tbuckley/cabot-search huggingface dataset:
DISTURBANCES OF IONIC EQUILIBRIUM OF INTRACELLULAR AND EXTRACELLULAR ELECTROLYTES IN PATIENTS WITH TUBERCULOUS MENINGITIS 1
Authors: Harold E. Harrison, Laurence Finberg, Evelyn Fleishman
Journal: Journal of Clinical Investigation (1952)

Diminished concentrations of chloride and sodium in plasma are frequently found in patients with acute bacterial infections (1). This type of deviation from the normal electrolyte pattern is also encountered in an occasional patient with pulmonary tuberculosis and has received special attention because of the problem of differential diagnosis of Addison's disease (2-5). By the use of methods of assessment of adrenocortical function which do not depend upon determinations of serum electrolytes it has been shown that hypochloremia and hyponatremia may be present in patients with tuberculosis without evidences of adrenal insufficiency (5). Reductions of the serum chloride and sodium values are consistently found in children with tuberculous meningitis. In the past this observation
Approaches to Controlling the Costs of Medical Care: Short-Range and Long-Range Alternatives
Authors: David Mechanic
Journal: New England Journal of Medicine (1978)

Cost containment requires changes either in patterns of consumption or in the way services are provided. Although the former includes prevention, changing social expectations and finding suitable substitutes for some types of care, the latter involves mix of personnel technologic inputs, auspices of care and the content of encounters. Ultimately, the future of medical care and cost containment depends on advances in biomedical and health-services research. In the short run, costs will be contained increasingly by rationing mechanisms. Whereas cost sharing is intended to affect consumer behavior, implicit rationing, as through capitation and prospective budgeting, is intended to encourage physicians to make tougher allocation decisions. Explicit rationing, in contrast, depends more on administrative decisions that limit physician discretion. A better understanding of the effects of different rationing technics on patient and physician behavior and the quality of care, as well as on cost, is required.
Identifying patients at low risk of bowel cancer: Personal or familial risk factors need to be mentioned
Authors: M. M O'Riordan
Journal: BMJ (2003)

Editor—The crucial role played by general practitioners in controlling access to specialist services is emphasised by Thompson et al in their article on patients at low risk of bowel cancer in general practice.1 For general practitioners to fulfil this gatekeeper role guidelines are welcome and needed to reduce the human and financial costs associated with inappropriate referral.

I am concerned that a personal or family history of colorectal cancer or inflammatory bowel disease were not mentioned as risk factors that should be taken into consideration when taking a history from a patient with new bowel related symptoms.2-4 The presence of such risk factors would increase the likelihood of colorectal cancer and need for subsequent referral. Therefore it would be appropriate to mention them as important points to consider in the history when defining risk status.
Lipid-Lowering Therapy and In-Hospital Mortality Following Major Noncardiac Surgery
Authors: Peter K. Lindenauer
Journal: JAMA (2004)

Cardiovascular complications following major noncardiac surgery are an important source of perioperative morbidity and mortality. Although lipid-lowering medications are considered a key component in the primary and secondary prevention of cardiovascular disease, their potential benefit during the perioperative period is uncertain.To examine the association between treatment with lipid-lowering medications and in-hospital mortality following major noncardiac surgery.A retrospective cohort study based on hospital discharge and pharmacy records of 780,591 patients aged 18 years or older who underwent major noncardiac surgery from January 1, 2000, to December 31, 2001, at any 1 of 329 hospitals throughout the United States. Only patients who survived through at least the second hospital day were included. Lipid-lowering therapy was defined as use during the first 2 hospital days. Propensity matching was used to adjust for numerous baseline differences.In-hospital mortality.Of the 780,591 patients, 77,082 patients (9.9%) received lipid-lowering therapy perioperatively and 23 100 (2.96%) died during the hospitalization. Treatment with lipid-lowering agents was associated with lower crude mortality (2.13% vs 3.05%, P<.001). In an analysis using matching by propensity score, 1595 patients (2.18%) treated with lipid-lowering medications died compared with 4158 patients (3.15%) who did not receive therapy or in whom treatment was initiated after the second day (P<.001). After adjusting for residual differences in the propensity matched groups using conditional logistic regression, risk of mortality remained lower among treated patients (adjusted odds ratio [OR], 0.62; 95% confidence interval [CI], 0.58-0.67). Based on this adjusted OR, the number needed to treat to prevent a postoperative death in the propensity matched cohort was 85 (95% CI, 77-98) and varied from 186 among patients at lowest risk to 30 among those with a revised cardiac risk index score of 4 or more. In a further analysis using the entire study cohort and adjusting for quintile of propensity, a significant effect of treatment persisted (adjusted OR, 0.71; 95% CI, 0.67-0.75).Treatment with lipid-lowering agents may reduce risk of death following major noncardiac surgery. Clinical trials are required to confirm this observation.
Circulating antibodies to cow's milk proteins in ulcerative colitis
Authors: D. P. Jewell, S. C. Truelove
Journal: Gut (1972)

Sera from patients with ulcerative colitis (51), Crohn9s disease (30), hypolactasia (13), untreated adult coeliac disease (11), irritable colon syndrome (24), and sera from 38 healthy control subjects were tested for antibodies to the principal cow9s milk proteins—casein, α-lactalbumin, and β-lactoglobulin. The red-cell-linked antigen-antiglobulin reaction was used to determine the titres of direct agglutinating antibodies and IgA and IgG incomplete antibodies. Apart from patients with coeliac disease, direct agglutinating antibodies were found infrequently and then in low titres. Approximately 50% of subjects had low titres of IgA and IgG antibodies. However, the titres found in sera from patients with ulcerative colitis did not differ from those found in the control subjects or in patients with Crohn9s disease, hypolactasia, or irritable colon syndrome. Patients with untreated coeliac disease frequently had high antibody titres to the milk proteins. In all subjects tested, incomplete antibodies of IgA or IgG immunoglobulin class occurred with equal frequency. The frequent occurrence in adults of low titres of antibodies to the milk proteins may be due to continued absorption of minute amounts of protein. Absorption of allergens may be facilitated by mucosal damage, such as that of coeliac disease, with stimulation of antibody production. At the present time, however, there is little evidence to suggest that milk allergy is a factor in the aetiology of ulcerative colitis.
Pathophysiology of the biphasic response using simultaneous dobutamine echocardiography and scintigraphy
Authors: K. Galatro, P. Dourdoutis, A.M. Amanullah, J. Heo, S. Brozena, A.E. Iskaridrian, F.A. Chaudhry
Journal: Journal of the American College of Cardiology (1998)
Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care?
Authors: Pierre A. Bulpa, Alain M. Dive, Maria-Grazia Garrino, Monique A. Delos, Manuel R. Gonzalez, Patrick A. Evrard, Youri Glupczynski, Etienne J. Installé
Journal: Intensive Care Medicine (2000)
The Harvard Public-Health Chest Clinic
Authors: Milton Elkin, Merrill C. Sosman
Journal: New England Journal of Medicine (1951)

THE great value of x-ray examination of the chest in tuberculosis case-finding programs is beyond a doubt. Bloch and his associates1 in 1938 stated the strong position of roentgenology: "Failure to make a diagnosis of pulmonary disease because a roentgen examination was not carried out should be regarded as negligence"; they estimated that more than 30 per cent of clinically important pulmonary disease is missed on physical examination. Photofluorography, because of its virtue of being relatively inexpensive, with no significant loss of accuracy, has made possible surveys of large numbers of persons with a minimal expenditure of funds and time; . . .
Expression and localization of hepatobiliary transport proteins in progressive familial intrahepatic cholestasis†
Authors: Verena Keitel, Martin Burdelski, Ulrich Warskulat, Thomas Kühlkamp, Dietrich Keppler, Dieter Häussinger, Ralf Kubitz
Journal: Hepatology (2005)

Mutations of the bile salt export pump (BSEP) or the multidrug resistance P-glycoprotein 3 (MDR3) are linked to impaired bile salt homeostasis and lead to progressive familial intrahepatic cholestasis (PFIC)-2 and -3, respectively. The regulation of bile salt transporters in PFIC is not known. Expression of hepatobiliary transporters in livers of ten patients with a PFIC phenotype was studied by quantitative reverse transcription polymerase chain reaction, Western blotting, and immunofluorescence microscopy. PFIC was diagnosed by clinical and laboratory findings. All patients could be assigned to PFIC-2 or PFIC-3 by the use of BSEP- and MDR3-specific antibodies and by MDR3 gene-sequencing. Whereas in all PFIC-2 patients, BSEP immunoreactivity was absent from the canalicular membrane, in three PFIC-3 livers, canalicular MDR3 immunoreactivity was detectable. Serum bile salts were elevated to 276 +/- 233 and to 221 +/- 109 micromol/L in PFIC-2 and PFIC-3, respectively. Organic anion transporting polypeptide OATP1B1, OATP1B3, and MRP2 mRNA and protein levels were reduced, whereas sodium taurocholate cotransporting polypeptide (NTCP) was only reduced at the protein level, suggesting a posttranscriptional NTCP regulation. Whereas MRP3 mRNA and protein were not significantly altered, MRP4 messenger RNA and protein were significantly increased in PFIC. In conclusion, PFIC-2 may be reliably diagnosed by immunofluorescence, whereas the diagnosis of PFIC-3 requires gene-sequencing. Several mechanisms may contribute to elevated plasma bile salts in PFIC: reduced bile salt uptake via NTCP, OATP1B1, and OATP1B3, decreased BSEP-dependent secretion into bile, and increased transport back into plasma by MRP4. Upregulation of MRP4, but not of MRP3, might represent an important escape mechanism for bile salt extrusion in PFIC.
A CASE OF PETROSITIS WITH SURGICAL DRAINAGE AND RECOVERY
Authors: Karl W. Gruppe
Journal: JAMA (1935)

In the last few years, medical journals have been presenting increasing numbers of reports of research and clinical work on the complication of mastoiditis known as petrositis, or involvement of the apex of the petrous pyramid. This complication, hardly recognized prior to the work of Gradenigo,<sup>1</sup>reported in 1904, is now receiving the attention it deserves. Diagnostic measures in which history, physical examination and roentgen studies<sup>2</sup>all play major parts have been established and various surgical approaches aimed at drainage of this remote region have been devised and tested. In the future, then, a lessening in the incidence of meningitis, brain abscess and chronic otorrhea from this cause may be anticipated only so far as otologists and general practitioners, who are often the first to see these cases, will familiarize themselves with the disease and the significant points in its diagnosis. My object in this paper is to present a case
Treatment of Volkmann's ischaemic contracture
Authors: H J Seddon
Journal: BMJ (1976)

dying of coeliac disease and Addison's disease showed lymphocytes, mononuclear cells, and giant cells in her fibrotic adrenal glands; it is likely that she had sarcoidosis initially because she had earlier shown generalised lymphadenopathy and erythema nodosum.5 Five patients with sarcoidosis had adrenal failure," and it is interesting that coeliac disease is also occasionally associated with active tubercu- losis.7Chronic changes only were seen in the lung biopsy in the case described by Dr J Cummiskey and his colleagues (5 June, p 1401), and the immune response had faded after four years.But the pulmonary inflammation was still active in other reported cases.Three patients whose lungs were biopsied showed non-caseating granulomas.One of them, biopsied percutaneously by Mr M Meredith- Brown, had a positive Mantoux test, a calcified ring-shadow in the same lung, and bilateral apical scars.She also showed the cell-mediated immunity which is found in sarcoidosis, Crohn's disease, and BCG non-reactors."The syndrome may have therefore been caused by sarcoidosis in these three cases, and in one other.9The sarcoid agent may be a cause of "extrinsic alveolitis," but earlier and wider investigation of such cases is needed to prove this point.
Reentrant ventricular rhythms in the late myocardial infarction period: prevention of reentry by dual stimulation during basic rhythm.
Authors: M Restivo, W B Gough, N el-Sherif
Journal: Circulation (1988)

Stimulation at two ventricular sites during basic rhythm as a means of preventing the induction of ventricular arrhythmias in the postinfarction heart was investigated. Isochronal maps of ventricular epicardial activation from dogs were analyzed 4 days after ligation of the left anterior descending coronary artery. Activation patterns were obtained by use of a computerized data acquisition system recording from 62 sites. Effective refractoriness and conduction time during basic paced rhythm (S1) for each site were summed to construct isochronal maps of recovery time. The patterns of recovery time on the heart were eccentrically layered, with a narrow zone of differentially prolonged recovery time along one border of the infarct. The formation of an arc of functional conduction block after premature stimulation (S2) was correlated with regions of differentially prolonged recovery time (59 +/- 30 msec, mean +/- SD) between recording sites spaced 5 to 10 mm apart. The recovery time difference between sites that did not block (17 +/- 14 msec) was significantly shorter. The spatial distribution of recovery time on the heart could be modified by application of stimuli at two sites during the basic rhythm. Reentry was prevented by appropriate placement of the secondary site in the ischemic zone and the temporal sequencing of the paired stimuli. Stimulation at the secondary site "peeled back" refractoriness in the ischemic zone. Prevention of reentry was a result of either: (1) a shift in the arc of conduction block toward the ischemic zone, (2) a reduction in the extent of the continuous arc, (3) early activation of regions distal to the arc, or (4) a combination of the above. In two dogs, the arc of block was abolished entirely after dual stimulation. This report illustrates the criteria for effective prevention of reentry, applied to a well-described verifiable model of reentrant activation.
Immunologic Approaches to Ovarian Cancer Treatment
Authors: Paul Sabbatini, Kunle Odunsi
Journal: Journal of Clinical Oncology (2007)

The clinical course of ovarian cancer is often marked by periods of relapse and remission until chemotherapy resistance develops. Patients in remission with minimal disease burdens are ideally suited for the evaluation of immune-based strategies. The role of immune surveillance in improving outcome has been supported by the correlation of increased survival with the presence or absence of tumor-infiltrating lymphocytes in a given patient. Major obstacles to the development of successful immune strategies include the identification of tumor-restricted immunogenic targets, generation of a sufficient immune response to cause tumor rejection, and approaches to overcome evasion of immune attack. As optimal strategies are being developed, many questions remain. Some of the questions are as follows: What is the best antigen form (eg, peptides, proteins, or tumor lysates)? What are the appropriate adjuvants? Are monovalent or multivalent vaccines likely to be more effective? What is the optimal frequency and duration of vaccination? How should antigen-specific responses be monitored? How should the anticancer response be maintained? In this review, we will explore representative examples of immune strategies under investigation for patients with ovarian carcinoma that illustrate many of these issues. We will review ongoing phase III studies for patients in first clinical remission. Basic principles generic to all these immunotherapeutic approaches will be discussed in the hopes of yielding the most promising results as the field continues to evolve.
F-18 PET Soft Tissue Uptake in Seatbelt Injury
Authors: Ian Jong, Shahker Ramdave, Eddie Lau, David Binns, Rodney Hicks
Journal: Clinical Nuclear Medicine (2004)

The clinical use of F-18 fluoro-2-deoxyglocuse (F-18 FDG) PET scanning is rapidly growing, particularly in the field of oncology. The recognition of normal physiological variants and benign false-positive F-18 FDG PET scan findings are crucial for accurate diagnosis, and hence the maintenance, of clinicians’ confidence. Traumatic bone injury is a recognized cause of false-positive results, and we now report that soft tissue injury can also cause false-positive results on F-18 FDG PET images and hence should be added to the list of benign causes of false-positive studies.
SURVIVAL AND REVERSE CARDIAC REMODELLING IN CHILDHOOD DILATED CARDIOMYOPATHY (DCM): RESULTS FROM A LONG-TERM NATIONAL POPULATION-BASED STUDY
Authors: Piers E.F. Daubeney, Peta Alexander, Alan Nugent, Katherine Lee, Steven Colan, Andrew Davis, Ingrid King, Robert Weintraub
Journal: Journal of the American College of Cardiology (2012)
The novel tyrosine kinase inhibitor AKN-028 has significant antileukemic activity in cell lines and primary cultures of acute myeloid leukemia
Authors: A Eriksson, M Hermanson, M Wickström, E Lindhagen, C Ekholm, A Jenmalm Jensen, A Löthgren, F Lehmann, R Larsson, V Parrow, M Höglund
Journal: Blood Cancer Journal (2012)

Aberrantly expressed tyrosine kinases have emerged as promising targets for drug development in acute myeloid leukemia (AML). We report that AKN-028, a novel tyrosine kinase inhibitor (TKI), is a potent FMS-like receptor tyrosine kinase 3 (FLT3) inhibitor (IC(50)=6 nM), causing dose-dependent inhibition of FLT3 autophosphorylation. Inhibition of KIT autophosphorylation was shown in a human megakaryoblastic leukemia cell line overexpressing KIT. In a panel of 17 cell lines, AKN-028 showed cytotoxic activity in all five AML cell lines included. AKN-028 triggered apoptosis in MV4-11 by activation of caspase 3. In primary AML samples (n=15), AKN-028 induced a clear dose-dependent cytotoxic response (mean IC(50) 1 μM). However, no correlation between antileukemic activity and FLT3 mutation status, or to the quantitative expression of FLT3, was observed. Combination studies showed synergistic activity when cytarabine or daunorubicin was added simultaneously or 24 h before AKN-028. In mice, AKN-028 demonstrated high oral bioavailability and antileukemic effect in primary AML and MV4-11 cells, with no major toxicity observed in the experiment. In conclusion, AKN-028 is a novel TKI with significant preclinical antileukemic activity in AML. Possible sequence-dependent synergy with standard AML drugs and good oral bioavailability has made it a candidate drug for clinical trials (ongoing).
Aglottic Breath-Holding Spells
Authors: Ehor W. Gauk, Langford Kidd, J. Stobo Prichard
Journal: New England Journal of Medicine (1966)

IT is generally accepted that breath-holding, although alarming to the parents, represents a benign behavior disorder in which young children, provoked to crying or a temper tantrum, voluntarily hold the breath to the point of cyanosis. The spells, ranging in duration from a few up to forty seconds, cease as the child grows older, rarely persisting after four or five years of age; the long-term outlook is good.1 Occasionally, children prolong the breathholding to the point of having seizures, in which they become opisthotonic, are incontinent and lose consciousness. Sometimes, frank convulsions occur. The long-term outlook, the clinical sequence and . . .
Hypersensitivity reactions to chemotherapy: Outcomes and safety of rapid desensitization in 413 cases
Authors: Mariana C. Castells, Nichole M. Tennant, David E. Sloane, F. Ida Hsu, Nora A. Barrett, David I. Hong, Tanya M. Laidlaw, Henry J. Legere, Samridhi N. Nallamshetty, Ross I. Palis, Jayanti J. Rao, Suzanne T. Berlin, Susana M. Campos, Ursula A. Matulonis
Journal: Journal of Allergy and Clinical Immunology (2008)
Sulphobromophthalein retention in gout and asymptomatic hyperuricaemia.
Authors: R Grahame, R M Haslam, J T Scott
Journal: Annals of the Rheumatic Diseases (1968)

In a recent study comparing the clinical effects of allopurinol with those of probenecid in the treatment of gout (Scott, Hall, and Grahame, 1966), a high incidence of abnormal sulphobromophthalein (BSP) retention was found in patients taking both drugs.This unexpected finding has now been further investigated. MethodsBSP excretion tests were performed on 73 patients with gout (defined as recurrent acute arthritis associated with an elevated serum uric acid level),* sixteen patients with asymptomatic hyperuricaemia not due to renal failure, and thirty control subjects who were either hospital patients (none of whom had known liver disease, gout, or hyperuricaemia) or healthy volunteers.The details of the patients and controls are shown in Table I.*For the purpose of this study the upper limit of normal for serum uric acid by the method used (Technicon Auto-analyser) is taken to be 7 mg./100ml. for men and post-menopausal women and 6 mg./100 ml. for pre-menopausal women.TABLE I 10 per cent.or more above Ideal Weight 32 7 II*Defined as those whose average daily intake is two pints of beer or two double whiskies or more.tApproximately 2/3 of these patients were receiving long-term treatment aimed at lowering the serum uric acid level.
HYPERADRENOCORTICISM
Authors: Ralph V. Ford
Journal: JAMA (1960)

Eighteen patients were treated for hyperadrenocorticism during its early stages by total adrenalectomy. In 14 of the patients the most significant problem before operation was cardiovascular deterioration; 9 of them had hypertension and 5 had congestive heart failure. The other four patients were women with progressive masculinization. Time elapsed since adrenalectomy varied from 12 to 35 months. The most significant improvement was the arrest of progressive cardiovascular damage. All patients demonstrated a decrease in osteoporosis; weakness was improved in all but four, and only one patient continued to demonstrate the moon face. There have been six episodes of addisonian crises. These were recognized early and treated adequately. All but one patient showed marked subjective improvement, especially a decrease in nervousness and emotional lability. There has been a significant reduction in hirsutism in the female patients. The long-term follow-up data on these 18 patients indicate the feasibility of total adrenalectomy for hyperadrenocorticism in the early stages.