tbuckley/cabot-search huggingface dataset:
'T's and Blues'
Authors: Alphonse Poklis
Journal: JAMA (1978)

<h3>To the Editor.—</h3> Concerning the letter on "Abuse of Pentazocine and Tripelennamine" by Showalter and Moore (239:1610, 1978), the illicit use of this drug combination is not confined to Chicago. Since the summer of 1977, drug addicts in St Louis have been using pentazocine and tripelennamine, both orally and intravenously, as a heroin substitute. The sale of these compounds does not carry the strict legal penalty associated with the sale of heroin because of a loophole in the Missouri Controlled Substance Act. The compounds are illegal to sell without prescription under federal law; however, the offense is only a misdemeanor. Since the drugs apparently act as a substitute for heroin, and since illicit sales are almost never prosecuted, the trade in "T's and Blues" has become a profitable business. This past February a drug war over the street distribution rights of "T's and Blues" erupted in St Louis. At least
A Cross-Sectional Study Comparing Two Quantitative Sensory Testing Devices in Individuals With Diabetes
Authors: Raelene E Maser, Charles Laudadio, M James Lenhard, G Stephen DeCherney
Journal: Diabetes Care (1997)

This study was designed to compare circumference discrimination thresholds, as assessed by the Tacticon (Tacticon, Inc., Westtown, PA), a new quantitative sensory testing (QST) device, with vibratory thresholds, an assessment modality of large sensory nerve fibers, in individuals with diabetes.In this study, 150 individuals with diabetes were evaluated. Vibratory thresholds and circumference discrimination thresholds, evaluated with the Tacticon, were determined using a two-alternative forced-choice procedure.Vibratory thresholds increased with decreasing ability to discriminate differences in circumference (P < 0.001) for those below and above 50 years of age. Agreement between the two QST devices was assessed via the kappa-statistic in both age-groups (i.e., < or = 50 years old [kappa = 0.67], > 50 years old [kappa = 0.55]). In multiple logistic regression, where circumference discrimination thresholds were the dependent variable, age, duration of diabetes, and height were found to be independently associated for those > 50 years old.The Tacticon offers a simple method of assessing the complex function of area discrimination. Our results suggest that the Tacticon can detect neuropathy in the primary care setting. Its cost, portability, and ease of use provide some advantages over existing QST equipment.
FRI0092 Disease activity at three months is an excellent predictor of long-term treatment failure in actively treated rheumatoid arthritis patients, 5-year results of the neo-raco trial
Authors: V. Rantalaiho, H. Kautiainen, M. Korpela, S. Järvenpää, M. Leirisalo-Repo
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Most rheumatoid arthritis (RA) patients achieve remission, have marginal radiographic progression and sustain normal function when an initial aggressive combination treatment with three disease modifying antirheumatic drugs (DMARDs) and prednisolone (PRD) is used, with or without early biologics. Still, a minority of patients have active, progressing disease [1,2]. <h3>Objectives</h3> To identify progressing RA despite aggressive treatment early in the disease run. <h3>Methods</h3> Ninety-nine patients with early (&lt;1 year), DMARD-naïve, active RA were treated with a combination of methotrexate, sulfasalazine, hydroxychloroquine, and PRD, and randomized to blindly receive either infliximab or placebo infusions during the first 6 months. After 24 months, if the patient was in remission, the treatments could be tapered, and, in case of flare-up, increased, with strict ACR remission as a goal. At 60 months, four different features of treatment failure were defined: Area under curve between 6-60 months (AUC<sub>6-60</sub>) for disease activity score assessing 28 joints (DAS28) &gt;2.6; AUC<sub>6-60</sub> for health assessment questionnaire (HAQ) &gt;0.5; progression in total Sharp van der Heijde score 0-60 months &gt;3 units; and need of PRD or biologic treatment at 60 months. <h3>Results</h3> Ninety-three patients (94%) were followed up for 60 months. Of these, 45 (48%) had no features of treatment failure, 30 (32%) had one, and only one (1%) patient had all four features (Figure). In a multivariate ordinal logistic regression model for the odds of having 0, 1, or 2-4 features of treatment failure, only the physician’s global estimate (OR 1.03, p=0,03) and HAQ (OR 2.25, p=0,05) at baseline were significant, while smoking, rheumatoid factor positivity, the randomization group, symptom duration, BMI, DAS28, sex, the presence of erosions, or age were not. However, with a ROC curve, DAS28&gt;2.28 at 3 months predicted ≥2 features of treatment failure at 60 months; LR 3.07 (95% CI: 1.88 to 4.84), (sens 78%, spec 75%). <h3>Image/graph</h3> <h3>Conclusions</h3> Only 20% of the early RA patients treated with a combination of DMARDs and PRD have more than one feature of treatment failure at 60 months. The most important predictor for identifying these patients early is the DAS28 at 3 months, with a cut-off value below the remission limit. <h3>References</h3> Leirisalo-Repo et al. Ann Rheum Dis 2012 Jun 30 [Epub ahead of print] Rantalaiho V et al. Ann Rheum Dis 2012;71(Suppl 3): 103. <h3>Disclosure of Interest</h3> None Declared
HEALTH AND THE DOCTORS
Authors: Kingsley Roberts
Journal: JAMA (1941)

To  Editor:—  I wish to comment on an item under current comments on page 1269 ofThe JournalOctober 11.  The part which quotes  last paragraph of Health and  Doctors, is excellent. This is  exact attitude that I have always hoped organized medicine would take. The use of the  of scientific  to determine  actual values before general adoption is clearly indicated.  During  past five years, I have tried to study at first hand  various forms of payment plans—both those which offer indemnification in cash and those which offer indemnification in service. Naturally I have formed certain opinions as to  effectiveness of various patterns. I am convinced that there is one very important major consideration, as yet neglected, that  technic of scientific experimentation will uncover, namely that payment plans will not assume major scientific and social importance until they become
1162-137 Valve surgery in octogenarians: In-hospital and long-term outcomes
Authors: Eduardo Bossone, Alessandro Frigiola, Giuseppe Di Benedetto, Silvia Cirri, Antonello Panza, Andrea Ballotta, Paolo Righini, Giannlignazio L Carbone, Jianming Fang, Alessandro Distante, Kim A Eagle, Rajendra H Mehta
Journal: Journal of the American College of Cardiology (2004)
Long-Term Follow-Up of a Pediatric Cohort With Short QT Syndrome
Authors: Juan Villafañe, Joseph Atallah, Michael H. Gollob, Philippe Maury, Christian Wolpert, Roman Gebauer, Hiroshi Watanabe, Minoru Horie, Olli Anttonen, Prince Kannankeril, Brett Faulknier, Jorge Bleiz, Takeru Makiyama, Wataru Shimizu, Robert M. Hamilton, Ming-Lon Young
Journal: Journal of the American College of Cardiology (2013)
Dissection of an aneurysmal ascending aorta in association with coarctation of the aorta.
Authors: R A Lawson, A Fenn
Journal: Thorax (1979)

A previously fit 21-year-old man presented with severel central chest pain. Clinical, electrocardiographic, and echocardiographic examination confirmed a dissection of an aneurysmal ascending aorta in the presence of previously undiagnosed severe aortic coarctation. Initial aortic dissection had occurred five days before admission. The medical and staged surgical management of the case are presented. Surgical survival with such a combination of lesions does not appear to have been previously recorded.
REMOTE EFFECTS OF TONSILLAR INFECTION.
Authors: PHILIP KING BROWN
Journal: JAMA (1907)

However much may be said of the tonsils as part of the system of the body's defense against bacterial invasion, the fact remains that this defensive function is easily overcome, especially in childhood, and once seriously interfered with it frequently does not regain its normal condition. Thenceforth it may be a positive menace to the body through its ready susceptibility to infection, or by the ease with which bacteria pass through its covering into the lymphatic channels beyond without marked reaction on the part of the organ. It is not my purpose to discuss whether the hypertrophied tonsil is a pathologic or physiologic result, whether it is Nature's method of increasing the defensive process or whether it is a pathologic hyperplasia from chronic and low-grade inflammation. It will be necessary to know far more about the function of the tonsil than we do now before these things can be decided.
Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care
Authors: K. Rost
Journal: BMJ (2002)

<h3>Abstract</h3> <b>Objectives:</b> To evaluate the long term effect of ongoing intervention to improve treatment of depression in primary care. <b>Design:</b> Randomised controlled trial. <b>Setting:</b> Twelve primary care practices across the United States. <b>Participants:</b> 211 adults beginning a new treatment episode for major depression; 94% of patients assigned to ongoing intervention participated. <b>Intervention:</b> Practices assigned to ongoing intervention encouraged participating patients to engage in active treatment, using practice nurses to provide care management over 24 months. <b>Main outcome measures:</b> Patients9 report of remission and functioning. <b>Results:</b> Ongoing intervention significantly improved both symptoms and functioning at 24 months, increasing remission by 33 percentage points (95% confidence interval 7% to 46%), improving emotional functioning by 24 points (11 to 38) and physical functioning by 17 points (6 to 28). By 24 months, 74% of patients in enhanced care reported remission, with emotional functioning exceeding 90% of population norms and physical functioning approaching 75% of population norms. <b>Conclusions:</b> Ongoing intervention increased remission rates and improved indicators of emotional and physical functioning. Studies are needed to compare the cost effectiveness of ongoing depression management with other chronic disease treatment routinely undertaken by primary care.
Spatial orientation of the subtalar joint axis is different in subjects with and without Achilles tendon disorders
Authors: Claudia A Reule, Wilfried W Alt, Heinz Lohrer, Harald Hochwald
Journal: British Journal of Sports Medicine (2011)

Background There are many possible predisposing factors for Achilles tendon disorders suggested in the literature but their pathogenetic relevance is not proven in most cases. The asymmetric mechanical load distribution within the Achilles tendon during locomotion is frequently addressed as a major risk factor for Achilles tendon disorders. The spatial orientation of the subtalar joint axis (STA) may influence the Achilles tendon loading possibly leading to overload injuries. Hypothesis There is a significant difference between the orientation of the STA in subjects with and without Achilles tendon pathologies. Materials and methods 614 subtalar joint axes determined in 307 long-distance runners with and without Achilles tendon disorders were included. Achilles tendon disorders were defined as any Achilles tendon–related pain during or following running, existing for more than 2 weeks in the past. Motion analysis of the foot was performed using an ultrasonic pulse-echo-based measurement system. The orientation of the STA was expressed by two angles. Results The mean inclination angle was 42±16° and the mean deviation angle was 11±23°. There was a significant difference (p=0.002) between the mean deviation angle measured in subjects with Achilles tendon pathologies (18±23°) and those without (10±23°). Conclusions The results demonstrate a wide interindividual variability of the spatial orientation of the STA. In addition, the mean deviation angle in people with Achilles tendon pathologies is significantly more oblique than in people without. This finding indicates that the spatial orientation of the STA is related to the incidence of overuse injuries of the Achilles tendon in the investigated sample.
Emergency Aneurysmectomy in the Small Hospital
Authors: John Archer
Journal: JAMA (1981)

<h3>To the Editor.—</h3> My own ruptured abdominal aortic aneurysm was successfully repaired with great competence in a community hospital (1975;234:24). While the hospital was larger than those mentioned in the preceding letter, it was not close to the size of those of major medical centers approximately 25 to 35 miles away. However, my escape was so narrow that I am sure I would have died if I had been subjected to the delays that transfer would have involved and that Abernathy et al have noted.
Evaluation of Potentially Preventable Deaths Among Pedestrian and Bicyclist Fatalities
Authors: Frederick P. Rivara
Journal: JAMA (1989)

The prehospital, emergency department, and in-hospital care of 84 patients who died following a pedestrian- or bicycle-motor vehicle collision in a four-county area was retrospectively reviewed using a systematic, detailed scoring system. The purpose of the study was to examine the effectiveness of an advanced paramedic-regionalized trauma care system and to examine the usefulness of a systematic evaluation tool in identifying preventable and possibly preventable deaths. Among the 84 deaths, one was judged to be preventable and 18 possibly preventable. The one preventable death occurred in the emergency department, while the possibly preventable deaths more commonly occurred after 48 hours and were due to central nervous system injury, sepsis, and multiple organ failure. Prolonged prehospital and emergency department time and failure to establish an airway were the most common problems identified as contributing to fatal outcome. The use of explicit criteria was demonstrated to be an effective addition to the analysis of trauma care systems.
Preliminary Studies of Diabetic Decompensation Assessed with Bedside Glucose-Monitoring Techniques
Authors: G E Umpierrez, J C Reed, S V Thacker, L S Phillips
Journal: Diabetes Care (1986)

Blood glucose-monitoring techniques originally developed to aid outpatient management of diabetic patients are now being used to facilitate hospital care. However, applications in hyperglycemic patients have been limited because many glucose-oxidase strips and meters respond only to glucose values ≤ 400 mg/dl. We asked if prior dilution of blood samples would permit reliable estimations. Ten consecutive decompensated diabetic patients (age 35–73, glucose 506–879, HCO3 12–28) had blood glucose determinations done simultaneously by the hospital laboratory and by Chemstrip bG after dilution of heparinized blood 1:2 in saline. Thirty-one samples were obtained before and during insulin therapy. Correlations with laboratory glucose values were 0.95 with strips read by Accu-Chek meter and 0.90 read visually, both P &amp;lt; 0.001. Average deviations from laboratory values were 7.9% with Accu-Chek and 12.9% with visual readings. Accu-Chek deviations averaged 9.6% for glucose &amp;gt; 700 mg/dl, and 6.9% for glucose &amp;gt; 400 mg/dl. Over the first hour of insulin therapy, glucose fell 150 ± 30 mg/dl by Accu-Chek, comparable to 168 ± 29 by laboratory measurement; the decrement by visual reading was 107 ± 32, not significantly different. We conclude that dilution of blood samples with glucose &amp;gt; 400 allows reliable estimation of elevated values by home glucose-monitoring techniques. This approach is cost-effective and provides the rapid feedback needed for the management of critically ill patients.
Computer aided diagnosis of acute abdominal pain: a multicentre study.
Authors: I D Adams, M Chan, P C Clifford, W M Cooke, V Dallos, F T de Dombal, M H Edwards, D M Hancock, D J Hewett, N McIntyre
Journal: BMJ (1986)

A multicentre study of computer aided diagnosis for patients with acute abdominal pain was performed in eight centres with over 250 participating doctors and 16,737 patients. Performance in diagnosis and decision making was compared over two periods: a test period (when a small computer system was provided to aid diagnosis) and a baseline period (before the system was installed). The two periods were well matched for type of case and rate of accrual. The system proved reliable and was used in 75.1% of possible cases. User reaction was broadly favourable. During the test period improvements were noted in diagnosis, decision making, and patient outcome. Initial diagnostic accuracy rose from 45.6% to 65.3%. The negative laparotomy rate fell by almost half, as did the perforation rate among patients with appendicitis (from 23.7% to 11.5%). The bad management error rate fell from 0.9% to 0.2%, and the observed mortality fell by 22.0%. The savings made were estimated as amounting to 278 laparotomies and 8,516 bed nights during the trial period--equivalent throughout the National Health Service to annual savings in resources worth over 20m pounds and direct cost savings of over 5m pounds. Computer aided diagnosis is a useful system for improving diagnosis and encouraging better clinical practice.
Trends for coronary heart disease and stroke and their risk factors in Japan.
Authors: T Shimamoto, Y Komachi, H Inada, M Doi, H Iso, S Sato, A Kitamura, M Iida, M Konishi, N Nakanishi
Journal: Circulation (1989)

Disease surveillance and population surveys of risk characteristics in a northeast rural community of Japan (1965 census population, 7,030) are combined in an attempt to relate morbidity and risk factor trends for coronary heart disease and stroke during the last 2 decades. Between 1964 and 1983, the incidence of coronary heart disease (i.e., combined myocardial infarction, angina pectoris, and sudden death) did not change significantly among men and women ages 40-69, and was lower than that for stroke. The incidence of all stroke declined about 60% for both men and women, ages 40-69, with a significant decrease in cerebral hemorrhage for both sexes and in cerebral infarction for men. Between 1963-1966 and 1980-1983, significant upward shifts occurred in the means and distributions of serum total cholesterol and serum total protein in every age and sex group, primarily during the 1st decade. Age-adjusted mean cholesterol levels rose 22 mg/dl to the 1980-1983 mean of 179 mg/dl in men ages 40-69. In women ages 40-69, the mean rose 29 mg/dl to 192 mg/dl. Among nutrients, animal fat intake doubled in men ages 40-59 from 4.5% of daily calories in 1969 to 9.6% in 1980-1983. Animal protein intake also increased, from 5.8% to 7.1%. Most of this increase occurred between 1969 and 1972-1975 and may be attributable to an increased intake of meat, eggs and dairy products. From 1963-1966 to 1980-1983, mean relative weight index rose significantly for all age-sex groups except men ages 50-69. Mean systolic and diastolic blood pressure levels declined for every age-sex group, with a 15-mm Hg age-adjusted decrease in systolic, 4-mm Hg decrease in diastolic pressure among men ages 40-69, and a 11-mm Hg systolic and 4-mm Hg diastolic decrease for women. Two cohorts of men and women ages 40-69 at baseline were followed for disease incidence: an early cohort (2,257 persons) followed from 1963-1966 to 1973 and a later cohort (2,711 persons) followed from 1972-1975 to 1983. In these cohorts, significant risk prediction for cerebral hemorrhage and infarction was obtained with blood pressure level and end organ effects in the electrocardiogram and fundus photographs. Serum cholesterol was inversely associated with cerebral hemorrhage in the early cohort but not in the later.(ABSTRACT TRUNCATED AT 400 WORDS)
Multifocal Fibrosclerosis Manifested by Vena Caval Obstructions and Associated with Vasculitis
Authors: ROBERT W. CARTON
Journal: Annals of Internal Medicine (1969)

Multifocal fibrosclerosis is the generic term currently use to describe a group of fibrosing conditions including chronic mediastinal fibrosis and retroperitoneal fibrosis. A 29-year-old brewery worker with obstructions of his superior and inferior vena cava due to mediastinal and retroperitoneal fibrosis was followed for 3 years until his death from hemoptysis. He also suffered from peripheral ulcerations due to disseminated vasculitis. Vasculitis has not been observed previously associated with chronic fibrous mediastinitis, although it has been found together with other members of the multifocal fibrosclerosis group (retroperitoneal fibrosis and sclerosing cholangitis). It is hypothesized that inflammation of the blood vessels may lead to multifocal fibrosclerosis or may be present in association with this condition in response to the same primary stimulus.
Measles Immunoglobulins in Subacute Sclerosing Panencephalitis
Authors: J. H. Connolly, M. Haire, D. S. M. Hadden
Journal: BMJ (1971)

Normal responses of measles specific immunoglobulins M and G (IgM and IgG) were defined in 10 children with measles. Abnormal responses of measles IgM and IgG were found in both sera and cerebrospinal fluids from three cases of subacute sclerosing panencephalitis. In two patients the serum titres of measles IgM and IgG were abnormally high. The measles IgM was present during prolonged illnesses in serum and cerebrospinal fluid, which suggested a correlation with the known persistence of measles virus antigen in the brain of the three patients. It was concluded that both measles IgM and IgG may be produced within the central nervous system in subacute sclerosing panencephalitis.
Morphologic correlates of technetium-99m stannous pyrophosphate imaging of acute myocardial infarcts in dogs.
Authors: L M Buja, R W Parkey, J H Dees, E M Stokely, R A Harris, F J Bonte, J T Willerson
Journal: Circulation (1975)

To obtain insight into the mechanism(s) responsible for the direct visualization of acute myocardial infarcts by myocardial scintigraphy with technetium-99m stannous pyrophosphate (99mTc-PYP), scintigraphic and morphologic studies were performed in 22 dogs subjected to occlusion of the proximal left anterior descending coronary artery (LAD). Grossly visible myocardial infarcts occurred in ten of 11 dogs with LAD occlusion for one day, five with LAD occlusion for two days, two with LAD occlusion for seven days and two with LAD occlusion for 13 days. Rare, microscopic foci of necrosis were observed in one dog with LAD occlusion for one day, and no lesions were present in two dogs subjected to temporary LAD occlusion for eight minutes and reflow for 24 hours. In the latter three dogs, 99mTc-PYP myocardial scintigrams were negative. In the 19 dogs with gross infarcts, 99mTc-PYP myocardial scintigrams were strongly positive at one and two days after LAD occlusion, much less positive at seven days and faintly positive at 13 days after occlusion. Positive myocardial scintigrams in most showed "doughnut" patterns, with marked peripheral concentration of radioactivity around central zones of much lower activity. On histologic examination, the one and two-day-old infarcts exhibited subendocardially located central zones and surrounding peripheral zones, both of which showed distinctive histopathological and histochemical features, including the selective occurrence in the peripheral zones of calcified muscle cells with ultrastructurally demonstrable apatite-like crystals in mitochondria. Selective occurrence of high tissue levels of 99mTc-PYP radioactivity also was demonstrated in the peripheral zones of four infarcts. Hearts with older infarcts (seven and 13 days) showed progressive replacement of necrotic myocardium by granulation tissue and progressive reduction in calcium deposits in the areas of damage. The data obtained in this study establish a temporal and topographical relationship between calcium accumulation in acute myocardial infarcts and 99mTc-PYP uptake responsible for scintigraphic detection of the lesions with this radionuclide in dogs subjected to proximal LAD occlusion.