tbuckley/cabot-search huggingface dataset:
PTH-015 Post-ercp Pancreatitis In Secondary Care: Can We Predict Who Would Benefit From A Prophylactic Pancreatic Stent?
Authors: O Old, TJ Hardy, D Hewin, H Barr, J Brown
Journal: Gut (2014)

<h3>Introduction</h3> Pancreatitis is a recognised complication of ERCP. Measures taken to reduce the incidence in high-risk patients include placement of prophylactic pancreatic stents and use of NSAIDs, but current practice varies widely. The frequency of post-ERCP pancreatitis (PEP) in unselected groups ranges from 1.3–6.7% in the largest reported series. Historically, prophylactic stents have not been used at our institution. This retrospective study was designed firstly to measure rates of PEP in our institution (a district general hospital), and secondly to identify those cases which may have benefitted from prophylactic pancreatic stenting. <h3>Methods</h3> A retrospective database search identified all patients undergoing ERCP across our Trust over a 5-year period (April 2007 to July 2012). A linked search with a county-wide biochemistry database then identified all those patients who had subsequently developed an elevated serum amylase up to 7 days following ERCP. A consensus grading system was used to define PEP as: clinical pancreatitis (new/worsened abdominal pain), requiring or prolonging hospital admission by ≥2 days, with serum amylase over 3 times upper limit of normal &gt;24 h post procedure (300 units/l). Additional risk factors for post-ERCP pancreatitis were identified: previous PEP, Sphincter of Oddi dysfunction, repeated cannulation, injection of contrast into pancreatic duct, Sphincter of Oddi manometry, balloon dilatation, precut sphincterotomy, or pancreatic sphincterotomy. <h3>Results</h3> 2699 patients underwent ERCP during the study period. 6 patients were excluded due to incomplete records. 57 patients with elevated serum amylase went on to notes review, of whom 36 (20 female, mean age 61) were determined to have clinical pancreatitis i.e. 1.3% of all patients undergoing ERCP. Of those with pancreatitis, 4 procedures had a complexity grading of Level 1, 27 of level 2, and 1 case of level 3. In 4 cases the endoscopist was unable to cannulate the CBD. None of the patients received prophylactic NSAIDs at the time of procedure. 3 patients required ITU admission and there were 2 deaths. In 14 cases of PEP (39%), risk factors were present that could be considered an indication for prophylactic stenting, i.e. 0.52% of all patients undergoing ERCP. <h3>Conclusion</h3> 2699 ERCP procedures were performed, no prophylactic stents were placed, but pancreatitis occurred as a complication in only 1.3% of procedures. Fewer than half of these patients would have been considered candidates for pancreatic stenting if available. With such a low baseline rate of PEP, the introduction of pancreatic stents should be appropriately selective in high-risk patients only, and NSAIDs considered in all high-risk patients without contraindications. <h3>Reference</h3> Freeman ML. Gastroenterol Hepatol 2012;8(9):618–20 <h3>Disclosure of Interest</h3> None Declared.
Health network will work to reduce poverty
Authors: E. Kalbfuss
Journal: BMJ (1995)

A group of health professionals has decided to set up a worldwide network to try to influence political leaders and policy makers to act to reduce poverty. Citing the link between poverty and ill health in the developing and industrialised world, representatives of Action in International Medicine (AIM) and the World Health Organisation (WHO) have called on doctors and nurses to become more politically involved.

“We truly believe we're facing a global health crisis,” Dr John Martin, deputy director …
Clinical course of hepatitis C virus during the first decade of infection: cohort study
Authors: H. E Harris
Journal: BMJ (2002)

IL-15 is a common γ-chain cytokine that has been shown to be more active than IL-2 in several murine cancer immunotherapy models. Although T lymphocytes do not produce IL-15, murine lymphocytes carrying an IL-15 transgene demonstrated superior antitumor activity in the immunotherapy of B16 melanoma. Thus, we sought to investigate the biological impact of constitutive IL-15 expression by human lymphocytes. In this report we describe the generation of a retroviral vector encoding a codon-optimized IL-15 gene. Alternate codon usage significantly enhanced the translational efficiency of this tightly regulated gene in retroviral vector-transduced cells. Activated human CD4<sup>+</sup> and CD8<sup>+</sup> human lymphocytes expressed IL-15Rα and produced high levels of cytokine upon retroviral transduction with the IL-15 vector. IL-15-transduced lymphocytes remained viable for up to 180 days in the absence of exogenous cytokine. IL-15 vector-transduced T cells showed continued proliferation after cytokine withdrawal and resistance to apoptosis while retaining specific Ag recognition. In the setting of adoptive cell transfer, IL-15-transduced lymphocytes may prolong lymphocyte survival in vivo and could potentially enhance antitumor activity.
Neurologic Disturbances with Folic Acid Therapy
Authors: Philip F. Wagley
Journal: New England Journal of Medicine (1948)

THERE are numerous reports in the literature of the past two years on the excellent results obtained with folic acid in the treatment of pernicious anemia, sprue and nutritional macrocytic anemias. The observations presented below suggest some limitations of the therapeutic value of folic acid‡ and indicate that its use, in the present state of knowledge, for the treatment of pernicious anemia entails a definite risk.Material and ObservationsFourteen cases of macrocytic anemia, 10 of pernicious anemia, 1 of tropical sprue, 2 of nontropical sprue, and 1 of macrocytic anemia associated with total gastrectomy were studied. Pernicious Anemia Cases . . .
Tender Teeth: Their Surgical Importance
Authors: H. T. Roper-Hall, A. P. Bertwistle
Journal: BMJ (1940)

A. The absorption band did not diminish in density after the addition of ammonia or potassium cvanide.It must therefore be concluded that the pigment responsible for the cyanosis was sulphaemoglobin.There was no anaemia and the leucocytes were normal.Blood examination gave the following result: red cells, 5,100,000 per c.mm. ; haemoglobin, 90 per cent.; white cells, 7,400 per c.mm.-polymorphs 58 per cent., lymphocytes 30 per cent., eosinophils 4 per cent., baso- phils 1 per cent., monocytes 7 per cent.Blood urea was 34 mg.per 100 c.cm., and there was no pathological alteration in the constituents of the urine.The patient remained in hospital for six weeks, and during that time the cyanosis gradually diminished in intensity, as did the density of the abnormal absorption band.Fig. 1 depicts graphically the absorption spectrum of the blood in the red, and shows during the period of hospitalization the diminution in the density of the absorption band associated with lessening of cyanosis.(These graphs are from figures obtained by exam- ining samples of blood of constant dilution with a large-model constant-deviation spectrometer and a Nutting photometer, using the method described by Marshal in his thesis of the University of Aberdeen.)On discharge the patient was still slightly cyanosed and sulphaemoglobinaemia could still be detected in the blood.The withdrawal of the analgesic powders was not associated with any difficulty or discomfort to the patient.There were no unpleasant subjective effects and no apparent craving.
Role of living liver donation: Requirement for transplantation is high
Authors: R. Williams
Journal: BMJ (2003)

Editor—Neuberger and Price make a good case that living liver donation should be available in the NHS, and one might well ask why this is taking so long when the procedure has been in use so widely over the past five years.1

There is certainly a need for more liver transplant operations as the figures quoted for 2002 show: 62 deaths in patients on the waiting list and another 25 patients removed from it because they had become too ill. The waiting list for recipients requiring blood group O cadaver organs in some transplant centres is now around 12 months, which is unacceptable.

The UK transplant rate is already one of the lowest in the West, and the chief medical officer in his annual report two years ago drew attention to the substantial and worrying increase in the number of deaths from cirrhosis in men of working age. Cases may not be referred for a variety of reasons. Eligibility criteria are strict, and many believe it is reasonable that these should be relaxed in the context of living liver donation.

The small number of transplant centres in this country also perpetuates the view that liver transplantation is a very difficult procedure, whereas in many countries elective grafting with cadaver organs has become almost a routine procedure.

Neuberger and Price also refer to “a few” living liver transplants having been done in the United Kingdom. In the programme at the Cromwell Hospital, which I started in October 1998 with Nigel Heaton, Mohamed Rela, and the surgical team from King's College Hospital, we have now treated 17 patients. Survival among recipients is 77%, and no major complications have occurred in the donors.2 It was set up for overseas patients because of the time they were having to wait for a cadaver organ graft.
AIDS: an old disease from Africa?
Authors: K M De Cock
Journal: BMJ (1984)

This report proposes that the infectious agent causing AIDS is endemic and unrecognized in parts of sub-Saharan Africa where from where it recently disseminated into external populations.  No other explanation unifies the confusing observations of the syndrome.  At the very least the common features of AIDS and pattern of disease in equatorial Africa demand intensive research. Although the possibility that originated in Africa is widely mentioned this hypothesis has not previously been examined in detail. (excerpt)
Precarious peace has brought little improvement to health in southern Sudan, charity says
Authors: Peter Moszynski
Journal: BMJ (2008)

Legislation to regulate the use of human embryos for research in the United Kingdom had its second reading in the House of Commons this week, but ministers face a fight to push the most contentious measures through.The Human Fertilisation and Embryology Bill, which updates 1990 legislation to take account of advances in technology, passed the second reading by 340 votes to 78, with only nine Labour MPs rebelling.
Higher Frequency of Certain Cancers in<i>LRRK2</i>G2019S Mutation Carriers With Parkinson Disease
Authors: Ilir Agalliu, Marta San Luciano, Anat Mirelman, Nir Giladi, Bjorg Waro, Jan Aasly, Rivka Inzelberg, Sharon Hassin-Baer, Eitan Friedman, Javier Ruiz-Martinez, Jose Felix Marti-Masso, Avi Orr-Urtreger, Susan Bressman, Rachel Saunders-Pullman
Journal: JAMA Neurology (2014)

Patients with Parkinson disease (PD) who harbor LRRK2 G2019S mutations may have increased risks of nonskin cancers. However, the results have been inconsistent across studies.To analyze pooled data from 5 centers to further examine the association between LRRK2 G2019S mutation and cancer among patients with PD and to explore factors that could explain discrepancies.Clinical, demographic, and genotyping data as well as cancer outcomes were pooled from 1549 patients with PD recruited across 5 movement disorders clinics located in Europe, Israel, and the United States. Associations between LRRK2 G2019S mutation and the outcomes were examined using mixed-effects logistic regression models to estimate odds ratios (ORs) and 95% CIs. Models were adjusted for age and ethnicity (Ashkenazi Jewish vs others) as fixed effects and study center as a random effect.All cancers combined, nonskin cancers, smoking-related cancers, hormone-related cancers, and other types of cancer.The overall prevalence of the LRRK2 G2019S mutation was 11.4% among all patients with PD. Mutation carriers were younger at PD diagnosis and more likely to be women (53.1%) and of Ashkenazi Jewish descent (76.8%) in comparison with individuals who were not mutation carriers. The LRRK2 G2019S mutation carriers had statistically significant increased risks for nonskin cancers (OR, 1.62; 95% CI, 1.04-2.52), hormone-related cancers (OR, 1.87; 95% CI, 1.07-3.26) and breast cancer (OR, 2.34; 95% CI, 1.05-5.22) in comparison with noncarriers. There were no associations with other cancers. There were no major statistically significant differences in the results when the data were stratified by Ashkenazi Jewish ethnicity; however, there was some evidence of heterogeneity across centers.This multinational study from 5 centers demonstrates that LRRK2 G2019S mutation carriers have an overall increased risk of cancer, especially for hormone-related cancer and breast cancer in women. Larger prospective cohorts or family-based studies investigating associations between LRRK2 mutations and cancer among patients with PD are warranted to better understand the underlying genetic susceptibility between PD and hormone-related cancers.
Germany moves closer to establishing national mortality register
Authors: N. Stafford
Journal: BMJ (2010)

A group of doctors, healthcare experts, and lawyers in Germany are in the final stages of drafting a detailed proposal for establishing the nation’s first national mortality registry, which could be used for medical, social, and public health research.

Ulrich Mueller, co-chairman of the 12 member working group that is drafting the proposal for the national death index, told the BMJ that attempts in the past to establish such a registry had failed, blocked by Germany’s stringent privacy laws and opposition from privacy advocates.

Dr Mueller, director of the Institute of Medical Sociology and Social Medicine at the University of Marburg, in the central state of Hesse, said that the proposal would probably be completed in June and would include recommendations for quality and procedural standards of a mortality registry and how those recommendations could …
Pulmonary restrictive effect of bracing in mild idiopathic scoliosis.
Authors: J D Kennedy, C F Robertson, A Olinsky, D R Dickens, P D Phelan
Journal: Thorax (1987)

The use of bracing in the treatment of mild idiopathic scoliosis is controversial. A study of 33 adolescents showed that bracing significantly decreased lung volumes. Functional residual capacity was reduced by a mean of 26%, 18% of children showing a reduction of greater than 40%. The mean reduction in total lung capacity was 16% and in forced vital capacity 18%. This restriction of lung function by bracing might have a deleterious effect on lung growth or might impose an additional risk factor in the presence of other disorders, such as asthma and diaphragmatic weakness. The use of bracing in individuals with mild scoliosis should be judiciously reassessed.
Reconstructing neural circuits using transplanted neural stem cells in the injured spinal cord
Authors: Tamir Ben-Hur
Journal: Journal of Clinical Investigation (2010)

Traumatic spinal cord injury is one of the most common causes of disability in young adults. Restoring independent ambulation in such patients is considered one of the biggest challenges in regenerative medicine because repair of spinal cord injury involves the complex processes of axonal regeneration, remyelination, and formation of new synaptic connections. In this issue of the JCI, Abematsu et al. report their attempts to rise to this challenge, showing in a mouse model of severe spinal cord injury that spinal neuronal circuits can be restored by neural stem cell transplantation, leading to impressive functional recovery in the hind limbs.
Folk Medical Beliefs and Their Implications for Care of Patients
Authors: LOUDELL F. SNOW
Journal: Annals of Internal Medicine (1974)

The folk medical system of low-income black Americans is described, from an ethnographic study of a black neighborhood in Tucson, Arizona. Comparable beliefs among Mexican-Americans, Puerto-Rican Americans, and Southern whites are traced, mainly from published sources. The system is a composite of rare elements of African origin, survivals from the folk and formal medicine of a century ago, and selected beliefs from modern scientific medicine. It includes beliefs about the prevention of illness, the classification of illnesses into "natural" and "unnatural" categories, home remedies and preventives, and the ranking of healing practitioners, according to the perception of their ability, their modes of curing, and the types of illnesses they can cure. Folk medical beliefs are at odds with scientific medicine in many respects. Medical personnel should be aware of these differences and how they might affect patient behavior.
Royal College of General Practitioners launches guide to managing long term conditions
Authors: A. Gulland
Journal: BMJ (2011)

The Royal College of General Practitioners is urging family doctors in England to let patients with long term conditions take an active role in managing their own healthcare.

The college has issued guidance setting out how GPs can “provide active support” to ensure that patients are in charge of their own care, amid a reluctance among doctors to relinquish control.

The guidance says: “There is good evidence that our care of people with [long term conditions] can be improved. Patients tell us that they want us to do more to support their own self care. However, the evidence also tells us that this is not happening. 

“While 95% of people with diabetes, for example, are seen annually, only 50% discuss a plan to manage their diabetes and …
THE RAT AND POLIOMYELITIS: AN EXPERIMENTAL STUDY
Authors: Harold L. Amoss, Peter Haselbauer
Journal: The Journal of Experimental Medicine (1918)

The central nervous organs and other viscera of six rats, collected in a district in Greater New York in which many cases of epidemic poliomyelitis occurred, have been proved incapable of inciting, on inoculation, experimental poliomyelitis in Macacus rhesus monkeys. The virus of poliomyelitis injected into the brain of white rats does not survive there as long as 4 days in a form or in amounts sufficient to cause infection when inoculated intracerebrally into monkeys. The failure of the virus injected into the brain of rats to incite infection in monkeys is not due to the quantity introduced, since at the expiration of 1(1/2) hours after the injection, the excised inoculation site when injected into the monkey caused typical experimental poliomyelitis. It does not appear probable, therefore, that the rat acts in nature as the reservoir of the virus of poliomyelitis.
The Concept of Heart Failure From Avicenna to Albertini
Authors: Rex N. MacAlpin
Journal: JAMA (1981)

In this scholarly work, Dr Jarcho has sought to illustrate and discuss the concepts held by physcians of a remote era about the nature, causes, and treatment of what is today termed "congestive heart failure." By limiting his study to a period from about 1000 AD to roughly 1748 AD, he has undertaken a very difficult task. Although this period extends more than 100 years beyond the publication of William Harvey's epochal description of the nature of the circulation (<i>De Motu Cordis</i>, 1628), these physiological concepts had not diffused significantly into clinical thought during the period under discussion. Consequently none of the approximately 19 physicians, whose writings Dr Jarcho has analyzed, was really aware of the function of the heart, and most did not even mention the possibility of cardiac malfunction as a cause of symptoms. There really was no concept of failure of the heart during those times, and
Hypothyroidism and Phenytoin
Authors: MARTIN I. SURKS
Journal: Annals of Internal Medicine (1985)

Letters and Corrections1 June 1985Hypothyroidism and PhenytoinMARTIN I. SURKS, M.D.MARTIN I. SURKS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-102-6-871_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The recent report of Kushnir and associates (1), which describes the case of a patient who developed hypothyroidism during phenytoin intoxication, is of interest and should alert clinicians who use this drug. However, in the discussion of their data, the authors make a series of statements with limited citation of literature that do not reflect the current state of knowledge concerning the interactions of phenytoin and the thyroid hormone system.These interactions have received renewed interest lately and have been discussed in detail by Dr. Smith and myself (2). In contrast to statements made by Kushnir and...References1. KUSHNIRWEINSTEINLANDAUSHAVITBECHARGADOTH MRBGMN. Hypothyroidism and phenytoin intoxication. Ann Intern Med. 1985;102:341-2. LinkGoogle Scholar2. SMITHSURKS PM. Multiple effects of 5,5-diphenylhydantoin on the thyroid hormone system. Endocr Rev. 1984:5:514-24. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByEffects of Other Pharmacological Agents on Thyroid FunctionThe effects of drugs on tests of thyroid functionThyroid dysfunction during chronic amiodarone therapy 1 June 1985Volume 102, Issue 6Page: 871-871KeywordsDrugsHypothyroidismIntoxicationThyroid hormones Issue Published: 1 June 1985 PDF DownloadLoading ...
Biliary lipid composition in monozygotic and dizygotic pairs of twins.
Authors: Y Antero Kesaniemi, M Koskenvuo, M Vuoristo, T A Miettinen
Journal: Gut (1989)

The relative contribution of genetic factors to biliary and serum lipid composition was studied in 17 monozygotic and 18 dizygotic middle aged male pairs of twins. Cholesterol precursors, squalene and Methylated sterols which reflect the activity of cholesterol synthesis were also measured. Pairwise intraclass correlations were determined for monozygotic and dizygotic twin pairs and heritability estimates were calculated. Molar % of biliary cholesterol and percentage distribution of biliary cholic acid and particularly deoxycholic acid showed significant pairwise correlations within the monozygotic but not the dizygotic pairs. Similar correlations were found for total biliary methylsterols and of the methylsterol subfractions for the two methostenols but not for squalene, lanosterol and dimethylsterols. In serum, the precursor sterols, but not squalene, showed even higher pairwise correlations in the monozygotic twins than the corresponding precursors in bile. Molar per cent of bile acids and phospholipids and cholesterol saturation index were not correlated significantly in either twin pairs, but the pairwise correlations tended to be higher in the monozygotic than in the dizygotic pairs. Gall stones were found in seven monozygotic and three dizygotic subjects. Two monozygotic twin pairs were concordant for gall stones; all the dizygotic pairs were discordant. Overall, these data suggest that molar percentage of biliary cholesterol, bile acid composition, cholesterol synthesis, bile cholesterol saturation, and gall stone formation may be under a significant genetic control.