tbuckley/cabot-search huggingface dataset:
Advance Directives, Due Process, and Medical Futility
Authors: Anne L. Flamm, Martin L. Smith
Journal: Annals of Internal Medicine (2004)

Letters2 March 2004Advance Directives, Due Process, and Medical FutilityAnne L. Flamm, JD and Martin L. Smith, STDAnne L. Flamm, JDFrom The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030.Search for more papers by this author and Martin L. Smith, STDFrom The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-5-200403020-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We are grateful for the contribution offered by Fine and Mayo (1) to the debate about the medical community's response to the problem of futility. We, too, participate in an ethics consultation service at a large tertiary care teaching hospital in Texas. We share Fine and Mayo's belief that the due process mechanism endorsed by the state legislature to resolve disagreements about end-of-life treatment provides practical assistance in resolving clinical impasse when patients and families seek “everything possible” from providers who are unwilling to concede their judgment of medical inappropriateness.We wish to clarify several points, however. ...References1. Fine RL, Mayo TW. Resolution of futility by due process: early experience with the Texas Advance Directives Act. Ann Intern Med. 2003;138:743-6. [PMID: 12729429] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoResolution of Futility by Due Process: Early Experience with the Texas Advance Directives Act Robert L. Fine and Thomas Wm. Mayo Advance Directives, Due Process, and Medical Futility Robert L. Fine and Thomas Wm. Mayo Advance Directives, Due Process, and Medical Futility Jeffrey T. Berger Advance Directives, Due Process, and Medical Futility Thomas E. Finucane Metrics Cited ByThe Fiction of Futility: What to Do With Policy? 2 March 2004Volume 140, Issue 5Page: 403-404KeywordsCancer treatmentHealth careHealth care facilitiesHematology and oncologyIntensive care unitsMedical conditionsMedical ethicsMedical lawPatient advocacyPersistent vegetative state ePublished: 2 March 2004 Issue Published: 2 March 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Studies on abnormal polymorphonuclear neutrophils in acute myelogenous leukemia: Clinical significance and changes after chemotherapy
Authors: T. Suda, T. Onai, T. Maekawa
Journal: American Journal of Hematology (1983)

Abstract In patients with acute myelogenous leukemia (AML), 34 out of 35 patients (97%) had cytochemically abnormal polymorphonuclear neutrophils (PMN). Some interesting regularity was noted in the appearance of cytochemical abnormalities of the PMNs. When peroxidase (PO) activity was low, both alkaline phosphatase (AP) and chloroacetate esterase (CAE) activities were also low (group A). When PO activity was normal, if AP activity was low, CAE activity tended to be high (group B) and if AP activity was high, CAE activity tended to be low (group C). Complete remission rate of group B (65%) seemed to be better than that of group C (20%) and group A (25%) although the differences was not statistically significant. In these patients, the number of peripheral leukemic blasts and PMNs showed a significant positive correlation (r = 0.69, p &lt; 0.005). Furthermore, patients with higher circulating PMN counts (more than 2 × 10 9 /L) had a significantly worse prognosis than patients with lower counts (p &lt; 0.05). These rather unexpected findings strongly suggest that cytochemically abnormal PMNs are progeny of AML blasts. The change in the proportion of abnormal PMNs associated with chemotherapy were studied in 21 patientas during the remission induction period. Abnormal PMNs disappeared from the circulation in patients who achieved complete remission. In contrast, abnormal PMNs persisted throughout the remission induction period in patients who failed to achieve complete remission.
PGLYRP-2 and Nod2 Are Both Required for Peptidoglycan-Induced Arthritis and Local Inflammation
Authors: Sukumar Saha, Jin Qi, Shiyong Wang, Minhui Wang, Xinna Li, Yun-Gi Kim, Gabriel Núñez, Dipika Gupta, Roman Dziarski
Journal: Cell Host & Microbe (2009)
Opitz syndrome is genetically heterogeneous, with one locus on Xp22, and a second locus on 22q11.2
Authors: Nathaniel H. Robin, George J. Feldman, Adam L. Aronson, Heather F. Mitchell, Rosanna Weksberg, Claire O. Leonard, Barbara K. Burton, Kevin D. Josephson, Renata Laxová, Kyrieckos A. Aleck, Judith E. Allanson, Maria Leine Guion-Almeida, Rick A. Martin, Lawrence G. Leichtman, R. Arlen Price, John M. Opitz, Maximilian Muenke
Journal: Nature Genetics (1995)
Molecular manipulation of drug compounds
Authors: G. M. Blessinger
Journal: JAMA (1971)

To the Editor.—  Largely due to the Food and Drug Administration's reluctance to approve new drugs, we have entered an era of molecular manipulation of existing compounds, The most recent example of this trend was the introduction of hetacillin. Hetacillin, a compound of ampicillin and acetone, has no inherent antibacterial activity, but is converted to ampicillin in the body. For some reason, the drug is marketed in the dosage forms of 225 mg and 450 mg of ampicillin activity, which is 10% less than the usual 250 mg and 500 mg of conventional ampicillin. If this trend continues, we can see in the future the possibility of the following letter being sent to physicians:  Dear Doctor:  The Ostrich Pharmaceutical Company is extremely proud to announce the introduction of a new product, HETAPRIN. Each tablet contains the equivalent of 292.5 mg of aspirin. Aspirin is the most widely used drug in
Supplemental Value of the Intracavitary Electrocardiograph in Cardiac Catheterization
Authors: ROBERT B. DICKERSON, TIMOTHY N. CARIS
Journal: Circulation (1959)

Characteristic intracavitary electrocardiographic complexes at various sites within the heart in normal individuals have been described previously. The intracardiac tracings in 150 catheterizations, 129 of which were abnormal hearts, predominantly congenital defects, were studied in relationship to the position within the heart as determined fluoroscopically. In our experience, the tracings remain sufficiently unchanged in abnormal hearts so that the intracavitary electrocardiogram may be used successfully as a guide, making it possible to decrease total x-ray exposure time considerably. In addition, the significance of an intracavitary injury current became apparent. A few diagnostically useful variants were found and are described.
Subarachnoid haemorrhage: lumbar puncture for every negative scan? Authors' reply
Authors: Rustam Al-Shahi, Philip M White, Richard J Davenport, Kenneth W Lindsay
Journal: BMJ (2006)

EDITOR—Coats suggests that a lumbar puncture should not be undertaken after a negative computed tomogram for every patient with “query subarachnoid haemorrhage.”1 We robustly disagree.

Firstly, in his bayesian calculations, Coats used the sensitivity of computed tomography for identifying subarachnoid blood at 12 hours after onset of headache (98%). Sensitivity decays rapidly within days, so patients who do not present immediately, or who have to wait for computed tomography, are less likely to be identified, and the importance of a subsequent lumbar puncture cannot be overstated. Furthermore, computed tomography is …
Clinical and histological follow-up after liver transplantation (LT) for hereditary hemochromatosis (HH)
Authors: J.C. Duclos-Vallee, B. Roche, P. Chanson, F. Yilmaz, F. Saliba, D. Castaing, H. Bismuth, D. Samuel, C. Guettier
Journal: Journal of Hepatology (2003)
THE GROWING PROBLEM OF CHRONIC DISEASE AMONG THE AGED
Authors: John H. Miller
Journal: JAMA (1952)

In recent years a great deal has been said and written about the problem of aging. It has been pointed out that the older persons among our population are increasing in number and in percentage of the total and that we are therefore facing serious economic, sociologic, and medical problems. This increase in the proportion of our population in the higher age brackets is attributed to three factors: (1) the virtual cessation of immigration nearly 30 years ago, (2) the long continued decline in the birth rate until the upturn that commenced about 1936, and (3) the steadily increasing longevity of our people. The economic problem of providing for the aged has increased not only as a result of the growing number of older citizens and their proportion to the total but also because of the gradual change in our economy from that of a primarily agrarian to a highly
Radiation-Related Thyroid Dysfunction: Implications for the Treatment of Hodgkin's Disease
Authors: STEPHEN C. SCHIMPFF, CHARLES H. DIGGS, JOHN G. WISWELL, PAULA C. SALVATORE, PETER H. WIERNIK
Journal: Annals of Internal Medicine (1980)

Thyroid-stimulating hormone (TSH) and thyroxine (T4) were measured in sera from 214 patients with Hodgkin's disease. The literature was reviewed for patients with lymphoma or head and neck carcinoma who had received prior radiation therapy that encompassed the thyroid. Among 169 patients who had been treated with mantle radiation therapy at our center, 112 (66%) had evidence of thyroid dysfunction, including 43 with depressed T4 levels. Among 45 who did not receive mantle irradiation, only three had evidence of dysfunction and none of these had T4 depression. Thyroid dysfunction developed slowly, with less than 15% of patients tested during the first year showing dysfunction and the maximum of 66% reached at about 6 years. This entity is very common in lymphoma patients yet often is overlooked except in instances of specific thyroid function evaluation for research. A substantial proportion of patients with head and neck carcinoma develop thyroid dysfunction after irradiation, especially if therapy includes hemithyroidectomy. Serum TSH measurement every 6 months for at least 5 to 6 years after irradiation will detect early thyroid dysfunction. All patients with elevated serum TSH should be treated with sodium levothyroxine, regardless of whether they are clinically hypothyroid.
Nyctohemeral growth hormone levels in children with growth retardation and inflammatory bowel disease ,
Authors: R. W. Gotlin, R. S. Dubois
Journal: Gut (1973)

Short stature is a common complication of inflammatory bowel disease. Recently McCaffery, Nasr, Lawrence, and Kirsner (1970) concluded, from blood growth hormone (GH) levels obtained during insulin-hypoglycaemic provocation, that GH deficiency contributed to the retardation in growth observed in subjects with inflammatory bowel disease. Although it was not possible to eliminate the possibility of partial hypopituitarism, this study does not confirm the existence of GH deficiency in six subjects with short stature complicating inflammatory bowel disease. The nyctohemeral (night and day) serum GH is described, and the insulin and glucose levels in these subjects and normal sleep-related GH rises in all are demonstrated. This finding is not compatible with growth hormone deficiency. In one subject the response to arginine provocation was blunted. Three subjects manifested hyperinsulinism and evidence for ;insulin resistance'. These findings are unexplained but suggest that insulin resistance may contribute to a blunted GH response to insulin-induced hypoglycaemia. Blunted GH response to both arginine and insulin-induced hypoglycaemia may also result from continuous secretion and reduced pituitary storage of growth hormone. This possibility is suggested by the pattern of raised blood GH levels in one of the subjects.
Upper intestinal motility in ulcerative colitis, idiopathic steatorrhoea, and the irritable colon syndrome.
Authors: J A Ritchie, S N Salem
Journal: Gut (1965)

EDITORIAL SYNOPSIS This is a study on the possible motility disturbances associated with small intestinal dysfunction.Reduced luminal resistance was found to correlate with reduced xylose absorption and may be the factor most likely to influence absorption mechanically in ulcerative colitis and steatorrhoea.10 ml.lots of water, saline, certain amino-acids, ascorbic 325 on July 29,
Abstract 955: Role of cMYC as a critical determinant of estrogen-independent growth of estrogen deprivation-resistant breast cancer cells
Authors: Surojeet Sengupta, Michael C. Biarnes, V Craig Jordan
Journal: Cancer Research (2012)

Abstract Around two-third of all breast cancers express estrogen receptor alpha (ER), which depend upon estrogen for proliferation of the ER positive breast cancer cells. Aromatase inhibitors (AI) are used extensively to treat postmenopausal patients, which block the synthesis of estrogen and render an “estrogen-deprived” environment. Unfortunately, long-term treatment with AIs is associated with “AI-resistant” breast cancers, which by-passes the dependency on estrogen for the growth of the resistant breast cancer cells. To mimic these resistant breast cancers we have developed an estrogen-deprivation (ED) resistant cell line known as MCF7:5C cells from the parental ER positive MCF7 cells by propagating them in estrogen-free conditions for more than a year. MCF7:5C cells are ER positive and grow spontaneously in vitro as well as form xenograft tumors in the athymic mice in absence of estrogen (ref: Lewis et al., JNCI, 2005; 97(23):1746-59). To understand the underlying mechanism and identify the molecular determinant responsible for the estrogen-independent growth of these breast cancer cells we found that a critical estrogen-regulated gene, cMYC, is upregulated in these ED-resistant MCF7:5C cells. Basal levels of cMYC mRNA as well as the protein level were elevated three to four fold as compared to parental MCF7 cells which are dependent on estrogen for growth. Cell cycle analysis revealed twice as many “S” phase MCF7:5C cells as compared to MCF7 cells under basal condition. Treating the cells with a cMYC inhibitor, 10058-F4, decreased the number of ‘S’ phase cells and increased the cells in ‘G1′ phase in MCF7:5C cells but not in parental MCF7 cells, in a dose dependent manner. Interestingly, treatment with fulvestrant, a complete anti-estrogen, which inhibits the growth of the MCF7:5C cells by 50% also decreased the cMYC mRNA levels by similar extent. To understand the precise mechanism by which high levels of cMYC transcripts are synthesized in MCF7:5C cells we investigated the promoter of the cMYC gene and found that under basal conditions the recruitment of phosphor-serine-2-RNA polymeraseII, which is a marker of RNA elongation, was significantly higher in MCF7:5C cells as compared to the parental MCF7 cells. This study strongly indicates cMYC as a critical determinant responsible for estrogen-independent growth of ED-resistant breast cancer cells. Grant Support: This work (VCJ) was supported by the Department of Defense Breast Program under Award number W81XWH-06-1-0590 Center of Excellence; the Susan G Komen For The Cure Foundation under Award number SAC100009. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 955. doi:1538-7445.AM2012-955
Eczematous reactions in atopic patients caused by epicutaneous testing with inhalant allergens
Authors: S. REITAMO, K. VISA, K. KAHONEN, K. KAYHKO, S. STUBB, O.P. SALO
Journal: British Journal of Dermatology (1986)

To determine whether inhalant allergens could induce eczematous lesions we studied 17 patients with atopic eczema (with or without allergic rhinitis), 13 patients with allergic rhinitis without atopic eczema and 10 healthy control subjects. The allergens, birch pollen (Betulaverrucosa) and house dust mite (Dermatophagoides pteronyssinus), were applied in aluminium chambers for 48 h on clinically normal skin. In 17 patients with atopic eczema, six epicutaneous test reactions of the delayed type to birch pollen and three to house dust mite were seen at 48 or 72 h. In 13 patients with allergic rhithitis without eczema there was one delayed reaction to birch pollen and none to house dust mite. No delayed type test reactions to either allergen were seen in the controls. Biopsies of the positive test sites revealed an eczematous reaction with epidermal spongiosis and microvesiculation. Immunostaining of cryostat sections showed dermal cell infiltrates consisting of mainly T lymphocytes (ratio of T4:T8, 2-6:1) and to a lesser degree Langerhans and indeterminate T6+ cells. 50–90% of the cells were Ia+. The numbers of basophils and mast cells did not exceed 10–15%.
Persistence of Use of Lipid-Lowering Medications
Authors: Jerry Avorn, Johanne Monette, Anne Lacour, Rhonda L. Bohn, Mark Monane, Helen Mogun, Jacques LeLorier
Journal: JAMA (1998)

Context.—Although clinical trials have demonstrated the benefits of lipid-lowering therapy, little is known about how these drugs are prescribed or used in the general population.Objective.—To estimate predictors of persistence with therapy for lipid-lowering drug regimens in typical populations of patients in the United States and Canada.Design.—A cohort study defining all prescriptions filled for lipid-lowering drugs during 1 year, as well as patients' demographic and clinical characteristics.Setting.—New Jersey's Medicaid and Pharmacy Assistance for the Aged and Disabled programs and Quebec's provincial medical care program.Patients.—All continuously enrolled patients older than 65 years who filled 1 or more prescriptions for lipid-lowering drugs (N=5611 in the US programs, and N = 1676 drawn from a 10% sample in Quebec).Main Outcome Measures.—Proportion of days during the study year for which patients had filled prescriptions for lipid-lowering drugs; predictors of good vs poor persistence with therapy.Results.—In both populations, patients failed to fill prescriptions for lipid-lowering drugs for about 40% of the study year. Persistence rates with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors were significantly higher than those seen with cholestyramine (64.3% vs 36.6% of days with drug available, respectively). Patients with hypertension, diabetes, or coronary artery disease had significantly higher rates of persistence with lipid-lowering regimens. In New Jersey, multivariable analysis indicated that the poorest patients (those enrolled in Medicaid) had lower rates of drug use than less indigent patients (those enrolled in Pharmacy Assistance for the Aged and Disabled) after adjusting for possible confounders, despite virtually complete drug coverage in both programs. When rates of use were measured in the US population for the 5 years following the study year, only 52% of surviving patients who were initially prescribed lipid-lowering drugs were still filling prescriptions for this drug class.Conclusion.—In all populations studied, patients who were prescribed lipid-lowering drug regimens remained without filled prescriptions for over a third of the study year on average. Rates of persistence varied substantially with choice of agent prescribed, comorbidity, and socioeconomic status, despite universal coverage of prescription drug costs. After 5 years, about half of the surviving original cohort in the United States had stopped using lipid-lowering therapy altogether.
Amblyopia: could we do better?
Authors: G. Woodruff
Journal: BMJ (1995)

Amblyopia is a common cause of visual loss affecting between 1 and 4% of the population.1 In most cases it is unilateral and is associated with either misalignment of the eyes (strabismus) or a difference in refraction between the two eyes (anisometropia). Treatment, which is effective only in childhood, consists of prescribing glasses when appropriate and occluding the good eye to force the child to use the amblyopic eye. There is no doubt that this treatment can be highly effective, and a recent prospective study reported cure—that is, visual acuity within one line of that in the unaffected eye—in 89% of patients.2 Despite this, amblyopia remains widely prevalent in adults. Why is this? How important a problem is it? And, what, if anything, needs to be done?

Most people with amblyopia are barely aware of their disability since they rely on their good eye. Certainly their visual …
Review: Rivaroxaban causes less fatal bleeding, but does not reduce mortality, compared with VKAs
Authors: Daniel M. Witt
Journal: Annals of Internal Medicine (2013)

ACP Journal Club17 September 2013Review: Rivaroxaban causes less fatal bleeding, but does not reduce mortality, compared with VKAsDaniel M. Witt, PharmD, FCCP, BCPSDaniel M. Witt, PharmD, FCCP, BCPSKaiser Permanente Colorado, Aurora, Colorado, USA (D.M.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-159-6-201309170-02013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationWasserlauf G, Grandi SM, Filion KB, Eisenberg MJ. Meta-analysis of rivaroxaban and bleeding risk. Am J Cardiol. 2013;112:454-60. https://pubmed.ncbi.nlm.nih.gov/23642380Clinical Impact RatingsCardiology: Hematology: References1 Patel MR, Mahaffey KW, Garg J, et al; ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-91. [PMID: 21830957] Google Scholar2 Larsen TB, Rasmussen LH, Skjøth F, et al. Efficacy and safety of dabigatran etexilate and warfarin in “real-world” patients with atrial fibrillation: a prospective nationwide cohort study. J Am Coll Cardiol. 2013;61:2264-73. [PMID: 23562920] Google Scholar3 Southworth MR, Reichman ME, Unger EF. Dabigatran and postmarketing reports of bleeding. N Engl J Med. 2013;368:1272-4. [PMID: 23484796] Google Scholar Author, Article, and Disclosure InformationAuthors: Daniel M. Witt, PharmD, FCCP, BCPSAffiliations: Kaiser Permanente Colorado, Aurora, Colorado, USA (D.M.W.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 17 September 2013Volume 159, Issue 6Page: JC13 ePublished: 8 March 2020 Issue Published: 17 September 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Eye-Strain and the General Practitioner.
Authors: James W. Walker
Journal: JAMA (1903)

Chicago, March 23, 1903. <h3>To the Editor:</h3> —Referring to your review inThe Journalof March 14 of Dr. Gould's book, "Biographic Clinics," dealing with the question of eye-strain and its effects, I can not but think it unfortunate that you should adopt such a critical attitude, because the general impression left in the mind of the reader will be that oculists are very prone to exaggerate the importance of eye-strain, and that in the absence of very direct indications the counsel of an oculist will be deemed superfluous and be dispensed with. It may be that Dr. Gould's claims are excessive, but as a general practitioner I do most certainly know that not nearly enough of our patients are referred to the oculist. Provided that a conscientious and skilled refractionist be employed, the fee and time spent in the examination are the only losses to the patient, yet many