tbuckley/cabot-search huggingface dataset:
PWE-007 The Incidence Of Venous Thromboembolism In The Bowel Cancer Screening Programme
Authors: HYH Kwok, L O’Sullivan, C Down, AF Muller
Journal: Gut (2014)

<h3>Introduction</h3> The Department of Health has published guidance stating that the development of venous thromboembolism (VTE) within 90 days of a Hospital event is a notifiable condition.<sup>1</sup> We have previously identified an increased risk of VTE<sup>2 </sup>in patients attending for endoscopic procedures although this was confined to those with predisposing factors including malignancy. This study examined the incidence of VTE in patients with positive faecal occult blood tests attending for bowel cancer screening colonoscopy. <h3>Methods</h3> Patients who participated in the bowel cancer screening programme in East Kent (BCSP) over a four year period from May 2009 to the end of April 2013 were included. Data was gathered from the ‘Exeter’ electronic database and cross referenced to the electronic radiology reporting system (PACS), to identify those patients with a history of VTE prior to, or within 90 days of colonoscopy (by Doppler Ultrasound, VQ scanning or Computerised Tomography of the Pulmonary Arteries – CTPA), a diagnosis of colon cancer made at colonoscopy; whether patients had been admitted for their procedures or had undergone surgery after the diagnosis. <h3>Results</h3> Over the 4 year study period, 2296 patients attended for colonoscopy (F: 912; M: 1384, mean age 65.5 years). 203 patients (8.8%) were diagnosed with colorectal cancer (CRC). There were 10 cases of VTE post colonoscopy (CRC : 8; normal result : 2). In the 8 cases diagnosed with CRC and VTE, only 2 were diagnosed within 90 days post procedure (F: 2; at 21 days – bilateral PE’s and 49 days – bilateral DVT’s). They had not undergone surgery. Of the 2 patients with a normal colonoscopy result and VTE, none were diagnosed within 90 days post procedure. None of the VTE patients had a previous history of thrombosis or had been admitted for bowel preparation. <h3>Conclusion</h3> The incidence of VTE in patients attending for colonoscopy in the BCSP is low, even in those patients diagnosed to have colorectal cancer. <h3>References</h3> Commissioning for quality and innovation 2013/2014 Guidance. Dept of Health Feb. 2013 Venkatachalapathy SV <i>et al</i>. Endoscopy and the risk of venous thromboembolism: a case control study. <i>Endoscopy International Open</i>. In Press 2014 <h3>Disclosure of Interest</h3> None Declared.
Integrated care pathways increase use of guidelines
Authors: D. Kitchiner, P. Bundred
Journal: BMJ (1998)

Persistence of the hypoglossal artery into adulthood is a rare vascular anomaly and, when present, provides the predominant vascular supply to the posterior circulation. We describe a case of vertebrobasilar insufficiency associated with severe high-grade stenosis of the persistent hypoglossal artery and tandem stenosis of the proximal ipsilateral internal carotid artery, treated by an endovascular approach. The unique anatomical and technical challenges associated with this case are reviewed in detail.
Pregnancy attributable to interaction between tetracycline and oral contraceptives.
Authors: J F Bacon, G M Shenfield
Journal: BMJ (1980)

Various drugs, including antibiotics, may be responsible for contraceptive failure and breakthrough bleeding in oral contraceptive (OC) users. A case history is reported of a woman who took OCs for 4 years without a problem. On October 16, 1978 she had a normal withdrawal bleed, and on October 20 she started the next course of Microgynon and also a 5-day course of tetracyline 500 mg 6 hourly for 3 days and also 250 mg 6 hourly for 2 days for sinusitis. She completed the course on October 24. She did not fail to take her OC, had no diarrhea or vomiting but had only a very light 2-day withdrawal bleed on November 14 and 15, 1978. She continued to take her OC for another 2 months until seen at the family planning clinic on January 8, 1979. Her uterus was then the size of at least a 12-week pregnancy. This would have corresponded with a previous menstrual period on about October 15 and indicated that she must have ovulated either when she was taking the tetracycline or in the week after. Termination confirmed the clinical assessment of the duration of pregnancy. The time course of this history of an OC user who had no problems for 4 years suggests that the tetracycline contributed to the contraceptive failure.
Contrasting effects of propranolol on sympathetic nerve activity and vascular resistance during orthostatic stress.
Authors: T N Jacobsen, R L Converse, R G Victor
Journal: Circulation (1992)

BACKGROUND Previous studies in humans advanced the concept that cardiac filling pressure and contractility, the primary determinants of ventricular mechanoreceptor discharge, are important determinants of sympathetic outflow during orthostatic stress. Thus, intravenous propranolol greatly attenuated forearm vasoconstrictor response to venous pooling with lower body negative pressure (LBNP). The aim of this study was to reevaluate the experimental support for this concept by using direct measurements of sympathetic nerve activity. METHODS AND RESULTS In 11 healthy humans, we recorded muscle sympathetic nerve activity (MSNA) with microelectrodes (peroneal nerve), as well as blood flow in the forearm and calf (venous occlusion plethysmography) at baseline and during graded LBNP. The same experiments were repeated after administration of propranolol (0.15 mg/kg i.v.), which is thought to decrease ventricular mechanoreceptor discharge. The major new findings are that propranolol neither increased baseline MSNA nor attenuated the increases in MSNA during graded orthostatic stress even though in the same subjects, propranolol simultaneously increased the baseline level of vascular resistance in both the forearm and calf and substantially attenuated the increases in regional vascular resistance during orthostatic stress. CONCLUSIONS Systemic beta-blockade causes a marked dissociation between sympathetic outflow and vascular resistance that invalidates the use of intravenous propranolol as an experimental model to examine the reflex effects of ventricular mechanoreceptors on peripheral vascular resistance in humans.
Diabetic Muscle Infarction: Myocardial infarct equivalent
Authors: Kai Ming Chow, Cheuk Chun Szeto, Teresa Yuk-hwa Wong, Franky Kay-tai Leung, Au Cheuk, Philip Kam-tao Li
Journal: Diabetes Care (2002)

Diabetic muscle infarction (DMI) is a serious complication seen in patients with long-standing diabetes. Evidence is accumulating since the first description of this entity in 1965 (1). Increasing awareness has led to prompt recognition of this previously underdiagnosed condition. Typically, acute presentation with atraumatic painful swelling, notably of the quadriceps or thigh muscles, is found in diabetic subjects with established vasculopathy including retinopathy and nephropathy. Laboratory investigations generally show high erythrocyte sedimentation rate, normal white cell count, and normal or mild elevation of creatine phosphokinase. Magnetic resonance imaging (MRI) findings are invariably characterized by increased signal intensity of the diffusely enlarged muscle groups on T2-weighted sequences, inversion-recovery, and gadolinium-enhanced images (2–4). The disease is generally believed to be self-limiting, although recurrence can occur in half of the cases (4,5).

We have previously reported two …
The Mechanism of Estrogen Action.
Authors: C. A. Villee
Journal: Annals of Internal Medicine (1963)

s1 April 1963The Mechanism of Estrogen Action.C. A. Villee, M.D.C. A. Villee, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-4-721_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSteroid molecules, though superficially complicated, are, in fact, relatively simple flat sheets with only a few reactive groups. Their chemical simplicity is in sharp contrast to their extreme biological specificity. Even more paradoxical are the very similar biological effects of the natural and the synthetic, nonsteroidal estrogens, such as diethylstilbestrol. Steroids are surface-active agents, capable of changing the shape and function of proteins and nucleic acids. Steroids have been postulated to affect the metabolism of tissues (1) by serving as a coenzyme, (2) by affecting the permeability of cell membranes, (3) by stimulating an enzyme, perhaps via an allosteric effect... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: C. A. Villee, M.D. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1963Volume 58, Issue 4Page: 721-721KeywordsCell membranesCoenzymesEnzyme metabolismEnzymesEstrogensNucleic acidsProteinsSpecificity ePublished: 1 December 2008 Issue Published: 1 April 1963 PDF downloadLoading ...
Straight Talk about Disease Prevention
Authors: Harold C. Sox
Journal: Annals of Internal Medicine (2007)

Editorials19 June 2007Straight Talk about Disease PreventionHarold C. Sox, MD, EditorHarold C. Sox, MD, EditorSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-12-200706190-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail When physicians say that the best part of being a doctor is talking to patients, I think of my father's internal medicine practice in Palo Alto, California. From 1935 to 1972, he practiced just the way he wanted to. New patients got an hour. Return patients got a half hour. Before Medicare, having an expensive test meant money out of pocket. Ten minutes of talk often led to a prescription for empirical antacids instead of an upper GI series. The talk was pleasurable, it was an exercise of clinical skill, and it made a difference.Despite the central role of ...References1. Tversky A, Kahneman D. Judgment under uncertainty: heuristics and biases. Science. 1974;185:1124-31. CrossrefMedlineGoogle Scholar2. Kahneman D, Slovic P, Tversky A. Judgment under Uncertainty: Heuristics and Biases. Cambridge, UK: Cambridge Univ Pr; 1982. Google Scholar3. Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981;211:453-8. [PMID: 7455683] CrossrefMedlineGoogle Scholar4. Halvorsen PA, Selmer R, Kristiansen IS. Different ways to describe the benefits of risk-reducing treatments. A randomized trial. Ann Intern Med. 2007;146:848-56. LinkGoogle Scholar5. Eraker SA, Sox HC. Assessment of patients' preferences for therapeutic outcomes. Med Decis Making. 1981;1:29-39. [PMID: 7052402] CrossrefMedlineGoogle Scholar6. McNeil BJ, Pauker SG, Sox HC, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982;306:1259-62. [PMID: 7070445] CrossrefMedlineGoogle Scholar7. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995;310:452-4. [PMID: 7873954] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Disclosures: Dr. Sox is a director of the Foundation for Informed Medical Decision Making, from which he receives only reimbursement of documented travel expenses.Corresponding Author: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDifferent Ways to Describe the Benefits of Risk-Reducing Treatments Peder A. Halvorsen , Randi Selmer , and Ivar Sønbø Kristiansen Metrics Cited ByAbsolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treatOn the pursuit of clinical excellence 19 June 2007Volume 146, Issue 12Page: 891-892KeywordsDecision makingExerciseForecastingHealth careHip fracturesMyocardial infarctionResidencyStatins ePublished: 19 June 2007 Issue Published: 19 June 2007 CopyrightCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Biorhythms and Disease
Authors: Hobart A. Reimann
Journal: JAMA (1963)

WITHOUT THE AID of modern diagnostic and therapeutic methods, physicians of old could only observe the nature and progression of disease. The ancients attributed rhythmicity of human behavior and recurrence of diseases to cosmic influence. Lunar phases supposedly controlled menstruation and lunacy, but maladies that recurred in no apparent relationship to any natural cycles weakened the concept. In 1629, Aubrey described his own trouble: "About 3 or 4 years, I had sickness of vomiting (the bellyake; pain in the side) for 12 hours every fortnight for several years, then monthly, then quarterly, and at least once in halfe a year.... about 12 it ceased."<sup>1</sup>Heberden<sup>2</sup>referred to "pains which are regularly intermittent, the fits of which return as periodically as the ague; such I have known in the bowels, stomach, breast, loins, arms and hips." These disorders have the earmarks of what now is called periodic peritonitis.
More than 700 people need critical care treatment as flu cases surge
Authors: Z. Kmietowicz
Journal: BMJ (2010)

Pressure on hospitals rose sharply in the last week of 2010 as the number of people with flu in critical care (intensive care and high dependency) more than doubled, rising to 738 in the week ending 30 December from 460 in the previous week. Of the people receiving critical care treatment 42 were children under 5 years, said the Department of Health.

Twelve people in the UK died from flu in the week ending 30 December, bringing the total number of deaths since the flu season began in October to 39.

According to the …
Selective Proximal Vagotomy
Authors: T. P. J. Hennessy
Journal: BMJ (1972)

contacts had no clinical or radiological evidence of disease.Two, a mother and son, developed active pulmonary tuberculosis and were treated apparently successfully with chemotherapy and discharged from the chest unit as cured years before their deaths.Five cases of disseminated sclerosis over the years, though a fairly high percentage of my list, admittedly can prove nothing, but in my opinion they are suggestive of more than just coincidence.I think it likely that the vigorous immune reaction against a massive tubercular onslaught is directed against the lipoids of the tubercle bacillus and, having achieved its object, goes on to attack the myelin of the central nervous system, which has a similar chemical com- position.-Iam, etc.,
A Cathepsin K Inhibitor Reduces Breast Cancer–Induced Osteolysis and Skeletal Tumor Burden
Authors: Céline Le Gall, Akeila Bellahcène, Edith Bonnelye, Jürg A. Gasser, Vincent Castronovo, Jonathan Green, Johann Zimmermann, Philippe Clézardin
Journal: Cancer Research (2007)

Abstract Osteoclasts mediate bone destruction in breast cancer skeletal metastases. Cathepsin K is a proteinase that is secreted by osteoclasts and degrades bone. Here, immunohistochemistry revealed that cathepsin K was expressed not only by osteoclasts but also by breast cancer cells that metastasize to bone. Following intratibial injection with cathepsin K–expressing human BT474 breast cancer cells, tumor-bearing mice treated with a clinical dosing regimen of cathepsin K inhibitor (CKI; 50 mg/kg, twice daily) had osteolytic lesions that were 79% smaller than those of tumor-bearing mice treated with the vehicle. The effect of CKI was also studied in a mouse model in which the i.v. inoculation of human B02 breast cancer cells expressing cathepsin K leads to bone metastasis formation. Drug administration was started before (preventive protocol) or after (treatment protocol) the occurrence of osteolytic lesions. In treatment protocols, CKI (50 mg/kg, twice daily) or a single clinical dose of 100 μg/kg zoledronic acid (osteoclast inhibitor) reduced the progression of osteolytic lesions by 59% to 66%. CKI therapy also reduced skeletal tumor burden by 62% compared with vehicle, whereas zoledronic acid did not decrease the tumor burden. The efficacy of CKI at inhibiting skeletal tumor burden was similar in the treatment and preventive protocols. By contrast, CKI did not block the growth of s.c. B02 tumor xenografts in animals. Thus, CKI may render the bone a less favorable microenvironment for tumor growth by inhibiting bone resorption. These findings raise the possibility that cathepsin K could be a therapeutic target for the treatment of bone metastases. [Cancer Res 2007;67(20):9894–902]
Evaluation of a composite scoring system in conjunctival challenge with allergen: reproducibility and evolution during loratadine treatment
Authors: J. Bousquet, I. Chanal, W. Czarlewski, F. B. Michel
Journal: Allergy (1995)

The reproducibility of any challenge and its sensitivity to change during therapeutic interventions should always be examined before any drug trial is conducted. Conjunctival challenge has been widely used to assess objectively the efficacy of antiallergic treatments. A double‐blind, placebo‐controlled, crossover study was carried out in 26 patients allergic to grass pollen to test the reproducibility of a composite symptom score during placebo and control days, and to check the ability of loratadine to increase the provocative dose inducing a positive challenge. Conjunctival challenge was carried out with increasing concentrations of a standardized orchard grass pollen extract until a composite symptom score of 5 was reached. The provocative dose inducing a positive challenge was similar for the baseline (6.94 ± 8.7 index of reactivity (IR)) and placebo days (20.0 ± 32.5 IR) and was significantly increased ( P &lt; 0.01 and P &lt; 0.001) when patients received loratadine (117.3 ± 136.8 IR). This study shows that the composite score used was reproducible and sensitive to change, making it possible to use in drug trials.
The comforts of spiritualism
Authors: T. Dalrymple
Journal: BMJ (2012)

Poor Sir Oliver Lodge! An eminent physicist, pioneer of radio, competitor with Marconi, he is remembered today, if at all, mainly for having been a propagandist for spiritualism. His best known book, Raymond or Life and Death , first published in 1916 and subsequently reprinted many times, recounts his efforts to get in posthumous touch with his son, Raymond, who was killed at Ypres in 1915.

Sir Oliver’s pain at losing his son clearly was assuaged by what he thought was evidence of Raymond’s continued existence on “the other side,” and his book, which came with all the authority of a celebrated fellow of the Royal Society, was just what tens of thousands of bereaved parents, for obvious reasons, wanted …
Bone Health in Adult Cancer Survivorship
Authors: Maryam B. Lustberg, Raquel E. Reinbolt, Charles L. Shapiro
Journal: Journal of Clinical Oncology (2012)

Optimizing health outcomes, including prevention of osteoporotic fractures, is essential for promoting the well-being of the growing number of cancer survivors. Medical providers who participate in the care of cancer survivors should be aware that various cancer treatments may cause bone loss, which can increase the risk of subsequent of osteoporosis. Healthy bone remodeling is a balanced and dynamic equation between new bone formation and bone resorption. Aging, natural menopause, and cancer treatments such as surgical oophorectomy, gonadotropin-releasing hormone agonists, chemotherapy-induced ovarian failure, androgen deprivation therapy, and aromatase inhibitors can all promote bone loss. The WHO Fracture Assessment Tool can be used as a clinical aid to assess an individual's osteoporotic fracture risk, with or without bone mineral density measurements obtained from dual-energy x-ray absorptiometry. Preventative strategies include adequate calcium and vitamin D supplementation and modifying risk factors such as alcohol intake, tobacco use, and lack of exercise. Bisphosphonate therapy and rank-ligand monoclonal antibody therapy are the most commonly used agents for management of bone loss resulting from cancer treatment. This review will summarize the mechanisms by which cancer treatments cause bone loss as well provide screening and treatment recommendations for the management of bone loss.
Private Sector Volunteerism as a Solution to Caring for the Uninsured
Authors: Paul L. Hart
Journal: JAMA (1995)

To the Editor.  —In his Editorial, 1 Dr Lundberg calls on  players in the entire health industry—for-profit and not-for-profit—to give away their fair share of free care to those in need. In March 1994, a free medical program was established in a local church in Worcester, Mass. The program is the joint effort of individuals from all over the community. Founded by a physician and a minister, nurses from local hospitals and medical students volunteer their time, and patients and church members help with registration and other nonmedical tasks. The local hospital provides clean patient gowns each week, a private laboratory provides free testing, and a private for-profit x-ray facility provides comprehensive radiology services. Pharmaceutical representatives provide free drug samples.  The entire program has been operated without a budget. There have been a few donations that are used for supplies. All of the administration is accomplished during brief meetings
Head Injuries and the General Surgeon
Authors: D. W. C. Northfield
Journal: BMJ (1967)

As the author points out in his preface, although patients with head injuries in whom severe complications arise are commonly transferred to special units, other patients, and indeed the majority, are of necessity cared for in the hospital to which they are first admitted.This book is written primarily for surgeons and doctors who have had no neuro- surgical training and who are called upon to care for such patients.The writer has had a long experience of head injuries, at Oxford, in the Army, and latterly at Cambridge, and his interest has been manifest in numerous articles and in his activities in the organization of accident services.The book is written in a clear, simple, and concise style and is " arranged from the view- point of a doctor called to see an acute head injury."Emphasis is placed upon " the need to seek a clinical diagnosis of the extent and
Clinical Dermatology: A Color Guide to Diagnosis and Therapy
Authors: M. W. Shelton
Journal: JAMA (2004)

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Immunogenicity of the Q fever skin test
Authors: Teske Schoffelen, Tineke Herremans, Tom Sprong, Marrigje Nabuurs-Franssen, Jos W.M. van der Meer, Leo A.B. Joosten, Mihai G. Netea, Henk A. Bijlmer, Marcel van Deuren
Journal: Journal of Infection (2014)