tbuckley/cabot-search huggingface dataset:
Anesthesiology Led in Establishing Standards of Care, Now Plans Practice Parameter Strategies
Authors: Marsha F. Goldsmith
Journal: JAMA (1992)

THEORIES ABOUND as to why the grateful patients of Dr Crawford Long's day gave way to the many litigious recipients of medical care more than a century later. Whatever the reason, by the mid 1980s in the United States, anesthesiologists and other physicians found themselves practicing in an adversarial climate. To mitigate the "malpractice crisis," in which an increasing number of legal claims by patients who suffered less than optimal outcomes was driving insurance premiums sky high, efforts were begun to improve patient care. <h3>Establishing Standards</h3> In 1986, anesthesiologists affiliated with nine teaching hospital departments that made up the Department of Anesthesia of Harvard Medical School, Boston, Mass, took the lead in establishing standards of care (<i>JAMA</i>. 1986;256:1017-1020). According to Burton S. Epstein, MD, chair of the American Society of Anesthesiologists' (ASA's) Committee on Standards of Care since 1985, such clearly stated standards had not existed before in any specialty.
Metabolism and biological activity of parathyroid hormone in renal cortical membranes.
Authors: D Goltzman, A Peytremann, E N Callahan, G V Segre, J T Potts
Journal: Journal of Clinical Investigation (1976)

Recent studies from several laboratories have documented the presence of fragments of parathyroid hormone in blood or peripheral tissues or in both. Inasmuch as amino-terminal fragments are known to be biologically active, it has been suggested that fragments, rather than the intact polypeptide of 84 amino acids, might be the active molecular species in tissue fluids. Accordingly, the metabolism of native bovine parathyroid hormone, bPTH-(1-84), was studied in purified renal cortical membranes from several species and correlated with hormonal stimulation of adenylyl cyclase in these membranes in vitro. Analysis of whole incubation mixtures or membrane-bound hormone by gel electrophoresis and gel chromatography after incubation of [3H]bPTH-(1-84) or 125-I-labeled bPTH-(1-84) or unlabeled biologically active bPTH-(1-84) with purified canine renal cortical membranes revealed no evidence of proteolysis, and yet the uncleaved hormone readily stimulated adenylyl cyclase. Kinetic studies of hormone-stimulated adenylyl cyclase activity revealed no difference in rate of onset of activity between bPTH-(1-84) And the active synthetic amino-terminal tetratriacontapeptide bPTH-(1-34), and hence there was no evidence of precursor-product relationship between the native hormone and an active amino-terminal fragment. The results suggest, insofar as the activity detected in these membranes reflects the biological response of the hormone in vivo, that the native hormone is indeed biologically active at the receptor level directly without the requirement for cleavage into active fragments.
Cardiac Auscultations Skills of Physicians in Training-Reply
Authors: Salvatore Mangione
Journal: JAMA (1997)

<h3>In Reply</h3> —Dr Nadoolman suggests that the simple detection of an auscultatory abnormality (without being able to better define it) might be sufficient. We disagree. First, it is not so easy to detect that "something is wrong" (many of our findings were missed entirely). Moreover, an acoustic event per se may not necessarily require much workup. For example, many systolic murmurs are benign. As Frye<sup>1</sup>noted, the extraordinary increase in use of echocardiography "reflects a growing dependence on sophisticated imaging technology, even in settings where obtaining a thorough history, physical examination, chest x-ray film and electrocardiogram may suffice for clinical decision making." Dr Lewis argues that Butterworth and Reppert used different methods than ours, that physicians' ability to recognize recorded sounds may correlate poorly with bedside skills, and that subtracting clinical history from physical examination eliminates an important guidance. These are all valid points, and we did acknowledge them in our article.
146 RELATIONSHIP BETWEEN GH/IGF-1 AXIS, GRAFT RECOVERY AND EARLY SURVIVORSHIP IN PATIENTS UNDERGOING LIVER TRANSPLANTATION
Authors: L. Baiocchi, G. Tisone, A. Salso, T.M. Manzia, C. Almerighi, I. Lenci, S. Francioso, L. Tariciotti, M. Carbone, M. Angelico
Journal: Journal of Hepatology (2009)
Complications of the Mainz Pouch II (Sigma Rectum Pouch)
Authors: Can &Ouml;bek, Ali Riza Kural, S&uuml;leyman Ataus, Enis Co&scedil;kuner, Oktay Demirkesen, Arman &Ccedil;it&ccedil;i, Ali Ulvi &Ouml;nder, Vural Solok
Journal: European Urology (2001)
Antimicrobial activity of calcium hydroxide and chlorhexidine on intratubular Candida albicans
Authors: Ronan Jacques Rezende Delgado, Thaís Helena Gasparoto, Carla Renata Sipert, Claudia Ramos Pinheiro, Ivaldo Gomes de Moraes, Roberto Brandão Garcia, Marco Antônio Hungaro Duarte, Clóvis Monteiro Bramante, Sérgio Aparecido Torres, Gustavo Pompermaier Garlet, Ana Paula Campanelli, Norberti Bernardineli
Journal: International Journal of Oral Science (2013)

This study investigated the efficacy of calcium hydroxide and chlorhexidine gel for the elimination of intratubular Candida albicans (C. albicans). Human single-rooted teeth contaminated with C. albicans were treated with calcium hydroxide, 2% chlorhexidine gel, calcium hydroxide plus 2% chlorhexidine gel, or saline (0.9% sodium chloride) as a positive control. The samples obtained at depths of 0–100 and 100–200 µm from the root canal system were analyzed for C. albicans load by counting the number of colony forming units and for the percentage of viable C. albicans using fluorescence microscopy. First, the antimicrobial activity of calcium hydroxide and the 2% chlorhexidine gel was evaluated by counting the number of colony forming units. After 14 days of intracanal medication, there was a significant decrease in the number of C. albicans colony forming units at a depth of 0–100 µm with chlorhexidine treatment either with or without calcium hydroxide compared with the calcium hydroxide only treatment. However, there were no differences in the number of colony forming units at the 100–200 µm depth for any of the medications investigated. C. albicans viability was also evaluated by vital staining techniques and fluorescence microscopy analysis. Antifungal activity against C. albicans significantly increased at both depths in the chlorhexidine groups with and without calcium hydroxide compared with the groups treated with calcium hydroxide only. Treatments with only chlorhexidine or chlorhexidine in combination with calcium hydroxide were effective for elimination of C. albicans. During root canal treatment, disinfection with chlorhexidine — an antimicrobial with long-lasting effect — can help prevent infection, Brazilian research shows. The complex anatomy of the canal, which is comprised of the pulp-containing canal and the microscopic dentinal tubules radiating outward to the tooth's edge, can harbor harmful microbes after a tooth's pulp is removed. Effective disinfection is therefore essential. Ronan Delgado and colleagues at the University of São Paulo, Brazil, tested two antimicrobial gels, chlorhexidine and calcium hydroxide, on extracted teeth infected with Candida albicans, a particularly tenacious oral microbe. Using fluorescence techniques to count live and dead cells very accurately, they determined that either alone or paired with calcium hydroxide, chlorhexidine was more effective against C. albicans than calcium hydroxide alone.
Defective methionine metabolism in cirrhosis: Relation to severity of liver disease
Authors: Professor Giulio Marchesini, Elisabetta Bugianesi, Giampaolo Bianchi, Andrea Fabbri, Elisabetta Marchi, Marco Zoli, Emilio Pisi
Journal: Hepatology (1992)

A block in the transsulfuration pathway has previously been suggested in cirrhosis on the basis of increased fasting methionine concentrations, decreased methionine elimination and low levels of methionine end products. To date, methionine elimination has never been studied under controlled steady-state conditions, and the relation of the severity of liver disease to impaired methionine metabolism has not been clarified. We measured methionine plasma clearance in 6 control subjects and in 12 patients with cirrhosis during steady-state conditions obtained by a primed, continuous methionine infusion. In the presence of high-normal fasting methionine concentrations (range = 14 to 69 μmol ± L−1 in controls and 26 to 151 μmol ± L−1 in cirrhotic patients), methionine plasma clearance was reduced in cirrhotic patients (2.25 ± S.D. 0.43 ml ± sec−1 vs. 2.86 ± S.D. 0.43 ml ± sec−1 in controls; p < 0.05), whereas methionine half-life was increased (282 ± 90 min vs. 187 ± 25 min in controls; p <0.05). Fasting methionine significantly correlated with methionine clearance. The infused methionine was not degraded to urea to any significant extent in cirrhotic patients, whereas a threefold increase in urinary urea nitrogen excretion rate was observed in controls. Similarly, taurine concentrations significantly increased both in plasma and in the urine in controls but not in cirrhotic patients. In cirrhotic patients methionine plasma clearance significantly correlated with galactose elimination capacity (r = 0.818) and with the Child-Pugh score (rs = −0.795). The study supports a major role of impaired liver cell function in the reduced metabolism of methionine and decreased formation of methionine end products that occur in cirrhosis. Impaired methionine metabolism is probably the basis for the hypermethioninemia of advanced cirrhosis. (HEPATOLOGY 1992;16:149–155.)
Methylmercury and the Brain: Griffiths et al. Respond
Authors: Charles Griffiths, Al McGartland, Maggie Miller
Journal: Environmental Health Perspectives (2007)

ADHD in those subjects with low ferritin levels.Given that lead exposure may contribute to ADHD and iron deficiency may exacerbate deleterious effects caused by lead, we recommend systematically seeking for iron deficiency in children with ADHD.We also think that controlled studies assessing the potential effectiveness of iron supplementation on ADHD symptoms should be encouraged.Such studies could aid the understanding of the complex pathophysiology underlying ADHD and provide effective therapeutic strategies for this disorder.
Diagnostic efficiency of an ultrarapid endoscopy room test for Helicobacter pylori.
Authors: A V Thillainayagam, A S Arvind, R S Cook, I G Harrison, S Tabaqchali, M J Farthing
Journal: Gut (1991)

There are several reliable methods for detecting Helicobacter pylori but all have as a major disadvantage the time required to yield a definitive result. We have modified the standard urease test so that a positive result is available in one minute. We describe the use of this test in biopsy specimens from the gastric antrum from 220 consecutive patients referred for upper gastrointestinal endoscopy. The performance of the 9one minute test9 was compared with a standard urease test, Gram stain, and microbiological culture. Using culture as the 9gold standard9 80 (36%) of the patients were H pylori positive. The one minute test produced no false positives and showed a sensitivity of 89% and specificity of 100%, while the predictive values of a positive and negative test were 100% and 94% respectively. The diagnostic efficiency of the test was 96% compared to 85% for both the Gram stain and direct urease test. All positive results using the one minute test were available within one minute. The test is easy to prepare and costs approximately pounds 0.04. This new modification of the urease test should be superior to the currently available urease tests because a reliable result will be available in almost 90% of infected individuals even before endoscopy is completed.
Nonabandonment: Medical Ethics
Authors: Gary C. Prechter
Journal: Annals of Internal Medicine (1995)

Letters15 September 1995Nonabandonment: Medical EthicsGary C. Prechter, MDGary C. Prechter, MDSouthwestern Medical Clinic; Berrien Center, MI 49102-9705Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-123-6-199509150-00031 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The article by Quill and Cassel [1] admirably stresses some of the lost concepts of medical practice, including a focus on human relationships and the role of “caring for the patient.” Interestingly, however, without ever using the dreaded word, we are encouraged throughout the article to consider active euthanasia. The argument is persuasive when we are told of a patient, Cynthia, who probably has a different philosophy of life from our own (she is a Buddhist) and who might well have desired more active participation on the part of her physician in terms of the timing of ...References1. Quill TE, Cassel CK. Nonabandonment: a central obligation for physicians. Ann Intern Med. 1995; 121:368-74. Google Scholar Author, Article, and Disclosure InformationAuthors: Gary C. Prechter, MDAffiliations: Southwestern Medical Clinic; Berrien Center, MI 49102-9705 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 September 1995Volume 123, Issue 6Page: 475KeywordsEuthanasiaMedical ethics ePublished: 15 August 2000 Issue Published: 15 September 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The sPLA <sub>2</sub> Inhibition to Decrease Enzyme Release After Percutaneous Coronary Intervention (SPIDER-PCI) Trial
Authors: Vladimír Džavík, Shahar Lavi, Kevin Thorpe, Paul M. Yip, Sylvain Plante, Douglas Ing, Christopher B. Overgaard, Mark D. Osten, Julie Lan, Kim Robbins, Steven E. Miner, Eric M. Horlick, Warren J. Cantor
Journal: Circulation (2010)

Secretory phospholipase A(2) (sPLA(2)) may play a role in myonecrosis after elective percutaneous coronary intervention (PCI). Inhibition of this enzyme may have a beneficial effect. The central hypothesis of this study was that treatment with varespladib, a small-molecule inhibitor of sPLA(2) would reduce postprocedural release of cardiac biomarkers after elective percutaneous coronary intervention.Between October 2007 and June 2009, 144 stable patients were randomized in a phase II trial to receive varespladib 500 mg PO BID or placebo 3 to 5 days before and for 5 days after elective percutaneous coronary intervention. The primary end point was elevation of troponin I or creatine kinase-MB above the upper limit of normal at 6 to 8 or 18 to 24 hours after percutaneous coronary intervention. Mean age was 63±10 and 64±10 years, with 38% and 42% with diabetes mellitus and 29% and 28% with prior myocardial infarction for the varespladib and placebo groups, respectively. The primary end point occurred in 75% of varespladib and 63% of placebo patients (P=0.14). Troponin I 3 times the upper limit of normal was observed in 57% and 50% (P=0.39) and creatine kinase-MB 2 times the upper limit of normal in 14% and 3% (P=0.018). Median (first and third quartiles) change in high-sensitivity C-reactive protein in these 2 groups was 0.65 mg/L (-0.18 and 1.48) and 0.70 mg/L (0.00 and 1.50) at 18 to 24 hours (P=0.81) and 0.20 mg/L (-0.70 and 1.40) and 0.60 mg/L (-0.12 and 1.72) at 3 to 5 days (P=0.23), whereas change in sPLA(2) activity at 3 to 5 days in a subset was -2.85 ng/ml (-3.40 and -1.85) and 0.25 ng/ml (-0.20 and 0.85) (P<0.001).Inhibition of sPLA(2) by varespladib administered for 3 to 5 days before the procedure does not reduce periprocedural myonecrosis associated with elective percutaneous coronary intervention.URL: http://www.clinicaltrials.gov. Unique identifier: NCT00533039.
Review: Addition of inhaled corticosteroids to long-acting β_2-agonists does not improve outcomes in stable COPD
Authors: Shawn D. Aaron
Journal: Annals of Internal Medicine (2010)

Source Citation Rodrigo GJ, Castro-Rodriguez JA, Plaza V. Safety and efficacy of combined long-acting β-agonists and inhaled corticosteroids vs long-acting β-agonists monotherapy for stable COPD: a systematic review. Chest. 2009;136:1029-38. 19633090
Website of the week: Childcare for working parents
Authors: R. MacDonald
Journal: BMJ (2003)

In this week's BMJ soap opera (see career focus p s23), Penelope Millstone, the pregnant, workaholic medical senior house officer, is arguing with her general practitioner husband, Giles Millstone, over whether she should work full or part time after their baby is born. Giles wants her to “concentrate on motherhood” but consents that she can work part time “once the baby is old enough.” Penelope is adamant that she wants …
Endoscopic submucosal dissection for gastric lesions: results of an European inquiry
Authors: F. Ribeiro-Mourão, P. Pimentel-Nunes, M. Dinis-Ribeiro
Journal: Endoscopy (2010)

Background and study aims: In Japanese centers, endoscopic submucosal dissection (ESD) is commonly used for the resection of early gastric lesions. However, in Europe, only a few reports have been published. The aim of the current study was to survey the current use of ESD by European endoscopists.
Diltiazem Improves Cardiac Function and Exercise Capacity in Patients With Idiopathic Dilated Cardiomyopathy
Authors: Hans R. Figulla, Frank Gietzen, Uwe Zeymer, Martin Raiber, Johannes Hegselmann, Reinhild Soballa, Reinhard Hilgers
Journal: Circulation (1996)

Background Evidence is arising that calcium antagonists in idiopathic dilated cardiomyopathy (IDC) may have beneficial effects on virus-induced cardiopathology, alcohol toxicity, microcirculatory disorders, and impaired calcium cycling, all possibly involved in the pathogenesis of the disease. Thus, the effect of adjunct diltiazem (60 to 90 mg TID) on standard treatment was investigated. Methods and Results The Diltiazem in Dilated Cardiomyopathy (DiDi) trial was a randomized, double-blind, placebo-controlled, multicenter trial of 186 patients (92 receiving diltiazem, 94 receiving placebo) with IDC diagnosed by coronary angiography, catheterization of the left side of the heart, and a left ventricular ejection fraction of &lt;0.50 (mean, 0.34±0.11). The effect of adjunct diltiazem treatment on transplant listing–free survival, hemodynamics, exercise capacity, and subjective status was investigated. During the 24-month study period, 33 patients dropped out of the study; 153 patients finished the study protocol. Twenty-seven patients died or had a listing for heart transplantation: 16 in the placebo group and 11 in the diltiazem group. The transplant listing–free survival rate was 85% for diltiazem and 80% for placebo recipients ( P =.444). After 24 months, only diltiazem significantly increased cardiac index at rest ( P =.01) and under a workload ( P =.02), systolic and diastolic pressures ( P =.003 and P =.004), stroke volume index ( P =.003), and stroke work index ( P =.000) and decreased both pulmonary artery pressure under workload ( P =.007) and heart rate ( P =.001). Diltiazem also increased exercise capacity ( P =.002) and subjective well-being ( P =.01). Adverse reactions were minor and evenly distributed in both groups, except for an increase in the PQ interval in the diltiazem group. Conclusions In patients with IDC, the adjunct therapy of diltiazem improves cardiac function, exercise capacity, and subjective status without deleterious effects on transplant listing–free survival.
Prognostic Impact of Fibroblast Growth Factor 2 in Non-small Cell Lung Cancer: Coexpression with VEGFR-3 and PDGF-B Predicts Poor Survival
Authors: Tom Donnem, Khalid Al-Shibli, Samer Al-Saad, Lill-Tove Busund, Roy M. Bremnes
Journal: Journal of Thoracic Oncology (2009)
Angiographic predictors of left ventricular ejection fraction after successful angioplasty in acute myocardial infarction: An angiographic risk score for use in the catheterization laboratory
Authors: Jose P. Henriques, Felix Zijlstra, Jan-Paul Ottervanger, Jan-Henk E. Dambrink, Arnoud W. van't Hof, Jan C. Hoorntje, Menko-Jan de Boer, Harry Suryapranata, Isala Klinieken
Journal: Journal of the American College of Cardiology (2003)
Welsh health service is “unsustainable,” report says
Authors: Roger Dobson
Journal: BMJ (2004)

Urgent, radical, and sweeping changes to health services in Wales are being urged by the Audit Commission.

A catalogue of problems identified in a new report include more than one in four beds blocked by patients who should not be there, poor use of resources, alienated clinicians, considerable overspending, and management weaknesses.

Day surgery and theatres are poorly used, beds in community hospitals are underused, and more progress is needed in public health.

“The challenges faced by all those concerned with the health of Wales and its people are daunting. Overall, the picture in Wales is one of an unsustainable service. Welsh comparative performance …
Bacillary angiomatosis: presentation of six patients, some with unusual features
Authors: R.A. SCHWARTZ, S.G. NYCHAY, C.K. JANNIGER, W.C. LAMBERT
Journal: British Journal of Dermatology (1997)

Bacillary angiomatosis (BA) is an unusual systemic vascular proliferation seen predominantly in patients with the acquired immunodeficiency syndrome. These vascular lesions are probably due to infection with a Bartonella species, most often B. henselae and. in some patients, B. quintana. BA is treatable and often curable, but without therapy, may be life‐threatening. Clinically, the lesions, when superficial, are said to often resemble pyogenic granulomas, appearing polypoid histologically with an epidermal collarette. We now report six patients, three of whom showed lesions of BA morphologically and histologically distinct from the other patients reported to date. Two patients' lesions appeared clinically as violaceous plaques and tumours resembling Kaposi's sarcoma; one of them had lesions histologically reminiscent of a papular angiokeratoma; and the other had lesions histologically suggestive of a combination of Kaposi's sarcoma and BA. Another patient presented with soft subcutaneous nodules which histologically showed extensive acute inflammation characteristic of an acute abscess, but which also displayed proliferating dilated small blood vessels with bulbous endothelial cells adjacent to numerous bacteria and also containing them. The Grocott‐methenamine silver stain and the Warthin‐Starry stain showed the organisms to better advantage in lesions of all six patients, although bacteria were also evident with the haematoxylin and eosin. periodic acid‐Schiff and alcian blue stains.
Genetic Correction of PSA Values Using Sequence Variants Associated with PSA Levels
Authors: Julius Gudmundsson, Soren Besenbacher, Patrick Sulem, Daniel F. Gudbjartsson, Isleifur Olafsson, Sturla Arinbjarnarson, Bjarni A. Agnarsson, Kristrun R. Benediktsdottir, Helgi J. Isaksson, Jelena P. Kostic, Sigurjon A. Gudjonsson, Simon N. Stacey, Arnaldur Gylfason, Asgeir Sigurdsson, Hilma Holm, Unnur S. Bjornsdottir, Gudmundur I. Eyjolfsson, Sebastian Navarrete, Fernando Fuertes, Maria D. Garcia-Prats, Eduardo Polo, Ionel A. Checherita, Mariana Jinga, Paula Badea, Katja K. Aben, Jack A. Schalken, Inge M. van Oort, Fred C. Sweep, Brian T. Helfand, Michael Davis, Jenny L. Donovan, Freddie C. Hamdy, Kristleifur Kristjansson, Jeffrey R. Gulcher, Gisli Masson, Augustine Kong, William J. Catalona, Jose I. Mayordomo, Gudmundur Geirsson, Gudmundur V. Einarsson, Rosa B. Barkardottir, Eirikur Jonsson, Viorel Jinga, Dana Mates, Lambertus A. Kiemeney, David E. Neal, Unnur Thorsteinsdottir, Thorunn Rafnar, Kari Stefansson
Journal: Science Translational Medicine (2010)

Sequence variants in the human genome are associated with serum levels of prostate-specific antigen.