tbuckley/cabot-search huggingface dataset:
Role of the Radiologist
Authors: Warren Bosley
Journal: JAMA (1982)

To  Editor.—  I was pleased to see that Marc J. Homer, MD, in  COMMENTARY The Role of  Radiologist (1981;246:2581), suggests that the x-ray requisition should be viewed as a request for a consultation rather than an order.  I have long questioned  practice of a radiologist interpreting all x-ray films that are taken in  hospital. I have long believed that I am capable of interpreting many x-ray films taken on my patients. I can recognize most fractures; I can interpret most chest films, including heart configurations; I can evaluate bone age; and I can even interpret a few computed tomographic scans. I have difficulty understanding  need for a radiologist to make a charge for interpreting an x-ray film of a fracture  morning after  fracture has occurred, when I have dealt with it in  emergency room  night before. His interpretation  next
Hospitalization for pain in patients with sickle cell disease treated with sildenafil for elevated TRV and low exercise capacity
Authors: Roberto F. Machado, Robyn J. Barst, Nancy A. Yovetich, Kathryn L. Hassell, Gregory J. Kato, Victor R. Gordeuk, J. Simon R. Gibbs, Jane A. Little, Dean E. Schraufnagel, Lakshmanan Krishnamurti, Reda E. Girgis, Claudia R. Morris, Erika B. Rosenzweig, David B. Badesch, Sophie Lanzkron, Onyinye Onyekwere, Oswaldo L. Castro, Vandana Sachdev, Myron A. Waclawiw, Rob Woolson, Jonathan C. Goldsmith, Mark T. Gladwin
Journal: Blood (2011)
ANAL CANCER MANAGEMENT AND OUTCOMES IN NORTHERN IRELAND 2002-2006
Authors: K McElvanna, A J Cole, R J A Harte, R M Park
Journal: Gut (2013)

<h3>Introduction</h3> Anal cancer is a relatively uncommon malignancy and requires a multidisciplinary management approach. <h3>Aims/Background</h3> The aim of this study was to review the surgical and oncological management and outcomes for anal cancer diagnosed in Northern Ireland between 2002–2006. <h3>Method</h3> Data was collected retrospectively from computerised records for patients diagnosed with anal cancer in Northern Ireland between 2002–2006. Patient demographics, radiological, histological, surgical and oncological data were recorded. Kaplan Meier estimates of overall survival were calculated. <h3>Results</h3> Eighty patients (43 female) were identified. Median age was 57 years (27–85 years). Ninety-three percent had squamous cell carcinoma. Sixty-three patients (78.8%) were treated with curative intent. Of these, 44 (69.8%) had chemoradiotherapy (CRT). Completion rates of chemotherapy and radiotherapy were 72.3% and 97.8% respectively. Twenty-six patients (32.5%) had primary surgical treatment (16 local excisions, 9 APER, 1 panproctocolectomy). Eight patients had a salvage APER and 1 had a recurrence locally excised. Twelve patients had a defunctioning loop stoma fashioned (2 were reversed). Overall APER and permanent stoma rates were 22.5% and 36.3%. Forty-three patients (53.8%) had excisional or defunctioning surgery as part of their management. Median overall survival (OS) was 9.1 years, 2 and 5 year OS was 79% and 62% respectively. In the curative CRT group 2 year and 5 year OS were 90.1% and 76.2% respectively. <h3>Conclusion</h3> Chemoradiotherapy is the primary treatment modality for patients with anal cancer. However, many patients require either local, radical or defunctioning surgery. Survival outcomes for this 5 year cohort are comparable with published series.
Biliary secretion of anionic polypeptide fraction is not coupled to that of phospholipids and cholesterol in rats
Authors: Henkjan J. Verkade, Folkert Kuipers, Nicole Domingo, Rick Havinga, Jeannie Léonardi, Roel J. Vonk, Huguette Lafont
Journal: Hepatology (1997)

Anionic polypeptide fraction (APF) is a phospholipid- and calcium-binding apoprotein present in animal and human bile, predominantly associated with cholesterol-phospholipid vesicles. In bile, the protein may play a physiological role in preventing precipitation of calcium salts. APF has also been suggested to be of regulatory importance in the process of biliary lipid secretion. The aim of the present study was to investigate whether the secretion rates of APF and that of biliary lipids are coupled, which would support a physiological role of APF in biliary lipid secretion. Biliary secretion rates of bile acids, phospholipids, and cholesterol were experimentally modulated in three different rat models. Secretion rates of APF were compared with that of bile acids, lipids, and with that of two other biliary proteins, the lysosomal protein beta-glucuronidase and apolipoprotein A-I (apo A-I). Model 1: diurnal variation in bile formation during chronic bile diversion; model 2: specific inhibition of biliary phospholipid and cholesterol, but not of bile acid secretion by infusion of the organic anion, sulfated lithocholyltaurine; model 3: acute interruption of the enterohepatic circulation in unanesthetized rats. The diurnal variation in bile formation involved a parallel increase of the biliary secretion rates of bile acids (+56 +/- 7%, mean +/- SD), phospholipids (+53 +/- 29%), cholesterol (+73 +/- 54%), and APF (+72 +/- 86%) during the night phase of the cycle. Infusion of sulfated lithocholyltaurine inhibited biliary phospholipid and cholesterol secretion (-78 +/- 15%, and -54 +/- 25%, respectively), but did not affect biliary bile acid or APF secretion rate (-19 +/- 14%, and +12 +/- 107%, respectively). Within 4 hours after interruption of the enterohepatic circulation, bile secretion rates for bile acids (-92 +/- 3%), phospholipids (-74 +/- 13%), cholesterol (-64 +/- 8%), and APF (-58 +/- 24%) rapidly declined to a new steady-state level. Correlation analysis using the data from the three experimental models indicated that the biliary secretion rate of APF was independent from that of phospholipids, cholesterol, beta-glucuronidase, and, presumably, apolipoprotein A-I, and positively correlated to bile acid secretion rate and bile flow. The data from three experimental models indicate that the biliary secretion rates of APF and of phospholipids/cholesterol are not coupled and, therefore, do not support a direct physiological role of APF secretion in biliary lipid secretion. APF secretion into bile may, at least partially, be controlled by biliary bile acid secretion.
Arterial Auscultation in Peripheral Vascular Disease
Authors: Stefan A. Carter
Journal: JAMA (1981)

Bruits between epigastrium and popliteal fossae were found in 63% of 309 patients with arterial obstruction and in 7% of 149 patients without obstruction. In the former group, ankle systolic pressure at rest was abnormal in 85% of limbs with bruits, indicating a hemodynamic abnormality. In the majority of limbs with bruits and normal pressures at rest, an abnormal pressure response to exercise suggests that auscultation is useful in detection of even milder arterial lesions. Auscultation, after exercise and during compression of arterial branches distal to the bruits, may unmark stenotic lesions that do not produce audible bruits at rest and may localize bruit-producing lesions. This study indicates that peripheral auscultation is a valuable technique for assessing the arterial system in individual patients and for screening population groups.
WHERE IS THE BICHLORIDE IN "BICHLORIDOL"?
Authors: R. N. Harger
Journal: JAMA (1930)

<h3>To the Editor:</h3> —The A. M. A. Chemical Laboratory recently reported (The Journal, Dec. 21, 1929, p. 1971) that samples of "Bichloridol" which it examined were found to contain much less mercury than was claimed on the label. On reading this report it occurred to me that the missing mercury had probably combined with the gelatin lining of the container ("collapsule"). Analyses showed that this explanation is correct. The samples of "Bichloridol" analyzed by me were stated to contain "one-half grain (0.03 gram)" of mercury bichloride and had been purchased on the open market within the last year. The contents and container were analyzed separately, organic matter being oxidized by means of hydrochloric acid and sodium chlorate (Fresenius-von Babo method) and the liberated mercury removed electrolytically. The mercury so deposited was distilled from the electrode and weighed. These gravimetric results were checked by a colorimetric method that I recently developed
Retrocalcaneal bursitis in polymyalgia rheumatica
Authors: I OLIVIERI
Journal: Annals of the Rheumatic Diseases (2001)

Polymyalgia rheumatica (PMR) is a relatively common disease of the elderly affecting the synovial membrane.1 

Recent studies have emphasised the prominent involvement of the extra-articular synovial structures in both proximal and distal regions of both the arms and legs.1-7 In the distal part of the arms tenosynovial membrane inflammation is responsible for carpal tunnel syndrome, distal swelling of hands and feet with or without pitting oedema, and localised episodes of distal tenosynovitis.4-7 

We recently observed the case of a patient with PMR showing retrocalcaneal bursitis, which we describe briefly here.

A 68 year old woman was referred to us for evaluation of a three month history of marked aching and morning stiffness in her neck, shoulder, and hip girdles associated with low grade fever. Her medical history was otherwise unremarkable except for a hereditary cerebellar cortical degeneration. Her family history was negative for rheumatic diseases, including spondarthritis.

Physical examination showed tenderness and limitation of cervical and shoulder movement. The typical gait and abnormal stance of cerebellar ataxia were also present.

Laboratory evaluation disclosed an erythrocyte sedimentation rate (ESR) of 72 mm/1st h (Westergren) and a C reactive protein (CRP) concentration of 80 mg/l (normal <5). Tests for rheumatoid factor, antinuclear antibodies, and serum tumour markers were negative, and HLA typing did not show the B27 antigen.

Methylprednisolone at a dose of 16 mg/day was started and symptoms rapidly disappeared. ESR …
Pneumococcal Vaccine for the `Healthy Elderly'?
Authors: Jonathan M. Mann
Journal: JAMA (1983)

<h3>To the Editor.—</h3> Vaccine manufacturers' recommendations for pneumococcal vaccine use differ in one extremely important respect from recommendations by the Centers for Disease Control<sup>1</sup>and the American College of Physicians.<sup>2</sup>At issue is whether healthy persons 50 years of age and older (the "healthy elderly") should routinely be given pneumococcal vaccine. A rational argument for routine pneumococcal vaccine use in this group requires, among other considerations such as vaccine safety and efficacy, knowledge of the incidence of pneumococcal pneumonia in the healthy elderly of this country. Unfortunately, the literature provides two surprisingly different incidence estimates for the general US population. At one extreme lie rates of two to five cases of pneumococcal pneumonia per 1,000 persons each year,<sup>3</sup>while rates up to 25 times lower (20 to 45 cases per 100,000 persons per year)<sup>3-5</sup>are also cited. Until studies in the healthy elderly accurately define the
Proteolysis and phenylalanine hydroxylation in response to parenteral nutrition in extremely premature and normal newborns.
Authors: S C Denne, C A Karn, J A Ahlrichs, A R Dorotheo, J Wang, E A Liechty
Journal: Journal of Clinical Investigation (1996)

To determine to what extent intravenous nutrition can reduce proteolysis in very immature and normal newborns, and to assess the capacity of preterm and normal newborns to convert phenylalanine to tyrosine, phenylalanine and leucine kinetics were measured under basal conditions and during parenteral nutrition in clinically stable, extremely premature (approximately 26 wk of gestation) infants and in normal term newborns. In response to parenteral nutrition, there was significantly less suppression (P < 0.001) of endogenous leucine and phenylalanine rate of appearance in extremely premature infants compared with term infants. Phenylalanine utilization for protein synthesis during parenteral nutrition increased significantly (P < 0.01) and by the same magnitude (approximately 15%) in both extremely premature and term infants. Phenylalanine was converted to tyrosine at substantial rates in both extremely premature and term infants; however, this conversion rate was significantly higher (P < 0.05) in extremely premature infants during both the basal and parenteral nutrition periods. These data provide clear evidence that there is no immaturity in the phenylalanine hydroxylation pathway. Furthermore, although parenteral nutrition appears to produce similar increases in protein synthesis in extremely premature and term infants, proteolysis is suppressed much less in extremely premature newborns. The factors responsible for this apparent resistance to suppression of proteolysis in the very immature newborn remain to be elucidated.
Hydroxocobalamin
Authors: George B. Jerzy Glass
Journal: JAMA (1963)

To explore the long-range effects of hydroxocobalamin (Alpharedisol) injections upon B 12 blood levels, the authors compared the effects of 10 to 14 weekly intramuscular injections of hydroxocobalamin and cyanocobalamin in 50 persons. During the cyanocobalamin treatment, B 12 . blood levels remained in the range of 1,000 to 1,700 μμg/ml (the maximal value not exceeding 2,000 μμg/ml), but during hydroxocobalamin therapy they leveled off at an average of 8,000 μμg/ml, with the maximal values reaching as high as 15,000 μμg/ml. After discontinuation of the cyanocobalamin treatment, B 12 blood levels reverted to normal within four to five weeks, but after hydroxocobalamin they did not return to the upper limit of the norm for six to seven months. At the end of the year, they were still about three times higher than before the treatment.
Domiciliary thrombolysis by general practitioners.
Authors: S. J. Pocock, D. J. Spiegelhalter
Journal: BMJ (1992)

study in the absence of electrocardiographic criteria is not necessarily generally applicable.Unless thrombolvsis is restricted to those presenting early and with classic symptoms of infarction, the proportion of alternative diagnoses (2-2%) is unlikely to be substantiated.For example, phase 1 of the myocardial infarction triage and intervention project found only one in six confirmed infarctions among those evaluated before admission to hospital.'The statement that "even in an urban area there would be a temporal advantage in the general practitioner giving thrombolytic therapy in the home" is untested and cannot be extrapolated from the present study.A 999 call and shortening of the delays in hospital would have reduced the difference between home and hospital treatment substantially.We have shown that in an urban area the time of administration of thrombolytic treatment after the onset of symptoms was reduced to a median of 150 minutes by the introduction of a "fast track" system.' Until these issues are resolved it may be pre- mature to advise the widespread implementation of pre-hospital thrombolysis without electrocardiographic confirmation.
Carcinoid Carcinomatous Meningitis
Authors: ROBERT A. NAGOURNEY
Journal: Annals of Internal Medicine (1985)

A 67-year-old woman with metastatic carcinoid tumor developed neurologic signs and symptoms of left facial paralysis and progressive lower extremity weakness. Results of cytologic evaluation of cerebrospinal fluid were normal. However, biochemical analysis of the cerebrospinal fluid showed extreme elevations of 5-hydroxyindoleacetic acid and serotonin, consistent with carcinomatous meningitis caused by carcinoid tumor. Subsequent contrast myelography confirmed the presence of meningeal metastases.
The wrong job at the wrong time
Authors: P. Keech
Journal: BMJ (1997)

When I was young I wanted to be a doctor. At 18, unlike some of my medical school colleagues who hailed from medical families, I had no realistic idea of what being a doctor meant. I admired and respected my parents' hard work as teachers and throughout my school years their working hours and holidays seemed similar to mine. My motivation to do medicine was based on wanting to please and impress them, together with a naive conviction that my enjoyment at visiting a local geriatric ward and cheering up the residents signalled a wider need to be indispensable to the sick and needy. I liked the vocational idea of medicine—other degrees seemed vague and open ended. But a recent failed attempt at being a partner in general practice has forced me to question my choice.

High quality career guidance was never in plentiful supply. At school the career guide suggested ergonomics, which puzzled me then and puzzles me still. At medical school I recall a “women in medicine” meeting where two women doctors told us their stories. When asked how to combine medicine with looking after a family, the first doctor intimated that she had dropped her babies so effortlessly and with so little upheaval that she was back at work faster than a male colleague with back pain. The second and older …
A Source of Error in Determination Cell Counts
Authors: B. Freedman
Journal: BMJ (1945)

suspensions in normal saline, using a normal saline control; marked localized urticar-ial reactions occurred with both the quinine and the mepacrine, while the control showed no reaction.As a result of these tests he was considered unfit for service in malarious areas.Such a condition must be very rare indeed, and I can find no reference to this double hypersensitivity in any textbook available to me at present.In fact, in Mem1oran1dulm oni Medical Diseases in Tropica-l antid SNhtropical A reas there occurs this statement: " Those with an idiosyncrasy to quinine can take rnepacrine with impunity.Mepacrine appears to provoke no similar condition."
P1194 EVALUATION OF OPTIMAL HCV RNA CUT-OFFS WITH TWO MAJOR REAL-TIME PCR-BASED ASSAYS FOR RESPONSE-GUIDED TRIPLE THERAPY WITH TELAPREVIR
Authors: C. Sarrazin, I. Dierynck, G. Cloherty, A. Ghys, K. Janssen, V. Van Eygen, D. Luo, J. Witek, M. Buti, G. Picchio, S. De Meyer
Journal: Journal of Hepatology (2014)
Congenital Hydrocolpos
Authors: Harry M. Spence
Journal: JAMA (1962)

Hydrocolpos, found chiefly in the new-born, characteristically presents as a mass in the lower abdomen associated with a cystic bulge at the introitus or an imperforate hymen. There is a membranous obstruction at the vaginal outlet in conjunction with excessive secretion of the glands of the infantile uterine cervix. A vaginogram made by injecting the cyst with radiopaque material helps to confirm the diagnosis. The best treatment is simple incision of the occluding vaginal diaphragm. In 6 of the 40 cases described in the literature since 1940, hysterocolpectomy was done, and the diagnosis was made only after examination of the removed surgical specimen. In 3 of the 4 cases reported by the author the condition occurred in newborn babies; in the fourth it became manifest at the age of 2 months.
Differential Effects of HRV Species On Cold and Asthma Symptoms
Authors: Hiba Bashir, Yury Bochkov, Fue Vang, Tressa Pappas, Kristine Grindle, Theresa Kang, Lisa Salazar, Elizabeth L. Anderson, Sheila Turcsanyi, Michael D. Evans, Ronald E. Gangnon, Kirsten Kloepfer, Daniel J. Jackson, Robert F. Lemanske, James Gern
Journal: Journal of Allergy and Clinical Immunology (2013)
Intra-islet insulin suppresses glucagon release via GABA-GABAA receptor system
Authors: Elaine Xu, Mohan Kumar, Yi Zhang, William Ju, Toshiyuki Obata, Nina Zhang, Shiying Liu, Anna Wendt, Shaoping Deng, Yousuke Ebina, Michael B. Wheeler, Matthias Braun, Qinghua Wang
Journal: Cell Metabolism (2006)
Cardiopulmonary Manifestations of Hepatosplenic Schistosomiasis
Authors: Monica Lapa, Bruno Dias, Carlos Jardim, Caio J.C. Fernandes, Paulo M.M. Dourado, Magda Figueiredo, Alberto Farias, Jeane Tsutsui, Mario Terra-Filho, Marc Humbert, Rogerio Souza
Journal: Circulation (2009)

Schistosomiasis is a highly prevalent disease with >200 million infected people. Pulmonary hypertension is one of the pulmonary manifestations in this disease, particularly in its hepatosplenic presentation. The aim of this study was to determine the prevalence of pulmonary hypertension in schistosomiasis patients with the hepatosplenic form of the disease.All patients with hepatosplenic schistosomiasis followed up at the gastroenterology department of our university hospital underwent echocardiographic evaluation to search for pulmonary hypertension. Patients presenting with systolic pulmonary artery pressure >40 mm Hg were further evaluated through right heart catheterization. Our study showed an 18.5% prevalence of patients with elevated systolic pulmonary artery pressure at echocardiography. Invasive hemodynamics confirmed the presence of pulmonary hypertension in 7.7% (95% confidence interval, 3.3 to 16.7) of patients, with a prevalence of precapillary (arterial) pulmonary hypertension of 4.6% (95% confidence interval, 1.5 to 12.7).Our study reinforces the role of echocardiography as a screening tool in the investigation of pulmonary hypertension, together with the need for invasive monitoring for a proper diagnosis. We conclude that hepatosplenic schistosomiasis may account for one of the most prevalent forms of pulmonary hypertension worldwide, justifying the development of further studies to evaluate the effect of specific pulmonary hypertension treatment in this particular form of the disease.
The Inhibitory Quotient
Authors: Kenneth J. Tack
Journal: JAMA (1982)

To the Editor.—  The description of the inhibitory quotient (IQ) by Paul D. Ellner, PhD, and Harold C. Neu, MD (1981;246:1575), was welcome, as it formalizes the thought processes that must occur whenever quantitative susceptibility data are interpreted by the clinician. It is important, however, to realize several limitations of the use of the IQ in practice.  The authors are careful to point out the need to consider specific tissue levels achievable, but fail to mention that considerable variation is seen between patients in CSF penetration. 1 Indeed, marked variability even of serum levels is seen with certain antimicrobial agents, underscoring the need for assay procedures to ensure therapeutic levels. 2 Antibacterial activity of aminoglycosides, tetracyclines, trimethoprim, and sulfonamides is diminished under the acid-base and redox conditions often encountered in infected tissue.  A fourfold to eightfold ratio between serum level of drug and minimum inhibitory concentration (MIC) is suggested as