tbuckley/cabot-search huggingface dataset:
Problems and Challenges of Consultation Psychiatry in Gynecology and Obstetrics
Authors: Dan G. Hertz
Journal: Psychotherapy and Psychosomatics (1974)

Clinical experiences of consultation-liaison psychiatry in gynecology and obstetrics were reviewed. Observations were based on the modality of 'host-agent' interaction. Most published reports concentrated on the psychiatrist's role in the consultative function. The present paper emphasized specific reactions of the 'host' (consultee) in a survey of 23 gynecologists and obstetricians in the setting of a general teaching hospital. While the overall reactions of the consultees were found to be similar to those reported about medical and surgical wards, some specific differences were pointed out. The definition of 'clinical duality' in gynecology was stressed, relating to the function of the gynecologist in the alternating therapeutic role between activity and passivity. Specific therapeutic fields were mentioned as areas of conflict and sources of countertransference for the gynecologist. In spite of the difficulties presented, an optimistic view is maintained about the future of integrated psychological counselling for the two clinical disciplines. Prolonged and continuous cooperation not only in ward setting but through organization of special integration clinics is advocated to help free both professions from mutual preconceived prejudices. Such clinics will promote training and research interest, develop the gynecologist's ability toward deeper awareness of psychological problems and stimulate the psychiatrist for active participation in the investigation of psychophysiological processes. This mutual growth through case-finding and diagnosis should lead toward better integration of a community-oriented approach, centered mainly around sexual education, study of problems of parenthood and marital interaction. Some possible complications emerging in the trainees must be carefully watched, like identity crisis, increased resistance stirred by therapeutic zeal and exaggeration in the evaluation of psychological stresses. They have to be dealt with through intensive supervision and active participation of senior psychiatric consultants. There is still a wide gap between the goals set by consultation psychiatry and their realization. We have to be constantly reminded that teaching is a never-ending process of learning. One can only hope that with every additional effort on our part to bring understanding to others, we shall gain knowledge to meet the multitude of challenges still ahead of us.
Outcome of Renal Crisis in Systemic Sclerosis: Relation to Availability of Angiotensin Converting Enzyme (ACE) Inhibitors
Authors: Virginia D. Steen
Journal: Annals of Internal Medicine (1990)

Objective: To determine the outcome of scleroderma renal crisis before and after the availability of angiotensin converting enzyme (ACE) inhibitors. Design: Evaluation of a large cohort of patients with systemic sclerosis and renal crisis who were followed prospectively. Setting: University scleroderma center. Patients: One hundred and eight patients who had scleroderma renal crisis between 1972 and 1987. Intervention: ACE inhibitors. Measurements and Main Results: Therapy with ACE inhibitors has dramatically improved the survival of patients with scleroderma 0renal crisis (1-year survival, 15% without and 76% with ACE inhibitors; P < 0.001). However, 24 (44%) of 55 patients with scleroderma renal crisis who were treated with ACE inhibitors died early or required permanent dialysis. Older age, male sex, an initial serum creatinine level of more than 270 µmol/L, inadequately controlled blood pressure, and congestive heart failure were associated with these poor outcomes, but only older age and congestive heart failure were significant in a multivariate logistic regression analysis. Eleven of twenty patients (55%) who survived dialysis more than 3 months and continued to receive therapy with ACE inhibitors were able to discontinue dialysis after 3 to 15 months compared with 0 of 15 dialysis patients who did not receive ACE-inhibitor therapy (P = 0.002). Conclusions: Patients with systemic sclerosis who develop hypertension should be treated with an ACE inhibitor. Improved survival and successful discontinuation of dialysis are possible when ACE inhibitors are used to treat scleroderma renal crisis.
Gallbladder Visualization on Routine Lung Perfusion Imaging
Authors: ALBERTO J. ARROYO, TIMOTHY J. JENKINS, YOGESH P. PATEL
Journal: Clinical Nuclear Medicine (1997)

Two routine lung SPECT studies showed what appeared to be uptake within the gallbladder. This finding was confirmed on coronal views and three-dimensional reconstruction. There was no contamination or problem with the radiopharmaceutical quality control. The patients had not had any prior nuclear procedures. Gallbladder visualization on routine lung imaging has not been previously observed. The purpose of this study was to ascertain the incidence of gallbladder uptake and to determine a possible mechanism.Fifty-four patients referred for routine lung perfusion imaging were examined. At the end of the lung imaging, an anterior and/or right lateral 3-5 minute view of the abdomen was obtained. Patients too ill for additional imaging or those with prior cholecystectomies were excluded.Nineteen of the 54 patients showed activity within the gallbladder. Activity within the gut, kidneys, and urinary bladder also were observed.Gallbladder activity after Tc-99m macroaggregated albumin injection for lung perfusion studies, is a fairly common finding.
Doctor and the Patient and the Law
Authors: Charles J. Frankel
Journal: JAMA (1964)

This excellent volume was published as a successor to the very successful and widely read volume of the same title by Dr. Regan. There has been a complete change of format and content and obvious extension of the motive. Formerly the volume was of interest only to doctors. This volume is directed also to lawyers and contains a very valuable list of citations which might also be of interest to the physician. The latter, however, would have to be taught the meaning of the various references. Perhaps in the next edition a short chapter can be added to help the physician read the legal literature. If there is any minor criticism to be leveled at the volume, it would concern itself only with the presentation of the material in such a way that the average physician might have some difficulty in understanding some of the legal language, however simple it
APPENDICITIS WITH GANGRENE AND RUPTURE OF APPENDIX AND CECUM: OPERATION: RECOVERY.
Authors: HARRY GREENBERG
Journal: JAMA (1900)

Sept. 13, 1899, at 11 a.m., I was called by Dr. A. Beyer to see with him Joseph W., 11 years old, who was suffering from what the Doctor diagnosed as appendicitis, having recognized that condition two days previously. The attack came on gradually, the boy complaining of abdominal pains and constipation, alternating with diarrhea for about ten days. When he was first seen by Dr. Beyer, 8 p. m., September 11, his temperature was 100.4, pulse 136; he complained of pain in the right iliac region, tympanites and tenderness all over the abdomen; he passed highly concentrated urine in small quantities, which caused him much suffering. September 14 the temperature was 103.4, pulse 140. Hot turpentin stupes were applied to the abdomen and tinctura opii camphorata with aconite administered internally. On that night, 11 p.m., while the boy was being moved from bed, he suddenly screamed out and became
THE ADVANTAGES OF THE SANITARIUM TREATMENT OF TUBERCULOSIS WHEN CHANGE OF CLIMATE IS NOT POSSIBLE.
Authors: E. S. OLIVER
Journal: JAMA (1900)

The writer has for two years past been living at Saranac Lake, N. Y., as a patient and physician, studying the problem of tuberculosis in his own person, in the Saranac laboratory for the study of tuberculosis, and as a member of the staff of the Adirondack Cottage Sanitarium. The views he is about to express are the results of two years' study and observation, and are to be regarded solely as the expression of his own opinion and not in any sense to represent officially the institution with which he is connected. As may be inferred from the title, it is accepted as a foregone conclusion that sanitarium treatment is the only solution of the many problems presented in this protean disease. The conclusion reached by the Berlin Congress and International Medical Congress in Paris leaves no room to doubt that the sanitarium treatment accomplishes what no "specific"—whether serums
Salmeterol Xinafoate in Asthma-Reply
Authors: Roger C. Bone
Journal: JAMA (1994)

<h3>In Reply.</h3> —My Editorial notes that salmeterol provides more effective bronchodilation than albuterol in patients requiring maintenance therapy for asthma. The Editorial, however, goes on to state that salmeterol should not be used more than twice daily at recommended doses. The drug is approved only for use this way. The package insert<sup>1</sup>for Serevent (salmeterol xinafoate) Inhalation Aerosol states: "Do Not Exceed Recommended Dose: The bronchodilator action of salmeterol usually lasts for at least 12 hours. Therefore, it should not be used more often than every 12 hours."<sup>1</sup>The information in the package insert is very specific about how salmeterol should be used. As I stated in my Editorial, although salmeterol inhalation aerosol may be a major advance in our treatment protocol, physicians and patients must be educated never to use salmeterol to treat the acute symptoms of asthma. The package insert notes that a salmeterol overdose may
Induced Abortion and Subsequent Pregnancy Loss-Reply
Authors: Stephen C. Schoenbaum
Journal: JAMA (1981)

In Reply.—  We agree that there is a potential bias in the risk estimates obtainable from a study such as ours. As Dr Chung points out, if such a bias is occurring, it is unlikely to account for the magnitude of increased risk of pregnancy loss that we observed in women with two or more previous induced abortions.  Furthermore, the potential bias would apply almost exclusively to losses experienced in the first trimester. Since more than 90% of induced abortions are performed in the first trimester,1a woman having a loss in the midtrimester has already had her chance to opt for induced abortion. We did observe a substantial increase in the risk of midtrimester, not just first trimester, losses. The midtrimester losses included missed abortions in which the problem most likely begins in the first trimester even though the loss is experienced in the midtrimester.  If the suggested
Brain Infarction and the Clinical Expression of Alzheimer Disease
Authors: Gustavo C. Roman
Journal: JAMA (1997)

To the Editor.  —Dr Snowdon and colleagues 1 emphasized the important contribution of lacunar infarcts to cognitive decline in patients with AD. However, with few exceptions, no clear correlation exists between location or number of lacunar infarcts and development of vascular dementia. 2,3 More than a direct cause of dementia, lacunar infarcts per se probably represent a surrogate or a marker for small-vessel disease(arteriolosclerosis) leading also to periventricular ischemic white matter disease in the elderly. 4 These lesions, rediscovered by brain imaging techniques under the name leukoaraiosis, constitute the pathological substratum of Binswanger disease, 5 a vascular form of senile dementia.  Moreover, Brun and Englund 6 demonstrated these lesions in about 60% of patients with AD. However, periventricular ischemic white matter lesions in the elderly may be undetectable to the naked eye examination of the brain
UK insurers postpone using predictive genetic testing until 2011
Authors: Susan Mayor
Journal: BMJ (2005)

Insurance companies in the United Kingdom have agreed to postpone using information from genetic tests that predicts risk of disease when they set insurance premiums. The postponement, announced by the Department of Health, will last until after 2011.

The health secretary, John Reid, announced that the government had negotiated an agreement with the Association of British Insurers, the trade organisation for insurance companies in the United Kingdom, to extend the current voluntary restrictions on the use of predictive genetic test results by insurers by five years, to November 2011.

The agreement is part of a new …
Deaths from acute abdominal conditions and geographic access to surgical care in India: a nationally representative population-based spatial analysis
Authors: Joshua S Ng-Kamstra, Anna J Dare, Jayadeep Patra, Sze Hang Fu, Peter S Rodriguez, Marvin Hsiao, Raju M Jotkar, J S Thakur, Jay K Sheth, Prabhat Jha
Journal: The Lancet (2015)

BackgroundAcute abdominal conditions have high case-fatality rates in the absence of timely surgical care. In India, and many other low-income and middle-income countries, few population-based studies have quantified mortality from surgical conditions and related mortality to access to surgical care. We aimed to describe the spatial and socioeconomic distributions of deaths from acute abdomen (DAA) in India and to quantify potential access to surgical facilities in relation to such deaths.MethodsWe examined deaths from acute abdominal conditions within a nationally representative, population-based mortality survey of 1·1 million Indian households and linked these to nationally representative facility data. Spatial clustering of deaths from acute abdominal conditions was calculated with the Getis-Ord Gi* statistic from about 4000 postal codes. We compared high or low acute abdominal mortality clusters for their geographic access to well-resourced surgical care (24 h surgical and anaesthesia services, blood bank, critical care beds, basic laboratory, and radiology).Findings923 (1·1%) of 86 806 study deaths in those aged 0–69 years were identified as deaths from acute abdominal conditions, corresponding to an estimated 72 000 deaths nationally in India in 2010. Most deaths occurred at home (71%), in rural areas (87%), and were caused by peptic ulcer disease (79%). There was wide variation in rates of deaths from acute abdominal conditions. We identified 393 high-mortality geographic clusters and 567 low-mortality clusters. High-mortality clusters of acute abdominal conditions were located significantly further from well-resourced hospitals than were low-mortality clusters. The odds ratio of a postal code area being a high-mortality cluster was 4·4 (99% CI 3·2–6·0) for living 50 km or more from well-resourced district hospitals (rising to an OR of 16·1 for >100 km), after adjustment for socioeconomic status and caste.InterpretationImprovements in human and physical resources at existing public hospitals are required to reduce deaths from acute abdominal conditions in India. Had all of the Indian population had access to well-resourced hospitals within 50 km, more than 50 000 deaths from acute abdominal conditions could have been averted in 2010, and likely more from other emergency surgical conditions. Our geocoded facility data were limited to public district hospitals. However, noting the high rate of catastrophic health expenditures in India, we chose to focus on publicly provided services which are the only option usually available to the poor.FundingThe Bill & Melinda Gates Foundation, Dalla Lana School of Public Health, and Canadian Institute of Health Research.
458 LONG TERM MORTALITY RISK FACTORS IN A LARGE COHORT OF WAITLISTED PATIENTS FOR LIVER TRANSPLANTATION IN BRAZIL
Authors: S. Basto, R. Raggio Luiz, A. Schmal, A. Barroso, L. Victor, C. Villela-Nogueira, H.S. Moraes Coelho, R.M. Perez
Journal: Journal of Hepatology (2010)
Perils of Prophylaxis
Authors: George A. Jacoby
Journal: New England Journal of Medicine (1982)

A major threat to patients with granulocytopenia and cancer is infection. Most infections develop from either endogenous or hospital-acquired organisms colonizing the alimentary tract and upper airways. Total reverse isolation with laminar air-flow rooms and microbial suppression with oral nonabsorbable antibiotics are effective in reducing infection, but their application is limited by expense and patient compliance.1 Hence, reports that oral prophylaxis with trimethoprim–sulfamethoxazole (TMP-SMX) without isolation precautions was also protective in patients with granulocytopenia have led to widespread adoption of this regimen.In this issue, Wilson and Guiney report on two patients with acute leukemia and granulocytopenia who were receiving . . .
Osmole and Water Excretion in Mercurial Diuresis in Congestive Heart Failure
Authors: NORTON SPRITZ, GEORGE W. FRIMPTER, WARREN S. BRAVEMAN, ALBERT L. RUBIN
Journal: Circulation (1959)

The relationhip between water and total solute excretion following mercurial administration has been previously studied in normal human subjects during superimposed water and solute diureses. It is the purpose of the study to determine the solute/water relationships in the mercurial diuresis produced in water-deprived patients with edema from congestive heart failure. The results indicate that in such patients, the diuresis produced has the relationship of a simple osmotic diuresis. The clinical implications are discussed.
Dietary Calcium, Vitamin D, and the Prevalence of Metabolic Syndrome in Middle-Aged and Older U.S. Women
Authors: Simin Liu, Yiqing Song, Earl S. Ford, JoAnn E. Manson, Julie E. Buring, Paul M. Ridker
Journal: Diabetes Care (2005)

OBJECTIVE—To examine whether and to what extent intakes of calcium and vitamin D are related to the metabolic syndrome in middle-aged or older women. RESEARCH DESIGN AND METHODS—We analyzed data from 10,066 women aged ≥45 years participating in the Women’s Health Study who were free of cardiovascular disease, cancer, or diabetes and who never used postmenopausal hormones. We used multiple logistic regression models to estimate multivariable odds ratios (ORs) and 95% CIs comparing different dietary intake levels of calcium and vitamin D. RESULTS—In age- and calorie-adjusted analyses, higher intakes of total, dietary, and supplemental calcium were significantly and inversely associated with the prevalence of metabolic syndrome. After further adjusting for smoking status, exercise, alcohol intake, multivitamin use, and parental history of myocardial infarction before age 60 years, the ORs of having the metabolic syndrome for increasing quintiles of total calcium intake were 1.00 (reference), 0.82 (95% CI 0.70–0.97), 0.84 (0.71–0.99), 0.70 (0.59–0.83), and 0.64 (0.54–0.77) (P for trend &amp;lt;0.0001). This association was not appreciably altered by additional adjustment for other dietary factors or total vitamin D intake. In contrast, neither total (P for trend = 0.13) nor supplemental (P for trend = 0.45) vitamin D was significantly associated with metabolic syndrome. Dietary vitamin D was inversely associated with prevalence of metabolic syndrome but was not independent of total calcium intake. Similar strong relations between intakes of dairy products and metabolic syndrome were also observed. After adjustment for lifestyle and dietary factors, the multivariable ORs comparing highest with lowest intake categories were 0.66 (0.55–0.80) (P for trend &amp;lt;0.0001) for total dairy products and 0.85 (0.71–1.02) (P for trend = 0.05) for total milk intake. CONCLUSIONS—Our results indicate that intakes of calcium and dairy products may be associated with lower prevalence of the metabolic syndrome in middle-aged and older women.
THE PLASMA PROTEIN IN POSTURAL ALBUMINURIA
Authors: FREDERIC W. SCHLUTZ
Journal: JAMA (1926)

The peculiar albuminuria that becomes manifest in certain persons if they assume the upright position, and disappears if they assume the recumbent position, has been the subject of considerable interest and study. It is generally spoken of as orthotic, orthostatic or postural albuminuria.  Moxon, 1 in 1878, gave the earliest description of the condition and called attention to the fact that the albuminuria was apparently unassociated with other evidence of renal disease. He distinguished an adolescent albuminuria with a fairly permanent showing of albumin in the urine, and a remittent type in which the albumin completely disappeared from the urine when the subject was recumbent and disappeared after assumption of the erect posture.  Pavy, 2 in 1885, reported a group of similar cases. Stirling 3 first emphasized the importance of posture and its definite connection with the appearance and disappearance of the albumin in the urin. Heubner 4 suggested the
1167 Sense and antisense RNA-mediated inhibition of hepatitis B virus
Authors: K NASH, G ALEXANDER, A LEVER
Journal: Hepatology (2003)

Tombusviruses, which are small plus-strand RNA viruses of plants, require the viral-coded p33 replication co-factor for template selection and recruitment into replication in infected cells. As presented in the accompanying paper [Shapka, N., Stork, J., Nagy, P.D., 2005. Phosphorylation of the p33 replication protein of Cucumber necrosis tombusvirus adjacent to the RNA binding site affects viral RNA replication. J. Virol. 343, 65–78.], p33 can be phosphorylated in vitro at serine and threonine residues adjacent to its arginine–proline-rich RNA binding site. To test the effect of phosphorylation on p33 function, in this paper, we used phosphorylation-mimicking aspartic acid mutants of Cucumber necrosis virus (CNV) p33 and in-vitro-phosphorylated p33 in gel mobility shift experiments. We found that phosphorylation inhibited the ability of p33 to bind to the viral RNA. In contrast, the nonphosphorylation-mimicking alanine mutants of p33 bound to viral RNA as efficiently as the nonphosphorylated wild type p33 did. In vitro assays with purified CNV replicase preparations revealed that phosphorylation-mimicking mutants of p33 did not support the assembly of functional CNV replicase complexes in yeast, a model host. Based on these results, we propose that the primary function of reversible phosphorylation of p33 is to regulate the RNA binding capacity of p33, which could affect the assembly of new viral replicase complexes, recruitment of the viral RNA template into replication and/or release of viral RNA from replication. Thus, phosphorylation of p33 might help in switching the role of the viral RNA from replication to other processes, such as viral RNA encapsidation and cell-to-cell movement in infected hosts.
[113] PROGRESSIVE FIBROSIS IN NON-ALCOHOLIC STEATOHEPATITIS - ASSOCIATION WITH ALTERED REGENERATION AND A DUCTULAR REACTION
Authors: M.M. Richardson, T.R. Jonsson, E.E. Powell, E.M. Brunt, B.A. Neuschwander-Tetri, P.S. Bhathal, J.B. Dixon, M.D. Weltman, H. Tilg, A.R. Moschen, D.M. Purdie, A.J. Demetris, A.D. Clouston
Journal: Journal of Hepatology (2007)