tbuckley/cabot-search huggingface dataset:
Hospital: An Oral History of Cook County Hospital
Authors: Fitzhugh Mullan
Journal: JAMA (1995)

This has been a big season on television for Chicago hospitals. "ER" and "Chicago Hope" grabbed spots close to the top of the ratings last fall and haven't let go, bringing a kind of blood and emotions chic to medical care in the Windy City. Less likely to be found on the cover of<i>Newsweek</i>, however, or on "The Tonight Show" are the stars of the year's real story of medicine in Chicago, Sidney Lewis'<i>Hospital: An Oral History of Cook County Hospital</i>. Lewis, a long-time associate of America's dean of oral history, Studs Terkel, set out in the spring of 1993 to record the voices of the women and men who populate Cook County Hospital day and night—doctors, nurses, patients, lab techs, police, maintenance workers, and ward clerks. Lewis' work is a staccato tour of the people and forces that make the hospital what it is. County's history and
Initiatives Focus on Limiting Radiation Exposure to Patients During CT Scans
Authors: Denise M. Goodman
Journal: JAMA (2013)

IN THE PAST DECADE OR SO, EMERGING data have raised concerns about increased cancer risk attributable to the radiation doses experienced by patients who undergo computed tomographic (CT) scanning. More than 80 million CT scans are performed annually in the United States. Limiting radiation exposure is a consideration for anyone, but the concern is heightened for children, who undergo about 6 million CT scans per year, according to the American College of Radiology (ACR). Children are growing, their tissues may be more radiosensitive, and their smaller size makes them more vulnerable if dosing is not adjusted accordingly. In addition, compared with adults, children who undergo a CT scan typically have many more years of life ahead of them and thus have a wider window of opportunity for the manifestation of radiation injury. One of the first reports on estimated risks of fatal cancer resulting from pediatric CT radiation exposure, by David Brenner, PhD, DSc, director of the Center for Radiological Research at ColumbiaUniversityMedicalCenterinNewYork City,andcolleagues,estimatedriskusing doses derived from studies of those exposedtoatomicbombsinJapan(Brenner DJ et al. AJR Am J Roentgenol. 2001;176: 289-296).Lastyear, researchersreported evidence of a relationship between leukemia incidence and estimated CT scan radiation doses to bone marrow during childhood, as well as between brain tumor incidenceandestimatedCTscanradiation doses to the brain (Pearce MS et al. Lancet. 2012;380[9840]:499-505).
Positive HIV ELISA test, autoimmune hemolytic anemia, and generalized lymphadenopathy: A unifying diagnosis
Authors: Jorge J. Castillo, Natalie Sinclair, Dariusz Stachurski, Eric D. Jacobsen
Journal: American Journal of Hematology (2011)

physician or group of physicians considers presentation and evolution of a real clinical case, reacting to clinical information and data (boldface type).This is followed by a discussion/commentary.
SOME SPECIAL REASONS WHY THE LAPAROTOMIST SHOULD CONSIDER THE MEDICO-LEGAL ASPECTS OF ABDOMINAL SURGERY.Read in the Section of Medical Jurisprudence at the Forty-first Annual Meeting of the American Medical Association, at Nashville, Tenn., May, 1890.
Authors: HENRY O. MARCY
Journal: JAMA (1890)

The evidence that the question under discussion is many-sided is shown by the different titles which the distinguished specialists have chosen who are announced to furnish, to-day, contributions upon the medico-legal aspects of abdominal surgery. I have selected a very minor subdivision of the topic, to which I propose to confine my remarks, to wit: namely, the opinions which the great body politic of the profession hold in relation to the justifiability of abdominal operations in general, and the influence which such opinions exert, as commonly expressed in everyday practice. Twenty years have elapsed since I became a special student of abdominal surgery. Leaders of the profession at that time in New England, without doubt with the most disinterested motives, earnestly gave me warning that if I allowed myself to be known as having special interest in this department of professional work, as viewed from the surgical aspect, it would
Expression of trefoil peptides pS2 and human spasmolytic polypeptide in gastric metaplasia at the margin of duodenal ulcers.
Authors: S Khulusi, A M Hanby, J M Marrero, P Patel, M A Mendall, S Badve, R Poulsom, G Elia, N A Wright, T C Northfield
Journal: Gut (1995)

Duodenal ulcers are associated with gastric metaplasia in the duodenum, both at the ulcer margin and at more distant sites in the duodenal bulb. pS2 and human spasmolytic polypeptide (hSP) are secretory peptides expressed in gastric epithelial cells and in gastric metaplasia. As these peptides may be important in ulcer healing, this study investigated the possibility that the expression of pS2 and hSP is increased in gastric metaplasia at the margin of duodenal ulcers. Duodenal bulb biopsy specimens from 12 duodenal ulcer patients were assessed. Sections were immunostained with monoclonal antibodies for pS2 and hSP. Cytoplasmic stain intensities were measured by an image analysis system and expressed as integrated optical density (IOD) units, In situ hybridisation for pS2 and hSP mRNA was carried out on parallel sections. Duodenal sections were also stained with diatase periodic acid Schiff/alcian blue to localise areas of gastric metaplasia. pS2 antigen staining in the duodenum was restricted to surface epithelial cells, and hSP to acinar and ductular components of Brunner9s gland. mRNA localisation corresponded to immunostaining cells. In gastric metaplasia, pS2 expression was greater at the ulcer margin than away from the ulcer, as judged by the intensity of antibody staining (mean IOD units (SEM), 20.6 (3.3) v 9.5 (3.0); p &lt; 0.001). There was a trend towards greater hSP staining at the ulcer margin but this did not achieve statistical significance. These findings support the putative role of pS2 and possible hSP in mucosal healing and providy further evidence for an autocrine 9ulcer-gastric metaplasia-repair9 loop involving these trefoil peptides.
Chymopapain Chemonucleolysis in Lumbar Disk Disease
Authors: Leon L. Wiltse
Journal: JAMA (1975)

Experience with chymopapain chemonucleolysis in 1,200 cases of lumbar disk disease indicates that it is an effective method of relieving pain resulting from an abnormal intervertebral disk. Complications were few; anaphylaxis occurring immediately after injection was by far the most serious. With the use of a corticosteroid and an antihistamine in preoperative preparation, the incidence of anaphylaxis had dropped, although it still occurs. On long-term follow-up, chemonucleolysis appears to be as good as laminectomy in properly selected cases.
[Ca <sup>2+</sup> ] <sub>i</sub> Inhibition of K <sup>+</sup> Channels in Canine Pulmonary Artery
Authors: Joseph M. Post, Craig H. Gelband, Joseph R. Hume
Journal: Circulation Research (1995)

Abstract Experiments were performed on smooth muscle cells isolated from canine pulmonary artery to identify the type of K + channel modulated by hypoxia and examine the possible role of [Ca 2+ ] i in hypoxic K + channel inhibition. Whole-cell patch-clamp experiments revealed that hypoxia (induced by the O 2 scavenger, sodium dithionite) reduced macroscopic K + currents, an effect that could be prevented by strong intracellular buffering of [Ca 2+ ] i . The inhibitory effects of hypoxia were mimicked by acute exposure of cells to caffeine and could be prevented by caffeine pretreatment, suggesting an important obligatory role of [Ca 2+ ] i in hypoxic inhibition of K + currents. Exposure of cells to low concentrations of 4-aminopyridine (4-AP, 1 mmol/L) prevented hypoxic inhibition of macroscopic K + currents, whereas low concentrations of tetraethylammonium were without effect, suggesting that the target K + channel inhibited by hypoxia is a voltage-dependent delayed rectifier K + channel, which is inhibited by [Ca 2+ ] i . Hypoxia failed to consistently modify the activity of large-conductance (118 picosiemens [pS] in physiological K + ) Ca 2+ -activated K + channels in inside-out membrane patches but reduced open probability of smaller-conductance (25-pS) delayed rectifier K + channels in cell-attached membrane patches. In inside-out membrane patches, 1 μmol/L Ca 2+ added to the cytoplasmic surface significantly reduced open probability of small-conductance (25-pS) 4-AP–sensitive delayed rectifier K + channels. Whole-cell current measurements using symmetrical K + to increase driving force for small currents active near the cell’s resting membrane potential revealed the presence of a 4-AP–sensitive K + current that activated near −65 mV and was inhibited by hypoxia. Simultaneous measurements of changes in [Ca 2+ ] i , using the Ca 2+ indicator indo 1, and membrane potential revealed that hypoxia causes an initial rise of [Ca 2+ ] i , which precedes hypoxia-induced membrane depolarization. It is concluded that in canine pulmonary arterial cells an early key event in hypoxic pulmonary vasoconstriction is release of Ca 2+ from caffeine-sensitive intracellular Ca 2+ stores, which causes inhibition of delayed rectifier K + channels and membrane depolarization, possibly leading to subsequent activation of Ca 2+ entry through voltage-dependent Ca 2+ channels.
Medulloblastoma metastasizing to the skin
Authors: E.J. Topham, N. Francis, C.B. Bunker
Journal: British Journal of Dermatology (2005)

Conflicts of interest: none declared. Sir, A 22‐year‐old patient presented with a 5‐month history of an enlarging red lesion on her right cheek. She had had a medulloblastoma of the posterior fossa treated with ventriculoperitoneal shunting, surgery, craniospinal radiotherapy and chemotherapy 2 years previously and had gone into remission. Her only medication was phenytoin. The lesion was a firm, irregular, erythematous, nodular tumour with areas of haemorrhage within it, measuring 4 × 2 cm (Fig. 1). There was no associated lymphadenopathy. The clinical differential diagnosis included a granulomatous process, lymphoma and metastasis. A punch biopsy of the nodule showed a subepidermal lesion composed of sheets of small round cells with scanty cytoplasm and round nuclei with nucleoli (Fig. 2). The tumour cells were positive for synaptophysin, weakly positive for neurone‐specific enolase and negative for neurofilament, confirming medulloblastoma metastasis in the skin. Medulloblastoma is a primitive neuroectodermal tumour of the central nervous system (cerebellum). It is the most common malignant brain tumour in children but 30% of cases occur in adults. Recurrent disease usually takes the form of local recurrence or metastasis within the brain or spinal cord. Systemic metastasis is rare, occurring in less than 5% of patients.1, 2 The commonest site is bone/bone marrow, followed by soft tissue and lymph nodes, then liver and lung. The median time to systemic metastasis is 2 years. Whether permanent shunting has an adverse effect on both the likelihood of metastasis and the time to metastasis is controversial. To our knowledge, this is the first case of systemic metastasis from medulloblastoma presenting in the skin and illustrates the need always to consider metastasis in the differential diagnosis of cutaneous nodules, however unlikely it may appear in terms of tumour biology.
Cumulative Exposure to Lead in Relation to Cognitive Function in Older Women
Authors: Jennifer Weuve, Susan A. Korrick, Marc A. Weisskopf, Louise M. Ryan, Joel Schwartz, Huiling Nie, Francine Grodstein, Howard Hu
Journal: Environmental Health Perspectives (2008)

BackgroundRecent data indicate that chronic low-level exposure to lead is associated with accelerated declines in cognition in older age, but this has not been examined in women.ObjectiveWe examined biomarkers of lead exposure in relation to performance on a battery of cognitive tests among older women.MethodsPatella and tibia bone lead—measures of cumulative exposure over many years—and blood lead, a measure of recent exposure, were assessed in 587 women 47–74 years of age. We assessed their cognitive function 5 years later using validated telephone interviews.ResultsMean ± SD lead levels in tibia, patella, and blood were 10.5 ± 9.7 μg/g bone, 12.6 ± 11.6 μg/g bone, and 2.9 ± 1.9 μg/dL, respectively, consistent with community-level exposures. In multivariable-adjusted analyses of all cognitive tests combined, levels of all three lead biomarkers were associated with worse cognitive performance. The association between bone lead and letter fluency score differed dramatically from the other bone lead-cognitive score associations, and exclusion of this particular score from the combined analyses strengthened the associations between bone lead and cognitive performance. Results were statistically significant only for tibia lead: one SD increase in tibia lead corresponded to a 0.051-unit lower standardized summary cognitive score (95% confidence interval: −0.099 to −0.003; p = 0.04), similar to the difference in cognitive scores we observed between women who were 3 years apart in age.ConclusionsThese findings suggest that cumulative exposure to lead, even at low levels experienced in community settings, may have adverse consequences for women’s cognition in older age.
Rheumatology. A coloured guide.
Authors: G D WRIGHT
Journal: Annals of the Rheumatic Diseases (1998)

Rheumatology. A coloured guide. By J M H Moll. (Pp 158; £9.50). Edinburgh: Churchill Livingstone, 1997. ISBN 0443058059.

As part of the “Colour guide series” I feel this book is almost certainly aimed for exam preparation for either final MB or MRCP.

The colour plates are …
No to QOF target of less than 7%, again
Authors: R. Lehman, H. M Krumholz
Journal: BMJ (2010)

A large observational study examining the effect of additional glucose lowering treatment in nearly 28 000 primary care patients with type 2 diabetes in the UK was published last month.1 2 A glycated haemoglobin concentration of 7.5% was associated with the lowest mortality. Concentrations below 7% were associated with a …
Selective induction of labour.
Authors: K O'Driscol, C J Carroll, M Coughlan
Journal: BMJ (1975)

In a prospective study of 1000 consecutive primigravidae labour was induced on 95 occasions. None of 16 perinatal deaths and none of 4 cases of suspected brain damage occurred after prolonged pregnancy or pre-eclampsia. It is concluded that a low incidence of induction is compatible with good results and that enthusiasm for the statistical concept of high risk in obstetric practice should be reviewed in the interest of mothers and children as individuals.
The pathogenesis of adoptive murine autoimmune diabetes requires an interaction between alpha 4-integrins and vascular cell adhesion molecule-1.
Authors: J L Baron, E P Reich, I Visintin, C A Janeway
Journal: Journal of Clinical Investigation (1994)

An adoptive transfer model of insulin-dependent diabetes mellitus (IDDM) in the nonobese diabetic mouse was used to examine the roles of alpha 4-integrin, vascular cell adhesion molecule 1 (VCAM-1); and intercellular adhesion molecule 1 (ICAM-1) in the pathogenesis of autoimmune diabetes. Antibodies specific for both alpha 4-integrin and one of its ligands, VCAM-1, were able to delay onset of diabetes and decrease the incidence of the disease in adoptive transfer studies. This blocking of disease was accompanied by a marked decrease in lymphocytic infiltration of the islets of Langerhans. Furthermore, these antibodies preferentially block entrance of CD4 T cells into the tissue. Antibodies specific for ICAM-1 had little effect on the onset or incidence of IDDM. Thus, we conclude that an alpha 4-integrin-VCAM-1 interaction is important in T cell entry into the islets of Langerhans and in the pathogenesis of IDDM. In addition, the cascade of events leading to T cell transit across endothelium may be different for CD4 and CD8 cells, and may differ depending on the endothelium involved. Our results support the more general conclusion that an alpha 4-integrin-VCAM-1 interaction may be crucial in allowing activated effector CD4T cells to leave the blood and enter tissue to clear infection.
Repetitive Transcranial Magnetic Stimulation in Bulimia Nervosa: Preliminary Results of a Single-Centre, Randomised, Double-Blind, Sham-Controlled Trial in Female Outpatients
Authors: M. Walpoth, C. Hoertnagl, B. Mangweth-Matzek, G. Kemmler, J. Hinterhölzl, A. Conca, A. Hausmann
Journal: Psychotherapy and Psychosomatics (2007)

&lt;i&gt;Background:&lt;/i&gt; Bulimia nervosa (BN) is often associated with depressive symptoms and treatment with antidepressants has shown positive effects. A shared deficient serotonergic transmission was postulated for both syndromes. The left dorsolateral prefrontal cortex was argued to regulate eating behaviour and to be dysfunctional in eating disorders. &lt;i&gt;Methods:&lt;/i&gt; Fourteen women meeting DSM-IV criteria for BN were included in a randomised placebo-controlled double-blind trial. In order to exclude patients highly responsive to placebo, all patients were first submitted to a one-week sham treatment. Randomisation was followed by 3 weeks of active treatment or sham stimulation. As the main outcome criterion we defined the change in binges and purges. Secondary outcome variables were the decrease of the Hamilton Depression Rating Scale (HDRS), the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Scale (YBOCS) over time. &lt;i&gt;Results:&lt;/i&gt; The average number of binges per day declined significantly between baseline and the end of treatment in the two groups. There was no significant difference between sham and active stimulation in terms of purge behaviour, BDI, HDRS and YBOCS over time. &lt;i&gt;Conclusion:&lt;/i&gt; These preliminary results indicate that repetitive transcranial magnetic stimulation (rTMS) in the treatment of BN does not exert additional benefit over placebo. A larger number of patients might clarify a further role of rTMS in the treatment of BN.
A STUDY OF THE ANTIGENICITY OF T3 AND T4 COLI-DYSENTERY BACTERIOPHAGES DURING THE VEGETATIVE STAGE OF DEVELOPMENT
Authors: Guy T. Barry
Journal: The Journal of Experimental Medicine (1954)

The development of viral neutralizing antibodies in animals injected with T(3) or T(4) phage is considerably inhibited by the presence of bacterial antigens. A new procedure has been described to liberate phage from infected E. coli B bacteria by inducing lysis with penicillin. By immunological means it has been shown that T(4)-infected cultures of E. coli B, in which phage development has been inhibited with proflavine, contain the viral neutralizing antigen after lysis. In contrast, it has not been possible to demonstrate by immunological means the appearance of viral neutralizing antigen in E. coli B infected with T(3) prior to the appearance of intracellular phage.
Ischaemic preconditioning protects hypertrophied myocardium
Authors: M E Speechly-Dick, G F Baxter, D M Yellon
Journal: Cardiovascular Research (1994)

Objective: Clinical and experimental evidence suggests that hypertrophied myocardium is more susceptible to injury from ischaemia than normal myocardium. This study was designed to investigate whether preconditioning confers protection on hearts with moderate hypertrophy. Methods: Cardiac hypertrophy induced by hypertension was produced in rats by giving saline drinking fluid and subcutaneous deoxycorticosterone acetate for four weeks. After thoracotomy, localisation of the left main coronary artery and stabilisation, groups of hypertensive animals with cardiac hypertrophy (HT) and their age matched normotensive controls (NT) underwent a preconditioning protocol consisting of 5 min occlusion of the left main coronary artery followed by 10 min reperfusion. This was followed by 45 min ischaemia and at least 2.5 h reperfusion. Control animals in the hypertrophied and normotensive groups were treated identically but were not subjected to the preconditioning protocol. Thus there were four experimental groups: HT preconditioned (n = 8), HT control (n = 7), NT preconditioned (n = 7), and NT control (n = 7). Infarct size was measured using triphenyl tetrazolium chloride and was expressed as a percentage of the volume at risk, measured with fluorescent particles. Results: Heart weight was greater (p < 0.01) in the HT groups than in the NT groups [HT preconditioned 1.7(SEM 0.06) g, HT control 1.71(0.02) g, NT preconditioned 1.3(0.04) g, NT control 1.31(0.03) g]. Infarct to risk volume ratio (I/R) was significantly lower (p < 0.05) in the preconditioned groups as compared with controls [HT preconditioned 19.1(1.5)% v HT control 67.1(5.6)%, and NT preconditioned 33.4(5.5)% v NT control 77.1(3.8)%]. There was no significant difference in the volume at risk of infarction between the four groups. Conclusions: Ischaemic preconditioning can induce myocardial protection in hypertrophied myocardium; this is the first study to demonstrate preconditioning in hypertrophy. Cardiovascular Research 1994;28:1025-1029
Aneuploidy in actinic keratosis and Bowen's disease—increased risk for invasive squamous cell carcinoma?
Authors: S. BIESTERFELD, K. PENNINGS, E.-I. GRUSSENDORF-CONEN, A. BOCKING
Journal: British Journal of Dermatology (1995)

The value of DNA single cell cytometry for the detection of aneuploidy was assessed in 100 specimens of actinic keratoses and 39 specimens of Bowen's disease. Ten seborrhoeic keratoses and 10 samples of normal epidermis served as negative control groups. Monolayer smears, prepared from formalin-fixed, paraffin-embedded tissues, were Feulgen-stained and used for interactive DNA-cytometry. In each specimen, the DNA content of 150 randomly chosen squamous epithelial cells was measured, using a TV-image analysis system (TAS-plus, Leica, Germany). Aneuploidy was diagnosed if at least three nuclei with a DNA content above 5c (5cEE > or = 3) were found. The aneuploidy rate in actinic keratosis was 69% (69 of 100) and in Bowen's disease was 95% (37 of 39). Another 20 specimens of actinic keratoses and the remaining two specimens of Bowen's disease were diagnosed as suspicious for aneuploidy (0 < 5cEE < 3). The 20 specimens of seborrhoeic keratoses and normal epidermis did not show any nuclei above the 5c level, and were classified as non-aneuploid. This indicates a sensitivity of 76% (106 of 139) and a specificity of 100% (20 of 20). The frequent occurrence of aneuploidy in actinic keratoses and Bowen's disease underlines the character of the lesions as epidermal carcinomas in situ, but does not explain the long-term low incidence of invasive growth.