tbuckley/cabot-search huggingface dataset:
Is Corticosteroid Coinjection Necessary for Radiosynoviorthesis of Patients with Hemophilia?
Authors: Gonca Kara Gedik, Ömer Uğur, Bülent Atilla, Semra Dündar
Journal: Clinical Nuclear Medicine (2004)

Radiation synovectomy is frequently combined with intraarticular corticosteroid injection in the treatment of rheumatoid arthritis to reduce local inflammation and lymphatic clearance of radiocolloid. However, this practice is not universally accepted because corticosteroids have local and systemic toxicity such as osteonecrosis and cartilage damage and whether simultaneous corticosteroid injection together with radiocolloids is necessary in other forms of chronic synovitis like patients with hemophilia remains to be determined.In this study, we performed radiosynoviorthesis in 14 joints of 12 patients with hemophilia with chronic knee synovitis without corticosteroid coadministration and measured radiocolloid leakage from the joint space. Five mCi Y-90 radiocolloid was injected under local anesthesia and the needle was flushed with additional lidocaine injection instead of corticosteroid. The joint was then manipulated through a full range of extension and flexion to distribute the particles homogeneously throughout the joint space. The joint was then splinted for 48 hours to minimize leakage from the joint space. After the immobilization period, radiocolloid leakage was evaluated using a gamma camera with a 20% window centered over the maximum Bremsstrahlung photopeak of Y-90. Regions of interest were drawn to the injection site on the knee joint and to the ipsilateral inguinal lymph node area. Leakage of radiocolloid was calculated by dividing the background-corrected counts/pixel at the inguinal region by the counts/pixel at the injection site.One of 12 patients who had knee arthroplasty was previously found to have a high amount of leakage. In this patient, 70% of radiocolloid at the injection site drained into the pelvic lymph nodes. In the remaining 11 patients, no lymph nodes were visualized in the groin area and the measured average leakage for these patients was 2.3% (range, 0-13).We concluded that in cases of appropriate particle size and strict immobilization of knee joints, leakage of radiocolloid was minimal and steroid coinjection might not be necessary for radiosynoviorthesis of patients with hemophilia with chronic knee synovitis.
Serum Creatine Kinase and Exercise
Authors: J. Pearce
Journal: BMJ (1965)

Trypanosomiasis in Britain SIR,-Two cases have recently come to my notice of failure to diagnose trypano- somiasis in an African in this country.In one, with the lapse of nearly three years since the patient was last in Africa, the possibility of a tropical cause of the illness may have been dismissed.In the other the presenting symptoms were personality changes, and trypanosomiasis was apparently never con- sidered as a possible cause.The chronic, Gambian form of trypano- somiasis may continue with virtually no symptoms for three, or even more, years before involvement of the central nervous system affects the patient noticeably.It may then present with complaint of persistent headache, with other meningeal symptoms, or with more apparently psychological signs such as increasing depression or with marked personality change, not infrequently with impaired responsibility.I wish to make an urgent plea for the consideration of a diagnosis of trypano- somiasis in any person from Africa, whether African or not, now under medical care, per- haps even in a mental hospital, in this country with undiagnosed symptoms which could be due to trypanosomiasis.The finding of a C.S.F. protein of under 30 mg./100 ml. and a normal cell count would be strong evidence against the diagnosis of trypanosomiasis, but if the C.S.F. protein is near or above 40 mg./ 100 ml., or if an abnormal cell count, particularly a lymphocytosis, in the C.S.F. is found, the possibility of trypanosomiasis should not be discarded until some other un- questionable cause has been found.If further opinion or advice is needed there are schools of tropical medicine with associated hospitals at London,
Comparison of the prognostic value of cardiac I-123 metaiodobenzylguanidine imaging and heart rate variability in patients with mild to moderate chronic heart failure
Authors: Takahisa Yamada, Masatake Fukunami, Tsuyoshi Shimonagata, Kazuaki Kumagai, Akio Hirata, Mitsutoshi Asai, Nobuhiko Makino, Hidetaka Kioka, Noritake Hoki
Journal: Journal of the American College of Cardiology (2002)
Subspecialty Leadership at a Time of Specialty Excess
Authors: Lewis G. Sandy
Journal: Annals of Internal Medicine (1994)

Editorials15 November 1994Subspecialty Leadership at a Time of Specialty ExcessLewis G. Sandy, MD and Steven A. Schroeder, MDLewis G. Sandy, MDThe Robert Wood Johnson Foundation, Princeton, NJ 08543-2316.Search for more papers by this author and Steven A. Schroeder, MDThe Robert Wood Johnson Foundation, Princeton, NJ 08543-2316.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-121-10-199411150-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A recent analysis suggests that the United States will face a surplus of 163 000 physicians by the end of the decade and that 85% of that surplus will be specialist physicians [1]. Further, the growth of managed care organizations, which use physicians in proportion to the needs of a defined population, is putting relentless pressure on the market for physician services.These marketplace dynamics have stimulated a major debate about how best to achieve a physician work force that meets the nation's needs. Arguments for active management of the physician work force, as opposed to relying solely on market ...References1. Weiner JP. Forecasting the effects of health reform on US physician workforce requirement. Evidence from HMO staffing patterns. JAMA. 1994; 272:222-30. Google Scholar2. Lyttle CS, Levey GS. The National Study of Internal Medicine Manpower: XX. The changing demographics of internal medicine residency training programs. Ann Intern Med. 1994; 121:435-41. Google Scholar3. Association of Subspecialty Professors. Training in subspecialty medicine. On the chessboard of health care reform. Ann Intern Med. 1994; 121:810-3. Google Scholar4. Page L. Filling the gap: IMGs practicing in the promised land. American Medical News. 1994; 1:7-8. Google Scholar5. Graduate Medical Education. JAMA. 1994; 272:726. Google Scholar6. Commission on Life Science. The funding of young investigators in the biological and biomedical sciences. National Research Council, National Academy Press. 1994:1. Google Scholar7. Fogelman AM. Strategies for training generalists and subspecialists. Ann Intern Med. 1994; 120:579-83. Google Scholar Author, Article, and Disclosure InformationAffiliations: The Robert Wood Johnson Foundation, Princeton, NJ 08543-2316.Corresponding Author: Steven A. Schroeder, MD, The Robert Wood Johnson Foundation, Princeton, NJ 08543-2316. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTraining in Subspecialty Internal Medicine: On the Chessboard of Health Care Reform Metrics Cited ByResident perspectives of ems as a subspecialty 15 November 1994Volume 121, Issue 10Page: 805-806KeywordsAcademic medicineFellowshipsGraduate medical educationMedical educationResearch designResidencyStatistical methodsSub-specialty careSyncopeVision Issue Published: 15 November 1994 CopyrightCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Differential proliferative index of resident smooth muscle cells and infiltrating leukocytes after balloon angioplasty and stenting of swine coronary arteries
Authors: Alka Redkar, Jianhua Cui, Jon Allen, Brent Swenson, Gustavo Cipolla, Spencer King, Nicolas Chronos, Keith Robinson, Hector De Leon
Journal: Journal of the American College of Cardiology (2003)
Real-Time Rationing of Scarce Resources: The Northeast Proton Therapy Center Experience
Authors: Reshma Jagsi, Thomas F. DeLaney, Karen Donelan, Nancy J. Tarbell
Journal: Journal of Clinical Oncology (2004)

The telephone line is silent. I have just delivered the news to an anxious mother whom I will never meet. We will not be able to offer her 3- year-old son, who recently underwent resection of a posterior fossa ependymoma, a treatment slot at the Northeast Proton Therapy Center in Boston, MA. Postoperative radiation is the standard of care for her son’s disease, and radiating with protons might reduce the late effects of treatment to her young son’s brain. Yet in light of the other patients competing for the scarce proton treatment slots, we must recommend that she pursue treatment for her son elsewhere, as we will not have an open slot in time. Because proton therapy is only available at our center and one in California, her son will most likely end up receiving conformal photon therapy, with a higher integral dose to the normal brain. “How can this be?” she asks. “Why can’t my son get the treatment we feel would be best? We’re in America.”
A False-Positive Artifact in the Investigation of Osteitis Pubis
Authors: I P C MURRAY, S BASS
Journal: Clinical Nuclear Medicine (1991)

In the investigation of exercise-induced pain, abnormal uptake in a bone scan was noted in the symphysis pubis. While the intensity suggested radioactive urine, osteitis pubis could not be excluded in the clinical context. The abnormal accumulation was no longer demonstrable, however, after removal of a tampon.
Possible link between flu jab and Guillain-Barre syndrome under investigation
Authors: C. Marwick
Journal: BMJ (2003)

The US Institute of Medicine's immunisation safety review committee has been investigating whether the influenza vaccine might carry a risk of the demyelinating disorder Guillain-Barre syndrome.

A sharp increase in cases of the disorder occurred in 1993–4 after immunisation. There were 74 cases in 1994, compared with only 37 cases in 1993 and 23 in 1991. Although the number of reports of vaccine associated cases of the syndrome has remained low in recent years—between 20 and 40—the sudden increase in 1994 raised concerns about vaccine safety.

In a fact finding session earlier …
Experimental myocardial infarction VII: effects of intra-aortic balloon pump counterpulsation on cardiac performance in intact conscious dogs with left ventricular failure due to coronary insufficiency
Authors: W. B. Hood, J. Joison, R. Kumar, J. C. Norman, J. V. Tyberg, C. W. Urschel
Journal: Cardiovascular Research (1971)

In intact conscious dogs with healing anterior myocardial infarcts due to left anterior descending coronary artery occlusion, severe left ventricular failure was produced by constricting the circumflex vessel. In this preparation intra-aortic balloon counterpulsation effectively reduced the degree of failure present.
Impact of Leukocyte Count on Mortality and Bleeding in Patients With Myocardial Infarction Undergoing Primary Percutaneous Coronary Interventions
Authors: Tullio Palmerini, Roxana Mehran, George Dangas, Eugenia Nikolsky, Bernhard Witzenbichler, Giulio Guagliumi, Darius Dudek, Philippe Genereux, Adriano Caixeta, LeRoy Rabbani, Giora Weisz, Helen Parise, Martin Fahy, Ke Xu, Bruce Brodie, Alexandra Lansky, Gregg W. Stone
Journal: Circulation (2011)

Background— The relationship between white blood cell count (WBCc) and mortality in patients with ST-segment–elevation acute myocardial infarction treated with percutaneous coronary intervention is poorly understood. Furthermore, whether there is a relationship between WBCc and risk of noncardiac mortality and bleeding after percutaneous coronary intervention is unknown. Methods and Results— The baseline WBCc was available in 3193 of 3345 patients (95.5%) who underwent percutaneous coronary intervention in the Harmonizing Outcome With Revascularization and Stent in Acute Myocardial Infarction (HORIZONS-AMI) trial. In a propensity-adjusted multivariable analysis, WBCc was an independent predictor of 1-year cardiac mortality (hazard ratio, 1.15; 95% confidence interval, 1.09 to 1.22), noncardiac mortality (hazard ratio, 1.19; 95% confidence interval, 1.10 to 1.29), and major bleeding (hazard ratio, 1.08; 95% confidence interval, 1.04 to 1.12). After adjustment for baseline creatinine phosphokinase levels and left ventricular ejection fraction, WBCc remained an independent predictor of 1-year all-cause mortality and cardiac mortality. In patients matched for baseline creatinine phosphokinase levels at hospital admission, the median peak creatinine phosphokinase level was significantly higher in patients with high WBCc (&gt;11 000 per 1 mm 3 ) compared with low WBCc (1851 U/L [range, 880-3307 U/L] versus 1241 U/L [range, 540 to 2,78], respectively; P &lt;0.0001). In this subgroup of patients, WBCc was an independent correlate of peak creatinine phosphokinase level, and remained an independent predictor of 1-year mortality. Conclusions— In patients with ST-segment–elevation acute myocardial infarction undergoing percutaneous coronary intervention, elevated baseline WBCc is an independent predictor of infarct size, as assessed by peak creatinine phosphokinase level, and of 1-year cardiac mortality, noncardiac mortality, and major bleeding. Clinical Trial Registration— URL: http://www.ClinicalTrials.gov . Unique identifier: NCT00433966.
PWE-186 iScan in the evaluation of small colonic polyps: outcomes, learning curve from a large propective series: Abstract PWE-186 Table 1
Authors: P J Basford, G R Longcroft-Wheaton, P Bhandari
Journal: Gut (2012)

<h3>Introduction</h3> Indigocarmine (IC) and narrow-band imaging have been shown to be effective in the in vivo diagnosis of small colonic polyps. The learning curve for achieving high level of accuracy with a new technology for real-time diagnosis of small colonic polyps has not been determined. <h3>Methods</h3> We aimed to assess the learning curve of a novel electronic in vivo diagnosis technology (Pentax iScan) for an expert endoscopist. Patients presenting for screening colonoscopy through the UK Bowel Cancer Screening Programme were prospectively recruited. All colonoscopies were performed by a single expert endoscopist, with extensive experience in in vivo diagnosis, using Pentax EC-3890Li 1.2 Megapixel HD colonoscopes and EPKi processor. Polyps &lt;10 mm in size were assessed sequentially using three modalities (1) White light HD endoscopy (WL), (2) Pentax iScan surface and tone enhancement, (3) IC chromoendoscopy. Optical magnification was not used. Predicted histology (non-neoplastic, adenoma, cancer) was recorded for each modality and compared to the final histopathological diagnosis. Results were analysed for sensitivity and specificity for neoplasia, and overall accuracy. To assess any learning effect results were analysed in three sets of 100 consecutive polyps. <h3>Results</h3> A total of 309 polyps were eligible for inclusion in the study. Mean polyp diameter was 4.1 mm, median 3 mm. 133 polyps were in the proximal colon and 176 in the distal colon. 109 polyps were non-neoplastic, 199 were adenomatous and one contained adenocarcinoma. Sensitivity and overall accuracy improved significantly for all three imaging modalities in the 3rd set of polyps as compared to sets 1 and 2 (p&lt;0.05). In Set 3 overall accuracies of 92.7%, 93.6% and 93.6% were achieved with WL, iScan and IC respectively. There were no significant differences in overall accuracy between the three modalities in Set 3. Negative predictive values for adenomatous histology of recto-sigmoid polyps ≤5 mm for the entire study were 96.5%, 93.4% and 98.3% for WL, iScan and IC respectively. <h3>Conclusion</h3> (1) Even in expert hands there is a significant learning curve for using a new technology for the in vivo diagnosis of small colonic polyps, with improvement in performance over the first 200 polyps assessed. (2) Excellent results can be achieved once the new technology has been mastered. (3) This is the first report of results achieved with high-definition white light endoscopy which are comparable with electronic chromoendoscopy and IC chromoendoscopy. <h3>Competing interests</h3> None declared.
CotH3 mediates fungal invasion of host cells during mucormycosis
Authors: Teclegiorgis Gebremariam, Mingfu Liu, Guanpingsheng Luo, Vincent Bruno, Quynh T. Phan, Alan J. Waring, John E. Edwards, Scott G. Filler, Michael R. Yeaman, Ashraf S. Ibrahim
Journal: Journal of Clinical Investigation (2013)

Angioinvasion is a hallmark of mucormycosis. Previously, we identified endothelial cell glucose-regulated protein 78 (GRP78) as a receptor for Mucorales that mediates host cell invasion. Here we determined that spore coat protein homologs (CotH) of Mucorales act as fungal ligands for GRP78. CotH proteins were widely present in Mucorales and absent from noninvasive pathogens. Heterologous expression of CotH3 and CotH2 in Saccharomyces cerevisiae conferred the ability to invade host cells via binding to GRP78. Homology modeling and computational docking studies indicated structurally compatible interactions between GRP78 and both CotH3 and CotH2. A mutant of Rhizopus oryzae, the most common cause of mucormycosis, with reduced CotH expression was impaired for invading and damaging endothelial cells and CHO cells overexpressing GRP78. This strain also exhibited reduced virulence in a diabetic ketoacidotic (DKA) mouse model of mucormycosis. Treatment with anti-CotH Abs abolished the ability of R. oryzae to invade host cells and protected DKA mice from mucormycosis. The presence of CotH in Mucorales explained the specific susceptibility of DKA patients, who have increased GRP78 levels, to mucormycosis. Together, these data indicate that CotH3 and CotH2 function as invasins that interact with host cell GRP78 to mediate pathogenic host-cell interactions and identify CotH as a promising therapeutic target for mucormycosis.
Clinical Assessment of Low Oestrogen Combined Oral Contraceptive
Authors: P. G. T. Bye, M. Elstein
Journal: BMJ (1973)

Results of experience with a low-oestrogen combined contraceptive in 1,085 women showed that a dosage of less than 50 μg is compatible with satisfactory cycle control and efficacy. The preparation used in the trial, which contained 0·5 mg dl-norgestrel and 0·03 mg ethinyloestradiol, proved acceptable to most of the women.
Motor memory: Consolidation–based enhancement effect revisited
Authors: Julien Doyon, Julie Carrier, Alain Simard, Abdallah Hadj Tahar, Amélie Morin, Habib Benali, Leslie G. Ungerleider
Journal: Behavioral and Brain Sciences (2005)

Following Karni's seminal work, Walker and other researchers have recently provided gradually convincing evidence that sleep is critical for the consolidation-based enhancement (CBE) of motor sequence learning. Studies in our laboratory using a motor adaptation paradigm, however, show that CBE can also occur after the simple passage of time, suggesting that sleep effects on memory consolidation are task-related, and possibly dependent on anatomically dissociable circuits.
Immediate reactions to methylprenisolone with tolerace of other corticosteroids
Authors: M. M. Escribano‐Rodríguez, J. González‐Pol, F. J. Muñoz‐Bellido, A. De La Calle‐Toral, E. Velázquez‐Amor, J. Conde‐Hernández
Journal: Allergy (1997)
Skeletal muscle glycolysis, oxidation, and storage of an oral glucose load.
Authors: D Kelley, A Mitrakou, H Marsh, F Schwenk, J Benn, G Sonnenberg, M Arcangeli, T Aoki, J Sorensen, M Berger
Journal: Journal of Clinical Investigation (1988)

Although muscle is considered to be the most important site for postprandial glucose disposal, the metabolic fate of oral glucose taken up by muscle remains unclear. We, therefore, employed the dual isotope technique (intravenous, [6-3H]-glucose; oral, [1-14C]glucose), indirect calorimetry, and forearm balance measurements of glucose, lactate, alanine, pyruvate, O2, and CO2 in nine normal volunteers to determine the relative importance of muscle glycogenic, glycolytic, and oxidative pathways in disposal of an oral glucose load. During the 5 h after glucose ingestion (1 g/kg), 37 +/- 3% (24.9 +/- 2.3 g) of the load was oxidized and 63 +/- 3% (42.8 +/- 2.7 g) was stored. At least 29% (19.4 +/- 1.3 g) was taken up by splanchnic tissues. Muscle took up 26% (17.9 +/- 2.9 g) of the oral glucose coincident with a 50% reduction in its oxidation of fat. 15% of the oral glucose taken up by muscle (2.5 +/- 0.9 g) was released as lactate, alanine, or pyruvate; 50% (8.9 +/- 1.4 g) was oxidized, and 35% (6.4 +/- 2.3 g) was available for storage. We conclude that muscle and splanchnic tissues take up a comparable percentage of an oral glucose load and that oxidation is the predominant fate of glucose taken up by muscle, with storage in muscle accounting for less than 10% of the oral load. Thus, contrary to the prevailing view, muscle is neither the major site of storage nor the predominant site of disposal of an oral glucose load.
Coronary Thrombolysis -- A Perspective for the Practicing Physician
Authors: Valentin Fuster
Journal: New England Journal of Medicine (1993)

Acute myocardial infarction is the most common cause of death in most Western countries. The clinical description of acute myocardial infarction by Herrick1 in 1912 suggested that acute coronary thrombosis was responsible. Indeed, the possibility of lysing occlusive thrombi in the coronary arteries was the principal rationale for the first trial of thrombolytic therapy with streptokinase in 19592. In the 1960s and 1970s, several randomized studies of intravenous thrombolytic therapy were conducted. However, widely varied treatment protocols and end-point analyses, along with small samples, produced conflicting results3. Furthermore, during this time the pathogenetic role of coronary-artery thrombus was . . .
Tyrosine kinase inhibitor usage, treatment outcome, and prognostic scores in CML: report from the population-based Swedish CML registry
Authors: Martin Höglund, Fredrik Sandin, Karin Hellström, Mats Björeman, Magnus Björkholm, Mats Brune, Arta Dreimane, Marja Ekblom, Sören Lehmann, Per Ljungman, Claes Malm, Berit Markevärn, Kristina Myhr-Eriksson, Lotta Ohm, Ulla Olsson-Strömberg, Anders Själander, Hans Wadenvik, Bengt Simonsson, Leif Stenke, Johan Richter
Journal: Blood (2013)