tbuckley/cabot-search huggingface dataset:
Using Clinical Guidelines Designed for Older Adults With Diabetes Mellitus and Complex Health Status
Authors: Samuel C. Durso
Journal: JAMA (2006)

Increasingly, adults are living to an advanced age. While many enjoy good health, nearly 50% of adults older than 65 years have 3 or more chronic medical conditions. Furthermore, within any age-sex cohort, older adults exhibit widely heterogeneous health status--ranging from robust to frail. This heterogeneity and individual medical complexity makes care for older patients particularly challenging and requires both careful medical judgment and a clear understanding of the patient's personal values and goals. Most current health care guidelines are disease-specific and do not address this complexity and heterogeneity, thus limiting their utility for guiding physicians in the care of older adult patients. The "Guidelines for Improving the Care of Older Persons With Diabetes Mellitus" are the first guidelines to specifically address this complexity and provide guidance to physicians who must prioritize therapies and goals for older adults with diabetes, comorbid medical conditions, and geriatric syndromes. By providing a rationale for prioritizing recommendations and the inclusion of geriatric syndromes that impact the patient's overall health and diabetic care, these guidelines may serve as a model for the development of other guidelines targeting older adults with complex health status.
Ultrasound Localization of Left Ventricular Outflow Obstruction in Hypertrophic Obstructive Cardiomyopathy
Authors: PRAVIN M. SHAH, RAYMOND GRAMIAK, DAVID H. KRAMER
Journal: Circulation (1969)

Simultaneous recordings of reflected ultrasound from the anterior mitral leaflet and left ventricular outflow, the ECG, the phonocardiogram, and a recording of the carotid artery pulse were obtained in six patients with hypertrophic obstructive cardiomyopathy. Abnormal sharp systolic anterior movement (SAM) of the mitral leaflet was observed. This movement began with the onset of ventricular ejection and reached a peak with the initial peak in the arterial pulse. The leaflet was apposed to the interventricular septum up to 60% of the ejection period. In the latter part of systole as the mitral leaflet moved away from the interventricular septum, the arterial pulse showed a second systolic wave. Onset of SAM coincided with onset of the systolic murmur. Spontaneous variations in amplitude of SAM coincided with alterations in contour of the arterial pulse and in the intensity of the murmur. Administration of methoxamine to four patients resulted in disappearance of SAM. In one patient following surgery, the SAM of the mitral leaflet was noted only in the post-ectopic beats. This specific abnormality of mitral leaflet movement represents the localization of dynamic outflow obstruction in hypertrophic obstructive cardiomyopathy.
The Shigella OspC3 Effector Inhibits Caspase-4, Antagonizes Inflammatory Cell Death, and Promotes Epithelial Infection
Authors: Taira Kobayashi, Michinaga Ogawa, Takahito Sanada, Hitomi Mimuro, Minsoo Kim, Hiroshi Ashida, Reiko Akakura, Mitsutaka Yoshida, Magdalena Kawalec, Jean-Marc Reichhart, Tsunehiro Mizushima, Chihiro Sasakawa
Journal: Cell Host & Microbe (2013)
Infected Cyst Localization with Gallium SPECT Imaging in Polycystic Kidney Disease
Authors: PRADEEP AMESUR, JOSEPH J. CASTRONUOVO, BELUR CHANDRAMOULY
Journal: Clinical Nuclear Medicine (1988)

This case report describes a 43-year-old woman with polycystic renal disease and cyst infection. Infected cysts of the left kidney were successfully localized with Ga-67 citrate SPECT imaging and CT. Other imaging, including planar gallium imaging, was helpful diagnostically, but could not determine the exact location of infection within the kidney.
55 PATHOLOGIC FEATURES OF NON-ALCOHOLIC STEATOHEPATITIS (NASH) AS INDEPENDENT PREDICTORS OF LIVER-RELATED MORTALITY
Authors: M. Stepanova, N. Rafiq, H. Makhlouf, Z. Younoszai, I. Kaur, R. Agrawal, Z. Goodman, Z. Younossi
Journal: Journal of Hepatology (2011)
Meditel: Computer Assisted Diagnosis.
Authors: William E. Worley
Journal: Annals of Internal Medicine (1990)

Reviews, Notes, and Listings15 January 1990Meditel: Computer Assisted Diagnosis.Version 1.0.William E. Worley, MD, Herbert S. Waxman, MD.William E. Worley, MDSearch for more papers by this author, Herbert S. Waxman, MD.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-2-154_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThis program provides the physician with a differential diagnosis for a patient with an undiagnosed systemic illness. The "User's Manual" is excellent. Instructions are well written, logical, and brief. Data on patients are easily entered using a three-digit code for each of the 254 clinical and 131 laboratory findings. A differential diagnosis can then be generated using the entire database or by one or more of four topic subsystems. The differential diagnosis is listed in order of "relative goodness of fit," an estimation of how well all the entered findings fit a given diagnosis relative to other diagnoses.Potentially disconcerting... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byFuzzy Logic-Based Formalisms for Gynecology Disease DiagnosisComputer-assisted diagnosis of rheumatic disordersComputer-Assisted DiagnosisHerbert S. Wax man, MD, William E. Worley, MD 15 January 1990Volume 112, Issue 2Page: 154-154KeywordsClinical laboratoriesComputersDatabasesResearch laboratories ePublished: 1 December 2008 Issue Published: 15 January 1990 PDF downloadLoading ...
Carboplatin in Clinical Stage I Seminoma: Too Much and Too Little at the Same Time
Authors: George J. Bosl, Sujata Patil
Journal: Journal of Clinical Oncology (2011)

(HR) of 1.28 (90% CI, 0.85 to 1.93). 8 The updated 5-year RFR is 1.34%. The upper limit of the 90% CI for 5-year RFR exceeds 3% (90%CI,0.7%to3.5%),andtheHRisgreaterthan1.0(HR,1.28; 90%CI,0.83to1.89). 7 Therefore,thedifferenceinRFRiswideningin a direction favoring RT. These results imply that a 2-year RFR end point was probably too short (consistent with surveillance studies in which 30% of relapses occurred after 2 years), and carboplatin may
Ischemic preconditioning protects against coronary endothelial dysfunction induced by ischemia and reperfusion.
Authors: V Richard, N Kaeffer, C Tron, C Thuillez
Journal: Circulation (1994)

Repetitive, brief periods of ischemia and reperfusion ("preconditioning") increase the resistance of myocardial tissue to subsequent prolonged ischemic episodes and limit infarct size. We investigated whether preconditioning also protects against coronary endothelial dysfunction induced by ischemia and reperfusion.Experiments were performed in four groups of rats (n = 8 in each group): group 1 rats underwent sham surgery, group 2 rats were subjected to 20 minutes of left coronary artery occlusion without reperfusion, group 3 rats underwent 20 minutes of occlusion followed by 1 hour of reperfusion, and group 4 rats (preconditioning group) underwent the same protocol as group 3 rats, preceded by three cycles of 5 minutes of ischemia and 5 minutes of reperfusion. At the end of the experiments, coronary segments (internal diameter, 250 to 300 microns) were removed distal to the occlusion site and mounted in wire myographs for isometric tension recording. Relaxations induced by increasing concentrations of acetylcholine, the calcium ionophore A23187, or the nitric oxide (NO) donor SIN-1 were determined in arteries precontracted by serotonin. Basal NO release was estimated by measuring contractions to NG-nitro L-arginine methyl ester (L-NAME). In addition, we determined the effect of preconditioning on infarct size in two additional groups that were subjected to the same protocols as those of groups 3 and 4. In those animals, area at risk (India ink injection) and infarct size (triphenyltetrazolium stain) were determined by computerized analysis of enlarged sections after video acquisition. Preconditioning markedly limited infarct size (percent of area at risk: controls, 57 +/- 2; preconditioning, 2.2 +/- 0.6; P < .01). Ischemia (without or with reperfusion) or preconditioning did not affect the coronary responses to L-NAME, serotonin, A23187, or SIN-1. Ischemia without reperfusion did not modify the relaxations to acetylcholine (maximal relaxation: sham, 58 +/- 4%; ischemia, 56 +/- 7%; P = NS). In contrast, ischemia followed by reperfusion markedly impaired the response to acetylcholine (26 +/- 6%; P < .01 versus sham). This impaired response was restored by preconditioning (maximal relaxation: 59 +/- 9%; P = NS versus sham; P < .01 versus ischemia/reperfusion).In addition to protecting myocardial cells, preconditioning also protects coronary endothelial cells against ischemia/reperfusion injury.
High-resolution Bone Scintigraphy of the Adult Wrist
Authors: NEETIN PATEL, B. DAVID COLLIER, GUILLERMO F. CARRERA, DOUGLAS P. HANEL, JAMES R. SANGER, HANI S. MATLOUB, DONALD A. HACKBARTH, ARTHUR Z. KRASNOW, ROBERTS. HELLMAN, ALI T. ISITMAN
Journal: Clinical Nuclear Medicine (1992)

Bony anatomic landmarks of the wrist (e.g., pisiform, hook of hamate, radioulnar joint, and styloid processes of the radius and ulna) were routinely identified in 28 adult patients examined for wrist pain. With the wrists prone and immobilized, bone scintigrams were obtained for 500,000 counts with an asymmetric (133 to 161 keV) Tc-99m energy window and either a converging (best choice) or straight-bore, high-resolution collimator. High-resolution scintigraphy precisely localized degenerative joint disease (nine patients), scaphoid fractures (five), pisiform fracture (one), lunate avascular necrosis (one), radioulnar arthritis (one), septic or inflammatory arthritis (six), ulnocarpal impingement (two), and reflex sympathetic dystrophy syndrome (two). Images obtained palm down with the wrist in ulnar deviation helped identify increased uptake within the scaphoid. Fracture and significant bone or joint disease were excluded in one patient.
An Integrated Department of Psychiatry/Community Mental Health Program: One Model
Authors: VAN BUREN O. HAMMETT, CLIFFORD J. BODARKY, PAUL J. FINK
Journal: American Journal of Psychiatry (1971)

The authors describe one model for setting up a good relationship between an academic department of psychiatry and a community mental health program. The "marriage model" emphasizes total integration. It has proved to be effective in providing a large volume of clinical service, a fruitful context for numerous education and training programs, and many opportunities for research.
Posting Presentations at Medical Meetings on the Internet
Authors: Jerome P. Kassirer
Journal: New England Journal of Medicine (1999)

Posting an audio recording of an oral presentation at a medical meeting on the Internet, with selected slides from the presentation, will not be considered prior publication. This will allow students and physicians who are unable to attend the meeting to hear the presentation and view the slides. If there are any questions about this policy, authors should feel free to call the Journal's Editorial Offices.
THE TREATMENT OF GONORRHEAL ARTHRITIS BY HYPEREMIA.
Authors: JOHANNES H. M. A. VON TILING
Journal: JAMA (1905)

All physicians who have seen gonorrheal arthritis know how unsatisfactorily the usual treatment—rest, massage, passive movements, salicylates, etc.—often proves in chronic cases, and how hard to overcome in those cases is the extreme painfulness and the stiffness of the diseased joint. It seems to me worth while, therefore, to call attention to a method of treatment which, so far as I have observed, in this country, has by no means found the notice and practice it deserves. I refer to congestive hyperemia by damming according to Bier, which, as his assistant, I saw him employ.  As is generally known, Bier recommended hyperemia by damming at first for tuberculous joint diseases; later he employed it also for other diseases, and in his book, Hyperœmie als Heilmittel, writes: Yet much more marked is the effect of hyperemia by damming on that form of gonorrheal joint inflammation which is so extremely painful. In these cases the pain becomes easier in from one-half to one hour after the application of the rubber bandage.
Localization of ammonia-metabolizing enzymes in human liver: Ontogenesis of heterogeneity
Authors: Antoon F. M. Moorman, Jacqueline L. M. Vermeulen, Robert Charles, Wouter H. Lamers
Journal: Hepatology (1989)

Immunohistochemical analysis of human liver (8 to 94 years) shows a compartmentation of ammonia-metabolizing enzymes across the acinus. The highest concentration of carbamoylphosphate synthetase (ammonia) is found in the parenchymal cells around the terminal portal venules. Glutamine synthetase is found in a small pericentral compartment two to three cells thick. In contrast to observations in rat liver, in human liver a well-recognizable intermediate zone can be distinguished in which neither enzyme can be detected. This intermediate zone is not yet established at the age of 8 years but can be recognized in livers from 25 years onward. Carbamoylphosphate synthetase can already be detected in the liver of human fetuses at 5 weeks of development. The enzyme distribution reveals a random heterogeneity among the hepatocytes, suggesting that not all hepatocytes start to accumulate carbamoylphosphate synthetase at the same time. From 9 weeks of development onward, the enzyme becomes homogeneously distributed throughout the liver parenchyma until at least 2 days after birth. Glutamine synthetase cannot be detected during this period. In addition, the definitive architecture of the acinus is not yet completed at birth. These results therefore support the idea that in human liver, metabolic zonation with respect to NH 3 metabolism exists as it does in rat liver. Furthermore, the data show that this functional compartmentation becomes established concomitant with the development of the acinar architecture. The fact that enzymic zonation is not yet established in the perinatal period may have important consequences for the regulation of ammonia fixation and pH homeostasis in preterm infants and neonates.
635 INSULIN RESISTANCE AND GEOGRAPHICAL ORIGIN ARE MAJOR PREDICTORS OF LIVER FIBROSIS AND RESPONSE TO PEGYLATED INTERFERON AND RIBAVIRIN IN GENOTYPE 4 CHRONIC HEPATITIS C PATIENTS
Authors: R. Moucari, M.-P. Ripault, M. Martinot-Peignoux, C. Castelnau, H. Voitot, A. El Ray, T. Asselah, N. Boyer, M. Vidaud, P. Bedossa, D. Valla, P. Marcellin
Journal: Journal of Hepatology (2009)
More Preoperative Assessment by Physicians and Less by Laboratory Tests
Authors: Michael F. Roizen
Journal: New England Journal of Medicine (2000)

The conclusion of the elegant study by Schein et al.1 in this issue of the Journal seems obvious from their data: we should stop ordering routine preoperative laboratory tests for patients before cataract operations or other relatively simple surgical procedures. On the other hand, without changes to the system to increase preoperative clinical assessment by physicians, we may see poorer patient outcomes and higher long-term costs.The ultimate goals of preoperative medical assessment are to reduce the morbidity associated with surgery, to increase the quality and decrease the cost of perioperative care, and to restore the patient quickly to the . . .
Evaluating care of patients reporting pain in fundholding practices
Authors: J G R Howie, D J Heaney, M Maxwell
Journal: BMJ (1994)

<h3>Abstract</h3> <b>Objective</b>: To compare quality of care between 1990 and 1992 in patients with self diagnosed joint pain. <b>Design</b>: Questionnaire and record based study. <b>Subjects</b>: Patients identified at consecutive consultations during two weeks in 1990, 1991, and 1992. <b>Setting</b>: Six practice groups in pilot fundholding scheme in Scotland. <b>Main outcome measures</b>: Length of consultation; numbers referred or investigated or prescribed drugs; responses to questions about enablement and satisfaction. <b>Results</b>: About 15% of patients consulted with joint pain each year. 25% (316) of them had social problems in 1990 and 37% (370) in 1992, about a fifth wanted to discuss their social problems. Social problems were associated with a raised general health questionnaire score. The mean length of consultation for patients with pain was 7.6 min in 1990 and 7.7 min in 1992. Patients wishing to discuss social problems received longer consultations (8.5 min 1990; 10.4 min 1992); but other patients with social problems received shorter consultations (7.4 min; 7.2 min). The level of prescribing was stable but the proportion of patients having investigations or attending hospital fell significantly from 1990 to 1992 (31% to 24%; 31% to 13% respectively). Fewer patients responded “much better” to six questions about enablement in 1992 than in 1990. Enablement was better after longer than shorter consultations for patients with social problems. <b>Conclusions</b>: Quality of care for patients with pain has been broadly maintained in terms of consultation times. The effects of lower rates of investigation and referral need to be investigated further.
Peripheral Nerves Regenerated in Familial Amyloid Polyneuropathy after Liver Transplantation
Authors: Shu-ichi Ikeda
Journal: Annals of Internal Medicine (1997)

Background: Liver transplantation holds promise as a treatment for familial amyloid polyneuropathy. Objective: To determine whether peripheral nerves regenerate in patients with familial amyloid polyneuropathy after liver transplantation. Design: Case report. Setting: University hospital in Matsumoto, Japan. Patient: A 34-year-old woman with familial amyloid polyneuropathy who had liver transplantation and showed marked clinical improvement 3 years after surgery. Measurements: Histopathologic examination and morphometric analysis of biopsy specimens taken from sural nerves. Results: Diffuse fiber loss and amyloid deposits were seen in a biopsy specimen of the left sural nerve obtained before liver transplantation (total number of myelinated fibers, 1326/mm2 of the endoneurial area). In the biopsy specimen of the right sural nerve, which was obtained 3 years after transplantation, amyloid deposits remained but the number of myelinated fibers was markedly increased (total number of myelinated fibers, 4740/mm2). Conclusion: Peripheral nerves regenerated in a patient with familial amyloid polyneuropathy after liver transplantation.
Palladium‐induced Th2 cytokine responses reflect skin test reactivity
Authors: J. Muris, A. J. Feilzer, C. J. Kleverlaan, T. Rustemeyer, I. M. W. van Hoogstraten, R. J. Scheper, B. M. E. von Blomberg
Journal: Allergy (2012)

Recently, a crucial role of Th2 responses in nickel allergic contact dermatitis (ACD) was demonstrated. As palladium allergy is an issue of growing interest, the diagnostic potential of Th2 parameters for palladium sensitization was investigated. Palladium (Na(2) [PdCl(4)])-induced lymphocyte proliferation (LPT), Th1 and Th2 cytokine production were correlated with skin test (ST) reactivity in 16 positive and 21 negative controls. Furthermore, the diagnostic potential of these assays was evaluated using receiver operating characteristics (ROC) analysis. For comparison, same experiments were carried out for nickel (NiSO(4)). Correlation coefficients between palladium ST reactivity and IFN-γ, LPT, IL-5, and IL-13 were 0.34, 0.51, 0.69, and 0.78, and overall test accuracies were 68%, 81%, 89%, and 95%, respectively. Both palladium- and nickel-mediated Th2 responses tightly correlate with ST reactivity, supporting recent findings on the crucial role of Th2 involvement in ACD. Therefore, these assays may have great potential as diagnostic tools for future in vitro sensitization testing.
Determinants of insulin sensitivity and consequences for lipoproteins and blood pressure in subjects with non-insulin-dependent diabetes mellitus
Authors: Marion C. Blonk, Maarten A.J.M. Jacobs, Cylla E. Friedberg, Jos J.P. Nauta, Ton Teerlink, Corrie Popp-Snijders, Robert J. Heine
Journal: Metabolism (1994)
Distribution of Variable vs Fixed Costs of Hospital Care
Authors: Rebecca R. Roberts
Journal: JAMA (1999)

Most strategies proposed to control the rising cost of health care are aimed at reducing medical resource consumption rates. These approaches may be limited in effectiveness because of the relatively low variable cost of medical care. Variable costs (for medication and supplies) are saved if a facility does not provide a service while fixed costs (for salaried labor, buildings, and equipment) are not saved over the short term when a health care facility reduces service.To determine the relative variable and fixed costs of inpatient and outpatient care for a large urban public teaching hospital.Cost analysis.A large urban public teaching hospital.All expenditures for the institution during 1993 and for each service were categorized as either variable or fixed. Fixed costs included capital expenditures, employee salaries and benefits, building maintenance, and utilities. Variable costs included health care worker supplies, patient care supplies, diagnostic and therapeutic supplies, and medications.In 1993, the hospital had nearly 114000 emergency department visits, 40000 hospital admissions, 240000 inpatient days, and more than 500000 outpatient clinic visits. The total budget for 1993 was $429.2 million, of which $360.3 million (84%) was fixed and $68.8 million (16%) was variable. Overall, 31.5% of total costs were for support expenses such as utilities, employee benefits, and housekeeping salaries, and 52.4% included direct costs of salary for service center personnel who provide services to individual patients.The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.
Aspirin Can Be Dangerous
Authors: Hugh H. Hussey
Journal: JAMA (1974)

Aspirin (acetylsalicylic acid) prolongs the bleeding time in normal persons by diminishing platelet adhesiveness, thereby interfering with the platelet aggregation so necessary for hemostasis. In patients with hemophilia, prolongation of bleeding time is even more pronounced when aspirin is administered, and it may potentiate or contribute to initiation of hemorrhage. Since sodium salicylate does not alter the bleeding time, the effect of aspirin has been ascribed to the acetyl radical. Studies by Sutor et al 1 demonstrated that acetaminophen (Tylenol) also does not interfere with hemostasis.  With these thoughts in mind, Binder and his co-workers, in the March issue of American Journal of Diseases of Children (127:371-373, 1974), have published their study of the effect on bleeding time of other common analgesic and anti-inflammatory agents that might be used for relief of pain in a patient with hemophilia. The authors note at the outset that pain in hemophilia is one