tbuckley/cabot-search huggingface dataset:
An unusual cause of blindness
Authors: R. A. Seville, J. Murchison, R. L. Riha
Journal: European Respiratory Journal (2009)

To the Editors: 

Allergic bronchopulmonary aspergillosis (ABPA) is caused by colonisation of the lungs with Aspergillus fumigatus resulting in a hypersensitivity reaction and bronchiectasis. Allergic aspergillus sinusitis (AAS) has similar histopathological features and yet simultaneous occurrence is rarely reported. We report a case of an aspergilloma in the paranasal sinuses causing unilateral blindness with associated AAS. The patient went on to develop ABPA resulting in a dramatic decline in lung function. Therapy consisted of oral steroids, an anti-fungal agent, bronchodilators and bronchial hygiene.

A 48-yr-old female presented to her general practitioner in 2006 with sudden loss of sight in the left eye. Following an urgent computed tomography (CT) head scan she was referred to the Ear Nose and Throat surgeons (Royal Infirmary Edinburgh, Edinburgh, UK) with the radiological diagnosis of a cystic lesion in the region of the sphenoethmoid sinus (fig. 1⇓). She underwent an endoscopic sphenoid sinus debridement and washout. Cellular pathology of the sinus biopsy showed an oedematous and hyalinised lamina propria, containing an infiltrate of plasma cells, eosinophils and lymphoid aggregates. Branching septate fungal hyphae consistent with Aspergillus sp. were identified. The patient was diagnosed with an aspergillus fungal ball and sinusitis. Full vision was …
Comparison between ifn induction therapy, IFN induction + Ribavirin and IFN + Ribavirin standard combination therapy in naive patients with chronic hepatitis C related to genotype 1: final report
Authors: Antonio Bellobuono, S. Tempini, C. Cattaneo, D. Grimoldi, Andrea Bellobuono, F. Di Berardino, G.M. Idéo, G. Idéo
Journal: Journal of Hepatology (2001)
Fibrosing Mediastinitis Causing Nonvisualization of One Lung on Pulmonary Scintigraphy
Authors: W H MALLIN, E B SILBERSTEIN, R T SHIPLEY, D N VU, J P ALSPAUGH, J S MOULTON
Journal: Clinical Nuclear Medicine (1993)

An interesting case of fibrosing mediastinitis, which is a rare cause of total nonvisualization of one lung on pulmonary scintigraphy, is presented. Scintigraphy with Tc-99m MAA showed a severe deficit of perfusion in the right lung, with normal perfusion of the left lung. Ventilation images were normal. CT and MRI each demonstrated the mediastinal nodal enlargement and MRI demonstrated the "flow void" signal phenomenon in the right pulmonary artery indicating its patency. Confirmation of actual patency without pulmonary artery emboli and with poor venous opacfication was documented with angiography. Multiple complementary imaging modalities were helpful in correctly diagnosing fibrosing mediastinitis from an extensive list of differential possibilities for unilateral non-visualization of the lung on perfusion scanning.
Nebuliser therapy in childhood
Authors: P. W. Barry, C. O'Callaghan
Journal: Thorax (1997)

tern is deep slow inhalations 5 accompanied by Clinical Sciences Building, breath holding.During larger breaths aerosol Leicester Royal is likely to penetrate further into the lung, Infirmary, increasing peripheral deposition.Conversely, Leicester LE2 7LX, UK at the higher flows of deep or fast breathing P W Barry turbulence is more likely to occur and inertial C O'Callaghan deposition in the upper airway and major bron-Flow Time Adult Child Infant Amount of drug inhaled Age ≈ 6 months Amount of drug inhaled per kg Age ≈ 6 months Nebuliser output
Occupational cancer in Germany.
Authors: I Brüske-Hohlfeld
Journal: Environmental Health Perspectives (1999)

As in probably mostly all other European countries, the incidence of occupational cancer in Germany increased steadily after World War II. In 1994 about 1,600 cases of occupational cancer were compensated--more than ever before. More than half of these cases were lung cancer, most caused either by asbestos (n=545) or by ionizing radiation ((italic)n(/italic)=306). Other frequent target organs of asbestos were the pleura and the peritoneum with 495 cases of mesotheliomas. Asbestos was the single most important risk factor for occupational cancer, causing more than 1000 deaths per year. All other malignant diseases, such as bladder cancer, leukemia, angiosarcoma of the liver, adenocarcinoma of the nose or nasal sinuses, and skin cancer, were comparatively rare. Although primary exposure to ionizing radiation in uranium ore mining occurred in the 1950s and attributable lung cancers seem to be on the decline, this is not true for asbestos, where the peak incidence in lung cancer and mesothelioma has not been reached yet.
Canalysis of trainer feedback from the jets E-portfolio
Authors: S. Samji, K. Dowler, R. Valori, P. Dunckley
Journal: Gut (2011)

<h3>Introduction</h3> The JAG Endoscopy Training System (JETS) e-portfolio was released in September 2009 and has been set up by over 75% of trusts at the time of writing. Following each training list, trainees have the option to submit anonymised feedback on the training received. This feedback populates the trainer9s e-portfolio and informs the training programme director (TPD) on the quality of training received at a trust level (anonymised data). Characteristics of a good trainer include: interpersonal skills, endoscopic skills, technical teaching attributes and motivation to teach.1 Recent surveys have shown that many trainees feel inadequately supervised in endoscopy throughout their training.2,3 Quality of time spent with a trainer therefore becomes more invaluable. The standard of training can now be determined by the trainees themselves. <h3>Methods</h3> Since the release of the JETS e-portfolio, 3074 trainer feedback forms have been completed. At the time of writing an average of 320 feedback forms are being completed each month by 140 trainees. In total, 376 trainees have completed trainer feedback on the JETS e-portfolio (out of 712 trainees currently using the system). Using a Likert scale trainees can provide scores on items such as: giving constructive feedback (FB), providing fair evaluation, putting the trainee at ease and whether the endoscopist is a skilled teacher. FB scores were evaluated by either averaging scores over a calendar year comparing scores over time or by comparing the first and last 5 scores of the trainers from September 2009. <h3>Results</h3> 87% of trainers obtained scores of over 4.0. Average FB scores were relatively stable (4.45 in 2008 to 4.48 in '09 and 4.50 in'10). The median score was 4.52. <h3>Conclusion</h3> This data confirms that trainees are willing to provide anonymous feedback on training received. The feedback then populates the trainer9s portfolio enabling the trainers to reflect on their training ability. Furthermore, TPDs can now access summated, anonymised feedback data for a trust, therefore supporting quality assurance of training for trainees in that region. On the whole the majority of UK trainees that gave FB anonymously on the JETS website feel they receive a high standard of training. This correlates with a previous study when 75% of trainees rated their endoscopy training as quite good to excellent.2
Bone marrow transplantation in precocious osteopetrosis.
Authors: N W Nisbet
Journal: BMJ (1987)

Childhood depression may be prevented to some extent by minimising bond disruption and promoting healthy mourn- ing.Young children of depressed mothers may need to be cared for by others while their mothers are receiving energetic treatment, and doctors and others should help children of all ages who are at high risk for depression by eliminating or reducing avoidable provoking and vulner- ability factors and strengthening the children's coping be- haviours.The psychotherapeutic work of the Tavistock Clinic with severely deprived children appears promising and urgently needs evaluating-as do other approaches.'8
Paradoxical narrowing of atherosclerotic coronary arteries induced by increases in heart rate.
Authors: E G Nabel, A P Selwyn, P Ganz
Journal: Circulation (1990)

Vasodilation in normal and vasoconstriction in atherosclerotic coronary arteries have been observed in response to complex stimuli such as exercise and the cold pressor test. To study a single parameter that changes during these activities, and to better understand the pathophysiology of ischemia associated with increases in heart rate, we studied coronary vasomotion and blood flow response to increasing heart rate alone, produced by atrial pacing, with quantitative angiographic and Doppler flow-velocity measurements in 15 patients. In five patients with angiographically smooth coronary arteries (group 1), tachycardia produced progressive dilation of the epicardial artery with increases in cross-sectional area (CSA) of +15.5 +/- 3.4%, +22.4 +/- 2.1%, +28.5 +/- 3.3%, and +30.6 +/- 2.2% at 90, 110, 130, and 150 beats/min, respectively. In contrast, in five patients with mild angiographic narrowings (group 2), coronary segments failed to dilate with progressive tachycardia (-6.3 +/- 2.0%, -8.3 +/- 2.0%, -12.5 +/- 2.0%, and -11.4% at 90, 110, 130, and 150 beats/min, respectively), and progressive loss of luminal area was observed in five patients with severe angiographic narrowings (group 3) (-34.4 +/- 3.4%, -49.6 +/- 2.2%, -59.2%, and -72.8% at 90, 110, 130, and 150 beats/min, respectively). Coronary blood flow increased significantly with tachycardia in group 1 (+44.5 +/- 10.2%, +86.0 +/- 24.6%, +105.8 +/- 29.3%, and +137.5 +/- 46.0%), increased slightly in group 2 (+7.8 +/- 3.2%, +9.4 +/- 4.4%, +8.4 +/- 3.9%, and +10.0%), and decreased significantly in group 3 (-31.8 +/- 6%, -42.6 +/- 10.7%, -61.0%, and -70.0%). We conclude that an isolated increase in heart rate in patients with normal coronary arteries results in a modest increase in flow and vasodilation. In early atherosclerosis, the flow increase is blunted and dilation is replaced with paradoxical loss in luminal size. In patients with stenoses, further loss in luminal size occurs accompanied by a decrease in coronary blood flow. Thus, increasing heart rate alone in the setting of coronary stenoses could produce myocardial ischemia by a reduction in coronary supply, as well as by an increase in oxygen demand.
Children at Risk of Allergic Development: The Parents’ Dyadic Relationship
Authors: Asbjorn O. Faleide, Vigdis Kjaer Galtung, Sissel Unger, Reidulf G. Watten
Journal: Psychotherapy and Psychosomatics (1988)

The paper describes a study of parents' dyadic interaction in high-/low-risk families (n = 161) with children at risk of asthmatic/allergic development. The high-risk couples tend to consist of a mother who denies negative affects and a dissatisfied father. The high-risk mothers tend to overrate the agreement especially on affective expression. There were no significant differences in dyadic interaction in low-risk couples. The results are discussed according to family communication patterns, repressed conflicts and possible immunological consequences of chronic emotional stress, learned coping and emotional expression styles.
Nitric oxide release accounts for insulin's vascular effects in humans.
Authors: U Scherrer, D Randin, P Vollenweider, L Vollenweider, P Nicod
Journal: Journal of Clinical Investigation (1994)

Insulin exerts effects on the vasculature that (a) may play a role in the regulation of blood pressure; and (b) by boosting its own delivery to target tissues, also have been proposed to play an integral part in its main action, the promotion of glucose disposal. To study the role of nitric oxide (NO) in the mediation of insulin's effects on the peripheral vasculature, NG-monomethyl-L-arginine (L-NMMA), a specific inhibitor of the synthesis of endothelium-derived NO, was infused into the brachial arteries of healthy volunteers both before, and at the end of a 2-h hyperinsulinemic (6 pmol/kg per min) euglycemic clamp. L-NMMA (but not norepinephrine, an NO-independent vasoconstrictor) caused larger reductions in forearm blood flow during hyperinsulinemia than at baseline. Moreover, L-NMMA prevented insulin-induced vasodilation throughout the clamp. Prevention of vasodilation by L-NMMA led to significant increases in arterial pressure during insulin/glucose infusion but did not alter glucose uptake. These findings indicate that insulin's vasodilatory effects are mediated by stimulation of NO release, and that they play a role in the regulation of arterial pressure during physiologic hyperinsulinemia. Abnormalities in insulin-induced NO release could contribute to altered vascular function and hypertension in insulin-resistant states.
Malaria in an Infant Transmitted by Transfusion
Authors: Emily E. Czapek
Journal: JAMA (1968)

To the Editor:—  The most common cause of fever and splenomegaly in the world at large is malaria, but this diagnosis is not routinely entertained for children who present with such symptoms in the United States. In Connecticut, malaria developed in an infant after two exchange transfusions for neonatal hyperbilirubinemia. To the best of our knowledge, this is the first case of infantile malaria secondary to exchange transfusion which has been reported in the United States.  Report of a Case:—  During the first 36 hours of life, the full-term product of an uncomplicated pregnancy and delivery received two exchange transfusions because of hyperbilirubinemia secondary to Rh incompatibility. The child was discharged from the hospital at five days of age and was well until two months at which time recurrent low-grade fevers developed. The patient was treated symptomatically during the next few months with antipyretics, but by 61/2 months of age
Changes in Levels of Nerve Growth Factor in Nasal Secretions after Capsaicin Inhalation in Patients with Airway Symptoms from Scents and Chemicals
Authors: Eva Millqvist, Ewa Ternesten-Hasséus, Arne Ståhl, Mats Bende
Journal: Environmental Health Perspectives (2005)

Patients complaining of upper and lower airway symptoms caused by scents and chemicals have previously been shown to have increased cough sensitivity to inhaled capsaicin, but the precise mechanisms behind this reaction are unknown. Hypothesizing that a neurochemical alteration related to sensory hyperreactivity (SHR) of the airway mucosa occurs, we measured levels of nerve growth factor (NGF) in nasal lavage fluid (NAL) before and after capsaicin inhalation provocations and related the capsaicin cough sensitivity to the NGF levels. Thirteen patients with SHR and 14 control subjects were provoked with capsaicin inhalation at three different doses. We measured NGF in NAL before and after provocation and recorded cough and capsaicin-induced symptoms. All subjects demonstrated a dose-dependent cough response to capsaicin inhalation, with a more pronounced effect in patients than in controls. Basal levels of NGF were significantly lower in the patient group than in the control subjects (p < 0.01). After capsaicin provocation, the patients showed a significant increase in NGF (p < 0.01), which was related to capsaicin cough sensitivity. The findings demonstrate that, in patients with airway symptoms induced by scents and chemicals, SHR is real and measurable, demonstrating a pathophysiology in the airways of these patients compared to healthy subjects.
Oral Contraceptives, Pregnancy, and Focal Nodular Hyperplasia of the Liver
Authors: Larry D. Scott, Allan R. Katz, James H. Duke, Daniel F. Cowan, Nabil F. Maklad
Journal: JAMA (1984)

There is uncertainty regarding the role, if any, of oral contraceptive steroids in the development of focal nodular hyperplasia of the liver. In a 36-year-old woman, a large left hepatic lobe tumor developed that was detected after 11 years of using these drugs. The tumor regressed when administration of the drug was stopped but began to increase in size during a subsequent pregnancy. A left hepatic lobectomy during the second trimester disclosed focal nodular hyperplasia. Both contraceptive steroids and pregnancy, with high levels of endogenous sex steroids, favored tumor growth in this patient, suggesting that focal nodular hyperplasia can be steroid related. (<i>JAMA</i>1984;251:1461-1463)
Bubonic plague in the Book of Samuel
Authors: F. R Freemon
Journal: Journal of the Royal Society of Medicine (2005)

Examining the potential impact of the proposed two-year cut in otology training, Jaydip Ray and colleagues conclude that intensification of training would be necessary to eradicate the significant difference in specialist surgical experience between current year-four and year-six otology trainees (June 2005 JRSM 1 ).In our opinion their article misses the point regarding the changes.The proposed model of four years' general training followed by two years of specialist training will not require future year-four trainees to have comparable operative experience to today's year-six trainees, as implied.The Specialist Advisory Committee for Otolaryngology has set stage-specific criteria of required operative competencies for higher surgical trainees. 2Georgalas et al., 3 in a recent survey of otolaryngology trainees, concluded that all stage-specific criteria were currently being met, and that training standards were satisfactory across the UK.They concluded that current training is adequate and that a system of twotier trainees, with four years of general training and two years devoted to the subspecialties, would be an adequate option for the vast majority of specialist registrars, provided that current standards are maintained. 2 Training in specialist otological surgery will not be offered or assessed in the new four-year 'generalist' higher surgical rotations, since specialist experience will be gained in accredited otology fellowships for prospective otologists.
Mental health in disaster settings
Authors: Lynne Jones, Joseph Asare, Mustafa Elmasri, Andrew Mohanraj
Journal: BMJ (2007)

Guidelines on mental health and psychosocial support in emergency settings were launched in Geneva last week by the Inter-Agency Standing Committee (IASC).1 They will provide guidance on protecting and promoting the mental and social wellbeing of all people affected by emergencies created by conflict or natural disasters. Among the many topics covered, the guidelines also give special attention to people with severe mental disorders in the community.
Percutaneous endoscopic gastrostomy tube placement in patients with compound hiatus hernia and intrathoracic stomach: a case series
Authors: R. S. Manjunath, N. C. Fisher
Journal: Gut (2011)

<h3>Introduction</h3> Percutaneous endoscopic gastrostomy (PEG) may be extremely difficult in patients with compound hiatus hernia. In this type of hernia, the stomach may be partly or entirely intrathoracic and is normally associated with organoaxial (figure 1A) or mesenteroaxial (figure 1B) rotation.1 There do not appear to be any widely accepted techniques for placement of a feeding prosthesis in this group of patients if artificial nutrition is required. We describe here a short series of successful PEG placements. <h3>Methods</h3> A 6-year retrospective review of PEG tube placements in patients with compound hiatus hernia. All patients had prior failed attempts using the conventional ‘finger indentation’ technique. The technique involves usage of a 20 cm/5 Fr drainage access needle which is inserted towards the stomach using a transhiatal approach from below the xyphisternum, and with combined endoscopic and fluoroscopic guidance. Once successful gastric puncture has been achieved, the procedure is completed as for a conventional PEG insertion. <h3>Results</h3> Six cases were attempted during this period. Indications for PEG were; multiple sclerosis (2); cerebrovascular disease (3); intermittent volvulus (1). In each case, the stomach was punctured in the fundus or body at a point within the thoracic cavity. All cases were completed without complication and with successful PEG feeding. <h3>Conclusion</h3> PEG tube placement for enteral nutrition may be completed in patients with compound hiatus hernia and intrathoracic stomach. The authors suggest however that a long drainage access needle and combined endoscopic and fluoroscopic guidance are essential for safe completion.
A Comparison of On-Pump and Off-Pump Coronary Bypass Surgery in Low-Risk Patients
Authors: Hendrik M. Nathoe, Diederik van Dijk, Erik W.L. Jansen, Willem J.L. Suyker, Jan C. Diephuis, Wim-Jan van Boven, Aart Brutel de la Rivière, Cornelius Borst, Cor J. Kalkman, Diederick E. Grobbee, Erik Buskens, Peter P.T. de Jaegere
Journal: New England Journal of Medicine (2003)

The performance of coronary bypass surgery without cardiopulmonary bypass ("off pump") may reduce perioperative morbidity and costs, but it is uncertain whether the outcome is similar to that involving the use of cardiopulmonary bypass ("on pump").In a multicenter, randomized trial, we randomly assigned 139 patients with predominantly single- or double-vessel coronary disease to on-pump surgery and 142 to off-pump surgery. Cardiac outcome and cost effectiveness were determined one year after surgery. The uncertainty surrounding the cost-effectiveness ratio (cost differences per quality-adjusted year of life gained) was addressed by bootstrapping.At one year, the rate of freedom from death, stroke, myocardial infarction, and coronary reintervention was 90.6 percent after on-pump surgery and 88.0 percent after off-pump surgery (absolute difference, 2.6 percent; 95 percent confidence interval, - 4.6 to 9.8). Graft patency in a randomized subgroup of patients was 93 percent after on-pump surgery and 91 percent after off-pump surgery (absolute difference, 2.0 percent; 95 percent confidence interval, - 6.5 to 10.4). On-pump surgery was associated with $1,839 in additional direct costs per patient ($14,908 vs. $13,069--a difference of 14.1 percent) and an increase in quality-adjusted years of life of 0.83 as compared with 0.82 (difference, 0.01 year; 95 percent confidence interval, - 0.03 to 0.04). Off-pump surgery was more cost effective than on-pump surgery in 95 percent of bootstrap estimates.In low-risk patients, there was no difference in cardiac outcome at one year between those who underwent on-pump bypass surgery and those who underwent off-pump surgery. Off-pump surgery was more cost effective.
PCI FOR ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: Dhaval Kolte, Sahil Khera, Sahil Agrawal, Marjan Mujib, Wilbert Aronow, Chandrasekar Palaniswamy, Jay Doshi, Nivas Balasubramaniyam, John McClung
Journal: Journal of the American College of Cardiology (2013)