tbuckley/cabot-search huggingface dataset:
Doctor's Rights
Authors: M. D. Thomas
Journal: BMJ (1975)

<h3></h3> A 72-year-old man was brought to the hospital after he was found unresponsive at home by his wife who reported that he has been sleepy in the last few days. He has a background of hypertension, myocardial infarct, and osteoarthritis. His medications include anti-hypertensive and morphine sulphate. On examination, he was drowsy with GCS fluctuating between 9–11 but maintaining his airways. He was moving all four limbs; pupils were small and unequal but reactive to light. Planter reflexes were downgoing. Opioid toxicity was suspected and treated with naloxone without any response. The CT head scan showed no acute pathology. He was subsequently started on IV ceftriaxone and acyclovir for possible meningitis and encephalitis. He later had an MRI, which showed restricted diffusion in bilateral paramedian thalami. Artery of Percheron is a rare anatomic variant where a single branch of posterior cerebral artery supplies blood to paramedian thalami and part of rostral midbrain bilaterally. AOP stroke accounts only 0.1% to 2% of all ischemic strokes. The presentation is variable due to the numerous functions relayed through the thalamus. MRI is diagnostic. Due to the non-classic stroke signs/symptoms and the lack of clinical awareness, timely diagnosis of AOP infarct is quite challenging. daniel.jiang77@gmail.com
Bondage, Dominance, Irrigation, and Aeromonas hydrophila: California Dreamin'
Authors: Frank Sorvillo
Journal: JAMA (1989)

<h3>To the Editor.—</h3> Colonic irrigation has been associated with transmission of enteric infections, including amebiasis and shigellosis.<sup>1,2</sup>A large, well-documented outbreak of amebiasis in Colorado linked to colonic irrigation at a chiropractic clinic involved 36 cases with six deaths. We report the isolation of<i>Aeromonas hydrophila</i>from the reservoir of a colonic irrigation machine of the type commonly used by colonic practitioners. The device was seized by Los Angeles Police Department officers during a vice raid of a local sex establishment described as a "bondage and dominance parlor." <h3>Methods.—</h3> Swabs were obtained for bacteriologic cultures from the reservoir, which had approximately 5 mL of liquid remaining, and from the terminal hose of the device. Laboratory procedures were geared toward the recovery of<i>Salmonella, Shigella</i>, and<i>Campylobacter</i>. Samples were inoculated onto<i>Campylobacter</i>cefoperazone/vancomycin/amphotericin B agar and into gramnegative broth, from which several selective and/or differential enteric agars were plated for
A nonfatal case and 2 fatal cases of paraneoplastic pemphigus: Can a complement indirect immunofluorescent test help to identify fatal “group A” paraneoplastic pemphigus cases?
Authors: Ernst H. Beutner, Stephen Pelton, Takashi Hashimoto, Yuelin Xu, Richard W. Plunkett, Neil J. Korman, Thomas N. Helm, Stefania Jablonska
Journal: Journal of the American Academy of Dermatology (2002)
Case of Acute Porphyria
Authors: Q. H. Gibson, D. C. Harrison, D. A. D. Montgomery
Journal: BMJ (1950)

Three years ago a patient with severe abdominal pain and nervous lesions was admitted to hospital.Laboratory investigation established a diagnosis of acute porphyria.A sample of porphyrin was obtained from the urine, but was not subjected to detailed examination at that time.In view of recent interest in this rare condition-e.g., Hare and Wilmore, 1948; Petrie, 1948; Davies, 1949- and particularly in view of the suggestion by Discombe (1948) that cases might be looked for in Northern Ireland, it seemed desirable to investigate this patient in more detail and record our findings. Case ReportThe patient, a girl aged 17, had had attacks of dull cramp-like para-umbilical pain for the previous four to five years.These attacks coincided with the beginning of the menstrual period and usually lasted from 12 to 24 hours.The attacks were stated to have shown a tendency to increase in severity as she got older.They were seldom accompanied by vomiting, but obstinate constipation was a constant feature.The periods were regular, occurring every 21 days and lasting for seven days.About 18 months previously there had been a mild attack of jaundice lasting for three weeks.
Decreased plasma and tissue isoleucine levels after simulated gastrointestinal bleeding by blood gavages in chronic portacaval shunted rats.
Authors: S W Olde Damink, C H Dejong, N E Deutz, P B Soeters
Journal: Gut (1997)

Previously, arterial concentrations of the essential branched chain amino acid isoleucine (Ile) were found to have decreased by more than 50% after gastrointestinal haemorrhage in patients and after intragastric blood administration in healthy humans and pigs. Hypothetically, this induced hypoisoleucinaemia could deplete tissue Ile pools.To study the effect of repeated blood gavages on arterial and tissue Ile levels during normal and impaired liver function.Male Wistar rats.14 days after portacaval shunting or sham surgery, rats received 3 ml bovine erythrocytes or saline at 0, 1, 2, and 3 hours via a gastrostomy catheter in the duodenum. At 0, 2, 4, 6 and 8 hours arterial blood and at 8 hours intestine, liver, muscle, and cerebral cortex were sampled for determination of ammonia and amino acid concentrations.In both groups repeated blood administration resulted in a marked decrease in plasma Ile (40-60%). This was accompanied by decreased tissue Ile concentrations in liver (50%), muscle (40-60%), and cerebral cortex (40-50%), but unaltered intestinal Ile levels. In contrast, the arterial and tissue concentrations of ammonia, urea, and of most amino acids increased, most strikingly of the other two branched chain amino acids, valine and leucine.Simulated gastrointestinal bleeding by blood gavages in rats with and without impaired liver function leads to hypoisoleucinaemia and decreased tissue Ile pools.
Early Intensive vs a Delayed Conservative Simvastatin Strategy in Patients With Acute Coronary Syndromes
Authors: James A. de Lemos, Michael A. Blazing, Stephen D. Wiviott, Eldrin F. Lewis, Keith A. A. Fox, Harvey D. White, Jean-Lucien Rouleau, Terje R. Pedersen, Laura H. Gardner, Robin Mukherjee, Karen E. Ramsey, Joanne Palmisano, David W. Bilheimer, Marc A. Pfeffer, Robert M. Califf, Eugene Braunwald, None for the A to Z Investigators
Journal: JAMA (2004)

2][3] More recently, 2 ran-domized controlled trials have evaluated earlier initiation of statin therapy following an ACS event and have noted a corresponding early reduction in major cardiovascular events. 5,
Remarks on ACUTE CONDITIONS IN THE LOWER ABDOMEN OF THE FEMALE
Authors: W. W. Chipman
Journal: BMJ (1928)

Two general considerations:1.The genital tract in the female hollow bifurcate above, which communicates skin surface and the peritoneal cavity.channel, or avenue of communication between surface and this mesothelial space!Boinney.)And tlmis genital tract is subject vicissitudes.There ar e the traumata of menstruation, childbirtlh, and anlortion; and the dangers associated disease.It is an imperfect world.the frequene of acute infections of abdomen.2. The peritoneal cavity is one enclosed chambers of the body-it three, thelargest lymphatic space. is immense, compared either with dural space.Hence the danger of this large space.The peritoneal Vallhalla-a perfect incubation chamber.These ac'mte conditions are sometimes grouped togetlier underthe temm, The acute abdomen," abdomen," or "The abdominal emergency."poimit of the emergency concerns both the surgeon, and any given individual has abdomen.To open or not to open-that is the ofteiitimes of very grave importance.
BMS-345541 Targets Inhibitor of κB Kinase and Induces Apoptosis in Melanoma: Involvement of Nuclear Factor κB and Mitochondria Pathways
Authors: Jinming Yang, Katayoun I. Amiri, James R. Burke, Johannes A. Schmid, Ann Richmond
Journal: Clinical Cancer Research (2006)

Abstract Purpose: Constitutive activation of inhibitor of κB kinase (IKK) confers melanoma resistance to apoptosis and chemotherapy. Whether IKK is able to serve as a therapeutic target in melanoma is unknown. We explored the possibility of exploiting IKK as a therapeutic target in melanoma by using BMS-345541, a novel compound with a highly selective IKKβ inhibitory activity, to trigger melanoma cell apoptosis. Experimental Design: Three human melanoma cell lines (SK-MEL-5, Hs 294T, and A375), all of which have high constitutive IKK activities, served as in vitro and in vivo melanoma models for treatment with BMS-345541. Two known antitumor drugs (temozolomide and bortezomib) were used as parallel controls for evaluation of the therapeutic efficiency and toxicity of BMS-345541. The effects of BMS-345541 on nuclear factor κB (NF-κB) signaling and on the apoptosis machinery were investigated. Results: Inhibition of constitutive IKK activity by BMS-345541 resulted in the reduction of NF-κB activity, CXCL1 chemokine secretion by cultured melanoma cells and melanoma cell survival in vitro and in vivo. The effect of BMS-345541 on tumor cell growth was through mitochondria-mediated apoptosis, based on the release of apoptosis-inducing factor, dissipation of mitochondrial membrane potential, and reduced ratio of B cell lymphoma gene-2 (Bcl-2)/Bcl-associated X protein (Bax) in mitochondria. The BMS-345541 execution of apoptosis was apoptosis-inducing factor–dependent, but largely caspase-independent. Conclusion: BMS-345541 down-regulation of IKK activity results in mitochondria-mediated apoptosis of tumor cells because the programmed cell death machinery in melanoma cells is highly regulated by NF-κB signaling. Therefore, IKK may serve as a potential target for melanoma therapy.
Adult‐onset cyclic bicytopenia: A case report and review of treatment of cyclic hematopoiesis
Authors: Ayalew Tefferi, Lawrence A. Solberg, Robert M. Petitt, Larry G. Willis
Journal: American Journal of Hematology (1989)

Abstract A unique case of adult‐onset synchronous cyclic neutropenia and thrombocytopenia occurring at six‐week intervals is presented. Periods of cytopenia were associated with fever, myalgias, gastrointestinal symptoms, and mild mucocutaneous bleeding. Alternate‐day steroid treatment failed to correct the periodic fluctuations in peripheral blood counts but ameliorated symptoms during cytopenia. The treatment of cyclic hematopoiesis is reviewed.
Plasma Propranolol Levels Associated with Suppression of Ventricular Ectopic Beats
Authors: D. J. Coltart, D. G. Gibson, D. G. Shand
Journal: BMJ (1971)

The plasma propranolol levels associated with the abolition of chronic, stable ventricular ectopic beats have been studied. Racemic propranolol (DL) suppressed the ectopic foci at plasma levels of 40-85 ng/ml in eight patients, but levels of 70-200 ng/ml were unsuccessful in four patients. Dextro-(D) propranolol levels of 180-310 ng/ml were ineffective in four patients who had previously responded at levels of 60-75 ng/ml of racemic propranolol. The significance of the sympathetic nervous system in the genesis of ectopic beats is discussed. It is concluded that propranolol is clinically effective by virtue of its beta-adrenergic blocking activity.
FOCAL SEPSIS OF DENTAL ORIGIN CAUSING MENTAL IMPAIRMENT
Authors: W. R. Ackland
Journal: BMJ (1925)

MTEnrCAL ff melancholia, and was soon quite insane.It seemed clear that his altered circumstances and the responsibilities of ownership and management had brought about his downfall.He had, however, a very septic mouth; extraction of all his teeth was followed by cornplete restoration to mental health.Case 4.-In this instance a manl had no fewer than three souirces of septic absorption : he suffered from chr-oniic nasal sinus disease, from dental sepsis, and from chronic appendicitis.The mental state was one of extreme introspection, with definite suicidal tendencies.Surgical treatment of all three foci has been zarried out.It is six weeks only since this was completed.He says he is " a new man."Although the history is so recent, it is full of promise.
Epigenetic Therapies Offer New Approach to Fighting Cancer at the Genetic Level
Authors: M. J. Friedrich
Journal: JAMA (2010)

BOSTON—In recent years, cancer researchers have begun to decipher how epigenetic changes, which alter gene activity without altering DNA sequence, collaborate with genetic mistakes to promote tumor development and progression. Now they are applying this information to devise new approaches to prevent and control cancer. Threedrugsthattargetepigeneticpathways are now used in the clinic to treat hematologic malignancies, and many more agents are in the pipeline. Oncologistsaretakinglessonslearnedatthebedside back to the bench to better understandhowthese therapiesworkandhow resistance to them develops, said JeanPierre Issa,MD,professorofmedicineat the University of Texas M. D. Anderson Cancer Center in Houston. Researchers also are exploring new ways of using the drugs—in different doses or in combination with other anticancer therapies—to improve their effectiveness and to treat a broader array of cancer types. Issa and his fellow researchers discussed advances in the field of cancer epigenetics at a plenary session on the cancer epigenome at the American Association of Cancer Research International Conference on Molecular Targets and Cancer Therapeutics in November.
Prevalence of Neuropathy in IDDM Patients in Piemonte, Italy
Authors: Massimo Veglio, Roberto Sivieri
Journal: Diabetes Care (1993)

OBJECTIVE In view of the scarce data available in Italy, to assess the prevalence of neuropathy in various subgroups of IDDM patients living in the Piemonte region of Italy and to develop, based on existing guidelines, and test the practicality of a standardized assessment of diabetic neuropathy. RESEARCH DESIGN AND METHODS All IDDM patients (766) attending 23 outpatient clinics, evenly distributed in the region, were stratified into 3 age-groups (15–29, 30–44, and 45–59 yr) and into 3 groups of diabetes duration (1–7, 8–14, and ≥ 15 yr). A random sample of 467 patients was selected; 81% of whom participated in the studies (196 men and 183 women). The following data were collected: personal and clinical data, structured questionnaire (SQ), neurological examination (NE), vibration sensation (tuning fork) (VS), and two cardiovascular tests (CTs). Patients were classified as follows: stage 0, (no neuropathy) &amp;lt;2 abnormalities among SQ, NE, VS, and CT; stage 1, (asymptomatic neuropathy) &amp;gt; 1 abnormality among NE, VS, and CT; stage 2, (symptomatic neuropathy) abnormalities in SQ and in NE, and/or VS, and/or CT. RESULTS The prevalence rates were as follows: stage 0 = 71.5%, stage 1 = 7.2%, and stage 2 = 21.3% and all had a 95% CI. No difference was found between men and women. The prevalence of neuropathy (stages 1 and 2) was higher (P &amp;lt; 0.01) in groups of longer diabetes duration or older age. CONCLUSIONS Polyneuropathy is a frequent complication in a north Italian IDDM population. Our results suggest that IDDM patients &amp;gt; 30 yr of age, with diabetes of &amp;gt; 15 yr duration, and who complain of symptoms suggestive of neuropathy, should be promptly assessed for the presence of diabetic polyneuropathy.
Platelet Monoamine Oxidase Activity in a Nonhuman Primate Model of Type 2 Excessive Alcohol Consumption
Authors: Claudia Fahlke, Håkan Garpenstrand, Lars Oreland, Stephen J. Suomi, J. Dee Higley
Journal: American Journal of Psychiatry (2002)

OBJECTIVE: Low platelet monoamine oxidase (MAO) activity is associated with "type 2 alcoholism." MAO activity is also affected by cigarette smoking. Since most alcoholics are smokers, it is difficult to evaluate the possible effect of platelet MAO activity on alcoholism independently of the effects of smoking. The authors investigated the relationship between platelet MAO activity and excessive alcohol consumption in rhesus macaques. METHOD: Platelet MAO activity and CSF metabolite concentrations were measured. The authors also investigated level of voluntary alcohol intake and social dominance rank. RESULTS: Subjects with low platelet MAO activity consumed alcohol to excess, had low CSF 5-hydroxyindoleacetic acid concentrations, and were less competent socially. CONCLUSIONS: These findings show that nonhuman primates that exhibit type 2-like alcohol features display low platelet MAO activity and support the notion that platelet MAO activity is a biologic marker for central serotonergic activity. The results also challenge the hypothesis that low platelet MAO activity in type 2 alcoholism is simply an artifact of smoking.
Vitamin D deficiency in obese rats exacerbates nonalcoholic fatty liver disease and increases hepatic resistin and toll-like receptor activation
Authors: Christian L. Roth, Clinton T. Elfers, Dianne P. Figlewicz, Susan J. Melhorn, Gregory J. Morton, Andrew Hoofnagle, Matthew M. Yeh, James E. Nelson, Kris V. Kowdley
Journal: Hepatology (2011)

Abstract Childhood obesity is associated with type 2 diabetes mellitus and nonalcoholic fatty liver disease (NAFLD). Recent studies have found associations between vitamin D deficiency (VDD), insulin resistance (IR), and NAFLD among overweight children. To further explore mechanisms mediating these effects, we fed young (age 25 days) Sprague-Dawley rats with a low-fat diet (LFD) alone or with vitamin D depletion (LFD+VDD). A second group of rats was exposed to a Westernized diet (WD: high-fat/high-fructose corn syrup) that is more typically consumed by overweight children, and was either replete (WD) or deficient in vitamin D (WD+VDD). Liver histology was assessed using the nonalcoholic steatohepatitis (NASH) Clinical Research Network (CRN) scoring system and expression of genes involved in inflammatory pathways were measured in liver and visceral adipose tissue after 10 weeks. In VDD groups, 25-OH-vitamin D levels were reduced to 29% (95% confidence interval [CI]: 23%-36%) compared to controls. WD+VDD animals exhibited significantly greater hepatic steatosis compared to LFD groups. Lobular inflammation as well as NAFLD Activity Score (NAS) were higher in WD+VDD versus the WD group (NAS: WD+VDD 3.2 ± 0.47 versus WD 1.50 ± 0.48, P &lt; 0.05). Hepatic messenger RNA (mRNA) levels of Toll-like receptors (TLR)2, TLR4, and TLR9, as well as resistin, interleukins (IL)-1β, IL-4, and IL-6 and oxidative stress marker heme oxygenase (HO)-1, were higher in WD+VDD versus WD animals ( P &lt; 0.05). Logistic regression analyses showed significant associations between NAS score and liver mRNA levels of TLRs 2, 4, and 9, endotoxin receptor CD14, as well as peroxisome proliferator activated receptor (PPAR)γ, and HO-1. Conclusion: VDD exacerbates NAFLD through TLR-activation, possibly by way of endotoxin exposure in a WD rat model. In addition it causes IR, higher hepatic resistin gene expression, and up-regulation of hepatic inflammatory and oxidative stress genes. (Hepatology 2012)
Overview of screening and management of familial adenomatous polyposis.
Authors: M Rhodes, D M Bradburn
Journal: Gut (1992)

The rarity of familial adenomatous polyposis (FAP) means that many clinicians may be unaware of the major advances that have taken place in screening for the condition over the past five years. This review is not only to document the current scene but also to give details of those involved in establishing registries throughout the country. FAP is a hereditary disorder which carries with it almost a 100% risk of colorectal cancer. The aim of screening is to detect gene carriers before they present with symptoms attributable to colonic polyps. In this way the incidence of colorectal cancer can be greatly reduced. The use of gene probes to identify patients with FAP is in its infancy but in selected pedigrees gene carriers can be identified using a venous blood sample. The recognition that congenital hypertrophy of the retinal pigment epithelium is an extracolonic manifestation of FAP in most pedigrees allows non-invasive ophthalmological screening of relatives at risk. The combination of these new screening methods with an effective regional registry for FAP can increase the number of patients detected by screening rather than by symptoms. This facilitates appropriate prophylactic surgery and reduces mortality related to colorectal cancer.
Intestinal Obstruction, with Stercoraceous Vomiting, Treated by Large Doses of Opium, Frequently Repeated
Authors: H. J. Hardwicke
Journal: BMJ (1876)

THE BRITISH MEDICAL YOURNAL.placenta was removed, and there was no haemorrhage nor any pro- minent symptom, save a severe gastric pain which lasted several days, and added greatly to the discomfort and exhaustion already present.Under the administration of suitable tonics and light nourishing food, the patient made a good recovery.She is still in the Institution and enjoys excellent health.
Troponin T Levels in Patients with Acute Coronary Syndromes, with or without Renal Dysfunction
Authors: Ronnier J. Aviles, Arman T. Askari, Bertil Lindahl, Lars Wallentin, Gang Jia, E. Magnus Ohman, Kenneth W. Mahaffey, L. Kristin Newby, Robert M. Califf, Maarten L. Simoons, Eric J. Topol, Peter Berger, Michael S. Lauer
Journal: New England Journal of Medicine (2002)

Among patients with suspected acute coronary syndromes, cardiac troponin T levels have prognostic value. However, there is concern that renal dysfunction may impair the prognostic value, because cardiac troponin T may be cleared by the kidney.
Cardiac arrhythmias during laparoscopy.
Authors: T R Morley
Journal: BMJ (1972)

suspected until a few months before death when increased pain necessitated surgery.All these patients had severe anaemia (Hb 55-60%) at diagnosis.All had a longstanding history of duodenal ulcer and were then found to have gastric cancer.It seems, therefore, that such cases need very careful examination if they come to operation for a duodenal ulcer.Tragically, all were late diagnoses chiefly because dyspeptic symp- toms were wrongly interpreted in the 16-12 months before laparotomy.It is said that duodenal ulcer and gastric cancer only rarely coexist,' and a report from the Birmingham Regional Cancer Registry and the United Birmingham Hos- pitals stated that no association was found between cancer and peptic ulcer.2-Iam, etc.,
Vagotomy and pyloric dilatation in chronic duodenal ulceration.
Authors: J D Thomson, J B Galloway
Journal: BMJ (1979)

A total of 101 patients suffering from duodenal ulcer underwent truncal vagotomy (TV) combined with pyloric dilatation (PD). They were followed up over six years, and the results were found to compare favourably with those in patients who underwent alternative surgical measures. Before any revisionary surgery 79 patients were classified as Visick grades I plus II. The incidence of recurrent ulceration was 4%. Side effects were noticeably less common than in patients in whom a drainage procedure had been performed, and overall results were compared with those reported for groups of patients treated by proximal gastric vagotomy. The combination of TV and PD is commended on account of its simplicity, safety, and effectiveness at a time when medical treatment for duodenal ulcer is becoming more specific and increasingly effective.
Available evidence on risk of injury in youth rugby
Authors: G. Trewartha, K. Stokes
Journal: BMJ (2015)

We fully support and advocate for the need to quantify risk of injury in youth rugby union to provide the evidence base for injury reduction strategies.1 However, some contemporary evidence is available.

We previously (2006-08) studied injury risk in secondary schools and in professional academies in England (16-18 year olds). Using a 24 hour time loss definition, which includes many “minor” injuries, the incidence …