tbuckley/cabot-search huggingface dataset:
Postprandial gall bladder motility and hormone release during intermittent and continuous subcutaneous octreotide treatment in acromegaly.
Authors: M F Stolk, K J van Erpecum, H P Koppeschaar, W I de Bruin, J B Jansen, C B Lamers, G P van Berge Henegouwen
Journal: Gut (1993)

Repeated daily injections of the somatostatin analogue, octreotide (SMS201-995, Sandostatin) are an effective treatment for acromegaly, but lead to gall stone formation in about 50% of cases during longterm treatment. This is probably because of impaired gall bladder contraction. This study examined whether the timing of intermittent injections in relation to meals, or alternatively, continuous 24 hour subcutaneous octreotide infusion (CSOI) might avert adverse effects on gall bladder contraction. In six patients with active acromegaly, gall bladder volume, plasma cholecystokinin (CCK), and pancreatic polypeptide (PP) were measured in the fasting state and after consumption of a fatty meal. Measurements were made on five separate days: (a) without treatment, (b) 45 minutes after 100 micrograms octreotide given subcutaneously, (c) four hours after 100 micrograms octreotide given subcutaneously, (d) eight hours after 100 micrograms octreotide given subcutaneously, and (e) during CSOI of 300 micrograms/24 h for two weeks. Without treatment, postprandial gall bladder contraction was 86.2 (2.1%). Fasting gall bladder volume increased after octreotide injection and was almost doubled during CSOI. Octreotide injections impaired postprandial gall bladder contraction as well as CCK and PP release for at least four hours. Eight hours after injection and during CSOI, postprandial gall bladder contraction was partly restored (43.4% and 50.8% respectively). Postprandial CCK release was normal at eight hours after injection but very low during CSOI. PP release was suppressed by each mode of octreotide treatment. This study indicates that octreotide injections impair postprandial gall bladder contraction for at least four hours. Eight hours after injection and during CSOI, gall bladder contraction is partly restored.
Changes in the Medical Knowledge of Candidates for Certification
Authors: John J. Norcini, Judy A. Shea, John A. Benson
Journal: Annals of Internal Medicine (1991)

Purpose: To determine whether the medical knowledge of candidates from different types of medical schools changed between 1983 and 1988. Subjects: Candidates for certification who took the 1983 to 1988 examinations in internal medicine were divided into five groups according to the type and location of the medical school they had attended and, in some instances, their citizenship: graduates of U.S. medical schools, of Canadian medical schools, and of osteopathic medical schools as well as U.S. citizens who graduated from foreign medical schools and non-U.S. citizens who graduated from foreign medical schools. Design: Performance on items that were common to four pairs of the 1983 to 1988 certifying examinations (1983 and 1985, 1984 and 1986, 1985 and 1987, and 1986 and 1988) was analyzed. Results: The scores of graduates of U.S. medical schools decreased, and the scores of non-U.S. citizens who graduated from foreign medical schools increased. Trends in the performance of graduates of Canadian and osteopathic medical schools and of U.S. citizens who graduated from foreign medical schools were not discernible. Conclusions: The cumulative decline in the performance of graduates from U.S. medical schools and the progressive improvement in the performance of non-U.S. citizens who graduated from foreign medical schools may ultimately manifest itself in patient care.
The Drug Lag
Authors: C. J. Cavallito
Journal: JAMA (1976)

To the Editor.—  In referring to propranolol and its indication for hypertension, Dr Crout states that the delay in consideration of the pending New Drug Application (NDA) resulted from the sponsor's not submitting the NDA until December 1974. That submission date is correct; however, if one examines the Food and Drug Administration's (FDA's) action record on propranolol in its entirety, Dr Freis' contention of a drug lag is not refuted.  The original submission of an NDA for use of propranolol in arrhythmias occurred on June 3, 1966, and approval was received on Nov 13, 1967— not a serious delay for a new drug. However, the NDA for use of propranolol in angina, originally submitted on April 4, 1968, was not approved until Sept 4, 1973—a period of more than five years. From 1969 to 1972, the attitude within the reviewing division was unreceptive, if not hostile, to propranolol, to β-adrenergic
Comparing Hospital Mortality in Adult Patients with Pneumonia: A Case Study of Statistical Methods in a Managed Care Program
Authors: A. Russell Localio
Journal: Annals of Internal Medicine (1995)

Objective: To compare and contrast a managed care program's analysis of differences in hospital mortality with results obtained by accepted statistical methods. Design: A re-analysis of computerized discharge data using the same method used by a managed care program, and using conventional methods of categorical data analysis. One thousand computer simulations of a method for comparing hospitals by severity-adjusted mortality were done to determine the probability of falsely identifying hospitals as high-mortality outliers. Setting: 22 acute care hospitals in central Pennsylvania. Patients: All adult patients with pneumonia (n = 4587; diagnosis-related groups 089-090) less than 65 years of age who were discharged from the 22 hospitals in 1989, 1990, and 1991, excluding patients with the acquired immunodeficiency syndrome and transplant recipients. Measurements: In-hospital mortality adjusted for age and severity of illness using MedisGroups admission severity group score. Results: The hospital that had the highest mortality for adult pneumonia according to the managed care program's analysis did not, according to an appropriate analysis, differ significantly from other area hospitals (likelihood ratio test, P = 0.23). Random variation in this sample of patients with a low average mortality rate (3.5%) showed a 60% chance that 1 or more of the 22 hospitals would be falsely identified as a "high-mortality outlier" when simplistic statistical methods were used. Conclusion: Organizations seeking to compare the quality of hospitals and physicians through outcome data need to recognize that simplistic methods applicable to large samples fail when applied to the outcomes of typical patients, such as those admitted for pneumonia. Although these comparisons are much in demand, careful attention must be paid to their statistical methods to ensure validity and fairness.
AUTOLOGOUS CARDIAC STEM CELLS FAVORABLY ALTER LATE REMODELING IN A LARGE ANIMAL MODEL OF MYOCARDIAL INFARCTION
Authors: Frederick Welt, Robert Gallegos, John Connell, Domenico D&apos;Amario, Jan Kajstura, Raymond Kwong, Otavio Coelho-Filho, Ravi Shah, Piero Anversa, Marc Pfeffer
Journal: Journal of the American College of Cardiology (2012)
VITILIGO, THYROID DISEASE AND AUTOIMMUNITY
Authors: W. J. CUNLIFFE, R. HALL, D. J. NEWELL, C. J. STEVENSON
Journal: British Journal of Dermatology (1968)

SUMMARY. There is a significant association between vitiligo and thyroid disease. Thyroglobulin antibodies are significantly associated with vitiligo, whether patients with psoriasis or a general practice population are taken as controls. Similarly complement-fixing antibodies are significantly associated with vitiligo as compared with psoriasis. There is no evidence that thyroid autoimmunity is associated positively or negatively with psoriasis. Alopecia areata, pernicious anaemia and diabetes mellitus are also significantly associated with vitiligo.
Recent advances in the diagnosis and management of migraine
Authors: Peter J Goadsby
Journal: BMJ (2006)

The World Health Organization considers that severe migraine can be as disabling as quadriplegia. 1The disorder affects as many of 15% of adults in North America and Western Europe and is probably one of the commonest reasons for patients to see their doctors.Traditionally, headache is given little time in medical teaching, but headache science is advancing rapidly, fuelled by developments in treatment and neuroscience, and there is a sense of excitement perhaps unrivalled in neurology.Many recent advances have particular relevance to clinical practice in terms of both diagnosis and management; I will highlight these.Interested readers should see recent monographs listed in the Further reading box for more detailed accounts of the management of headache disorders. MethodsI based my selection of topics for this review on clinical themes that arise from referrals to the Headache Group at the National Hospital for Neurology and Neurosurgery.Thus the primary driver for the review is clinical practice.Information has come particularly from my reading large sections of a major reference work on headache as an editor (see Further reading box), and from the major headache journals, Cephalalgia and Headache, which I hand searched for the past decade.These sources are supplemented by PubMed searches and information from the most recent congress of the International Headache Society in Kyoto (10-12 October 2005).Some aspects of this review are based on a recent publication. 2
Afterload dependent prolongation of left ventricular relaxation: importance of asynchrony
Authors: S. Schafer, V. B Fiedler, V. Thamer
Journal: Cardiovascular Research (1992)

Acute increases in afterload and in left ventricular asynchrony both independently prolong left ventricular isovolumetric relaxation. The aim of the study was to investigate whether an increased left ventricular afterload augments left ventricular asynchrony, which in turn could mediate the afterload dependent prolongation of left ventricular isovolumetric relaxation.Seven chloralose anaesthetised open chest dogs were instrumented with a left ventricular pressure gauge and two pairs of ultrasonic wall thickness crystals in the antero-apical and postero-basal left ventricular wall. At a constant heart rate of 149(SEM 7) beats.min-1, left ventricular pressure was acutely increased by brief manual clamping of the descending (AOCD) and ascending AOCA) thoracic aorta. Left ventricular asynchrony was quantified by the phase difference of the first Fourier harmonic between postero-basal and antero-apical wall motion. Global left ventricular relaxation was measured as the time constant of isovolumetric pressure fall, tau. Regional myocardial relaxation was assessed as the mean rate to half end diastolic thinning.AOCD increased left ventricular peak systolic pressure from 141.9(6.9) mm Hg to a maximum of 182.0(5.1) mm Hg and tau from 34.3(2.4) ms to 48.0(5.0) ms (p less than 0.05). Simultaneously, phase difference increased markedly during AOCD, from 12.7(3.5) degrees to 24.4(2.2) degrees (p less than 0.05). At matched left ventricular peak systolic pressures, AOCA increased tau from 33.4(2.5) ms to only 42.5(4.3) ms (p less than 0.05 v control and AOCD). Concomitantly, the increase in phase difference was smaller and statistically non-significant, at 13.7(2.9) degrees v 17.1(2.5) degrees. During 13 out of the 14 aortic clampings (7 AOCD, 6 AOCA), tau correlated linearly with phase difference [mean r = 0.74(0.03)]. In contrast to their effects on global left ventricular relaxation and asynchrony, neither AOCD nor AOCA influenced the rate to half end diastolic thinning.(1) left ventricular asynchrony may increase during an acute augmentation of left ventricular afterload; (2) this increased left ventricular asynchrony possibly contributes to the afterload dependent prolongation of left ventricular isovolumetric relaxation rate.
UK business secretary imposes restrictions on export of execution drug
Authors: C. Dyer
Journal: BMJ (2010)

The United Kingdom is to place restrictions on the export of thiopental sodium, an anaesthetic used in death row executions in the United States, after the business secretary, Vince Cable, reconsidered his original refusal to add it to the list of restricted products.

Mr Cable made the U-turn during the hearing of a High Court challenge to his initial refusal after learning that the import of the drug into the US for medical purposes is illegal, officials said.

Lawyers for two men on death row in the US, where some states …
Atrial fibrillation precipitated by acute hypovolaemia.
Authors: J D Edwards, R G Wilkins
Journal: BMJ (1987)

Six patients with varying degrees of acute cardiorespiratory failure were seen. All patients deteriorated noticeably when rapid atrial fibrillation developed. In all patients intravenous digitalis failed to slow the ventricular response, and in three patients misguided attempts at electrical cardioversion failed. Haemodynamic monitoring showed a normal or low pulmonary artery occlusion pressure in all patients. Controlled expansion of plasma volume was associated with an immediate slowing of the heart rate in all patients, and the heart rate in all patients returned to sinus rhythm within 30 minutes of transfusion. It is suggested that hypovolaemia in critically ill patients may contribute to the development of atrial fibrillation.
Juvenile Achlorhydric Pernicious Anemia With IgA Deficiency
Authors: Jesse I. Spector
Journal: JAMA (1974)

The seventh reported case of achlorhydric juvenile pernicious anemia occurred in a 19-year-old man, who in addition, had a selective IgA deficiency. Family studies reveal pernicious anemia in three consecutive generations, but no other cases of IgA deficiency. (<i>JAMA</i>228:334-336, 1974)
Surgical Treatment of Diverticulitis
Authors: Stephen H. Tolins
Journal: JAMA (1975)

In the past 5 1/2 years, 71 patients with diverticulitis were operated on— 20.8% of all cases of diverticulitis admitted to the Bronx Municipal Hospital Center. Operative mortality was 22%, primarily because of delayed diagnosis, inadequate surgery, and a high incidence of associated disease. Only 20% of patients operated on had a previous history of diverticular disease. Hemorrhage was the indication for surgery in 16 cases; in this situation, a subtotal colectomy in one stage is the operation of choice. Perforation was the indication in 47 cases, eight of these being acute and with free air under the diaphragm. In cases with peritoneal contamination, a two-stage procedure (removing the diseased portion of colon at stage one) is advocated. Colostomy without drainage, or closure of a free perforation, is condemned. (<i>JAMA</i>232:830-832, 1975)
Spending on NHS in Wales is set to drop by 7.6% in real terms
Authors: R. Dobson
Journal: BMJ (2010)

In cash terms the NHS budget for Wales will remain the same over the next two years, with a small increase in the third year, but in real terms the spending plans amount to a 7.6% drop in total revenue and capital spending.

The Welsh Assembly, which is losing around £860m (€1bn; $1.4bn) in real terms in overall funding from the UK government (down from £15.1bn this year to £14.3bn next year), said it would continue to invest 40% of its budget—the largest single amount—in health and social services.

The assembly’s draft budget shows that revenue funding …
Posttraumatic Stress Disorder and Cognitive Behavioral Therapy—Reply
Authors: Paula P. Schnurr, M. Tracie Shea, Matthew J. Friedman, Charles C. Engel
Journal: JAMA (2007)

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The Mammography Quality Standards Act of 1992
Authors: Cullen Ruff
Journal: JAMA (1993)

<h3>To the Editor.</h3> —We wish to inform readers of legislation designed to improve breast cancer detection. The Mammography Quality Standards Act of 1992 was passed by the US Congress in October 1992 as Public Law 102-539, an amendment to the Public Health Service Act. This bill originated from the Senate Committee of Labor and Human Resources, Subcommittee on Aging, with collaboration from the American College of Radiology and the National Cancer Institute. After October 1,1994, only facilities accredited by a designee of the Secretary of the Department of Health and Human Services may perform mammography. This accreditation process specifies that (1) equipment used be dedicated to mammography; (2) personnel performing mammography be licensed or certified; (3) physicians interpreting mammograms be certified; and (4) mammographic and film-processing equipment be inspected by a medical physicist at least annually. This law provides for an advisory committee of health professionals to assess quality standards
The Inhibitor of Death Receptor Signaling, Flice-Inhibitory Protein Defines a New Class of Tumor Progression Factors
Authors: Mounira Djerbi, Valentina Screpanti, Anca Irinel Catrina, Bjarne Bogen, Peter Biberfeld, Alf Grandien
Journal: The Journal of Experimental Medicine (1999)

Death receptor–mediated apoptosis can be modulated by several antiapoptotic proteins, such as the FLICE (FADD [Fas-associated death domain]-like IL-1β–converting enzyme)-inhibitory proteins (FLIPs). The FLIP family includes both cellular and viral members. The Kaposi's sarcoma–associated herpesvirus protein (KSHV)-FLIP is expressed by human herpesvirus 8 (HHV-8), which is associated with malignancies such as Kaposi's sarcoma and certain lymphomas. In this paper, we demonstrate that KSHV-FLIP protects cells from Fas-mediated apoptosis by inhibiting caspase activation and permits clonal growth in the presence of death stimuli in vitro. Furthermore, we show that KSHV-FLIP can act as a tumor progression factor by promoting tumor establishment and growth in vivo. When injected into immunocompetent recipient mouse strains, murine B lymphoma cells (A20) transduced with KSHV-FLIP rapidly develop into aggressive tumors showing a high rate of survival and growth. The tumor-progressive activity of KSHV-FLIP is mediated by prevention of death receptor–induced apoptosis triggered by conventional T cells. Consequently, inhibitors of death receptor signaling can be regarded as a new class of tumor progression factors, and HHV-8–associated tumors may represent naturally occurring examples of the tumorigenic effect of such inhibitors.
Adjuvant MAGE-A3 Immunotherapy in Resected Non–Small-Cell Lung Cancer: Phase II Randomized Study Results
Authors: Johan Vansteenkiste, Marcin Zielinski, Albert Linder, Jubrail Dahabreh, Emilio E. Gonzalez, Wojciech Malinowski, Marta Lopez-Brea, Tonu Vanakesa, Jacek Jassem, Haralabos Kalofonos, Jakub Perdeus, Reiner Bonnet, Jazeps Basko, Richard Janilionis, Bernward Passlick, Tom Treasure, Marc Gillet, Frédéric F. Lehmann, Vincent G. Brichard
Journal: Journal of Clinical Oncology (2013)

The MAGE-A3 protein is expressed in approximately 35% of patients with resectable non-small-cell lung cancer (NSCLC). Several immunization approaches against the MAGE-A3 antigen have shown few, but often long-lasting, clinical responses in patients with metastatic melanoma.A double-blind, randomized, placebo-controlled phase II study was performed assessing clinical activity, immunologic response, and safety following immunization with recombinant MAGE-A3 protein combined with an immunostimulant (13 doses over 27 months) in completely resected MAGE-A3-positive stage IB to II NSCLC. The primary end point was disease-free interval (DFI).Patients were randomly assigned to either MAGE-A3 immunotherapeutic (n = 122) or placebo (n = 60). After a median postresection period of 44 months, recurrence was observed in 35% of patients in the MAGE-A3 arm and 43% in the placebo arm. No statistically significant improvement in DFI (hazard ratio [HR], 0.75, 95% CI, 0.46 to 1.23; two-sided P = .254), disease-free survival (DFS; HR, 0.76; 95% CI, 0.48 to 1.21; P = .248), or overall survival (HR, 0.81; 95% CI, 0.47 to 1.40; P = .454) was observed. Corresponding analysis after a median of 70 months of follow-up revealed a similar trend for DFI and DFS. All patients receiving the active treatment showed a humoral immune response to the MAGE-A3 antigen, although no correlation was observed with outcome. No significant toxicity was observed.In this early development study with a limited number of patients, postoperative MAGE-A3 immunization proved to be feasible with minimal toxicity. These results are being investigated further in a large phase III study.
The case against showing patients their records.
Authors: A P Ross
Journal: BMJ (1986)

same reason opinions, whether diagnoses or problem defini- tions, would have to become more disciplined than they often are, while the judgmental statements we sometimes see in records would have to be omitted.Fisher et al quote the distress of a patient finding something that was "untrue, and a long time ago."There are operational problems, but these should not be insurmountable.Assertions that patients would lose their records have to be set against the average non-availability of records at outpatient encounters and surgery attendances.Patients must be given time to read their records.Perhaps the most cogent reason for at least delaying the introduction of sharing is the quality of the records them- selves.Fisher et al report that only 44% ofpatients could read
Arbitration in medicolegal disputes
Authors: J Quarrie
Journal: BMJ (1994)

EDITOR, - Malcolm Forsythe's editorial on arbitration and the internal market is a useful contribution to the growing debate on the resolution of disputes in medicine.1 Though arbitration undoubtedly offers a viable alternative to litigation in medicolegal disputes, however, it is not the only alternative but is part of a range of techniques encompassed by the term “alternative dispute resolution.” The other main technique is mediation, which …