tbuckley/cabot-search huggingface dataset:
Thymoma, myasthenia gravis, eruptions of pemphigus vulgaris and a favourable course of relapsing melanoma: an immunological puzzle
Authors: S. Meyer, M. Kroiss, M. Landthaler, T. Vogt
Journal: British Journal of Dermatology (2006)

Conflicts of interest: none declared. Sir, The paraneoplastic appearance of pemphigus vegetans, pemphigus vulgaris (PV), pemphigus foliaceus and pemphigus erythematosus with thymoma and/or myasthenia gravis is well documented.1, 2 However, cases of pemphigus associated with malignant melanoma (MM) are very unusual. We report a woman with a history of thymoma/myasthenia gravis who had recurring episodes of PV triggered by local relapses of the MM with an otherwise remarkably favourable course. A 57‐year‐old white woman was referred to our outpatient clinic for excision of an acral lentiginous MM on the sole of the left foot with a 2‐cm safety margin (Clark level IV, Breslow thickness 1·2 mm, pT2). The excision site was grafted and further staging was performed (N0, M0). Apart from this, physical examination revealed areas of figurate erythema resembling ‘timber grain’ on the trunk and blisters in the centre of those areas. Oral manifestations were not found. There was no history of medical problems or drugs which may have caused a bullous drug reaction. Histology of a corresponding skin specimen revealed intraepithelial blistering with acantholysis and focal eosinophilic spongiosis. The upper dermis was infiltrated by lymphocytes and eosinophils. Direct immunofluorescence revealed intercellular deposition of IgG; indirect immunofluorescence was positive for pemphigus antibodies on monkey oesophagus, but negative on rat bladder. Immunoblotting did not show the specific autoantibody spectrum of paraneoplastic pemphigus such as antibodies to desmoplakin 1 (250 kDa), bullous pemphigoid antigen 1 (230 kDa), envoplakin and desmoplakin 2 (210 kDa) and periplakin (190 kDa).2 Instead, autoantibodies against desmoglein 1 and 3 were detected, indicating PV. In addition, due to muscle weakness and a high titre of antiacetylcholine receptor (AChR) antibodies thoracic computed tomographic (CT) scans were performed and a mediastinal tumour bioptically classified as benign mixed‐type thymoma was diagnosed.
Increased occurrence of left ventricular thrombi during early treatment with timolol in patients with acute myocardial infarction.
Authors: K A Johannessen, J E Nordrehaug, G von der Lippe
Journal: Circulation (1987)

To examine whether early intervention with timolol influences the occurrence of left ventricular thrombi in acute anterior myocardial infarction, 40 patients with acute anterior myocardial infarction admitted to hospital within 6 hr of onset of symptoms were randomly assigned to receive intravenous followed by oral timolol maleate or placebo. Five (25%) of 20 patients in the placebo group and 14 (73.7%) of 19 patients with confirmed infarction in the timolol group developed a left ventricular apical thrombus as detected by two-dimensional echocardiography from 2 to 10 days after inclusion (p less than .005). Patients received anticoagulants only after a left ventricular thrombus had been diagnosed. Only one patient with thrombus suffered peripheral embolization (timolol group). The treatment groups were comparable with respect to location of regional left ventricular dysfunction, electrocardiographic changes, and infarct size estimated by creatine kinase release. However, computer-assisted regional wall motion analysis demonstrated significantly reduced apical wall motion in the timolol group compared with the placebo group (p less than .01). Also, the mean heart rate during the first 10 days after the acute infarction was reduced by 13% in the timolol group (p less than .001). The reduction in heart rate and left ventricular apical wall motion caused by timolol in patients with acute anterior myocardial infarction may increase the occurrence of left ventricular thrombi.
KCl cotransport activity in light versus dense transferrin receptor-positive sickle reticulocytes.
Authors: R S Franco, M Palascak, H Thompson, C H Joiner
Journal: Journal of Clinical Investigation (1995)

A subset of sickle cells becomes K(+)-depleted and dehydrated before or soon after leaving the bone marrow. These young cells may be identified in blood as transferrin receptor-positive (TfR+) dense reticulocytes. KCl cotransport, which is normally active in young erythroid cells with a maximum at pH 6.8, is a candidate pathway for K+ depletion of sickle reticulocytes. In this investigation, KCl cotransport activity was evaluated in young, TfR+ cells which had become dense in vivo and in age-matched cells which had retained normal hydration. Sickle erythrocytes were first separated into three primary density fractions, with care taken to preserve the in vivo hydration state. After normalization of intracellular hemoglobin concentration with nystatin, the cells were incubated at 37 degrees C for 20 min at pH 6.8 and 7.4. Before and after incubation, each primary fraction was separated into four secondary density fractions. The percentage of TfR+ cells in each secondary fraction was measured and a density distribution for TfR+ cells was determined for each primary fraction before and after incubation. The density shift during incubation was a measure of KCl cotransport. TfR+ cells from the denser primary fractions II and III had significantly more density shift than TfR+ cells from the light fraction I. Although the shifts were larger at low pH, differences between primary fractions were also observed at pH 7.4. These data indicate that the cells which become dense quickly in vivo have more KCl cotransport activity than those which remain light in vivo, and support this pathway as a primary mechanism for dehydration of young sickle cells.
Intrauterine devices should be offered to women wanting emergency contraception
Authors: S. Mayor
Journal: BMJ (2012)

Intrauterine devices (IUDs) provide highly effective emergency contraception and should be included in options offered to women who seek help after unprotected intercourse, concludes a systematic review published this week.1

The review found that IUDs had a failure rate of less than one in 1000 and were a more effective form of emergency contraception than the morning-after pill. And IUDs can provide ongoing protection for several years if women choose to have them left in place, making their use very cost effective.

Reviewers analysed 42 studies in which IUDs were used as emergency contraception, where the number of pregnancies was documented and loss to follow-up was clearly defined. IUDs were inserted between two and 10 or more days after …
Relief from Pain in Obstetrics
Authors: M. J. Ellis
Journal: BMJ (1948)

MEDCAL JOUNAAnother point is that I have followed up a number of patients who have suffered from non-pulmonary tuberculosis and who later married, and have found that pregnancies were unusual among them.This difference between patients with phthisis and patients with other forms of tuberculosis offers an interest- ing commentary on the pathogenesis of the disease.-Iam, etc.,
PWE-274 TACE or TAE for treatment of hepatocellular carcinoma?: Abstract PWE-274 Table 1
Authors: P Meredith, K Kohler, C Jeffries-Chung, T-C See, W J Griffiths
Journal: Gut (2012)

<h3>Introduction</h3> Transarterial Chemoembolisation (TACE) and Transarterial Embolisation (TAE) are established treatments for Hepatocellular Carcinoma (HCC) though the superiority of TACE remains uncertain. The aim of this study was to evaluate and compare the efficacy of these modalities. <h3>Methods</h3> Data for all patients undergoing a first course treatment of TACE or TAE at Addenbrooke9s NHS Hospital over a 22-month period were retrospectively reviewed (n=41). All patients had radiologically and/or histologically diagnosed HCC. 23 patients underwent TACE until May 2010 and a change in policy, followed by 18 patients receiving TAE (there were no changes in selection criteria). 11 (27%) patients were bridged to liver transplantation, while 30 (73%) patients were palliative. Outcome measures included radiological response to “treatment” (1–3 TACE or TAE sessions), complications and survival. The fisher exact probability test and unpaired t-test were used for comparisons. <h3>Results</h3> Five patients who did not undergo follow-up imaging were excluded. Overall a radiological response (partial or complete) was seen in 67% of patients. No significant difference was seen between TACE and TAE although there was a trend towards complete response in the TACE group (p=0.24) (Abstract PWE-274 table 1). Although number of lesions did not correlate with radiological response, a non-significant trend was seen in relation to size of largest lesion (median 41 mm with response vs median 33 mm with no response). No patient in the waiting list group developed clinical complications whereas 6 (20%) of the palliative group developed a significant infective complication (p=0.13). Complications appeared more common in those receiving TACE compared with TAE (25% vs 6%, p=0.15). Median survival in palliative patients was 15.1 months (6 deaths with TACE, 3 with TAE). In the waiting list group 8/11 received TAE and 10 have undergone transplant (median wait time 141 days), the remaining patient active 13 months since listing. <h3>Conclusion</h3> This study has demonstrated reasonable efficacy of TAE for the treatment of HCC with minimal complications. There may be a trend towards more complete response with TACE though accompanied by increased complications. Both treatments appear similarly efficacious in prolonging survival which was favourable when compared with historical data.<sup>1</sup> TAE appeared effective in bridging patients to transplant and was well tolerated. <h3>Competing interests</h3> None declared. <h3>Reference</h3> 1. <b>Llovet JM</b>, Ricci S, Mazzaferro P, <i>et al.</i> Sorafenib in advanced hepatocellular carcinoma. <i>N Engl J Med</i> 2008;<b>359</b>:378–90.
A novel mutation of the SLC39A4 gene causing acrodermatitis enteropathica
Authors: S. S Kilic, M. Giraud, S. Schmitt, S. Bézieau, S. Küry
Journal: British Journal of Dermatology (2007)

Conflicts of interest: none declared. Acrodermatitis enteropathica (AE, OMIM 201100) is an autosomal recessive disease characterized by skin findings caused by defective intestinal zinc absorption. The skin lesions include erythema, erosions and small blisters in the perioral and perianal regions, hands and feet, which develop soon after weaning.1 The AE gene has recently been identified as SLC39A4.2 This gene, located on chromosomal region 8q24.3, encodes a novel zinc transporter protein belonging to the ZIP (zinc/iron‐regulated transporter‐like protein) family.3 It was found mutated in several distinct families with AE coming from Europe, North Africa, Japan and the Middle East.4 5–6 We report a 23‐month‐old boy with AE who exhibits a new mutation in exon 11 of the SLC39A4 gene. This is the first report on the screening of SLC39A4 mutations from Turkey. A 23‐month‐old boy, who was born to first‐degree consanguineous parents, presented with vesicular and crusted lesions together with well‐defined, erythematous, moist plaques on perioral, perigenital and perianal regions that he had had since 15 months of age. He had intermittent diarrhoea, recurrent respiratory tract infections and a 2‐month history of irritability. He had been weaned from breast feeding at 8 months of age.
Cadmium Exposure and Cancer Mortality in a Prospective Cohort: The Strong Heart Study
Authors: Esther García-Esquinas, Marina Pollan, Maria Tellez-Plaza, Kevin A. Francesconi, Walter Goessler, Eliseo Guallar, Jason G. Umans, Jeunliang Yeh, Lyle G. Best, Ana Navas-Acien
Journal: Environmental Health Perspectives (2014)

Cadmium (Cd) is a toxic metal classified as a human carcinogen by the International Agency for Research on Cancer.We evaluated the association of long-term Cd exposure, as measured in urine, with cancer mortality in American Indians from Arizona, Oklahoma, and North and South Dakota who participated in the Strong Heart Study during 1989-1991.The Strong Heart Study was a prospective cohort study of 3,792 men and women 45-74 years of age who were followed for up to 20 years. Baseline urinary Cd (U-Cd) was measured using inductively coupled plasma mass spectrometry. We assessed cancer events by annual mortality surveillance.The median (interquintile range) U-Cd concentration was 0.93 (0.55, 1.63) μg/g creatinine. After adjusting for sex, age, smoking status, cigarette pack-years, and body mass index, the adjusted hazard ratios (HRs) comparing the 80th versus the 20th percentiles of U-Cd were 1.30 (95% CI: 1.09, 1.55) for total cancer, 2.27 (95% CI: 1.58, 3.27) for lung cancer, and 2.40 (95% CI: 1.39, 4.17) for pancreatic cancer mortality. For all smoking-related cancers combined, the corresponding HR was 1.56 (95% CI: 1.24, 1.96). Cd was not significantly associated with liver, esophagus and stomach, colon and rectum, breast, prostate, kidney, or lymphatic and hematopoietic cancer mortality. On the basis of mediation analysis, we estimated that the percentage of lung cancer deaths due to tobacco smoking that could be attributed to Cd exposure was 9.0% (95% CI: 2.8, 21.8).Low-to-moderate Cd exposure was prospectively associated with total cancer mortality and with mortality from cancers of the lung and pancreas. The implementation of population-based preventive measures to decrease Cd exposure could contribute to reducing the burden of cancer.
Shall Medical Research Be Regulated?
Authors: Lewis T. Bullock
Journal: JAMA (1963)

To the Editor:  —Those who would restrict medical research today pose a much more serious threat than did the old-time antivivisectionists. Traveling under the banner of humane societies, modern antivivisectionists do not make a direct effort to prevent use of animals in research laboratories. They claim, instead, that they are in favor of medical research but wish merely to stop the sadistic tortures which medical investigators inflict on laboratory animals. Through widespread propaganda and appeals to all animal lovers, they have mobilized strong support for restrictive legislation.  In the last Congress, the Griffiths and Moulder bills were introduced with the sponsorship of the humane societies. These are provisions of the bills controlling research with Federal funds: (1) A certificate of compliance with the act by the laboratory and the investigator would have to be obtained each year before an investigator could obtain any funds for research from the National Institutes
424 RESPIRATORY ALTERATIONS IN GENOTYPE 2/3 CHRONIC HEPATITIS C PATIENTS TREATED WITH PEGYLATED INTERFERON OR ALBINTERFERON-ALFA-2B PLUS RIBAVIRIN IN A RANDOMIZED STUDY
Authors: G. Foster, R. Flisiak, W.-L. Chuang, J. George, J. Rasenack, A. Sood, P. Komolmit, S. Thongsawat, T. Tanwandee, R. Sola, W. Sukeepaisarnjaroen, M. Weltman, Y. Yin, G. Feutren, K. Brown
Journal: Journal of Hepatology (2011)
Thyroid Scintigraphy of Hyperthyroxinemia
Authors: CHARLES M. INTENZO, CHAN H. PARK, SUNG M. KIM
Journal: Clinical Nuclear Medicine (1993)

The term "hyperthyroxinemia" encompasses clinical syndromes associated with elevated levels of thyroid hormone in the presence of increased, normal, or decreased thyroid function. The clinical presentation (i.e., history and physical examination), in vitro thyroid function tests, as well as radioisotope thyroid imaging all play key roles in the diagnosis of the underlying thyroid disorder. Many of these disorders and their appearance on thyroid scintigraphy are presented in this atlas.
Palliation of malignant dysphagia.
Authors: J Payne-James, J J Misiewicz, D Silk
Journal: Gut (1990)

Palliation of malignant dysphagia SIR,-Dr Barr et al are to be congratulated on their work examining the role of laser and laser + intubation in the palliation of malignant dysphagia.'We would agree with their conclu- sion that laser therapy should be restricted to specialist centres, and others have highlighted that, apart from operator expertise, high capital cost is another reason for restricting its availability to designated centres.2So what happens to these patients elsewhere?Dissat- isfaction with intubation as a palliative tech- nique prompted us to examine the role of endoscopic tumour destruction using ethanol injections.This technique of ethanol-induced tumour necrosis (ETN) has recently been described,3 and fulfils the criteria suggested by Cox and Bennett for an ideal palliative technique.4It is quick, safe, painless, needs only a short inpatient stay, and has a low complication rate.The results achieved compared favour- ably with all published results of laser palliation.As with laser, apparent complete occlusion of the lumen does not prevent this technique being used.The cost of ETN is considerably less than that of either laser or intubation as there is no initial capital cost and no maintenance cost.The only treatment cost (apart from that of endoscopy) is that of the ethanol for injection.The technique can be quickly learnt by experienced therapeutic endoscopists.We believe that there is an imperative need to institute a prospective randomised trial of laser therapy v ETN.If results were comparable, one would have to conclude not as Barr et al have stated that 'both techniques [laser and intubation] should be available for the management of patients with malignant dysphagia' but 'first line treatment for palliation of malignant dysphagia is ETN.If this treatment fails treatment by laser or intubation should be considered.'
Doing a combined residency
Authors: M. S. George
Journal: JAMA (1990)

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More research is needed--but what type?
Authors: F. Godlee
Journal: BMJ (2010)

My move from clinical medicine to the BMJ as a junior editor 20 years ago meant learning a host of new rules. The best of them are still part of our every day on the journal. When judging research, we were taught to ask three questions on behalf of the reader: “do I understand it, do I believe it, do I care?” though not always in that order. When editing we were taught to think of the reader not the author. “If in doubt cut it out” may not be a good maxim for surgeons but it’s an excellent one for editors.

Adjectives …
Race-Specific Differences in Endothelial Function
Authors: Leszek Kalinowski, Iwona T. Dobrucki, Tadeusz Malinski
Journal: Circulation (2004)

The prevalence of the endothelium-impaired function disorders, such as hypertension and diabetes mellitus, and the severity of their complications are considerably greater in blacks than whites. Evidence has accumulated that superoxide (O2-) production and its interaction with nitric oxide (NO), yielding the strong oxidant peroxynitrite (ONOO-), play central roles in vascular pathophysiology. We hypothesized that the differences in endothelial NO/O2-/ONOO- metabolism may highlight the potential predisposition to endothelial dysfunction and cardiovascular complications prevalent in blacks.Highly sensitive tandem electrochemical NO/O2-/ONOO- nanosensors were positioned in single human umbilical vein endothelial cells (HUVECs) isolated from blacks and whites, and the kinetics of NO/O2-/ONOO- release were recorded in vitro. HUVECs were also analyzed by Western immunoblotting and enzyme activity assays for NAD(P)H-oxidase and endothelial NO synthase (eNOS). Compared with whites, HUVECs from blacks elicited reduced release of bioactive NO with an accompanying increase in the release of both O2- and ONOO-. The greater potency of NO production because of eNOS upregulation in HUVECs from blacks is associated with a decrease in the NO bioavailability. This is due to increased NO degradation by excess O2- produced primarily by 2 enzymatic sources: NAD(P)H-oxidase and uncoupled eNOS.Compared with whites, the steady-state NO/O2-/ONOO- balance in endothelial cells from blacks is kept closer to the redox states characteristic for the endothelium-impaired function disorders. This may explain the differences in racial predisposition to the endothelium dysfunction during ongoing vascular disturbances with the hallmark of enhanced NO inactivation within the endothelium by oxidative stress.
Uniformity versus Diversity in Medical Care
Authors: John Lister
Journal: New England Journal of Medicine (1977)

ON a recent visit to the United States one of my tasks was to speak about health care in Britain today at a symposium on the wider topic of world health care. While preparing my presentation, I found myself recalling the serious problems that have confronted the National Health Service (NHS) in the last few years, and I realized that many of the political decisions that have greatly changed the character of the health service could be justified in the light of the conditions prevailing at the time they were taken.Thus, the controversial reorganization of the NHS in 1974 . . .