tbuckley/cabot-search huggingface dataset:
The Perils of PERRLA
Authors: Leonard A. Levin
Journal: Annals of Internal Medicine (2007)

Letters17 April 2007The Perils of PERRLALeonard A. Levin, MD, PhDLeonard A. Levin, MD, PhDFrom University of Wisconsin Medical School and University of Montréal; Montréal, Québec, Canada.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-8-200704170-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: The pupillary examination is arguably the single most useful clinical test of the nervous system in the conscious or unconscious patient. When properly done with a few swings of a light, the examination can assess the functional status of the retina, optic nerve, contralateral optic tract, cranial nerve III, dorsal midbrain, and sympathetic chain from the hypothalamus down to the lower cervical spinal cord and up to the cavernous sinus and orbit. The results of normal pupil testing are frequently documented with PERRLA (pupils equal, round, reactive to light, and accommodation). But PERRLA is not only incorrect and inexact—it ...Reference1. Levatin P. Pupillary escape in disease of the retina or optic nerve. Arch Ophthalmol. 1959;62:768-79. [PMID: 14416133] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Leonard A. Levin, MD, PhDAffiliations: From University of Wisconsin Medical School and University of Montréal; Montréal, Québec, Canada.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 17 April 2007Volume 146, Issue 8Page: 615-616KeywordsDenervationOptic nerveOptic neuropathyParalysisReflexesRetinaSpinal cordSympathetic nervous systemVisionVisual impairments ePublished: 17 April 2007 Issue Published: 17 April 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Diatrizoate Absorption From the Intestine
Authors: Lawrence A. Davis
Journal: JAMA (1965)

<h3>To the Editor:—</h3> The Clinical Note on "A Rapid Bedside Test for Intestinal Perforation" by McGraw and associates (<i>JAMA</i><b>191</b>:939-941 [March 15] 1965) requires some comment. Water-soluble opaque may be absorbed from the intact gastrointestinal tract and appear in the urine. No actual break or perforation need be present. Berman and Avnet reported (<i>Brit J Radiol</i><b>33</b>:92, 1960) that the urinary tract was visualized routinely in 26% of patients receiving upper gastrointestinal examinations with a water-soluble opaque medium. We have also noted visualization of the urinary tract in patients with inflammatory conditions of the intestinal tract and in patients with intestinal obstruction. Though the latter conditions may be clinically and readily ruled out, water-soluble opaque in the urine following oral administration does not necessarily mean a perforation of the intestinal tract. In any case, the authors' idea is ingenious and certainly simple to perform.
TYPHOID FEVER—A SYNOPSIS.Read in the Section of Practice of Medicine, at the Forty-fourth Annual Meeting of the American Medical Association.
Authors: M. J. CROUCH
Journal: JAMA (1893)

I retain the old name in preference to the newer ones, as "enteric fever." This new name refers to a single lesion, which lesion, however constant, is not the cause, exclusive seat, or descriptive of the condition; but is plainly the result of a general process. Nor is all the fever produced in or confined to the intestinal tract. Typhoid fever is a specified condition of the economy, with local modifications. We shall consider the condition known as typhoid fever first, then the lesions which are results of the process producing that condition. The laws of "disease" in general are to be reached inductively, by generalizations of physiological facts supported by clinical phenomena and morbid anatomy. These laws applied to the special conditions under consideration, are illustrated and supported by the phenomena and changes observed. The fever is the<i>result</i>, and not the<i>cause</i>of the abnormal condition. Heat is
Letter: The "filth row".
Authors: M Thomas
Journal: BMJ (1974)

prompts me to describe a similar experience.While I was attempting to demonstrate that penicillinase-producing Staphylococcus aureus may show large zones of inhibition around penicillin discs the organism was inoculated on to DST agar medium (Oxoid) on which discs stated to contain 5 units of benzylpenicillin and 2 ,g, 10 pg, and 25 Ag ampicillin respectively were placed.
Why do we overtreat hypertension?
Authors: Des Spence
Journal: BMJ (2012)

“Bloody GPs: sending up this dross!” When medical referrals were received the air was always thick with vitriol, cigarette smoke, and expletives. “Why don’t you send them home if you think the referrals are such rubbish?” I quizzed. The answer: “No one gets sued for admitting patients!” It’s true. No one complains about doctors who are overcautious, overinvestigating, or overtreating. Medicine was once about assessing individual risk, making decisions, and giving a balanced opinion. But in today’s climate it is simpler to intervene early and involve everyone rather than leave …
Experiences with a technique of neuroleptanalgesia for bronchography
Authors: H. M. Stevenson, S. K. Pandit, J. W. Dundee, S. McDowell, J. D. Morrison
Journal: Thorax (1972)

The use of a mixture of 2 mg phenoperidine and 5 mg droperidol as an adjunct to topical anaesthesia for bronchography, with or without prior bronchoscopy, is reported in 100 adult patients. Given slowly over 2 to 10 minutes this produces good operating conditions in the majority of patients. However, if parenteral pethidine or diazepam are used as premedication, patients may be too drowsy to co-operate with changes in posture. In the absence of excessive sedation respiratory depression will respond to the simple expedient of asking the patient to breathe. It is recommended that atropine alone be given as premedication, perhaps with oral diazepam in apprehensive patients. Despite the good operating conditions most patients remembered the procedure and half of them found it to be unpleasant.
A novel loss-of-function mutation in the proton-coupled folate transporter from a patient with hereditary folate malabsorption reveals that Arg 113 is crucial for function
Authors: Inbal Lasry, Bluma Berman, Rachel Straussberg, Yael Sofer, Hanna Bessler, Mohamad Sharkia, Fabian Glaser, Gerrit Jansen, Stavit Drori, Yehuda G. Assaraf
Journal: Blood (2008)
The Life and Contributions of Walter Bradford Cannon, 1871-1945: His Influence on the Development of Physiology in the Twentieth Century
Authors: Lester S. King
Journal: JAMA (1975)

Walter B. Cannon, the outstanding American physiologist, famous for his brilliant researches in several quite distinct areas of his chosen discipline, was born on Oct 19, 1871. While his birthday was recognized during the actual centenary year, a major celebration was a symposium held in May 1972, attended by former students as well as by investigators who had added to the various fields of knowledge that Cannon had cultivated with such success. The present volume records the contributions made in his honor. Cannon's first great scientific achievement dates from 1896, when he started to use the newly discovered x-rays to clarify the functions of the gastrointestinal tract. He was the first to use opaque contrast medium to study the problems of gastrointestinal motility. The first chapter in the present book reviews his contributions to gastroenterology and the progress made since then. Other major fields to which he made pioneer contributions
Effect of staphylococcal enterotoxin B on specific antibody production in children with atopic dermatitis
Authors: Gwang-Cheon Jang, Myung-Hyun Sohn, Cheol-Hong Kim, Woo Kyung Kim, Kyung-Eun Lee, Kyu-Earn Kim, Ki-Young Lee
Journal: Journal of Allergy and Clinical Immunology (2002)
Comment: The Conversion Ratio as a Basis for Elective Neck Node Therapy
Authors: Philip Rubin
Journal: JAMA (1971)

Textent need to define the exact extent of the cancer is essential to selection of the therapeutic regimen and treatment plan. The limitations of clinical examination do not permit accuracy or precision in estimating the true microscopic extent of the neoplastic process. The clinical stage is, at best, the apparent and not true pathologic stage. The ratio between the apparent stage and the true stage will be referred to as the<i>conversion ratio</i>. The critical factor in clinical cancer decision-making is estimating whether the conversion ratio is high or low, ie, in the decision of when to use elective measures to treat neck nodes in cancer of the oral cavity, pharynx, and larynx. Since precise information is lacking, the conversion ratio for each subgroup of cancer can only be estimated. It is immediately apparent that if all Tumor, Node, Metastasis (TNM) combinations are considered, there are 32 possibilities (4T×4N×2M). The
Review and management of drug interactions with boceprevir and telaprevir
Authors: Jennifer J. Kiser, James R. Burton, Peter L. Anderson, Gregory T. Everson
Journal: Hepatology (2012)

Abstract Boceprevir (BOC) and telaprevir (TPV), when added to pegylated interferon and ribavirin for the treatment of chronic hepatitis C virus (HCV) infection, increase the rates of sustained virologic response in treatment-naïve persons to approximately 70%. Though these agents represent an important advance in the treatment of chronic HCV, they present new treatment challenges to the hepatology community. BOC and TPV are both substrates and inhibitors of the hepatic enzyme, cytochrome P450 3A, and the drug transporter, P-glycoprotein, which predisposes these agents to many drug interactions. Identification and appropriate management of potential drug interactions with TPV and BOC is critical for optimizing therapeutic outcomes during hepatitis C treatment. This review highlights the pharmacologic characteristics and drug-interaction potential of BOC and TPV and provides guidance on the management of drug interactions with these agents. (Hepatology 2012;)
Preferential expression of cytochrome CYP CYP2R1 but not CYP1B1 in human cord blood hematopoietic stem and progenitor cells
Authors: Shuoqi Xu, Zhihua Ren, Yanan Wang, Xinxin Ding, Yongping Jiang
Journal: Acta Pharmaceutica Sinica B (2014)

Cytochrome P450 (CYP) enzymes metabolize numerous endogenous substrates, such as retinoids, androgens, estrogens and vitamin D, that can modulate important cellular processes, including proliferation, differentiation and apoptosis. The aim of this study is to characterize the expression of CYP genes in CD34+ human cord blood hematopoietic stem and early progenitor cells (CBHSPCs) as a first step toward assessment of the potential biological functions of CYP enzymes in regulating the expansion or differentiation of these cells. CD34+ CBHSPCs were purified from umbilical cord blood via antibody affinity chromatography. Purity of CD34+ CBHSPCs was assessed using fluorescence-activated cell sorting. RNA was isolated from purified CD34+ CBHSPCs and total mononuclear cells (MNCs) for RNA-PCR analysis of CYP expression. Fourteen human CYPs were detected in the initial screening with qualitative RT-PCR in CD34+ CBHSPCs. Further quantitative RNA-PCR analysis of the detected CYP transcripts yielded evidence for preferential expression of CYP2R1 in CD34+ CBHSPCs relative to MNCs; and for greater expression of CYP1B1 in MNCs relative to CD34+ CBHSPCs. These findings provide the basis for further studies on possible functions of CYP2R1 and CYP1B1 in CBHSPCs׳ proliferation and/or differentiation and their potential utility as targets for drugs designed to modulate CD34+ CBHSPC expansion or differentiation.
An Anomaly of the Sedimentation Rate in Rheumatic Diseases
Authors: S. Goldberg, L. E. Glynn, E. G. L. Bywaters
Journal: BMJ (1952)

<h3>PROBLEM ADDRESSED</h3> The Family Medicine Residency Program at the University of Alberta has used academic sessions and clinical-based teaching to prepare residents for private practice. Before the new curriculum, academic sessions were large group lectures given by specialists. These sessions lacked consistent quality, structured topics, and organization. <h3>OBJECTIVE OF PROGRAM</h3> The program was designed to improve the quality and consistency of academic sessions by creating a new curriculum. The goals for the new curriculum included improved organizational structure, improved satisfaction from the participants, improved resident knowledge and confidence in key areas of family medicine, and improved performance on licensing examinations. <h3>PROGRAM DESCRIPTION</h3> The new curriculum is faculty guided but resident organized. Twenty-three core topics in family medicine are covered during a 2-year rotating curriculum. Several small group activities, including problem-based learning modules, journal club, and examination preparation sessions, complement larger didactic sessions. A multiple-source evaluation process is an essential component of this new program. <h3>CONCLUSION</h3> The new academic curriculum for family medicine residents is based on a variety of learning styles and is consistent with the principles of adult learning theory. This structured curriculum provides a good basis for further development. Other programs across the country might want to incorporate these ideas into their current programming.
Proposed MHRA changes to UK children's paracetamol dosing recommendations: modelling study
Authors: Sally Eyers, James Fingleton, Kyle Perrin, Richard Beasley
Journal: Journal of the Royal Society of Medicine (2012)

Objectives Paracetamol is the most commonly administered medicine to children. A recent study highlighted the risk of overdose of paracetamol using British National Formulary for Children (BNFC) age-based dosing guidelines. This current study assesses the safety of changes to the UK paracetamol product dosing system proposed by the Medicines and Healthcare products Regulatory Authority (MHRA) which include a larger number of narrower age bands and a single dose per age band. Design Theoretical comparison of the proposed MHRA dosing system with the product dosing instructions of a commonly prescribed form of paracetamol in the UK. Setting United Kingdom Participants Proposed MHRA dosing recommendations and current product dosing instructions were compared using a previously validated model. Main outcome measures For both dosing recommendations, single and cumulative daily doses of paracetamol for boys and girls at the 9th, 50th and 91st centiles for weight were calculated for 3 month, 1 year, 6 year and 12 year age groups. Results With the current product dosing instructions, underweight children are at risk of receiving approximately two times the recommended single and cumulative daily dose of paracetamol, particularly at age 1 year and 6 years. This risk is negligible when the same model is applied to the proposed MHRA dosing system, whereby underweight, average weight and overweight children at all ages receive doses marginally above or within the recommended dose range or limit. Conclusion The proposed MHRA dosing recommendations for paracetamol use in children are effective at reducing the risk of paracetamol overdose in children of all ages, when compared with current product dosing instructions.
Multiple-Organ Necrosis in Shock
Authors: G. Nigogosyan
Journal: JAMA (1963)

<h3>To the Editor:—</h3> It was interesting to read the article by Dr. Haber and his colleagues titled "Ischemic Necrosis of Multiple Organs in Prolonged Shock," in the March 30 issue ofThe Journal(<b>183</b>:1107). Their explanation for the extensive necrosis of the liver and other organs is very attractive. Since both patients developed this complication following general anesthesia, it would be interesting to know what kind of anesthetic agent or agents were used.
Avoid creeping privatisation of NHS, policy institute argues
Authors: J. Wise
Journal: BMJ (2008)

Increasing the role of the private sector in the UK health system will not make the service more efficient and should not be seen as a solution to rising long term healthcare costs, argues the Institute for Public Policy Research (IPPR).

The centre left institute’s report to mark the 60th anniversary of the NHS concludes that taxation or collective funding is still the most efficient and fairest way to fund health care.

The report states that governments that have tried to shift costs from the public to private purse rarely save and sometimes increase costs. For example, France’s system of high charges for services such as seeing a doctor or treatment as an outpatient has not controlled rising costs.

Total healthcare spending in …
Posteroventral Medial Pallidotomy in Advanced Parkinson's Disease
Authors: Anthony E. Lang, Andres M. Lozano, Erwin Montgomery, Jan Duff, Ronald Tasker, William Hutchinson
Journal: New England Journal of Medicine (1997)

Posteroventral medial pallidotomy sometimes produces striking improvement in patients with advanced Parkinson's disease, but the studies to date have involved small numbers of patients and short-term follow-up.
Support grows for retaining the opt-out to the 48 hour week
Authors: Rory Watson
Journal: BMJ (2005)

Moves by the European Union to establish a clear legal definition for active and inactive on-call time for medical staff and other essential services, and to abolish the opt-out from the 48 hour maximum working week, have become entangled in the wider political debate on the future of the 25 member bloc's economic policy.

Social affairs and health ministers were unable to reach agreement on the latest proposed changes to the EU's working time directive last week. Some argued that its flexibility was essential …
Emotion-specific clues to the neural substrate of empathy
Authors: Anthony P. Atkinson
Journal: Behavioral and Brain Sciences (2002)

Research only alluded to by Preston &amp; de Waal (P&amp;deW) indicates the disproportionate involvement of some brain regions in the perception and experience of certain emotions. This suggests that the neural substrate of primitive emotional contagion has some emotion-specific aspects, even if cognitively sophisticated forms of empathy do not. Goals for future research include determining the ways in which empathy is emotion-specific and dependent on overt or covert perception.
Foreign Medical Graduates: The Position of the American College of Physicians
Authors: JACK A. GINSBURG
Journal: Annals of Internal Medicine (1986)

Editorials1 December 1986Foreign Medical Graduates: The Position of the American College of PhysiciansJACK A. GINSBURG, M.S.JACK A. GINSBURG, M.S.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-105-6-963 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn an era of federal budgetary constraints and an apparent abundance of physicians, the appropriateness of federal funding of graduate medical education for foreign medical graduates is being questioned increasingly, particularly at a time when U.S. medical schools are being encouraged to reduce enrollments. Proposals that would simply end all funding of graduate medical education for foreign medical graduates fail to acknowledge the necessity of sharing America's medical knowledge with other nations, as well as the important contributions the foreign graduates make to the care of patients in this country who might otherwise be medically underserved.The issues concerning foreign...Reference1. Foreign medical graduates [Position paper]. Philadelphia: American College of Physicians; 3 March 1986. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: JACK A. GINSBURG, M.S.Affiliations: American College of Physicians Washington, D.C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 1986Volume 105, Issue 6Page: 963-964KeywordsGraduate medical educationHealth careMedical educationPatientsPrevention, policy, and public healthPublic policy ePublished: 1 December 2008 Issue Published: 1 December 1986 PDF downloadLoading ...
How Best to Improve Patient Safety?—Reply
Authors: Peter M. Layde
Journal: JAMA (2002)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Tumor-Associated NH2-Terminal Fragments Are the Most Stable Part of the Adenomatous Polyposis Coli Protein and Can Be Regulated by Interactions with COOH-Terminal Domains
Authors: Zhuoyu Li, Inke S. Näthke
Journal: Cancer Research (2005)

Abstract Truncation mutations in the adenomatous polyposis coli (APC) gene are responsible for familial and sporadic colorectal cancer. APC is a large, multifunctional protein involved in cell migration, proliferation, and differentiation. Dominant effects that have been attributed to the NH2-terminal fragments of APC expressed in tumors may result from loss of functions due to lack of COOH-terminal regions or gain of functions due to fewer regulatory interactions. Resolving this issue and determining how structural changes contribute to the multiple functions of the APC protein requires knowledge about the structural organization of the APC molecule. To this end, we used limited proteolysis to distinguish regions of the molecule with limited structure from those that form well-folded domains. We discovered that the NH2-terminal region of APC was most resistant to proteolytic degradation, whereas middle and COOH-terminal regions were significantly more sensitive. Binding of APC to microtubules protected COOH-terminal regions of APC against proteolysis, consistent with the idea that this region of the molecule becomes ordered when bound to microtubules. Furthermore, interactions between the NH2- and COOH-terminal domains of APC were identified in vitro and in vivo, suggesting that NH2-terminal fragments of APC may be regulated by interactions with COOH-terminal domains. Indeed, expressing COOH-terminal APC fragments in tumor cells resulted in changes in the protein interactions of endogenous NH2-terminal fragments in these cells. Thus, the dominant function of NH2-terminal APC fragments found in tumor cells could be explained by loss of this regulation in tumors where COOH-terminal domains are missing.
1103-194 Identification of novel genetic markers associated with risk of myocardial infarction from a genomic scale scan of putative functional polmorphisms
Authors: Dov Shiffman, May Luke, Olga Iakoubova, Bradley E Aouizerat, Christian A Zellner, Clive R Pullinger, Denis W Drew, Joseph J Catanese, Diane U Leong, Dongming Liu, Judy Z Louie, David Lew, Carmen H Tong, David A Ross, Linda B McAllister, Charles M Rowland, Kit F Lau, James J Devlin, Mary J Malloy, John P Kane
Journal: Journal of the American College of Cardiology (2004)