjects for oxidized DNA and lipids were 0.53 (0.29-0.76) and 0.73 (0.18-1.28) in blood and 0.52 (0.22-0.82) and 0.49 (0.01-0.97) in urine, respectively. The standardized mean difference for oxidized lipids was 0.64 (0.07-1.21) in the airways. Restricting analyses to studies unlikely to have substantial biomarker or exposure measurement error, studies likely to have biomarker and/or exposure error, or studies likely to have both sources of error resulted in standardized mean differences of 0.55 (0.19-0.90), 0.66 (0.37-0.95), and 0.65 (0.34-0.96), respectively.Exposure to combustion particles is consistenly associated with oxidatively damaged DNA and lipids in humans, suggesting that it is possible to use these measurements as biomarkers of biologically effective dose.
Comparison of Gallbladder Ejection Fraction with Histopathologic Changes in Acalculous Biliary Disease
Authors: JOSEPH R. DECAMP, KATHERINE TABATOWSKI, DONALD S. SCHAUWECKER, ASLAM SIDDIQUI, F MICHAEL MULLINIX
Journal: Clinical Nuclear Medicine (1992)

This selective retrospective study was undertaken to establish whether the gallbladder contraction (ejection fraction) calculated during cholescintigraphy correlates with the histopathologic changes in the surgical specimen. The medical records of 243 patients who underwent hepatobiliary scintigraphy were reviewed. Of these, 215 patients had cholecystokinin cholescintigraphy and 100 went on to cholecystectomy. The original histologic slides from 67 gallbladders were available and reviewed by a pathologist who graded each specimen based on presence and severity of changes associated with “chronic” cholecystitis. There was no significant correlation between the severity of histopathologic change and cholecystokinin-induced gallbladder emptying.
Complications from the Use of Tranquilizing Drugs
Authors: Leo E. Hollister
Journal: New England Journal of Medicine (1957)

TRANQUILIZING drugs, for better or worse, have established a place in medical therapy. Within less than four years after their introduction in general use in this country, many reports have concerned their beneficial effects in a wide variety of emotional and physical disorders. A smaller but rapidly growing number of reports has been concerned with some of their ill effects. The increasing realization of the possible adverse effects of these agents has confirmed the need for close medical supervision of their use.Excellent reviews have already appeared on the complications of chlorpromazine1 2 3 or both chlorpromazine and reserpine.4 , 5 This paper reviews . . .
DYSTOCIA DUE TO FETAL ASCITES.
Authors: GEORGE L. BRODHEAD
Journal: JAMA (1904)

Among the very rare causes of dystocia we find fetal ascites. The condition of ascites in itself is rare enough to be of great interest, but there are comparatively few cases recorded in which the amount of fluid was so great as to cause serious difficulty at the time of labor. The history of the case is of unusual interest from the fact that the complication occurred very early in pregnancy, gestation having advanced to a period between five and one-half and six months. <h3>History.</h3> —The patient, a primipara, 18 years of age, native of Germany, was first seen in the first stage of labor in the outdoor service of the Post-Graduate Hospital. The history of the patient, prior to the date of her pregnancy, was absolutely normal, and no history of syphilis could be obtained. ' Her height was about 4 2/3 feet and weight about 96 pounds.
Review of cancer services in England and Wales reveals poor coordination
Authors: S. Mayor
Journal: BMJ (2001)

Cancer services in England and Wales have improved in response to recent guidelines, but lack of coordination means that some patients still receive poor care, reported a major review published this week.

The report was prepared by the Audit Commission, an independent governmental body, and the Commission for Health Improvement, which reports to the Department of Health. It is the first in a series of reviews of the implementation of national service frameworks (NSFs) in different specialties.

Researchers assessed the current state of cancer services and how far they have developed since the publication of the Calman-Hine report in 1995. This report recommended major organisational changes, based on the introduction of cancer centres and units working together within cancer networks. It also recommended increased professional specialisation in cancer care and closer team working in those providing such care. The implementation of more recent guidelines, including the Cancer Plan for England (2000), which set out a policy framework for cancer services, was also assessed.

The review was based on visits to eight randomly selected cancer networks in England (based on centres providing substantial radiotherapy services, typically covering a population of about 1.5 million), including one nearby unit and …
Noncommunicable Diseases in Developing Countries: Focus on Research Capacity Building—Reply
Authors: Karen Sliwa, Albertino Damasceno, Bongani M. Mayosi
Journal: JAMA Internal Medicine (2013)

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