tbuckley/cabot-search huggingface dataset:
PHENOMENON OF LOCAL SKIN REACTIVITY TO BACTERIAL FILTRATES: EFFECT OF BACTERIAL FILTRATES INJECTED INTRAVASCULARLY UPON REACTIONS TO ANTIGEN + ANTIBODY COMPLEXES
Authors: Gregory Shwartzman
Journal: The Journal of Experimental Medicine (1936)

Rabbits were sensitized by a single intravenous injection of horse serum 6 days prior to the experiments. In these rabbits there appeared hemorrhagic and necrotic reactions in sites of intradermal tests with horse serum when the tests were preceded by 1 hour, or followed 18 to 24 hours later by an intravenous injection of potent bacterial filtrates. The skin-preparatory and reacting potencies of the filtrates were titrated by means of the phenomenon of local skin reactivity to bacterial filtrate. The experiments demonstrated that the ability of bacterial filtrates to elicit reactions in the antigen injected sites in sensitized animals is strictly conditioned by their skin-preparatory potency and seems to be quite independent of their provocative potency. Combinations of animal protein antigens with homologous antisera, which are endowed with provocative potency but are totally devoid of skin-preparatory potency, fail to elicit reactions in antigen-injected sites. The various methods of elicitation of the phenomenon of local tissue reactivity are summarized and discussed in the text.
Recent advances: Otolaryngology
Authors: A. Richards, M. Gleeson
Journal: BMJ (1999)

Life is punctuated with problems arising from the ears, nose, and throat. Minor ailments like colds and pharyngitis incapacitate briefly but remind us how wonderful it is to be well. We take for granted the ability to hear, walk straight, smell, breathe freely, speak clearly, sing, and swallow our own saliva easily and without conscious effort. Life becomes exceptionally difficult when disease affects these basic functions. Recent advances in otolaryngology have gone some way to addressing a few of these problems, which affect thousands of patients every year and have the potential to destroy the quality of their lives for decades.
Myopathy induced by rifampicin.
Authors: P Jenkins, P A Emerson
Journal: BMJ (1981)

and wondered whether the inhalation of the dust particles might have caused his illness.Regrettably, no samples of the old paint were available for laboratory analysis.Physical examination on admission showed no abnormality.In particular, the patient had no pallor, no perianal or gum lead line (he was edentulous), his blood pressure was normal, there were no cardiovascular or objective neurological signs.A straight abdominal radiograph showed gas-filled, dilated loops of bowel with several fluid levels.A barium enema examination showed grossly distended and redundant colon, which accommodated 6 litres of barium with only partial filling (see figure).The haemoglobin concentration was 7 9 g/dl with small (mean cell volume 69 8 fl) hypochromic red cells showing pronounced basophilic stippling.Blood lead concentration (whole blood) on admission was 6 8 pmol/l (140 ug/100 ml), and the erythrocyte protoporphyrin concentration was 1-94 ng/l (normal values: lead<15 ,umol/l (30 j,g/100 ml); erythrocyte protoporphyrin<049 ng/l).The blood lead concentration was measured by anodic-stripping voltometry; the erythrocyte protoporphyrin concentration was measured fluorimetrically.2An electrocardiogram showed T-wave inversion in the lateral leads with high amplitude QRS complexes, suggesting left ventricular hypertrophy and strain.Manometric studies showed normal function of the myenteric plexus of the lower colon.3X-ray film of barium enema, showing grossly distended and redundant colon.Treatment was a modification of the method outlined by Chisholm,4 using a five-day course of a combination of dimercaprol 3 mg/kg four hourly intramuscularly and sodium calciumedetate 12-5 mg/kg four hourly intra- muscularly.After five days of chelation treatment was continued with penicillamine 500 mg orally twice daily for six weeks, when the blood lead concentration had fallen to 3-1 lumol/l (65 itg/I0O ml), and the urinary lead excretion was 0-77 Hmol/l/24 h (160 ,ug/24 h).The patient has remained symptom-free, and a barium enema examination performed two months after treatment had been completed showed no abnormality.
Unusual Findings of Benign Enchondroma in the Ulna on 3-Phase Bone Scintigraphy
Authors: Min-Woo Kim, Seok Tae Lim, Myung-Hee Sohn
Journal: Clinical Nuclear Medicine (2003)

Enchondroma is a common benign cartilaginous tumor arising from the medullary cavity, most commonly in the phalanges and metacarpals of the hand. Enchondroma involving the ulna is very rare. Typically, benign enchondroma shows normal or only slightly increased uptake of a bone-seeking agent on delayed bone scintigraphy. Markedly increased activity of enchondroma with pain is most often associated with pathologic fracture or malignant degeneration. The authors present the 3-phase bone scintigraphic findings of a benign enchondroma associated with pain, which showed focal hyperperfusion, hyperemia, and intense bone uptake in the distal right ulna.
OC-029 Dyspepsia management in Malawi: a prospective audit
Authors: M G Keane, A Thumbs, K Hellberg, T Allain, A Kankwatira, W Howson, J Geraghty, R Malamba, M A Gordon, P O'Toole
Journal: Gut (2012)

<h3>Introduction</h3> Dyspepsia is a very common symptom world wide. Unless managed effectively it can burden endoscopy services and create high treatment costs. Management algorithms are widely used in developed countries but have not been validated in sub-Saharan Africa. In Malawi, <i>Helicobacter pylori</i> (HP) infection rates are high, endoscopy facilities are scarce and proton pump inhibitors (PPIs) expensive. In addition the region has extremely high rates of oesophageal cancer and HIV. The incidence of gastric cancer is not known. These conditions make dyspepsia management particularly challenging. Queen Elizabeth Central Hospital (QECH) in Blantyre is Malawi9s tertiary hospital, and provides endoscopy services for a large part of the Southern Region. <h3>Methods</h3> A prospective audit of all patients presenting routinely to the outpatient department or endoscopy unit at QECH with dyspeptic symptoms over a 4-week period between August and September 2010. Patients were interviewed and health records and prescriptions reviewed. <h3>Results</h3> 105 patients with dyspepsia were identified; 55 already listed for endoscopy. 143 prescriptions for HP eradication were reviewed; 95% of these did not conform to a recognised regimen. Most errors were in dosing or duration but 38% used a H<sub>2</sub> receptor antagonist instead of a PPI and 31% included only one antibiotic. The 55 patients undergoing gastroscopy had all received prior HP eradication therapy. Mean symptom duration was 33.8 months. The clinical diagnosis matched endoscopic findings in only 18%. 9% were found to have peptic ulcer disease and “gastritis” was recorded for 35%. There was one gastric cancer and 10 oesophageal cancers. Seven of these 11 patients had dysphagia and malignancy had been suspected; 4/11 malignancies were not suspected. Only 5.5% of endoscopies were normal. <h3>Conclusion</h3> Empirical management of dyspepsia in Malawi is poor. HP eradication therapy is given frequently but almost always incorrectly. This is likely to promote antibiotic resistance and make subsequent HP eradication more difficult. Referral criteria for endoscopy are not clear, yet the yield of serious pathology is surprisingly high. The low rate of normal endoscopic findings contrasts with UK practice but may be explained by over-diagnosis of “gastritis”. In light of this audit, guidelines on dyspepsia management were developed and implemented. They emphasise correct medical management in young dyspeptic patients without alarm symptoms and urgent referral for gastroscopy if malignancy is suspected at any age. Urease testing has been piloted. The impact of these changes will be assessed later this year. <h3>Competing interests</h3> None declared.
TCT-297 Stent edge dissections detected by Optical Coherence Tomography, incidence, predictors and 12-month outcome
Authors: Rasmus Christensen, Niels Holm, Trine Ørhøj, Michael Maeng, Lars Krusell, Christian Terkelsen, Jouke Dijkstra, Anne Kaltoft, Steen Kristensen, Hans Erik Bøtker, Leif Thuesen, Jens Flensted Lassen, Evald Høj Christiansen
Journal: Journal of the American College of Cardiology (2012)
PTU-250 Management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures: compliance with existing guidelines
Authors: O Patani, S Khalid
Journal: Gut (2012)

<h3>Introduction</h3> It is not uncommon for patients on anticoagulants and antiplatelets to undergo endoscopic procedures. The main issue in such cases is balancing the risk of gastro-intestinal bleed and the need for anticoagulation. Recognising this, the British Society of Gastroenterology (BSG) issued in 2008 practice guidelines on the management of anticoagulants and antiplatelet therapy in patients undergoing endoscopic procedures. Aspirin, Clopidogrel and Warfarin are the most commonly used antiplatelets and anticoagulants in the UK. Aspirin is recommended to be continued for all endoscopic procedures while Clopidogrel and Warfarin should be tailored to the bleeding risk category of the procedure and the thrombotic risk of the patient9s condition. Our clinical practice was retrospectively audited to assess adherence to the BSG guidelines. <h3>Methods</h3> All patients on antiplatelets and anticoagulants undergoing endoscopic procedures except ERCP were included in the audit. Data were collected from case notes, endoscopy records and the Éclair pathology reporting system. <h3>Results</h3> 48 patients were identified to have 52 procedures with 37 (64%) on Aspirin alone, 6 (10%) on Clopidogrel alone, 9 (16%) on Warfarin alone, 4 (7%) on Aspirin and Clopidogrel and 2 (3%) on Aspirin and Warfarin. 16/37 (43%) in Aspirin alone group had it stopped inappropriately for 3–7 days. 3/6 (50%) Clopidogrel alone patients had it stopped while having one high risk procedure and two low risk procedures. Warfarin was stopped inappropriately in 7/9 (78%) patients undergoing eight procedures. <h3>Conclusion</h3> Endoscopic procedures have evolved over the years to include increasingly complex and invasive procedures carrying risk of serious complications including bleeding. Also significant proportions of patients are on multiple medications including anticoagulants and antiplatelets. It is therefore essential that appropriate management plan for the anticoagulant and antiplatelet therapy should be made to minimise the haemorrhagic and thromboembolic risk when requesting endoscopic procedures. The findings of this audit underline significant non-compliance to existing guidelines with potential serious implications for the standard of patient care. While endoscopy is performed by trained endoscopists, the procedures are requested by clinicians with variable knowledge and awareness of the existing BSG guidelines. This hurdle can be overcome using a combination of raising awareness through educational events and modification of the endoscopy requesting software by including a link to the anticoagulation management guideline flow chart making it accessible to the clinicians at the time of requesting. We hope these measures will result in improvement of service and make endoscopy safer in our hospital. <h3>Competing interests</h3> None declared.
Membrane potential of hepatic mitochondria after acute cocaine administration in rats-The role of mitochondrial reduced glutathione
Authors: A Masini
Journal: Hepatology (1997)

Cocaine hepatotoxicity may be mediated by oxidative damage, possibly involving mitochondrial injury. The effect of an acute dose of cocaine in rats on the mitochondrial level of reduced glutathione, nicotinamide adenine dinucleotide (NADH) and nicotinamide adenine dinucleotide phosphate (NADPH), important determinants in cellular defense against oxidative stress, was investigated. Under these conditions, the extent of lipid peroxidation was assessed as thiobarbituric acid reactive substances formation and the energy transducing capability of the inner mitochondrial membrane was evaluated by membrane potential measurements. Female Wistar albino rats were given an acute 50 mg/kg intraperitoneal dose of cocaine and, 6 hours later, hepatic and mitochondrial biochemical analyses were made. Rats administered intraperitoneally, 7.5 hours before the sacrifice, a specific inhibitor of glutathione synthesis, L-buthionine-(S,R)-sulphoximine, either alone or in combination with cocaine, underwent in parallel the same determinations. Cocaine intoxication did not impair mitochondrial functions, although a significant increase of lipid peroxidation occurred. By contrast the combination of L-buthionine-(S,R)-sulphoximine with cocaine induced a severe derangement of mitochondrial functional efficiency, a large depletion of reduced glutathione, and a further enhancement of lipid peroxidation. The mitochondrial functional anomalies were largely restored by the use of cyclosporin A, ethyleneglycotetraacetic acid (EGTA) and glutathione methylmonoester. A nonspecific calcium dependent inner membrane permeabilty transition (pore opening) accounted for the partial loss of mitochondrial coupled functions at a period of cocaine intoxication when no cell damage occurred. The level of mitochondrial glutathione played a critical role in protecting inner membrane functional integrity against cocaine-induced oxidative stress. (Hepatology 1997 Feb;25(2):385-90)
Sutureless Artificial Heart Valves
Authors: GEORGE J. MAGOVERN, EDWARD M. KENT, HARRY W. CROMIE
Journal: Circulation (1963)

Valvular prostheses which incorporate an original method of mechanical fixation never previously described have been developed and successfully used in the aortic and mitral positions. Their principal advantage is a rapid, non suture method of permanent fixation which requires but a few seconds, thereby eliminating the need for prolonged cardiopulmonary bypass, myocardial perfusion, and hypothermia. The risk of subsequent thrombus formation has been reduced by the elimination of sutures and cloth cuffs ordinarily used for fixation to the tissues.
Abstract 2207: An analysis of circulating sex steroid hormones in relation to Barrett's esophagus
Authors: Michael B. Cook, Shannon Wood, Brooks D. Cash, Patrick Young, Ruben D. Acosta, Roni T. Falk, Ruth Pfeiffer, Nan Hu, Carol Giffen, Veronique Turcotte, Patrick Caron, Chantal Guillemette, Sanford M. Dawsey, Christian C. Abnet, Paula L. Hyland, Philip R. Taylor
Journal: Cancer Research (2014)

Abstract Introduction: Barrett's esophagus (BE) is the precursor lesion of esophageal adenocarcinoma (EA). The male-to-female incidence rate ratio of BE is ∼2 while EA is ∼6 for reasons that remain unknown. We assessed whether sex steroid hormones were associated with BE in a male population. Methods: The Barrett's Esophagus Early Detection Case Control Study (BEEDS) was based at the National Naval Medical Center (NMMC). We quantitated 13 sex steroid hormones, using mass spectrometry, and sex hormone binding globulin (SHBG), using ELISA, in 173 male BE patients and 213 endoscopy-negative controls. We also calculated free estradiol and free testosterone using formulas known to accurately estimate such. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for smoking status, alcohol consumption, body mass index (BMI; kg/m2), heartburn, regurgitation, and gastroesophageal symptom score (excluding heartburn and regurgitation). Results: Free testosterone was positively associated with BE risk, peaking in the highest quartile with an OR of 4.42 (95%CI: 1.91, 10.24, p=0.0005). Estrone-sulphate was inversely associated with BE risk (OR 4th quartile=0.23, 95%CI:0.10, 0.53, p=0.0006). No other hormone was associated with BE risk. Relationships were not modified by age or BMI. Conclusion: High testosterone may delay re-epithelization of esophageal lesions leading to increased risk of metaplastic growth. Citation Format: Michael B. Cook, Shannon Wood, Brooks D. Cash, Patrick Young, Ruben D. Acosta, Roni T. Falk, Ruth Pfeiffer, Nan Hu, Carol Giffen, Veronique Turcotte, Patrick Caron, Chantal Guillemette, Sanford M. Dawsey, Christian C. Abnet, Paula L. Hyland, Philip R. Taylor. An analysis of circulating sex steroid hormones in relation to Barrett's esophagus. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2207. doi:10.1158/1538-7445.AM2014-2207
Genetic Mechanisms in Human Disease: Chromosomal Aberrations
Authors: C. C. Li
Journal: JAMA (1962)

Since the historic finding of Tjio and Levan (1956) that the human somatic cell normally has 23 pairs of chromosomes, the studies and reports on human cytogenetics have increased by leaps and bounds. These studies have been promptly rewarded by the discoveries of sex chromosomal aberrations resulting in intersexuality and of an autosomal trisomic condition resulting in mongolism. These and many other discoveries are directly responsible for the "explosion" in cytogenetic research in medical circles. Pertinent literature appears everywhere: in journals of medicine, pediatrics, obstetrics, genecology, and urology, as well as genetics and cytology. The volume under review is a collection of published material, mostly of the years 1959 and 1960, bearing on human chromosomal aberrations and diseases. It includes 55 papers by 112 authors. It also contains a bibliography of publications during 1956 through 1960, reprinted from<i>The Human Chromosome Newsletter, no. 3</i>, and some supplementary references up to
Adenosine monophosphate-activated protein kinase modulates the activated phenotype of hepatic stellate cells
Authors: Alessandra Caligiuri, Cristiana Bertolani, Cristina Tosti Guerra, Sara Aleffi, Sara Galastri, Marco Trappoliere, Francesco Vizzutti, Stefania Gelmini, Giacomo Laffi, Massimo Pinzani, Fabio Marra
Journal: Hepatology (2007)

Adiponectin limits the development of liver fibrosis and activates adenosine monophosphate-activated protein kinase (AMPK). AMPK is a sensor of the cellular energy status, but its possible modulation of the fibrogenic properties of hepatic stellate cells (HSCs) has not been established. In this study, we investigated the role of AMPK activation in the biology of activated human HSCs. A time-dependent activation of AMPK was observed in response to a number of stimuli, including globular adiponectin, 5-aminoimidazole-4-carboxamide-1-beta-4-ribofuranoside (AICAR), or metformin. All these compounds significantly inhibited platelet-derived growth factor (PDGF)-stimulated proliferation and migration of human HSCs and reduced the secretion of monocyte chemoattractant protein-1. In addition, AICAR limited the secretion of type I procollagen. Knockdown of AMPK by gene silencing increased the mitogenic effects of PDGF, confirming the negative modulation exerted by this pathway on HSCs. AMPK activation did not reduce PDGF-dependent activation of extracellular signal-regulated kinase (ERK) or Akt at early time points, whereas a marked inhibition was observed 24 hours after addition of PDGF, reflecting a block in cell cycle progression. In contrast, AICAR blocked short-term phosphorylation of ribosomal S6 kinase (p70(S6K)) and 4E binding protein-1 (4EBP1), 2 downstream effectors of the mammalian target of rapamycin (mTOR) pathway, by PDGF. The ability of interleukin-a (IL-1) to activate nuclear factor kappa B (NF-kappaB) was also reduced by AICAR.Activation of AMPK negatively modulates the activated phenotype of HSCs.
Montezuma's treasure
Authors: Richard G Roberts
Journal: BMJ (2005)

Has Mexico found malpractice gold in conciliation-arbitration? 

T ena-Tamayo and Sotelo report in this issue (p 528) on Mexico's conciliation-arbitration system for handling malpractice disputes. Their report reminds us that finding the perfect medical liability system is like panning for gold—it is a global endeavor with a low chance of success finding a mineral that fluctuates widely in value depending on time and place. What works well in one locale may not in another.

In 1996, Mexico's president established Conamed in the Ministry of Health to arbitrate malpractice cases. Conamed is sponsored by the government, provides expert opinion on negligence, and referees malpractice disputes. Both parties must consent to participate, and if agreement is reached, the case cannot be taken to the civil courts. Averaging 5000 cases per year, Conamed has resolved three fourths of its cases within 48 hours, and more than 90% of claims conclude without either party proceeding to court.

Have the Mexicans stumbled onto Montezuma's gold with a system for the speedy, inexpensive, and effective resolution of medical malpractice disputes? Sadly, no. What works well in Mexico has not been as effective in …
GAS ANALYSIS WITH AN ALL-GLASS SYRINGE FOR PNEUMONIA TENTS
Authors: Yandell Henderson
Journal: JAMA (1931)

Oxygen tents are now coming into extensive use for the treatment of pneumonia. As a rule, analysis of the atmosphere in these tents is unnecessary. If the gas is passed in at the rate of 7 or 8 liters a minute, there is a considerable diffusion of air inward and oxygen outward through the bedclothes, even if the curtains of the tent are tucked in tightly. The result is a concentration of 40 to 50, or at most 60, per cent of oxygen. Higher concentrations are inadvisable. The reactions of the patient are really the most significant indication of the best concentration.  For purposes of investigation, however, and particularly for a special form of tent for the administration of mixtures of oxygen and carbon dioxide soon to be introduced, gas analyses are convenient. But as precise gas analysis is a highly specialized technic, which is usually unfamiliar to a hospital
SOME FINDINGS IN SUMMER DIARRHEAS OF CHILDREN.
Authors: JOHN C. COOK
Journal: JAMA (1904)

These cases came under observation during July and August, 1903, and are reported to show the relative frequency of some bacteria not ordinarily given prominence in this relation. The study was begun with the hope of making some clinical deductions from the microscopic findings and to trace, if possible, any bacterial relations between the buccal cavity and intestinal disorders. Twenty-nine cases in all were observed and cultures were simultaneously made from mouth and fecal discharges, and observed as nearly together as possible, but much of the work was not completed owing to the sanitarium closing before all the cultures were worked out. No note will be made of the ordinary inhabitants of the canal, such as colon groups, staphylococcus, etc., but only such as may have some pathologic bearing on the clinical findings. <h3>Cases 1, 2 and 3.</h3> —Nothing of value was found, notwithstanding that there were some clinical
Edward (“Eddie”) James Mac Flynn
Authors: R L Carson
Journal: BMJ (2006)

​FormerFormer general practitioner Dungiven, County Derry (b 1914; q Dublin 1939; BAO, DPH, JP), d 7 April 2006.



Figure 1



After studies in Dublin and Belfast and periods working in the north of England, Edward James Mac Flynn (“Eddie”) returned to his native County Derry in 1944. He served the people of Dungiven for over 35 years, carrying out his extensive obstetric duties in the Roe Valley Hospital, Limavady. He continued working in the school medical clinics and retired finally to Limavady in 1985. Eddie was deeply involved in the community and served as chairman of the rural district council and as a member of Londonderry County Council. He was BMA chairman for County Derry in the 1970s, served as deputy coroner, and became a justice of the peace in 1969. He leaves a wife, Claire; four children; and 10 grandchildren.