tbuckley/cabot-search huggingface dataset:
Delayed Improvement in Exercise Capacity With Restoration of Sinoatrial Node Response in Patients After Combined Treatment With Surgical Repair for Organic Heart Disease and the Maze Procedure for Atrial Fibrillation
Authors: Jun Tamai, Yoshio Kosakai, Takao Yoshioka, Etsuko Ohnishi, Hiroshi Takaki, Yoshiaki Okano, Yasunaru Kawashima
Journal: Circulation (1995)

Although the Maze procedure successfully restores sinus rhythm in patients with heart disease and atrial fibrillation, it is still uncertain whether an addition of the Maze procedure in cardiac surgery is beneficial for exercise performance of the patients after surgery.The Maze procedure was performed in 25 patients (age, 37 to 70 years) during valve surgery (18 patients) or closure of atrial septal defect (7 patients). A cardiopulmonary exercise test using ramp incremental protocol (15 W/min) was performed before and 1 month, 6 months, and 1 year after surgery. Sinus conversion was obtained in 23 of 25 patients 1 month after surgery. However, sinoatrial (SA) node response to exercise was attenuated by surgery: Mean heart rate (HR) was 83 +/- 13/min at rest, 94 +/- 13/min at 60 W, and 107 +/- 17/min at peak exercise. Peak oxygen uptake (PVO2) was unchanged at this period (before, 17.6 +/- 4.5 mL.min-1.kg-1; 1 month after, 17.5 +/- 4.2 mL.min-1.kg-1). Thereafter, SA node response was restored 6 months after surgery: Mean HR was 84 +/- 13/min at rest, 104 +/- 16/min at 60 W, and 130 +/- 20/min at peak exercise (P < .01 versus 1 month). PVO2 was also improved at this period (20.7 +/- 4.0 mL.min-1.kg-1, P < .01). The increase in PVO2 from 1 month to 6 months after surgery was correlated with the increase in peak HR (y = 0.73x +/- 3.6, r = .79). There were no further changes in heart rate response or PVO2 from 6 months to 1 year after surgery.Atrial fibrillation was successfully treated by combined treatment with surgical repair for organic heart disease and the Maze procedure. However, SA node response to exercise was attenuated early after surgery. Thus, exercise capacity was improved at the late phase after surgery, which was related to the extent of restoration in SA node response.
Prevention of Malaria
Authors: Stephen L. Hoffman
Journal: JAMA (1991)

In 1990, the World Health Organization estimated that 2.1 billion people live in malarious areas of the world and that 270 million people develop new malaria infections each year.<sup>1</sup>Although transmission of malaria was interrupted in the United States in the early 1950s, it is still a major concern to the 7 million Americans who visit countries with malaria every year. Several years ago I was asked to consult on a patient with cerebral malaria. The patient had visited Kenya (East Africa) on safari several weeks earlier and had not taken chemoprophylaxis. Eight days before I saw him he developed fever and headache, and 2 days later he presented to an emergency department with the chief complaint, "I have malaria." The malaria smear was reported as negative (review revealed low parasitemia). The physician prescribed an antipyretic and follow-up in 2 days if his condition did not improve. Three days
Unusual Foreign Body Pathway to the Heart
Authors: Patricia M. McCormack
Journal: JAMA (1977)

<h3>To the Editor.—</h3> A wide variety of foreign objects find their way into the tracheobronchial tree<sup>1</sup>and the heart.<sup>2</sup>Most are ingested, inhaled, or iatrogenically<sup>3,4</sup>introduced. In this case, five delicate embroidery needles emigrated through the skin of the abdomen and chest, and two reached the pericardium and lung parenchyma. A review of the literature revealed one other case of a sewing needle self-introduced into the chest, resulting in traumatic pericarditis.<sup>5</sup> <h3>Report of a Case.—</h3> A 58-year-old woman had two very tender masses: one, 2×5 cm, was located between the clavicle and left breast near the axilla; a smaller ecchymotic mass was located 2 cm below the xiphoid process. She dated the onset to a fall backwards into a bathtub two weeks previously. Chest x-ray films disclosed the presence of five sewing needles, two associated with the lower mass and three with the upper (Fig 1
Rhinovirus (RV) plays an etiologic role in acute asthma hospitalizations in adults
Authors: D.L. Venarske, W.W. Busse, M.R. Griffin, P.A. Minton, E. Weisshaar, R. Virtis, T. Gebretsadik, S.B. Higgins, A.K. Shintani, T.V. Hartert
Journal: Journal of Allergy and Clinical Immunology (2005)
Association of Treatment With Carvedilol vs Metoprolol Succinate and Mortality in Patients With Heart Failure
Authors: Björn Pasternak, Henrik Svanström, Mads Melbye, Anders Hviid
Journal: JAMA Internal Medicine (2014)

The β-blockers carvedilol and metoprolol succinate both reduce mortality in patients with heart failure (HF), but the comparative clinical effectiveness of these drugs is unknown.To investigate whether carvedilol is associated with improved survival compared with metoprolol succinate.Cohort study of patients with incident HF with reduced left ventricular ejection fraction (LVEF) (≤40%) who received carvedilol (n = 6026) or metoprolol succinate (n = 5638) using data from a Danish national HF registry linked with health care and administrative databases.All-cause mortality (primary outcome) and cardiovascular mortality (secondary outcome) were analyzed using Cox regression with adjustment for a propensity score, derived from a range of clinical, socioeconomic, and demographic characteristics.The mean (SD) age of the patients was 69.3 (9.1) years, 71% were men, and 51% were hospitalized at index HF diagnosis. During a median (interquartile range) 2.4 (1.0-3.0) years of follow-up, 875 carvedilol users and 754 metoprolol users died; the cumulative incidence of mortality was 18.3% and 18.8%, respectively. The adjusted hazard ratio for carvedilol users vs metoprolol users was 0.99 (95% CI, 0.88 to 1.11), corresponding to an absolute risk difference of -0.07 (95% CI, -0.84 to 0.77) deaths per 100 person-years. Estimates were consistent across subgroup analyses by sex, age, levels of LVEF, New York Heart Association classification, and history of ischemic heart disease. A higher proportion of carvedilol users achieved the recommended daily target dose (50 mg; 3124 [52%]) than did metoprolol users (200 mg; 689 [12%]); among patients who reached the target dose, the adjusted hazard ratio was 0.97 (95% CI, 0.72-1.30). A robustness analysis with 1:1 propensity score matching confirmed the primary findings (hazard ratio, 0.97 [95% CI, 0.84-1.13]). The adjusted hazard ratio for cardiovascular mortality was 1.05 (95% CI, 0.88-1.26).These findings from real-world clinical practice indicate that the effectiveness of carvedilol and metoprolol succinate in patients with HF is similar.
Natural History of Markers of Collagen Turnover in Patients With Early Diastolic Dysfunction and Impact of Eplerenone
Authors: George J. Mak, Mark T. Ledwidge, Chris J. Watson, Dermot M. Phelan, Ian R. Dawkins, Niamh F. Murphy, Anil K. Patle, John A. Baugh, Kenneth M. McDonald
Journal: Journal of the American College of Cardiology (2009)
Congenital Arteriovenous Anastomosis
Authors: A. G. Watkins
Journal: BMJ (1941)

secretion of this hormone, and thus in essence a medical rather than a surgical condition.An increase in the dis- tance between the bones at the symphysis pubis, had it been visible on the radiographs, would have afforded valu- able confirmation of this hypothesis, but was not in fact demonstrable.My thanks are due to Mr. R.
ARTIFICIAL PNEUMOTHORAX: MANOMETRIC ABERRATIONS
Authors: F. C. Coley
Journal: BMJ (1915)

there appeared a short description of what was called a new disease occurring amongst soldiers wlho had been for a considerable time in the trenches.Certainly from my own clinical hospital experience I had not met with suclh a symptom-complex, and as the etiology of this condition has up to tlle present remained uncertain, a careful record of cases is desirable. CASE I.A soldier, aged 33, was sent down from the front suffering from acute nephritis.He had been in the trenches for seven weeks, and had often been up to his waist in water.He stated that the onset was sudden, and that he first noticed a feeling of chilliness and swelling of face and feet.The urinary changes
Sensory Nerves Promote Ozone-induced Lung Inflammation in Mice
Authors: REGINA M. GRAHAM, MITCHELL FRIEDMAN, GARY W. HOYLE
Journal: American Journal of Respiratory and Critical Care Medicine (2001)

Genetically manipulated mice exhibiting altered innervation of the airways were used to examine the role of sensory nerves in ozone-induced lung inflammation. Transgenic mice expressing nerve growth factor (NGF) from the lung-specific Clara cell secretory protein (CCSP) promoter exhibit hyperinnervation of the airways by sympathetic and tachykinin-containing sensory nerve fibers. Mice carrying a mutation in the low-affinity NGF receptor (NGFR) gene possess deficits in sensory innervation. CCSP-NGF transgenic mice exhibited a twofold increase in the number of lung lavage neutrophil level whereas NGFR knockout mice exhibited a nearly 50% decrease in neutrophilic inflammation compared with wild-type mice 18 h after ozone inhalation. Treatment with neurokinin receptor antagonists reduced the level of neutrophilic inflammation in both wild-type and CCSP-NGF mice. Examination of lavage fluid cytokine concentrations revealed that 4 h after ozone exposure CCSP-NGF mice produced significantly higher amounts of the chemokine KC than wild-type mice exposed to ozone. The results of this study indicate that sensory nerves are important mediators of ozone-induced inflammation in mice.
The Patient with Cancer — His Changing Pattern of Communication
Authors: Ruth D. Abrams
Journal: New England Journal of Medicine (1966)

ALMOST every physician will admit that he is uncomfortable when he faces a patient with cancer. What is he going to say? What does the patient want to hear, to know? Observations suggest that the physician can lighten this burden by seeking guidance from the patient. For it is the patient himself who offers the clues to how much, how little or how often he wishes to discuss his diagnosis and prognosis.What, then, is the mode of communication between the physician and the patient with cancer? The latter has different thresholds of needs, defenses and fantasies at different stages . . .
Upper gastrointestinal tumors
Authors: R. Lambert
Journal: Endoscopy (2008)

Barrett’s esophagus, which is more frequent in Caucasians and in males, is associated with an increased risk for adenocarcinoma in the esophagus. The endoscopic diagnosis of Barrett’s esophagus is easy and reliable when the distal esophagus is lined with a long segment of metaplastic columnar epithelium. The detection of short (< 3 cm) or ultra-short (< 1 cm) segments of columnar metaplasia in the esophagus requires more attention and a precise analysis of the landmarks at the esophagogastric junction. The extremely precise anatomical study of the esophagogastric junction conducted in Japan by Takubo et al. [1] applies to the landmarks that are accessible to the endoscopist. The squamocolumnar epithelial junction is a major landmark between the squamous lining of the distal esophagus and the columnar lining of the short segment of gastric cardiac epithelium. The islands of esophageal cardiac epithelium, unstained by Lugol and located in the squamous epithelium above the squamocolumnar epithelial junction, should not be mistaken for an ultra-short Barrett’s segment. When small islands of squamous epithelium are detected by Lugol at this level they point to an ultra-short segment of Barrett’s because they correspond to the opening of ducts of submucosal glands that are located in the esophagus.
Relation of infant feeding to adult serum cholesterol concentration and death from ischaemic heart disease.
Authors: C. H. Fall, D. J. Barker, C. Osmond, P. D. Winter, P. M. Clark, C. N. Hales
Journal: BMJ (1992)

OBJECTIVE--To examine whether method of infant feeding is associated with adult serum lipid concentrations and mortality from ischaemic heart disease. DESIGN--Follow up study of men born during 1911-30. SETTING--Hertfordshire, England. SUBJECTS--5718 men, for 5471 of whom information on infant feeding had been recorded by health visitors and 1314 of whom had died. 485 of the men born during 1920-30 and still living in Hertfordshire who had blood lipid measurements. MAIN OUTCOME MEASURES--Death from ischaemic heart disease; serum cholesterol and apolipoprotein concentrations. RESULTS--474 men had died from ischaemic heart disease. Standardised mortality ratios were 97 (95% confidence interval 81 to 115) in men who had been breast fed and had not been weaned at 1 year, 79 (69 to 90) in breast fed men who had been weaned at 1 year, and 73 (59 to 89) in men who had been breast and bottle fed. Compared with men weaned before one year men not weaned had higher mean serum concentrations of total cholesterol (6.9 (not weaned) v 6.6 (weaned) mmol/l), low density lipoprotein cholesterol (5.0 v 4.6 mmol/l) and apolipoprotein B (1.14 v 1.08 g/l). Men who had been bottle fed also had a high standardised mortality ratio for ischaemic heart disease (95; 68 to 130) and high mean serum concentrations of total cholesterol (7.0 mmol/l), low density lipoprotein cholesterol (5.1 mmol/l), and apolipoprotein B (1.14 g/l). In all feeding groups serum apolipoprotein B concentrations were lower in men with higher birth weight and weight at 1 year. CONCLUSIONS--Age of weaning and method of infant feeding may influence adult serum low density lipoprotein cholesterol concentrations and mortality from ischaemic heart disease. Adult serum apolipoprotein B concentrations are related to growth in fetal life and infancy.
A colour atlas of upper gastrointestinal surgery
Authors: A G Johnson
Journal: Gut (1983)

Varicocoele caused by a pancreatic pseudocyst Sir, We were interested to read the case report by Drs Dixon, Armstrong, and Fremin of a varicocoele caused by a pancreatic pseudocyst (Gut 1983; 24: 438-40), but we believe the pancreatogram reproduced in Fig. 1 may have been misinterpreted.While accepting the difficulty of interpreting reproduced radiographs, we believe the appearances shown, and the description in the text of a blind ending to the main pancreatic duct are more suggestive of main pancreatic duct obstruction, a radiological feature which may be seen in the presence of a pseudocyst, rather than the fine terminal arborisation of the duct system more typical of an unfused ventral pancreas.2Although this in no way detracts from the interest of the report we would hesitate to ascribe this patient's recurrent acute pancreatitis to congenital duct malfusion, particularly in the presence of gall stones.
MMR vaccine policy is backed
Authors: H. Bower
Journal: BMJ (1998)

An expert group has backed vaccination with the combined measles, mumps, and rubella (MMR) vaccine after a day long examination of controversial evidence claiming that vaccination is linked with bowel disease and autism.

Professor John Pattison, chairman of the expert group, said: “There is no evidence whatsoever that would lead anyone to suggest a change in the current vaccination policy in the UK.”

The 37 …
Impact of variability among surgeons on postoperative morbidity and mortality and ultimate survival.
Authors: C S McArdle, D Hole
Journal: BMJ (1991)

OBJECTIVE--To assess the differences among surgeons in postoperative complications, postoperative mortality, and survival in patients undergoing surgery for colorectal cancer. DESIGN--Prospective study of patients with colorectal cancer managed by one of 13 consultant surgeons, none of whom had a special interest in colorectal surgery. SETTING--Royal Infirmary, Glasgow. PATIENTS--645 sequential patients with colorectal cancer presenting over the six years from 1974 to 1979. MAIN OUTCOME MEASURES--Postoperative complications, postoperative mortality (within 30 days), and survival (up to 10 years); predictive factors for postoperative mortality and survival; and relative hazard rate ratios for individual surgeons. RESULTS--The proportion of patients undergoing apparently curative resection varied among surgeons from 40% to 76%; overall postoperative mortality varied from 8% to 30%. After curative resection postoperative mortality varied from 0% to 20%, local recurrence from 0% to 21%, and the rate of anastomotic leak from 0% to 25%. Survival at 10 years in patients who underwent curative resection varied from 20% to 63%, two year survival in those who underwent palliative resection varied from 7% to 32%, and median survival in those who underwent palliative diversion varied from one to eight months. The hazard rate ratios among individual surgeons, taking into account the identified risk factors, varied from 0.56 to 2.03, from 0.17 to 1.92, and from 0.57 to 1.50 for curative resection, palliative resection, and palliative diversion, respectively. CONCLUSION--There were significant variations in patient outcome among surgeons after surgery for colorectal cancer; such differences compromise survival. A considerable improvement in overall survival might be achieved if such surgery were undertaken by surgeons with a special interest in colorectal surgery or surgical oncology.
Inappropriateness of randomised trials for complex phenomena
Authors: Isabelle Boutron, Philippe Ravaud, Bruno Giraudeau
Journal: BMJ (2005)

Evidence based medicine: does it make a difference? Use wiselyEditor-The term "evidence based medicine" entered the scientific lexicon only a little more than a decade ago. 1 What caused its remarkable spread, and what are the implications of its broad and rapid diffusion?The team that coined the term at first considered using the phrase "scientific medicine" but rejected it because it implied that other approaches were by definition unscientific. 2However, critics have argued that the term evidence based medicine carries a similar moral valence and linguistic slipperiness. 3 Who could argue against the notion of providing care that integrates individual clinical skill and the best external evidence? 4 Originally developed as a method for teaching medical residents, evidence based medicine is being applied ever more broadly to the organisation and delivery of medical services.Multiple stakeholders now seek to assume its mantle for purposes that often contradict its original intent.Managers, equating lack of evidence with lack of effectiveness, use it as a rationale for cutting services.Industry generates evidence of questionable quality to promote its products.Medical researchers come to believe that they hold a monopoly on generating and interpreting evidence.Evidence based medicine, developed as a means of taming the unscientific and messy world of clinical practice, has itself entered the unscientific and messy world of politics. 5ike any technology, evidence based medicine carries risks and benefits and can be used appropriately or inappropriately.Overly inclusive definitions threaten to deprive the term of meaning, and unchecked use increases the risk of misuse.In the past decade, evidence based medicine has contributed much to how we teach, deliver, and think about clinical services.In the coming decade, we must continue to ensure that it is not only used widely but wisely.
TREATMENT OF TYPHOID FEVER.
Authors: L. G. Hardman
Journal: JAMA (1883)

Harmony Grove, Ga., Nov. 8, 1883. N. S.Davis, M.D., <h3>Dear Doctor:</h3> —I notice an article in theJournal of the American Medical Associationon the treatment of typhoid fever, which was very interesting to me, as I had been making some investigations on the same line of treatment. I have been using an iodide mixture with iron and acid mixture; which I find to be the most successful of any treatment I have ever used. I find patients under this get well quicker and suffer less from dryness of the mucous membranes. I believe this is the most rational treatment that ever has been used in the early part of the disease, as it acts on the glandular system and thereby prevents, as I believe, often the breaking down of the glands and the formation of the ulcers and other troubles accompanying them. I am in the habit
The Arg972 Variant in Insulin Receptor Substrate-1 Is Associated With an Increased Risk of Secondary Failure to Sulfonylurea in Patients With Type 2 Diabetes
Authors: Giorgio Sesti, Maria Alelaide Marini, Marina Cardellini, Angela Sciacqua, Simona Frontoni, Francesco Andreozzi, Concetta Irace, Davide Lauro, Agostino Gnasso, Massimo Federici, Francesco Perticone, Renato Lauro
Journal: Diabetes Care (2004)

OBJECTIVE—The aim of this study was to investigate whether diabetic patients carrying the Arg972 insulin receptor substrate-1 (IRS-1) variant are at increased risk for secondary failure to sulfonylurea. RESEARCH DESIGN AND METHODS—A total of 477 unrelated Caucasian type 2 diabetic patients were recruited according to the following criteria: onset of diabetes after age 35 years, absence of ketonuria at diagnosis, and anti-GAD− antibody. Type 2 diabetes was diagnosed according to the American Diabetes Association criteria. Patients with secondary sulfonylurea failure were defined as those requiring insulin due to uncontrolled hyperglycemia (fasting plasma glucose &amp;gt;300 mg/dl) despite sulfonylurea-metformin combined therapy, appropriate diet, and absence of any conditions causing hyperglycemia. RESULTS—Of the total patients, 53 (11.1%) were heterozygous for the Arg972 IRS-1 variant, 1 (0.2%) was homozygous, and the remainder (88.7%) were homozygous for the wild-type allele. The genotype frequency of the Arg972 IRS-1 variant was 8.7% among diabetic patients well controlled with oral therapy and 16.7% among patients with secondary failure to sulfonylurea (odds ratio 2.1 [95% CI 1.18–3.70], P = 0.01). Adjustment for age, sex, BMI, metabolic control, age at diagnosis, duration of diabetes, and Pro12Ala polymorphism of peroxisome proliferator–activated receptor-γ2 gene in a logistic regression analysis with secondary failure to sulfonylurea as a dependent variable did not change this association (2.0 [1.38–3.86], P = 0.038). CONCLUSIONS—These data demonstrate that the Arg972 IRS-1 variant is associated with increased risk for secondary failure to sulfonylurea, thus representing a potential example of pharmacogenetics in type 2 diabetes.