tbuckley/cabot-search huggingface dataset:
Requiem for an Unknown Leper
Authors: William G. Ryan
Journal: JAMA (1992)

<h3>To the Editor.</h3> —Dr Crawshaw's "Requiem for an Unknown Leper"1 is a moving description of the stigma of Hansen's disease (leprosy) and how this stigma and so-called treatment amplified the suffering of those ill with the disease. It closes with a strong plea for physicians not to be "numb" to the experience of their patients. As a practicing psychiatrist, I can hardly quarrel with this. But as a practicing psychiatrist, I find the essay marred by apparently uninformed criticisms of ECT, referred to as "shock therapy." Crawshaw states that "electroshock treatment is iatrogenic numbness," and that we should "First do no harm with our mind-numbing tests, procedures, and pharmacopeia, the chemical equivalent of electroshock." I don't know what specialty Crawshaw practices, but I doubt that it is psychiatry, since contact with the current clinical use of ECT should dispel the popular but erroneous myth that the procedure somehow damages brains
Adenosine infusion for the reversal of pulmonary vasoconstriction in biventricular failure. A good test but a poor therapy.
Authors: G A Haywood, J F Sneddon, Y Bashir, S H Jennison, H H Gray, W J McKenna
Journal: Circulation (1992)

BACKGROUND Elevation of pulmonary vascular resistance is an important determinant of right ventricular function in patients with end-stage biventricular heart failure. Vasodilator drug therapy directed at the pulmonary vasculature is used in the hemodynamic assessment of patients for orthotopic heart transplantation, and therapy aimed at decreasing pulmonary vascular resistance and transpulmonary pressure gradient has been advocated in patients awaiting heart transplantation. Adenosine infusion has been shown to cause selective pulmonary vasodilatation in normal subjects and in patients with primary pulmonary hypertension but has not been assessed in patients with biventricular heart failure. METHODS AND RESULTS Using two infusion doses, we studied the pulmonary and renal hemodynamic effects of adenosine on patients referred for heart transplantation (n = 21) and compared it with sodium nitroprusside (n = 18). Patients received 30% oxygen via face mask throughout the study. Adenosine at 100 micrograms/kg min achieved the same percentage fall in pulmonary vascular resistance as nitroprusside (41 +/- 6% versus 42 +/- 4%) and a greater and more consistent fall in transpulmonary pressure gradient (35 +/- 6% versus 9 +/- 30%, p less than 0.02). The mean arterial blood pressure fell by 16 mm Hg with nitroprusside but was unchanged by adenosine, indicating that in contrast to nitroprusside, adenosine acted as a selective pulmonary vasodilator. Despite this, cardiac index showed only a modest increase with adenosine (1.73 +/- 0.09 to 1.89 +/- 0.16 l.m-2, p less than 0.05), and there was a rise in pulmonary capillary wedge pressure from baseline at the higher dose (29.7 +/- 2.5 to 33.4 +/- 3.4 mm Hg, p less than 0.05). Renal blood flow was unchanged during adenosine infusion. CONCLUSIONS Adenosine is a potent selective pulmonary vasodilator in patients with biventricular heart failure and is preferable to sodium nitroprusside as a test for the reversibility of pulmonary vasoconstriction. However, its deleterious effects on left atrial pressure make it unsuitable as a therapeutic agent in patients awaiting heart transplantation.
Preventing Sudden Cardiac Death
Authors: Stephen G. Pauker, N. A. Mark Estes, Deeb N. Salem
Journal: Annals of Internal Medicine (2005)

Letters15 November 2005Preventing Sudden Cardiac DeathStephen G. Pauker, MD, N. A. Mark Estes, MD, and Deeb N. Salem, MDStephen G. Pauker, MDFrom Tufts-New England Medical Center, Boston, MA 02111.Search for more papers by this author, N. A. Mark Estes, MDFrom Tufts-New England Medical Center, Boston, MA 02111.Search for more papers by this author, and Deeb N. Salem, MDFrom Tufts-New England Medical Center, Boston, MA 02111.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-143-10-200511150-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:As Dr. Achtelik points out, the 500 000 estimate in McClellan and Tunis's editorial (1) referred to the total number of Medicare beneficiaries who would become eligible under expanded criteria. Assuming a life expectancy of 9 years, he estimated that the annual incidence of newly eligible patients would be one ninth of 500 000 or 56 000. Because the Medicare population is older than the MADIT-II (Multicenter Automatic Defibrillator Implantation Trial-II) population, the assumed life expectancy of 9 years might be rather generous. If the actual life expectancy were only 5 years, then the corresponding annual incidence would be 100 000 among ...References1. McClellan MB, Tunis SR. Medicare coverage of ICDs. N Engl J Med. 2005;352:222-4. [PMID: 15659721] CrossrefMedlineGoogle Scholar2. Buxton AE, Moss AJ. Should everyone with an ejection fraction less than or equal to 30% receive an implantable cardioverter-defibrillator? Circulation. 2005;111:2537-49; discussion 2537-49. [PMID: 15897357] Google Scholar Author, Article, and Disclosure InformationAuthors: Stephen G. Pauker, MD; N. A. Mark Estes, MD; Deeb N. Salem, MDAffiliations: From Tufts-New England Medical Center, Boston, MA 02111.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPreventing Sudden Cardiac Death: Can We Afford the Benefit? Stephen G. Pauker , N. A. Mark Estes , and Deeb N. Salem Preventing Sudden Cardiac Death Michael Achtelik Metrics 15 November 2005Volume 143, Issue 10Page: 756KeywordsConflicts of interestFallsHealth careLife expectancyMedicareSudden cardiac death ePublished: 15 November 2005 Issue Published: 15 November 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Abstract IA1-1: Systematic functional genomics and cancer target identification and validation
Authors: William C. Hahn
Journal: Clinical Cancer Research (2010)

Abstract Recent advances in genomics now make it possible to consider enumerating all of the genetic lesions in specific cancers. While these approaches will yield critical information regarding the identify, number, and types of alterations found in human tumors, a complementary approach to decipher the molecular basis of malignant transformation depends upon the application of genome scale tools to annotate the function of genes involved in cancer initiation and progression. Over the past several years, we have developed genome scale RNAi libraries and open reading frame expression libraries that permit a systematic evaluation of genes involved in cancer initiation and maintenance. Using these libraries, we have now performed screens in a panel of human cancer cell lines to systematically identify cancer vulnerabilities. By combining these functional approaches with information derived from mapping the structural abnormalities present in cancer genomes, we have identified several new oncogenes that contribute to cancer development. In addition, many commonly occurring and well- validated oncogenes and tumor suppressor genes remain refractory to molecularly targeted therapies. For example, the proto-oncogene KRAS is mutated in a wide array of human cancers, most of which are aggressive and respond poorly to standard therapies. An alternative strategy for targeting KRAS is to identify gene products that, when suppressed or inhibited, result in cell death only in the presence of an oncogenic allele. Through the use of systematic RNAi screens, we have identified two kinases, TBK1 and STK33 that act in a synthetic lethal manner to selectively kill cancer cell lines that depend on mutant KRAS. Taken together, these studies suggest that combining forward and reverse genetic approaches with information derived from the cancer genome characterization projects will yield a comprehensive list of cancer vulnerabilities and establish a general approach for the rational identification of oncogenic and codependent pathways in cancer. Citation Information: Clin Cancer Res 2010;16(14 Suppl):IA1-1.
Successful treatment with pineapple juice of a gastric bezoar caused by mastic
Authors: Barış Yılmaz, Akif Altınbas, Fuat Ekiz, Bora Aktaş
Journal: Endoscopy (2014)

A 59-year-old man was admitted to our department with epigastric pain and nausea. The patient mentioned that he had swallowed heated mastic to treat constipation shortly before his symptoms developed. He had no history of any diseases. His vital signs were within normal limits. The physical examination findings were normal, and the results of laboratory tests were unremarkable.
Risk of Type 1 Diabetes Development in Children With Incidental Hyperglycemia
Authors: Renata Lorini, A. Alibrandi, L. Vitali, C. Klersy, M. Martinetti, C. Betterle, G. d’Annunzio, E. Bonifacio
Journal: Diabetes Care (2001)

OBJECTIVE—The aim of our study was to determine whether children with incidental hyperglycemia are at an increased risk of developing type 1 diabetes. RESEARCH DESIGN AND METHODS—A total of 748 subjects, 1–18 years of age (9.04 ± 3.62, mean ± SD), without family history of type 1 diabetes, without obesity, and not receiving drugs were studied and found to have incidental elevated glycemia defined as fasting plasma glucose &amp;gt;5.6 mmol/l confirmed on two occasions. Subjects were tested for immunological, metabolic, and immunogenetic markers. RESULTS—Islet cell antibodies &amp;gt;5 Juvenile Diabetes Foundation units were found in 10% of subjects, elevated insulin autoantibody levels in 4.6%, GAD antibody in 4.9%, and anti-tyrosine phosphatase-like protein autoantibodies in 3.9%. First-phase insulin response (FPIR) was &amp;lt;1st centile in 25.6% of subjects. The HLA-DR3/DR3 and HLA-DR4/other alleles were more frequent in hyperglycemic children than in normal control subjects (P = 0.012 and P = 0.005, respectively), and the HLA-DR other/other allele was less frequent than in normal control subjects (P = 0.000027). After a median follow-up of 42 months (range 1 month to 7 years), 16 (2.1%) subjects (11 males and 5 females), 4.1–13.9 years of age, became insulin dependent. All had one or more islet autoantibodies, and the majority had impaired insulin response and genetic susceptibility to type 1 diabetes. Diabetes symptoms were recorded in 11 patients and ketonuria only in 4 patients. The cumulative risk of type 1 diabetes was similar in males and females, and it was also similar in subjects under or over 10 years, whereas the cumulative risk of type 1 diabetes was increased in subjects with one or more autoantibodies and in those with FPIR &amp;lt;1st centile. CONCLUSIONS—Children with incidental hyperglycemia have a higher-than-normal frequency of immunological, metabolic, or genetic markers for type 1 diabetes and have an increased risk of developing type 1 diabetes.
Pharmacology of the Sulphanilamide Group
Authors: G. A. H. Buttle
Journal: BMJ (1939)

BRMySt A 269 tions without marked local tissue changes.Hence these drugs are not likely to obviate operative procedures where focal lesions such as accumulations of pus or extensive necrosis of bone or other tissues have occurred.Accord- ingly, powerful antiseptics which act when brought into close contact with the organisms locally, and which are relatively harmless to the tissues, will continue to be required also in the treatment of many septic infections.
The role of role avoidance
Authors: P. Reynolds
Journal: BMJ (2002)

I've only recently heard of the term “role avoidance.” Looking back I realise that it's a strategy I've been using for a long time but one which has remained nameless until now. Perhaps I should explain. I am a doctor who stammers and have just embarked on a course at the City Literary Institute in London in what is called “block modification.” Those of you who are familiar with stammering therapy will know what this entails. For those of you who aren't, it is based on the work of a number of American speech pathologists, including Charles Van Riper and Joseph Sheehan, and basically comprises three stages—identification, desensitisation, and modification.

The identification stage involves looking at both …
Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program
Authors: Larry A. Allen, G. Michael Felker, Stuart Pocock, John J.V. McMurray, Marc A. Pfeffer, Karl Swedberg, Duolao Wang, Salim Yusuf, Eric L. Michelson, Christopher B. Granger
Journal: European Journal of Heart Failure (2009)
Mass Treatment with Single-Dose Azithromycin for Yaws
Authors: Oriol Mitjà, Wendy Houinei, Penias Moses, August Kapa, Raymond Paru, Russell Hays, Sheila Lukehart, Charmie Godornes, Sibauk Vivaldo Bieb, Tim Grice, Peter Siba, David Mabey, Sergi Sanz, Pedro L. Alonso, Kingsley Asiedu, Quique Bassat
Journal: New England Journal of Medicine (2015)

Mass treatment with azithromycin is a central component of the new World Health Organization (WHO) strategy to eradicate yaws. Empirical data on the effectiveness of the strategy are required as a prerequisite for worldwide implementation of the plan.We performed repeated clinical surveys for active yaws, serologic surveys for latent yaws, and molecular analyses to determine the cause of skin ulcers and identify macrolide-resistant mutations before and 6 and 12 months after mass treatment with azithromycin on a Papua New Guinean island on which yaws was endemic. Primary-outcome indicators were the prevalence of serologically confirmed active infectious yaws in the entire population and the prevalence of latent yaws with high-titer seroreactivity in a subgroup of children 1 to 15 years of age.At baseline, 13,302 of 16,092 residents (82.7%) received one oral dose of azithromycin. The prevalence of active infectious yaws was reduced from 2.4% before mass treatment to 0.3% at 12 months (difference, 2.1 percentage points; P<0.001). The prevalence of high-titer latent yaws among children was reduced from 18.3% to 6.5% (difference, 11.8 percentage points; P<0.001) with a near-absence of high-titer seroreactivity in children 1 to 5 years of age. Adverse events identified within 1 week after administration of the medication occurred in approximately 17% of the participants, included nausea, diarrhea, and vomiting, and were mild in severity. No evidence of emergence of resistance to macrolides against Treponema pallidum subspecies pertenue was seen.The prevalence of active and latent yaws infection fell rapidly and substantially 12 months after high-coverage mass treatment with azithromycin, with the reduction perhaps aided by subsequent activities to identify and treat new cases of yaws. Our results support the WHO strategy for the eradication of yaws. (Funded by Newcrest Mining and International SOS; YESA-13 ClinicalTrials.gov number, NCT01955252.).
Making the Critical Choices
Authors: Robert J. Blendon
Journal: JAMA (1992)

IN THE year sinceThe Journalpublished its theme issue on "Caring for the Uninsured and Underinsured" (May 15, 1991), the debate over the need for a national health plan has intensified. The already broad interest in health care reform has been widened by a diverse group of proposals by presidential candidates, members of Congress, professional associations, and national leadership groups that can be added to the 13 proposals we reviewed. Opinion surveys show that public interest in national solutions to these problems remains intense. When asked in January 1992 what issues besides the economy and foreign For editorial comment see p 2521. affairs presidential candidates should emphasize, the public ranked health care and health insurance highest among all items mentioned.<sup>1</sup>Similarly, when queried about the future content of the President's State of the Union Address, 93% of Americans reported that they thought it should include a program for
The Aging Gut: Pathophysiology, Diagnosis, and Management
Authors: Summer C. Kraft
Journal: JAMA (1984)

This easy-to-read paperback originated in a conference held in Little Rock, Ark, on Gastroenteropathy of Aging and consists of 17 chapters, nine of which were authored by Dr Texter and his colleagues at the University of Arkansas for Medical Sciences, Little Rock. The editor has succeeded in concisely blending pertinent basic science information with selected clinical topics such as geriatric aspects of nutrition, hepatobiliary disease, vascular problems, inflammatory bowel disease, colorectal polyps, and cancer. It was elected not to emphasize other malignant neoplasms or pancreatic abnormalities, although it is pointed out that pancreatic insufficiency in older subjects may be more frequent than previously recognized.  The small bowel is the focus of almost a third of the text, including a comprehensive, well-documented, 24-page presentation by Dr Peter R. Holt on intestinal absorption and malabsorption in the elderly. Other noteworthy chapters discuss pharyngoesophageal function and swallowing problems in the aging patient and
Prognostic Value of LV Deformation Parameters Using 2D and 3D Speckle-Tracking Echocardiography in Asymptomatic Patients With Severe Aortic Stenosis and Preserved LV Ejection Fraction
Authors: Yasufumi Nagata, Masaaki Takeuchi, Victor Chien-Chia Wu, Masaki Izumo, Kengo Suzuki, Kimi Sato, Yoshihiro Seo, Yoshihiro J. Akashi, Kazutaka Aonuma, Yutaka Otsuji
Journal: JACC. Cardiovascular imaging (2015)
Pursuing the dream
Authors: P McCrory
Journal: British Journal of Sports Medicine (2004)

It has long been known that sporting performance can be significantly enhanced by boosting the blood’s oxygen carrying capacity through the use of blood doping practices. This method was banned after the 1984 LA Olympics where there was considerable speculation that the silver medal winning US men’s pursuit cycling team used such a method to improve their performance. Previous to this, there were numerous stories of elite athletes purportedly drinking reindeer blood or the like, to achieve their extraordinary performances.

Of course transfusing blood into your …
Pre-S2 defective hepatitis B virus infection in patients with fulminant hepatitis
Authors: T Pollicino, A R Zanetti, I Cacciola, M A Petit, A Smedile, S Campo, L Sagliocca, M Pasquali, E Tanzi, G Longo, G Raimondo
Journal: Hepatology (1997)

Controversial data were recently published concerning the association of hepatitis B virus (HBV) variants with fulminant hepatitis (FH). In this study, we first analyzed the complete nucleotide sequences of HBV genomes isolated from serum samples from a surgeon and his mother, who was accidentally infected by the son; both died of FH. The infecting viruses were genetically almost identical in both patients; all the clones examined carried a double nucleotide mutation in the start codon of the pre-S2 region that prevented the synthesis of the corresponding protein. Analyses of different serum samples from the son revealed only wild-type precore sequences in a high viremic serum, whereas hepatitis B e antigen (HBeAg)-defective strains were prevalent when the viremia had decreased. Subsequently, we extended the analysis to the viral genomes isolated from 18 additional patients with acute HBV infection and different clinical behaviors: 3 of 5 patients with FH and without previous liver disease had pre-S2 start codon mutations preventing pre-S2 protein synthesis, whereas none of the 13 control cases had similar genomic rearrangements. Analysis of the precore region showed that viral populations normally producing HBeAg were the only or the prevalent viral strains in all of these cases. In summary, our results support the hypothesis that the pre-S2 protein is not essential for HBV infectivity. They also show that infection by pre-S2-defective virus is frequently associated with FH, indicating that this variant might play a pathogenetic role in cases of acute liver failure. Finally, they suggest that the emergence of HBeAg-defective viruses might be a late event in the course of FH, occurring when HBeAg-producing viruses have been mostly cleared.
Interactions of Drugs and Amines in the Brain
Authors: Ross J. Baldessarini
Journal: New England Journal of Medicine (1972)

IN the recent past, there has been a remarkable upsurge of interest in the pharmacology of synaptic transmitters in the central nervous system since synapses are very likely sites of interaction between a neuroactive or psychoactive drug and a neuronal network. For a biologically active small molecule to attain the status of a putative neurotransmitter, it must meet several criteria, including its presence in central neurons with enzymes required for its metabolism, its release by depolarizing stimuli and evidence of a physiologic post-synaptic effect and the means of terminating its actions. Historically, the acceptance of new candidate substances has been . . .
Fractional flow reserve–guided PCI reduced major adverse cardiac outcomes compared with angiography-guided PCI in multivessel CAD
Authors: Arun Kalyanasundaram
Journal: Annals of Internal Medicine (2009)

ACP Journal Club19 May 2009Fractional flow reserve–guided PCI reduced major adverse cardiac outcomes compared with angiography-guided PCI in multivessel CADArun Kalyanasundaram, MD, Peter Berger, MDArun Kalyanasundaram, MDGeisinger Clinc, Danville, Pennsylvania, USA (A.K., P.B.)Search for more papers by this author, Peter Berger, MDGeisinger Clinc, Danville, Pennsylvania, USA (A.K., P.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-10-200905190-02007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationTonino PA, De Bruyne B, Pijls NH, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213-24. https://pubmed.ncbi.nlm.nih.gov/19144937Clinical Impact RatingsCardiology: References1 Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49:2105-11. [PMID: 17531660] Google Scholar2 Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-16. [PMID: 17387127] Google Scholar Author, Article, and Disclosure InformationAffiliations: Geisinger Clinc, Danville, Pennsylvania, USA (A.K., P.B.)This article was published at Annals.org on 5 May 2009. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 19 May 2009Volume 150, Issue 10Page: JC5-7KeywordsAngiographyCoronary arteriesLesionsMyocardial infarctionPercutaneous coronary interventionQuality of lifeRevascularizationStable coronary artery diseaseStenosisStent implantation ePublished: 19 May 2009 Issue Published: 19 May 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...