tbuckley/cabot-search huggingface dataset:
The Decline in Coronary Artery Bypass Graft Surgery Mortality in New York State
Authors: Edward L. Hannan
Journal: JAMA (1995)

<h3>Objective.</h3> —To examine the longitudinal relationship between surgeon volume and in-hospital mortality for coronary artery bypass graft (CABG) surgery in New York State and to explain changes in mortality that occurred over time. <h3>Design.</h3> —Observation of clinically risk-adjusted operative mortality over time. <h3>Setting.</h3> —All 30 New York State hospitals in which CABG surgery was performed for 1989 through 1992. <h3>Patients.</h3> —All 57187 patients undergoing isolated CABG surgery in New York State in 1989 through 1992 in the 30 hospitals. <h3>Main Outcome Measures.</h3> —Actual, expected, and risk-adjusted mortality. <h3>Results.</h3> —Risk-adjusted in-hospital mortality decreased for all categories of surgeons. Low-volume surgeons (≤50 operations per year) experienced a 60% reduction in risk-adjusted mortality in the 4-year period, whereas the highest-volume surgeons (&gt;150 operations per year) experienced a 34% reduction. The percentage of patients undergoing CABG surgery by low-volume surgeons decreased from 7.6% in 1989 to 5.7% in 1992, a 25% decrease. <h3>Conclusions.</h3> —The overall decline in risk-adjusted mortality could not be explained by shifts in patients away from low-volume surgeons to high-volume surgeons. The proportionately larger decrease in risk-adjusted mortality for low-volume surgeons could not be explained by changes in patient case mix or by improvements in the performance of surgeons with persistently low volumes. Part of the decrease was a result of the exodus of low-volume surgeons with high risk-adjusted mortality (in all years studied), the markedly better performance of surgeons who were new to the system (especially in 1991 and 1992), and the performance of surgeons who were not consistently low-volume surgeons (especially in 1992). (<i>JAMA</i>. 1995;273:209-213)
Smoking-related interstitial lung diseases: a concise review
Authors: J.H. Ryu, T.V. Colby, T.E. Hartman, R. Vassallo
Journal: European Respiratory Journal (2001)

Interstitial lung diseases (also known as diffuse infiltrative lung diseases) are a heterogeneous group of parenchymal lung disorders of known or unknown cause. These disorders are usually associated with dyspnoea, diffuse lung infiltrates, and impaired gas exchange. The majority of interstitial lung diseases are of unknown cause. Known causes of interstitial lung disease include inhalation of organic and inorganic dusts as well as gases or fumes, drugs, radiation, and infections. This review summarizes the clinical, radiological, and histopathological features of four interstitial lung disorders that have been linked to smoking. These disorders include desquamative interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, pulmonary Langerhans' cell histiocytosis, and idiopathic pulmonary fibrosis. Available evidence suggests most cases of desquamative interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, and pulmonary Langerhans' cell histiocytosis are caused by cigarette smoking in susceptible individuals. Smoking cessation should be a main component in the initial therapeutic approach to smokers with these interstitial lung diseases. In addition, smoking appears to be a risk factor for the development of idiopathic pulmonary fibrosis.
Immunologic Studies of Serum Sickness from Bovine Antitetanus Toxin
Authors: Robert E. Reisman, Noel R. Rose, Carl E. Arbesman
Journal: JAMA (1961)

Administration of bovine tetanus antitoxin to a patient who was sensitive to horse serum was followed by serum disease. Immunological studies revealed a preexisting hemagglutinating antibody titer of 2,000 against horse serum, but none to bovine serum. After the onset of symptoms, both titers rose. The reaction against bovine serum reached a titer of 100,000. A transitory skin-sensitizing antibody against bovine serum was also produced. An alpha globulin component of bovine serum was found to be the precipitating antigen. Thus, this patient probably reacted to a serum fraction other than the active antitoxin. The results suggest an antigenic cross relationship between horse and beef sera, limiting the usefulness of bovine antitoxin. Greater use of toxoid could help eliminate the problem of serum reactions. Certainly, horse-serum sensitivity should make active immunization mandatory.
Effects of adenosine on atrial refractoriness and arrhythmias
Authors: G. Kabell, L. V Buchanan, J. K Gibson, L. Belardinelli
Journal: Cardiovascular Research (1994)

Objective: Transient atrial fibrillation is sometimes observed following adenosine administration and adenosine is known to shorten atrial action potential duration and refractory period. This study was designed to characterise the dose-response relationship of adenosine on these variables relative to arrhythmia induction with single atrial premature stimuli. The effects of adenosine during sustained atrial flutter were also determined. Methods: Intravenous bolus doses of adenosine were given to pentobarbitone anaesthetised dogs following cervical vagotomy and autonomic blockade with atropine and nadolol. Monophasic action potential catheter recordings were obtained from the right atrium and a programmable stimulator was used for pacing. Results: Placebo had no effect on monophasic action potential duration (MAPD) or atrial effective refractory period (ERP) and no arrhythmias were observed. Adenosine (0.1-1.0 mg·kg−1) produced dose related decreases in MAPD and ERP and transient atrial fibrillation (5-122 s) was repeatedly and reproducibly induced in 12 dogs. In six dogs, intravenous dipyridamole (0.25 mg·kg−1) enhanced the effects of adenosine on MAPD and ERP and increased the incidence of atrial fibrillation. In another six dogs, 8-sulphophenyltheophyIIine (5.0 mg·kg−1, intravenously) markedly blunted the effects of adenosine, and atrial fibrillation could no longer be induced by premature stimuli. In a separate series of experiments the effects of adenosine were evaluated in seven dogs in which sustained atrial flutter could reproducibly be induced by rapid atrial pacing. Administration of placebo never caused termination of the arrhythmia, whereas intravenous boluses of adenosine (0.1-1.0 mg·kg−1) decreased and produced variation in atrial flutter cycle length, and then terminated the arrhythmia in all cases. These effects of adenosine were also enhanced by dipyridamole and antagonised by 8-sulphophenyltheophylline. Conclusions: Adenosine produces a receptor mediated shortening of monophasic action potential duration and refractoriness which increases vulnerability to transient atrial arrhythmias. During sustained atrial flutter, these effects may also contribute to destabilisation and termination of the arrhythmia. Cardiovascular Research 1994;28:1385-1389
Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden.
Authors: L Lapidus, C Bengtsson, B Larsson, K Pennert, E Rybo, L Sjostrom
Journal: BMJ (1984)

A longitudinal population study of 1462 women aged 38-60 was carried out in Gothenburg, Sweden, in 1968-9. In univariate analysis the ratio of waist to hip circumference showed a significant positive association with the 12 year incidence of myocardial infarction, angina pectoris, stroke, and death. The association with incidence of myocardial infarction remained in multivariate analysis and was independent of age, body mass index, smoking habit, serum cholesterol concentration, serum triglyceride concentration, and systolic blood pressure. The relation between the ratio of waist to hip circumference and the end points of myocardial infarction, angina pectoris, stroke, and death was stronger than for any other anthropometric variable studied.
Frailty related aspects of care are under-recognised in UK medical curriculums
Authors: P. V. Knight, D. Oliver, Z. Wyrko, A. L. Gordon, G. Turner
Journal: BMJ (2014)

Patients presenting to the NHS are increasingly frail and affected by multiple comorbidities, polypharmacy, cognitive impairment, and physical dependency. Geraint and Fuller recently proposed a model of care for this cohort—recourse to multiple medical specialisms—which is not evidence based.1 One of the examples used to underline their argument, the Cochrane review of stroke unit care,2 is an exemplar of …
Comparison of the Double Two-Step Test and the Maximal Exercise Treadmill Test
Authors: SAMUEL BELLET, LAURIAN ROMAN
Journal: Circulation (1967)

A comparison of the double two-step test and a more strenuous type of exercise test was made to assess the value of the latter procedure in increasing the sensitivity of the electrocardiographic exercise test. In young, normal women, 17 to 20 years of age, who represent a group with minimal chances for significant silent coronary heart disease, both the double two-step test and graded maximal exercise tests were always normal. This is consistent with the view that ischemic electrocardiographic changes are not usually elicited in subjects with normal coronary circulation, even after strenuous exercise. In middle-aged men and women, 40 to 65 years of age, in whom the possible existence of clinically silent coronary heart disease was suggested by age and other parameters (atypical chest pain, hypertension, or diabetes, or all three), the maximal exercise test on the treadmill, as compared to the double two-step test, increased the yield of positive electrocardiographic results by 12%. These findings suggest that, in selected "coronary-prone" subjects on whom the double two-step test is negative, increasing the amount of exercise might be of value in the evaluation of the exercise test.
A new mutant erythrocyte glucosephosphate isomerase (GPI) associated with GSH abnormality
Authors: Alberto Zanella, Paolo Rebulla, Crescenzio Izzo, Francesco Zanuso, Girolamo Sirchia, Itzhak Kahane, Ermete Molinari
Journal: American Journal of Hematology (1978)

Abstract A case of congenital nonspherocytic haemolytic anaemia associated with a new abnormal glucosephosphate isomerase (GPI), GSH (reduced glutathione) deficiency, and instability and altered carbohydrate membrane composition is reported. The only functional abnormality of the mutant enzyme seems to be a marked instability to heat, urea, and guanidine‐HCl. Family studies suggest that the propositus is doubly heterozygous for a maternal gene producing an inactive enzyme and a paternal gene responsible for a structural alteration causing marked lability of the coded enzyme. Experiments of incubation of normal GPI and the propositus's GPI with oxidizing and reducing agents seem to indicate that the abnormality resides in the SH groups of the mutant GPI.
Noninvasive testing is done only in low risk patients with unstable angina and non-Q-wave Myocardial Infarction (MI): Results from GUSTO-IIa
Authors: Christopher B. Granger, Robert M. Califf, Paul W. Armstrong, Gail Haffey, Daniel B. Mark, Eric J. Topol
Journal: Journal of the American College of Cardiology (1996)
Contractile and coronary vascular effects of pituitary adenylate cyclase activating polypeptide in neonatal pig hearts
Authors: Robert J. Ascuitto, Nancy T. Ross-Ascuitto, Alice E. Waddell, Phillip J. Kadowitz
Journal: Cardiovascular Research (1996)

The purpose was to investigate the influence of the 38-amino-acid neuropeptide, pituitary adenylate cyclase activating polypeptide (PACAP38), on contractile function and coronary vascular tone in neonatal hearts.Isolated, paced (150 bpm), isovolumically-beating, piglet hearts (n = 19) underwent retrograde aortic perfusion at constant coronary flow (approximately 2.5 ml/min/gwet) with an erythrocyte-enriched (Hct 15-20%) solution (37 degrees C). Agonists were injected into the aortic root of hearts, and the changes in +dP/dtmax and -dP/dtmax (reflecting contractility), and coronary perfusion pressure (reflecting vascular tone) were determined. Responses to PAPCAP38 were compared to isoproterenol, and to the truncated peptide PACAP6-38.PACAP38 (0.1 and 0.5 nmol) increased +dP/dtmax from 1387.4 +/- 134.6 to 1619.0 +/- 118.7, and from 1296.2 +/- 93.4 to 1872.2 +/- 111.4 mmHg/s (P < 0.05); changed -dP/dtmax from -1087.6 +/- 107.5 to -1206.6 +/- 93.6, and from -1025.0 +/- 46.8 to -1375.4 +/- 80.9 mmHg/s (P < 0.05) and decreased coronary perfusion pressure from 61.8 +/- 2.5 to 51.0 +/- 3.8, and from 62.5 +/- 1.0 to 45.3 +/- 3.3 mmHg (P < 0.005), respectively. In comparison, isoproterenol (0.1 nmol) increased +dP/dtmax from 1313.6 +/- 62.8 to 1679.0 +/- 74.4 (P < 0.05), and -dP/dtmax from -1026.4 +/- 54.1 to -1222.6 +/- 57.4 mmHg/s (P < 0.05). PACAP6-38 reduced PACAP38's coronary vasodilatory, but not its contractile, effect. When compared to our previous studies of the 27-amino-acid neuropeptide PACAP27, PACAP38 had less potent contractile, but similar vasodilatory effects.PACAP38 enhanced contractility and produced coronary vasodilation in piglet hearts, which may make PACAP38 a promising cardiotonic agent for the treatment of neonates with heart failure.
Ambient Particulate Matter Air Pollution and Venous Thromboembolism in the Women’s Health Initiative Hormone Therapy Trials
Authors: Regina A. Shih, Beth Ann Griffin, Nicholas Salkowski, Adria Jewell, Christine Eibner, Chloe E. Bird, Duanping Liao, Mary Cushman, Helene G. Margolis, Charles B. Eaton, Eric A. Whitsel
Journal: Environmental Health Perspectives (2010)

BackgroundThe putative effects of postmenopausal hormone therapy on the association between particulate matter (PM) air pollution and venous thromboembolism (VTE) have not been assessed in a randomized trial of hormone therapy, despite its widespread use among postmenopausal women.ObjectiveIn this study, we examined whether hormone therapy modifies the association of PM with VTE risk.MethodsPostmenopausal women 50–79 years of age (n = 26,450) who did not have a history of VTE and who were not taking anticoagulants were enrolled in the Women's Health Initiative Hormone Therapy trials at 40 geographically diverse U.S. clinical centers. The women were randomized to treatment with estrogen versus placebo (E trial) or to estrogen plus progestin versus placebo (E + P trial). We used age-stratified Cox proportional hazard models to examine the association between time to incident, centrally adjudicated VTE, and daily mean PM concentrations spatially interpolated at geocoded addresses of the participants and averaged over 1, 7, 30, and 365 days.ResultsDuring the follow-up period (mean, 7.7 years), 508 participants (2.0%) had VTEs at a rate of 2.6 events per 1,000 person-years. Unadjusted and covariate-adjusted VTE risk was not associated with concentrations of PM < 2.5 μm (PM2.5) or < 10 μm (PM10)] in aerodynamic diameter and PM × active treatment interactions were not statistically significant (p > 0.05) regardless of PM averaging period, either before or after combining data from both trials [e.g., combined trial-adjusted hazard ratios (95% confidence intervals) per 10 μg/m3 increase in annual mean PM2.5 and PM10, were 0.93 (0.54–1.60) and 1.05 (0.72–1.53), respectively]. Findings were insensitive to alternative exposure metrics, outcome definitions, time scales, analytic methods, and censoring dates.ConclusionsIn contrast to prior research, our findings provide little evidence of an association between short-term or long-term PM exposure and VTE, or clinically important modification by randomized exposure to exogenous estrogens among postmenopausal women.
Gall stones and treatment with octreotide for acromegaly
Authors: J A H Wass, J V Anderson, G M Besser, R H Dowling
Journal: BMJ (1989)

show increased direct catabolism of VLDL apo- lipoprotein B without conversion to low density lipoprotein resulting in lower concentrations of total and low density lipoprotein cholesterol than in white people.Whether such compensatory mechanisms operate in other ethnic groups is not known, but the lipid/lipoprotein patterns found in Asians suggest that they do not.In Afro-Caribbean people (who currently have low rates of coronary disease) similar patterns to those in the Pima Indians are found, but in black Americans (in whom insulin resistance and high rates of coronary disease and diabetes now occur) the lipid profile is closer to that of white Americans.56Contrary to Professor Jarrett's negative view of current hypotheses, there is much in favour of the C peptide-insulin-atheroma link, particularly if data from in vitro experiments on insulin-like growth factors and homologous peptides are in- cluded.Refinements and novel approaches to these ethnic differences, rather than the guillotine, are required.Vive la difference!
Sex ratios in healthcare occupations: population based study
Authors: V. J Grant
Journal: BMJ (2004)

research that requires only answering questions, without risk of psychological distress. 5The sooner this concept is implemented by committeees in all countries, the sooner we can stop unnecessary applications which are both risky and costly.I thank the research partners from the IMPROVE project who completed the survey questionnaire.I also thank the referee of the first version.
Treatment of Vesicoureteral Reflux
Authors: Lester Persky
Journal: New England Journal of Medicine (1969)

Ureteral reflux has been a subject of major concern to all physicians dealing with recurrent urinary-tract sepsis. Internists as well as urologists and pediatricians have dealt with this problem since ureteral reflux may also be the cause of persistent infection in the adult as well as the child. Despite intensive efforts by a variety of investigators, including clinicians, anatomists and physiologists, and despite a host of publications dealing with this problem no true unanimity of opinion concerning management seems to have evolved. The disparate theories about etiology, treatment and cause were reflected in the three-day workshops on ureteral reflux in . . .
Carcinoma of the larynx in two patients with keratoacanthoma
Authors: R.S. CHAPMAN, O.A. FINN
Journal: British Journal of Dermatology (1974)

Two cases of poorly differentiated squamous cell carcinoma of the larynx are described, one occurring in a patient with a solitary keratoacanthoma, the other in a patient with multiple keratoacanthomas. Investigation and treatment in the conventional manner are strongly advised. Any temptation to delay, based on the rare entity of benign eruptive keratoacanthoma, should be resisted.
Addition of rifampicin in persistent Haemophilus influenzae type B meningitis.
Authors: M A Lewis, B L Priestley
Journal: BMJ (1986)

Biochemical data (mean (SD)) on control group and group who collapsed at end ofhalf marathon Group who Laboratory Control group collapsed reference (n=63) (n=34) p* range Age(years) 31-1(8-4) 27-9(7 4) NS Sodium (mmol/l) 143-3(1-7) 144-1 (2-7) NS 134-147 Potassium (mmol/l) 4-25 (0 45) 4-24 (0-52) NS 3-5-5-0 Chloride (mmol/l) 103-9 (2-6) 103 3 (2-6) NS %-106 Total carbon dioxide (mmol/l) 21-7 (2-4) 18-7 (3-0) <0 001 22-29 Anion gap ( mmol/l) 21-8 (2 3) 26-3 (4-0) <0 001 12-20 Urea (mmol/l) 6-40(1-08) 6-76(1-33) NS 1-5-7-0 Creatinine (mol/l) 137 (19) 164 (31) <0 001 53-125 Glucose (mmol/l) 4-77 (1-35) 4-62 (122) NS 3 5-5 0 Lactate(mmol/l) 3-7(1-9) 7-1 (3-7) <0 001 0-6-2-4 Calcium(mmol/l) 2 57(0-14) 2-63 (0-23) NS 2-25-2 75 Phosphate (mmol/l) 1 02 (020) 0-69 (033) <0 001 0-65-1-30 Alkaline phosphatase (U/l)t 78 (18) 73 (17) NS 30-130 Total protein (g/l) 78 5 (3-4) 79-2 (7 5) NS 60-80 Albumin (g/l) 47-5 (2-1) 48-8 (5-0) NS 34-50 Aspartate transaminase (U/l)t 31 (9) 30 (8) NS <37 Creatine kinase (U/l)t 245 (110) 266 (95) NS <175 Lactate dehydrogenase (U/l)t 517 (83) 618 (178) <0 005 <430 * Student's t test with Cochran's correction for unequal variances.t Measured at 37°C.Conversion: SI to traditional units-Sodium, potassium, chloride, total carbon dioxide:1 mmol/l=l mEq/l.Urea: 1 mmol/Il6 mg/100 ml.Creatinine: 1 smol/l 11-3 [sg/I00 ml.Glucose: 1 mmol/lz 18 mg/100 ml.Lactate: 1 mmol/1=9 mg/100 ml.Calcium: 1 mmol/l=4 mg/100 ml.Phosphate: 1 mmol/l-3 1 mg/100 ml.(0 9 mg/100 ml) after 50 minutes) was still hypophosphataemic (0 54 mmol/l (1-7 mg/100 ml)) 24 hours later but was able to return to work on the second day after the run.
Surgical correction of nasal obstruction in the treatment of mild sleep apnoea: importance of cephalometry in predicting outcome.
Authors: F Series, S St Pierre, G Carrier
Journal: Thorax (1993)

BACKGROUND--A study was undertaken to determine if cephalometric radiographs could identify those who will benefit from nasal surgery in patients with a sleep apnoea hypopnoea syndrome (SAHS) and chronic nasal obstruction. METHODS--Fourteen patients with SAHS were enrolled. Those with normal posterior airway space and mandibular plane to hyoid bone distances on preoperative cephalometric radiographs were matched with those with abnormal cephalometry for the frequency of sleep disordered breathing and body mass index. Polysomnographic studies (all subjects) and nasal resistance measurements (n = 10) were performed one to three months before and two to three months after surgery (septoplasty, turbinectomy, and polypectomy). RESULTS--There was no difference in the baseline results of the polysomnographic studies between the two groups of patients. Nasal resistance decreased from a mean (SE) value of 2.9 (0.3) cm H2O/l/s before surgery to 1.4 (0.1) cm H2O/l/s after surgery in the normal cephalometry group and from 2.7 (0.3) cm H2O/l/s to 1.3 (0.3) cm H2O/l/s in the other group. The apnoea + hypopnoea index returned to normal (&lt; 10 breathing abnormalities/hour) in all but one subject with normal cephalometric measurements, and sleep fragmentation improved with a decrease in the arousal index from 23.9 (3.3)/hour at baseline to 10.6 (2.5)/hour after surgery. Both of these parameters remained unchanged after surgery in the patients with abnormal cephalometry. CONCLUSIONS--Normal cephalometry is helpful in identifying patients with mild SAHS and nasal obstruction who will benefit from nasal surgery. The presence of craniomandibular abnormalities makes it unlikely that nasal surgery will improve sleep related breathing abnormalities.
ACUTE TOXIC NEPHRITIS COMPLICATING ACUTE OBSTRUCTION OF THE SMALL INTESTINE
Authors: N. I. Fox
Journal: JAMA (1931)

S. B., a Negro, aged 24, was admitted, April 14, 1930, to the surgical services of the Cook County Hospital, Chicago, because of a swelling in the right inguinal region, vomiting, and severe abdominal cramps for the past twenty-four hours. The patient stated that he had had a right inguinal hernia for the past two years. The day before, about 2 p. m., he suddenly developed a sharp, colicky pain in the right inguinal region. An hour later he noticed a round, hard and tender mass in the same area. The pain was followed soon by nausea and vomiting, the vomitus consisting of food material and mucus. About 3 o'clock the pain had spread over the entire abdomen and was especially marked around the umbilicus. He vomited again at 5 and at 6 a considerable amount of grayish material. He tried to go to sleep but was awakened again by