tbuckley/cabot-search huggingface dataset:
Functions of the Doctor
Authors: MASON G. ROBERTSON
Journal: Annals of Internal Medicine (1971)

Letters and Comments1 July 1971Functions of the DoctorMASON G. ROBERTSON, M.D., F.A.C.P.MASON G. ROBERTSON, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-75-1-143_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: To say there are "two essential functions" of the doctor (quote from Sir Macfarlane Burnet's Changing Patterns. An Atypical Autobiography, Ann Intern Med 74:289, 1971), namely outpatient and hospital patient care, fails to note the enormous complexities of a burgeoning list of functions we confront, with no end in sight. Let's face it. The historically evolved concept of the doctor is inadequate to the task of serving them all.The doctor has become a data bank. Insurance companies and plaintiff lawyers and welfare and rehabilitation agencies now "buy" information about the patient. Time and energy spent in... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: MASON G. ROBERTSON, M.D., F.A.C.P. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 July 1971Volume 75, Issue 1 Page: 143-144 Keywords Outpatient clinics Patients ePublished: 1 December 2008 Issue Published: 1 July 1971 PDF downloadLoading ...
Lymphadenopathy and selective IgA deficiency.
Authors: M A French
Journal: BMJ (1984)

Four men presented with unexplained lymphadenopathy. Three had a history of recurrent respiratory infections for several years, and two had lymph node or hepatic granulomas. None was noted to have symptoms of immunodeficiency at the time of presentation. In one patient routine direct immunofluorescence study failed to detect IgA, and immunological investigations were therefore conducted in the rest. In all patients the findings were similar and characterised by a severe deficiency of IgA. In the absence of a more serious cause selective IgA deficiency may be enough to explain "idiopathic" lymphadenopathy.
Influenza A virus enhances basophil histamine release and the enhancement is abolished by carbohydrates
Authors: P. Clementsen, S. Norn, K. S. Kristensen, C. Hannoun
Journal: Allergy (1990)

Basophil histamine release was studied in leukocyte suspensions from normal individuals and from patients allergic to house dust mite or birch pollen. Mediator release caused by IgE‐mediated reactions was examined by stimulating the cells with anti‐IgE or specific antigens, and the calcium ionophore A23187 was used for a non‐immunological histamine release. In all experiments influenza A virus caused a synergistic enhancement of the mediator release and the potentiation was abolished by galactose (10 −2 to 10 −6 M) and by 10 −6 to 10 −3 M of N‐acetylglucosamine, alpha‐methyl‐D‐glucoside, alpha‐methyl‐D‐mannoside, N‐acetylneuraminic acid and lactose, but not by glucose. Wash‐out experiments show that the sugars prevent the aggravation of mediator release by a binding of sugar to the basophil cell membrane, thereby causing a blockade of binding sites responsible for the potentiating effect of virus.
Overexpression of Pendrin in Intercalated Cells Produces Chloride-Sensitive Hypertension
Authors: Thibaut Jacques, Nicolas Picard, R. Lance Miller, Kent A. Riemondy, Pascal Houillier, Fabien Sohet, Suresh K. Ramakrishnan, Cara J. Büsst, Maximilien Jayat, Nicolas Cornière, Hatim Hassan, Peter S. Aronson, Jean Christopher Hennings, Christian A. Hübner, Raoul D. Nelson, Régine Chambrey, Dominique Eladari
Journal: Journal of the American Society of Nephrology (2013)

Inherited and acquired disorders that enhance the activity of transporters mediating renal tubular Na+ reabsorption are well established causes of hypertension. It is unclear, however, whether primary activation of an Na+-independent chloride transporter in the kidney can also play a pathogenic role in this disease. Here, mice overexpressing the chloride transporter pendrin in intercalated cells of the distal nephron (TgB1-hPDS mice) displayed increased renal absorption of chloride. Compared with normal mice, these transgenic mice exhibited a delayed increase in urinary NaCl and ultimately, developed hypertension when exposed to a high-salt diet. Administering the same sodium intake as NaHCO3 instead of NaCl did not significantly alter BP, indicating that the hypertension in the transgenic mice was chloride-sensitive. Moreover, excessive chloride absorption by pendrin drove parallel absorption of sodium through the epithelial sodium channel ENaC and the sodium-driven chloride/bicarbonate exchanger (Ndcbe), despite an appropriate downregulation of these sodium transporters in response to the expanded vascular volume and hypertension. In summary, chloride transport in the distal nephron can play a primary role in driving NaCl transport in this part of the kidney, and a primary abnormality in renal chloride transport can provoke arterial hypertension. Thus, we conclude that the chloride/bicarbonate exchanger pendrin plays a major role in controlling net NaCl absorption, thereby influencing BP under conditions of high salt intake.
Unsuspected Deep Venous Thrombophlebitis Detected by Gallium-67 Imaging
Authors: PATRICK V. FORD, HOWARD G. PARKER
Journal: Clinical Nuclear Medicine (1987)

Ga-67 imaging revealed abnormal activity in the left lower extremity of a 30-year-old male intravenous drug abuser who had experienced two weeks of fever spikes and leukocytosis, unresponsive to antibiotic therapy. Radiographic venography confirmed the diagnosis of thrombophlebitis. The patient responded to anticoagulant therapy.
Intestinal transcription and synthesis of apolipoprotein AI is regulated by five natural polymorphisms upstream of the apolipoprotein CIII gene.
Authors: S Naganawa, H N Ginsberg, R M Glickman, G S Ginsburg
Journal: Journal of Clinical Investigation (1997)

To understand the factors contributing to the synthesis of human apolipoprotein AI (apoAI), relative apoAI synthesis was measured from endoscopic biopsy samples obtained from 18 healthy volunteers. The relative amount of apoAI synthesis was directly correlated with steady state intestinal apoAI mRNA levels and a 10-fold within-group variability was observed. Analysis of genomic DNA from the subjects revealed five polymorphic sites which defined two haplotypes in the intestinal enhancer region of the apoAI gene located upstream of the apolipoprotein CIII gene transcriptional start site (+ 1): (-641 C to A, -630 G to A, -625 T to deletion, -482 C to T, and -455 T to C). The population frequencies of the wild-type and mutant alleles were 0.53 and 0.44, respectively. Mean steady state apoAI mRNA levels and mean relative apoAI synthesis were 49 and 37% lower, respectively, in homozygotes for the mutant allele and 28 and 41% lower, respectively, in heterozygotes than in homozygotes for the wild-type allele (P < 0.05 for both). Site-directed mutants of apoAI gene promoter/reporter constructs containing the above mutations were transfected into Caco-2 cells and showed a 46% decrease in transcriptional activity compared with the wild type (P < 0.001); however, no significant differences were observed in HepG2 cells. Electrophoretic mobility shift assays showed that the mutated sequences from -655 to -610 bound Caco-2 cell nuclear protein(s) while the wild type did not. These results indicate that intestinal apoAI gene transcription and protein synthesis are genetically determined and are reduced in the presence of common mutations which induced binding of nuclear protein(s), possibly a transcriptional repressor.
THE STABILITY OF INFLUENZA VIRUS IN THE PRESENCE OF SALTS
Authors: C. A. Knight
Journal: The Journal of Experimental Medicine (1944)

The stability of centrifugally purified PR8 influenza virus at pH 7 in 0.001, 0.01, 0.1, and 1.0 M phosphate buffers, in veronal and borate buffers, and in adjusted solutions of saline and distilled water was investigated. The results demonstrate that the stability of this virus can vary considerably at pH 7 depending upon the nature and concentration of the salts present. Borate, veronal, and phosphate buffers at a concentration of about 0.1 M showed almost equal ability to maintain virus activity over several weeks of time at 4 degrees C. In many cases, it may prove inconvenient to use veronal buffer, however, because of the difficulty in determining protein concentration in its presence. The 0.1 M phosphate buffer has proved in tests not described here to be slightly more consistent in preserving virus activity than the borate and may, therefore, be considered slightly superior to the latter. It is apparent that unbuffered saline is a poor solvent for preserving virus activity regardless of pH. The activity of partially inactivated virus in distilled water and in saline solutions was increased ten to 1000 times by diluting such solutions with 0.1 M phosphate buffer. Some reactivation was also effected with veronal but not with borate buffers.
Exercise-Induced Pseudoarrhythmia
Authors: ALDEN S. GOOCH
Journal: Annals of Internal Medicine (1971)

During treadmill exercise of a 43-year-old man an electrocardiographic change was noted that simulated a severe ventricular arrhythmia. This was a harmless effect of sinus tachycardia in a subject with left bundle-branch block. The summation of the upright T wave, U wave, and following P wave caused a high, wide reflection that resembled an additional QRS. The gradual evolution of this pattern is illustrated during walking and is further confirmed by carotid sinus massage after the exercise.
GMC may be open to accusations of racial bias
Authors: O. Dyer
Journal: BMJ (2003)

A report commissioned by the General Medical Council claims that the council has left itself open to accusations of racial bias because of its treatment of complaints against doctors who qualified outside the United Kingdom.

Doctors who qualified outside the United Kingdom who are reported to the GMC are more likely than UK qualified doctors to face the professional conduct committee, to be found guilty of serious professional misconduct, and to be struck off, said the report, which based its conclusions on a statistical review of cases over the …
Pneumonia in Acute Leukemia
Authors: EDWARD A. SICKLES
Journal: Annals of Internal Medicine (1973)

Pneumonia is a quite frequent and often fatal complication in patients with acute leukemia. During a 19-month period 52 episodes of pneumonia were found among 68 leukemia patients. Except for fever and chest X-ray abnormalities, presenting signs and symptoms were few and subtle. The responsible infectious agent was isolated in 71% of cases, but only half were found antemortem. Most were Gram-negative bacilli, with a 25% incidence of fungal pneumonia. The overall mortality rate was a disturbingly high 65%, indicating that acute leukemia itself is an important mortality risk factor. Profound granulocytopenia, bacteremia, isolation of either a fungus or Gram-negative bacillus as causative organism, and administration of absorbable or oral nonabsorbable antibiotics prior to development of pneumonia were also significant mortality risk factors. Measures to more effectively treat pneumonia in these patients must include a much more aggressive diagnostic approach, especially in obtaining bronchopulmonary secretions.
Providing Price Displays for Physicians
Authors: Kevin R. Riggs, Matthew DeCamp
Journal: JAMA (2014)

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
C-REACTIVE PROTEIN IN ACUTE DECOMPENSATED HEART FAILURE: INSIGHTS FROM ASCEND-HF
Authors: Andreas P. Kalogeropoulos, Javed Butler, Amy Hsu, G. Michael Felker, Adrian Hernandez, Richard W. Troughton, Adriaan A. Voors, Stefan D. Anker, Marco Metra, John J.V. McMurray, Barry Massie, Justin A. Ezekowitz, Robert Califf, Christopher O'Connor, Randall Starling, Wai Hong Tang
Journal: Journal of the American College of Cardiology (2013)
Acetazolamide for the prophylaxis of acute mountain sickness
Authors: C. Imray
Journal: BMJ (2012)

In 2000, a systematic review concluded that when ascending rapidly to above 4000 m, prophylactic dexamethasone 8-16 mg daily or acetazolamide 750 mg daily both reduced acute mountain sickness.1 However, acetazolamide 500 mg daily was not found be effective. At the time, many doctors who specialise in high altitude sickness thought that this did not reflect their clinical experience, and there were concerns about incomplete inclusion criteria, inadequate control of ascent rates, and unduly strict endpoints.2 3

In a linked systematic review and meta-analysis (doi:10.1136/bmj.e6779), Low and colleagues look at the important question of the efficacy of acetazolamide at lower doses to prevent acute mountain sickness above 3000 m.4 They found that acetazolamide 250 mg and 500 mg daily were both effective in reducing the severity of acute mountain sickness. The different altitudes studied (3000 v 4000 m) could have led to differences in the incidence and severity of acute mountain sickness and may partly account for the studies’ different conclusions.1 4

More people are travelling to high altitude for work (soldiers, miners, construction workers, and astronomers) or recreation (skiing, trekking, mountain biking, and mountaineering). On ascent to altitude, several adaptive physiological processes occur (including hyperventilation, erythropoiesis, and increased cardiac output), all of which tend to increase convective oxygen transport to the tissues, a process termed “acclimatisation.”5
Peripheral vascular tone in patients with cirrhosis: role of the renin–angiotensin and sympathetic nervous systems
Authors: David Ernest Newby, Rajiv Jalan, Satoko Masumori, Peter Clive Hayes, Nicholas Antony Boon, David John Webb
Journal: Cardiovascular Research (1998)

The aims of the study were to establish the roles of angiotensin II and of the cardiopulmonary baroreceptor reflex in the regulation of peripheral vascular tone in patients with cirrhosis.Forearm blood flow responses to subsystemic, locally active intrabrachial infusions were measured in patients with Child's Grade C cirrhosis and matched controls using bilateral venous occlusion plethysmography. Responses were determined to the angiotensin II type I receptor antagonist, losartan, noradrenaline, angiotensin II and the nitric oxide synthase inhibitor, L-NG-monomethyl arginine.Losartan at 30 and 90 micrograms/min caused no significant change in blood flow in controls, but caused 23 +/- 6% and 27 +/- 5% increases in patients respectively (p < 0.001). Lower body negative pressure caused a mean bilateral reduction in forearm blood flow of 20 +/- 4% in controls (p < 0.001) but only tended to reduce flow (9 +/- 5%; p = 0.06) in patients (p < 0.001; controls vs. patients). Noradrenaline, angiotensin II and L-NG-monomethyl arginine caused significant vasoconstriction (p < 0.001) in both patients and controls although angiotensin II caused significantly less vasoconstriction in patients (p = 0.01).We conclude that angiotensin II makes an important contribution to basal peripheral vascular tone in patients with cirrhosis in the face of reduced vascular responses to its local administration. In addition, the vasoconstrictor response to cardiopulmonary baroreceptor unloading is attenuated despite normal vascular responses to noradrenaline. These responses are consistent with chronic activation of the renin-angiotensin and sympathetic nervous systems in patients with advanced cirrhosis.
Communicating with patients.
Authors: J. Bennett, P. Bridger
Journal: BMJ (1992)

took a median of 30 minutes to arrive at the patient's home and 20 minutes to reach the hospital.When the same variables were analysed in the patients subsequently confirmed to have definite or probable acute myocardial infarction it was found that the decision time was shorter if relatives were with the patient at the onset of symptoms.The interval between admission to hospital and administration of streptokinase in those given the drug was the longest single delay (median 102 minutes).No factors were identified that significantly influenced the time of administration of streptokinase.Thus most elderly patients reach hospital in time to benefit from thrombolytic treatment but many elderly patients are not admitted to coronary care units.Not only must attention be given to shorten- ing the time to administration of thrombolytic treatment but elderly patients with suspected acute myocardial infarction should have the potential benefit of specialised coronary care.
A Clinicopathological Study of Minute Polypoid Lesions of the Colon based on Magnifying Fiber-Colonoscopy and Dissecting Microscopy
Authors: Mamoru Nishizawa, Toshikuni Okada, Fumio Satō, Atsushi Kariya, Sokō Mayama, Kyōichi Nakamura
Journal: Endoscopy (1980)

Magnifying fiber-colonoscopy reveals that adenoma, minute carcinomatous lesion in an adenoma (which is termed focal carcinoma), and mucosal carcinoma of the colon, each has its own characteristic pit pattern. Inspection by dissecting microscope of resected specimens obtained from subjects whose colonic mucosa had been considered normal, often reveals an abnormal pit pattern of less than 1 mm, and subsequent histologic examination confirms the frequent presence of incipient adenoma. Clinical magnification inspection of areas of colonic mucosa considered normal on the basis of ordinary observation, reveals pit patterns identical to those seen in resected specimens.
Fulvine and the pulmonary circulation
Authors: J. M. Kay, D. Heath, P. Smith, G. Bras, J. Summerell
Journal: Thorax (1971)

The pyrrolizidine alkaloid, fulvine, is now accepted as a major cause of veno-occlusive disease of the liver in the West Indies, where it is ingested as a decoction of the plant <i>Crotalaria fulva</i> in bush tea. Fulvine is similar in chemical structure to monocrotaline, which is known to cause pulmonary hypertension in rats. Thirty young female rats were given a single dose of fulvine either by intraperitoneal injection (50 mg/kg body weight) or by stomach tube (80 mg/kg body weight). Eleven of these rats died of acute haemorrhagic centrilobular necrosis of the liver, and two of pneumonia, within 23 days of receiving fulvine. These 13 showed no evidence of hypertensive pulmonary vascular disease. The remaining 17 rats (which survived from 24 to 37 days) developed hypertensive pulmonary vascular disease with right ventricular hypertrophy together with medial thickening of the pulmonary trunk and muscular pulmonary arteries. The pulmonary arterioles showed hypertensive changes and some contained thrombi. In four animals an acute necrotizing arteritis also occurred. We have shown that fulvine resembles monocrotaline in its ability to produce pulmonary hypertension in rats. We suggest that, in any patient presenting with unexplained pulmonary hypertension, a careful enquiry should be made to elicit the possibility of recent ingestion of drugs or plant extracts that may have caused a rise in the pulmonary arterial pressure.
Biological effects of short-term, high-concentration exposure to methyl isocyanate. V. Morphologic evaluation of rat and guinea pig lungs.
Authors: E H Fowler, D E Dodd, C M Troup
Journal: Environmental Health Perspectives (1987)

The morphologic changes induced in the lungs of rats and guinea pigs exposed to high concentrations of MIC vapor (100, 600, and 1000 ppm in the rat and 25, 125, 225, and 675 ppm in the guinea pig) for a short time (15 min) in a static exposure chamber were evaluated at varying postexposure periods (0, 1, 2, 4, and 16 hr). The 675 ppm-exposed guinea pigs were evaluated only immediately following removal from the chamber. Attention was primarily focused on the intrapulmonary conducting airways and the parenchyma (gas exchange region) of the lungs. The severity of morphologic changes observed by light microscopy was directly correlated with exposure concentration and time postexposure in both species. Specifically, degenerative changes were observed in the bronchial, bronchiolar, and alveolar epithelium in both species. Quantitative differences were observed; 100 ppm of MIC in the rat resulted in much less damage than did 125 ppm of MIC in the guinea pig. Morphologic evidence of sloughing of large sheets of conducting airway epithelium with fibrin buildup and increased mucus production resulted in plugging of major airways and atelectasis. These observations support the hypothesis that tissue hypoxia was a major contributing factor resulting in death.
Cost of counselling women who undergo mastectomy.
Authors: P Maguire, A Pentol, D Allen, A Tait, M Brooke, R Sellwood
Journal: BMJ (1982)

The psychiatric morbidity associated with mastectomy and brest cancer was substantially reduced by a specialist nurse who counselled women before and after surgery and monitored their progress. A controlled study was, therefore, carried out to determine what this cost. National Health Service costs were almost wholly covered by savings made because counselled subjects who developed psychiatric problems were recognised and treated much earlier than control patients. Counselled and control subjects suffered considerable financial losses, but these were offset in the counselled group by their relatives9 earlier return to work. Such counselling schemes are necessary and effective and may be implemented at little extra cost.
INVERSION QF THE UTERUS
Authors: RALPH W. FRENCH
Journal: JAMA (1923)

Inversion of the uterus is one of those extremely rare conditions which only a few surgeons have seen. When one is confronted with this situation, it becomes a very real problem. The case in point will illustrate some of the pitfalls in the diagnosis and will, I trust, be helpful to those who are yet to encounter this condition in which the uterus is upside down and inside out. It is not my intention to discuss the vexed question of the etiology, but it is of interest to note that, of 641 cases of inversion of the uterus compiled from the literature by Thorn<sup>1</sup>from the entire world, 81.2 per cent, were obstetric in origin, 13 per cent, were due to uterine tumors, 2.2 per cent, occurred postmortem, 2 per cent, were idiopathic, and 1.6 per cent, occurred after abortions or premature labors. In the obstetric group, the rarity
Low bone marrow oxygen tension and hypoxia-inducible factor-1α overexpression characterize patients with multiple myeloma: role on the transcriptional and proangiogenic profiles of CD138+ cells
Authors: S Colla, P Storti, G Donofrio, K Todoerti, M Bolzoni, M Lazzaretti, M Abeltino, L Ippolito, A Neri, D Ribatti, V Rizzoli, E Martella, N Giuliani
Journal: Leukemia (2010)