tbuckley/cabot-search huggingface dataset:
Randomised controlled trial of computer assisted management of hypertension in primary care.
Authors: N H McAlister, H D Covvey, C Tong, A Lee, E D Wigle
Journal: BMJ (1986)

The hypothesis that general practitioners would obtain better outcomes for patients with hypertension using a computer than doctors not using a computer was tested. Sixty family physicians were randomised to two treatment strategies. "Test" physicians completed a data collection form after each visit from a patient with hypertension and mailed the forms to the test centre for processing. Computer feedback on management was mailed to the doctors. This encouraged doctors to apply the "stepped care" protocol, supplied charts of diastolic blood pressure v time, and ranked patients9 diastolic blood pressures by percentile. Letters were mailed to patients to remind them of appointments. "Control" doctors filled out the same data collection forms as test physicians, but neither doctors nor patients received computer feedback. Physicians who used the computer saw more patients per practice than control doctors (test 50 patients, control 40). For all patients the length of follow up was significantly longer in test practices (test 199 days, control 167), and a smaller percentage dropped out of active treatment in test practices (test 37.5%, control 42.1%). For patients with "moderate" hypertension of a baseline diastolic pressure of greater than 104 mm Hg the mean score of the last recorded pressure was below the goal of 90 mm Hg in test practices (88.5 mm Hg), but it failed to reach this goal in control practices (93.3 mm Hg). A greater average reduction of diastolic pressure was achieved in test practices (test 21.7 mm Hg, control 16.7 mm Hg). Though patients with "moderate" hypertension were better controlled in test practices than in control practices, the patients in test practices visited their doctors less often (test 13.3 visits per patient-year, control 17.4 visits). Among patients with newly detected hypertension test practices achieved a greater reduction in diastolic pressure than control practices (test 15.1 mm Hg v control 11.3 mm Hg) and more sustained control of hypertension (test 323 days per patient-year with a diastolic pressure of 90 mm Hg or less v control 259 days).
Achieving the best from care in early labour
Authors: H. Spiby, M. J Renfrew
Journal: BMJ (2008)

The lateral habenula (LHb) sends complex projections to several areas of the mesopontine tegmentum, the raphe, and the hypothalamus. However, few markers have been available to distinguish subsets of LHb neurons that may serve these pathways. In order to address this complexity, we examined the mouse and rat LHb for neurons that express the GABA biosynthesis enzymes glutamate decarboxylase 1 and 2 (GAD1, GAD2), and the vesicular GABA transporter (VGAT). The mouse LHb contains a population of neurons that express GAD2, while the rat LHb contains discrete populations of neurons that express GAD1 and VGAT. However, we could not detect single neurons in either species that co-express a GABA synthetic enzyme and VGAT, suggesting that these LHb neurons do not use GABA for conventional synaptic transmission. Instead, all of the neuronal types expressing a GABAergic marker in both species showed co-expression of the glutamate transporter VGluT2. Anterograde tract-tracing of the projections of GAD2-expressing LHb neurons in Gad2<sup>Cre</sup> mice, combined with retrograde tracing from selected downstream nuclei, show that LHb-GAD2 neurons project selectively to the midline structures in the mesopontine tegmentum, including the median raphe and nucleus incertus, and only sparsely innervate the hypothalamus, rostromedial tegmental nucleus, and ventral tegmental area. Postsynaptic recording of LHb-GAD2 neuronal input to tegmental neurons confirms that glutamate, not GABA, is the fast neurotransmitter in this circuit. Thus GAD2 expression can serve as a marker for functional studies of excitatory neurons serving specific LHb output pathways in mice. <b>SIGNFICANCE STATEMENT</b> The lateral habenula provides a major link between subcortical forebrain areas and the dopamine (DA) and serotonin (5HT) systems of the midbrain and pons, and it has been implicated in reward mechanisms and the regulation of mood states. Few markers have been available for the specific cell types and complex output pathways of the lateral habenula. Here we examined the expression of genes mediating GABAergic and glutamatergic transmission in the mouse and rat LHb, where no neurons in either species expressed a full complement of GABAergic markers, and all expressed the glutamatergic marker VGluT2. Consistent with this, in mice the LHb GAD2 neurons are excitatory and appear to use only glutamate for fast synaptic transmission.
At Any Cost: Corporate Greed, Women, and the Dalkon Shield
Authors: Carl J. Levinson
Journal: JAMA (1987)

The A. H. Robins Company was noted for simple products: cough medicine, antispasmodics, relief from nasal congestion. It was seeking a product in the sphere of gynecology... and stepped through the looking glass into a new world. The company purchased and marketed the Dalkon Shield, an intrauterine device (IUD) whose memory shall be long sustained. Were the officials of the A. H. Robins Company careless, profit motivated, unwilling to investigate the product, and guilty of delaying tactics that became, in essence, a cover-up? Morton Mintz, author of<i>At Any Cost</i>, is certain that the Robins Company is guilty of that much and much more, based on the facts presented, gleaned from hours of reviewing records of the corporation, the medical literature, trials, and committees. He cites this "brutal fact": "Corporations run by human beings regularly and deliberately undertake activities that cause grave environmental damage, or lead to largescale disease, injury,
Effect of Changes in Posture on Peripheral Circulation, with Special Reference to Skin Temperature Readings and the Plethysmogram
Authors: R. H. GOETZ
Journal: Circulation (1950)

Effects of changes in posture upon plethysmogram and skin temperature are investigated. Since posture, by altering venous return, affects pulse volume and response of digital volume and skin temperature to procedures releasing sympathetic tone, these should not be interpreted solely in terms of arterial blood flow. In the normal elevated limb, e.g., the skin temperature response to body heating simulates organic arterial disease. The clinical significance of these findings is discussed with particular reference to interpretation of skin temperature readings, the diagnosis of thromboantiitis obliterans, indications for sympathectomy in poliomyelitis, the management of the edematous limb and other conditions.
Clinical, hematological, and molecular features in sicilians with Hb S‐β‐thalassemia
Authors: G. Schiliro', P. Samperi, R. Testa, R. B. Gupta, L.‐H. Gu, T. H. J. Huisman
Journal: American Journal of Hematology (1992)

Abstract The clinical, hematological, and molecular features of 81 patients with Hb S‐β‐thalassemia and relatives from 76 unrelated families are reported. We analyzed the β‐thalassemia mutations and the β S haplotypes in all patients and detected 6 different β‐thalassemia alleles: codon 39 (C→T) (39 cases), IVS‐I‐1 (G→A) (12 cases), IVS‐II‐1 (G→A) (4 cases), IVS‐l‐6 (T→C) (6 cases), IVS‐I‐110 (G→A) (14 cases), and IVS‐II‐745 (G→C) (6 cases). Eighty patients had haplotype #19 or the Benin type and one had haplotype #17 or the Cameroon type. The type of β‐thalassemia allele had the greatest influence on the phenotypic expression; this was observed for patients with Hb S‐β‐thalassemia and for simple β‐thalassemia heterozygotes. The mild IVS‐I‐6 (T→C) mutation produced borderline abnormal erythrocytic indices and Hb A 2 levels in heterozygotes. Overall, there was a milder expression in β S β + patients (only 7.7% presented severe disease) than in those with the β S β° condition (22.6% had the severe form of the disease). © 1992 Wiley‐Liss, Inc.
Highly Flexible Self-Expanding Meshed Metal Stents for Palliation of Malignant Esophagogastric Obstruction
Authors: K. E. Grund, D. Storek, H. D. Becker
Journal: Endoscopy (1995)

Palliative treatment methods for esophageal and cardiac cancer include dilation, laser vaporization and other thermal methods, alcohol injection, and stent insertion. None of these procedures, however, has proved to be a simple, well-tolerated, and lasting method. We present here our results with a new, highly flexible self-expanding metal stent made of nitinol, which is considered to be particularly useful for difficult (long and tortuous) malignant strictures.From November 1991 to December 1994, 114 patients with unresectable esophagogastric malignancies or tumor recurrences (92 men, 22 women, mean age 64 years) were treated using 138 highly flexible meshed self-expanding metal stents. Regular clinical and endoscopic follow-up was performed, and stent obstruction or overgrowth was treated by argon plasma coagulation (APC). Patients were followed up until death (n = 78; average follow-up 17 weeks, range 1-90 weeks). Thirty-six patients were alive in December 1994 and had had an average of 20 weeks of follow-up (range 1-160 weeks).Stent insertion was technically successful in 97% of cases, and led to a reduction of dysphagia (graded 0-4) from a mean score of 3.5 to a mean score of 1.5. Preparatory treatment to open tight strictures was necessary in 80% of cases. Balloon dilation to support stent expansion was carried out in 42 patients (37%). During follow-up, tumor ingrowth occurred in 66% of cases after a mean of seven weeks, and was successfully treated by APC. Including preparatory treatment and re-treatment, patients underwent a mean of 3.5 endoscopic procedures (range 1-12 procedures), which led to good clinical success in 73% of cases. Ninety-six percent of the patients continued to be able to swallow (dysphagia score < or = 2) during follow-up.Highly elastic self-expanding metal stents can be successfully implanted in the majority of patients, particularly in those with difficult malignant strictures not easily amenable to other methods. The devices provide good palliation with effective relief of dysphagia, easy handling and implantation, and offer a satisfactory quality of life to the patient. However, tumor ingrowth is a significant problem, even though it can be successfully managed by APC. Adequate covering of the stent that does not affect its mechanical properties or firm anchoring should solve at least some of these problems.
PROTHROMBIN DEFICIENCY AND THE BLEEDING TENDENCY IN LIVER INJURY (CHLOROFORM INTOXICATION)
Authors: H. P. Smith, E. D. Warner, K. M. Brinkhous
Journal: The Journal of Experimental Medicine (1937)

The bleeding tendency in acute chloroform intoxication is due to deficiency in both plasma fibrinogen and plasma prothrombin. If the disorder is mild, no bleeding occurs. However, the prothrombin falls to rather low levels, although the fibrinogen falls only moderately. A bleeding tendency may also be produced by giving small repeated doses of chloroform. In such experiments, the hemorrhagic tendency is due to a deficiency in prothrombin alone. The fibrinogen level is unaffected. The relation of the liver injury to the plasma prothrombin level indicates that the liver is concerned in the manufacture of prothrombin. Prothrombin formation appears to be more easily interfered with than does fibrinogen formation.
Thyroid Supplementation for Hypothyroidism
Authors: Piero Mustacchi
Journal: JAMA (1977)

In four subpopulations grouped by varying durations of thyroid supplementation (none, one to five years, six to 15 years, and 15 years or more), breast cancer frequency correlated positively with attained age. The cancer experience of persons in the same age-group was relatively stable regardless of how long women took thyroid supplements. The present data support the provisional inference that breast cancer and duration of thyroid therapy are both age-dependent and question the belief that pretreatment with thyroid supplements increases the risk of breast cancer development. Relationship of these two variables can only be determined by prospective studies. (<i>JAMA</i>237:1446-1447, 1977)
Penicillin-Induced Seizures during Cardiopulmonary Bypass
Authors: K. B. Seamans, P. Gloor, A. R. C. Dobell, J. D. Wyant
Journal: New England Journal of Medicine (1968)

Penicillin, when administered intravenously in massive doses (50,000,000 units) during cardiopulmonary bypass, induced generalized seizures, evident clinically and electroencephalographically in four patients. Experiments in dogs showed that seven out of eight animals receiving high doses of penicillin intravenously during full cardiopulmonary bypass had epileptic seizures, whereas neither the bypass alone nor large amounts of penicillin given intravenously alone produced this neurologic complication. Our electroencephalographic data, as well as the clinical and experimental studies, suggest that these seizures result from penetration of penicillin into the brain through a blood–brain barrier rendered abnormally permeable by factors not yet clearly determined.
The Consult Guys - What Does Aortic Stenosis Have to Do With Heme Positive Stool?
Authors: Geno J. Merli, Howard H. Weitz
Journal: Annals of Internal Medicine (2014)

Web Exclusives18 February 2014The Consult Guys - What Does Aortic Stenosis Have to Do With Heme Positive Stool?FREEGeno J. Merli, MD and Howard H. Weitz, MDGeno J. Merli, MDSearch for more papers by this author and Howard H. Weitz, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G14-3002 SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.For more videos from and information on The Consult Guys, visit www.annals.org/ConsultGuys. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Disclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Bayer, sanofi-aventis; Consultancies: Bristol-Myers Squibb, Bayer, sanofi-aventis. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 February 2014Volume 160, Issue 4Page: CG2KeywordsConflicts of interestHemeResearch grantsResearch reporting guidelinesStenosis ePublished: 18 February 2014 Issue Published: 18 February 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.Loading ...
Colon-Polyp Surveillance — Do Patients Benefit?
Authors: David Lieberman
Journal: New England Journal of Medicine (2014)

In March 2014, newspaper headlines trumpeted the stunning reduction in mortality from colorectal cancer of 30% from 2000 to 2010 in the United States.1 There were also significant reductions in colorectal-cancer incidence. Some of this reduction is due to colonoscopic detection and removal of adenomas.2,3 Patients in whom adenomas develop remain at risk (owing to genetics or lifestyle) for the discovery of adenomas on subsequent examinations, leading to the logical rationale for surveillance colonoscopy in adenoma-bearing patients.4 Colon-polyp surveillance now accounts for about 25% of colonoscopies among persons over 50 years of age in the United States, a substantial . . .
A British Medical Association Lecture on SOME POINTS IN THE SURGERY OF GASTRIC AND DUODENAL ULCERS
Authors: H. S. Souttar
Journal: BMJ (1927)

OF all the advances which hav-e been made in surgery in the last twenty years nione are mlior e remarkable than those 'in' the diagnosis and treatmenit of chlroniic ulcers of the stomach and duodenum.Not only has surgery provided a complete cure for one of the most cripplinig conditions w-lhich can affect a man in the full v-igour of life, but surgeons have actually supplied physicians with a precise system of diagnosis in a field wlhichi was formerly most obscure.Routine explorationis of the stomiach anid conistant conltact with the physical facts of its diseases have enabled surgeons to reveal its living patlhology, and to build up a cliniical picture remarkable for its precision.Before discussing the purely clinical aspects of the subject it will be well to note its extent, aiid to formn a clear idea of the pathological enitity w-e are discussinig.Tlle extent can be fairly gauged by the admissions to a general hospital.In the three years 1923-25 close upon 30,000 patients were admiiitted to the surgical wards of the london Hospital, and of these no fewer than 1,275 were admiitted for gastric and duodenal ulcers.It ould appear, thlerefore, that over 4 per cen't.of' the cases admitted to the surgical beds of a large general hospital are suffering firom this conditioni.,;'Remembering that the hospital admiosidns 'form only a small fraction of the actual cases, it will be seen that the disease is onie of considerable
Is Depressed Myocyte Contractility Centrally Involved in Heart Failure?
Authors: Steven R. Houser, Kenneth B. Margulies
Journal: Circulation Research (2003)

This review examines the evidence for and against the hypothesis that abnormalities in cardiac contractility initiate the heart failure syndrome and drive its progression. There is substantial evidence that the contractility of failing human hearts is depressed and that abnormalities of basal Ca2+ regulation and adrenergic regulation of Ca2+ signaling are responsible. The cellular and molecular defects that cause depressed myocyte contractility are not well established but seem to culminate in abnormal sarcoplasmic reticulum uptake, storage, and release. There are also strong links between Ca2+ regulation, Ca2+ signaling pathways, hypertrophy, and heart failure that need to be more clearly delineated. There is not substantial direct evidence for a causative role for depressed contractility in the initiation and progression of human heart failure, and some studies show that heart failure can occur without depressed myocyte contractility. Stronger support for a causal role for depressed contractility in the initiation of heart failure comes from animal studies where maintaining or improving contractility can prevent heart failure. Recent clinical studies in humans also support the idea that beneficial heart failure treatments, such as beta-adrenergic antagonists, involve improved contractility. Current or previously used heart failure treatments that increase contractility, primarily by increasing cAMP, have generally increased mortality. Novel heart failure therapies that increase or maintain contractility or adrenergic signaling by selectively modulating specific molecules have produced promising results in animal experiments. How to reliably implement these potentially beneficial inotropic therapies in humans without introducing negative side effects is the major unanswered question in this field.
Assessing Inheritance of Agammaglobulinemia
Authors: Rebecca H. Buckley
Journal: New England Journal of Medicine (1994)

In the 42 years since Ogden Bruton discovered agammaglobulinemia,1 more than 50 additional immunodeficiency syndromes have been described2. Until recently, there was little insight into the fundamental problems underlying most of these conditions. Within the past 16 months, however, the molecular bases of three X-linked immunodeficiency disorders -- X-linked hyper-IgM syndrome, X-linked agammaglobulinemia, and X-linked severe combined immunodeficiency -- have been reported3. These remarkable accomplishments have been made possible by a combination of new knowledge of molecular signaling mechanisms between and within cells of the immune system and greatly improved approaches to the mapping of disease loci within . . .
Four Brothers with Neurofibromatosis
Authors: A. Garland
Journal: BMJ (1941)

was felt to be in a state similar to that of the glutei, and after a little searching the bomb fragment, 2 by 3 /4 by 1/2 inch, was -emoved.A careful search was then made for a hole in the peritoneum covering the iliacus, but none was found.I re- marked to my assistant that it was a fortunate thing that we had found the fragment, otherwise I should have had to open the .abdomenthrough the midline, in spite of the absence of signs | .......
THE MEDICAL COLLEGE FRATERNITY, NU SIGMA NU.
Authors: BAYARD HOLMES
Journal: JAMA (1895)

Perhaps this effort to bring a college fraternity to the notice of the medical profession will not be approved by many public-spirited physicians. The wars between the Greeks and the barbarians are still going on in all our American colleges and universities. Much can be said for and against the fraternities as they exist or have existed. Medical men are no exception to the mass of educated men in being prejudiced either for or against the Greeks. This article is written to inform, not to convert. The introduction of fraternities into medical schools marks a distinct stage in the development of medical education. While the medical college was open only a few weeks each winter for bombastic lectures embellished with obscene stories on the part of teachers and for boisterous cramming on the part of students, all repeated once or twice on successive seasons, there was neither time nor incentive
Pathogen survival trajectories: an eco-environmental approach to the modeling of human campylobacteriosis ecology.
Authors: Chris Skelly, Phil Weinstein
Journal: Environmental Health Perspectives (2002)

Campylobacteriosis, like many human diseases, has its own ecology in which the propagation of human infection and disease depends on pathogen survival and finding new hosts in order to replicate and sustain the pathogen population. The complexity of this process, a process common to other enteric pathogens, has hampered control efforts. Many unknowns remain, resulting in a poorly understood disease ecology. To provide structure to these unknowns and help direct further research and intervention, we propose an eco-environmental modeling approach for campylobacteriosis. This modeling approach follows the pathogen population as it moves through the environments that define the physical structure of its ecology. In this paper, we term the ecologic processes and environments through which these populations move "pathogen survival trajectories." Although such a modeling approach could have veterinary applications, our emphasis is on human campylobacteriosis and focuses on human exposures to Campylobacter through feces, food, and aquatic environments. The pathogen survival trajectories that lead to human exposure include ecologic filters that limit population size, e.g., cooking food to kill Campylobacter. Environmental factors that influence the size of the pathogen reservoirs include temperature, nutrient availability, and moisture availability during the period of time the pathogen population is moving through the environment between infected and susceptible hosts. We anticipate that the modeling approach proposed here will work symbiotically with traditional epidemiologic and microbiologic research to help guide and evaluate the acquisition of new knowledge about the ecology, eventual intervention, and control of campylobacteriosis.