tbuckley/cabot-search huggingface dataset:
Primary Care Performance in Fee-for-Service and Prepaid Health Care Systems
Authors: Dana Gelb Safran
Journal: JAMA (1994)

To examine differences in the quality of primary care delivered in prepaid and fee-for-service (FFS) health care systems.Longitudinal study of 1208 adult patients with chronic disease whose health insurance was through a traditional indemnity (FFS) plan, an independent practice association (IPA), or a health maintenance organization (HMO). Both IPA and HMO represent prepaid care systems. Patient- and physician-provided information was obtained by self-administered questionnaires.A total of 303 physician offices (family medicine, general internal medicine, endocrinology, or cardiology) in solo and group practices in three US cities.Seven indicators of primary care quality--accessibility (financial and organizational), continuity, comprehensiveness, coordination, and accountability (interpersonal and technical) of care. Performance on each was evaluated in FFS, IPA, and HMO settings. Analyses controlled for patient and physician characteristics.Financial access was highest in prepaid systems. Organizational access, continuity, and accountability were highest in the FFS system. Coordination was highest and comprehensiveness was lowest in HMOs.The results mark notable differences in core dimensions of primary care quality in each of three payment systems and raise questions regarding the associated cost inefficiencies and outcomes of care. In the current health care delivery reform climate, these findings call for consideration of the relative strengths and weaknesses of each system. We suggest strategies for elevating performance in each.
Activating mutation in the TSLPR gene in B-cell precursor lymphoblastic leukemia
Authors: E Chapiro, L Russell, E Lainey, S Kaltenbach, C Ragu, Della-Valle, K Hanssens, EA Macintyre, I Radford-Weiss, E Delabesse, H Cave, T Mercher, CJ Harrison, F Nguyen-Khac, P Dubreuil, OA Bernard
Journal: Leukemia (2009)
-Opioid receptor activation prevents acute hepatic inflammation and cell death
Authors: D. Chakass, D. Philippe, E. Erdual, S. Dharancy, M. Malapel, C. Dubuquoy, X. Thuru, J. Gay, C. Gaveriaux-Ruff, P. Dubus, P. Mathurin, B. L Kieffer, P. Desreumaux, M. Chamaillard
Journal: Gut (2007)

<b>Background and aims:</b> The detrimental impact of opioid agonist on the clinical management of inflammatory diseases remains elusive. Given the anti-inflammatory properties of the μ-opioid receptor (MOR) agonists at the intestinal barrier, we hypothesised that MOR activation might also dampen acute hepatic inflammation and cell death—major determinants in the pathogenesis of liver diseases. <b>Patients and methods:</b> The expression of MOR in liver biopsy specimens and peripheral blood mononuclear cells of untreated patients with chronic hepatitis C virus infection and controls, primary hepatocytes and cell lines was determined by quantitative PCR, immunoblotting and/or immunohistochemistry. The effects of peripheral MOR agonist (d-Ala2,NMe-Phe4,Gly5-ol (DAMGO)) and/or antagonist (naloxone methiodide) were explored in two models of acute hepatitis in mice. MOR-deficient mice were used to evaluate the essential regulatory role of MOR during carbon tetrachloride (CCl<sub>4</sub>)-induced hepatitis. The role of DAMGO in cell death was investigated using terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling (TUNEL) analysis and quantification of lactate dehydrogenase release. <b>Results:</b> The key role of MOR in the prevention of acute hepatic inflammation and cell death in vivo and in vitro is reported. Whereas MOR gene expression increased transiently in the model of acute liver injury and TNFα-treated HepG2 cells, an impaired expression of MOR mRNA in human chronic hepatitis C samples was found. Furthermore, preventive administration of the selective MOR agonist DAMGO enhanced hepatoprotective-signalling pathways in vivo that were blocked by using naloxone methiodide. Consistently, genetic and pharmacological inhibition of MOR enhanced the severity associated with experimental hepatotoxin-induced hepatitis. Finally, treatment with DAMGO was shown to prevent cell death in vitro in HepG2 cells in a MOR-dependent manner and to prevent concanavalin A- and CCl<sub>4</sub>-induced cell death in vivo, providing a possible explanation for the anti-inflammatory role of MOR activation in the liver. <b>Conclusions:</b> The results indicate that MOR agonists may prevent acute hepatitis and hold promising therapeutic use to maintain remission in both chronic inflammatory bowel and liver diseases.
Trials of Oral Streptomycin for Infants with Non-specific Gastroenteritis: I. Trial at the City Hospital, Edinburgh
Authors: G. M. Lowdon, M. M. McNeill
Journal: BMJ (1951)

The cortisone excretions we have observed may not represent the whole amounts originally present, in the urines, as some may well be lost.ordestroyed in the process of extraction (Paterson, Cox, and Marrian, 1950).Nevertheless, until more reliable methods of extraction are developed we believe that much useful information can be obtained by the bio-assay of such extracts. SummaryThe combined cortisone and compound F content of human urine has been measured by bio-assay.In resting normals the output ranges from 40 to 120 pug.daily.In many types of stress due to medical disease the output is raised.The stress output ranges from 160 to 320 jug. a day.The output of cortisone-like hormone is raised in late normal pregnancy.A progressive rise in output occurs during A.C.T.H. therapy, when maximum outputs of over 600 lAg.daily have been observed.The response to A.C.T.H. varies in different persons.Ephedrine increases the output of cortisone-like hormone in the urine.It is unable to maintain adrenaline stimulation induced by A.C.T.H.After cortisone, either injected or by mouth, a rise in output in the urine occurs, and may persist for at least a week after the last injection.Excretion of cortisone-like hormone is usually reduced in Addison's disease and in panhypopituitarism.The increased output of cortisone which medical stress normally provokes did not occur in a case of panhypopituitarism subjectedto stress.
Skeletal Concentrations of Lead in Ancient Peruvians
Authors: Jonathon E. Ericson, Hiroshi Shirahata, Clair C. Patterson
Journal: New England Journal of Medicine (1979)

The level of biologic lead (expressed as the ratio of atomic lead to atomic calcium) in bones of Peruvians buried 1600 years ago was found to be 3 x 10(-8), as compared to 2100 to 3500 x 10(-8) in the bones of present-day residents of England and the United States. The ratio of barium to calcium was 2 to 3 x 10(-6) in bones of ancient Peruvians and present-day Americans. Barium and lead have similar morphologic distributions in organisms, so this discrepancy for lead must result from overexposure of present-day people to industrial lead and not from natural variations. The magnitude of this discrepancy has been confirmed by two different lines of investigation not reported in this article. This new evidence suggests that natural interactions of lead in human cells have not yet been determined because reagents, nutrients and controls used in laboratory and field studies have been contaminated with lead far in excess of naturally occurring levels.
Management of neonatal posterolateral diaphragmatic hernia.
Authors: U R Nair, A Entress, D R Walker
Journal: Thorax (1983)

From March 1978 to April 1982 13 neonates with a left posterolateral diaphragmatic hernia were seen in respiratory distress within 12 hours of birth. Each had severe acidosis and hypoxia. They were immediately intubated and ventilated. Arterial and central venous lines were inserted, the acidosis was partially corrected, and a dopamine infusion of 4-8 micrograms/kg/min was begun immediately. Continuous monitoring of arterial and venous pressures, core and skin temperatures, blood gases, and pH was instituted. Diaphragmatic defects were repaired by direct suture in nine neonates and by Gore-Tex patches in four. The left lung in all patients was hypoplastic. Ventilation and inotropic support were continued for four to five days after operation and close control of acid-base balance was maintained. All but one survive and are doing well. We consider the key to survival to be management of the dangerous combination of acidosis (by enhancing peripheral and renal perfusion with dopamine) and hypoxia (by prolonged assisted ventilation).
Epidemiology of Silicone Breast Implants
Authors: Barbara G. Silverman
Journal: Annals of Internal Medicine (1997)

Letters15 April 1997Epidemiology of Silicone Breast ImplantsBarbara G. Silverman, MD, MPH, S. Lori Brown, PhD, MPH, and Roselie A. Bright, ScDBarbara G. Silverman, MD, MPHU.S. Food and Drug Administration, Rockville, MD 20850Search for more papers by this author, S. Lori Brown, PhD, MPHU.S. Food and Drug Administration, Rockville, MD 20850Search for more papers by this author, and Roselie A. Bright, ScDU.S. Food and Drug Administration, Rockville, MD 20850Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-8-199704150-00034 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree that anecdotal reports and case series are insufficient to establish the existence of a new disease entity or determine its cause. The purpose of our article was not to discuss such reports, which have been summarized elsewhere and do not meet the criteria for epidemiologic studies. Still, as Dr. Whysner points out, such reports may be the first clues to a previously unrecognized disease entity. Although many “new” syndromes are in fact variants of known disorders, new diseases such as the eosinophilia-myalgia syndrome and Lyme disease are occasionally reported [1]. Crucial to the study of such ...References1. Rise and fall of diseases. Lancet. 1993; 341:151-2. Google Scholar2. Silver RM, Heyes MP, Maize JC, Quearry B, Vionnet-Fuasset M, Sternberg EM. Scleroderma, fasciitis, and eosinophilia associated with the ingestion of tryptophan. N Engl J Med. 1990; 322:874-81. Google Scholar3. Varga J, Uitto J, Jimenez SA. The cause and pathogenesis of the eosinophilia-myalgia syndrome. Ann Intern Med. 1992; 116:140-7. Google Scholar Author, Article, and Disclosure InformationAffiliations: U.S. Food and Drug Administration, Rockville, MD 20850 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 April 1997Volume 126, Issue 8Page: 667-668KeywordsCase seriesConnective tissueConnective tissue diseasesEpidemiologyLyme diseaseSclerodermaTryptophan Issue Published: 15 April 1997 Copyright & PermissionsCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Effects of thromboxane synthase inhibition on vascular responsiveness in the in vivo rat mesentery.
Authors: E K Jackson
Journal: Journal of Clinical Investigation (1985)

The purpose of this investigation was to determine the effects of thromboxane synthase inhibition on vascular responsiveness. To achieve this goal, the effects of thromboxane synthase inhibitors on mesenteric vascular responses to sympathetic nerve stimulation, norepinephrine, and angiotensin II were determined in vivo. In normotensive rats, chronic treatment with the thromboxane synthase inhibitor, UK38,485 (100 mg/kg X d X 7 d), attenuated vascular responses to nerve stimulation and angiotensin II, but not to norepinephrine. Indomethacin treatment (5 mg/kg X three doses) did not attenuate vascular responses, but did prevent chronic UK38,485 administration from attenuating vascular reactivity. A single dose of UK38,485 (100 mg/kg) did not modify vascular responses to nerve stimulation or angiotensin II, even though platelet thromboxane synthase was inhibited completely. In spontaneously hypertensive rats, chronic administration (100 mg/kg X d X 7 d) of either UK38,485, OKY1581, or U-63557A (three structurally distinct thromboxane synthase inhibitors) attenuated vascular responses to nerve stimulation and angiotensin II. Only U-63557A suppressed responses to norepinephrine. Chronic treatment with UK38,485 or U-63557A did not influence vascular reactivity in hypertensive rats treated with indomethacin. Also, chronic administration of lower doses of UK38,485 or U-63557A (30 mg/kg X d X 7 d) did not affect vascular responsiveness in hypertensive rats, despite complete blockade of platelet thromboxane synthase. These data indicate that chronic administration of high doses of thromboxane synthase inhibitors attenuates vascular responses to sympathetic nerve stimulation and angiotensin II, but not usually to norepinephrine. This action may be mediated by endoperoxide shunting within the blood vessel wall.
Traumatic chylous knee effusion.
Authors: A J Reginato, E Feldman, J L Rabinowitz
Journal: Annals of the Rheumatic Diseases (1985)

A 47-year-old patient presented with a chylous knee effusion and traumatic infected skin lacerations.The diagnosis of septic arthritis was considered because of purulent looking joint fluid, spuriously high synovial fluid white cell count, and signs of acute knee synovitis.Synovial fluid lipid analysis showed increased total lipids due to high concentration of neutral lipids, mainly triglycerides, and repeated knee radiographs showed a small fracture of the tibial spine.Joint trauma with subchondral fracture can be associated with frank chylous effusion, which may mimic acute septic arthritis.Key words: trauma,
Oral Urea Therapy in Sickle-Cell Anemia
Authors: EDMUND C. LIPP
Journal: Annals of Internal Medicine (1972)

Oral urea was administered to five patients with homozygous sickle-cell anemia who were not in crisis, to study its effect on chronic hemolysis. After a suitable control period the subjects were given urea orally (1 g/kg body weight · day) for 3½ to 7 weeks. At the end of the study period there was no significant change in the level of anemia nor degree of hemolysis in each subject. One patient developed a painful crisis while receiving urea. The only statistically significant group change noted was elevation of the blood urea nitrogen. In three patients there may have been increased hemolysis during therapy, reflected by increased fecal urobilinogen excretion. In these five patients there was no apparent clinical benefit from oral urea administration.
AN INSTRUCTIVE CASE OF APPENDICITIS NECESSITATING AN UNUSUAL METHOD OF OPERATION.
Authors: JOHN A. WYETH
Journal: JAMA (1894)

On Sept. 29, 1894, I saw, in consultation with Dr. Herriman, of Long Island City, New York, a young lady, 16 years of age, who, from the history given me at the time, evidently had an attack of appendicitis beginning ten days before this time. There was a large well-recognized tumor in the right iliac fossa, and although deeply seated, fluctuation was evident by palpation through the abdominal wall and the intervening viscera. Operation was advised, and undertaken at once. The anesthetic used was chloroform. Upon opening into the peritoneal cavity through the usual incision, a large mass was discovered, in no place adherent to the abdominal wall. It was evidently an abscess due to perforation of the appendix, the walls of this abscess being made up of plastic lymph thrown out in advance of the inflammatory process, and agglutination of the neighboring intestines. I recognized that any attempt at
Ruptured Peptic Ulcer-Reply
Authors: Abraham W. Danish
Journal: JAMA (1961)

To the Editor:—  Dr. Kadish's comments concerning our article on ruptured peptic ulcer during triamcinolone therapy indicate another possible source of ulcer and rupture. Regarding our case report, the patient received a total of 4 analgesic compound (Empirin) tablets while in the hospital, all in his last week, the final tablet 3 days before his demise. The ACTH was given in doses of 20 to 30 units by intramuscular injection every few days for a total of 220 units in 23 days. The last three doses, of 25, 25, and 20 units respectively, were administered 10, 9, and 3 days before his death. It is difficult to assume a causal relationship in this case because of the small doses and the time relationship.  There have been numerous reports tending to show an association between gastroduodenal ulceration and its complications, and the administration of ACTH as well as corticosteroids. Whether this
Neurological Presentation of Glandular Fever
Authors: B. Seltzer
Journal: BMJ (1953)

BITISH 83 hemicolectomy, and the continuity of the intestine was restored by means of an isoperistaltic, side-to-side ileo- transverse anastomosis.The patient made a good recovery from the operation and was eventually discharged to his home when the frac- tures had united.He later returned to work. COMMENTThis case is of interest, for it was practically a week before any symptoms or signs of an intra-abdominal lesion appeared.Had it not been for the multiple fractures it is quite possible that this patient would not have been admitted to hospital, or, if he had been, he might have been dis- charged before the intestinal perforation became manifest.It is of interest also to speculate on the possible mechanism of the perforation of the caecum.We believe that minor damage to the caecum resulting in a haematoma in its wall occurred after the injury.It is well known that intra-abdominal traumatic lesions are common at the sites of junction of fixed and mobile intestine.The retroperitoneal haematoma probably caused some degree of ileus and caecal distension.The latter eventually became severe enough to cause the bowel wall to give way at the site of a haematoma.
CHARACTERISTICS OF AN IMMUNE SYSTEM COMMON TO CERTAIN EXTERNAL SECRETIONS
Authors: Thomas B. Tomasi, Eng M. Tan, Alan Solomon, Robert A. Prendergast
Journal: The Journal of Experimental Medicine (1965)

The gamma(1)A present in saliva and colostrum exists largely in the form of higher polymers, the major component of which has a sedimentation coefficient of 11S. The 11S gamma(1)A in these fluids differs from the polymers found in normal and myeloma sera both immunologically and by the fact that their sedimentation coefficients are unaffected by disulfide bond reduction in the absence of urea. However, like other gamma-globulins the 11S gamma(1)A molecules consist of multiple polypeptide chains linked by disulfide bonds. Local synthesis of gamma(1)A in the salivary gland has been shown by fluorescent and autoradiographic studies, although the fraction of the total salivary gamma(1)A which is derived from local production is uncertain. No evidence of transport of intravenously administered I(131)-labeled 7S gamma(1)A from serum to saliva was obtained. Immunological specificity has been demonstrated in the salivary and colostral gamma(1)A. Whether that portion of the gamma(1)A which is immunologically specific is a piece incorporated during the local synthesis of gamma(1)A in the gland or is added by the epithelial cell in the process of transport remains to be determined. Antibody activity (isohemagglutinins) have been demonstrated in saliva and colostrum and have been shown to be of the gamma(1)A-type. In both of these fluids activity is associated primarily with gamma(1)A-polymers of 11S and 18S sizes. There appears to be an immunological system which is characteristic of certain external secretions. Its properties including the local production of a distinctive type of antibody separate it from the "systemic" system responsible for the production of circulating antibody. This system may play a significant role in the body's defense mechanisms against allergens and microorganisms.
ADMINISTRATION OF SERUM BY THE MOUTH
Authors: G. I. Cumberlege
Journal: BMJ (1911)

Result.Case.tions.30 Chronic 6 Cure. 31Chronic, granular, pannus left eye 9 Cure.32 Vide 28 7 Cure. 33Ditto 6 Cure. 34Chronic, papillary 2 Did not return. 35Chronic, scarring advanced 6 Cure. 36Ditto 7 Cure. 37Entropion vision P.L. 1 Did not return.38 Acute papillary 18 Cure. 39Chronic, papillary 14 Cure.40 Chronic, scarring advanced 9 Cure. 41Acute papillary 10 Still under treat- mient.42 Old cicatrices in lids, pannus 7 Cure. 43Vide 40 8 Still under treat- ment. 44Chronic granular 9 Cure. 45Ditto 13 Cure.46 Old case, expression done 5 Cure. 47Acute papillary 8 Under treatment.
Serial High-Spatial-Resolution, Multisequence Magnetic Resonance Imaging Studies Identify Fibrous Cap Rupture and Penetrating Ulcer Into Carotid Atherosclerotic Plaque
Authors: Baocheng Chu, Chun Yuan, Norihide Takaya, Jason R. Shewchuk, Alexander W. Clowes, Thomas S. Hatsukami
Journal: Circulation (2006)
Biochemistry for Medical Students
Authors: William Veale Thorpe
Journal: BMJ (1943)

This synopsis of biochemistry, intended to be complementary to textbooks of physiology, contains sufficient material in condensed form to enable one to understand physiologic and biochemical processes. On one hand it contains much information for its size, on the other it lacks important details which would excite interest in reading. Cross references help to keep the book concise. It is a good attempt to give an outline of biochemistry to medical students in order to facilitate study for examinations.
Depression and Illness Behavior in a General Hospital: a Prevalence Study
Authors: Giovanni A. Fava, Issy Pilowsky, Alessandra Pierfederici, Manuela Bernardi, Dorothy Pathak
Journal: Psychotherapy and Psychosomatics (1982)

Occurrence and characteristics of depression and illness behavior were studied in 325 inpatients of a general hospital in the northern part of Italy. Patients were surveyed in six separate wards (medicine, surgery, dermatology, obstetrics and gynecology, orthopedics and ophthalmology) and represented about 90% of their actual population during a 1-week period. Two self-report scales were used for screening: the CES-D for measuring depression developed by the NIMH and the Illness Behavior Questionnaire (IBQ) developed by Pilowsky and Spence. Both scales were administered in their validated Italian translations. Applying the generally used cut-off point of 16 in the CES-D score, about 58% of the patients were classified as depressed. This cut-off was derived from community studies in the US. Applying a rather more conservative cut-off point of 23 (derived from the scores of psychiatrically depressed patients in Italy), still 33.5% of the patients emerged as depressed. The IBQ scores of the depressed patients showed significantly (p less than 0.001) higher levels of general hypochondriasis, disease conviction, dysphoria and irritability than the nondepressed patients. There were no relevant differences between wards in the amount of depression and IBQ scores even when differences were adjusted for age, sex, marital status and social class. Implications for psychosomatic research (sociodemographic characteristics of depression and illness behavior, bias in comparing hospital patients and controls in the general population, etc.) and treatment (consultation-liaison psychiatry) are discussed.