tbuckley/cabot-search huggingface dataset:
Balloon mitral commissurotomy after previous surgical commissurotomy. The National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry participants.
Authors: C J Davidson, T M Bashore, M Mickel, K Davis
Journal: Circulation (1992)

BACKGROUND Mitral restenosis after surgical mitral commissurotomy often occurs within 5-15 years, necessitating a repeat procedure. Balloon mitral commissurotomy (BMC) has been advocated as an alternative to repeat surgery for mitral restenosis. METHODS AND RESULTS The purposes of this study are to determine the short- and intermediate-term outcomes of patients undergoing BMC after previous surgical commissurotomy, to compare these patients with those undergoing balloon mitral commissurotomy as an initial procedure, and to elucidate the multivariate determinants of acute procedural and clinical outcome. Of 738 patients undergoing BMC as part of the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry, 133 underwent BMC after previous surgical mitral commissurotomy. Prospective data obtained included demographic, hemodynamic, echocardiographic, and clinical follow-up. BMC after previous surgical commissurotomy produced a significant reduction in transvalvular gradient from 13 +/- 5 to 6 +/- 3 mm Hg (p less than 0.0001) and an increase in mitral valve area from 1.0 +/- 0.3 to 1.8 +/- 0.8 cm2 (p less than 0.0001). BMC as an initial procedure increased valve area from 1.0 +/- 0.4 to 2.0 +/- 0.8 cm2 (p less than 0.0001) (p = 0.03 versus prior surgery). Baseline characteristics including mitral valve echo score were similar for both groups. Comparing 6-month status in patients with prior surgery to those without, 80% versus 90% were New York Heart Association (NYHA) functional class I or II (p = 0.004). Mortality was similar. In patients with previous mitral valve surgery, multivariate predictors of improvement in 6-month clinical status included the experience of the center (p = 0.006), lower echocardiographic score (p = 0.001), and lower left ventricular end-diastolic pressure (p = 0.008). Multivariate determinants of a final mitral valve area greater than or equal to 1.5 cm2 were a lower baseline NYHA functional class (p = 0.003) and lower mitral valve echocardiographic score (p = 0.008). CONCLUSIONS BMC after previous surgical mitral commissurotomy results in similar hemodynamic changes as in patients undergoing BMC as an initial procedure. Symptomatic improvement at 6 months is slightly less frequent in prior commissurotomy patients. Patients with favorable valvular morphology and preserved left ventricular function who undergo BMC in experienced centers are most likely to achieve symptomatic improvement after previous surgical commissurotomy. In general, BMC is an effective treatment for mitral restenosis after previous surgical commissurotomy.
Educational "events" have only a small part in how doctors learn, conference is told
Authors: N. Hawkes
Journal: BMJ (2013)

The requirement that doctors keep their skills and knowledge up to date has become an item of faith in most developed countries, but evidence on how best it can be done is scarce, and there is no adequate way of measuring its effectiveness, a conference at BMA House in London on 26 June was told. 

The conference, jointly organised by the BMJ and the Association of the British Pharmaceutical Industry, was jolted out of any sense of complacency by these claims from Janet Grant, an educational psychologist who is director of the Centre for Medical Education in Context. 

“There are a lot of declamatory statements and a lot of assertions made about continuing medical education,” she said, “but not a lot of evidence, no common rationale, no systematic relationship to need, and no robust evidence of beneficial effects on a …
Risk of diabetes from statins may be higher in women
Authors: E. Vos
Journal: BMJ (2011)

Article abstract-Pseudotumor cerebri (PTC), or idiopathic intracranial hypertension, is a syndrome associated with multiple clinical conditions. We hypothesize that most if not all etiologies result in an increase in intracranial venous pressure as a final common pathway. We studied 10 patients with PTC. Five had dural venous outflow obstruction as demonstrated by venography, and the five remaining patients had normal venous anatomy. Pressure measurements, made during venography in eight patients, all showed elevated pressures. Pressure measurements in the superior sagittal sinus ranged from 13 to 24 mm Hg (mean, 16.6 mm Hg). Patients with obstruction tended to have a high pressure gradient across the stenotic segment. Five patients with normal dural venous anatomy had elevated right atrial pressures (range, 6 to 22 mm Hg; mean, 11.8 mm Hg), which were transmitted up to the intracranial venous sinuses. Endovascular techniques, including angioplasty and infusion of thrombolytic agents in some cases, improved outlet obstruction from a hemodynamic perspective but were ineffective in consistently and reliably alleviating the clinical manifestations of PTC.Patients in both groups tended to respond well to conventional CSF diversion procedures. Our study suggests that elevated intracranial venous pressure may be a universal mechanism in PTC of different etiologies.This elevated venous pressure leads to elevation in CSF and intracranial pressure by resisting CSF absorption. Although the mechanism leading to venous hypertension in the presence of outflow obstruction is obvious, the etiology of increased intracranial and central systemic venous pressure in PTC remains obscure. <b>NEUROLOGY 1996;46: </b> 198-202
Purpura Fulminans
Authors: William N. Chambers, John B. Holyoke, Robert F. Wilson
Journal: New England Journal of Medicine (1952)

PURPURA fulminans is a rare clinical syndrome characterized by sudden appearance of rapidly progressive symmetrical subcutaneous ecchymoses and accompanied by high fever, intense systemic symptoms and death, which usually occurs within a few days of the onset.Ever since this syndrome was first described by Guelliot1 in 1884 there have been scattered reports in the literature of cases, all characterized by strikingly similar clinical courses, hemorrhagic manifestations and autopsy findings. The laboratory investigations in most cases are equivocal. In a number of cases the fulminating purpura is preceded by scarlet fever, suddenly appearing in the second to the fourth week . . .
Medical and Surgical Treatment of Appendicitis.
Authors: Wilbur F. Sterman
Journal: JAMA (1899)

Winterset, Iowa, March 14, 1899. <h3>To the Editor:</h3> —An article published in theJournalof Dec. 18, 1897, written by me was later very favorably commented upon and sustained throughout by a more lengthy article from the pen of Dr. Haughton of Richmond, Ind., in theJournal. One great, and I trust general, good has been accomplished through the controversy elicited by the article mentioned, however, and that is the expression of the profession as a whole, as well as the medical press of this country, sustaining conservatism and common sense against radicalism and the lack of it. The constant aim of every member of the medical profession should be the welfare of humanity at large, and the greatest good to the greatest number. Taking into consideration the fact that autopsies held for the purpose "have demonstrated the existence of some pathologic condition of the appendix in over 30 per
The Effect of On-pump Coronary Artery By-pass Surgery on Aortic Functions
Authors: Fahriye Vatansever Ağca, Kemal Karaagac, Tezcan Peker, Ozlem Arıcan Ozluk, Erhan Tenekecioğu, Muhammed Şenturk, Mustafa Yılmaz
Journal: Journal of the American College of Cardiology (2013)
Influenza vaccination reduces risk of hospitalisation for heart disease and CVD in subjects aged 65 years
Authors: B Yung
Journal: Thorax (2003)

▴ Nichol KL, Nordin J, Mullooly J, et al . Influenza vaccination and reduction in hospitalisations for cardiac disease and stroke among the elderly. N Engl J Med2003;348:1322–32 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Serious influenza related illnesses cause considerable morbidity and mortality to patients and put enormous pressure on health, social care and other services. An increased risk of ischaemic heart disease and cerebrovascular disease (CVD) are known to be associated with upper respiratory tract … [1]: {openurl}?query=rft.jtitle%253DNew%2BEngland%2BJournal%2Bof%2BMedicine%26rft.stitle%253DNEJM%26rft.issn%253D0028-4793%26rft.aulast%253DNichol%26rft.auinit1%253DK.%2BL.%26rft.volume%253D348%26rft.issue%253D14%26rft.spage%253D1322%26rft.epage%253D1332%26rft.atitle%253DInfluenza%2BVaccination%2Band%2BReduction%2Bin%2BHospitalizations%2Bfor%2BCardiac%2BDisease%2Band%2BStroke%2Bamong%2Bthe%2BElderly%26rft_id%253Dinfo%253Adoi%252F10.1056%252FNEJMoa025028%26rft_id%253Dinfo%253Apmid%252F12672859%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1056/NEJMoa025028&link_type=DOI [3]: /lookup/external-ref?access_num=12672859&link_type=MED&atom=%2Fthoraxjnl%2F58%2F7%2F572.atom [4]: /lookup/external-ref?access_num=000181949100003&link_type=ISI
Hope for Treatment of Thrombocytopenia
Authors: B P Schick
Journal: New England Journal of Medicine (1994)

Thrombocytopenia has been a major problem in the treatment of patients undergoing bone marrow transplantation or chemotherapy for cancer. Thrombopoietin, the hormone thought to stimulate the production and maturation of megakaryocytes (Figure 1), which in turn produce platelets, has recently been purified and cloned14. This discovery may lead to advances in the treatment of thrombocytopenia caused by deficient production of platelets.The recovery of platelets after bone marrow transplantation or chemotherapy often occurs later (23 to 60 days after transplantation) than the recovery of other hematopoietic lineages. Treatment has relied on the administration of many units of platelet . . .
Reviews, Notes, and Listings: Textbook of Adolescent Medicine
Authors: J. Dennis Fortenberry
Journal: Annals of Internal Medicine (1993)

Literature of Medicine15 August 1993Reviews, Notes, and Listings: Textbook of Adolescent MedicineJ. Dennis FortenberryJ. Dennis FortenberryUniversity of Oklahoma Health Sciences Center, Oklahoma City, OK 73105.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-119-4-199308150-00033 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Textbook of Adolescent MedicineElizabeth R. McAnarney, Richard E. Kreipe, Donald P. Orr, and George D. Comerci; eds. 1280 pages. Philadelphia: W.B. Saunders Company; 1992. $120.00.Good textbooks are more than compendia of technical facts to which a practitioner turns as a chef to a cookbook. Textbooks outline the perimeters of a field; when asked for a definition of a pediatrician or internist, we may lift a text and reply, a master of this. The Textbook of Adolescent Medicine serves such a function for the subspecialty of adolescent medicine. Moreover, it points to the increasing sophistication all specialties need to ... Author, Article, and Disclosure InformationAffiliations: University of Oklahoma Health Sciences Center, Oklahoma City, OK 73105. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 August 1993Volume 119, Issue 4Page: 349-350KeywordsAdolescent medicineAdolescentsClinical epidemiologyEpidemiologyExtrapolationMedical conditionsPathogenesisPrimary hypertensionPsychologySub-specialty care ePublished: 15 August 2000 Issue Published: 15 August 1993 Copyright & PermissionsCopyright © 1993 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Descartes and the gut: “I'm pink therefore I am”
Authors: D G THOMPSON
Journal: Gut (2001)

See articles on pages 209 and 214 

In 1637 Rene Descartes wrote “The soul by which I am, what I am, is entirely distinct from my body and even if the body were not, the soul would not cease to be what it is”.1 Descartes was thus reflecting on the longstanding conundrum of relationships between body and soul which have continued to this day and are equally mirrored in our views on diseases of the gastrointestinal tract.

The fathers of gastroenterology clearly recognised the relationships between the brain and gut. In his classic studies of the control of gastric secretion conducted on his subject Tom with a permanent gastric fistula,2 Stuart Wolf found that emotional state affected secretion and that mucosal blood flow, measured by a simple thermistor, altered in parallel.3 Similar relationships between rectal mucosal blood flow and psychological state were also reported by Almy.4 In his now classic “hoax” experiment, he induced anxiety in a “volunteer” by pretending to identify an abnormality during sigmoidoscopy. This induced a marked change in colonic motor activity and a change in mucosal colour.

In the last half century however the onset of an era of objectivity has influenced how we view gastrointestinal symptoms. Quite rightly …
Inherited Perforin and<i>Fas</i>Mutations in a Patient with Autoimmune Lymphoproliferative Syndrome and Lymphoma
Authors: Rita Clementi, Lorenzo Dagna, Umberto Dianzani, Loïc Dupré, Irma Dianzani, Maurilio Ponzoni, Angela Cometa, Annalisa Chiocchetti, Maria Grazia Sabbadini, Claudio Rugarli, Fabio Ciceri, Rita Maccario, Franco Locatelli, Cesare Danesino, Marina Ferrarini, Marco Bregni
Journal: New England Journal of Medicine (2004)

A 27-year-old man with the autoimmune lymphoproliferative syndrome and a large-B-cell lymphoma had heterozygous mutations in the Fas and perforin (Prf1) genes. The Fas mutation was inherited from his healthy father and was also carried by his healthy brother, whereas the Prf1 mutation was inherited from his healthy mother. The combined effect of the two mutant genes may have contributed to the development of the autoimmune lymphoproliferative syndrome and lymphoma in this patient.
Shorter durations and lower doses of peginterferon alfa-2a are associated with inferior hepatitis B e antigen seroconversion rates in hepatitis B virus genotypes B or C
Authors: Y.-F. Liaw, J.-D. Jia, H. L.Y. Chan, K. H. Han, T. Tanwandee, W. L. Chuang, D. M. Tan, X. Y. Chen, E. Gane, T. Piratvisuth, L. Chen, Q. Xie, J. J.Y. Sung, C. Wat, C. Bernaards, Y. Cui, P. Marcellin
Journal: Hepatology (2011)

As there is currently a lack of consensus on the most appropriate dose and duration of peginterferon alfa-2a (PEG-IFNα-2a) therapy in hepatitis B e antigen (HBeAg)-positive patients, the efficacy and safety of either 24 or 48 weeks' duration and 90 μg/week or 180 μg/week doses were compared. HBeAg-positive patients (n = 544; 34% genotype B, 51% genotype C) were randomized to receive PEG-IFNα-2a (2 × 2 factorial design) for 24 or 48 weeks and at 90 μg/week or 180 μg/week and included in the per-protocol population. The primary efficacy endpoint of the noninferiority study was HBeAg seroconversion 6 months posttreatment. The prespecified odds ratio (OR) noninferiority margin was 1.88 with a one-sided significance level of 0.025. The highest rates of HBeAg seroconversion 6 months posttreatment were in the 180/48 arm (36.2% versus 14.1%-25.8% in the other arms). When the dose and duration arms were pooled, the OR for noninferiority of 24 weeks versus 48 weeks was 2.17 (95% confidence interval [CI] 1.43, 3.31; P = 0.749) and for 90 μg versus 180 μg was 1.79 (95% CI 1.18, 2.72; P = 0.410). As the upper limit of the 95% CI of the ORs were &gt;1.88, 24 weeks were inferior to 48 weeks and 90 μg/week was inferior to 180 μg/week. The highest rates of response in the 180/48 arm were achieved by patients with HBsAg &lt;1,500 IU/mL at Week 12 (58%) or Week 24 (57%), whereas patients with HBsAg &gt;20,000 IU/mL did not respond. Adverse events were typical of those associated with PEG-IFNα-2a. Conclusion: Compared with lower doses and shorter durations, the licensed PEG-IFNα-2a treatment regimen (180μg/48 weeks) was the most efficacious and beneficial for HBeAg-positive patients predominantly infected with hepatitis B virus genotypes B or C. (Hepatology 2011;)
Annual Review of Microbiology, Volume 40.
Authors: C. E. Clifton, S. Raffel, M. P. Starr
Journal: Annals of Internal Medicine (1987)

In this volume the custom of publishing critical reviews of the current literature is continued. The virologist will find excellent summaries on the developmental stages of viruses, the biochemical aspects of viral growth, and the ecology of mosquitoborne viruses. In addition, a chapter on viral and rickettsial toxins is included. Of interest to the parasitologist are discussions on amebiasis, the morphology of protozoa, and the metabolism, nutrition, and chemotherapy of helminths. The subject of medical mycology is introduced here for the first time. The soil as an important reservoir of pathogenic fungi and the correlation between climatological conditions and the incidence of fungous infections are among the topics discussed. In the field of bacteriology, reviews on the following subjects are presented: acid-fast bacteria, genetics of micro-organisms, biological nitrogen fixation, food poisoning, and the microbiology of water and sewage. The production of antibiotics, alcohols, organic acids, vitamins, bacterial polysaccharides, and enzymes
Scintigraphic Localization of the Bleeding Site of a Large Retroperitoneal Hematoma Following Renal Angioplasty
Authors: LAWRENCE C. SWAYNE, DANIEL P. PETERSON, CHRISTOPH POHL
Journal: Clinical Nuclear Medicine (1994)

Although the scintigraphic detection of a few soft tissue hematomas have been reported, these usually have been serendipitous discoveries that were small and selflimited. The authors report a case of a large, rapidly expanding retroperitoneal hematoma that occurred following a left renal angioplasty. While the hematoma was initially detected by CT imaging, the precise source of the bleeding could not be definitively localized. Scintigraphy with labeled RBC cells, however, identified the left femoral artery puncture site as the bleeding source, which was subsequently surgically repaired.
Abstract 3554: CCT137690, a dual inhibitor of Aurora and FLT3 kinases, sensitizes FLT3-ITD positive acute myeloid leukemia and overcomes resistance to selective FLT3-inhibition
Authors: Andrew S. Moore, Amir Faisal, Vassilios Bavetsias, Chongbo Sun, Butrus Atrash, Melanie Valenti, Alexis de Haven Brandon, Sian Avery, David Gonzalez de Castro, Florence I. Raynaud, Paul Workman, Andrew DJ Pearson, Julian Blagg, Suzanne A. Eccles, Spiros Linardopoulos
Journal: Cancer Research (2011)

Abstract The Aurora kinases are a family of serine-threonine kinases that play key roles in different stages of mitosis. Over-expression of Aurora kinases has been demonstrated in a range of malignancies including leukemia. Aurora kinase inhibitors are emerging as promising agents in the treatment of acute myeloid leukemia (AML) with a number of compounds currently being assessed in clinical trials (Moore AS et al, Leukemia 2010). CCT137690, an imidazo[4,5-b]pyridine derivative discovered at our Institute, is an orally bioavailable, potent, pan-Aurora and FLT3 inhibitor. CCT137690 showed in vitro and in vivo activity in human colon cancer cell lines and xenograft models (Bavetsias V et al, J Med Chem 2010). Here we report the in vitro and in vivo activity of CCT137690 in FLT3-ITD positive AML and demonstrate that CCT137690 overcomes resistance to the selective FLT3 inhibitor MLN518. In cellular assays using FLT3-ITD positive MOLM-13 cells, CCT137690 inhibits autophosphorylation of Aurora A and Aurora B kinases and phosphorylation of histone H3, a direct target of Aurora B kinase. CCT137690 also inhibits autophosphorylation of FLT3 and its downstream targets phospho-STAT5 and phospho-p44/42 MAPK. Dual inhibition of Aurora and FLT3 kinases in FLT3-ITD positive AML with CCT137690 induces apoptosis and results in a unique cell cycle profile with cells accumulating in G2/M. When given orally to athymic mice, CCT137690 achieved target modulation and potently inhibited the growth of subcutaneous MOLM-13 xenografts, with no obvious toxicity or loss of body weight. Inhibition of MOLM-13 xenograft growth was more pronounced with CCT137690 compared to the selective FLT3 inhibitor MLN518, suggesting that dual inhibition of Aurora and FLT3 kinases may have advantages compared to selective FLT3 inhibition alone. To assess whether dual Aurora-FLT3 inhibition with CCT137690 could overcome FLT3-inhibitor resistance, we successfully cultured MOLM-13 cells in the presence of increasing concentrations of MLN518. Although resistant to MLN518, these cells maintained sensitivity to dual Aurora-FLT3 inhibition with CCT137690. The potent preclinical activity of CCT137690 in FLT3-ITD positive AML models supports the growing body of evidence that dual pan-Aurora and FLT3 kinase inhibitors may be of benefit in the high-risk group of patients with FLT3-ITD positive AML, including those with FLT3-inhibitor resistance. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3554. doi:10.1158/1538-7445.AM2011-3554
The Gheel experience. Eternal spirit of the chainless mind!
Authors: C. D. Aring
Journal: JAMA (1974)

PROBLEMS in the wake of state mental hospital closings were touched on in a recent COMMENTARY. The release of these patients to communities not prepared to receive them has engendered anxiety, and not merely because the citizenry is unfamiliar with untoward behavior. Towns in the immediate vicinity of these hospitals have been particularly affected. The expatients seem to relish their newfound freedom, although they have been doing little besides aimlessly walking about and accordingly have been dubbed, walkers. Besides the uneasiness they engender, it is claimed that these newly released patients are straining the public services. They are being given little care, and efforts at their rehabilitation have been desultory, to say the least. This is nothing new, but as the walls are tumbling down, the time is rather late.  In light of a development that can be regarded as progressive, it may be useful to outline the experience in