tbuckley/cabot-search huggingface dataset:
Diuretics and coronary heart disease
Authors: M. Moser
Journal: JAMA (1985)

<h3>In Reply.—</h3> We could not agree more with Drs Moser and Gifford. The reported adverse effect of diuretics for the treatment of mild hypertension in patients with certain minorECG abnormalities needs to be viewed with caution. We also agree that all adequately designed hypertension studies using diuretics have shown a reduction in morbidity and mortality from pressure complications such as stroke, but not from CHD, and that is just the point. The Hypertension Detection and Follow-up Program study<sup>1</sup>that is mentioned cannot help to solve this question because of its lack of an untreated control group. In the Australian study<sup>2</sup>which we believe is the best designed randomized trial in mild hypertension, no beneficial effect of thiazides on the incidence of acute myocardial infarction could be demonstrated: 33 cases of acute myocardial infection were observed in each group. Vague indications of a possible adverse effect on CHD
Murder in the NHS
Authors: W J Appleyard
Journal: BMJ (1994)

Individuals and organisations cannot plan for the truly extraordinary. When a once in a millennium event occurs there is a high chance that people will react badly and make mistakes. The deliberate killing and injuring of children in a British hospital by nurse Beverley Allitt was just such an event,1 and many mistakes have been made in the aftermath.

But for the diligence of the two consultant paediatricians, Drs Nelson Porter and Charith Nanayakkara, at Grantham and Kesteven Hospital Beverley Allitt would probably not have been convicted of murder. Now, however, nine months after she was convicted of killing four children and injuring nine more in the children's ward of Grantham and Kesteven Hospital,1 the two consultants are without their jobs. They also fear criticism from the Clothier inquiry, set up by the secretary of state for health into the circumstances of the murders and due to report next week. The consultants have not had a chance to defend themselves in public. Because of the decision to hold the Clothier inquiry in private, health service employees and the public cannot be sure that all the lessons that might have been learnt will be learnt. And, worst of all, services for children in Grantham have been diminished.

In an environment such as a children's ward, …
Quantitation of immunocompetence in Hodgkin's disease.
Authors: G B Faguet
Journal: Journal of Clinical Investigation (1975)

In vitro cellular immunocompetence was investigated on 35 patients with Hodgkin's disease by studying their in vitro lymphocyte responsiveness to full range stimulation achieved by a spectrum of phytohemagglutinin concentrations. When compared to the normal lymphocyte profile elicited from 35 control subjects, the Hodgkin's patterns of response enabled the identification of a quantifiable lymphocyte defect present in most patients regardless of their clinical status. Increasing severity of this defect was found with progression of the disease and was most pronounced in patients with skin anergy and absolute lymphopenia. The marked abnormality observed in patients restudied after intensive therapy returned towards normal in patients achieving a long lasting, unmaintained complete remission. The data suggest the early presence of an intrinsic functional lymphocyte defect, increasing severity of which may lead to progressive immunoincompetence, reflected to vitro by imparied lymphocyte responsiveness and in vivo by skin anergy and ultimately lymphopenia.
946 PK-PD MODELING OF VIRAL KINETICS DURING TREATMENT WITH DEBIO-025 PLUS PEGYLATED INTERFERON ALPHA-2A IN TREATMENT-NAIVE HCV PATIENTS
Authors: E. Herrmann, A. Käfer, R. Flisiak, V. Nicolas-Métral, S. Zeuzem, R. Crabbe
Journal: Journal of Hepatology (2009)
Thomas Henry Flewett
Authors: Dick Madeley, Alasdair Geddes
Journal: BMJ (2007)

Thomas Henry Flewett was born on 29 June 1922 in India, where his father was a member of the Indian Civil Service. He attended Campbell College, Belfast, followed by medical education at Queen's University, Belfast, where he graduated with honours in 1945. He was a founder member (and subsequently fellow) of the Royal College of Pathologists and was elected (by distinction) a fellow of the Royal College of Physicians of London in 1978.

Diarrhoeal diseases, principally caused by viruses, are among the commoner causes of death in infants in tropical countries. Tom Flewett, who died on 12 December 2006, was the first to name one of the most frequent causes, rotaviruses, during the course of his seminal research into the causes of gastroenteritis.

In 1956 Tom was appointed consultant virologist to East Birmingham Hospital, where he established, and became director of, one of the first regional virus laboratories in England, serving a population of more than five …
Lumbar puncture should not be delayed in subarachnoid haemorrhage
Authors: C. J Gerber, P. Crawford, A D Mendelow, A. Gholkar, R P Sengupta
Journal: BMJ (1998)

EDITOR—Wasserberg and Barlow's article is a timely reminder of the important position that lumbar puncture still has in diagnosing subarachnoid haemorrhage.1 Although we endorse their general conclusions, we disagree about the timing of lumbar puncture after subarachnoid haemorrhage.

The authors suggest that lumbar puncture …
Laparoscopic Histopathological Analysis of “Gentle Undulation” Findings observed in Patients with Primary Biliary Cirrhosis
Authors: M. Onji, Y. Yamashita, T. Kato, H. Kondo, H. Bandou, N. Horiike, Y. Ohta
Journal: Endoscopy (1987)

Laparoscopic findings of the liver in 13 cases with primary biliary cirrhosis (PBC) diagnosed by wedge or needle biopsy were investigated. The characteristic features of laparoscopic appearance--gentle undulation--were observed in 11 out of 13 (85%) patients with PBC. These gentle undulations were irregularly shaped areas from 0.5 to 3 cm in diameter. Those observed in s-PBC were greater in number and more pronounced than those in a-PBC. In the concave areas of these undulations, the number of portal tracts was significantly greater than in the convex areas (p less than 0.005). On the contrary, the number of interlobular bile ducts in the concave area was significantly less than in the convex area (p less than 0.005). Therefore, gentle undulation was relatively specific to PBC, and was caused by scar formation and chronic non-suppurative destructive cholangitis in the portal area.
Lack of involvement of thromboxane A2 in postischemic recovery of stunned canine myocardium.
Authors: N E Farber, G M Pieper, G J Gross
Journal: Circulation (1988)

Modification of the thromboxane: prostacyclin ratio alters the severity of reperfusion arrhythmias and postischemic damage in long-term, irreversibly injured myocardium. In this study, the effects of the thromboxane synthetase inhibitor dazmegrel and the thromboxane receptor antagonist BM 13.505 on myocardial postischemic functional recovery and preservation of tissue adenine nucleotides was examined after a 15-minute episode of ischemia followed by 3 hours of reperfusion (myocardial stunning). Dazmegrel (3 or 8 mg/kg) or BM 13.505 (10 mg/kg) was given 15 minutes before coronary occlusion and compared with a control group in barbital-anesthetized dogs. Regional segment shortening (percent segment shortening, sonomicrometry), regional myocardial blood flow (microspheres), and coronary venous eicosanoid and high-energy phosphate levels (biopsies after 3 hours of reperfusion) were measured. Areas at risk, regional myocardial blood flow, and regional segment shortening during coronary occlusion were similar in all groups. Dazmegrel (3 mg/kg) attenuated the decrease in endocardial and midmyocardial adenosine 5'-triphosphate, and both doses significantly improved regional segment shortening during reperfusion. Coronary venous thromboxane levels were significantly decreased throughout the experiment in both dazmegrel-treated groups, and thromboxane levels were significantly elevated in the control group 3 hours after reperfusion. Prostacyclin, measured in the form of its main metabolite, 6-keto-prostaglandin F1 alpha, did not change significantly in the control group throughout the experiment, but it was markedly increased in dazmegrel groups throughout reperfusion, particularly in the dazmegrel group receiving 3 mg/kg. BM 13.505 exerted no beneficial effects on postischemic function or metabolism. In conclusion, after a reversible ischemic insult, postischemic recovery of function and metabolic status was not enhanced by preocclusion treatment with a thromboxane receptor blocker, and thus, the beneficial effects of thromboxane synthesis inhibition on postischemic abnormalities was not due to a reduction in thromboxane but was the result of endoperoxide shunting and a subsequent increase in prostacyclin. Therefore, thromboxane does not appear to be an important mediator of reversible ischemia-reperfusion damage.
Week 48 resistance surveillance in two phase 3 clinical studies of adefovir dipivoxil for chronic hepatitis B
Authors: Christopher E. Westland, Huiling Yang, William E. Delaney, Craig S. Gibbs, Michael D. Miller, Michael Wulfsohn, John Fry, Carol L. Brosgart, Shelly Xiong
Journal: Hepatology (2003)

Seven hundred nucleoside treatment–naive patients were enrolled in two phase 3 trials of adefovir dipivoxil (ADV) for the treatment of chronic hepatitis B. To monitor for the emergence of potential adefovir resistance mutations over the first 48 weeks, all intent–to–treat patients (467 ADV–treated and 228 placebo patients) were included in a prospectively defined, treatment–blinded, virology substudy. The study protocol mandated genotypic analysis for all patients with detectable hepatitis B virus (HBV) DNA by Roche Amplicor polymerase chain reaction (PCR) at baseline and week 48, and in vitro phenotypic analyses for patients with conserved site substitutions in HBV polymerase or 1.0 log 10 or greater increase in HBV DNA from nadir. Paired sequences of the entire HBV reverse transcriptase were obtained for 271 ADV–treated and 227 placebo patients by using a sequencing method that detects down to 30% of minor species present within mixtures. Four substitutions (rtS119A, rtH133L, rtV214A, and rtH234Q) developed once each at conserved sites in HBV polymerase in 4 ADV–treated patients. Seven conserved site substitutions developed in 6 placebo patients. HBV mutants encoding the 4 substitutions that emerged in ADV–treated patients remained fully susceptible to adefovir in vitro . Furthermore, these 4 ADV–treated patients had HBV–DNA reductions of 3.3 to 5.9 log 10 copies/mL by week 48 with no rebound. All other substitutions occurred at very low frequencies (&lt;1.6%) at polymorphic sites and were not associated with HBV–DNA increases in patients or adefovir resistance in vitro . In conclusion, no adefovir resistance mutations were identified in a large group of chronic hepatitis B patients treated with ADV for 48 weeks.
Significance of Paroxysmal Atrial Fibrillation Complicating Acute Myocardial Infarction in the Thrombolytic Era
Authors: Michael Eldar, Menachem Canetti, Zeev Rotstein, Valentina Boyko, Shmuel Gottlieb, Elieser Kaplinsky, Solomon Behar
Journal: Circulation (1998)

Background —Paroxysmal atrial fibrillation (PAF) is considered a frequent complication of acute myocardial infarction (AMI), associated with increased in-hospital and long-term mortality rates. This notion is based on data collected before thrombolysis and additional modern methods of treatment became widely available, and no information is available on the significance of PAF in the general population with AMI in the thrombolytic era. The aim of the present study was to define the incidence, associated clinical parameters, and short- and long-term prognostic significance of PAF in patients with AMI in the thrombolytic era. Methods and Results —A prospective, nationwide survey was conducted of 2866 consecutive patients admitted with AMI in all 25 coronary care units in Israel during January/February 1992, 1994, and 1996 (thrombolytic era [TE]). The data were compared with a previous Israeli study of 5803 patients with AMI hospitalized in 1981 through 1983 (prethrombolytic era [PTE]). Patients in the TE with PAF were older and had a worse risk profile than those without PAF. PAF in the TE was independently associated with increased 30-day (odds ratio, 1.32; 95% confidence interval, 0.92 to 1.87) and 1-year (relative risk, 1.33; 95% confidence interval, 1.05 to 1.68) mortality rates. The incidence of PAF (8.9% and 9.9%) and the 30-day (25.1% and 27.6%) and 1-year (38.4% and 42.5%) mortality rates of patients with PAF were similar in the TE and PTE, although PAF in the TE occurred in older and sicker patients than those in the PTE. After adjustment for conventional risk factors, PAF was associated with significantly lower 30-day (odds ratio, 0.64; 95% confidence interval, 0.44 to 0.94) and 1-year (relative risk, 0.69; 95% confidence interval, 0.54 to 0.88) mortality rates compared with the PTE. Conclusions —Patients with AMI who develop PAF in the TE have significantly worse short- and long-term prognoses than patients without PAF, mostly due to their worse risk profile. After adjustment for confounding factors, patients with PAF in the TE have a better overall outcome than counterparts in the PTE, probably reflecting the better management of patients with AMI in the TE.
Functional T Cell Immunodeficiencies (with T Cells Present)
Authors: Luigi D. Notarangelo
Journal: Annual Review of Immunology (2013)

Severe combined immunodeficiency (SCID) comprises a group of disorders that are fatal owing to genetic defects that abrogate T cell development. Numerous related defects have recently been identified that allow T cell development but that compromise T cell function by affecting proximal or distal steps in intracellular signaling. These functional T cell immunodeficiencies are characterized by immune dysregulation and increased risk of malignancies, in addition to infections. The study of patients with these rare conditions, and of corresponding animal models, illustrates the importance of intracellular signaling to maintain T cell homeostasis.
Scientific Basis of Transfusion Medicine: Implications for Clinical Practice
Authors: Ruth Andrea Seeler
Journal: JAMA (1995)

A new classic textbook has arrived, and it is a must-own for all who work in hematology, oncology, pathology, and blood banking—fellows and faculty with adult or pediatric expertise. Anyone interested in any aspect of fluid blood will find this volume to be an encyclopedia of current knowledge and speculation for future research. Each section was written by the experts with a completeness of detail that is unusual for many modern textbooks. In many ways this is more a hematology-immunology text than a blood-banking manual. Throughout, the graphics are of such quality and reflect such clarity of thought that this reviewer predicts they will start to appear as slides in lectures given by the book's users. Certainly the little anchor silhouette to represent the anchoring protein<i>ankyrin</i>on page 178 and the facial expressions on the pathogen in the diagram on page 225 will make vivid and memorable points. Although
Benign and Malignant Tumors And Tumor-Like Conditions of Fibrous Tissue
Authors: T. K. D. Gupta, R. D. Brasfield
Journal: CA A Cancer Journal for Clinicians (1969)

Althoughthe term fibroblastic tu mors should be restricted to growths composed of fibers derived from true fibrocytes, excluding all fibrous growths derived from other types of cells acting as facultative fibroblasts, this distinc tion may be difficult, as pointed out by Stout and Lattes, and, furthermore, is not always essential for treating a tu mor of the soft somatic tissue.1 Gen erally, tumors of fibrous tissue origin may be classified clinically as follows:
Effect of sublingual nitroglycerin on regional flow in patients with and without coronary disease.
Authors: J Mehta, C J Pepine
Journal: Circulation (1978)

We evaluated the effects of sublingual nitroglycerin on indices of regional coronary flow and coronary resistance (CR) in 12 selected patients with coronary artery disease (CAD) and eight with normal coronary arteries (NCA), using continuous thermodilution. Resting total left ventricular flow, reflected by coronary sinus flow (CSF), and anterior regional flow, reflected by great cardiac vein flow (GCVF), in NCA and CAD patient groups, were similar. However, in a subgroup of six patients, with CAD limited to the anterior descending artery, GCVF was lower and anterior regional CR (CRANT) higher than the NCA subjects. Nitroglycerin reduced the systolic pressure-heart rate product similarly in both patient groups. CSF and GCVF in NCA subjects declined 15% and 17%, respectively, as total CR (CRT) and CRANT increased. In the CAD subgroup, consisting of patients with CAD limited to the anterior descending, GCVF increased 48% as CRANT declined 50%, and CSF was unchanged. In the other CAD subgroup of patients with CAD in the right and/or circumflex arteries, GCVF declined 32% and CRANT increased 46% as CSF was minimally increased. These data imply that sublingual nitroglycerin reduces both CSF and GCVF in NCA patients as oxygen demands decrease. In certain CAD patients, however, nitroglycerin alters regional coronary venous blood flow, suggesting a redistribution of flow from normally perfused to hypoperfused regions.
Clinical significance of serum p53 antigen in patients with pancreatic carcinomas.
Authors: H Suwa, G Ohshio, N Okada, Z Wang, M Fukumoto, T Imamura, M Imamura
Journal: Gut (1997)

<h3>Objective</h3> This study aimed to examine the prevalence and determinants of benzodiazepine prescription among older adults in Switzerland, and analyse association with hospitalisation and costs. <h3>Design</h3> Retrospective analysis of claims data. <h3>Setting</h3> The study was conducted in nine cantons in Switzerland. <h3>Participants</h3> Older adults aged 65 years and older enrolled with a large Swiss health insurance company participated in the study. <h3>Primary and secondary outcome measures</h3> The primary outcome was prevalence of benzodiazepine prescription. The secondary outcomes were (1) determinants of any benzodiazepine prescription; (2) the association between any prescription and the probability of hospitalisation for trauma and (3) the association between any prescription and total healthcare expenditures. <h3>Results</h3> Overall, 69 005 individuals were included in the study. Approximately 20% of participants had at least one benzodiazepine prescription in 2017. Prescription prevalence increased with age (65–69: 15.9%; 70–74: 18.4%; 75–80: 22.5%; &gt;80: 25.8%) and was higher in women (25.1%) compared with men (14.6%). Enrollees with the highest deductible of Swiss Francs (CHF) 2500 were 70% less likely to receive a prescription than enrollees with the lowest deductible of CHF 300 (adjusted OR=0.29, 95% CI 0.24 to 0.35). Individuals with at least one prescription had a higher probability of hospitalisation for trauma (OR=1.31, 95% CI 1. 20 to 1.1.44), and 70% higher health care expenditures (β=0.72, 95% CI 0. 67 to 0.77). Enrollees in canton Valais were three times more likely to receive a prescription compared to enrollees from canton Aargau (OR=2.84, 95% 2.51 to 3.21). <h3>Conclusions</h3> The proportion of older adults with at least one benzodiazepine prescription is high, as found in the data of one large Swiss health insurance company. These enrollees are more likely to be hospitalised for trauma and have higher healthcare expenditures. Important differences in prescription prevalence across cantons were observed, suggesting potential overuse. Further research is needed to understand the drivers of variation, prescription patterns across providers, and trends over time.
New interim guidance on assisted suicide
Authors: R. Huxtable, K. Forbes
Journal: BMJ (2009)

Doctors need more help on how to keep within the law 

At the insistence of the House of Lords, in its final judgment before reconvening as the Supreme Court,1 the director of public prosecutions has issued interim guidance on prosecution policy in cases of assisted suicide that seem to fall foul of English law.2 Clarity is undoubtedly important here,3 yet the policy prompts serious questions, not least for medical professionals looking to navigate a course within the boundaries of responsible (and demonstrably lawful) practice.

The problems begin with the purpose (and audience) of the policy. Strictly speaking, it is a tool for retrospective use by prosecutors—it is not meant to provide tips for the potential assistant in suicide. The policy therefore differs from proposals for legalising assisted suicide, and this is not the only difference. Such proposals typically clarify the types of activity that would (not) be permitted.4 But the circumstances in which the prosecution policy might apply are less clear. The policy is certainly capable of encompassing a wide range of behaviours and actors, from the cell mate who encourages suicide, to the loved one or doctor who “provides the pills,” knowing how they might be used.5 Yet uncertainty surrounds some of the other activities in which medical personnel might be involved or implicated.

“Assisted suicide tourism” is particularly problematic.6 …
Editorial: Interferon‐γ: Friend or Foe in Systemic Juvenile Idiopathic Arthritis and Adult‐Onset Still's Disease?
Authors: Scott W. Canna
Journal: Arthritis & Rheumatology (2014)

We may know just enough about cytokines in autoinflammatory diseases to be dangerous. Insights from animal models and cell lines, observations from patient samples, and outcomes of directed cytokine modulating treatments constantly refine this understanding, while also unearthing deeper layers of complexity. The recent advances in our understanding of systemic autoinflammatory disorders have brought the interaction of basic cytokine biology and patient care to the fore.
Leukocyte Scanning With 111In Is Superior to Magnetic Resonance Imaging in Diagnosis of Clinically Unsuspected Osteomyelitis in Diabetic Foot Ulcers
Authors: Lisa G Newman, John Waller, Christopher J Palestro, George Hermann, Michael J Klein, Myron Schwartz, Elizabeth Harrington, Martin Harrington, Sheila H Roman, Alex Stagnaro-Green
Journal: Diabetes Care (1992)

To compare the accuracies of MRI and leukocyte scanning in diagnosing clinically unsuspected osteomyelitis in diabetic foot ulcers.A prospective study of 16 diabetic foot ulcers in 12 patients, including both ambulatory and hospitalized patients, was performed at a university medical center. Pedal images were obtained by leukocyte scanning with [111In]oxyquinoline and MRI. Definitive diagnosis of osteomyelitis then was determined by bone biopsy for culture and histology.Biopsy-proven osteomyelitis was present in 7 (44%) of the 16 foot ulcers. The diagnosis was suspected clinically in 0%. Leukocyte scanning was 100% sensitive, whereas MRI was only 29% sensitive in diagnosing osteomyelitis in diabetic foot ulcers. Specificities were 67 and 78%, respectively. The positive and negative predictive values (70 and 100%, respectively) for the leukocyte scan also were greater than those of MRI (50 and 58%, respectively).Leukocyte scanning is superior to MRI in detecting clinically unsuspected osteomyelitis in diabetic foot ulcers.