tbuckley/cabot-search huggingface dataset:
A comparison of aspirin and anticoagulation following thrombolysis for myocardial infarction (the AFTER study): a multicentre unblinded randomised clinical trial
Authors: D G Julian, D A Chamberlain, S J Pocock
Journal: BMJ (1996)

<h3>Abstract</h3> <b>Objective</b>: To compare aspirin with anticoagulation with regard to risk of cardiac death and reinfarction in patients who received anistreplase thrombolysis for myocardial infarction. <b>Design</b>: A multicentre unblinded randomised clinical trial. <b>Setting</b>: 38 hospitals in six countries. <b>Subjects</b>: 1036 patients who had been treated with anistreplase for myocardial infarction were randomly assigned to either aspirin (150 mg daily) or anticoagulation (intravenous heparin followed by warfarin or other oral anticoagulant). The trial was stopped earlier than originally intended because of the slowing rate of recruitment. <b>Main outcome measure</b>: Cardiac death or recurrent myocardial infarction at 30 days. <b>Results</b>: After 30 days cardiac death or reinfarction, occurred in 11.0% (57/517) of the patients treated with anticoagulation and 11.2% (58/519) of the patients treated with aspirin (odds ratio 1.02, 95% confidence interval 0.69 to 1.50, P=0.92). Corresponding findings at three months were 13.2% (68/517) and 12.1% (63/519) (0.91, 0.63 to 1.32, P=0.67). Patients receiving anticoagulation were more likely than patients receiving aspirin to have had severe bleeding or a stroke by three months (3.9% v 1.7% (0.44, 0.20 to 0.97, P=0.04)). <b>Conclusion</b>: No evidence of a difference in the incidence of cardiac events was found between the two treatment groups, though the trial is too small to claim treatment equivalence confidently. A higher incidence of severe bleeding events and strokes was detected in the group receiving anticoagulation, suggesting that aspirin may be the drug of choice for most patients in this context. <h3>Key messages</h3> After anistreplase, aspirin (150 mg daily) resulted in a lower risk of bleeding and stroke than intravenous heparin followed by warfarin The rate of cardiac death or reinfarction at 30 days seemed similar for both treatments More evidence is needed, however, before thera- peutic equivalence can be claimed confidently Aspirin is the drug of choice for most patients
Response to Cantagallo and Castelli
Authors: Suzanne E. Geerlings, Andy I.M. Hoepelman
Journal: Diabetes Care (2001)

We read with interest the letter of Cantagallo and Castelli (1), which describes the prevalence of asymptomatic bacteriuria (ASB) in women with diabetes before and after hygiene modifications. They showed that even after the modification of hygiene habits, diabetic women still had a 20.2% prevalence of ASB, which is comparable with the prevalence of ASB …
Tissue damage is commonest cause of surgical negligence suits
Authors: M. Pownall
Journal: BMJ (1999)

Damage to underlying structures is the commonest complication for which patients successfully sue surgeons, a UK survey suggests. The survey, by the Medical Defence Union, found that damage to veins, nerves, and other underlying structures accounted for nearly one third of 115 successful claims, with infection accounting for another 12%.

Retained items and …
Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Authors: C. Boustière, A. Veitch, G. Vanbiervliet, P. Bulois, P. Deprez, A. Laquiere, R. Laugier, G. Lesur, P. Mosler, B. Nalet, B. Napoleon, B. Rembacken, N. Ajzenberg, J. Collet, T. Baron, J.-M. Dumonceau
Journal: Endoscopy (2011)

With the increasing use of antiplatelet agents (APA), their management during the periendoscopic period has become a more common and more difficult problem. The increase in use is due to the availability of new drugs and the widespread use of drug-eluting coronary stents. Acute coronary syndromes can occur when APA therapy is withheld for noncardiovascular interventions. Guidelines about APA management during the periendoscopic period are traditionally based on assessments of the procedure-related risk of bleeding and the risk of thrombosis if APA are stopped. New data allow better assessment of these risks, of the necessary duration of APA discontinuation before endoscopy, of the use of alternative procedures (mostly for endoscopic retrograde cholangiopancreatography [ERCP]), and of endoscopic methods that can be used to prevent bleeding (following colonic polypectomy). This guideline makes graded, evidence-based, recommendations for the management of APA for all currently performed endoscopic procedures. A short summary and two Tables are included for quick reference.
Notes on Some Surgical Cases in the Recent Suakin Campaign
Authors: H. Hendley
Journal: BMJ (1886)

see slightly with the right.March 12th.Last night he had very severe pain in the head, re- lieved by one-eighth of a grain of morphine.He had good sleep.He still discharged rather foetid pus from the wound in the palate.March 15th.The paralysis of the left arm was much improved; sensation all over was still rather deadened, but mending.
Changes in maternal age distribution and their possible impact on demand for prenatal diagnostic services
Authors: S. Holloway, D. J H Brock
Journal: BMJ (1988)

Between 1977 and 1985 there was a 65% increase in births to women aged 35 or more in England and Wales, but only a 15% increase in all births. Two factors of roughly equal importance were responsible for this differential increase. Firstly, the proportion of older women (35-44) among all women of reproductive age (15-44) increased from 28% in 1977 to 31% in 1985; and, secondly, in the same period the fertility rate for women aged 35-39 increased from 18·2 to 24·1 per 1000 and for women aged 40-44 from 4·1 to 4·6 per 1000. The increased fertility rate among older women is not due to an extension of the reproductive period but to a delay in childbearing. This delay was seen in women married only once and also in those who had remarried. As prenatal diagnosis for the exclusion of chromosome abnormalities is customarily offered to older mothers the increased numbers of women aged 35 or more and their increased fertility rate have important implications for the provision of obstetric and laboratory services. There were 51 859 live births to women aged 35 and over in 1985; the projected figure for 2001 is 85 000. If the use of prenatal diagnosis continues to increase facilities for about 70 000 prenatal cytogenetic analyses will be needed in 2001.
Diagnosis of perforated enterocystoplasty
Authors: P. Lowthian
Journal: Journal of the Royal Society of Medicine (2003)

The data presented by Dr Fontaine and his colleagues (August 2003 JRSM 1 ) suggest that perforation of an enterocystoplasty is often associated with an overfilled bladder which, in turn, can be produced by poor compliance with a strict intermittent catheterization regimen.It would be interesting to know how many of the total patients involved had diminished pain sensibility in their bladders, and what proportion of these were in the perforation group.Even the most fastidious patients may let their catheterization routine slip and this is a particular temptation when delay in performing catheterization does not result in pain.It could be that such patients need an efficient 'pain substitute'. 2Perhaps urological surgeons should reconsider the plastic surgeon's technique (when repairing pressure ulcers) of using normally innervated autografts?Such a graft, using perhaps expanded skin, might one day be incorporated into reconstructed bladders that would otherwise have absent or diminished pain sensibility.I appreciate that this would not be an easy operation, and skin might not be the best tissue to use.
Therapy of hepatitis C: Interferon alfa-n1 trials
Authors: G C Farrell
Journal: Hepatology (1997)

Interferon alfa-n1 is produced from a lymphoid cell line and consists of multiple α interferon subtypes. Early studies indicated that interferon alfa-n1 was effective against hepatitis C, and a meta- analysis of published trials indicated that it was equally likely as recombinant α interferons to produce an end-of-treatment biochemical and histological response. However, there appeared to be a lower rate of posttreatment relapse after a 6-month course of interferon alfa-n1, so that the sustained response rate was 25% compared with 16% for recombinant α interferons. Subsequently, the efficacy of interferon alfa-n1 has been compared with recombinant α interferon directly in two large multicenter studies. The 096 International Hepatitis Comparative Study compared alfa-n1 with interferon alfa-2b in doses of 3 million units (MU) three times weekly for 24 weeks in a total of 1,071 patients. Biochemical end-of-treatment response rates were similar (35% for alfa-n1; 38% for alfa-2b), as were virological and histological responses. Relapse occurred more frequently after interferon alfa-2b, so that sustained biochemical (10.3% vs. 6.7%) and virological responses at 12 months were higher for alfa-n1. In a second study from Italy, interferon alfa-n1 was compared with interferon alfa-2a, using higher doses (6 MU three times weekly) until a biochemical response was obtained, and then using 3 MU three times weekly for a total of 12 months. The combined biochemical and virological sustained response rates were higher than reported with 6 months of treatment and were similar for alfa-n1 (17%) as for alfa-2a (16%). The superiority of 12 versus 6 months of treatment was also confirmed in the large multicenter 091 European Comparative Treatment Schedules study of 440 patients given four different regimens of therapy. Sustained biochemical response rates were 6% in patients who received 3 MU three times weekly for 6 months and 19% in those who received this dose for 12 months. When given for 12 months, there was no advantage to a slightly higher dose of interferon alfa-n1 (5 MU three times weekly). Thus, therapy with interferon alfa-n1 produces sustained response rates equivalent to the best obtained with recombinant α interferon. The optimal treatment regimen appears to be 3 MU given three times weekly for 12 months.
Prophylaxis of postoperative deep vein thrombosis: selective use of low-dose heparin in high-risk patients.
Authors: A J Crandon, K R Peel, J A Anderson, V Thompson, G P McNicol
Journal: BMJ (1980)

Administration of prophylactic low-dose subcutaneous heparin to prevent postoperative deep vein thrombosis is expensive, entails treating many patients unnecessarily, and causes some side effects. By using a predictive index a population of patients who are at particularly high risk of developing postoperative deep vein thrombosis may be identified preoperatively. Prophylaxis was given only to these patients, resulting in an incidence of deep vein thrombosis of 3.8% compared with 16.1% in previous studies in which no specific prophylaxis was given. By limiting prophylaxis to the group of patients identified by the predictive index as being at high risk of developing postoperative deep vein thrombosis results may be obtained that are as good as those expected from treating the whole population. Thus many patients are saved from exposure to low-dose subcutaneous heparin.
Risks of intrauterine contraceptive devices
Authors: H. L D Duguid, I. D Duncan, D. Parratt, D. Taylor
Journal: BMJ (1984)

but no obstructing lesion or other abnormality were found.He had an uneventful recovery.Acute pseudo-obstruction of the large bowel is a recognised, potentially fatal, clinical syndrome.'The mechanism is unknown, but the condition may be associated with serious pathology inside or outside the abdomen.'-3Our experience suggests that pulmonary thromboembolism may lead to this condition.1 Addison NV.Pseudo-obstruction of the large bowel.
High leptin and resistin expression in chronic heart failure: adverse outcome in patients with dilated and inflammatory cardiomyopathy
Authors: Peter Bobbert, Alexander Jenke, Thomas Bobbert, Uwe Kühl, Ursula Rauch, Dirk Lassner, Carmen Scheibenbogen, Wolfgang Poller, Heinz‐Peter Schultheiss, Carsten Skurk
Journal: European Journal of Heart Failure (2012)
Modified Therapy for Gestational Diabetes Using High-Risk and Low-Risk Fetal Abdominal Circumference Growth to Select Strict Versus Relaxed Maternal Glycemic Targets
Authors: Siri L. Kjos, Ute M. Schaefer-Graf
Journal: Diabetes Care (2007)

The traditional treatment goal for gestational diabetes mellitus (GDM) has been to achieve “normal” range values for maternal glucose by diet and or insulin therapy, adapting a strategy successful in treating pregestational diabetes during pregnancy. Intensive insulin therapy to achieve strict euglycemia in GDM pregnancies has improved perinatal morbidity; however, it has not eliminated the excess rate of macrosomia compared with the reference populations (1). Increasing evidence suggests that disturbances in the intrauterine metabolic environment produced by GDM appear to increase the risk in offspring for obesity and diabetes. The obesity risk in early childhood in offspring born to mothers with GDM has been correlated with the birth weight and parental obesity, and those children who were large-for-gestational-age (LGA) at birth had obesity rates close to 40% compared with 25% in those born with normal weight (2). Studies that have attempted to reduce macrosomia rates by setting very strict glycemic targets during pregnancy have required insulin therapy in two-thirds of the women (3). However, only a minority of offspring of GDM mothers appear to be at risk for fetal overgrowth and newborn morbidity, even when GDM is untreated in blinded controlled trials (4,5). The Toronto Tri-Hospital Gestational Diabetes Project demonstrated a modest association of newborn morbidity with antenatal maternal glucose concentrations, adjusting for other risk factors (6). However, no threshold values that would suggest treatment were found.

These facts led Buchanan et al. (7) to advocate using fetal ultrasound measurements of growth in addition to maternal glycemia to identify which fetuses in utero are at increased and decreased risk for complications. This approach relaxes glycemic targets in women whose fetuses are at low risk for LGA growth and intensifies therapy by using stricter glycemic targets for those at high risk.

### Amniotic fluid insulin levels

Fetal hyperinsulinism is believed to play a central …
Prevention of Involutional Bone Loss by Exercise
Authors: JOHN F. ALOIA
Journal: Annals of Internal Medicine (1978)

To ascertain whether exercise could prevent involutional bone loss, we studied 18 postmenopausal women, half of whom exercised for 1 h three times a week. Total and regional bone mass were measured before and after 1 year of exercise by the techniques of total-body neutron activation analysis (total body calcium) and photon absorptiometry (bone mineral content) of the distal radius. Total body potassium was measured by whole body counting. Bone mineral content and total body potassium did not change significantly in either group. Total body calcium increased in the exercise group from 781 ± 95 g to 801 ± 118 g (SD). In contrast, total body calcium decreased in each subject in the sedentary group. The daily calcium balance derived from the difference in total body calcium measurements was significantly different in the two groups of women (P < 0.001). These data support the hypothesis that exercise can modify involutional bone loss.
Regulation of the endothelial cell urokinase-type plasminogen activator receptor. Evidence for cyclic AMP-dependent and protein kinase C-dependent pathways.
Authors: D J Langer, A Kuo, K Kariko, M Ahuja, B D Klugherz, K M Ivanics, J A Hoxie, W V Williams, B T Liang, D B Cines
Journal: Circulation Research (1993)

Binding of urokinase-type plasminogen activator (u-PA) to specific receptors (u-PAR) on the surface of endothelial cells contributes to the regulation of plasmin-dependent processes such as fibrinolysis and angiogenesis. We studied the effect of raising intracellular levels of cyclic AMP (cAMP) and/or activating protein kinase C on the expression of u-PAR in cultured human umbilical vein endothelial cells (HUVEC). Incubation of HUVEC with forskolin stimulated a time- and concentration-dependent increase in the expression of u-PAR, measured both by an increase in the specific binding of radiolabeled single-chain u-PA (scu-PA) and by increased binding of anti-u-PAR antibodies. Maximal increase in u-PAR expression (81 +/- 11% above control, n = 11) was not associated with a change in receptor affinity for scu-PA when HUVEC were incubated for 20 hours at 37 degrees C with 50 microM forskolin. Receptor induction by forskolin was inhibited when HUVEC were preincubated with deoxyadenosine monophosphate (DAM), an inhibitor of adenylyl cyclase. A similar increase in receptor expression (128 +/- 27% above control, n = 3) was induced by the cAMP analogue 8-bromoadenosine 3':5'-cyclic monophosphate (50 mM). Forskolin induced an approximately twofold increase in the expression of a single approximately 1.4-kb u-PAR messenger RNA (mRNA) transcript within 2 hours. Phorbol myristate acetate (PMA) also stimulated a time- and concentration-dependent increase in specific scu-PA binding. The maximal increase in u-PAR expression (254 +/- 27% above control, n = 11) was observed when HUVEC were preincubated with 10 nM PMA for 20 hours. Induction of u-PAR by PMA was inhibited when HUVEC were preincubated with either cycloheximide or H7 but was unaffected by DAM. u-PAR induced by PMA showed a reduced affinity for scu-PA (Kd, 14 +/- 2 nM versus 3.6 +/- 0.6 nM, p &lt; 0.001; n = 8). PMA stimulation for 20 hours resulted in a sixfold increase in a single approximately 1.4-kb u-PAR mRNA transcript, with increased levels detectable within 30 minutes. Coincubation of HUVEC with optimal concentrations of forskolin and PMA for 20 hours produced a fully additive increase in u-PAR expression at both the mRNA and protein levels. These data suggest that both cAMP-dependent and protein kinase C-dependent protein kinase pathways may independently regulate u-PAR expression in human endothelial cells.
Transcatheter coil embolotherapy: a safe and effective option for major colonic haemorrhage
Authors: A A Nicholson, D F Ettles, J E Hartley, I Curzon, P W R Lee, G S Duthie, J RT Monson
Journal: Gut (1998)

The management of major colonic bleeding is problematic. A proportion of patients require emergency surgery which is associated with high morbidity and mortality. Percutaneous embolotherapy, previously considered a high risk procedure in the colon, may provide an alternative treatment in this group of patients.To assess the safety and efficacy of embolotherapy in the treatment of life threatening colonic haemorrhage.Thirty eight patients with fresh haemorrhage per rectum were referred for surgery because of failed conservative treatment. All underwent angiography; in 14 a bleeding site or vascular abnormality was detected. A coaxial catheter was directed to the most distal bleeding artery and this was embolised with platinum coils.Detection of a bleeding site correlated with haemodynamic stability at the time of angiography (r = 1 for a systolic blood pressure less than 100 mm Hg). Bleeding sites or vascular abnormalities were detected and embolised in 14 patients (37%). In 12/14 there was immediate and sustained haemodynamic improvement; two continued to bleed and required emergency hemicolectomy (14%). Three developed ischaemic complications (21.4%); these were managed conservatively and required no intervention. The 30 day mortality was 7.1% in the embolotherapy group and 10.5% in the overall group of 38 patients.Colonic embolotherapy for life threatening haemorrhage is an effective, relatively safe procedure with a low incidence of major complications. Its use depends on the identification of a focal bleeding point or vascular abnormality, which in turn depends on the haemodynamic stability of the patient at the time of angiography.
SOME REMARKS ON THE PLANTAR REFLEX, WITH ESPECIAL REFERENCE TO THE BABINSKI PHENOMENON.
Authors: J. T. ESKRIDGE
Journal: JAMA (1901)

Believing that the duty of the specialist in this association, working in a special line other than surgical, is to bring forward for discussion, observations and recent discoveries on mooted points that will aid the railroad surgeon and physician in the diagnosis of certain diseased conditions, I shall attempt to give the generally accepted views, of neurologists at least, on the value of the "Babinski sign," the pathological plantar reflex; or, better yet, slow extension of the great toe, with or without extension and separation of the other toes, as an aid in diagnosing disease in certain portions of the central nervous system. My observations have been made on 830 cases, 380 in hospital and 450 in private and consulting work. Besides, 2550 cases taken from my old records, I have utilized for the purpose of determining the frequency of the plantar reflex in nervous diseases in general. I wish
Cost-Effectiveness of Aspirin Chemoprevention for Barrett's Esophagus
Authors: C. Hur, N. S. Nishioka, G. S. Gazelle
Journal: JNCI Journal of the National Cancer Institute (2004)

Recent data suggest that nonsteroidal anti-inflammatory drugs, including aspirin, may prevent the progression of Barrett's esophagus to adenocarcinoma. However, use of aspirin is associated with numerous potential complications, including gastrointestinal bleeding and hemorrhagic strokes. We used a modeling approach to determine and compare the effectiveness and cost-effectiveness of aspirin with and without endoscopic surveillance to prevent esophageal adenocarcinoma.A Markov Monte Carlo decision model was constructed to compare four strategies for management of Barrett's esophagus: aspirin therapy, endoscopic surveillance with biopsies, both, or neither. Patients who took a daily enteric-coated aspirin were modeled to have a 50% reduction in the incidence of esophageal adenocarcinoma but could have complications related to therapy, at which point the aspirin was discontinued. Potential cardiac benefits of aspirin and its role in the chemoprevention of other cancers were not included in the analysis. The analysis was from a societal perspective from age 55 years until death. Sensitivity analyses were performed to investigate the effects of changes in model parameters on estimated costs and effectiveness outcomes across a wide range of assumptions.Aspirin therapy was more effective and less costly than no therapy, resulting in 0.19 more quality-adjusted life years (QALYs). The combination of aspirin and endoscopic surveillance produced 0.27 more QALYs than no therapy at a cost of 13,400 U.S. dollars more, for an associated incremental cost-effectiveness ratio of 49,600 U.S. dollars/QALY. Aspirin use in combination with endoscopic surveillance dominated endoscopic surveillance alone, resulting in 0.06 more QALYs and 11,400 U.S. dollars less cost. The model's results were sensitive to increasing age and to decreased benefit or delay in aspirin's chemopreventive efficacy.Using published values of parameters, regardless of whether a patient undergoes endoscopic surveillance, aspirin use in the management of Barrett's esophagus appears to be a cost-effective strategy to prevent esophageal adenocarcinoma.