tbuckley/cabot-search huggingface dataset:
Hypercoagulability after Hip and Knee Replacement
Authors: Ralph L. Nachman
Journal: Annals of Internal Medicine (1994)

Letters15 March 1994Hypercoagulability after Hip and Knee ReplacementRalph L. Nachman, MD and Roy Silverstein, MDRalph L. Nachman, MDThe New York Hospital-Cornell Medical Center; New York, NY 10021Search for more papers by this author and Roy Silverstein, MDThe New York Hospital-Cornell Medical Center; New York, NY 10021Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-6-199403150-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We did not discuss management of hypercoagulable events after hip and knee replacement because not enough data are available to determine preferable pre- and postoperative approach. However, accumulating evidence suggests that low-molecular-weight heparin may represent a useful new therapeutic strategy for postoperative prophylaxis. In recent trials [1-3], low-molecular-weight heparin has led to a risk reduction of between 70% and 80% with no increase in clinically important bleeding compared with placebo. This therapy seems as effective as dose-adjusted heparin and warfarin in hip replacement and more effective than warfarin in knee replacement [4]. Anti-inflammatory agents combined with antithrombotic therapy ...References1. Leclerc JR, Geerts WH, Desjardins L, Jobin F, Laroche F, Delorme F, et al. Prevention of deep vein thrombosis after major knee surgery—a randomized, double-blind trial comparing a low molecular weight heparin fragment (enoxaparin) to placebo. Thromb Haemost. 1992; 67:417-23. Google Scholar2. Turpie AG, Levine MN, Hirsch J, Carter CJ, Jay RM, Powers PJ, et al. A randomized, controlled trial of a low molecular weight heparin (enoxaparin) to prevent deep vein thrombosis in patients undergoing elective hip surgery. N Engl J Med. 1986; 315:925-9. Google Scholar3. Hoek J, Nurmohamed MT, ten Cate H, ten Cate JW, Buller HR. Prevention of deep vein thrombosis (DVT) following total hip replacement by a low molecular weight heparinoid (ORG 10172) (Abstract). Thromb Haemost. 1989; 62:520. Google Scholar4. Hirsch J, Levine MN. Low molecular weight heparin. Blood. 1992; 79:1-17. Google Scholar Author, Article, and Disclosure InformationAffiliations: The New York Hospital-Cornell Medical Center; New York, NY 10021 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 March 1994Volume 120, Issue 6Page: 523KeywordsClinical trialsEndothelial cellsHemorrhageHeparinHipKneesLow molecular weight heparinPhenotypesProphylaxis ePublished: 15 August 2000 Issue Published: 15 March 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Racing to a Cure: A Cancer Victim Refuses Chemotherapy and Finds Tomorrow's Cures in Today's Scientific Laboratories
Authors: J. D. Bitran
Journal: JAMA (2004)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Formation and Excretion of Pyrrole-2-Carboxylate in Man
Authors: Anne M. Heacock, Elijah Adams
Journal: Journal of Clinical Investigation (1974)

A detailed investigation of the purification of pyrrole-2-carboxylate (PCA) from human and rat urine indicates that previously reported mean values overestimate the correct quantity of free PCA by a factor of approximately three for rat urine and approximately five for human urine. Although several criteria of purity were satisfied by a previous method, pyrrole-reactive impurities were still present in the final fractions. These impurities are separated from PCA by chromatography through an amino acid analyzer ion-exchange resin. With the corrected method, normal human values for endogenous urinary PCA in 16 individuals averaged 0.51 mumol/day, with a range of 0.20-1.3 mumol and a SD of 0.31 mumol. The probable source of human PCA is free hydroxy-L-proline, as inferred from the high value for PCA in the urine of a subject with hereditary hydroxyprolinemia, and from the threeto eightfold elevation in PCA excretion by two normal subjects after a large oral load of hydroxyl-L-proline. Subcutaneous administration of [2-(14)C]PCA to a single human subject indicated almost complete conversion of the exogenous compound to derivatives, which are largely excreted in the urine. Data are discussed suggesting that much or all of the PCA in human urine may be formed in urine from a labile precursor, presumably Delta(1)-pyrroline-4-hydroxy-2-carboxylate.
Access to health care in Afghanistan is improving, study shows
Authors: Tessa Richards
Journal: BMJ (2007)

The government has admitted that it will have to wait years before it discovers whether there are real productivity gains from the new consultants' contract.NHS leaders also told the House of Commons Committee of Public Accounts last week that lessons had been learnt from mistakes made when the contract was introduced, such as not piloting it before implementation.They were giving evidence as part of the committee's inquiry into the consultants' contract.The session was prompted by the publication earlier this month of a report from the government's
Muscle cramps, collapse, and seizures in two patients taking metolazone.
Authors: M X Fitzgerald, N J Brennan
Journal: BMJ (1976)

Pleural fluid lysozyme in tuberculous and non-tuberculous pleurisyIn several diseases the concentration of lysozyme is often high in body fluids.Raised serum lysozyme levels have been reported in such granulomatous diseases as sarcoidosis, pulmonary tuberculosis, and Crohn's disease.1 2 We have extended studies on the diagnostic significance of lysozyme content in body fluids to the pleural fluid in pleurisy of various aetiologies.
CAR and PXR agonists stimulate hepatic bile acid and bilirubin detoxification and elimination pathways in mice
Authors: Martin Wagner, Emina Halilbasic, Hanns‐Ulrich Marschall, Gernot Zollner, Peter Fickert, Cord Langner, Kurt Zatloukal, Helmut Denk, Michael Trauner
Journal: Hepatology (2005)

Induction of hepatic phase I/II detoxification enzymes and alternative excretory pumps may limit hepatocellular accumulation of toxic biliary compounds in cholestasis. Because the nuclear xenobiotic receptors constitutive androstane receptor (CAR) and pregnane X receptor (PXR) regulate involved enzymes and transporters, we aimed to induce adaptive alternative pathways with different CAR and PXR agonists in vivo. Mice were treated with the CAR agonists phenobarbital and 1,4-bis-[2-(3,5-dichlorpyridyloxy)]benzene, as well as the PXR agonists atorvastatin and pregnenolone-16α-carbonitrile. Hepatic bile acid and bilirubin-metabolizing/detoxifying enzymes (Cyp2b10, Cyp3a11, Ugt1a1, Sult2a1), their regulatory nuclear receptors (CAR, PXR, farnesoid X receptor), and bile acid/organic anion and lipid transporters (Ntcp, Oatp1,2,4, Bsep, Mrp2-4, Mdr2, Abcg5/8, Asbt) in the liver and kidney were analyzed via reverse-transcriptase polymerase chain reaction and Western blotting. Potential functional relevance was tested in common bile duct ligation (CBDL). CAR agonists induced Mrp2-4 and Oatp2; PXR agonists induced only Mrp3 and Oatp2. Both PXR and CAR agonists profoundly stimulated bile acid–hydroxylating/detoxifying enzymes Cyp3a11 and Cyp2b10. In addition, CAR agonists upregulated bile acid–sulfating Sult2a1 and bilirubin-glucuronidating Ugt1a1. These changes were accompanied by reduced serum levels of bilirubin and bile acids in healthy and CBDL mice and by increased levels of polyhydroxylated bile acids in serum and urine of cholestatic mice. Atorvastatin significantly increased Oatp2, Mdr2, and Asbt, while other transporters and enzymes were moderately affected. In conclusion, administration of specific CAR or PXR ligands results in coordinated stimulation of major hepatic bile acid/bilirubin metabolizing and detoxifying enzymes and hepatic key alternative efflux systems, effects that are predicted to counteract cholestasis. (HEPATOLOGY 2005.)
Peak Bone Mineral Density in Young Women-Reply
Authors: Tom Lloyd
Journal: JAMA (1993)

In Reply.  —The comments by Drs Recker and Heaney call to attention our incomplete understanding of the dynamics and probable variation in the peak bone mass concept. From the three recent cross-sectional studies 1-3 of bone density among a total of 197 young women, aged 9 to 21 years, peak lumbar spine and peak femoral neck bone density were observed for between 15 and 18 years. From the two large cross-sectional studies 4,5 using a total of 694 women, aged 20 to 40 years, no peak was observed for lumbar spine or femoral neck bone density after age 20 years. From their longitudinal study of 98 young women aged 9 to 19 years, Theintz and coworkers 6 observed cessation of lumbar spine and femoral neck bone gain by age 18 years. In contrast, Recker and Heaney reported that cessation of total body and spinal bone mineral gain occurred at about age
Primary sclerosing cholangitis and Hodgkin's disease
Authors: Kevin M. Man, Anne Drejet, Emmet B. Keeffe, Richard Garcia-Kennedy, Joanne C. Imperial, Carlos O. Esquivel
Journal: Hepatology (1993)

Three patients with primary sclerosing cholangitis and Hodgkin's disease, a previously unrecognized association, are reported. All three patients were men, and one patient had Crohn's disease of the colon. Primary sclerosing cholangitis was diagnosed 2, 11 and 17 yr before diagnosis of Hodgkin's disease in the three patients, and all three had advanced biliary cirrhosis prompting referral for liver transplantation. The symptoms of Hodgkin's disease were often masked by similar manifestations of primary sclerosing cholangitis, particularly symptoms of recurrent biliary sepsis. Hodgkin's disease is another disorder that may occur in patients with primary sclerosing cholangitis, particularly in the setting of advanced disease, and may be masked by the underlying hepatobiliary disease.
Effects of Desoxycorticosterone Acetate on Cholesterolemia, Blood Pressure and Atherogenesis in Chicks
Authors: J. STAMLER, R. PICK, L. N. KATZ, E. Levinson, P. Johnson, M. Dudley, C. Bolene
Journal: Circulation (1951)

Chronic exhibition of chicks to desoxycorticosterone acetate produces a slight but definite rise in blood pressure. This effect is increased by addition of salt to the diet. This regimen does not affect cholesterol levels and atherogenesis in the chick on ordinary mash. However, in the presence of a mildly atherogenic diet (0.25 per cent cholesterol) concomitant DCA exhibition increases the incidence and severity of atherosclerosis.
Clinical Problem Solving
Authors: MICHAEL D. REYNOLDS
Journal: Annals of Internal Medicine (1978)

Letters and Corrections1 December 1978Clinical Problem SolvingMICHAEL D. REYNOLDS, M.D.MICHAEL D. REYNOLDS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-89-6-1006_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The recent paper "Clinical Problem Solving: A Behavioral Analysis," by Drs. Kassirer and Gorry (Ann Intern Med 89:245-255, 1978) provides evidence about the thought processes used by physicians when eliciting and recording clinical information. In accord with the authors' thesis, I have for several years taught student-physicians that the logical structure of the written report of interview and examination of a patient is determined by the clinician's formulation of a series of hypotheses about the illness. This model of the physician's behavior has a number of important corollaries worth noting.1. A physician cannot use a complete...References1. ALBERT D: The logical structure of the patient history. J Med Educ 49:1152-1157, 1974 MedlineGoogle Scholar2. WEED L: Medical Records, Medical Education, and Patient Care. The Problem-Oriented Record as a Basic Tool. Cleveland, Case Western Reserve University Press, 1969 Google Scholar3. ELSTEINKAGANSHULMANJASONLOUPE ANLHM: Methods and theory in the study of medical inquiry. J Med Educ 47:85-92, 1972 MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of California Irvine Medical Center Orange, CA 92668 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 1978Volume 89, Issue 6Page: 1006-1006KeywordsBehaviorProblem solving Issue Published: 1 December 1978 PDF DownloadLoading ...
Brain insulin action augments hepatic glycogen synthesis without suppressing glucose production or gluconeogenesis in dogs
Authors: Christopher J. Ramnanan, Viswanathan Saraswathi, Marta S. Smith, E. Patrick Donahue, Ben Farmer, Tiffany D. Farmer, Doss Neal, Philip E. Williams, Margaret Lautz, Andrea Mari, Alan D. Cherrington, Dale S. Edgerton
Journal: Journal of Clinical Investigation (2011)

In rodents, acute brain insulin action reduces blood glucose levels by suppressing the expression of enzymes in the hepatic gluconeogenic pathway, thereby reducing gluconeogenesis and endogenous glucose production (EGP). Whether a similar mechanism is functional in large animals, including humans, is unknown. Here, we demonstrated that in canines, physiologic brain hyperinsulinemia brought about by infusion of insulin into the head arteries (during a pancreatic clamp to maintain basal hepatic insulin and glucagon levels) activated hypothalamic Akt, altered STAT3 signaling in the liver, and suppressed hepatic gluconeogenic gene expression without altering EGP or gluconeogenesis. Rather, brain hyperinsulinemia slowly caused a modest reduction in net hepatic glucose output (NHGO) that was attributable to increased net hepatic glucose uptake and glycogen synthesis. This was associated with decreased levels of glycogen synthase kinase 3β (GSK3β) protein and mRNA and with decreased glycogen synthase phosphorylation, changes that were blocked by hypothalamic PI3K inhibition. Therefore, we conclude that the canine brain senses physiologic elevations in plasma insulin, and that this in turn regulates genetic events in the liver. In the context of basal insulin and glucagon levels at the liver, this input augments hepatic glucose uptake and glycogen synthesis, reducing NHGO without altering EGP.
SERCA2a Gene Transfer Enhances eNOS Expression and Activity in Endothelial Cells
Authors: Lahouaria Hadri, Regis Bobe, Yoshiaki Kawase, Dennis Ladage, Kiyotake Ishikawa, Fabrice Atassi, Djamel Lebeche, Evangelia G Kranias, Jane A Leopold, Anne-Marie Lompré, Larissa Lipskaia, Roger J Hajjar
Journal: Molecular Therapy (2010)

Congestive heart failure (HF) is associated with impaired endothelium-dependent nitric oxide-mediated vasodilatation. The aim of this study was to examine the effects of sarco/endoplasmic reticulum (ER) Ca(2+)-ATPase 2a (SERCA2a) gene transfer on endothelial function in a swine HF model. Two months after the creation of mitral regurgitation to induce HF, the animals underwent intracoronary injection of adeno-associated virus (AAV) carrying SERCA2a (n = 7) or saline (n = 6). At 4 months, coronary flow (CF) was measured in the mid-portion of the left anterior descending (LAD) artery. In the failing animals, CF was decreased significantly; SERCA2a gene transfer rescued CF to levels observed in sham-group [ml/min/g, 0.47 +/- 0.064 saline versus 0.89 +/- 0.116, SERCA2a; P < 0.05; 1.00 +/- 0. 185 sham P = NS (nonsignificant)]. In coronary arteries from HF animals, SERCA2a and endothelial isoform of nitric oxide synthase (eNOS) protein expression were decreased, but restored to normal levels by SERCA2a gene transfer. In human coronary artery endothelial cells (HCAECs), SERCA2a overexpression increased eNOS expression, phosphorylation, eNOS promoter activity, Ca(2+) storage capacity, and enhanced histamine-induced calcium oscillations, eNOS activity, and cyclic guanosine monophosphate (cGMP) production. Thus, SERCA2a gene transfer increases eNOS expression and activity by modulating calcium homeostasis to improve CF. These findings suggest that SERCA2a gene transfer improves vascular reactivity in the setting of HF.
Decision-Making About Tamoxifen in Women at High Risk for Breast Cancer: Clinical and Psychological Factors
Authors: Sharon L. Bober, Lizbeth A. Hoke, Rosemary B. Duda, Meredith M. Regan, Nadine M. Tung
Journal: Journal of Clinical Oncology (2004)

Purpose To explore the health-related and psychological factors that influence decision making about tamoxifen (Nolvadex; AstraZeneca, Waltham, MA) chemoprevention in women at increased risk for developing breast cancer. Methods This study involves the assessment of 129 women eligible to take tamoxifen following cancer-risk counseling. Treatment decision and decision satisfaction were measured at 2 and 4 months following counseling. Health-related factors included physician recommendation, personal and family-related health history, and concern about side effects. Psychological factors included breast cancer–related anxiety, risk perception, and depression. Results At 2 months’ follow-up, 44% of participants declined tamoxifen treatment. This number increased to 49% at 4 months. Personal and family health history were not related to the decision, but history of abnormal biopsy did predict tamoxifen use. Physician recommendation was highly correlated with treatment decision. Concern about side effects was related to the decision to decline treatment. Breast cancer–related anxiety and heightened risk perception were associated with the decision to take tamoxifen. However, anxiety and psychological distress were also negatively related to treatment satisfaction. Conclusion Decision-making about tamoxifen is complex, and many eligible women decline treatment or remain undecided. Findings call for further educational follow-up with high-risk women after they undergo initial counseling. Factors related to misperceptions of risk and side effects, as well as psychological distress, may be particularly important targets for intervention.
Health-related quality of life in active injecting drug users with and without chronic hepatitis C virus infection
Authors: Olav Dalgard, Atle Egeland, Kjell Skaug, Kostas Vilimas, Tore Steen
Journal: Hepatology (2004)

This study assessed the effect of chronic hepatitis C virus (HCV) infection on the health-related quality of life (HRQOL) of injecting drug users, comparing the HRQOL of injecting drug users with and without chronic HCV infection. The study included 199 injecting drug users of more than 18 years of age who participated in a needle exchange program. Blood samples were tested for the presence of HCV RNA in serum with a polymerase chain reaction method. HRQOL was measured using the questionnaire SF-36, measuring HRQOL over the last 4 wk. The HCV RNA test was positive in 102 (51%) and negative in 97 (49%) subjects. The HRQOL scores of actively injecting drug users were markedly reduced compared to the population norm. However, we did not find poorer HRQOL in injecting drug users with chronic HCV infection than in injecting drug users without HCV infection. HCV RNA positive injecting drug users who were aware of the infection had lower HRQOL scores than those unaware of the infection in 4 of the 8 SF-36 dimensions (general health, physical functioning, physical role, and vitality). HCV RNA negative subjects, who believed they were infected, scored worse in one dimension (general health) compared to those who did not believe they were infected. In conclusion, chronic HCV infection per se did not negatively affect the HRQOL of active injecting drug users. Those who thought they were infected had a lower HRQOL scores than those who believed they were not infected. (Hepatology 2004;39:74-80.)
Malaria in British Troops in West Africa
Authors: S. B. Hughes, R. R. Bomford
Journal: BMJ (1944)

The symptoms of this fever, it is to be regretted, are so various and irregular, in different cases and under different circumstances, that a mere nosological definition of them would afford no precise information and might mislead those it was intended to instruct."Since Boyle in 1831 wrote these words in his gloomy Account of the-Fevers of Western Africa the prognosis of subtertian malaria has greatly altered, but the diversity of its manifestations has not.Modern textbooks may claim to provide more than a mere nosological definition, but they tend to emphasize the severer and rarer types of the disease to the exclusion of its commoner and milder, though no less protean, forms.As the latter are prevalent in troops in West Africa at the present time and are not uncommon in those returning to this country, we believe that a fresh description of them may be of value.Pernicious types will receive little notice, as in our experience they occurred infrequently, and methods of investigation requiring more than the simple use of the microscope will hardly be mentioned.The description is based on over 1,200 cases seen and treated by one or both of us in two military hospitals in West Africa in 1941 and 1942.Where figures are given these refer to 846 unselected cases in 584 patients from one hospital in each of which the diagnosis was confirmed by the finding of malaria parasites in the blood.In 380 cases the parasites were diagnosed as Plasmodium falciparum.In the remainder no diagnosis of the type of parasite was attempted, but it can be assumed for the purpose of this paper that all or nearly all were due to PI. falciparum, since in no instance did the appearance of the parasite or the clinical features of the disease suggest the contrary, and workers in the district concerned agree that other types of malaria are rare, occurring, when they do, usually in visitors who have been infected elsewhere.Our account deals with a group of white males aged 18 to 51 who had been passed as fit for oversea service, who were in most cases in a malarious district for the first time, and amongst whom the observance of antimalarial precautions and the taking of a suppressive drug were enforced, so far as they could be, by disciplinary measures.Further, in British West Africa subtertian malaria is for the molst part hyperendemic and, on account of the climate and the varying habits of the principal anopheline vectors (A.gambiae, A. gambiae var.*nelas, and A. funiestus), infections, though commonest in the wet season, occur all the year round.Conclusions based on the study of a particular type of patient in an area with particular characteristics are not necessarily applicable to other types of patient in other areas.Previous Descriptions We know of no previous account of the clinicalfeatures of malaria in white troops in West Africa.Small groups or single cases of the disease, acquired in West Africa but treated in