tbuckley/cabot-search huggingface dataset:
Effects of fibrinolytic inhibitors on mortality from upper gastrointestinal haemorrhage.
Authors: D. A. Henry, D. L. O'Connell
Journal: BMJ (1989)

OBJECTIVE--To see whether fibrinolytic inhibitors are of value when given to patients with upper gastrointestinal haemorrhage. DESIGN--Meta-analysis of six randomised double blind placebo controlled trials. Two methods used for obtaining an overall estimate of effect, including a random effects model incorporating any heterogeneity of outcome in the estimate of the overall treatment effect. SETTING--Inpatient care in hospitals in the United Kingdom, Sweden, and Australia. PATIENTS--1267 Patients admitted to hospital with primary diagnosis of acute upper gastrointestinal haemorrhage. Five of the six trials included a high proportion of elderly patients. Most patients were bleeding from peptic ulcers in the stomach and duodenum (43-88%) or gastric erosions (4-23%). A variable proportion had a degree of clinical shock at entry. INTERVENTIONS--Tranexamic acid 3-6 g/day given intravenously for two or three days followed by 3-6 g/day by mouth for a further three to five days (four trials) or 4.5-12 g/day by mouth for two to seven days (two trials). END POINTS--Frequency of recurrent haemorrhage, need for surgery, and death. MAIN RESULTS--Treatment with tranexamic acid was associated with a 20-30% reduction in the rate of rebleeding, a 30-40% reduction (95% confidence interval 10% to 60%) in mortality. CONCLUSIONS--Treatment with tranexamic acid may be of value to patients considered to be at risk of dying after an upper gastrointestinal haemorrhage.
Metabolism of α-methyltyrosine in man: relationship to its potency as an inhibitor of catecholamine biosynthesis
Authors: Karl Engelman, Eric Jéquier, Sidney Udenfriend, Albert Sjoerdsma
Journal: Journal of Clinical Investigation (1968)

The metabolic fate of the tyrosine hydroxylase inhibitor, alpha-methyl-para-tyrosine (alpha-MPT), was studied after oral administration of single and multiple doses to patients with pheochromocytoma and essential hypertension. No major urinary excretion product was found other than the drug itself, which accounted for 44-88% of the fate of single or repeated oral doses. Though less than 1% of the administered drug could be recovered in the urine as catechol metabolites, it was possible to identify alpha-methyldopa, alpha-methyldopamine, and alpha-methylnorepinephrine and to quantify the excretion of the first two of these compounds. This minor route of metabolism required revision of methodology (presented herein) for measuring urinary catecholamines during alpha-MPT treatment since these compounds produce spurious fluorescence in routine methods of assay for catecholamines. The catechol metabolites probably are not present in sufficient amounts to contribute to the biochemical effects of the drug. Determination of plasma concentrations of alpha-MPT during maintenance therapy and considerations of the kinetics of enzyme inhibition enabled a calculation to be made of the degree of inhibition of catecholamine synthesis to be expected in the patient. This was calculated to be about 75% for the highest doses employed and is similar in magnitude to experimentally determined values.
A retrospective analysis of emergency double-balloon enteroscopy for small-bowel bleeding
Authors: K. Mönkemüller, H. Neumann, F. Meyer, R. Kuhn, P. Malfertheiner, L. Fry
Journal: Endoscopy (2009)

Although the role of emergency esophagogastroduodenoscopy (EGD) and colonoscopy for upper and lower gastrointestinal bleeding (GIB) is well defined, there are no data on the concept of emergency double-balloon enteroscopy (DBE) for small-bowel bleeding. The aim of this study was to retrospectively evaluate the concept of emergency DBE in overt obscure GIB and assess its impact on patient management. A total of 17 emergency DBEs for overt obscure GIB were carried out in ten patients (six women, four men; mean age 68 years, range 35 - 83). The following diagnoses were made: actively bleeding Dieulafoy lesions of the small bowel, n = 2; bleeding tumors, n = 4 (carcinoids n = 2, adenocarcinoma n = 1, lipoma n = 1); bleeding angiodysplasias and/or large arteriovenous malformation (AVM), n = 2; multiple ulcers, n = 1; and no diagnosis, n = 1. Endoscopic therapies included argon plasma coagulation (n = 6), injection of epinephrine (n = 3), and use of fibrin glue (n = 1). It appears that emergency DBE is technically feasible, facilitates both diagnosis and therapy and enables management of patients with massive overt obscure GIB. This study is a first step in establishing the concept of emergency DBE for patients with suspected small-bowel bleeding.
Abstract 3888: Therapeutically activating the RB pathway in breast cancer: Key mechanisms of response and failure
Authors: Jeffry L. Dean, Christopher A. Reed, A. Kathleen McClendon, Erik S. Knudsen
Journal: Cancer Research (2010)

Abstract A hallmark of cancer is the deregulation of cell cycle machinery, ultimately providing aberrant proliferation that fuels tumorigenesis and disease progression. Particularly, in breast cancers, cyclin D1 plays a crucial role in the development of disease. Recently, a highly-specific inhibitor of CDK4/6 activity (PD-0332991) has been developed that may have efficacy in the treatment of breast and additional cancers. To interrogate the utility of PD-0332991 in treating breast cancers, therapeutic response was evaluated in panel of breast cancer cell lines. These analyses demonstrated that the chronic loss of Rb is specifically associated with evolution to a CDK4/6-independent state and, thus, resistance to PD-0332991. However, to interrogate the functional consequence of Rb directly, knockdown experiments were performed in models that represent immortalized mammary epithelia and multiple subtypes of breast cancer. These studies demonstrated a highly-specific role for Rb in mediating the response to CDK4/6 inhibition that was dependent on transcriptional repression manifest through E2F and the ability to attenuate CDK2 activity. In spite of these caveats, in specific models, PD-0332991 was a particularly effective therapy, which induced Rb-dependent cytostasis. Combined, these findings indicate the critical importance of fully understanding cell cycle regulatory pathways in directing the utilization of CDK inhibitors in the clinic. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 3888.
Serum salicylate levels in a breast fed infant.
Authors: J Unsworth, A d'Assis-Fonseca, D T Beswick, D R Blake
Journal: Annals of the Rheumatic Diseases (1987)

All drugs should be given with caution to pregnant or breast feeding women. Recent concern about the role of salicylates in the aetiology of Reye9s syndrome has prompted the DHSS to restrict the use of aspirin in children. The case of a 9 week old breast fed infant whose serum contained 0.47 mmol/l of salicylate is reported. Her mother was taking aspirin 2.4 g/day, and it is concluded that salicylates must not be taken by breast feeding mothers.
The Role of Transjugular Portosystemic Shunting in Patients with Ascites
Authors: John R. Lake
Journal: New England Journal of Medicine (2000)

Ascites is one of the most important complications of cirrhosis. It predisposes patients to several additional complications, including spontaneous bacterial peritonitis, the hepatorenal syndrome, and hepatic hydrothorax, and it is one of the most common indications for liver transplantation. Ascites is typically managed initially with diuretics and restriction of sodium intake. When this approach fails, the alternatives have been less than ideal. A number of therapies have been tried, including peritoneovenous shunts and side-to-side portocaval shunts, both of which are associated with an unacceptable incidence of severe adverse effects, such as disabling hepatic encephalopathy. More recently, large-volume paracentesis, the transjugular . . .
Sir William Osler
Authors: Emile Holman
Journal: JAMA (1969)

Delightfully informal, erudite beyond comparison, entertaining but surprisingly effective, Sir William Osler enjoyed teaching. So interestingly and compactly were his presentations arranged, it took little effort to remember them. At his death in 1919 at the age of 70, he was characterized universally as the greatest physician and medical teacher of his time, perhaps even of all time. He had been professor of medicine at four renowned universities—McGill, Pennsylvania, Hopkins, and Oxford. He had written a textbook of medicine that became the bible of the practitioner and student of his day. Sixteen editions, 84 reprintings, and 300,000 copies sold gave evidence of Osler's widespread influence on his own and succeeding generations of doctors. It was translated into German, French, Spanish, and, believe it or not, Chinese. It was at Oxford that I knew him, a gracious and generous host—especially to American doctors and students, a profound student of the classics
ENDOTOXINS AND DISEASE MECHANISMS
Authors: D C Morrison, J L Ryan
Journal: Annual Review of Medicine (1987)

In this chapter, current concepts about the mechanisms of action of endotoxin are reviewed. Particular attention is focused upon endotoxin-induced production of soluble mediators from macrophages and mononuclear cells and on the potential contribution of these mediators to endotoxin shock. In many cases, the interrelationships between these mediators as primary and/or secondary consequences of endotoxin stimulation of mononuclear phagocytes are discussed. Final comments address the relevance of these mediators to the therapy of endotoxin shock.
MALIGNANT DISEASE OF THE THROAT
Authors: W. S. Syme
Journal: BMJ (1927)

<h3>Background</h3> Research conducted in the past decade challenges the traditional view that essential tremor (ET) is characterised exclusively by movement disorder, and increasingly shows that these patients have deficits in cognitive and behavioural functioning. The available evidence suggests that this impairment might arise from dysfunction in either the fronto-subcortical or cortico-cerebellar circuits. Although abnormalities in the fronto-subcortical circuits could imply difficulty in lying, no study has investigated deception in patients with ET. <h3>Aims</h3> To examine the cognitive functions regulating deception in patients with ET, we used a computerised task, the Guilty Knowledge Task (GKT). We also tested a group of patients with Parkinson9s disease (PD), a disease associated with a known difficulty in lie production, and a group of healthy subjects (HS). <h3>Results</h3> In the GKT for deception, patients with ET responded less accurately than HS (p=0.014) but similarly to patients with PD (p=0.955). No differences between groups were found in truthful responses (p=0.488). <h3>Conclusions</h3> Besides confirming impaired deception in patients with PD, our results show a lie production deficit in patients with ET also. These findings suggest that difficulty in lying is an aspecific cognitive feature in movement disorders characterised by fronto-subcortical circuit dysfunction, such as PD and ET. Current knowledge along with our new findings in patients with ET—possibly arising from individually unrecognised extremely mild, cognitive difficulties—should help in designing specific rehabilitative programmes to improve cognitive and behavioural disturbances in patients.
NOTE ON A KIND OF CHRONIC ERYTHEMA OF THE LEGS IN GIRLS AND YOUNG WOMEN, SOMETIMES LEADING TO DIFFUSE THICKENING AND SCLERODERMIA-LIKE INDURATION OF THE SKIN AND SUBCUTANEOUS TISSUE WITHOUT NODULES OR ULCERS.
Authors: F. PARKES WEBER
Journal: British Journal of Dermatology (1925)

Journal Article NOTE ON A KIND OF CHRONIC ERYTHEMA OF THE LEGS IN GIRLS AND YOUNG WOMEN, SOMETIMES LEADING TO DIFFUSE THICKENING AND SCLERODERMIA‐LIKE INDURATION OF THE SKIN AND SUBCUTANEOUS TISSUE WITHOUT NODULES OR ULCERS. Get access F. PARKES WEBER, M.A., M.D., F.R.C.P. F. PARKES WEBER, M.A., M.D., F.R.C.P. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology and Syphilis, Volume 37, Issue 6, 1 June 1925, Pages 259–262, https://doi.org/10.1111/j.1365-2133.1925.tb09956.x Published: 01 June 1925
Rationing Intensive Care
Authors: Robert A. Gatter
Journal: JAMA (1994)

<h3>To the Editor.</h3> —We commend the Society of Critical Care Medicine Ethics Committee<sup>1</sup>for its clear and insightful recent statement on the distribution of intensive care resources among individual patients. The statement rightly acknowledges resource scarcity and the subsequent potential for conflict between the value of intensive care for individual patients and other medical and nonmedical values, though it does not directly address the thorny question of how those competing values should be balanced. The statement also emphasizes the need for public disclosure of triage policies; we would add that the public should be given an opportunity to contribute to the formulation of such policies, at least in public hospitals. We agree with the committee that the concept of triage provides a better model for these decisions than the widely discussed concept of futility. Unlike futility, triage clearly connotes the evaluation of both benefits and burdens in a context
The Frequency and Cost of Treatment Perceived to Be Futile in Critical Care
Authors: Thanh N. Huynh, Eric C. Kleerup, Joshua F. Wiley, Terrance D. Savitsky, Diana Guse, Bryan J. Garber, Neil S. Wenger
Journal: JAMA Internal Medicine (2013)

<h3>Importance</h3> Physicians often perceive as futile intensive care interventions that prolong life without achieving an effect that the patient can appreciate as a benefit. The prevalence and cost of critical care perceived to be futile have not been prospectively quantified. <h3>Objective</h3> To quantify the prevalence and cost of treatment perceived to be futile in adult critical care. <h3>Design, Setting, and Participants</h3> To develop a common definition of futile care, we convened a focus group of clinicians who care for critically ill patients. On a daily basis for 3 months, we surveyed critical care specialists in 5 intensive care units (ICUs) at an academic health care system to identify patients whom the physicians believed were receiving futile treatment. Using a multivariate model, we identified patient and clinician characteristics associated with patients perceived to be receiving futile treatment. We estimated the total cost of futile treatment by summing the charges of each day of receiving perceived futile treatment and converting to costs. <h3>Main Outcome and Measure</h3> Prevalence of patients perceived to be receiving futile treatment. <h3>Results</h3> During a 3-month period, there were 6916 assessments by 36 critical care specialists of 1136 patients. Of these patients, 904 (80%) were never perceived to be receiving futile treatment, 98 (8.6%) were perceived as receiving probably futile treatment, 123 (11%) were perceived as receiving futile treatment, and 11 (1%) were perceived as receiving futile treatment only on the day they transitioned to palliative care. The patients with futile treatment assessments received 464 days of treatment perceived to be futile in critical care (range, 1-58 days), accounting for 6.7% of all assessed patient days in the 5 ICUs studied. Eighty-four of the 123 patients perceived as receiving futile treatment died before hospital discharge and 20 within 6 months of ICU care (6-month mortality rate of 85%), with survivors remaining in severely compromised health states. The cost of futile treatment in critical care was estimated at $2.6 million. <h3>Conclusions and Relevance</h3> In 1 health system, treatment in critical care that is perceived to be futile is common and the cost is substantial.
BIOCHEMICAL STUDIES ON SHOCK
Authors: Frank L. Engel, Mary G. Winton, C. N. H. Long
Journal: The Journal of Experimental Medicine (1943)

During and following the production of shock by hemorrhage in the normal, suprareno-demedullated, and suprarenalectomized rat, the following significant changes in amino acid and carbohydrate metabolism have been observed. 1. In the intact, suprareno-demedullated, and suprarenalectomized rat there is a progressive rise in the whole blood and plasma amino acid nitrogen levels during and after a fatal, shock-inducing hemorrhage. The rate of rise varies inversely with the survival time. In animals surviving the hemorrhage there is little or no elevation in whole blood amino acid levels during the 8 hours following hemorrhage, and a decrease in 24 hours due to hemodilution. The plasma amino acids, however, rise slightly. 2. The blood amino acid nitrogen elevation occurs only after the blood pressure has fallen to between 85 and 90 mm. of Hg. 3. The blood keto acids, as pyruvate, and the blood lactate become elevated during shock in the normal, suprareno-demedullated and suprarenalectomized rat. 4. In the normal fasted rat with low liver glycogen stores the blood sugar may rise moderately or may not rise at all during hemorrhagic shock. In animals with high liver glycogen levels (fed rats or fasted rats previously fed high protein diets) shock generally induces a marked hyperglycemia. In both groups hypoglycemia may occur terminally. 5. In the suprareno-demedullated and suprarenalectomized rats shock is always accompanied by a fall in the blood sugar. 6. There is no significant difference between the liver glycogen levels of suprareno-demedullated rats fasted 48 hours and those similarly fasted but surviving 24 hours after a hemorrhage. The blood chemical changes have been interpreted as due to a decrease in hepatic function resulting from early anoxia of the liver and to the later effects of anoxia on the peripheral tissues causing an increased rate of protein breakdown and of glucose utilization and an accumulation of lactate and pyruvate in the blood and tissues.
Manson’s Tropical Diseases
Authors: William A. Petri
Journal: JAMA (2009)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Does infection with HIV affect the outcome of pregnancy?
Authors: F. D Johnstone, L. Maccallum, R. Brettle, J M Inglis, J. Peutherer
Journal: BMJ (1988)

Details are presented on the outcome of pregnancy in a group of Edinburgh women identified as positive for antibodies to HIV and in women who had a history of drug abuse or a partner known to be seropositive but who were themselves negative for HIV antibody. Pregnant women who had been tested for HIV up to June 1987 were identified. HIV state was known for 205 pregnant women. Most cases were determined during pregnancy, but in 23 (9 seropositive patients) it was determined retrospectively. Seropositivity was only found in women who had been intravenous drug users or whose partner was known seropositive. Of 50 women who were seropositive, 46 were intravenous drug users and 4 had seropositive partners. In 64 cases who were seronegative, 45 had used intravenous drugs since 1983, and 19 had a seropositive partner. These women tended to be young, unmarried, and smoked heavily. They usually lived in areas of Edinburgh with multiple deprivation. Both they and their partners were usually unemployed. In the seropositive group, spontaneous abortion showed an apparent increase, but this may be due to differences in ascertainment as the incidence in the seronegative group was low. Premature delivery, intrauterine growth retardation, and low birth weight were common compared with the total population, but seropositive and seronegative women did not differ from each other in these variables. Compared with rates in the total population of Edinburgh, the rates of prematurity and intrauterine growth retardation were increased more than 2-fold and the rate of low birthweight babies was increased nearly 4-fold, though the 1 twin pregnancy contributed to this. Adverse outcome was equally distributed between the seropositive and seronegative women, and there was no suggestion that infection with HIV itself had any effect. Although no evidence from this study shows that infection with HIV per se affects the outcome of pregnancy, none of these women showed symptomatic illness.
Astrocytes as determinants of disease progression in inherited amyotrophic lateral sclerosis
Authors: Koji Yamanaka, Seung Joo Chun, Severine Boillee, Noriko Fujimori-Tonou, Hirofumi Yamashita, David H Gutmann, Ryosuke Takahashi, Hidemi Misawa, Don W Cleveland
Journal: Nature Neuroscience (2008)
Family similarities in the age at coronary death in familial hypercholesterolaemia.
Authors: A Heiberg, J Slack
Journal: BMJ (1977)

In a combined Norwegian and British study of the age at death from coronary heart disease of heterozygotes for familial hypercholesterolaemia (FH) the correlation coefficients within families for 43 sib pairs was 0-70 and for 14 first cousin pairs 0-61. There was no significant correlation between the age at death and serum cholesterol concentration in either series. The intrafamilial correlations suggest that information about the age at death from coronary heart disease in heterozygotes within families may have some prognostic value and may also be interpreted as evidence for genetic heterogeneity in FH.
UK trusts urged to stamp out bullying and harassment at work
Authors: Zosia Kmietowicz
Journal: BMJ (2006)

The health services' watchdog has reiterated its stance that bullying and harassment in the workplace will not be tolerated, after investigations of two trusts which were plagued by widespread complaints of abuse and low staff morale.

The UK Healthcare Commission investigated East Sussex Hospitals NHS Trust after complaints from staff and a local GP that grievances of bullying and harassment were not being tackled appropriately or consistently. It found that although the perception of bullying and harassment in staff at the organisation was particularly high, the actual number of allegations was no higher than at other similar trusts.

The report did find problems in the organisation, however. It said …