tbuckley/cabot-search huggingface dataset:
Letting intrauterine devices lie
Authors: A J Eynon-Lewis
Journal: BMJ (1982)

in the first 12 months,7 a comparison of the curves beginning after year 1 may be con- founded by variables related to survival.A number of presumably high-risk patients in the beta-blocker group were saved in the first year, most probably resulting in a patient population on that treatment which was, on average, sicker than that on placebo after one year.Thus, parallel and even converging curves beyond one year could be consistent with continued benefit.In addition, we do not know what would happen if the treatment were stopped at one year.Rose9 has posed the question, "Do beta-blockers merely keep the wolf from the door, and when protection is withdrawn, does he retum ?"We tend to conclude from the absolute difference in the number of deaths between the beta-blocker and placebo groups at the end of a trial how many lives had been prolonged.The results from the Norwegian timolol trial could imply that 54 deaths (152 minus 98) were delayed by an average of at least 17 months.Another interpretation could be that more than 150 patients had their lives prolonged by an average of six months.We have no way of knowing with certainty over what period of time during the entire patient follow-up protection is provided-that is, when the door is closed on the wolf.For these reasons, it seems prudent to recommend beta-blocker treatment to survivors of a heart attack for at least three years, the duration of the trial7 which followed patients for the longest time.
The Influence of Consensus on the Assessment of Physical Disease in Chronic Community Psychiatric Patients
Authors: A. Honig, E.S. Tan, P. Pop, H. Philipsen, R. de Wit, P. van Pelt
Journal: Psychotherapy and Psychosomatics (1989)

Physical disease is a frequent concomitant of mental disease. The majority of chronic psychiatric patients have physical complaints. Screening physical disease on a regular basis in an ambulatory setting for chronic psychiatric patients is often impossible if only for lack of medical manpower and facilities. Especially for the nonmedical personnel of a community psychiatric unit (CPU) for chronic patients, approaching and handling physical complaints and diseases poses a formidable problem. This paper addresses the issue of screening physical disease from a completely different viewpoint than that of the often advocated but just as often infeasible routine physical examination and laboratory workup. It is argued that consensus (i.e., agreement and mutual understanding) between patient and therapist on the physical well-being of the patient may increase the accuracy with which a CPU therapist, irrespective of his/her discipline, assesses physical disease. This hypothesis was tested in a sample of 156 chronic ambulatory psychiatric patients. Consensus between patient and CPU therapist was measured by means of a questionnaire. The CPU therapist assessment on physical disease in both the consensus and no consensus group was compared with those of two external medical observers; the patients' general practitioner and a specialist in internal medicine, who followed a protocolized physical screening procedure. The results tend to support the proposed hypothesis. Replication of this study using a larger samples is recommended in order to confirm the value of consensus in the assessment of physical disease in at least some subgroups of chronic ambulatory psychiatric patients and for the implications that consensus could have for daily community psychiatric practice.
Transesophageal Echocardiography: Useful Tool or Expensive Toy?
Authors: Claudia Stollberger
Journal: Annals of Internal Medicine (1998)

Letters1 November 1998Transesophageal Echocardiography: Useful Tool or Expensive Toy?Claudia Stollberger, MD and Josef Finsterer, MDClaudia Stollberger, MDFor the ELAT Study Group; A-1030 Vienna, AustriaSearch for more papers by this author and Josef Finsterer, MDFor the ELAT Study Group; A-1030 Vienna, AustriaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-129-9-199811010-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:It is questionable to draw common conclusions from two studies on atrial fibrillation that have different aims and inclusion criteria [1]. The SPAF-III study aimed to correlate TEE characteristics with subsequent stroke in patients with high risk for thromboembolism [2]. The ELAT study, an observational study, aimed to correlate TEE characteristics with subsequent thromboembolism in outpatients [3].The ELAT study assessed interobserver variabilities for atrial thrombi, spontaneous echocardiographic contrast, and left atrial appendage size; the SPAF-III study did not [4, 5]. Although criteria for thrombi differed between these studies, both studies showed that patients with atrial thrombi ...References1. Manning WJ, Douglas PS. Transesophageal echocardiography and atrial fibrillation: added value or expensive toy? [Editorial] Ann Intern Med. 1998; 128:685-7. Google Scholar2. Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Ann Intern Med. 1998; 128:639-47. Google Scholar3. Stollberger C, Chnupa P, Kronik G, Brainin M, Finsterer J, Schneider B, et al. Transesophageal echocardiography to assess embolic risk in patients with atrial fibrillation. Ann Intern Med. 1998; 128:630-8. Google Scholar4. ELAT study (Embolism in Left Atrial Thrombi): baseline clinical and echocardiographic data. Cardiology. 1995; 86:457-63. Google Scholar5. Kronik G, Stollberger C, Schuh M, Abzieher F, Slany J, Schneider B. Interobserver variability in the detection of spontaneous echo contrast, left atrial thrombi, and left atrial appendage thrombi by transesophageal echocardiography. Br Heart J. 1995; 74:80-3. Google Scholar Author, Article, and Disclosure InformationAuthors: Claudia Stollberger, MD; Josef Finsterer, MDAffiliations: For the ELAT Study Group; A-1030 Vienna, Austria PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1998Volume 129, Issue 9 Page: 749 Keywords Atrial fibrillation Echocardiography Heart failure Hypertension Longitudinal studies Multivariate analysis Observational studies Outpatients Stroke Thromboembolism ePublished: 15 August 2000 Issue Published: 1 November 1998 Copyright & PermissionsCopyright © 1998 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Cerebrospinal Fluid Leakage in Intracranial Hypotension Syndrome: Usefulness of Indirect Findings in Radionuclide Cisternography for Detection and Treatment Monitoring
Authors: Tomoaki Morioka, Takatoshi Aoki, Yoshinori Tomoda, Hiroyuki Takahashi, Shingo Kakeda, Iwao Takeshita, Masato Ohno, Yukunori Korogi
Journal: Clinical Nuclear Medicine (2008)

Purpose: To evaluate indirect findings of cerebrospinal fluid (CSF) leakage on radionuclide cisternography and their changes after treatment. Materials and Methods: This study was approved by the hospital's institutional review board and informed consent was obtained before each examination. A total of 67 patients who were clinically suspected of spontaneous intracranial hypotension (SIH) syndrome underwent radionuclide cisternography, and 27 patients who had direct findings of CSF leakage on radionuclide cisternography were selected for this evaluation. They were 16 males and 11 females, aged between 26 and 58 years. Sequential images of radionuclide cisternography were acquired at 1, 3, 5, and 24 hours after injection. We assessed the presence or absence of 4 indirect findings; early visualization of bladder activity, no visualization of activity over the brain convexities, rapid disappearance of spinal activity, and abnormal visualization of the root sleeves. Changes of the direct and indirect findings after treatment were also evaluated in 14 patients who underwent epidural blood patch treatment. Results: Early visualization of bladder activity was found in all 27 patients. Seven of 27 (25.9%) patients showed no activity over the brain convexities. Rapid disappearance of spinal activity and abnormal root sleeve visualization were present in 2 (7.4%) and 5 (18.5%) patients, respectively. After epidural blood patch, both direct CSF leakage findings and indirect findings of early visualization of bladder activity had disappeared or improved in 12 of 14 patients (85.7%). The other indirect findings also disappeared after treatment in all cases. Conclusion: Indirect findings of radionuclide cisternography, especially early visualization of bladder activity, may be useful in the diagnosis and posttreatment follow-up of CSF leakage.
Immune response to hepatitis B vaccine in staff and patients in renal dialysis units
Authors: Fernanda Bergamini, Alessandro Remo Zanetti, Pierino Ferroni, Elisabetta Tanzi, Luigi Minetti, Angelo Perego, Giovanni Civati, Giuliano Mecca, Romana Licini, Fabio Sereni, Luciana Ghio, Paola Piccoli
Journal: Journal of Infection (1983)
Characterization of cytotoxic effect of asbestos on normal human fibroblasts.
Authors: M J Chang, N P Singh, A Turturro, R W Hart
Journal: Environmental Health Perspectives (1983)

Using viable cell counting and the incorporation of radioactive thymidine in cell TCA precipitate, we have attempted to separate the effects of asbestos on cell growth inhibition (reproductive failure) vs. cell killing. NIEHS crocidolite and NIEHS intermediate-sized chrysotile at a concentration of 10 micrograms/mL were studied. Cytotoxic effects were demonstrated with both types of asbestos. Thymidine incorporation expressed as cpm/viable cell was enhanced in the presence of either form of asbestos. It is concluded that both negatively charged crocidolite and positively charged chrysotile are toxic to human fibroblast cells in culture and exert their cell killing but not growth inhibition effect concurrently with a stimulation of DNA synthesis.
Role of Nitric Oxide in the Regulation of Cerebral Blood Flow in Humans
Authors: Shahar Lavi, Rania Egbarya, Ronit Lavi, Giris Jacob
Journal: Circulation (2003)

Background— From animal studies it emerged that nitric oxide is important for the modulation of CO 2 -mediated cerebral blood flow (CBF chemoregulation) but not for the pressor-dependent mechanism (mechanoregulation). This hypothesis was tested in 18 healthy subjects. Methods and Results— Peak velocity (PV), diastolic velocity (DV), and mean velocity (MV) were measured by transcranial Doppler of the middle cerebral artery. Chemoregulation was assessed during normocapnia, hypocapnia, and after inhaled mixture of 95% O 2 +5% CO 2 . Mechanoregulation was evaluated by incremental doses of phenylephrine. Measurements were repeated during infusion of sodium nitroprusside (SNP). Regional cerebrovascular resistance (CVR) was calculated as mean blood pressure (BP)/MV. SNP infusion decreased mean BP by 7 mm Hg and CVR decreased from 1.38±0.08 to 1.29±0.09 mm Hg/cm · s −1 ; P =0.01, resulting in unaffected CBF. Phenylephrine (25 to 250 μg) caused a similar increase in BP in a dose-response fashion before and during SNP infusion. Despite the increments in BP and CVR, CBF remained unaffected. During hyperventilation (end-tidal CO 2 ≈24 mm Hg), CVR increased by 75±3% and PV and DV decreased by 27±2% and 43±2%, respectively ( P &lt;0.001 for all). SNP infusion blunted the vasoconstrictive effect of hypocapnia; CVR increased only by 57±5%, and PV and DV decreased by 23±2% and 35±3%, respectively, ( P &lt;0.05 for all). Similarly, SNP augmented the vasodilatory effect of hypercapnia. Conclusions— Exogenous nitric oxide donor affects the basal cerebral vascular tone without affecting the CBF mechanoregulation. However, it selectively affects only the chemoregulatory mechanism (CO 2 -dependent). Thus, the CO 2 -NO axis is a cardinal pathway for CBF regulation in humans.
AN OPERATION FOR CYSTOCELE.
Authors: GEORGE H. NOBLE
Journal: JAMA (1901)

The necessity of operating for cystocele, either with or without plastic operations, of the female genital tract, is not an infrequent occurrence. The unsatisfactory results of operations usually employed, especially in old women with relaxed and dilated vaginal outlets, are frequent. Usually failure is due to stretching of the newly formed cicatrix, or to imperfect attachment when the base of the bladder is anchored to structures above the plane of the anterior vaginal wall. In the absence of dense fascia in this part of the genital canal the repair of cystocele must depend upon the fixation of soft yielding structures to similar parts, but should be reinforced by ample support from the posterior vaginal wall and perineum, and in certain cases with ventrosuspension or some similar operation. Even then the results are not invariably good. This, with the fact that extensive operations in old women are objectionable, makes an urgent
Arterial Pressure Responses to Discontinuing Antihypertensive Drugs
Authors: HARRIET P. DUSTAN, IRVINE H. PAGE, ROBERT C. TARAZI, EDWARD D. FROHLICH
Journal: Circulation (1968)

A wide spectrum of arterial pressure responses to discontinuing long-term antihypertensive drug treatment was found in 65 patients. In five, spontaneous pressure variations prevented judging effects of drug discontinuance. Of the remaining 60, pressure returned to pretreatment levels in 21, and rose toward control levels in 37; while in two, diastolic hypertension did not reappear in more than 8 years. Rate of rise of arterial pressure seemed related to type of hypertension and to height of diastolic pressure and severity of vascular disease before treatment. In six of nine patients who had had malignant hypertension and six of nine with renal arterial disease, pressure rose promptly and treatment was restarted within a month. Among essential hypertensive patients, those who remained off treatment for 2 to 6 months had significantly lower pretreatment pressure than those whose hypertension returned in less than 2 months. The two whose diastolic hypertension seemed "cured" had no distinguishing features. These results suggest that most hypertensive patients require continuous treatment for good pressure control; downward resetting of pressure by treatment is rare.
440 PROGNOSIS OF CRITICALLY ILL CIRRHOTIC PATIENTS UNDERGOING MECHANICAL VENTILATION: IMPLICATIONS FOR THE MANAGEMENT OF ACUTE-ON- CHRONIC LIVER FAILURE
Authors: W. Abdel Razek, C. Francoz, R. Moreau, A. Pironti, C. Paugam-Burtz, J. Mantz, D. Valla, F. Durand
Journal: Journal of Hepatology (2009)
Abnormal Amygdala Resting-State Functional Connectivity in Adolescent Depression
Authors: Kathryn R. Cullen, Melinda K. Westlund, Bonnie Klimes-Dougan, Bryon A. Mueller, Alaa Houri, Lynn E. Eberly, Kelvin O. Lim
Journal: JAMA Psychiatry (2014)

<h3>Importance</h3> Major depressive disorder (MDD) frequently emerges during adolescence and can lead to persistent illness, disability, and suicide. The maturational changes that take place in the brain during adolescence underscore the importance of examining neurobiological mechanisms during this time of early illness. However, neural mechanisms of depression in adolescents have been understudied. Research has implicated the amygdala in emotion processing in mood disorders, and adult depression studies have suggested amygdala-frontal connectivity deficits. Resting-state functional magnetic resonance imaging is an advanced tool that can be used to probe neural networks and identify brain-behavior relationships. <h3>Objective</h3> To examine amygdala resting-state functional connectivity (RSFC) in adolescents with and without MDD using resting-state functional magnetic resonance imaging as well as how amygdala RSFC relates to a broad range of symptom dimensions. <h3>Design, Setting, and Participants</h3> A cross-sectional resting-state functional magnetic resonance imaging study was conducted within a depression research program at an academic medical center. Participants included 41 adolescents and young adults aged 12 to 19 years with MDD and 29 healthy adolescents (frequency matched on age and sex) with no psychiatric diagnoses. <h3>Main Outcomes and Measures</h3> Using a whole-brain functional connectivity approach, we examined the correlation of spontaneous fluctuation of the blood oxygen level–dependent signal of each voxel in the whole brain with that of the amygdala. <h3>Results</h3> Adolescents with MDD showed lower positive RSFC between the amygdala and hippocampus, parahippocampus, and brainstem (<i>z</i>&gt;2.3, corrected<i>P</i>&lt; .05); this connectivity was inversely correlated with general depression (<i>R</i> = −.523,<i>P</i> = .01), dysphoria (<i>R</i> = −.455,<i>P</i> = .05), and lassitude (<i>R</i> = −.449,<i>P</i> = .05) and was positively correlated with well-being (<i>R</i> = .470,<i>P</i> = .03). Patients also demonstrated greater (positive) amygdala-precuneus RSFC (<i>z</i>&gt;2.3, corrected<i>P</i>&lt; .05) in contrast to negative amygdala-precuneus RSFC in the adolescents serving as controls. <h3>Conclusions and Relevance</h3> Impaired amygdala-hippocampal/brainstem and amygdala-precuneus RSFC have not previously been highlighted in depression and may be unique to adolescent MDD. These circuits are important for different aspects of memory and self-processing and for modulation of physiologic responses to emotion. The findings suggest potential mechanisms underlying both mood and vegetative symptoms, potentially via impaired processing of memories and visceral signals that spontaneously arise during rest, contributing to the persistent symptoms experienced by adolescents with depression.
Further Application of Electric Countershock in Ventricular Tachycardia
Authors: Joseph P. Crehan
Journal: JAMA (1962)

THE EFFICACY of external electric countershock in the termination of ventricular tachycardia has been confirmed. These reports are concerned with medical patients in whom the arrhythmia varied in duration from 9 hours to 22 days, and circulatory collapse, congestive failure, and resistance to drug therapy called for more immediately effective measures. Our experience deals with a surgical patient whose arrhythmia occurred during the induction of anesthesia. Although shock was a prominent feature, congestive failure was not evident. The arrhythmia was of 2 hours' duration, and drug therapy had produced signs of toxicity. Since the patient was in the operating room and anesthetized, electric countershock could be applied without further preparation. Report of a Case A 62-year-old man was admitted to the hospital for reconstructive surgery of a hip. The history revealed 2 attacks of myocardial infarction, 9 and 6 years previously. When examined 3 weeks before admission, the patient was
T–cell mediated rejection of gene–modified HIV–specific cytotoxic T lymphocytes in HIV–infected patients
Authors: Stanley R. Riddell, Mark Elliott, Deborah A. Lewinsohn, Mark J. Gilbert, Linda Wilson, Sara A. Manley, Stephen D. Lupton, Robert W. Overell, Thomas C. Reynolds, Lawrence Corey, Philip D. Greenberg
Journal: Nature Medicine (1996)
Medicosocial aspects of depopulation in Belarus
Authors: S V Kondrichin
Journal: BMJ (1997)

CONSORT statement on the reporting standards of clinical trials Recommendations are inappropriate for trial reportsEditor-In his editorial on the CONSORT statement Douglas G Altman states that since "only randomised trials have the potential directly to affect patient care ... it is ... reasonable to require higher standards for papers reporting randomised trials than those describing other types of study." 1 But although randomised trials are usually the preferred approach for the unbiased evaluation of treatments, non-randomised observational studies also influence treatment.Because the correct interpretation of observational studies is much more difficult, largely due to uncontrollable biases, their description and analysis call for at least as much care as do randomised trials.Sometimes, of course, randomised comparisons are unnecessary-for example, to determine the value of fetoprotein screening for neural tube defects.CONSORT is the product of deliberations conducted almost entirely through North American journals. 2Journal editors and statisticians are well represented among those involved, but clinicians and others with experience in actually conducting trials less so.Experience of the procedures recommended seems to be limited and not wholly positive.The authors of one trial report who had been persuaded to rewrite it 3 in the structured format expressed mixed feelings: the paper was rendered less readable with "ideas that are logically linked together (such as point estimates with 95% confidence intervals) torn asunder." 4 Inflexibility and a lengthier manuscript were other reported disadvantages.The editor stated that a journal "should change the way it structures articles only when there is good agreement on the new format in the communities we serve" 4 ; this includes writers and readers of trial reports as well as editors.Feedback from the test case 3 or from other commentators does not seem to have materially altered the final version of CONSORT.By announcing its decision, less than a fortnight after publication of CONSORT, the BMJ pre-empted input from many with experience of planning, conducting, and reporting trials.Few will dispute the need for improvements in the reporting of all studies with implications for patient care, whatever their design.But without appropriate consultation, the BMJ seems to have made its decision on CONSORT prematurely.The requirement that randomised trials report the numbers of patients excluded is generally pointless, 5 and making authors indicate where a large number of checklist items are dealt with would be unduly prescriptive.The CONSORT recommendations should not be imposed unilaterally.Others with experience of trial conduct should be consulted on the nature of any guidelines for the reporting of randomised trials and, more importantly, of observational studies of treatments.
Role of endothelium-derived relaxing factor and prostaglandins in responses of coronary arteries to thromboxane in vivo.
Authors: K Szwajkun, K G Lamping, W P Dole
Journal: Circulation Research (1990)

We examined the relative contribution of endothelial and vascular smooth muscle-derived prostaglandins and endothelium-derived relaxing factor in modulating both the large coronary artery and resistance vessel responses to thromboxane in vivo. Vascular responses to the thromboxane analogue U46619 were measured in four separate experimental protocols: 1) The vascular responses were measured in the presence and absence of intact endothelium to examine the role of endothelium-derived vasodilators. 2) Responses were measured in the presence of intact endothelium before and after inhibition of cyclooxygenase with indomethacin to examine the role of endothelial and vascular smooth muscle-derived prostaglandins. 3) Responses were measured after endothelial removal before and after indomethacin to examine the role of vascular smooth muscle-derived prostaglandins. 4) Responses were measured after indomethacin and before and after removal of endothelium to examine the role of endothelium-derived relaxing factor. In anesthetized dogs (n = 41) that underwent constant pressure perfusion of the left anterior descending coronary artery (LAD), LAD diameter was measured with sonomicrometer crystals, and coronary flow was measured with an electromagnetic flow probe. Intracoronary infusion of U46619 (0.01-1.0 microgram/min) produced a dose-dependent constriction of LAD. Constriction of the LAD was augmented after endothelial removal, after indomethacin treatment in both the presence and absence of endothelium, and after removal of the endothelium in the presence of indomethacin. Inhibition of prostaglandin synthesis had the greatest effect of augmenting constriction of LAD to thromboxane. Coronary flow was decreased by U46619 only in the presence of indomethacin.(ABSTRACT TRUNCATED AT 250 WORDS)