tbuckley/cabot-search huggingface dataset:
Neonatal Abstinence Syndrome and Associated Health Care Expenditures
Authors: Stephen W. Patrick, Robert E. Schumacher, Brian D. Benneyworth, Elizabeth E. Krans, Jennifer M. McAllister, Matthew M. Davis
Journal: JAMA (2012)

Neonatal abstinence syndrome (NAS) is a postnatal drug withdrawal syndrome primarily caused by maternal opiate use. No national estimates are available for the incidence of maternal opiate use at the time of delivery or NAS.To determine the national incidence of NAS and antepartum maternal opiate use and to characterize trends in national health care expenditures associated with NAS between 2000 and 2009.A retrospective, serial, cross-sectional analysis of a nationally representative sample of newborns with NAS. The Kids' Inpatient Database (KID) was used to identify newborns with NAS by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code. The Nationwide Inpatient Sample (NIS) was used to identify mothers using diagnosis related groups for vaginal and cesarean deliveries. Clinical conditions were identified using ICD-9-CM diagnosis codes. NAS and maternal opiate use were described as an annual frequency per 1000 hospital births. Missing hospital charges (<5% of cases) were estimated using multiple imputation. Trends in health care utilization outcomes over time were evaluated using variance-weighted regression. All hospital charges were adjusted for inflation to 2009 US dollars.Incidence of NAS and maternal opiate use, and related hospital charges.The separate years (2000, 2003, 2006, and 2009) of national discharge data included 2920 to 9674 unweighted discharges with NAS and 987 to 4563 unweighted discharges for mothers diagnosed with antepartum opiate use, within data sets including 784,191 to 1.1 million discharges for children (KID) and 816,554 to 879,910 discharges for all ages of delivering mothers (NIS). Between 2000 and 2009, the incidence of NAS among newborns increased from 1.20 (95% CI, 1.04-1.37) to 3.39 (95% CI, 3.12-3.67) per 1000 hospital births per year (P for trend < .001). Antepartum maternal opiate use also increased from 1.19 (95% CI, 1.01-1.35) to 5.63 (95% CI, 4.40-6.71) per 1000 hospital births per year (P for trend < .001). In 2009, newborns with NAS were more likely than all other hospital births to have low birthweight (19.1%; SE, 0.5%; vs 7.0%; SE, 0.2%), have respiratory complications (30.9%; SE, 0.7%; vs 8.9%; SE, 0.1%), and be covered by Medicaid (78.1%; SE, 0.8%; vs 45.5%; SE, 0.7%; all P < .001). Mean hospital charges for discharges with NAS increased from $39,400 (95% CI, $33,400-$45,400) in 2000 to $53,400 (95% CI, $49,000-$57,700) in 2009 (P for trend < .001). By 2009, 77.6% of charges for NAS were attributed to state Medicaid programs.Between 2000 and 2009, a substantial increase in the incidence of NAS and maternal opiate use in the United States was observed, as well as hospital charges related to NAS.
UNUSUAL FOREIGN BODIES IN THE GASTRO-INTESTINAL TRACT
Authors: Jacob Buckstein
Journal: JAMA (1926)

A. M., calling himself "The Count with the Hidden Jewels," by which title he has become known, was accidentally noticed swallowing a tablespoon bent on itself. This led to an examination of the abdomen, with the result seen in the accompanying illustration. In the stomach were present a tablespoon bent on itself, a bed spring, several metal door fixtures and a part of a lock. In the ileocecal region, there was a spring of some sort. In the rectosigmoid area was a conglomeration of nondescript articles. At the end of seven days, the latter articles were evacuated. Those in the stomach and illeocecal region remained. 1 West Eighty-Fifth Street
Is Metformin Cardioprotective?
Authors: Afshin Sasali, Jack L. Leahy
Journal: Diabetes Care (2003)

The study by Johnson et al. (1) in the December 2002 issue of Diabetes Care makes conclusions that in part seem to support the controversial finding of the U.K. Prospective Diabetes Study (UKPDS) that metformin usage as monotherapy was associated with a lower death rate compared with sulfonylureas or insulin (2,3). Such a claim has huge importance to practitioners and patients. Diabetes incidence and costs (the large bulk of which are attributed to type 2 diabetes) are skyrocketing around the world. The increased cardiovascular (CV) risk with diabetes is well recognized (4), and atherosclerotic heart disease, stroke, peripheral vascular disease, and heart failure account in large part for the excess death rate. The decision about what drug to use for monotherapy is currently based on many factors, such as contraindications, side effects, and cost of the available drugs; our wish to minimize weight gain; the patient’s age and accompanying co-illnesses; the practitioner’s familiarity and comfort level with the various drugs; and perhaps most importantly, what drugs are covered by the patient’s insurance. Efficacy does not play much of a role, as there is little solid evidence for any class of drugs being much different than the rest when used as monotherapy (5). However, showing clinically relevant CV benefits for any of the available drugs would move this decision point to the top of the list. It would be hard to be enthusiastic about another drug irrespective of what other advantages it might have.

In their study, Johnson et al. (1) retrospectively surveyed oral agent usage in Saskatchewan from 1 January 1991 to 31 December 1999, looking for “new users,” who were determined based on not having been prescribed an oral hypoglycemic agent in the prior 12 months. The survey used the computerized outpatient prescription drug …
A Novel Mouse with B Cells but Lacking Serum Antibody Reveals an Antibody-independent Role for B Cells in Murine Lupus
Authors: Owen T.M. Chan, Lynn G. Hannum, Ann M. Haberman, Michael P. Madaio, Mark J. Shlomchik
Journal: The Journal of Experimental Medicine (1999)

The precise role of B cells in systemic autoimmunity is incompletely understood. Although B cells are necessary for expression of disease (Chan, O., and M.J. Shlomchik. 1998. J. Immunol. 160:51–59, and Shlomchik, M.J., M.P. Madaio, D. Ni, M. Trounstine, and D. Huszar. 1994. J. Exp. Med. 180:1295–1306), it is unclear whether autoantibody production, antigen presentation, and/or other B cell functions are required for the complete pathologic phenotype. To address this issue, two experimental approaches were used. In the first, the individual contributions of circulating antibodies and B cells were analyzed using MRL/MpJ-Faslpr (MRL/lpr) mice that expressed a mutant transgene encoding surface immunoglobulin (Ig), but which did not permit the secretion of circulating Ig. These mice developed nephritis, characterized by cellular infiltration within the kidney, indicating that B cells themselves, without soluble autoantibody production, exert a pathogenic role. The results indicate that, independent of serum autoantibody, functional B cells expressing surface Ig are essential for disease expression, either by serving as antigen-presenting cells for antigen-specific, autoreactive T cells, or by contributing directly to local inflammation.
Efficacy and Safety of Low Doses of OnabotulinumtoxinA for the Treatment of Refractory Idiopathic Overactive Bladder: A Multicentre, Double-Blind, Randomised, Placebo-Controlled Dose-Ranging Study
Authors: Pierre Denys, Loïc Le Normand, Idir Ghout, Pierre Costa, Emmanuel Chartier-Kastler, Philippe Grise, Jean-François Hermieu, Gérard Amarenco, Gilles Karsenty, Christian Saussine, Frédéric Barbot
Journal: European Urology (2011)
Case 49-1976
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, Grant V. Rodkey, Austin L. Vickery
Journal: New England Journal of Medicine (1976)

Presentation of CaseA 64-year-old man was admitted to the hospital because of hematemesis.There was a 30-year history of hypertension treated with diuretics. Ten years before admission inferior myocardial infarction occurred, followed by anterior myocardial infarction three years later. Fluoroscopic examination showed a hypokinetic area in the anterior wall of the left ventricle. Three years before admission congestive heart failure developed, with atrial fibrillation. Cardioversion restored a normal rhythm but was followed by embolic occlusion of the left femoral artery, which required an embolectomy. Digoxin and warfarin were begun. Thirteen months before entry the patient remained in normal rhythm; . . .
Bowel preparation at home: prospective study of adverse effects in elderly people
Authors: T D Heymann, K Chopra, E Nunn, L Coulter, D Westaby, I M Murray-Lyon
Journal: BMJ (1996)

Table 1-Results (No (%1)) of screening and contact tracing schoolchildren with positive responses to Heaf and Mantoux tests Contacts of children with active No tuberculosis Contacts of Mantoux positive children confirmed No from No with Heaf on Mantoux Previous Indian active Active Mantoux Active Mantoux grade testing BCG subcontinent tuberculosis No tuberculosis positive No tuberculosis positive
Emergencies in Obstetrics and Gynaecology
Authors: P A Driscoll
Journal: BMJ (1995)

Lindsey Stevens, Anthony Kenney Oxford University Press, £16.95, pp 265 ISBN 0 19 262051 7

Presentation to the accident and emergency department with an obstetric or gynaecological complaint is common--the average incidence being around 1 in 20--but is still associated with considerable problems. This is because distinguishing between those underlying conditions that are benign and those that are immediately life threatening can be difficult. The chance of a wrong diagnosis is increased further by busy units, cramped conditions, and inexperience.

It therefore behoves …
GSK lawyer is indicted on charges of obstructing FDA proceeding
Authors: J. H. Tanne
Journal: BMJ (2010)

The US Department of Justice has charged Lauren Stevens, a retired GlaxoSmithKline (GSK) lawyer, in relation to alleged off-label marketing of a drug. She faces one count of obstructing an official proceeding, one count of concealing and falsifying documents to influence a federal agency, and four counts of making false statements to the Food and Drug Administration.

Although drug companies have in the past been charged with off-label marketing of drugs, and several have paid large fines, it is thought that this is the first time an individual has been charged. GSK has not been charged and is not identified in the indictment.

The charges relate to the alleged off-label marketing of the antidepressant bupropion (marketed by GSK as Wellbutrin) for weight loss, and each carries a possible …
Primary Defect in Restrictive Lung Disease
Authors: R. T. ABBOUD
Journal: Annals of Internal Medicine (1977)

Comments and Correction1 February 1977Primary Defect in Restrictive Lung DiseaseR. T. ABBOUD, M.D., F.R.C.P.(C)R. T. ABBOUD, M.D., F.R.C.P.(C)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-86-2-242 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: I read with great interest the case report, "Reversible Restrictive Lung Disease Simulating Asthma" (Ann Intern Med 85:328-332, 1976). The authors suggest two possibilities to explain their findings: marked and variable respiratory muscle weakness or alveolar duct constriction; despite their detailed studies they could not differentiate between the two.Their observation that maximum inspiratory recoil pressure was markedly decreased after exercise (Figure 3 of their paper) suggests that limitation of chest expansion rather than airway closure was the primary cause of the restriction. The authors could have ascertained whether inspiratory muscle weakness was the primary pathogenetic mechanism...References1. BLACK L and HYATT R: Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis 99:696-702, 1969 MedlineGoogle Scholar2. BLACK L and HYATT R: Maximal static respiratory pressures in generalized neuromuscular disease. Am Rev Respir Dis 103:641-750, 1971 MedlineGoogle Scholar1. STUBBS S and HYATT R: Effective increased lung recoil pressure on maximal expiratory flow in normal subjects. J Appl Physiol 32:325-331, 1972 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: R. T. ABBOUD, M.D., F.R.C.P.(C)Affiliations: Respiratory Section Department of Medicine University of British Columbia Vancouver, B.C. V5Z 1M9 Canada PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 February 1977Volume 86, Issue 2Page: 242-243KeywordsAsthmaExerciseLungsMusclesPathogensThorax ePublished: 1 December 2008 Issue Published: 1 February 1977 PDF downloadLoading ...
Excessive Use of Urine Cultures for Inpatients
Authors: HOWARD J. WORMAN
Journal: Annals of Internal Medicine (1987)

Letters and Corrections1 July 1987Excessive Use of Urine Cultures for InpatientsHOWARD J. WORMAN, M.D.HOWARD J. WORMAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-107-1-115 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The utility of certain diagnostic tests has received considerable attention in a recent series of articles in Annals (1). One of these articles examined the urinalysis and urine culture in women with dysuria (2). A major recommendation was that urine culture is of clear value only in patients with acute pyelonephritis or subclinical pyelonephritis (2). The present data show how medical house officers, and even nurses, not familiar with the indications for urine culture can create significant unnecessary costs for hospital patients and thirdparty insurers through the inappropriate use of urine cultures.Admission notes, orders, and laboratory...References1. HUTH E. A new series of papers on diagnostic tests [Editorial]. Ann Intern Med. 1986;104:117. LinkGoogle Scholar2. KOMAROFF A. Urinalysis and urine culture in women with dysuria. Ann Intern Med. 1986;104:212-8. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: HOWARD J. WORMAN, M.D.Affiliations: Cornell University Medical College New York, NY 10021 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEvolving approaches to management of quality in clinical microbiology 1 July 1987Volume 107, Issue 1 Page: 115-116 Keywords Inpatients Pyelonephritis Research laboratories Urine ePublished: 1 December 2008 Issue Published: 1 July 1987 PDF downloadLoading ...
What are the functional deficits produced by hippocampal and perirhinal cortex lesions?
Authors: A. R. Mayes, R. van Eijk, P. A. Gooding, C. L. Isaac, J. S. Holdstock
Journal: Behavioral and Brain Sciences (1999)

A hippocampal patient is described who shows preserved item recognition and simple recognition-based recollection but impaired recall and associative recognition. These data and other evidence suggest that contrary to Aggleton &amp; Brown's target article, Papez circuit damage impairs only complex item-item-context recollection. A patient with perirhinal cortex damage and a delayed global memory deficit, apparently inconsistent with A&amp;B's framework, is also described.
Stretch-elicited Na+/H+ exchanger activation: the autocrine/paracrine loop and its mechanical counterpart
Authors: Horacio Eugenio Cingolani, Néstor Gustavo Pérez, Burket Pieske, Dirk von Lewinski, María Cristina Camilión de Hurtado
Journal: Cardiovascular Research (2003)

The stretch of the cardiac muscle is immediately followed by an increase in the contraction strength after which occurs a slow force increase (SFR) that takes several minutes to fully develop. The SFR was detected in a wide variety of experimental preparations including isolated myocytes, papillary muscles and/or trabeculae, left ventricle strips of failing human myocardium, in vitro isovolumic and in vivo volume-loaded hearts. It was established that the initial increase in force is due to an increase in myofilament Ca2+ responsiveness, whereas the SFR results from an increase in the Ca2+ transient. However, the mechanism(s) for this increase in the Ca2+ transient has remained undefined until the proposal of Na+/H+ exchanger (NHE) activation by stretch. Studies in multicellular cardiac muscle preparations from cat, rabbit, rat and failing human heart have shown evidence that the stretch induces a rise in intracellular Na+ ([Na+]i) through NHE activation, which subsequently leads to an increase in Ca2+ transient via reverse-mode Na+/Ca2+ (NCX) exchange. These experimental data agree with a theoretical ionic model of cardiomyocytes that predicted an increased Na+ influx and a concurrent increase in Ca2+ entry through NCX as the cause of the SFR to muscle stretch. However, there are aspects that await definitive demonstration, and perhaps subjected to species-related differences like the possibility of an autocrine/paracrine loop involving angiotensin II and endothelin as the underlying mechanism for stretch-induced NHE activation leading to the rise in [Na+]i and reverse-mode NCX.
Phase II Trial of Docetaxel and Cisplatin Combination Chemotherapy in Patients With Squamous Cell Carcinoma of the Head and Neck
Authors: Bonnie S. Glisson, Barbara A. Murphy, Gary Frenette, Fadlo R. Khuri, Arlene A. Forastiere
Journal: Journal of Clinical Oncology (2002)

PURPOSE: To assess the antitumor activity and toxicity of docetaxel plus cisplatin chemotherapy in patients with recurrent or incurable squamous cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Patients with recurrent or incurable SCCHN were eligible if they were chemotherapy naive or if they had received one prior regimen as neoadjuvant or concurrent treatment with radiation. Patients who had received chemotherapy for recurrence or prior taxanes were ineligible. Patients received docetaxel 75 mg/m2 and cisplatin 75 mg/m2 on day 1; cycles were repeated every 21 days. RESULTS: Toxic effects and length of survival were assessable in 36 patients and tumor response was assessable in 32, for whom the overall response rate was 40% (13 of 32) (6% complete response and 34% partial response). Median time to response was 5 weeks, and median duration was 4.9 months. In the intent to treat population (n = 36), median time to disease progression was 4 months. Median survival (n = 36) was 9.6 months, and the 12-month survival rate was 27%. Grade 4 neutropenia was observed in 71% of patients. Two patients (6%) experienced serious fever during grade 4 neutropenia (without documented infection) that required intravenous antibiotics, and an additional four patients had grade 3 infection. Other severe (grades 3 and 4) toxic effects were asthenia (25%), nausea (11%), fever (8%), vomiting (8%), severe hypersensitivity reactions (8%), and diarrhea (8%). Severe stomatitis (grade 3) occurred in only one patient. CONCLUSION: Docetaxel plus cisplatin is an effective regimen with an acceptable safety profile for palliation of recurrent SCCHN. Relative to the standard regimen of cisplatin/fluorouracil, this regimen may offer higher tumor response and survival rates with short outpatient administration and a lower incidence of severe mucosal toxicity.
Absence of Junctional Rhythm During Successful Slow-Pathway Ablation in Patients With Atrioventricular Nodal Reentrant Tachycardia
Authors: Ming-Hsiung Hsieh, Shih-Ann Chen, Ching-Tai Tai, Wen-Chung Yu, Yi-Jen Chen, Mau-Song Chang
Journal: Circulation (1998)

Background —The presence of junctional rhythm has been considered to be a sensitive marker of successful slow-pathway ablation. However, in rare cases, junctional rhythm was absent despite multiple radiofrequency applications delivered over a large area in the Koch’s triangle, and successful ablation was achieved in the absence of a junctional rhythm. Methods and Results —This study included 353 patients with AV nodal reentrant tachycardia (143 men and 210 women; mean age, 50±17 years) who underwent catheter ablation of the slow pathway. Combined anatomic and electrogram approaches were used to guide ablation. Inducibility of AV nodal reentrant tachycardia was assessed after each application of radiofrequency energy. Successful sites were located in the posterior area in 18 (90%) of 20 patients without junctional rhythm during slow-pathway ablation compared with 200 (60%) of 333 patients with junctional rhythm ( P &lt;0.001). The fast-slow form of tachycardia was more common in patients without than in those with junctional rhythm (30% versus 3%; P =0.001). At the successful ablation sites, patients with junctional rhythm had a higher incidence of a multicomponent or slow-pathway potential (51% versus 10%; P &lt;0.001), a longer duration of the atrial electrogram (64±8 versus 50±9 ms; P =0.04), and a smaller atrial/ventricular electrogram amplitude ratio (0.29±0.18 versus 0.65±0.27; P &lt;0.001) than those without junctional rhythm. Mean temperatures at successful sites (56±6°C versus 58±9°C; P =0.57) and incidence of transient AV block (2% versus 0%; P =0.86) were similar between patients with and without junctional rhythms. By multivariate analysis, location of ablation sites, atrial/ventricular electrogram amplitude ratio, absence of a multicomponent or slow-pathway potential, and occurrence of the fast-slow form of tachycardia were independent predictors of the absence of a junctional rhythm during successful slow-pathway ablation. Conclusions —In some rare cases, successful slow-pathway ablation is possible in the absence of a junctional rhythm.
Pulmonary disease in polymyositis/dermatomyositis: a clinicopathological analysis of 65 autopsy cases.
Authors: S Lakhanpal, J T Lie, D L Conn, W J Martin
Journal: Annals of the Rheumatic Diseases (1987)

The clinical and autopsy records of 65 patients with either polymyositis (24) or dermatomyositis (41) and pulmonary disease were reviewed. Pulmonary symptoms were recorded in 43 of the cases and included dyspnoea in 31, cough in 23, and chest pain in six. Interstitial lung disease was noted at autopsy in 27 patients; almost half of these had arthritis. Bronchopneumonia was found in 35 patients, 31 of these had received prednisone. Dysphagia was present in a similar proportion of patients with and without pneumonia. Pulmonary vasculitis was seen in five patients; pulmonary symptoms, arthritis, and raised erythrocyte sedimentation rate were present in four of these cases and all five had associated interstitial lung disease. Other pulmonary manifestations included pulmonary oedema, primary pulmonary malignancy, diffuse alveolar damage, fibrinous pleuritis, pulmonary emboli, and diaphragmatic atrophy. The mean survival after disease onset was 29 months but was much less for those with interstitial lung disease and pulmonary vasculitis.
Pituitary-adrenal function after prolonged use of topical corticosteroids
Authors: D. D. MUNRO, D. C. CLIFT
Journal: British Journal of Dermatology (2006)

Forty patients with chronic skin disease who have used potent topical corticosteroids for a prolonged period were studied to determine if adrenal axis suppression had occurred. Thirty‐seven cases (92·5%) were normal when the first test was performed and all were normal when retested. Adrenal axis suppression was therefore not of importance in this group of typical outpatients with chronic skin disease. This is an important finding to put into perspective a theoretical rather than a real complication of topical corticosteroid therapy in adults.
Book Review Deathright: Culture, medicine, politics, and the right to die By James M. Hoefler, with Brian E. Kamoie. 291 pp. Boulder, Colo., Westview Press, 1994. $55 (cloth); $16.95 (paper). 0-8133-1701-0 (cloth); 0-8133-1702-9 (paper).
Authors: Carlos F. Gomez
Journal: New England Journal of Medicine (1995)