tbuckley/cabot-search huggingface dataset:
Epidural Analgesia in Laparoscopic Colorectal Surgery
Authors: Wissam J. Halabi, Celeste Y. Kang, Vinh Q. Nguyen, Joseph C. Carmichael, Steven Mills, Michael J. Stamos, Alessio Pigazzi
Journal: JAMA Surgery (2013)

IMPORTANCEThe use of epidural analgesia in laparoscopic colorectal surgery has demonstrated superiority over conventional analgesia in controlling pain.Controversy exists, however, regarding its cost-effectiveness and its effect on postoperative outcomes.OBJECTIVES To examine the use of epidural analgesia in laparoscopic colorectal surgery at the national level and to compare its outcomes with those of conventional analgesia.DESIGN, SETTING, AND PARTICIPANTS This is a retrospective review of laparoscopic colorectal cases performed with or without epidural analgesia for cancer, diverticular disease, and benign polyps.Patient demographic characteristics, disease and procedure types, and hospital settings were listed for patients in the epidural and conventional analgesia groups.A 1 to 4 case-matched analysis was performed, matching for patient demographic characteristics, hospital setting, indications, and procedure type.Data were obtained from the Nationwide Inpatient Sample between January 1, 2002, and December 31, 2010.MAIN OUTCOMES AND MEASURES Total hospital charge, length of stay, mortality, pneumonia, respiratory failure, urinary tract infection, urinary retention, anastomotic leak, and postoperative ileus.RESULTS A total of 191 576 laparoscopic colorectal cases were identified during the study period.Epidural analgesia was used in 4102 cases (2.14%).Epidurals were more likely to be used in large teaching hospitals, cancer cases, and rectal operations.On case-matched analysis, epidural analgesia was associated with a longer hospital stay by 0.60 day (P = .003),higher hospital charges by $3732.71(P = .02),and higher rate of urinary tract infection (odds ratio = 1.81;P = .05).Epidural analgesia did not affect the incidence of respiratory failure, pneumonia, anastomotic leak, ileus, or urinary retention. CONCLUSIONS AND RELEVANCEThe perioperative use of epidural analgesia in laparoscopic colorectal surgery is limited in the United States.While epidural analgesia appears to be safe, it comes with higher hospital charges, longer hospital stay, and a higher incidence of urinary tract infections.
Left Ventricular Structure and Function in Children Infected With Human Immunodeficiency Virus
Authors: Steven E. Lipshultz, Kirk A. Easley, E. John Orav, Samuel Kaplan, Thomas J. Starc, J. Timothy Bricker, Wyman W. Lai, Douglas S. Moodie, Kenneth McIntosh, Mark D. Schluchter, Steven D. Colan
Journal: Circulation (1998)

Background —The frequency of, course of, and factors associated with cardiovascular abnormalities in pediatric HIV are incompletely understood. Methods and Results —A baseline echocardiogram (median age, 2.1 years) and 2 years of follow-up every 4 months were obtained as part of a prospective study on 196 vertically HIV-infected children. Age- or body surface area–adjusted z scores were calculated by use of data from normal control subjects. Although 88% had symptomatic HIV infection, only 2 had CHF at enrollment, with a 2-year cumulative incidence of 4.7% (95% CI, 1.5% to 7.9%). All mean cardiac measurements were abnormal at baseline (decreased left ventricular fractional shortening [LV FS] and contractility and increased heart rate and LV dimension, mass, and wall stresses). Most of the abnormal baseline cardiac measurements correlated with depressed CD4 cell count z scores and the presence of HIV encephalopathy. Heart rate and LV mass showed significantly progressive abnormalities, whereas FS and contractility tended to decline. No association was seen between longitudinal changes in FS and CD4 cell count z score. Children who developed encephalopathy during follow-up had depressed initial FS, and FS continued to decline during follow-up. Conclusions —Subclinical cardiac abnormalities in HIV-infected children are common, persistent, and often progressive. Dilated cardiomyopathy (depressed contractility and dilatation) and inappropriate LV hypertrophy (elevated LV mass in the setting of decreased height and weight) were noted. Depressed LV function correlated with immune dysfunction at baseline but not longitudinally, suggesting that the CD4 cell count may not be a useful surrogate marker of HIV-associated LV dysfunction. However, the development of encephalopathy may signal a decline in FS.
THE BACTERICIDAL ACTION OF HUMAN SERUM ON HEMOLYTIC STREPTOCOCCI
Authors: William S. Tillett, C. Chester Stock
Journal: The Journal of Experimental Medicine (1937)

Aerobic Tests. Changes in pH Which Occurred during Incubation.-(a) The pH of sterile specimens of both normal and patients' sera increased, during 24 hours incubation, from 8.0-8.8 up to 9.2-9.6. (b) The pH of patients' sera, inoculated with hemolytic streptococci, progressed in the alkaline direction as did the sterile specimens. (c) The pH of normal sera, inoculated with hemolytic streptococci, pursued a variable course at lower levels than the sterile specimens. The differences in the changes in pH which occurred in streptococcidal sera and in normal controls were dependent upon and secondary to the presence or absence of killing action in the specimens. Aerobic Tests. Effect of Different Levels of Hydrogen Ion Concentration, Adjusted at Beginning of Experiment, but Uncontrolled during Period of Incubation.-(a) The streptococcidal activity of patients' sera was inactivated when the hydrogen ion concentration of the specimens was adjusted to levels ranging from 6.4 to 7.4. The inactivation of highly potent samples of sera required a greater reduction in pH than did specimens of moderate killing activity. (b) Normal sera, adjusted to pH 9.2 or higher, exhibited a relatively slowly acting bactericidal process, which seemed to represent the toxic effect of alkalinity. Aerobic Tests. Effect of Glutathione and Sodium Ascorbate.-The streptococcidal action of patients' sera was markedly impaired by the addition of reducing agents. The inactivation was, in general, comparable to that previously obtained under conditions of anaerobiosis. The results, suggesting that some factor pertaining to biological oxidation-reduction may influence the streptococcidal action of sera, have been discussed. Tests Performed in Closed Jars by Means of Which Relatively Constant pH Was Maintained during the Period of Incubation.-Under the experimental conditions which were employed, the effectiveness of the streptococcidal action of patients' sera was maintained only in alkaline ranges. The most potent specimens of sera were active at lower levels of pH (7.9-8.2) than were other samples (8.4-8.8). All of the observations reported in this article were made with a strain of hemolytic streptococcus of the beta type, which is highly sensitive to the destructive action of serum from acutely ill patients.
Uptake of bowel screening is only 33% among UK South Asians
Authors: Owen Dyer
Journal: BMJ (2008)

England’s fledgling bowel cancer screening programme is attracting poor uptake from people of South Asian origin, says a new study of the pilot project in Coventry and Warwickshire.

In comparison with people from non-Asian ethnic groups, South Asians were only half as likely to respond positively to an invitation for bowel cancer screening, found the study, which was led by Ala Szczepura, professor of health services research at Warwick University, and funded by the NHS cancer screening programme. In particular it found that the response rate among Muslim South Asians was less than a third that in non-Asians. 

The difference in uptake between South Asians and non-Asians was far larger than that found in the early years of the breast cancer screening programme, say the researchers, who also tracked uptake of breast cancer screening …
Emergency Treatment of Acute Drug Ingestions
Authors: Robert S. Hoffman
Journal: JAMA (1991)

<h3>To the Editor.</h3> —I read with great interest the Contempo 1991 (June 19,1991) issue of<i>JAMA</i>. This issue allows the reader to view both the current state of the art and the future of medicine as seen through the eyes of specialists in each field. I am concerned, however, with the inclusion of a large discussion of toxicology under the Emergency Medicine section.<sup>1</sup>While the American Board of Medical Specialties currently does not recognize medical toxicology, it is unacceptable to ignore the fact that the American Board of Medical Toxicology and the American Academy of Clinical Toxicology have been training physicians in the practice of medical toxicology for many years. As part of my training in medical toxicology, I learned how to interpret research from other fields that attempt to answer questions of toxicological importance. After reading Dr Barsan's discussion<sup>1</sup>of gastrointestinal decontamination for acute drug ingestion, the
Left Ventricular Longitudinal Function Predicts Life-Threatening Ventricular Arrhythmia and Death in Adults With Repaired Tetralogy of Fallot
Authors: Gerhard-Paul Diller, Aleksander Kempny, Emmanouil Liodakis, Rafael Alonso-Gonzalez, Ryo Inuzuka, Anselm Uebing, Stefan Orwat, Konstantinos Dimopoulos, Lorna Swan, Wei Li, Michael A. Gatzoulis, Helmut Baumgartner
Journal: Circulation (2012)

Background— Sudden cardiac death and life-threatening ventricular arrhythmia remain a concern in adult patients with repaired tetralogy of Fallot. Longitudinal left ventricular (LV) function is sensitive in detecting early myocardial damage and may have prognostic implications in this setting. Methods and Results— We included 413 tetralogy of Fallot patients (age, 36±13 years; QRS duration, 148±27 milliseconds; LV ejection fraction, 55±10%). A composite end point of sudden cardiac death/life-threatening ventricular arrhythmia (sustained ventricular tachycardia, resuscitated sudden cardiac death, or appropriate implantable cardioverter-defibrillator discharge) was used. During a median follow-up of 2.9 years, 5 patients died suddenly, 9 had documented sustained ventricular tachycardia, and another 5 had appropriate implantable cardioverter-defibrillator shocks. On univariate Cox analysis, QRS duration (hazard ratio [HR], 1.02 per 1 ms; P =0.046), right atrial area (HR, 1.05 per 1 cm 2 ; P =0.02), right ventricular fractional area change (HR, 0.94 per 1%; P =0.02), right ventricular outflow tract diameter (HR, 1.08 per 1 mm; P =0.01), mitral annular plane systolic excursion (HR, 0.84 per 1 mm; P =0.03), and LV global longitudinal 2-dimensional strain (HR, 0.87 per 1%; P =0.03) were related to the combined end point. On bivariable analysis, mitral annular plane systolic excursion and LV global longitudinal 2-dimensional strain were related to outcome independently of QRS duration ( P =0.002 and P =0.01, respectively). In addition, a combination of echocardiographic variables, including right atrial area, right ventricular fractional area change, and LV global longitudinal 2-dimensional strain or mitral annular plane systolic excursion, was also found to be significantly related to outcome ( P &lt;0.001; c statistic, 0.70). Conclusions— LV longitudinal dysfunction was associated with greater risk of sudden cardiac death/life-threatening ventricular arrhythmias. In combination with echocardiographic right heart variables, also available from routine echocardiography, these measures provide important outcome information and should be considered a useful adjunct to established markers such as QRS duration in the estimation of prognosis in this challenging population.
BOVERI'S WORK ON CANCER
Authors: Maynard M. Metcalf
Journal: JAMA (1925)

<h3>To the Editor:</h3> —More than ten years ago, Boveri published suggestions as to the fundamental nature of cancer, based on his previous studies in mitosis and development of doublefertilized sea-urchin eggs. Boveri was the greatest cytologist of his generation and probably the leading zoologist of his time—a man so keen, so careful and so cautious that any least suggestion from him deserves most thorough consideration. The German government recognized the importance of his suggestions as to cancer by inviting him to come to Berlin as head of a research institute which they would establish on such scope and plan as he might desire. But he was unable to accept this invitation. His work on this subject is not known to American men of medicine. I have mentioned it to two past presidents of the American Medical Association, to thirty professors in medical schools, to the head of an important American
Liver Disease in Addicts
Authors: FEREIDOUN AZIZI
Journal: Annals of Internal Medicine (1972)

Letters, Comments, and Corrections1 May 1972Liver Disease in AddictsFEREIDOUN AZIZI, M.D.FEREIDOUN AZIZI, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-76-5-829 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Adulterant substances used in "street drugs" have been implicated as causes of cardiotoxicity (1), acute intravascular hemolysis (2), and pulmonary angiothrombosis (3). The latter was reinvestigated by Douglas, Kafilmout, and Patt (4) who reported, in the December 1971 issue, the abnormal pulmonary function tests and pathological findings of foreign-body type in the lungs of their addict patients. The role of these substances in the pathogenesis of addict liver disease has not been fully investigated.As many as 80% of heroine and cocaine addicts have abnormal liver function tests (5, 6), with nonspecific changes in liver structure (7)....References1. LUPOVICHPILEWISKISAPIRA PRJ: Cardiotoxicity of quinine as adulterant in drugs. JAMA 212:1216, 1970 CrossrefMedlineGoogle Scholar2. MEDRANOTANAKA VK: Acute intravascular hemolysis from heroin injection intravenously. JAMA 212:1380, 1970 CrossrefMedlineGoogle Scholar3. SZWED J: Pulmonary angiothrombosis caused by "blue velvet" addiction. Ann Intern Med 73:771-774, 1970 LinkGoogle Scholar4. DOUGLASKAFILMOUTPATT FKN: Foreign particle embolism in drug addicts: respiratory pathophisiology. Ann Intern Med 75:865-872, 1971 LinkGoogle Scholar5. MARKSCHAPPLE VP: Hepatic dysfunction in heroin and cocaine users. Br J Addict 62:189-195, 1967 CrossrefGoogle Scholar6. POTTERCOHENNORRIS HNR: Chronic hepatic dysfunction in heroin addicts. JAMA 174:2049-2051, 1960 CrossrefMedlineGoogle Scholar7. NORRISPOTTER RH: Hepatic inflammation in narcotic addicts. Arch Environ Health 11:662-668, 1965 CrossrefMedlineGoogle Scholar8. CHERUBINHARGROVEPRINCE CRA: The serum hepatitis related antigen (SH) in illicit drug users. Am J Epidemiol 91:510-517, 1970 CrossrefMedlineGoogle Scholar1. CHERUBIN C: The medical sequelae of narcotic addiction. Ann Intern Med 67:23-33, 1967 LinkGoogle Scholar2. ISHAKISHAK BK: Foreign-body reaction in the liver of a drug addict. J Forensic Sci 14:515-520, 1969 MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: St. Elizabeth's Hospital of Boston Boston, Mass. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1972Volume 76, Issue 5Page: 829-830KeywordsAbnormal liver function testsAddictsCocaineLiverLiver diseasesLungsPathogenesisPulmonary diseasesPulmonary function Issue Published: 1 May 1972 PDF DownloadLoading ...
Role of 2-month sputum smears in predicting culture conversion in pulmonary tuberculosis
Authors: W-J. Su, J-Y. Feng, Y-C. Chiu, S-F. Huang, Y-C. Lee
Journal: European Respiratory Journal (2010)

Sputum smears and culture conversion are frequently used to evaluate treatment response in pulmonary tuberculosis patients. Limited data are available on the evaluation of the correlation between under-treatment sputum smear results and culture conversion. This prospective study included sputum culture-proven pulmonary tuberculosis patients at six hospitals in Taiwan. At least two sets of sputum were collected at the completion of 8 weeks of TB treatment. The sensitivities and specificities of 2-month sputum smears were estimated based on culture conversion status. A total of 371 patients were enrolled for analysis. Factors associated with culture conversion included having a smear positive before treatment, presence of a cavity on radiography, rifampicin resistance and usage of the DOTS (directly observed therapy, short course) strategy. The sensitivities of 2-month sputum smears for culture conversion among all patients, initially smear-positive patients and initially smear-negative patients were 64.3, 71.4 and 38%, respectively, and the specificities were 81.6, 69.9 and 92.8%, respectively. In patients who were 2-month sputum smear-positive, the 2-month culture conversion rate was 80% if the patients were under DOTS and without cavitary lesions in radiograms. The predictive value of 2-month sputum smears in culture conversion was limited and highly influenced by clinical factors in pulmonary tuberculosis patients.
The Clinical Effect of Dihydroergocornine Methanesulphonate (DHO-180) in Arterial Hypertension: A Preliminary Report
Authors: R. M. TANDOWSKY
Journal: Circulation (1950)

A controlled clinical and statistical study of 47 unselected patients with sustained arterial hypertension who received dihydroergocornine intravenously and orally is presented. The study demonstrates the central effect of this drug in temporarily lowering the systolic and diastolic blood pressure and pulse rate. This action occurs irrespective of associated pathology or extent of the hypertensive state when the drug is given parenterally. Orally, little effect was demonstrated.
Heart rate variability in patients with congestive heart failure and ischemic heart disease by Holter monitoring
Authors: Hirokazu Nagayoshi, Akira Kurita, Bonpei Takase, Hiroyuki Hikita, Hideki Mitani, Takayuki Miyake, Akimi Uehata, Toshihiko Nishioka, Toshiharu Maruyama, Kimio Satomura, Kyouichi Mizuno, Haruo Nakamura
Journal: Journal of the American College of Cardiology (1991)
Effects of a 6-month lifestyle modification intervention on the cardiometabolic risk factors and health-related qualities of life in women with metabolic syndrome
Authors: Eui Geum Oh, So Youn Bang, Sa Saeng Hyun, Soo Hyun Kim, Sang Hui Chu, Justin Y. Jeon, Jee-Aee Im, Mi Kyung Lee, Jung Eun Lee
Journal: Metabolism (2010)
429 Chemokine receptor expression on T cells according to inflammatory activity and liver fibrosis in chronic hepatitis C virus (HCV) infection
Authors: M. Calvino, J.R. Larrubia, E. Sanz, C. Perna, J. Pérez, S. Benito, E. González, T. Parra, A. Bienvenido
Journal: Journal of Hepatology (2006)
How Research on Stakeholder Perspectives Can Inform Policy on Cognitive Enhancement
Authors: Cynthia Forlini, Eric Racine, Jochen Vollmann, Jan Schildmann
Journal: The American Journal of Bioethics (2013)

Click to increase image sizeClick to decrease image size Acknowledgments The work of C. Forlini was supported by a fellowship of the International Visiting Fellowship Program of the Institute for Medical Ethics and the History of Medicine of the Ruhr University Bochum. J. Schildmann and C. Forlini thank the Mercator Research Center Ruhr (Global Young Faculty II) for support of their work. E. Racine acknowledges support of the Social Sciences and Humanities Research Council.
Variation in Rh Antibody during Pregnancy
Authors: M. D. Hickey, E. de Valera
Journal: BMJ (1947)

Perforation occurred only in Case 7. On this occasion a piece of wire 3 in. (7.5 cm.) long became impacted in the pelvic colon for seven days.At operation the wire was found projecting into the peritoneal cavity through a hole in the pelvic colon and there was considerable pelvic peritonitis.The wire was removed, the bowel repaired, and a left iliac colostomy performed.This was later closed, but the man was in hospital for three months.The chances of perforation are evidently not great; neverthe- less every effort must be made to avert it.It has been suggested that it is worth swallowing some cotton-wool in the hope that it will entangle a sharp foreign body in a woolly bolus.This was tried on one or two occasions, but with no noticeable effect.Liquid paraffin may safely be given, but it is not advisable, on theoretical grounds, to give any purgatives, as convulsive movements of the bowel might precipitate a perforation.In some of the earlier cases in this series it was con- sidered, from the size or quantity of objects in the stomach, that they were unlikely to negotiate the intestinal tract without damage, and in these laparotomy was performed.However, in several cases, although the foreign bodies had been shown in pre-operative radiographs, when the abdomen was opened nothing was palpable in the stomach.The abdomen was closed without further exploration, and in all cases the foreign bodies ultimately appeared per rectum.It seems likely that an injection of morphine and hyoscine relaxes the pylorus and helps the stomach to empty.This was given with success in Cases 3 and 11, and it is well worth trying where there is no indication for early operation.Indications for Operation
175 UTILITY OF ORGAN FAILURE PROGNOSTIC SCORING SYSTEMS IN A LARGE COHORT OF CRITICALLY ILL PATIENTS WITH CIRRHOSIS: IMPROVED PREDICTION OF IN-HOSPITAL MORTALITY OVER MELD
Authors: M.J. McPhail, D.L. Shawcross, R.D. Abeles, M. Austin, A. Yeoman, A.J. Portal, E. Sizer, G. Auzinger, W. Bernal, J.A. Wendon
Journal: Journal of Hepatology (2011)
EMBOLISM OF THE CENTRAL ARTERY OF THE RETINA.
Authors: C. F. CLARK
Journal: JAMA (1898)

The first instance in which a correct diagnosis of embolism of the central artery of the retina was made by the use of the ophthalmoscope was the classic case seen by that pioneer in ophthalmology, Von Graefe, in 1858, and described by Schweigger a few years later. While there is a general agreement among ophthalmologists as to the phenomena of complete embolic obstruction of the central artery, the relatively rare instances in which a portion of the retina has retained its vascular supply and continued to perform its functions have been the subject of some differences of opinion among careful observers, and this fact would seem to warrant us in bringing to the attention of the profession such cases as may come within the range of our experience. <h3>Case 1.</h3> —On Jan. 12, 1896, I was consulted by Mrs. C. E., aged 51 years, who was referred to me by
II. Potentials for Development
Authors: George Bugbee
Journal: JAMA (1962)

THEREIS so much unfinished business in the health field, and our current problems are so complex compared to those of only 50 years ago, that we are forced to agree that the potentials for community health development are great. The 20th century has seen the most dramatic discoveries in medical knowledge of any time in human history, and the resulting improvements, intertwined with other scientific advances, make it easy to forget how much our society has had to adjust to change and how vast the changes have been.  When I was a boy in the early 1900's a bad cold and fever were promptly treated with calomel, followed the next day by relatively massive doses of castor oil or, as one grew older, epsom salts. A major medical episode in our family during the first decade of the century was a ruptured appendix suffered by my older sister. It