tbuckley/cabot-search huggingface dataset:
Open Heart Surgery Following Bacterial Endocarditis.
Authors: William B. Stason
Journal: Annals of Internal Medicine (1968)

s1 May 1968Open Heart Surgery Following Bacterial Endocarditis.William B. Stason, M.D., Roman W. DeSanctis, M.D., F.A.C.P., Arnold N. Weinberg, M.D., W. Gerald Austen, M.D.William B. Stason, M.D.Search for more papers by this author, Roman W. DeSanctis, M.D., F.A.C.P.Search for more papers by this author, Arnold N. Weinberg, M.D.Search for more papers by this author, W. Gerald Austen, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-68-5-1163_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptOpen heart surgery was performed at the Massachusetts General Hospital in 13 patients less than 6 months after the initiation of treatment for acute or subacute bacterial endocarditis. The endocarditis involved the aortic valve in 12 cases and a mitral valve prosthesis in the other. In 2 patients there was concomitant rupture of chordae tendineae in the mitral valve. Five patients were still receiving antibiotics for their mitral infection at the time of surgery. The primary indication for surgery in all cases was progressive or intractable congestive heart failure. Ten underwent replacement of the aortic valve alone, 2 had both... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachuetts PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1968Volume 68, Issue 5Page: 1163-1163KeywordsAntibioticsAortic valveCardiac surgeryEndocarditisHeart failureMitral valve replacementOpen heart surgerySurgery Issue Published: 1 May 1968 PDF DownloadLoading ...
Relation between recurrence of cancer of the colon and blood transfusion.
Authors: N Blumberg, M M Agarwal, C Chuang
Journal: BMJ (1985)

Data suggest that blood transfusion can cause immunosuppression. The incidence of recurrence of tumours was examined retrospectively in patients who had undergone potentially curative operations for cancer of the colon during 1970-81. Tumours recurred in six of 68 patients (9%) who had not been given transfusions and in 56 of 129 patients (43%) who had (p much less than 0.0001). Transfusion was also found to be significantly associated with the time to recurrence after adjustment for other baseline prognostic factors (p less than 0.05). Perioperative transfusion may be a significant risk factor in the prognosis of cancer of the colon. Whether this association is causal is unknown.
Synergistic Damage of Tumor Vessels with Ultra Low-Dose Endothelial-Monocyte Activating Polypeptide-II and Neovasculature-Targeted Tumor Necrosis Factor-α
Authors: Luca Crippa, Anna Gasparri, Angelina Sacchi, Elisabetta Ferrero, Flavio Curnis, Angelo Corti
Journal: Cancer Research (2008)

Abstract High-dose endothelial-monocyte activating polypeptide II (EMAP-II), a tumor-derived antiangiogenic cytokine, can sensitize tumor vasculature to the damaging activity of high-dose tumor necrosis factor (TNF)-α. However, this combination cannot be used for systemic treatment of patients because of prohibitive toxicity. We have found that this limitation can be overcome by combining a TNF-targeting strategy with the use of ultra low-dose EMAP-II. Coadministration of 0.1 ng of EMAP-II and 0.1 ng of CNGRCG-TNF (NGR-TNF), a peptide-TNF conjugate able to target tumor blood vessels, inhibited lymphoma and melanoma growth in mice, with no evidence of toxicity. This drug combination induced endothelial cell apoptosis in vivo and, at later time points, caused reduction of vessel density and massive apoptosis of tumor cells. Ligand-directed targeting of TNF was critical because the combination of nontargeted TNF with EMAP-II was inactive in these murine models. The synergism was progressively lost when the dose of EMAP-II was increased in the nanogram to microgram range, supporting the concept that the use of low-dose EMAP-II is critical. Studies on the mechanism of this paradoxical behavior showed that EMAP-II doses &amp;gt;1 ng induce the release of soluble TNF receptor 1 in circulation, a strong counter-regulatory inhibitor of TNF. Tumor vascular targeting with extremely low amounts of these cytokines may represent a new strategy for cancer treatment. [Cancer Res 2008;68(4):1154–61]
Expression of a human β-globin transgene in erythroid cells derived from retrovirally transduced transplantable human fetal liver and cord blood cells
Authors: Franck E. Nicolini, Suzan Imren, Il-Hoan Oh, R. Keith Humphries, Philippe Leboulch, Mary E. Fabry, Ronald L. Nagel, Connie J. Eaves
Journal: Blood (2002)
Press: MS and sex link puts neurologist in hotseat
Authors: G. Watts
Journal: BMJ (2002)

There was a time when medical journals were read exclusively by the professionals for whose enlightenment they were and still are principally intended. No longer. The press unearthed a public taste for reading about the clever doings of their doctors. The hacks began to scan the learned journals in search of titbits.

The journals—most of them commercial enterprises as dependent on being read as daily newspapers such as the Sun or the Mirror —decided to help out by picking what they judged to be the best or most intriguing stuff, and issuing press releases. In this way much useful information is routinely disseminated. Research charities are able to flag up their work and raise more money. Many a consultant ego has been pleasantly tickled. Everyone is happy. So publicising medical journals has proved to be a Good Thing.



No longer a closed community



Alas, even the best of Good Things has a down side—as one Essex neurologist has discovered. If Dr Christopher …
Ventricular–Vascular Stiffening in Patients With Repaired Coarctation of Aorta
Authors: Hideaki Senzaki, Yoichi Iwamoto, Hirotaka Ishido, Satoshi Masutani, Mio Taketazu, Toshiki Kobayashi, Toshiyuki Katogi, Shunei Kyo
Journal: Circulation (2008)

Despite successful repair, patients with coarctation of the aorta (COA) often show persistent hypertension at rest and/or during exercise. Previous studies indicated that the hypertension is mainly due to abnormalities in the arterial bed and its regulatory systems. We hypothesized that ventricular systolic stiffness also contributes to the hypertensive state in these patients in addition to increased vascular stiffness.The study involved 43 patients with successfully repaired COA and 45 age-matched control subjects. Ventricular systolic stiffness (end systolic elastance) and arterial stiffness (effective arterial elastance) were measured invasively by ventricular pressure-area relationship during varying preload before and after beta-adrenergic stimulation. The mean systolic blood pressure was significantly higher with concomitant increases in both end systolic elastance and effective arterial elastance in patients with COA compared with control subjects (113.2+/-16.8 versus 91.0+/-9.1 mm Hg, 44.5+/-17.0 versus 19.2+/-6.7 mm Hg/mL/m(2), and 27.8+/-11.4 versus 20.2+/-4.8 mm Hg/mL/m(2), respectively; P<0.01 for each). End systolic elastance and effective arterial elastance of patients with COA showed exaggerated responses to beta-adrenergic stimulation, further amplifying blood pressure elevation. Quantification analyses assuming that ventricular systolic stiffness of patients with COA is equal to that of the control revealed that ventricular systolic stiffness accounts for approximately 50% to 70% of the elevated blood pressure in patients with COA. Furthermore, combined ventricular-arterial stiffening amplified systolic pressure sensitivity to increased preload during abdominal compression and limited stroke volume gain/relaxation improvement induced by beta-adrenergic stimulation.Increased ventricular systolic stiffness, coupled with increased arterial stiffness, plays important roles in hypertension in patients with repaired COA. Thus, ventricular systolic stiffness is a potentially suitable target for reduction of blood pressure and improvement of prognosis of patients with COA.
Does NHS England have a slow puncture?
Authors: N. Hawkes
Journal: BMJ (2013)

So much for decentralisation: England’s health secretary can’t keep his hands off the NHS



It hasn’t taken long for former health secretary Andrew Lansley’s plan for a “hands-off” NHS to hit the rocks. His successor, Jeremy Hunt, is behaving as if the Health and Social Care Act 2012, with its careful separation of powers, had never passed into law. If there’s a problem—and there are plenty—it isn’t long before Hunt comes up with a new wheeze for dealing with it, as health secretaries always have.

From pressure on emergency care to hospital quality or the supposed iniquities of the general practitioner contract, he’s there with an opinion and an initiative. His junior minister, Dan Poulter, has echoed his master’s voice with a plan of his own, suggesting with no great originality that the NHS could save money by better procurement.1

The merits of these interventions matter less than their frequency and specificity, which tell us that the Lansley plan is in tatters. Liberating the NHS , the July 2010 white paper that set out the plan, said that the aim was to give the NHS greater freedoms and to prevent political micromanagement. The NHS Commissioning Board (now NHS …
Vaccine-Induced Anti-HA2 Antibodies Promote Virus Fusion and Enhance Influenza Virus Respiratory Disease
Authors: Surender Khurana, Crystal L. Loving, Jody Manischewitz, Lisa R. King, Phillip C. Gauger, Jamie Henningson, Amy L. Vincent, Hana Golding
Journal: Science Translational Medicine (2013)

Vaccine-induced disease enhancement has been described in connection with several viral vaccines in animal models and in humans. We investigated a swine model to evaluate mismatched influenza vaccine-associated enhanced respiratory disease (VAERD) after pH1N1 infection. Vaccinating pigs with whole inactivated H1N2 (human-like) virus vaccine (WIV-H1N2) resulted in enhanced pneumonia and disease after pH1N1 infection. WIV-H1N2 immune sera contained high titers of cross-reactive anti-pH1N1 hemagglutinin (HA) antibodies that bound exclusively to the HA2 domain but not to the HA1 globular head. No hemagglutination inhibition titers against pH1N1 (challenge virus) were measured. Epitope mapping using phage display library identified the immunodominant epitope recognized by WIV-H1N2 immune sera as amino acids 32 to 77 of pH1N1-HA2 domain, close to the fusion peptide. These cross-reactive anti-HA2 antibodies enhanced pH1N1 infection of Madin-Darby canine kidney cells by promoting virus membrane fusion activity. The enhanced fusion activity correlated with lung pathology in pigs. This study suggests a role for fusion-enhancing anti-HA2 antibodies in VAERD, in the absence of receptor-blocking virus-neutralizing antibodies. These findings should be considered during the evaluation of universal influenza vaccines designed to elicit HA2 stem-targeting antibodies.
Paternal occupational exposures and childhood cancer.
Authors: M Feychting, N Plato, G Nise, A Ahlbom
Journal: Environmental Health Perspectives (2001)

The objective of the study described here was to test the hypothesis that paternal occupational exposure near conception increases the risk of cancer in the offspring. We conducted a cohort study based on a population of 235,635 children born shortly after two different censuses in Sweden. The children were followed from birth to 14 years, and cases of cancer were identified in the Swedish Cancer Registry. Occupational hygienists assessed the probability of exposure to different agents in each combination of the father's industry and occupation as reported in the censuses. We also analyzed individual job titles. We compared the cancer incidence among children of exposed fathers to that among children of unexposed fathers using Cox proportional hazards modeling. The main findings were an increased risk of nervous system tumors related to paternal occupational exposure to pesticides [relative risk (RR) = 2.36; 95% confidence interval (CI), 1.27-4.39] and work as a painter (RR = 3.65; 95% CI, 1.71-7.80), and an increased risk of leukemia related to wood work by fathers (RR = 2.18; 95% CI, 1.26-3.78). We found no associations between childhood leukemia and paternal exposure to pesticides or paint. Our results support previous findings of an increased risk of childhood brain tumors and leukemia associated with certain paternal occupational exposures. Some findings in previous studies were not confirmed in this study.
Health department selects GPs to test drive commissioning reforms
Authors: A. Gulland
Journal: BMJ (2010)

Nearly 2000 of the 8230 general practices in England will begin trying out the government’s reformed commissioning system, the Department of Health has announced.

Fifty two GP consortiums—covering 1860 practices and nearly 13 million patients—have been chosen to test the government’s plans, two years ahead of all consortiums taking on statutory commissioning responsibilities in April 2013.

The groups, or pathfinders, will begin testing the new arrangements from January 2011 and will be joined by other consortiums over the next two years.

David Rooke, chairman of a consortium of 76 practices in Somerset, Wyvern Health, said he was pleased that his group had been selected as a pathfinder. …
Serum Immunoreactive Erythropoietin in HIV-Infected Patients
Authors: Jerry L. Spivak
Journal: JAMA (1989)

Serum immunoreactive erythropoietin (SIE) and hemoglobin levels were measured in 152 patients infected with the human immunodeficiency virus. Anemia was present in 18% of asymptomatic patients who tested positive for the human immunodeficiency virus, 50% of patients with a condition related to the acquired immunodeficiency syndrome (AIDS), and 75% of patients with AIDS. The mean SIE level for untreated AIDS patients (26.2 +/- 2.4 mU/mL) was greater than for patients who tested positive for human immunodeficiency virus or patients with an AIDS-related condition but not outside the normal range for SIE (4 to 26 mU/mL), and the incremental increase in SIE level for a given decline in hemoglobin level was much less in AIDS patients than in patients with uncomplicated iron deficiency anemia. Forty-two patients were treated with zidovudine, and the hemoglobin level fell 10 g/L or more in 48%. In contrast to the untreated patients, however, the mean SIE level rose 10-fold to 214 mU/mL, and the incremental change in SIE level for a given decline in hemoglobin level was markedly increased. In the zidovudine-treated patients, erythrocyte mean corpuscular volume also rose significantly from a mean of 88.1 fL to 102 fL. However, in only 1 patient was there a corresponding increase in reticulocytes and in none was there amelioration of anemia. The data indicate that SIE level is inappropriately low in anemic AIDS patients. The ability of these patients to produce erythropoietin is intact and can be expressed with zidovudine therapy. However, even very high levels of SIE fail to stimulate erythropoiesis adequately.
Effect of cimetidine on 24-hour intragastric acidity in normal subjects.
Authors: R E Pounder, J G Williams, G J Milton-Thompson, J J Misiewicz
Journal: Gut (1976)

The effect of H2-receptor blockade on intragastric acidity was studied in nine normal males. The pH of their gastric contents was measured at hourly daytime and two hourly nighttime intervals for 48 hours. The subjects ate identical meals, drank identical volumes of fluid, and smoked the same number of cigarettes during the two study days. Their physical activity was unrestricted in a ward environment. Blood cimetidine and plasma gastrin were measured in serial blood samples. The nine subjects were treated in random sequence with cimetidine 0-8-1-0 g on one day and placebo capsules on the other. The drug was given in four divided doses: four subjects received it before, and five after, the three main meals. All took the fourth dose at bedtime. Replicate studies in an additional subject given placebo on both study days showed good reproducibility (r=0-80, P less than 0-01). Cimetidine therapy decreased intragastric acidity in all nine subjects. The decrease was similar in the two groups taking the drug before or after meals, mean 24 h intragastric hydrogen ion activity being lowered by 70 and 72% respectively. Nocturnal anacidity was recorded in only two of 45 samples. Administration of cimetidine before meals produced earlier and higher drug blood levels than post-prandial medication, but when it was taken after food the blood levels were highest at the time when the buffer capacity of the food was waning. Blood concentrations of cimetidine exceeded the secretory IC50 level for most of the time between doses. The results show that cimetidine 0-8-1-0 g/day in four divided doses produces a striking and consistent decrease of intragastric acidity. Although variation in the timing of the dose in relation to meals did not affect the decrease of acidity, the absorption data suggest that patients should take the drug after meals.
The pressure profile of the gastroduodenal junctional zone in dogs
Authors: B. M. Brink, J. F. Schlegel, C. F. Code
Journal: Gut (1965)

Two experiments were undertaken in dogs to discover the influence of cortisone on the parietal cell population of the stomach. In one, samples of mucosa were removed at operation before and after the administration of cortisone in an average total dose of 39 mg. per kg. (in seven days). The thickness of the mucosa was increased by 16% and the number of parietal cells per unit area was increased by 33%. In the other experiment different doses were given by daily intramuscular injection for various periods. The dogs were killed and their whole stomachs were examined. Cortisone in an average total dose of 28 mg. per kg. (in three to seven days) increased the mean mucosal thickness by 27%, increased the number of parietal cells underlying a unit area of the gastric mucosa by 50%, and the total parietal cell population by a similar proportion. It did not influence the area of the gastric mucosa. Smaller doses of cortisone were less effective and larger ones tended to reduce the mucosal thickness and the number of parietal cells.
Occult Bony Metastatic Disease Demonstrated on Labeled Leukocyte Scintigraphy
Authors: Lily Shen, Chuong Bui, Robert Mansberg, Diep Nguyen, Andrew Lipinski
Journal: Clinical Nuclear Medicine (2005)

Labeled leukocyte scintigraphy is well established in confirming the presence of infection and/or inflammation. There are various methods of labeling leukocytes with either indium-111 or technetium-99m. Although the procedure is sensitive, it is not specific. As a result of the low specificity of the test, abnormal findings may reveal pathology other than infection and/or inflammation. A 69-year-old woman underwent a labeled leukocyte scan to assess for a possible renal abscess after an episode of pyelonephritis not responding to antibiotic therapy. Areas of absent bone marrow activity were incidentally noted, which demonstrated increased osteoblastic activity on a subsequent bone scan and lytic lesions on a computed tomography scan consistent with osseous metastases. Renal biopsy confirmed the diagnosis of transitional cell carcinoma.
Sustained AAV-mediated Dystrophin Expression in a Canine Model of Duchenne Muscular Dystrophy with a Brief Course of Immunosuppression
Authors: Zejing Wang, Christian S Kuhr, James M Allen, Michael Blankinship, Paul Gregorevic, Jeffrey S Chamberlain, Stephen J Tapscott, Rainer Storb
Journal: Molecular Therapy (2007)

Adeno-associated virus-based vector (AAV)-mediated gene delivery has been successful in some animal models of human disease such as the mdx mouse model of human Duchenne muscular dystrophy (DMD). However, recent evidence of immune-mediated loss of vector persistence in dogs and humans suggests that immune modulation might be necessary to achieve successful long-term transgene expression in these species. We have previously demonstrated that direct intramuscular injection of AAV2 or AAV6 in wild-type random-bred dogs resulted in a robust immune response to capsid or capsid-associated proteins. We now demonstrate that a brief course of immunosuppression with a combination of anti-thymocyte globulin (ATG), cyclosporine (CSP), and mycophenolate mofetil (MMF) is sufficient to permit long-term and robust expression of a canine micro-dystrophin (c-micro-dys) transgene in the skeletal muscle of a dog model for DMD (canine X-linked muscular dystrophy, or cxmd dog) and that its expression restored localization of components of the dystrophin-associated protein complex at the muscle membrane. This protocol has potential applications to human clinical trials to enhance AAV-mediated therapies.
From Coercion to Consent
Authors: A. Louis McGarry
Journal: New England Journal of Medicine (1966)

THE status of the mentally ill has had a long journey from the demonology of the Middle Ages. Beginning with the Renaissance through the nineteenth and most of the twentieth centuries, a quasi-criminal model was employed by secular courts in the isolation of the mentally ill from society. In time mental illness appears substantially at last to have achieved a medical status.The increasing number of psychiatric wards in general hospitals, the unlocking of doors in public mental hospitals and, perhaps most dramatically, the increasing numbers of voluntary patients in state hospitals are hard evidence of the changing status of . . .
The genesis of the diastolic murmur of complete heart block. Phono-echocardiographic observations.
Authors: M Jelveh, M Berger, E Goldberg
Journal: Circulation (1978)

A 72-year-old man with calcific aortic stenosis and complete heart block was noted to have an intermittent diastolic murmur. Using combined echocardiography and phonocardiography, it was demonstrated that the murmur occurred while the mitral valve was closing. This suggested that antegrade flow across a closing mitral orifice is of etiologic importance in the production of the murmur. Atrial sounds were also recorded and probably have a similar etiology. It is postulated that reduced ventricular compliance resulting in a more rapid rate of mitral valve closure was of etiologic importance in the genesis of the murmur.
Chronic Variant of Myocarditis Associated With Hepatitis C Virus Infection
Authors: Masanori Okabe, Keisuke Fukuda, Kikuo Arakawa, Masahiro Kikuchi
Journal: Circulation (1997)

Background Although molecular biological studies suggest a pathogenic link between enterovirus infection and dilated cardiomyopathy (DCM), the frequency of detection of enteroviral RNA is not consistently high in myocardial tissue from patients with DCM. A recent study has suggested that hepatitis C virus (HCV) may also be involved in the development of DCM. Methods and Results We performed genomic analysis for HCV in three patients with chronic active myocarditis. In all three patients, serum aminotransferase activities remained within normal ranges until the terminal stage of heart failure. At necropsy, all three livers showed evidence of tissue damage caused by chronic congestion, and one liver had evidence of chronic hepatitis. Routinely processed, paraffin-embedded tissue blocks of myocardium and liver were analyzed. Renal specimens were also analyzed to exclude the possibility of myocardial contamination with HCV material from the circulating blood. RNA extracted from the heart, liver, and kidney was subjected to strand-specific reverse transcription and amplified by semi-nested polymerase chain reaction. The target nucleotide sequence was a 178-bp fragment of the highly conserved 5′-noncoding region. Both positive- (genomic) and negative-strand RNA (replicative intermediates) were present in myocardial and liver tissue samples from all three patients. However, negative-strand RNA was undetectable in renal tissue from one patient. Conclusions These findings suggest that HCV replicated in myocardial tissue of these patients with myocarditis. Thus, HCV infection may contribute to the development of this unusual form of myocarditis.