tbuckley/cabot-search huggingface dataset:
Complications From Combination Chemotherapy and Irradiation in Oat Cell Lung Cancer
Authors: Silvio A. Aristizabal
Journal: JAMA (1977)

<h3>To the Editor.—</h3> The enhancement of radiation effects in normal tissues by anticancer drugs is a matter of considerable current interest. In the recent MEDICAL NEWS article (236:2153, 1976) about the effectiveness of combination chemotherapy and irradiation on oat cell carcinoma, a substantial number of patients had toxic acute skin reactions. Many patients also experienced severe esophagitis, three suffered esophageal strictures, and one of them died of self-imposed starvation. A similar combination (doxorubicin hydrochloride [Adriamycin], cyclophosphamide, and irradiation to chest wall and regional lymphatics) has been used at the Arizona Medical Center during the past 12 months in the postoperative treatment of breast cancer patients.<sup>1,2</sup>Initially, both modalities were given concurrently (5,000 rads in five weeks, with 21-day cycles of intravenous doxorubicin hydrochloride on day 1 and oral cyclophosphamide daily on days 3 to 6); however, because of the frequency and severity of skin and esophageal reactions observed, a
Warfarin‐associated multiple digital necrosis complicating heparin‐induced thrombocytopenia and Raynaud's phenomenon after aortic valve replacement for adenocarcinoma‐associated thrombotic endocarditis
Authors: Theodore E. Warkentin, Richard P. Whitlock, Kevin H.T. Teoh
Journal: American Journal of Hematology (2003)

Abstract Necrosis of the digits is a rare complication of warfarin therapy of obscure pathogenesis. We report a 61‐year‐old woman with a 12‐month history of Raynaud's phenomenon who developed multiple digital necrosis following aortic valve replacement with mechanical prosthesis for aortic insufficiency caused by nonbacterial thrombotic endocarditis. Exacerbation of Raynaud's phenomenon occurred during the postoperative period, with daily episodes of ischemia of the fingers and toes that improved with local warming. However, coincident with the occurrence of immune heparin‐induced thrombocytopenia, and while undergoing routine warfarin anticoagulation because of the mechanical valve prosthesis, the patient abruptly developed progression of digital ischemia to multiple digital necrosis on postoperative day 8, at the time the international normalized ratio reached its peak value of 4.3. All limb pulses were readily palpable, and vascular imaging studies showed thrombosis only in the superficial femoral and popliteal veins of the right leg. Coagulation studies showed greatly elevated levels of thrombin–antithrombin complexes and prothrombin fragment F1.2 levels, consistent with uncontrolled thrombin generation. After vitamin K administration, no abnormalities of the protein C anticoagulant pathway were identified, consistent with previous studies of other patients with warfarin‐induced necrosis complicating heparin‐induced thrombocytopenia. Subsequently, the patient was shown to have metastatic breast adenocarcinoma, which explained the patient's initial presentation with nonbacterial thrombotic endocarditis. This patient case suggests that multiple digital gangrene can result from the interaction of various localizing and systemic factors, including compromised microvascular blood flow (Raynaud's phenomenon), increased thrombin generation (heparin‐induced thrombocytopenia, adenocarcinoma), and warfarin‐induced failure of the protein C natural anticoagulant pathway. Am. J. Hematol. 75:56–62, 2004. © 2003 Wiley‐Liss, Inc.
Letter: Dynamism and inflation.
Authors: D Livingstone
Journal: BMJ (1974)

thidine, and mecamylamine, the patient was given 10 mg of propranolol twice, six hours apart.She had no apparent response to the first dose; however, within two hours of the second dose her pulse rate fell from 120 to 60/min and her blood pressure from 240/120 to 90/50 mm Hg, and she became unresponsive.An intravenous infusion of isoprenaline was required for several hours to restore and maintain pulse rate and blood pressure at noraml levels.Within a day thereafter, without additional medication, the patient's tachycardia and hyper- tension returned.She had no symptomatic or objective response of visceral or peripheral neuropathy to propranolol.Several days later the patient developed bleeding due to "stress" ulceration of the gastric mucosa.While receiving fluid and blood replacement she developed acute congestive heart failure and pulmonary oedema at a time when her blood pressure was low and clinically it was felt her intravascular volume depletion had not been corrected entirely.We interpret these events as indicating that our patient was compensat-ing haemodynamnically for elevated blood pressure (before and during her acute attack) by fl-adrenergic stimulation of cardiac function.This increase in /3-adrenergic activities may have resulted from physiological reflex mechanisms and/or from an influence of acute intermittent porphyria on the sympathetic nervous system.Irn any event the positive chronotropic and inotropic effects of endogenous catecholamines appeared essential to cardiovascular homoeostasis, which was adversely and severely affected even by a ma'lll amou-nt of ipropranolol.While propranolol is of benefit in some patients in poriphyric relapsse, it is not with- out risk in oatients with incipient cardiac failure.It may also be of risk in the pro- nounced hypovolaemic states which have been observed in patients with acute inter- mittent porphyria8 in the absence of apparent excessive volume loss.Beta-adrenergic stimulation in some episodes of porphyria may provide haemodynaniic compensation ra:her than being simply a manifestation of acute relapse.-Weare, etc.,
A MALIGNANT CONDITION OF THE PERICARDIUM
Authors: MAURICE CAMPAGNA
Journal: JAMA (1928)

Diseases of the pericardium were reported in the literature as far back as 1825. From time to time since then medical writers have reported cases which in themselves have proved interesting from a standpoint of rarity, but no effort has been made to attempt to classify under definite headings the different types of malignant conditions of this important structure. Douglas, 1 in 1906, made a comprehensive study and recorded the frequency of malignant tumors of the pericardium, though in his article he took into consideration only growths arising primarily within the thoracic cavity.  In reviewing the literature, we find it rather replete with interesting and varied cases of new growths of the pericardium, even though a great majority of these cases were not malignant. Primary malignancy of the pericardium seems to be almost nonexistent, there being only three cases, reported by Nichols, 2 Sir William Broadbent 3 and J. C.
Assessment of myocardial contractile reserve during dobutamine stress echocardiography in patients with coronary artery disease by the novel index of contractile function: myocardial acceleration during isovolumic contraction
Authors: Linda B. Pauliks, Christoph F. Madler, Robert I. Williams, Michael Vogel, Andrew N. Redington, Nicola Payne, Alan G. Fraser
Journal: Journal of the American College of Cardiology (2002)
PERITONITIS AND POST-OPERATIVE SEPSIS.
Authors: A. H. CORDIER
Journal: JAMA (1894)

The peritoneum is a "sacred sac," and he who permits the surgeon to enter therein with unclean hands and dirty instruments will suffer (not from his own iniquities), but from the septic agents introduced into the peritoneal cavity. Cleanliness is next to godliness in intra-peritoneal surgery. Peritonitis is a disease of the gravest character, presenting many varied types and symptoms. One case dying with a diffused septic peritonitis with a sub-normal temperature and a pulse of 55; another seemingly with the same local pathologic process present, will have a temperature reaching a dangerous hyperpyrexia, with a pulse of 180. In one case you will find a distended abdomen, filled with paretic bowel and rigid abdominal muscles, and writhing from the pain. Again you will find a case with alike origin, with a flattened abdomen, free from pain and tenderness, and at the<i>postmortem</i>find very little evidence of so grave
Reply to M. B. Mortensen
Authors: Mohammad Al-Haddad
Journal: Endoscopy (2008)

I would like to thank Dr. Mortensen on behalf of myself and co-authors for his interest in our recently published prospective study on the safety of EUS-FNA [1]. Dr. Mortensen and his colleagues have previously published their extensive experience in this field [2]. Their study included a total of 3324 patients who underwent EUS, including 670 patients with FNA, and reported an overall complication rate of 0.3 % including two fatalities. I would like to emphasize that the tabulated data presented in our discussion from the eight other EUS safety studies, was meant to be representative rather than inclusive. The inclusion criteria of our and Dr. Mortensen's studies were different and we elected to include, over 12 months, consecutive patients who underwent FNA, regardless of the indication.
Book Review Neuro-Oncology of CNS Tumors Edited by Jörg-Christian Tonn, Manfred Westphal, James T. Rutka, and Stuart A. Grossman. 706 pp., illustrated. Berlin, Springer-Verlag, 2006. $229. 3-540-25833-7
Authors: Lisa M. DeAngelis
Journal: New England Journal of Medicine (2006)
Licit and Illicit Drugs: The Consumers' Union Report on Narcotics, Stimulants, Depressants, Inhalants, Hallucinogens, and Marijuana—Including Caffeine, Nicotine, and Alcohol
Authors: Barry I. Liskow
Journal: JAMA (1973)

Authored by a lucid, conscientious journalist and sponsored by Consumers' Union, this book tries to formulate "a set of recommendations designed to minimize both adverse pharmacological effects and adverse legal and social effects of drug use." In approaching this ambitious goal, Brecher holds that the division of drugs into licit and illicit categories is medically irrational and rooted mainly in historical and sociological factors. He considers separately the major licit drugs, caffeine, alcohol and tobacco; the major nonprescription illicit drugs, heroin, hallucinogens, cocaine, marihuana, and volatile solvents; and the prescription drugs used illicitly, such as amphetamines and sedatives. For each of these drugs, Brecher presents well-documented historical, legal, and pharmacological data. He convincingly separates conclusions logically inferred from these data from those conclusions based on prejudice, propaganda, or fear. His conclusions are troubling. The drug problem, ie, the human and societal destruction from drugs, is often due less to the
Elucidating the Mechanisms of Atrial Flutter Cycle Length Variability Using Power Spectral Analysis Techniques
Authors: Bruce S. Stambler, Kenneth A. Ellenbogen
Journal: Circulation (1996)

The mechanism of the small beat-to-beat variations in cycle length of atrial flutter in humans has not been fully explained. We investigated the beat-to-beat control of atrial flutter cycle length using time and frequency analysis techniques.Mean, SD, and power spectra of atrial cycle lengths were calculated from atrial recordings in 28 patients with type I atrial flutter. In control patients, mean and SD values of atrial cycle length were 265 +/- 37 and 4.9 +/- 1.7 ms. Power spectra contained two or three major peaks with 10.6 +/- 9.2% in band 1 (0.0 to 0.18 Hz), 26.7 +/- 15.9% in band 2 (0.18 to 0.6 Hz), and 63.1 +/- 17.7% in band 3 (0.6 to 2.2 Hz). Isoproterenol infusion (n = 8) increased percentage of total power in band 1 (7.1 +/- 5.6% to 25.7 +/- 18.9%, P < .001). Percentage of total power in band 1 was less in patients receiving (n = 5) versus not receiving (n = 18) oral beta-blockers (2.2 +/- 1.9% versus 10.6 +/- 9.2%, P = .003). Standard deviation (2.5 +/- 1.3 versus 4.9 +/- 1.7 ms, P = .009) and total power (2025 +/- 1350 versus 9768 +/- 8874 ms2, P = .005) were less in heart transplant recipients (n = 5) than control patients. Increases in respiratory rate (n = 6) shifted band 2 frequency peak to higher frequencies (0.26 +/- 0.13 to 0.38 +/- 0.18 Hz, P < .05). Atrial cycle length was longer and monophasic action potential duration was shorter during inspiration than during expiration. Band 3 frequency peak was correlated with heart rate (r = .797, P < .0001).Atrial flutter cycle length variability has an underlying periodic pattern that is detected by spectral analysis. Atrial flutter is modulated on a beat-to-beat basis by an interplay between the autonomic nervous and respiratory systems and the ventricular rate.
Zimbabwean doctors see big rise in cases of trauma in wake of political violence
Authors: Owen Dyer
Journal: BMJ (2008)

Zimbabwe’s doctors have been overwhelmed by the burden of serious physical trauma in recent weeks, as thousands of opposition supporters have been systematically beaten by militiamen loyal to Robert Mugabe.

The Zimbabwean Association of Doctors for Human Rights reported last week that its members had seen 1007 such patients during May, of whom 119 had fractures, in many cases multiple or compound fractures.

“There has been a gross surge in both the quantity and severity of injury. Fracture cases alone increased threefold in number from April to May,” the association reported in an email sent to supporters abroad. “It is certain that a far …
Intestinal transplantation and the European implication: impact of experience and study design
Authors: Kareem M Abu-Elmagd, George Mazariegos
Journal: Gut (2011)

Pironi et al recently published an article challenging current indications for intestinal transplantation (IT).1 The European home parenteral nutrition (HPN) database of 41 centres in nine countries was utilised and a 5-year prospective cross-sectional survey was conducted focusing on transplant candidacy with survival and causes of death as end points. With appreciation of the authors' scientific contribution, we felt obligated to highlight major flaws in the study design.

Identification of HPN patients who are candidates for transplant was the Achilles' heel of the study. Unfortunately, such determination, without formal listing, was based upon broad definitions and questionnaire data short of documented objective testing that is crucial to transplant candidacy.2 Another major concern is the small number of candidates who were actually transplanted (14.5%). In addition, limited centre experience in transplant versus HPN questioned the accuracy of data interpretation. Equally important is …
The Renin-Angiotensin System and Hypertension
Authors: FRANZ GROSS
Journal: Annals of Internal Medicine (1971)

In renal hypertension the activity of the renin-angiotensin system may be increased, normal, or depressed. By the clamping of one renal artery, leaving the contralateral kidney untouched, the renin system is stimulated, whereas the activity is normal when the contralateral kidney is removed. In the latter condition, however, the normal renin activity corresponds to a relative increase, since after unilateral nephrectomy plasma renin activity and renal renin decrease. Reduction of renal mass by 70% is followed by suppressed renin activity and hypertension, which in the initial phase is caused by increased cardiac output. In unilaterally nephrectomized normotensive patients plasma renin activity was low, and its response to furosemide was suppressed, confirming the observation in rats that after reduction of renal mass the response of the renin system is blunted. In renal hypertensive rats negative sodium balance develops when blood pressure exceeds 180 mm Hg, resulting in high renin activity, which is the consequence and not the cause of hypertension.
Side Effects of Hypotensive Agents Evaluated by a Self-administered Questionnaire
Authors: C. J. Bulpitt, C. T. Dollery
Journal: BMJ (1973)

A self-administered symptom questionnaire was completed by 477 patients in a hypertension clinic. The complaints of the patients were analysed according to the type of therapy being given and the dose of drug taken. Methyldopa therapy was associated with sleepiness, weakness of the limbs, sleeping longer at night, and rising more frequently at night to pass urine. Diarrhoea, impotence, failure of ejaculation, blurred vision, depression, and the symptoms of postural hypotension were not related to methyldopa therapy. Bethanidine administration was related to postural hypotension, impotence, and failure of ejaculation but not to weakness of the limbs, blurred vision, depression, or diarrhoea. Patients receiving guanethidine complained of postural hypotension, failure of ejaculation, and had their bowels open more frequently. Similarly, patients receiving propranolol had an increased frequency of defaecation but also tended to complain of weakness of the limbs.Considering each drug individually, 5% of patients failed to take the prescribed dose of diuretic whereas
Foreign Bodies in the Lung
Authors: A. W. Fowler
Journal: BMJ (1954)

<h3>ABSTRACT</h3> Synaptotagmin-1 (Syt1) is a vesicular calcium sensor required for synchronous neurotransmitter release. It is composed of a single-pass transmembrane domain linked to two tandem C2 domains (C2A and C2B) that bind calcium, acidic lipids, and SNARE proteins that drive fusion of the synaptic vesicle with the plasma membrane. Despite its essential role, how Syt1 couples calcium entry to synchronous release is not well understood. Calcium binding to C2B, but not to C2A, is critical for synchronous release and C2B additionally binds the SNARE complex. The C2A domain is also required for Syt1 function, but it is not clear why. Here we asked what critical feature of C2A may be responsible for its functional role, and compared this to the analogous feature in C2B. We focused on highly conserved poly-lysine patches located on the sides of C2A (K189-192) and C2B (K324-327). We tested effects of charge-neutralization mutations in either region (Syt1<sup>K189-192A</sup> and Syt1<sup>K326-327A</sup>) side-by-side to determine their relative contributions to Syt1 function in cultured cortical mouse neurons and in single-molecule experiments. Combining electrophysiological recordings and optical tweezers measurements to probe dynamic single C2 domain-membrane interactions, we show that both C2A and C2B polybasic patches contribute to membrane binding, and both are required for evoked release. The readily releasable vesicle pool or spontaneous release were not affected, so both patches are specifically required for synchronization of release. We suggest these patches contribute to cooperative binding to membranes, increasing the overall affinity of Syt1 for negatively charged membranes and facilitating evoked release. <h3>Significance Statement</h3> Synaptotagmin-1 is a vesicular calcium sensor required for synchronous neurotransmitter release. Its tandem cytosolic C2 domains (C2A and C2B) bind calcium, acidic lipids, and SNARE proteins that drive fusion of the synaptic vesicle with the plasma membrane. How calcium-binding to Synaptotagmin-1 leads to release and the relative contributions of the two C2 domains is not clear: unlike C2B, calcium-binding to C2A is not critical for evoked release, yet both domains are needed for Syt1 function. Combining electrophysiological recordings from cultured neurons and optical tweezers measurements that probe single C2 domain-membrane interactions, we show that conserved polybasic regions in both domains contribute to membrane binding cooperatively, and both are required for evoked release, likely by increasing the overall affinity of Synaptotagmin-1 for negatively charged membranes.
AIDS Treatment Center: Is the Concept Premature?-Reply
Authors: Charles L. Bennett
Journal: JAMA (1989)

In Reply.—  We would like to thank Green et al for underscoring both the importance and the limitations of our study. However, we disagree with some of their specific comments. With respect to choice of hospitals for the study, we made no attempt to make a complete survey. Future studies will address these issues. The sample represented hospitals with varied characteristics, and the strength of our results suggest that the conclusions are generalizable.  We agree with their view that mortality should be studied on the basis of a fixed time window because of confounding factors such as hospices. In our study, this was unlikely to be a significant factor, as well-developed outpatient networks were not available in the study hospitals during the study years.  Finally, we think that Green et al may have misrepresented our policy implications. In our study, we outlined three recommendations that apply to both regionalization and
Allergen-induced Airway Inflammation in Rats: Role of Insulin
Authors: Elcio O. Vianna, J. Garcia-Leme
Journal: American Journal of Respiratory and Critical Care Medicine (1995)

Clinical asthma appears to be less severe when diabetes mellitus is superimposed. To examine whether insulin influences the development of allergic reactions in the airway mucosa following antigen challenge, normal and diabetic rats sensitized against ovalbumin (OA) were used. Compared with controls, animals rendered diabetic by the injection of alloxan presented markedly decreased cell yields from bronchoalveolar lavage after OA challenge. The impaired response was not related to antibody production because enhanced IgE antibody titers of the same magnitude were found in both control and diabetic animals. Similarly, the mechanism underlying the inhibited responses could not be ascribed to hyperglycemia or intracellular glucopenia, first, because correction of blood glucose levels through fasting did not restore the decreased response, and second, because administration of 2-deoxyglucose, which blocks glucose utilization, did not affect the bronchoalveolar reaction to OA challenge in normal animals. Reversal of the impaired responses was attained by treatment of diabetic animals with insulin. There is evidence that insulin exerts proinflammatory effects. We conclude that insulin might modulate the inflammatory component of asthmatic responses.