tbuckley/cabot-search huggingface dataset:
Increased Pulse Pressure and Risk of Heart Failure in the Elderly
Authors: Claudia U. Chae
Journal: JAMA (1999)

Context Arterial stiffness increases with age.Thus, pulse pressure, an index of arterial stiffening, may predict congestive heart failure (CHF) in the elderly. ObjectiveTo study prospectively the association between pulse pressure and risk of CHF.Design Prospective cohort study. SettingThe community-based East Boston Senior Health Project, East Boston, Mass.Patients A total of 1621 men and women (mean [SD] age, 77.9 [5.0] years) free of CHF who had blood pressure measurements taken in 1988-1989 and were followed up for 3.8 years.Main Outcome Measure Incidence of CHF as ascertained by hospital discharge diagnosis (n = 208) and death certificates (n = 13). ResultsAfter controlling for age, sex, mean arterial pressure, history of coronary heart disease, diabetes mellitus, atrial fibrillation, valvular heart disease, and antihypertensive medication use, pulse pressure was an independent predictor of CHF.For each 10-mm Hg elevation in pulse pressure, there was a 14% increase in risk of CHF (95% confidence interval, 1.05-1.24;P = .003).Those in the highest tertile of pulse pressure (Ͼ67 mm Hg) had a 55% increased risk of CHF (P = .02)compared with those in the lowest (Ͻ54 mm Hg).Pulse pressure was more predictive than systolic blood pressure alone and was independent of diastolic blood pressure. ConclusionPulse pressure, an easily measurable correlate of pulsatile hemodynamic load, is an independent predictor of risk of CHF in this elderly cohort.
Chemotherapy of Malaria
Authors: G. Covell
Journal: BMJ (1964)

The recent war, which carried troops into al1 the highly malarious regions of the world, gave great impetus to the search for better antimalaria1 drugs. The greatest concerted effort was put forth in the United States under the guidance of the Board for Coordination of Malaria1 Studies. The principal objective was the discovery of a drug of low toxicity which would also be at least one of the following against al1 types of human malaria: a true causal prophylactic, a better therapeutic or suppressive agent than was then available, or a truly curative agent. Under this coordinated program, over 14,000 compounds of various types were screened against severa1 of the avian malarias. The pharmacology and toxicology of many of the compounds of promise were studied in lower mammals, and approximately 100 were finally tested against the human malarias. The principal practica1 results were the development of rational regimens for the use of quinacrine (atabrine), based on its physiological disposition and antimalarial activity; the development of chloroquine, a therapeutic and suppressive agent of great value; and the development of the curative agents pentaquine and isopentaquine. The British effort, although on a smaller scale, resulted in the synthesis and elucidation of the highly interesting drug paludrine. The object of this paper is to set forth the general usefulness of the better chemotherapeutic agents when used for the suppression, alleviation or radical cure of human malaria. Any drug to be generally useful must be effective against Plasmodium falciparum, and it is now known
A woman with fatigue, dyspnoea, and orthopnoea
Authors: V. Sharma, M. P Agarwal
Journal: BMJ (2010)

A 55 year old woman presented to the emergency department with a history of generalised fatigue of about four months and breathlessness of one month. She had also experienced shortness of breath when lying flat during the past week. She had no history of chest pain or cough, no relevant medical history, and she was not taking drugs.

On arrival, her blood pressure was 92/66 mm Hg, her pulse was 67 beats/min, her respiratory rate was 20 breaths/min, and oxygen saturation on air was 94%. On examination, her neck veins were distended and cardiac sounds were muffled. She had coarsening of the facies and the deep tendon reflexes showed delayed relaxation. Her chest radiograph showed an increased cardiothoracic ratio, with the appearance of a globular heart. The pulmonary parenchyma seemed to be normal (figure⇓). Electrocardiography revealed low voltage complexes.



Chest radiograph showing an increased cardiothoracic ratio, with the appearance of a globular heart 





### 1 What is the diagnosis on the basis of the clinical findings, chest radiography, and electrocardiography?

#### Short answer

The diagnosis is pericardial effusion with features of tamponade.

#### Long answer

The pericardium has two layers, a single cell visceral pericardium and a fibrous parietal pericardium. The pericardium is thought to act as a barrier to infection and to have a mechanical function in restraining the cardiac volume. The space between the two layers is called the pericardial sac. It normally contains around 15-35 ml of serous fluid.1 The fluid is an ultrafiltrate of plasma that lubricates the two layers of pericardium. Abnormal increases in the volume of fluid …
DNA hypermethylation in tumorigenesis: epigenetics joins genetics
Authors: Stephen B Baylin, James G Herman
Journal: Trends in Genetics (2000)

Recently, the concept that epigenetic, as well as genetic, events might be central to the evolution of human cancer is re-emerging. Cancers often exhibit an aberrant methylation of gene promoter regions that is associated with loss of gene function. This DNA change constitutes a heritable state, not mediated by altered nucleotide sequence, that appears to be tightly linked to the formation of transcriptionally repressive chromatin. This epigenetic process acts as an alternative to mutations to disrupt tumor-suppressor gene function and can predispose to genetic alterations through inactivating DNA-repair genes. Dissecting the molecular processes that mediate these methylation changes will enhance our understanding of chromatin modeling and gene regulation and might present novel possibilities for cancer therapy. Methylation changes constitute potentially sensitive molecular markers to define risk states, monitor prevention strategies, achieve early diagnosis, and track the prognosis of cancer.
Epidemiology supports oral contraceptives as a risk factor in Crohn's disease
Authors: M ALIC
Journal: Gut (2000)

Editor,—A recent clinical alert ( Gut 1999; 44 :311–12) commented on a study of risk factors for relapse in Crohn's disease.1 The author concluded that, unlike the established association with smoking, the link with oral contraceptive use is still controversial. To contribute to this discussion, I have investigated temporal trends in age and sex specific disease incidence and correlated them with the chronology of oral contraceptive use.

The birth control pill was first introduced in 1960 and soon became widely accepted; 10 million American women were taking it by 1973.2 Concerns about side effects prompted further research, and by the mid-1970s most women taking were taking oral contraceptive pills containing 50 μg or less of oestrogen—a considerable decrease from the …
OBSTRUCTION OF THE BOWEL DUE TO A ROUND WORM IN THE APPENDIX.
Authors: W. ALBERT NASON
Journal: JAMA (1904)

The following case has some unique features which make it of sufficient interest to report. <h3>Patient.</h3> —M. E. H., girl, aged 15 years, of Coalmont, Pa., was taken sick Tuesday, Aug. 16, 1904, vomiting freely, for which home remedies were tried. <h3>History.</h3> —Wednesday, August 17, at 4 p. m., Dr. Evans of Saxton, four miles away, was called. Friday, August 19, Dr. Evans was again called, as vomiting persisted and was accompanied by some pain. Saturday morning, August 20, a consultation was held with Dr. Schum of Huntingdon. It was concluded that there was an obstruction of the bowels and that an operation probably would be necessary. <h3>Examination.</h3> —I reached the case Saturday evening and found the patient suffering some pain, though it was not severe. Temperature had been
"RUBBER TUBE PERCUSSION."
Authors: ARNOLD C. KLEBS
Journal: JAMA (1907)

Dr. F. M. Pottenger has recently recommended<sup>1</sup>immediate percussion with a rubber tube, which, he believes, is a "method of greater precision" and possessing "superior advantages over methods in common use." The usefulness of all methods of percussion depends, of course, largely on the individual who uses them; good as well as bad results can be obtained with almost any method. But a new clinical method must have both intrinsic as well as heuristic value, otherwise it constitutes merely an encumbrance to an already confusingly large diagnostic armamentarium. If we analyze Pottenger's announcement we find that he really does not describe a method, but merely advocates the use of a rubber tube instead of the hammer. One naturally surmises, since nothing to the contrary is stated clearly, that the tube is to be used as one ordinarily uses the hammer or the finger, i. e., with a rebounding blow.
How to manage term breech deliveries
Authors: A. Shennan, S. Bewley
Journal: BMJ (2001)

At term 3-4% of all babies will present by the breech. The Term Breech Trial has recently clarified whether a vaginal breech delivery at term should be avoided.1 Until now this argument has been muddied by the emotive debate about natural versus caesarean delivery, against a background of poor evidence to support or refute the safety of breech delivery for mother or baby.

The Term Breech Trial showed a significant increase in perinatal mortality and morbidity (3.4%) with planned vaginal delivery. As breech presentation is itself significantly associated with poor perinatal outcome, previous observational studies have been too seriously confounded to be able to inform clinical decisions. Until this trial there had been only two randomised controlled trials comparing planned caesarean section and vaginal breech delivery at term. 2 3 These studies were small (only 313 women) but suggested a worse outcome for the mother and a better outcome for the baby if caesarean section was planned. Some obstetricians routinely performed caesarean sections for breech at term, while others selected appropriate term breech babies …
Initiation of Antihypertensive Treatment During Nonsteroidal Anti-inflammatory Drug Therapy
Authors: Jerry H. Gurwitz
Journal: JAMA (1994)

<h3>Objective.</h3> —To determine whether there is an increased risk for the initiation of antihypertensive therapy in older persons prescribed nonaspirin, nonsteroidal anti-inflammatory drugs (NSAIDs). <h3>Design.</h3> —Case-control study. <h3>Setting.</h3> —New Jersey Medicaid program. <h3>Patients.</h3> —Medicaid enrollees aged 65 years and older. The 9411 case patients were newly started on an antihypertensive medication between November 1981 and February 1990. A similar number of controls were randomly selected among other enrollees. <h3>Main Outcome Measures.</h3> —We used logistic regression to determine the odds ratio for the initiation of antihypertensive therapy in patients using NSAIDs relative to nonusers, after adjusting for age, sex, race, nursing home residence, number of prescriptions filled, intensity of physician utilization, and days hospitalized. <h3>Results.</h3> —The adjusted odds ratio for the initiation of antihypertensive therapy for recent NSAID users compared with nonusers was 1.66 (95% confidence interval, 1.54 to 1.80). The odds ratio increased with increasing daily NSAID dose: the adjusted odds ratio for users of low average daily doses relative to nonusers was 1.55 (95% CI, 1.38 to 1.74), that for medium-dose users was 1.64 (95% CI, 1.44 to 1.87), and that for high-dose users was 1.82 (95% CI, 1.62 to 2.05). <h3>Conclusions.</h3> —Use of NSAIDs may increase the risk for initiation of antihypertensive therapy in older persons. Given the high prevalence of NSAID use by elderly persons, this association may have important public health implications for the management of hypertension in the older population. (<i>JAMA</i>. 1994;272:781-786)
Now we are quite old
Authors: C. Douglas
Journal: BMJ (2003)

Of the original 150 of us, about 50–most with partners–gather at a country hotel on a Friday afternoon. The sky is dull, and rain threatens. Little groups form and re-form, on the lawn and in the car park and hotel lobby, and around a pinboard with odd memorabilia: an ancient class list, typed and yellowing; the menu from our graduation dinner; a group photograph of our 20th year reunion. How young we looked then.

Who's who? It's not always clear, but …
Prostaglandin E2 selectively increases interferon gamma receptor expression on human CD8+ lymphocytes.
Authors: M N elMasry, R R Rich
Journal: Journal of Clinical Investigation (1989)

We previously reported that prostaglandin E2 (PGE2) at a physiologic concentration (10(-8) M) and interferon gamma (IFN gamma), acting sequentially, were required for the differentiation of suppressor cells in mitogen-stimulated cultures. The present study was designed to test whether PGE2 might mediate IFN gamma-dependent effects on CD8+ cells by altering the number and/or affinity of their IFN gamma receptors. CD8+ and CD4+ cells when cultured for 18 h expressed comparable numbers of IFN gamma receptors of a single high affinity. Incubation with 10(-8) M PGE2 for 18 h, however, increased the number of IFN gamma receptors on CD8+ cells without affecting the binding affinity. Similar effects were not observed with CD4+ cells, nor when CD8+ cells were cultured in 10(-8) M PGD2. Concentrations of PGE2, which were ineffective in the induction of IFN gamma-dependent suppressor cell differentiation, also did not affect IFN gamma receptor expression on CD8+ cells. This observation of a specific stimulatory effect of PGE2 on the display of IFN gamma receptors of CD8+ cells suggests a novel mechanism for eicosanoid function through tissue-specific regulation of hormone receptors.
More on<i>Angiostrongylus cantonensis</i>Infection
Authors: Thomas W. Simpson
Journal: New England Journal of Medicine (1995)

To the Editor: Bravo to Dr. Gottlieb for her Sounding Board article.The silence of organized medicine in the face of two decades of terrorist assaults on women, physicians who perform abortions, and personnel assisting in abortions has been nothing less than scandalous.Were such murderous rage and harassment unleashed against physicians who perform vasectomies, their patients, and their staffs, it is not far-fetched to believe that the American Medical Association and the American College of Surgeons would long since have voiced their outrage publicly.But in the face of the terrorist campaign against women and abortion providers by right-wing fanatics and religious bigots, organized medicine has responded with craven silence.
Mechanism of Procainamide-Induced Prevention of Spontaneous Wave Break During Ventricular Fibrillation
Authors: Young-Hoon Kim, Masaaki Yashima, Tsu-Juey Wu, Rahul Doshi, Peng-Sheng Chen, Hrayr S. Karagueuzian
Journal: Circulation (1999)

Background —Ventricular fibrillation (VF) is maintained by 2 mechanisms: first by reentry formation and second by spontaneous wave break or wave splitting. We hypothesized that spontaneous wave break results from a critical shortening of the action potential duration (APD) during VF and that its prevention by procainamide eliminates spontaneous wave break. Methods and Results —The endocardial surfaces of 7 isolated, perfused swine right ventricles were mapped with a 3.2×3.8 cm plaque with 477 bipolar electrodes. Activation pattern during VF was visualized dynamically while simultaneously recording epicardial action potentials with a glass microelectrode. APD restitution curves were constructed during VF (dynamic) and during S 1 S 2 protocols. At baseline, VF was maintained by 5.3±1 wavelets. Procainamide (PA) at 10 μg/mL decreased the number of wavelets to 3.5±1 ( P &lt;0.05). At baseline VF was maintained by spontaneous wave break and by new reentrant wave front formation. PA eliminated spontaneous wave break during VF while having no effect on reentry formation. PA increased the cycle length of the VF (148.5±41.2 ms vs 81±10 ms, P &lt;0.01) and the core area of the reentry from 5.8 to 14.5 mm 2 ( P &lt;0.05). Dynamic APD restitution curve during VF showed that PA eliminated the initiation of activation with APDs shorter than 30 ms. The effects of PA on cellular properties and wave front dynamics were reversed during 60 minutes of drug-free perfusion. Conclusions —Critically short APDs during VF promote spontaneous wave break. Their elimination with PA, however, maintains VF by generating new reentrant wave front.
Durable complete remission of macroglobulinemia after splenectomy: A report of two cases and review of the literature
Authors: Jeffrey S. Humphrey, C. Lockard Conley
Journal: American Journal of Hematology (1995)

Abstract Two patients with macroglobulinemia (monoclonal lgM in the serum) and massive splenomegaly were incapacitated by progressive disease refractory to standard chemotherapy. In each case, palliative splenectomy was followed by a prompt, complete, and unexpected clinical remission with disappearance from the serum of the monoclonal IgM component. One patient remains free of disease 12 years after splenectomy. The other patient remained free of detectable macroglobulinemia for 13 years after splenectomy. A review of the literature revealed other cases of remission of macroglobulinemia attributable to splenectomy alone. Data in humans and animals suggest that the spleen may facilitate IgM secretion by normal and malignant B lymphocytes. Splenectomy should be considered a possible treatment option for patients with massive splenomegaly and macroglobulinemia who progress on chemotherapy. © 1995 Wiley‐Liss, Inc.
Reduction in mortality from breast cancer
Authors: Per-Henrik Zahl, Jan Mæhlen
Journal: BMJ (2005)

Reduction in mortality from breast cancerDecrease with screening was marked in younger age group Editor-Based on a complicated statistical model, Olsen et al reported that the breast cancer mortality in Copenhagen dropped by 25% for women aged 50-79 when comparing mortality in the screening period (1991-2001) with a pre-screening period (1981-91) and claimed that this decrease was caused by screening. 1According to Statistics Denmark, 217 breast cancer deaths occurred in Copenhagen in the age group 35-54 years in the period 1981-90 and 196 deaths in 1991-2000. 2By comparing these data with those in the article by Olsen et al we calculate that less than 5% of the breast cancer mortality in this age group is caused by tumours diagnosed after age 50 years when women were invited to screening.The number of exposure years increased from about 484 000 to about 538 000.This gives a significant 19% (age adjusted) reduction in breast cancer mortality in the age group 35-54 years.No reduction at all occurred in the age group 55-79. 2Our estimates are based on raw and complete data.In contrast, the estimates in the paper by Olsen et al are sensitive to exclusion of data and model choice.In Copenhagen a drop in breast cancer mortality may reflect a higher fertility quotient due to non-Western immigration, fewer nulliparous women, and other non-screening related factors.It is therefore strange that no causal note was made by Olsen et al on the marked decrease in the breast cancer mortality in the age group 35-54 years.
Environmental estrogens alter early development in Xenopus laevis.
Authors: Cassandra L Bevan, Donna M Porter, Anita Prasad, Marthe J Howard, Leslie P Henderson
Journal: Environmental Health Perspectives (2002)

A growing number of environmental toxicants found in pesticides, herbicides, and industrial solvents are believed to have deleterious effects on development by disrupting hormone-sensitive processes. We exposed Xenopus laevis embryos at early gastrula to the commonly encountered environmental estrogens nonylphenol, octylphenol, and methoxychlor, the antiandrogen, p,p-DDE, or the synthetic androgen, 17 alpha-methyltestosterone at concentrations ranging from 10 nM to 10 microM and examined them at tailbud stages (approximately 48 hr of treatment). Exposure to the three environmental estrogens, as well as to the natural estrogen 17 beta-estradiol, increased mortality, induced morphologic deformations, increased apoptosis, and altered the deposition and differentiation of neural crest-derived melanocytes in tailbud stage embryos. Although neural crest-derived melanocytes were markedly altered in embryos treated with estrogenic toxicants, expression of the early neural crest maker Xslug, a factor that regulates both the induction and subsequent migration of neural crest cells, was not affected, suggesting that the disruption induced by these compounds with respect to melanocyte development may occur at later stages of their differentiation. Co-incubation of embryos with the pure antiestrogen ICI 182,780 blocked the ability of nonylphenol to induce abnormalities in body shape and in melanocyte differentiation but did not block the effects of methoxychlor. Our data indicate not only that acute exposure to these environmental estrogens induces deleterious effects on early vertebrate development but also that different environmental estrogens may alter the fate of a specific cell type via different mechanisms. Finally, our data suggest that the differentiation of neural crest-derived melanocytes may be particularly sensitive to the disruptive actions of these ubiquitous chemical contaminants.
Group Writing of Letters to the Editor as the Goal of Journal Club
Authors: Alexander J. Kallen, Chad T. Wilson, Michelle A. Russell, Robin J. Larson, Louise Davies, Brenda E. Sirovich, Lisa M. Schwartz, Steven Woloshin, H. Gilbert Welch
Journal: JAMA (2006)

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