tbuckley/cabot-search huggingface dataset:
The Rational Clinical Examination: Detecting Abnormal Systolic Murmurs-Reply
Authors: Edward Etchells
Journal: JAMA (1997)

<h3>In Reply.</h3> —I agree with both Dr Fosnocht and Dr Ali that education and research on the clinical examination remain important goals. Fosnocht identifies 2 potentially relevent studies that were not included in our article. The first study,<sup>1</sup>which was published after we completed our manuscript, reinforces 1 conclusion of our article: the clinical examination by cardiologists is accurate for ruling in and ruling out an abnormal systolic murmur. The second study,<sup>2</sup>published in 1994, was not included in our article because of several methodological concerns. First, the study outcome was not solely related to systolic murmurs. Outcomes included "any pathologic valve or myocardial findings that could potentially alter the management of the patient... all (reported) trace regurgitant lesions were considered significant by the echocardiographers." The sample, therefore, included patients with isolated diastolic murmurs or myocardial abnormalities such as left ventricular hypertrophy. Second, the prediction model used by Fink et
Sex differences and evolutionary by-products
Authors: Thomas Wynn, Forrest Tierson, Craig Palmer
Journal: Behavioral and Brain Sciences (1996)

Abstract From the perspective of evolutionary theory, we believe it makes more sense to view the sex differences in spatial cognition as being an evolutionary by-product of selection for optimal rates of fetal development. Geary does not convince us that his proposed selective factors operated with “sufficient precision, economy, and efficiency.” Moreover, the archaeological evidence does not support his proposed evolutionary scenario.
Pudendal nerve stimulation for bowel dysfunction in complete cauda equina patients
Authors: A. George, T. C. Dudding, R. J. Nicholls, C. J. Vaizey
Journal: Gut (2011)

<h3>Introduction</h3> Abnormal bowel function is a major disability in patients with complete cauda equina1 syndrome (CES). With sacral nerve stimulation (SNS) being unlikely to work in these patients due to damage sustained to the sacral nerve roots,2 treatment options are limited. <h3>Aim</h3> To assess the effect of chronic pudendal nerve stimulation (PNS) in complete CES. <h3>Methods</h3> Complete CES patients, who failed to improve with conservative treatments, underwent insertion of a permanent PNS electrode3 followed by a 3-week screening period. A permanent neurostimulator was implanted for a ≥50% reduction in number of incontinence episodes per week (incontinence patients) or a 50% improvement in the frequency of defecation and/or a ≥50% reduction in the feeling of incomplete evacuation post defecation (constipation patients), as measured by a prospectively kept bowel diary. <h3>Results</h3> Thirteen patients (11 female, 2 male, mean age: 46 years) underwent temporary screening. Five patients had faecal incontinence and eight patients had constipation secondary to the CES. All five patients with faecal incontinence symptoms showed a &gt;50% improvement during the trial phase in the number of episodes of faecal incontinence per week (mean (SD) 9 (10.4) pre vs 0 (0.5) post)) (p=0.04) and in their ability to defer defecation (minutes; mean (SD) 2 (1.8) pre versus 11 (5.5) post) (p=0.02). The St Mark9s Scores improved from a mean of (SD) 18 (1) pre to 4 (4.6) (p=0.003) at the 1 month visit. Five of the eight constipation patients improved during the trial phase in their bowel movements per week (SD) (3 (0.4) pre versus 8 (1) post)(p=0.11) and in their sense of incomplete evacuation (80% pre versus; 0% post) (p=0.004). The Wexner constipation scores improved from a mean (SD) of 17 (3.2) pre to 9 (1.8) (p=0.03) at the 1 month visit. One patient lost efficacy at 6 months due to a lead migration. One patient had an infection which required removal and re-implantation of the permanent implant. Improvement in bowel function was maintained in nine of the ten implanted patients at a mean of 12 (SD 3.2) months follow-up. 6 patients improved in their urinary function with improved ability to defer urination and reduction in number and volumes of urine leakages. <h3>Conclusion</h3> PNS is a promising new treatment in patients with bowel dysfunction secondary to complete CES.
Functional integration of acute myeloid leukemia into the vascular niche
Authors: C R Cogle, D C Goldman, G J Madlambayan, R P Leon, A Al Masri, H A Clark, S A Asbaghi, J W Tyner, J Dunlap, G Fan, T Kovacsovics, Q Liu, A Meacham, K L Hamlin, R A Hromas, E W Scott, W H Fleming
Journal: Leukemia (2014)
Laserlithotripsy of common bile duct stones.
Authors: C Ell, G Lux, J Hochberger, D Muller, L Demling
Journal: Gut (1988)

Endoscopic retrograde laser lithotripsy of common bile duct stones is a new technique which can be carried out through the endoscope without anaesthesia using ordinary endoscopic equipment. In the method described here a flashlamp pulsed Neodymium YAG laser (wave length 1064 nm) was used. Light energy was transmitted along a highly flexible quartz fibre with a diameter of 0.2 mm. This new technique was used in nine patients with concrements in the common bile duct, which could not be removed with the established endoscopic techniques. In eight of the nine the concrements (maximum diameter 4.7 x 3.1 cm) could be fragmented and in six the fragments could be extracted from the common bile duct. The total energy required was 80-300 J; complications were not observed.
A transatlantic brush with the law
Authors: K. Cranfield
Journal: BMJ (1997)

The letter dropped through the letter box on a wet day in October. Inside was a thick law suit from the United States, with my name and the name of my supervising staff anaesthetist in bold print. It stated that I had presented myself as a competent paediatric anaesthetist and had been negligent in my care of a 6 week old boy. My first reaction was disbelief, and then I relaxed as I read the details. I could remember the child but I had not been told that he had been unwell after the operation. I was satisfied that nothing untoward had occurred.

It took a few days to contact the other anaesthetist concerned and he was reassuring. The child's parents had sued anyone who had had any contact with the child, including the surgeon, the paediatrician, the hospital, and the neurologist. I regretted not having retained my carbon copy of the anaesthetic record. I am always meticulous in filling in the regular observations, and so I was confident that the record would be complete if the case came to court.

The law suit contained a letter from the plaintiff's attorney stating that I had to …
Support for suspended surgeon
Authors: J. Shea, G. Ford, W. Case, P. Angus, E. Stickley, J. Thomlinson, V. Moore, K. Bhabra, G. Wilson, H. Mathew, A. Tucker, A. Gandhi, P. Coulden, O. Maher, S. Brayshaw, D. Lloyd, A. Mishra, P. Smith, J. Wetherill, T. Kemp, P. James, M. Lynch, B. Ikoku, M. Mohanraj, P. Ahfat, P. Gudgeon, C. Logan, M. Evans, S. Barnes, C. Biswas, R. Kundu
Journal: BMJ (1992)

uses current investment to defray dividends owing to past investors, which can possibly work only in an expanding economy (and is a questionable business practice).This is now being questioned.The famous buck referred to by Heginbotham stopped with Harry Truman, not some anonymous purchaser health authority.Truman did not avoid uncomfortable decisions, even in 1948 when he fought for his political life.It is in this spirit of personal integrity and accountability that the experimental Oregon scheme should be viewed.
Influence of Atropine and of Vagally Mediated Bradycardia on the Occurrence of Ventricular Arrhythmias following Acute Coronary Occlusion in Closed-Chest Dogs
Authors: ROBERT E. GOLDSTEIN, RICHARD B. KARSH, ELDON R. SMITH, MICHAEL ORLANDO, DOUGLAS NORMAN, GARY FARNHAM, DAVID R. REDWOOD, STEPHEN E. EPSTEIN
Journal: Circulation (1973)

In contrast to previous opinions, recent investigations have suggested that increasing heart rate (HR) with atropine when moderate sinus bradycardia accompanies acute myocardial infarction is not necessarily beneficial. To further characterize the influence of vagally mediated changes in HR during ischemia, we evaluated the effects of atropine and of electric stimulation of the vagus nerves on the incidence of ventricular arrhythmias during acute coronary occlusion in closed-chest dogs. Protection from occlusion-induced arrhythmia was not observed when 28 dogs receiving atropine were compared with 27 control dogs. Rather, the total incidence of ventricular arrhythmias was significantly higher ( P &lt; 0.05) and ventricular fibrillation tended to occur more frequently in the atropine-treated group. Moreover, fewer ventricular arrhythmias (and total absence of ventricular fibrillation or close-coupled premature beats) were noted in 12 control animals with spontaneous bradycardia (HR&lt;60 beats/min) compared with 15 nonbradycardic animals. When vagal stimulation produced bradycardia (HR = 40-60 beats/min) during coronary occlusion, occurrence and character of ventricular arrhythmias were the same as in dogs with normal rates (HR = 80-100 beats/min). Although these results may not necessarily apply to man, further studies are needed before it can be assumed that all individuals with moderate bradycardia during acute myocardial infarction should receive vagolytic agents.
Child molestation and pedophilia
Authors: B. Lyles
Journal: JAMA (1989)

To the Editor.—  We congratulate the editors of JAMA on the publication of the fascinating and scholarly review by Dr Fuller1 1 entitled Child Molestation and Pedophilia: An Overview for the Physician. Though otherwise comprehensive, the review omitted emphasis of one of the most prevalent and traumatic categories of child sexual abuse, ie, incest (intrafamilial child sexual abuse). Dr Fuller mentions incestuous abuse only twice in his review. Our concern is that such omission might serve to perpetuate what some have labeled one of this century's greatest tragedies: the failure of society (and medicine) to acknowledge the presence and devastating impact of the scourge of incest on our children.  The brief reference to incest might be taken by the reader to imply that incest is not significant enough to warrant discussion, even in a general review. Such cannot be the case when 10% to 50% of all child sexual abuse is
Inflammatory Markers and Poor Outcome after Stroke: A Prospective Cohort Study and Systematic Review of Interleukin-6
Authors: William Whiteley, Caroline Jackson, Steff Lewis, Gordon Lowe, Ann Rumley, Peter Sandercock, Joanna Wardlaw, Martin Dennis, Cathie Sudlow
Journal: PLoS Medicine (2009)

Background The objective of this study was to determine whether: (a) markers of acute inflammation (white cell count, glucose, interleukin-6, C-reactive protein, and fibrinogen) are associated with poor outcome after stroke and (b) the addition of markers to previously validated prognostic models improves prediction of poor outcome. Methods and Findings We prospectively recruited patients between 2002 and 2005. Clinicians assessed patients and drew blood for inflammatory markers. Patients were followed up by postal questionnaire for poor outcome (a score of>2 on the modified Rankin Scale) and death through the General Register Office (Scotland) at 6 mo. We performed a systematic review of the literature and meta-analysis of the association between interleukin-6 and poor outcome after stroke to place our study in the context of previous research. We recruited 844 patients; mortality data were available in 844 (100%) and functional outcome in 750 (89%). After appropriate adjustment, the odds ratios for the association of markers and poor outcome (comparing the upper and the lower third) were interleukin-6, 3.1 (95% CI: 1.9–5.0); C-reactive protein, 1.9 (95% CI: 1.2–3.1); fibrinogen, 1.5 (95% CI: 1.0–2.36); white cell count, 2.1 (95% CI: 1.3–3.4); and glucose 1.3 (95% CI: 0.8–2.1). The results for interleukin-6 were similar to other studies. However, the addition of inflammatory marker levels to validated prognostic models did not materially improve model discrimination, calibration, or reclassification for prediction of poor outcome after stroke. Conclusions Raised levels of markers of the acute inflammatory response after stroke are associated with poor outcomes. However, the addition of these markers to a previously validated stroke prognostic model did not improve the prediction of poor outcome. Whether inflammatory markers are useful in prediction of recurrent stroke or other vascular events is a separate question, which requires further study. Please see later in the article for the Editors' Summary
Prolonged Targeting of Ischemic/Reperfused Myocardium by Liposomal Adenosine Augments Cardioprotection in Rats
Authors: Hiroyuki Takahama, Tetsuo Minamino, Hiroshi Asanuma, Masashi Fujita, Tomohiro Asai, Masakatsu Wakeno, Hideyuki Sasaki, Hiroshi Kikuchi, Kouichi Hashimoto, Naoto Oku, Masanori Asakura, Jiyoong Kim, Seiji Takashima, Kazuo Komamura, Masaru Sugimachi, Naoki Mochizuki, Masafumi Kitakaze
Journal: Journal of the American College of Cardiology (2009)
High Femoral Neck Fracture
Authors: Otto E. Aufranc
Journal: JAMA (1963)

Dr. David Mitchell: On the day of admission, this 81-year-old woman tripped over a stool and fell to the floor, injuring her left hip. She was able to arise and sit in a chair. Shortly thereafter, she got up but was able to walk only about 10 ft because of pain in her left hip. She was taken to the emergency ward of the Massachusetts General Hospital. On examination, the left lower extremity was found to be shortened and to lie in extremity was found to be shortened and to lie in external rotation. Rotation of the extremity produced pain in the hip.  Her medical history was noteworthy in that 40 years previously she had had rheumatic fever and a heart murmur had been present since that time. Five years ago, a diagnosis of hypertension was made. The patient had been treated with reserpine (Serpasil). In addition, she was being treated for glaucoma and had had a peptic ulcer three
Polyvalent Influenza Vaccine
Authors: Edward F. Skinner
Journal: JAMA (1963)

ABSTRACT To the Editor:— In the July 13 issue of The Journal (185:148), there is a letter from Dr. Aaron J. Shwayder regarding polyvalent influenza vaccine administered intradermally. I would like to take exception to his conclusion. The adeno-virus-influenza vaccine (Resprogen) results in the formation of a granuloma occasionally when given intradermally. But all the polyvalent influenza vaccines should not be incriminated.The product in question is an aluminumphosphate-adsorbed vaccine, and it is apparently the small amounts of aluminum which cause the skin granulomas. We also have seen this granuloma formation from this product and have therefore discontinued giving it intradermally. However, for several years we have used other polyvalent vaccines which are not aluminum precipitated and we have used them intradermally without any granuloma formation. I would conclude, therefore, that polyvalent influenza vaccine can be given intradermally provided one is careful to use a vaccine which is not aluminum-phosphate
Everolimus in Combination with Pemetrexed in Patients with Advanced Non-small Cell Lung Cancer Previously Treated with Chemotherapy: A Phase I Study Using a Novel, Adaptive Bayesian Dose-Escalation Model
Authors: Johan Vansteenkiste, Benjamin Solomon, Michael Boyer, Jürgen Wolf, Neil Miller, Lilla Di Scala, Ilona Pylvaenaeinen, Katarina Petrovic, Sasa Dimitrijevic, Beatrijs Anrys, Eckart Laack
Journal: Journal of Thoracic Oncology (2011)
Differences in synthesis of membrane proteins by leukemic cells from spleen and peripheral blood indicate distinct subsets of malignant cells in a patient with prolymphocytic leukemia
Authors: Robert C. Spiro, Jack Ansell, Isao Katayama, Kamala Muralidharan, John L. Sullivan, Robert E. Humphreys
Journal: American Journal of Hematology (1981)

Abstract Morphological and biochemical differences were demonstrated between prolymphocytic leukemia cells obtained from the spleen and peripheral blood of one patient. Peripheral blood prolymphocytes had consistently smaller nuclear‐cytoplasmic ratios than did splenic prolymphocytes. Percoll gradient‐purified prolymphocytes from the spleen synthesized abundant amounts of some membrane proteins which were hardly expressed by peripheral blood prolymphocytes. Peripheral blood prolymphocytes did not change their expression of membrane proteins during three days in culture. These findings are consistent with the view that prolymphocytic leukemia cells from the spleen exist, on the average, at an earlier stage of differentiation than do circulating leukemic cells, and that peripheral blood leukemic cells are frozen at a specific phase of differentiation.
THE CARDIAC DISTURBANCES ASSOCIATED WITH DISEASES OF THE THYROID GLAND
Authors: FRANK N. WILSON
Journal: JAMA (1924)

There are two diseases of the thyroid that we can dispose of very quickly. The smooth, uniform enlargement of this gland which occurs so frequently in children and in young people, particularly in young women, in this region and everywhere about the Great Lakes, and which appears to be due to a lack of iodin in the food and water, does not produce heart disease. Myxedema and hypothyroidism are very frequently associated with hypertension, nephritis or arteriosclerosis, or with a combination of these,<sup>1</sup>and consequently with the type of cardiac disturbances to which they give rise. Most of the cardiac abnormalities produced by thyroid disease occur in those toxic states in which there is an elevation of the basal metabolic rate. So far as the disturbances of the cardiovascular system are concerned, there is little difference between typical exophthalmic goiter and so-called "adenoma with hyperthyroidism." It is convenient in
Mercury in human hair due to environment and diet: a review.
Authors: D Airey
Journal: Environmental Health Perspectives (1983)

Hair mercury levels increase with the amount of fish in the diet and the amount of mercury in the fish species consumed. If hair mercury levels in people throughout the world were monitored by a standard analytical procedure, the results would indicate locations where people's body burden of mercury is high enough to be subclinically unhealthy and where controls on environmental emissions might be beneficial. The relationship of hair mercury concentration to the method of sampling and analysis of hair, the analysis of the results, the amount of fish consumed, the country and location from which samples were taken and the age, sex and occupation of the donor is discussed.
Partition of xenon and iodoantipyrine among erythrocytes, plasma, and myocardium.
Authors: R Carlin, S Chien
Journal: Circulation Research (1977)

A new method was developed for determining directly the distribution of 133Xe between red cells and plasma in vitro without an air-fluid interface; the partitioning of 133Xe and 133-i-iodantipyrine between blood and myocardium was investigated in the dog in situ. The red cell-plasma partition coefficient for 133Xe (lambdacpX, unit: ml/ml) at 37 degrees C was 2.27 +/- 0.07 (mean +/- SD) for human blood and 3.31 +/- 0.06 for dog blood. The red cell-plasma partition coefficient for 131I-iodantipyrine (lambdacpI, ml/ml) was 0.75 +/- 0.04 for human blood and 0.97 +/- 0.03 for dog blood. lambdacpX and lambdacpI did not change significantly after the intravenous administration of sodium pentobarbital (30 mg/kg) into the dog. lambdacpX of dog blood varied inversely with temperature, whereas lambdacpI showed very little change with temperature. The blood-left ventricle partition coefficient for 133Xe (lambda'btX, corrected for trapped blood) varied directly with directly with red cell volume fraction (H): lambda'btX = 1.32 + 2.00 H. Blood-left ventricle partition coefficient for 131I-iodoanitpyrine did not vary significantly with H. The results support the concept of a three-compartment partition of the indicator among erythrocytes, plasma, and myocardium. The mean values (+/- SD) of the hematocrit-independent plasma-tissue partition coefficient in the left ventricle for 133Xe and 131I-iodoantipyrine were 1.08 +/- 0.16 and 1.54 +/- 0.20 g/ml, respectively.
Renal vasoconstriction in cirrhosis evaluated by duplex doppler ultrasonography
Authors: David Sacerdoti, Massimo Bolognesi, Carlo Merkel, Paolo Angeli, Angelo Gatta
Journal: Hepatology (1993)

Studies of renal perfusion when kidney function tests are still normal could be useful to understand the pathophysiology of functional kidney impairment in cirrhosis; currently, this requires invasive methodology. Duplex Doppler ultrasonography allows noninvasive evaluation of intrarenal arterial resistances. In 19 nonascitic and 35 ascitic cirrhotic patients with normal kidney function (normal serum creatinine and urea levels) and in 17 controls, we measured the intrarenal arterial pulsatility index (Pulsatility index = [Peak systolic velocity-Minimum diastolic velocity]/Mean velocity) and the resistive index (Resistive index = [Peak systolic velocity-Minimum diastolic velocity]/Peak systolic velocity) by duplex Doppler ultrasonography after visualization of interlobar, interlobular or arcuate arteries by color Doppler ultrasonography. The pulsatility index and resistive index (calculated as the mean of three to five consecutive determinations) were significantly higher in cirrhotic patients than in control patients (pulsatility index: 1.16 +/- 0.24 vs. 0.78 +/- 0.05 [mean +/- S.D.], p < 0.001; resistive index: 0.67 +/- 0.06 vs. 0.53 +/- 0.03, p < 0.001). The pulsatility index and resistive index were significantly higher in nonascitic cirrhotic patients than in control patients, in ascitic patients than in nonascitic patients, in ascitic patients not treated with diuretics than in nonascitic ones and in ascitic patients treated with diuretics than in those not treated. The pulsatility index and resistive index measured before and after treatment with diuretics (7 to 15 days) in seven patients were significantly increased by treatment. The pulsatility index and resistive index were significantly higher in Child-Turcotte-Pugh class B and C patients than in class A patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Diagnostic equipment misused in India
Authors: G. Mudur
Journal: BMJ (1998)

Radiologists in India have criticised the widespread misuse of x ray and ultrasound equipment by inappropriately qualified doctors.

Members of the Indian Radiological and Imaging Association say that unrestricted access to equipment has prompted doctors with inadequate training in radiology to set up imaging centres, sometimes leading to wrong diagnoses. Of India's half a million doctors, about 7000 are qualified in radiology. But the actual …