tbuckley/cabot-search huggingface dataset:
V. The 'Old Code' of Medical Ethics and Some Problems It Had to Face
Authors: Lester S. King
Journal: JAMA (1982)

The National Medical Convention, meeting in 1846, wanted a single code of medical ethics that would apply to all the states. The committee appointed to draw up such a code made its report in 1847 with a formulation that was quickly accepted and then remained unchanged until 1903. In the report, which contained the whole elaborate code, an introductory section, signed by John Bell of Philadelphia, reveals quite strikingly the problems facing the medical profession. It lets us glimpse the rationale behind the specific exhortations, and the scope of "medical ethics." Even a cursory reading makes us realize the low esteem in which the public held the medical profession at that time. Thus, Bell noted that while physicians have duties, they also have corresponding rights. One of these is the "right to be attentively and respectfully listened to." The physician is entitled "to, at least, the same respectful and considerate
Gastrointestinal Bleeding Secondary to Pancreatitis
Authors: William A. Kisken
Journal: JAMA (1967)

<h3>To the Editor:—</h3> Occasionally patients with the diagnosis of pancreatitis have guaiac positive reaction in stool specimens and usually anemia which in spite of thorough investigation defies accurate diagnosis. The case presented below typifies such a patient, but the etiology of gastrointestinal bleeding was eventually determined. In September 1964, A 48-year-old man, had the onset of stabbing epigastric pain on the left side which radiated to the lower left side of the posterior part of the chest. Intense pain lasted for 30 to 60 minutes with mild discomfort lasting as long as 24 hours. The attacks were precipitated by fatty foods and were preceded by nausea. In June 1965, he was admitted to the local hospital for this pain. A thorough examination which included an x-ray examination of the upper gastrointestinal tract, a barium sulfate enema examination, a cholecystogram, and a pyelogram after intravenous injection of a contrast medium did
Serum alpha - fetoprotein levels in patients with cystic fibrosis and their parents and siblings.
Authors: R K Chandra, K Madhavankutty, R C Way
Journal: BMJ (1975)

Patients with cystic fibrosis (C.F.) showed raised serum levels of alpha-fetoprotein (AFP). A moderate but significant increase in serum AFP was present in their parents and some siblings. There was no correlation between the clinical severity of the disease and serum AFP concentration. Samples from control groups with gluten-induced malabsorption and bronchiectasis had normal levels. Persistent synthesis of AFP may be an associated marker of C.F. genes, and estimation of serum AFP might help in detecting heterozygote carriers in families at risk.
Where do hunger strikers' rights end?
Authors: E Ernst
Journal: BMJ (1981)

years by neoarsphenamine) shortened the "incubation period" between syphilitic infec- tion and onset of neurosyphilis.In the 1920s the view was expressed that the "modern" treatment of syphilis furthered the development of general paralysis of the insane (GPI).'Our own review of the former antisyphilitic treatment received by 863 GPI patients (admitted to the neurological-psychiatric university clinic at the Charite, Berlin, under Professor Bonhoeffer during 1925-35) concluded that "modern" therapy of syphilis did not favour the onset of GPI.'However, one was left with the feeling that no treatment known at the time was certain always to prevent later GPI, and anyway today's "adequate" therapy might prove in the light of later developments to have been "inade- quate."That (possibly inadequate) penicillin therapy of early syphilis does not always prevent neurosyphilis has been demonstrated in the past" and again by Hoffman's patient" quoted in your leading article.One is therefore left wondering whether despite "excellent . . .response to adequate treatment" in the great majority, in certain cases even "excellent" antisyphilitic therapy may nevertheless prove inadequate in preventing neurosyphilis-as did yesterday's "adequate" treatment.
Clinical Practice Management
Authors: Charles E. Driscoll
Journal: JAMA (1993)

How can a physician master the important business aspects of medical practice while learning the art and craft of medicine? The answer is "not very well," and perhaps that is one frustration that contributes to the "hassle factor" so often spoken of in today's medical coffee-room chats. Most of us went through medical school and residency with the primary goal of learning to diagnose and treat a patient's pneumonia with only passing thoughts of how we would place ourselves in a position to be fairly compensated for the effort. Dr Robert Solomon, a business professor whose father was a medical professional, draws from experience and a thorough review of relevant literature to provide a concise, readable source for understanding the basics of medical office direction. This appears to be one of the best introductory texts published to date. <i>Clinical Practice Management</i>teaches the lessons that are often learned only with
A comparison of two methods to perform a breathing trial before extubation in pediatric intensive care patients
Authors: J. Farias, A. Retta, I. Alía, F. Olazarri, A. Esteban, A. Golubicki, D. Allende, O. Maliarchuk, C. Peltzer, M. Ratto, R. Zalazar, M. Garea, E. Moreno
Journal: Intensive Care Medicine (2001)
Collagen XVIII is localized in sinusoids and basement membrane zones and expressed by hepatocytes and activated stellate cells in fibrotic human liver
Authors: Orlando Musso, Marko Rehn, Janna Saarela, Nathalie Théret, Jocelyne Liétard, Elina Hintikka, Dominique Lotrian, Jean-Pierre Campion, Taina Pihlajaniemi, Bruno Clément
Journal: Hepatology (1998)

Type XVIII collagen is a recently discovered nonfibrillar collagen associated with basement membranes in mice and expressed at high levels in human liver. We studied the origin, distribution, and RNA levels of type XVIII collagen in normal and fibrotic human livers by in situ hybridization, immunohistochemistry, and Northern and dot blots and compared procollagen alpha1(XVIII) RNA levels with those of procollagen alpha1(IV) and laminin gamma1, the two major components of liver basement membranes. In normal liver, type XVIII collagen was heavily deposited in perisinusoidal spaces and basement membrane zones. The major source of type XVIII collagen was hepatocytes and, to a lesser extent, endothelial, biliary epithelial, and vascular smooth muscle cells and peripheral nerves. In cirrhosis, type XVIII collagen formed a thick deposit along capillarized sinusoids. Grain counts after in situ hybridization showed myofibroblasts to increase their expression 13-fold in active and twofold in quiescent fibrosis, whereas hepatocytes increased their expression only twofold in both active and quiescent fibrosis. Activated stellate cells in vitro expressed type XVIII collagen at high levels. These data indicate that type XVIII collagen is a component of the perisinusoidal space and is associated with basement membrane remodeling. Hepatocytes and activated stellate cells are important sources of type XVIII collagen in normal and fibrotic liver respectively, which suggests tissue-specific regulation of its expression.
Long acting phenothiazines.
Authors: J Denham, L Adamson
Journal: BMJ (1971)

This hepatotoxic effect of busulphan ther- apy appears to be rare and in this case was associated with prolonged therapy.However, we suggest that jaundice in patients under treatment for chronic granulocytic leukaemia may be attributable to busulphan therapy rather than severe leukaemic infiltration of the liver.-Weare, etc.,
Decreased Wait Times After Institution of Office-Based Hand Surgery in a Veterans Administration Setting
Authors: Stephen Duquette, Naveed Nosrati, Adam Cohen, Imtiaz Munshi, Sunil Tholpady
Journal: JAMA Surgery (2014)

Carpal tunnel syndrome is a common peripheral nerve compression disorder causing symptoms of numbness, tingling, weakness, and muscle atrophy. Open carpal tunnel release (CTR) is a common treatment modality traditionally performed in the operating room with sedation or general anesthesia. It can also be performed in the surgeon’s office under local anesthesia only. 1 In our study, we examined the number of days from initial consultation and visit to operative intervention in a Veterans Administration (VA) setting. A significant decrease in wait time from initial consultation to operative intervention and from initial visit to operative intervention was hypothesized to occur with the transition to office-based hand surgery procedures, without an increase in complications. Methods | Institutional review board approval from the Richard L. Roudebush VA Medical Center was obtained to construct a database of recent surgical procedures performed for carpal tunnel syndrome by the plastic surgery service. Operations including CTR in conjunction with other procedures were excluded. The minor procedure room is located within the plastic surgery clinic, with a single nurse serving as a circulating nurse. The hand and forearm are prepped and draped, and both monopolar cautery and bipolar cautery are available. A more specific description to a similar configuration can be found in
THE EXPERIMENTAL INDUCTION OF GLOMERULONEPHRITIS LIKE THAT IN MAN BY INFECTION WITH GROUP A STREPTOCOCCI
Authors: Carl G. Becker, George E. Murphy
Journal: The Journal of Experimental Medicine (1968)

106 rabbits received one or more courses of inoculations, spaced 1-4 months apart, with Group A streptococci, usually of strains isolated from patients with acute glomerulonephritis. 8 days to a few weeks after onset of a given infection with streptococci known to have been nephritogenic for man, marked proteinuria, often with hematuria and occasionally with azotemia, was detected in 22 of the animals. 15 of these were sacrificed a few days to a few weeks thereafter, and 10 showed renal changes like those of acute or recurrent acute glomerulonephritis in man. Such changes occurred in three other rabbits whose urine was not examined that died or were sacrificed 1-3 wk after onset of infection with streptococci of a serotype known to include a strain nephritogenic for man. The remaining seven animals in which marked proteinuria had occurred died or were sacrificed many months later, in some cases after additional infections. Two of these had become azotemic and two convulsed and died after giving birth; in these animals, there were renal changes like those that occur in man in chronic latent glomerulonephritis, toxemia of pregnancy super-imposed on chronic latent glomerulonephritis, or chronic active glomerulonephritis. Anatomical changes in the kidneys in the experimentally induced and in naturally occurring glomerulonephritis, from acute to chronic stages, are compared and illustrated. The pathogenesis of poststreptococcal glomerulonephritis is discussed.
AIDS and Its Metaphors
Authors: David Michael Levin
Journal: JAMA (1989)

ABSTRACT AIDS and Its Metaphors is an intelligent, well-informed, thought-provoking book. Responding, now, to the worldwide crisis surrounding the acquired immunodeficiency syndrome, Sontag has written a book that attempts to change the way people think about AIDS and to free both AIDS patients and a population irrationally frightened by AIDS from the spell of emotionally and ethically charged meanings that add unnecessarily to the suffering of AIDS patients. Examining this complex of meanings, she demonstrates how they not only obscure and falsify the medical reality, but stand in the way of humane social responses—effective public health care policies, funding for basic research, adequate forms of medical treatment, and the administration of preventive medicine. There is much to be said for the ethical substance of Sontag's argument, and above all for her aims: to enlighten the public and to alleviate, as she says, so much unnecessary suffering.Astutely perceiving in the panic
Misdiagnosis of angle closure glaucoma
Authors: Patel Gordon-Bennett, Tsiang Ung, Chris Stephenson, Melanie Hingorani
Journal: BMJ (2006)

Angle closure glaucoma is a sight threatening ophthalmic emergency.Patients classically present with an acutely painful red eye and periocular headache, loss of vision, nausea, and vomiting, but sometimes the presentation is less dramatic or more systemic than ocular.The diagnosis may be missed in such cases, leading to unnecessary investigations, delayed treatment, and blindness.We describe three cases of angle closure glaucoma in which initial diagnostic uncertainty led to a delay in treatment and which highlight the need for a wider awareness of this condition. Case reportsCase 1 A 66 year old woman was admitted to the orthopaedic ward for elective spinal canal decompression for spinal stenosis.She was otherwise healthy and was taking oral diclofenac, morphine, and amitriptyline.During the operation, she was placed prone for spinal laminectomy.Postoperatively, she received regular opiate analgesia.On the third postoperative day the patient developed severe headache, photophobia, and neck stiffness without focal neurological deficit.An urgent computed tomography scan of the head was normal.On the fourth postoperative day she complained of visual loss, a red eye was noted, and an ophthalmology referral was made.Her visual acuity was counting fingers for both eyes.Slit lamp examination was hampered by her immobility, but both eyes were red with cloudy corneas; shallow anterior chambers; fixed, middilated pupils; and high intraocular pressures of 45 mm Hg in the right eye and 33 mm Hg in the left eye (normal < 21 mm Hg).A diagnosis of bilateral angle closure glaucoma was made.She was treated immediately with the standard medical regimen (using eye drops to constrict the pupil and systemic acetazolamide to lower the intraocular pressure).Her amitriptyline was stopped, as it was a potential precipitating factor.Her response to medical treatment was partial, and, as she had coexistent cataracts, bilateral lens extraction, lens implantation, and surgical peripheral iridotomies were done.The anterior chambers deepened immediately, and the intraocular pressures normalised postoperatively.Two months later, intraocular pressures were normal without treatment.The best corrected Snellen visual acuity was only 6/12 in either eye, with bilateral visual field constriction and reduced colour vision associated with glaucomatous optic atrophy (fig 1).
Mid-Thigh Amputation in a Patient with Hemophilia
Authors: John H. Crandon, Leonard Staudinger, Eli Friedman
Journal: New England Journal of Medicine (1953)

REVIEW of the literature on surgery in hemophilia reveals a liberal sprinkling of unauthenticated case reports. Nevertheless, it appears to be the general consensus at present that in this disease surgery should not be performed, particularly where the operative site will be inaccessible to local pressure dressings.1 Thus, when a diagnosis of appendicitis has been made, the treatment is preferably medical.The present case deals with a patient with proved hemophilia in whom a hematoma of the popliteal space developed, with resulting compromise of the circulation to the lower leg. Efforts to relieve the local pressure by incision of the . . .
THE BINDING OF PENICILLIN IN RELATION TO ITS CYTOTOXIC ACTION
Authors: Harry Eagle
Journal: The Journal of Experimental Medicine (1954)

1. (a) Mammalian cells in tissue culture (mouse fibroblasts and malignant human uterine epithelium) did not concentrate penicillin from the culture medium. Even at low concentrations, the cellular accumulation was usually less than that in the surrounding fluid, and most of it was removed by washing. The radioactive material in such eluates was actively bactericidal, and was presumably in large part unchanged penicillin. (b) Penicilloic acid, produced by the action of penicillinase, was bound to the same (limited) extent as the active antibiotic. In both these respects mammalian cells behaved like naturally penicillin-resistant bacteria, and unlike such penicillin-sensitive bacteria as Streptococcus pyogenes or Diplococcus pneumoniae. 2. Cell-free sonic extracts of the L strain had the same limited reactivity with penicillin as the intact cells. The relatively minute amounts bound by the cells are therefore not due to their impermeability, but instead reflect the inherently low reactivity of the cellular constituents with penicillin. 3. It is suggested that the relative non-toxicity of penicillin for the mammalian host, and for mammalian cells in tissue culture, may be related to this low order of reactivity with the antibiotic.
Association of Hemoglobin A<sub>1c</sub> with Cardiovascular Disease and Mortality in Adults: The European Prospective Investigation into Cancer in Norfolk
Authors: Kay-Tee Khaw, Nicholas Wareham, Sheila Bingham, Robert Luben, Ailsa Welch, Nicholas Day
Journal: Annals of Internal Medicine (2004)

Background: Increasing evidence suggests a continuous relationship between blood glucose concentrations and cardiovascular risk, even below diagnostic threshold levels for diabetes. Objective: To examine the relationship between hemoglobin A1c, cardiovascular disease, and total mortality. Design: Prospective population study. Setting: Norfolk, United Kingdom. Participants: 4662 men and 5570 women who were 45 to 79 years of age and were residents of Norfolk. Measurements: Hemoglobin A1c and cardiovascular disease risk factors were assessed from 1995 to 1997, and cardiovascular disease events and mortality were assessed during the follow-up period to 2003. Results: In men and women, the relationship between hemoglobin A1c and cardiovascular disease (806 events) and between hemoglobin A1c and all-cause mortality (521 deaths) was continuous and significant throughout the whole distribution. The relationship was apparent in persons without known diabetes. Persons with hemoglobin A1c concentrations less than 5% had the lowest rates of cardiovascular disease and mortality. An increase in hemoglobin A1c of 1 percentage point was associated with a relative risk for death from any cause of 1.24 (95% CI, 1.14 to 1.34; P < 0.001) in men and with a relative risk of 1.28 (CI, 1.06 to 1.32; P < 0.001) in women. These relative risks were independent of age, body mass index, waist-to-hip ratio, systolic blood pressure, serum cholesterol concentration, cigarette smoking, and history of cardiovascular disease. When persons with known diabetes, hemoglobin A1c concentrations of 7% or greater, or a history of cardiovascular disease were excluded, the result was similar (adjusted relative risk, 1.26 [CI, 1.04 to 1.52]; P = 0.02). Fifteen percent (68 of 521) of the deaths in the sample occurred in persons with diabetes (4% of the sample), but 72% (375 of 521) occurred in persons with HbA1c concentrations between 5% and 6.9%. Limitations: Whether HbA1c concentrations and cardiovascular disease are causally related cannot be concluded from an observational study; intervention studies are needed to determine whether decreasing HbA1c concentrations would reduce cardiovascular disease. Conclusions: The risk for cardiovascular disease and total mortality associated with hemoglobin A1c concentrations increased continuously through the sample distribution. Most of the events in the sample occurred in persons with moderately elevated HbA1c concentrations. These findings support the need for randomized trials of interventions to reduce hemoglobin A1c concentrations in persons without diabetes.
STUDIES ON TYPHUS FEVER
Authors: Hans Zinsser, M. Ruiz Castaneda
Journal: The Journal of Experimental Medicine (1933)

1. Vaccines consisting of formalinized Rickettsiae of Mexican typhus fever, obtained by our X-ray rat method, produce definite resistance in guinea pigs to subsequent infection with the virus of this disease. 2. The resistance so produced amounts to complete immunity when the subsequent infectious dose is moderate—that is, consists of typhus blood or of tunica material in reasonable amounts (not more than one-quarter of a tunica—i.e., roughly 100 to 250 infectious doses). When, as in the first experiment, excessive doses of infectious material were given, the vaccination protection was, in two of the three animals, incomplete. 3. Subcutaneous vaccination is fully as effective as intraperitoneal —even when the subsequent infection is intraperitoneal. 4. As in previously reported experiments, the vaccines made with the Mexican organisms conferred only partial and feeble protection against the European virus (Breinl strain).
Secular trend of the viral genotype distribution in children with chronic hepatitis B virus infection after universal infant immunization
Authors: Wan-Hsin Wen, Huey-Ling Chen, Yen-Hsuan Ni, Hong-Yuan Hsu, Jia-Horng Kao, Fu-Chang Hu, Mei-Hwei Chang
Journal: Hepatology (2010)

Genotypes B and C are the major hepatitis B virus (HBV) genotypes in Taiwan, and genotype C is associated with more severe liver disease than genotype B. Whether the implementation of the hepatitis B immunization program has affected the secular trend of the HBV genotype distribution remains unknown. We thus investigated the HBV genotypes in hepatitis B surface antigen (HBsAg)-carrier children born before the implementation of the universal infant immunization program and in those born afterward. One hundred seven children who were infected with HBV despite appropriate immunization were enrolled as immunized cases with HBV breakthrough infection. Each case was matched with two unimmunized HBsAg carriers according to the age at enrollment. HBV genotypes were determined with molecular methods. Compared with unimmunized HBsAg carriers, more immunized children had HBsAg-positive mothers (65.9% versus 100%, P < 0.001) and were infected with genotype C (16.4% versus 42.1%, P < 0.001). Among the children born to HBsAg-positive mothers, the mothers' and children's HBV genotypes were highly concordant in both unimmunized [κ = 0.97, 95% confidence interval (CI) = 0.90-1.00] and immunized children (κ = 0.97, 95% CI = 0.92-1.00). After adjustments for gender, maternal age, and delivery mode, immunized HBsAg-carrier children born to HBsAg-positive mothers had a higher likelihood of genotype C infection than unimmunized children (odds ratio = 3.03, 95% CI = 1.62-5.65, P = 0.001). However, the increased genotype C to genotype B ratio was not seen in the HBsAg-carrier mother pool in the postimmunization era.In the postimmunization era, most HBV breakthrough infections are due to maternal transmission, and immunized children born to genotype C mothers may have a higher rate of breakthrough infection than those born to genotype B mothers.
World Trade Organisation agreements should be subject to health impact assessment
Authors: M. Douglas
Journal: BMJ (2000)

EDITOR—Drager's editorial reminds us that the international agreements negotiated in the World Trade Organisation have wide ranging implications for public health.1 The agreements are enforceable, unlike other international agreements on the environment, human rights, and social welfare. Governments can be challenged for implementing laws intended to protect public health if they restrict free trade. In settlements of World Trade Organisation disputes so far, trade issues have …