tbuckley/cabot-search huggingface dataset:
Anti-TNFalpha : a new dimension in the pharmacotherapy of the spondyloarthropathies !?
Authors: J BRAUN
Journal: Annals of the Rheumatic Diseases (2000)

The therapeutic options for treatment of the spondyloarthropathies (SpA), especially for ankylosing spondylitis (AS), are limited. Physiotherapy is important and non-steroidal anti-inflammatory drugs (NSAIDs) provide significant symptomatic benefit, as has been shown in many studies, and recently in a six week/one year trial.1 Apart from sulfasalazine, a disease modifying antirheumatic drug, which many rheumatologists use to treat patients with peripheral arthritis and gut disease in early and in active stages of SpA, few innovative treatments have arisen in the past decades since indometacin was developed.2 The Cox-2 selective agent rofecoxib, recently introduced, causes fewer gastric ulcers but is no more effective than established NSAIDs.3 The efficacy of rofecoxib in ankylosing spondylitis (AS) has not been studied to date. Up to 20% of patients with AS do not respond well or at all to NSAIDs.4Corticosteroids are effective when applied locally intra-articularly5 but not systemically in most patients—an interesting difference from rheumatoid arthritis (RA), the pathophysiological basis of which is unclear. Interestingly, quite a few rheumatologists use methotrexate to treat AS,6though there are no randomised trials for this indication.

However, possibly positive effects of thalidomide7 and of pamidronate8 for the treatment of AS were recently reported from two open studies. Both drugs work, at least partly, by blocking the proinflammatory cytokine tumour necrosis factor α (TNFα),9 10 which is also the target of recently introduced new treatments for the treatment of RA11 and Crohn's disease.12 Shortly after the initial experience of our group with anti-TNF in AS13and of others in psoriatic arthritis,14 both for the first time reported in Boston at the American College of Rheumatology meeting 1999, several studies with “biological” agents acting against TNFα in SpA were reported. One study from our Belgian colleagues …
BMA proposes strategy to reformulate waiting lists
Authors: J. Fricker
Journal: BMJ (1999)

A fairer and more transparent approach to managing UK hospital waiting lists has been suggested in a report published this week by the BMA.

The report recommends the banding of waiting lists into five categories, ranging from emergencies to the lowest priority. It suggests that patients should be given severity scores when they are put on a waiting list, which would reflect their clinical priority …
Mechanism of transfusion-related acute lung injury induced by HLA class II antibodies
Authors: Ulrich J. H. Sachs, Wiebke Wasel, Behnaz Bayat, Rainer M. Bohle, Katja Hattar, Heike Berghöfer, Angelika Reil, Jürgen Bux, Gregor Bein, Sentot Santoso, Norbert Weissmann
Journal: Blood (2010)
Nod1-Mediated Innate Immune Recognition of Peptidoglycan Contributes to the Onset of Adaptive Immunity
Authors: Jörg H. Fritz, Lionel Le Bourhis, Gernot Sellge, Joao Gamelas Magalhaes, Hafida Fsihi, Thomas A. Kufer, Cathy Collins, Jérôme Viala, Richard L. Ferrero, Stephen E. Girardin, Dana J. Philpott
Journal: Immunity (2007)
Carotid Sinus Massage and the Diagnosis of Syncope
Authors: NEIL L. COPLAN
Journal: Annals of Internal Medicine (1984)

Letters and Corrections1 August 1984Carotid Sinus Massage and the Diagnosis of SyncopeNEIL L. COPLAN, M.D.NEIL L. COPLAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-101-2-282_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The recent editorial on evaluation of syncope (1 ) did not mention the importance of looking for carotid sinus hypersensitivity. Symptomatic carotid sinus hypersensitivity is probably not a common cause of syncope, but the diagnosis should always be considered in patients presenting with transient neurologic symptoms because it is a potentially treatable disorder. Importantly, most patients with "carotid sinus syncope" do not recall a specific motion (for example, turning the head or shaving) immediately before the syncopal episode (2, 3). Thus, the diagnosis may frequently be missed if the physician relies on the patient's history for deciding...References1. KAPOORKARPFLEVEY WMG. Issues in evaluating patients with syncope [Editorial]. Ann Intern Med. 1984;100:755-7. LinkGoogle Scholar2. SMITHMOERSCH HF. Further study on the hypersensitive carotid sinus reflex syndrome: report on 31 additional cases. Proc Staff Meet Mayo Clin. 1936;11:380-3. Google Scholar3. DRAPER A. The cardioinhibitory carotid sinus syndrome. Ann Intern Med. 1950;32:700-16. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 August 1984Volume 101, Issue 2Page: 282-282KeywordsHypersensitivitySyncope Issue Published: 1 August 1984 PDF DownloadLoading ...
Addiction to Methyprylon
Authors: Herbert Berger
Journal: JAMA (1961)

THE PATIENT, a 24-year-old nurse, was first seen on Oct. 2, 1959. She was desirous of breaking her addiction to methyprylon (Noludar), a drug which she had been using for 18 months. During the past year, she reported using a minimum of 25 300-mg. tablets (7,500 mg.) per day. Frequently her intake reached 40 of these tablets (12,000 mg.) per day. She had used barbiturates to excess from 1953 to January, 1958, when, in a self-imposed attempt to terminate her addiction to these materials, she substituted methyprylon. It is significant that she could replace the barbiturates with methyprylon, despite their dissimilar chemistry (see figure). <h3>Report of a Case</h3> The patient's history included a diagnosis of pernicious anemia in 1952 which was "confirmed" by the presence of achlorhydria. She took vitamin B<sub>12</sub>orally and by injection for a few months, and has had no evidence of anemia or combined-system
PTU-084 Treatment of Hepatitis C Through an In-Prison Specialist Clinic
Authors: A Shalabi, A G Lim, L T Tan
Journal: Gut (2013)

<h3>Introduction</h3> There is a high prevalence of hepatitis C virus (HCV) among inmates in UK prisons. Treatment of prisoners in hospital clinics proved to be logistically complex and expensive and resulted in high levels of treatment failures. Our aim was to establish specialist hepatitis C treatment clinics entirely within prison facilities and to evaluate their efficacy. <h3>Methods</h3> Clinics were established in two prisons, HMP High Down (Capacity of 1103 inmates) and HMP Downview (capacity of 364 inmates) and run twice a month. The specialist team collaborated with the prison healthcare team to diagnose, investigate and treat HCV entirely within the prison setting. Link nurses would refer inmates with positive antibodies for further investigation including detailed virology and ultrasound scan. Suitable patients were offered treatment and monitired for progress and side effects. <h3>Results</h3> 163 inmates with an average age of 40 were referred to the clinic. 62.6% were females and 37.4% were males. 73 patients received genotyping, 50.68% were genotype 1, 43.84% were genotype 3, 2.74% were genotype 2 and 2.74% were genotype 4. Out of the patients who completed treatment data is available on 58%. To date, 85% of patents who completed treatment tested negative after completion of treatment (EOT). 100% of patients who received follow-up testing acheived a sustained viral response (SVR) at 6 months. 9.5% of patients withdrew from treatment because they left prison. 1 patient withdrew as a result of side-effects (severe thrombocytopenia). <h3>Conclusion</h3> An in-prison treatment service reduced the number of failed attendances at our hospital service. We were very successful in completing therapy for patients serving longer sentences in prison with good eradication rates. As the prison population is mobile, more effective collaboration between different prisons and community teams are needed to improve treatment and follow up of HCV infected prisoners. <h3>Disclosure of Interest</h3> None Declared <h3>References</h3> Department of Health. Hepatitis C Strategy for England, 2002. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4059510.pdf (accessed 21 October 2012). Skipper C, Guy JM, Parkes J, Roderick P, Rosenberg WM. Evaluation of a prison outreach clinic for the diagnosis and prevention of hepatitis C: implications for the national strategy. Gut 2003; 52: 1500–1504. Vescio MF, Longo B, Babudieri S, Strnini G, Carbonara S, Rezza G, Monarca R. Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis. J Epdemiol Community Health 2008; 62: 305–313.
The Children's Dermatology Life Quality Index (CDLQI): initial validation and practical use
Authors: M.S. LEWIS-JONES, A.Y. FINLAY
Journal: British Journal of Dermatology (2010)

Skin disease can cause severe disability and handicap in children. Measurement of the impact of skin disease on the quality of life is required to aid clinical decision-making, for clinical research, for audit of paediatric dermatology services, and for political reasons, to aid arguments for more resources for the care of children with skin disease. Adult measures are inappropriate, as the lives of children differ markedly from those of adults. The purpose of this study was to create and initially validate a simple practical questionnaire for use in children. One hundred and sixty-nine children, aged 3-16 years, attending a paediatric dermatology clinic, wrote down, with the help of their parents, all the ways in which their skin disease affected their lives. One hundred and eleven different aspects were identified; 10 questions were composed to cover these aspects, using a structure similar to the Adult Dermatology Life Quality Index. This draft questionnaire was piloted on two series, totalling 40 children, and minor alterations were made to improve clarity. The Children's Dermatology Life Quality Index (CDLQI) questionnaire (maximum score 30) was then given to a further 233 dermatology paediatric out-patients (CDLQI mean = 5.1, SD = 4.9), 47 normal controls (mean 0.4, 0.7) and 55 control patients attending a general paediatric clinic (mean 0.7, 2.5). The CDLQI scores for eczema (mean = 7.7, 5.6, n = 47), psoriasis (5.4, 5.0, n = 25) and acne (5.7, 4.4, n = 40), were all highly significantly greater than for moles and naevi (2.3, 2.9, n = 29). The highest mean score was that for scabies (mean = 9.5, 10.5, n = 6).(ABSTRACT TRUNCATED AT 250 WORDS)
DERMATITIS VENENATA FROM THE LACQUER ON THE BOXES OF MAH JONGG SETS
Authors: OSCAR L. LEVIN
Journal: JAMA (1924)

The development of a cutaneous inflammation subsequent to contact with a chemical is, of course, familiar. The term dermatitis venenata is applied to the various conditions due to chemical irritation. Recently I have observed several cases in which it was apparent that the instigating chemical agent was present in the lacquer on the boxes of mah jongg sets. It is my purpose in this communication to call attention to this etiologic factor in the production of a form of dermatitis which promises to become common.  REPORT OF CASE  J. B., a man, aged 26, a silk salesman, was referred by his physician as suffering from a vesicular inflammation of the skin. The history, as described, was that for one week the eyelids had been swollen, and that the skin of the adjacent cheeks had shown vesicles on an inflammatory base. Similar lesions had developed prior to this on the fingers
The Natural Progression of Autonomic Neuropathy and Autonomic Function Tests in a Cohort of People With IDDM
Authors: Naomi S Levitt, Kevin B Stansberry, Sinclair Wynchank, Aaron I Vinik
Journal: Diabetes Care (1996)

OBJECTIVE To test the natural progression of symptoms of autonomic neuropathy (AN) and function tests in subjects with IDDM. RESEARCH DESIGN AND METHODS Seventy-six subjects with IDDM of &amp;lt; 10 years duration had cardiovascular autonomic reflex tests and were evaluated for signs and symptoms of AN. RESULTS Fifty-seven subjects (66%) were available for restudy 9 years later (15 had died, 4 could not be located). Of the symptoms of AN, only gastroparesis increased in prevalence (P &amp;lt; 0.01). Of the five cardiovascular AN measures, only the R-R response to the Valsalva maneuver deteriorated (F[1,44] = 10.61, P &amp;lt; 0.01). CONCLUSIONS The progression of AN in IDDM is monitored best longitudinally by the Valsalva maneuver because of the small variance ratio in repeated measures. Prevalence rates can be monitored by expiration-to-inspiration R-R or Valsalva ratios. Most clinical signs and symptoms of AN do not progress, underscoring the need for objective and quantitative autonomic function tests to identify people at risk for premature death.
Interstitial dendritic cells of the rat heart. Quantitative and ultrastructural changes in experimental myocardial infarction.
Authors: J Zhang, Z X Yu, S Fujita, M L Yamaguchi, V J Ferrans
Journal: Circulation (1993)

BACKGROUND This study was undertaken to investigate the qualitative and quantitative changes that interstitial dendritic cells (IDC) of the heart undergo during the time course of experimental myocardial infarction. METHODS AND RESULTS Left coronary arterial ligations were performed in 43 rats that were killed 2, 4, 7, 14, and 21 days after surgery. Thirteen unoperated and 39 sham-operated rats were used as controls. Frozen sections were stained with monoclonal antibodies (OX 6 and W3/25) to identify and count IDC by light microscopy. Immunoelectron microscopy was also used to identify IDC. The number of IDC per mm2 of tissue section was calculated for all hearts. In hearts with myocardial infarction, IDC were counted in three areas: the center of the myocardial infarction, the border zone, and the noninfarcted left ventricle. In OX 6 antibody-stained preparations, the number of IDC per mm2 was 82 +/- 10 in the left ventricle of unoperated rats. Hearts with myocardial infarction showed marked increases in the numbers of IDC per mm2 in the border zone (796 +/- 79 at 7 days and 528 +/- 98 at 14 days). In the border zone, IDC often were associated with small clusters of T-helper lymphocytes, which reacted with W3/25 antibody (the rat homologue of human CD4). The center of the myocardial infarction showed an increase in IDC only on day 7 (120 +/- 18). By 21 days, IDC in the border zone were only slightly increased (159 +/- 15). CONCLUSIONS These findings suggest that IDC migrate to the myocardial infarction border zone. They participate in the activation of lymphocytes and in the initiation of immune responses and decrease in number as inflammation subsides and scarring develops.
Peritoneoscopic Findings and Liver Function in Chronic Liver Disease
Authors: Yohei Fukumoto, Kiwamu Okita, Takahiro Kodama, Ken-ichi Noda, Toshinori Harada, Tadayoshi Takemoto
Journal: Endoscopy (1980)

In 100 cases with chronic liver disease, peritoneoscopy and liver biopsy were performed, and the association between peritoneoscopic findings and liver function was studied. With respect to liver function, a series of tests which seem to indicate residual liver function were selected as follows; dye excretion, serum levels of albumin and cholinesterase, and subfractions of serum proteins. In evaluating the periotoneoscopic view, new criteria for the classification of liver surface findings are proposed. All cases were divided into 5 types in accordance with these criteria. Analysis of the correlation between peritoneoscopic findings and liver function showed that the degree of liver dysfunction was clearly indicated by liver surface alterations. As a result, the residual liver function may be determined quite well by using this classification.
Therapy of Nonnecrotizing Anterior Scleritis with Subconjunctival Corticosteroid Injection
Authors: Elmer Y. Tu, William W. Culbertson, Stephen C. Pflugfelder, Andrew Huang, James C. Chodosh
Journal: Ophthalmology (1995)

Objective: To determine the safety and efficacy of subconjunctival triamcinolone (Kenalog) in treating nonnecrotizing anterior scleritis. Design: The authors conducted a retrospective review of all patients treated with depot subconjunctival Corticosteroid injection for scleritis from January 1988 to May 1993. Response to therapy was determined by subjective improvement in pain and a decrease in clinical signs of ocular inflammation. All patients received subconjunctival injections of triamcinolone by the same technique, and the minimum observation period for complications was 6 weeks. Results: Eighteen patients (90%) had relief of their symptoms with clinically observable improvement in inflammation, whereas two patients (10%)responded poorly. Nine patients (45%)required no further therapy. Average symptom-free interval was 18 weeks in patients with recurrent scleritis. No complications of scleral thinning, perforation, or glaucoma occurred in any patients. Conclusion: Subconjunctival triamcinolone injection is highly efficacious in treating nonnecrotizing anterior scleritis without unreasonable risk of thinning and jor perforation and should be considered as adjunctive therapy in localized disease. Objective: To determine the safety and efficacy of subconjunctival triamcinolone (Kenalog) in treating nonnecrotizing anterior scleritis. Design: The authors conducted a retrospective review of all patients treated with depot subconjunctival Corticosteroid injection for scleritis from January 1988 to May 1993. Response to therapy was determined by subjective improvement in pain and a decrease in clinical signs of ocular inflammation. All patients received subconjunctival injections of triamcinolone by the same technique, and the minimum observation period for complications was 6 weeks. Results: Eighteen patients (90%) had relief of their symptoms with clinically observable improvement in inflammation, whereas two patients (10%)responded poorly. Nine patients (45%)required no further therapy. Average symptom-free interval was 18 weeks in patients with recurrent scleritis. No complications of scleral thinning, perforation, or glaucoma occurred in any patients. Conclusion: Subconjunctival triamcinolone injection is highly efficacious in treating nonnecrotizing anterior scleritis without unreasonable risk of thinning and jor perforation and should be considered as adjunctive therapy in localized disease.
Beyond the Best Interests of a Child
Authors: William J. Curran
Journal: New England Journal of Medicine (1991)

Among the most sensitive tasks of our courts of law is dealing with disputes among parents over the best interests of children.1 The Illinois Supreme Court was recently faced with an unusual case in which one of the parties to such a dispute was a father attempting to save the life of a child critically ill with leukemia.2 The sick child was Jean Pierre, 12 years of age. He had been living with his father, Tamas Bosze, in Colombia, where his illness was misdiagnosed. A few months later, the boy and the father returned to the United States, and another . . .
Health-Information Altruists — A Potentially Critical Resource
Authors: Isaac S. Kohane, Russ B. Altman
Journal: New England Journal of Medicine (2005)

Although we have successfully sequenced the human genome, progress toward defining the genetic basis of disease has been limited by the availability of people willing to share their phenotypic information along with their genotypic information. In this article, the authors offer a proposal to increase participation in genetic studies.
Global Transcript Profiles of Fat in Monozygotic Twins Discordant for BMI: Pathways behind Acquired Obesity
Authors: Kirsi H Pietiläinen, Jussi Naukkarinen, Aila Rissanen, Juha Saharinen, Pekka Ellonen, Heli Keränen, Anu Suomalainen, Alexandra Götz, Tapani Suortti, Hannele Yki-Järvinen, Matej Orešič, Jaakko Kaprio, Leena Peltonen
Journal: PLoS Medicine (2008)

The acquired component of complex traits is difficult to dissect in humans. Obesity represents such a trait, in which the metabolic and molecular consequences emerge from complex interactions of genes and environment. With the substantial morbidity associated with obesity, a deeper understanding of the concurrent metabolic changes is of considerable importance. The goal of this study was to investigate this important acquired component and expose obesity-induced changes in biological pathways in an identical genetic background.We used a special study design of "clonal controls," rare monozygotic twins discordant for obesity identified through a national registry of 2,453 young, healthy twin pairs. A total of 14 pairs were studied (eight male, six female; white), with a mean +/- standard deviation (SD) age 25.8 +/- 1.4 y and a body mass index (BMI) difference 5.2 +/- 1.8 kg/m(2). Sequence analyses of mitochondrial DNA (mtDNA) in subcutaneous fat and peripheral leukocytes revealed no aberrant heteroplasmy between the co-twins. However, mtDNA copy number was reduced by 47% in the obese co-twin's fat. In addition, novel pathway analyses of the adipose tissue transcription profiles exposed significant down-regulation of mitochondrial branched-chain amino acid (BCAA) catabolism (p < 0.0001). In line with this finding, serum levels of insulin secretion-enhancing BCAAs were increased in obese male co-twins (9% increase, p = 0.025). Lending clinical relevance to the findings, in both sexes the observed aberrations in mitochondrial amino acid metabolism pathways in fat correlated closely with liver fat accumulation, insulin resistance, and hyperinsulinemia, early aberrations of acquired obesity in these healthy young adults.Our findings emphasize a substantial role of mitochondrial energy- and amino acid metabolism in obesity and development of insulin resistance.
Coeliac disease in the elderly.
Authors: G L Hankey, G K Holmes
Journal: Gut (1994)

Of 228 patients with adult coeliac disease, 42 (19%) were diagnosed aged 60 years or over. In this series, of 35 patients who did not have dermatitis herpetiformis, 15 had attended family doctors and hospital outpatient departments for an average of 28 years with unexplained symptoms or abnormalities in blood tests but the diagnosis of coeliac disease had been missed. This is unsatisfactory because these patients can both manage and respond to a gluten free diet. Thirty eight patients complied strictly with the diet with resolution of symptoms. Significant improvement in weight, haemoglobin, albumin, calcium, and alkaline phosphatase values after a year on the diet also occurred. Clinicians should be alert to the possibility of coeliac disease in the elderly particularly in patients with non-specific complaints in the presence of unexplained anaemia.
Landmark perspective: The landmark identical twin case
Authors: T. E. Starzl
Journal: JAMA (1984)

In the autumn of 1979, the 25th anniversary was observed in Boston of the kidney transplantation that was the subject of the LANDMARK ARTICLE by Merrill and co-workers<sup>1</sup>that is reproduced in this issue. All of the authors of the article were members of the Harvard Medical School Faculty serving at the Peter Bent Brigham Hospital, where research in renal transplantation had been an important activity for several preceding years and where such work has continued to the present time. The decision at these institutions to focus for a historical celebration on the first identical twin transplantation rather than some earlier or subsequent event revealed an in-house perception of the importance of the case that has been shared by outside students of medical history such as Groth<sup>2</sup>of Stockholm. Of the four authors, Merrill and Guild were internists. The specialty of nephrology was somewhere between nonexistent and fledgling.