tbuckley/cabot-search huggingface dataset:
Another Standard of Care—The Patient-Reply
Authors: Odysseus Argy
Journal: JAMA (1996)

In Reply.  —I appreciate Dr Kellerman's thoughtful commentary regarding the addition of another standard of  to the list described in my article.  I had, in fact, considered including the patient's standard of  as a separate entity from the others. Rather than portray it as another standard, however, I preferred to incorporate it into the physician-patient relationship in the personal standard of care. As I noted in the original piece, by applying that personal standard of care,  physician is thus better able to educate the  about medical issues, thoughtfully listen to and address the patient's needs and desires, and incorporate the  as an active participant in an individualized  plan.  The patient's needs, desires, fears, and previous direct or indirect medical experiences all contribute to an expectation—a patient standard of care if you will—that needs to be recognized and addressed by the physician.  By listening to the patient,
Ischaemic necrosis of lesser curve after proximal gastric vagotomy.
Authors: F P Moore, J H Wyllie
Journal: BMJ (1975)

among the most significant advances in the medical treatment of these conditions in the history of medicine.These facts must be weighed against the extremely rare instances of these relatively minor epidermal reactions.Rashes are not infrequent in hypertensive patients taking methyldopa, while 1 in 5 patients treated with the latter develop a positive Coombs test and 1 in 500 go on to develop haemolytic anaemia.5Such features have occasioned less comment than the development of this rare and usually reversible oculo- cutaneous syndrome in patients on treatment with beta-blocking drugs.We are appreciative of the professional advice offered in this case by Mr B Martin.
Poor Survival of Treatment-Related Acute Nonlymphocytic Leukemia
Authors: Alfred I. Neugut
Journal: JAMA (1990)

Population-based data on more than 1 million patients registered in the Surveillance, Epidemiology, and End-Results Program of the National Cancer Institute, 1973 to 1984, were analyzed to determine the survival of patients with de novo acute nonlymphocytic leukemia (ANLL) and following a first primary tumor treated (with chemotherapy and/or radiation therapy) or untreated. Cases that occurred within 12 months of the first malignant neoplasm were excluded. Survival was estimated using Cox proportional-hazards modeling, with age, sex, and specific type of ANLL as covariates. The 6271 patients with de novo ANLL had an estimated 12-month survival of 30%, while the 107 patients with treatment-related ANLL (radiation therapy, 60; chemotherapy, 29; both, 18) had an estimated 12-month survival of 10%. This is not due to lingering effects of the first tumor since ANLL following solid tumors not treated with chemotherapy or radiation therapy (118 cases) has similar survival (estimated 12-month survival, 36%) as de novo ANLL. We conclude that ANLL that occurs after chemotherapy or radiation therapy is biologically more aggressive and/or resistant to therapy than spontaneous ANLL. This provides a rationale for current studies on treatment-induced cellular changes and on more aggressive therapy for these patients.
Is bacteriologic surveillance in endoscope reprocessing stringent enough?
Authors: J. Kovaleva, N. Meessen, F. Peters, M. Been, J. Arends, R. Borgers, J. Degener
Journal: Endoscopy (2009)

Endoscopes, including duodenoscopes, are medical devices that are frequently associated with outbreaks of nosocomial infections. We investigated an outbreak of multidrug-resistant PSEUDOMONAS AERUGINOSA sepsis affecting three patients after endoscopic retrograde cholangiopancreaticography (ERCP). Epidemiologic investigation supplemented by molecular typing revealed that one ERCP scope was the source of infection with P. AERUGINOSA. No contamination with this microorganism was found after screening of washer-disinfectors, connecting tubes, and environmental surfaces in the endoscopy center. PSEUDOMONAS isolates from blood and endoscope channels before gas sterilization with ethylene oxide (ETO) were characterized by molecular typing as "linked isolates". Though the current surveillance system did not prevent the infections in three patients, our microbiological surveillance protocol with routine culturing of endoscopes was helpful in detecting the source of contamination and probably avoided numerous cross-contaminations in other patients who underwent ERCP procedures with endoscopes.
EXPERIMENTAL TRANSMISSION OF SIMIAN ACQUIRED IMMUNODEFICIENCY SYNDROME (SAIDS) AND KAPOSI-LIKE SKIN LESIONS
Authors: WilliamT. London, DavidL. Madden, Maneth Gravell, MarinosC. Dalakas, SidneyA. Houff, JohnL. Sever, RoyV. Henrickson, DonaldH. Maul, KentG. Osborn, MurrayB. Gardner
Journal: The Lancet (1983)
The Forgiveness of Coinsurance
Authors: M S Lachs, J L Sindelar, R I Horwitz
Journal: New England Journal of Medicine (1990)

IN forgiving coinsurance, a health care provider agrees to accept a third-party payer's reimbursement as sole and total compensation for services rendered. The practice is common; a recent survey suggested that 23 percent of patients with fee-for-service health insurance had a health care provider waive an insurance copayment — the patient's share of the bill — within the previous three years.1 In many cases the impetus is noble; needy patients are spared out-of-pocket expenses that might have resulted in financial hardship. In other settings the motivation may be less altruistic. In a competitive environment, for example, the forgiveness of coinsurance . . .
Intracellular and extracellular CPPD crystals are a regular feature in synovial fluid from uninflamed joints of patients with CPPD related arthropathy
Authors: A Martinez Sanchis
Journal: Annals of the Rheumatic Diseases (2005)

To determine whether calcium pyrophosphate dihydrate (CPPD) crystals can be found in the synovial fluid of non-inflamed joints in patients with CPPD related arthropathy; if so, to determine whether they interact with cells and produce subclinical inflammation in this setting.74 synovial fluid samples were obtained from non-inflamed knees of 74 patients with CPPD related arthropathy. Identification of CPPD crystals and synovial fluid cell counts were done manually in undiluted samples using a haematocytometric chamber. A supravital stain (Testsimplets, Boehringer Mannheim) was used to carry out differential counts and to assess the presence of intracellular crystals.All 74 samples contained CPPD crystals. The mean cell count was 301.4 cells/microl (95% confidence interval (CI), 216.6 to 386.4; range 22 to 2302.5). Mononuclear cells accounted for 83.2% (95% CI, 80.4% to 86.1%; range 43% to 99%), the rest being polymorphonuclear (PMN) cells (16.8% (95% CI, 13.9% to 19.6%; range 1% to 57%)). All the samples contained intracellular CPPD crystals, which were found in 24.0% of all the cells (95% CI, 20.1% to 27.9%; range 1% to 78%). Most of the intracellular crystals were inside mononuclear cells (22.2% of all the cells (95% CI, CI 18.5% to 25.9%)), although some PMN also contained them (1.8% of all the cells (95% CI, 1.1% to 2.4%)).CPPD crystals are normally found in synovial fluid of non-inflamed joints of patients with CPPD related arthropathy, and they interact with cells. The raised cell counts and percentage of PMN suggest mild subclinical inflammation in these joints.
The Effect of Oral 13-cis-retinoic Acid on Retinal Redetachment after Surgical Repair in Eyes with Proliferative Vitreoretinopathy
Authors: Sharon Fekrat, Eugene de Juan, Peter A. Campochiaro
Journal: Ophthalmology (1995)

To determine if postoperative oral 13-cis-retinoic acid alters the rate of recurrent retinal detachment in eyes undergoing surgery for proliferative vitreoretinopathy (PVR).Twenty eyes of 20 adult patients with a detachment due to PVR were identified after retrospective review of the patient records of a single vitreoretinal surgeon (EdJ) over an 18-month period (January 1992-August 1993). All 20 eyes underwent surgical repair using similar techniques. Ten patients received 40 mg oral 13-cis-retinoic acid twice daily for 4 weeks postoperatively (study group). The remaining ten patients did not (control group). The main outcome measure was retinal attachment or detachment.No statistically significant differences in preoperative patient characteristics or surgical procedure were present between the groups. Nine of ten eyes in the study group remained attached during a mean follow-up of 8.3 months, whereas four of ten eyes in the control group remained attached (P = 0.061) during a mean follow-up of 9.6 months. The rate of macular pucker was similar between the groups. The one eye in the study group that redetached did not have PVR. Of the six eyes in the control group that detached, four had 6 or more clock hours of PVR. The final visual acuity was better than 20/400 in six study eyes and four control eyes.Despite the small sample size and retrospective nature, the postoperative administration of oral 13-cis-retinoic acid appears to decrease proliferative vitreoretinopathy and increase the rate of retinal attachment after surgical repair. A prospective, randomized, controlled clinical trial is warranted.
Bedside Endosonography and Endosonography-Guided Fine-Needle Aspiration in Critically III Patients: A Way out of the Deadlock?
Authors: None Fritscher-Ravens, None Sriram, None Pothman, None Füllekrug, None Jäckle, None Thonke, None Soehendra
Journal: Endoscopy (2000)

Endosonography and endosonography-guided fine-needle aspiration (EUS-FNA) are now established diagnostic techniques, which are performed electively in endoscopy suites. We report here the bedside use of EUS-FNA in three critically ill patients in an intensive-care unit, with a significant impact on the outcome. A mediastinal abscess after percutaneous dilational tracheotomy was aspirated in one patient, leading to appropriate antibiotic therapy and complete recovery. A paratracheal hematoma compressing the right main bronchus was aspirated in a patient with polytrauma, relieving the pressure effects. The third patient, who had end-stage dilated cardiomyopathy and was being evaluated for cardiac transplantation, was found to have an apical lung lesion suspicious for bronchogenic carcinoma. EUS was performed to exclude mediastinal metastasis and allow simultaneous resection at the time of transplantation. Although a metastasis was excluded by EUS-FNA, the patient died while awaiting surgery. We conclude that bedside EUS-FNA is a feasible procedure, and in experienced hands it can offer an alternative in life-threatening situations.
Factors influencing duodenal trypsin levels following a standard test meal as a test of pancreatic function
Authors: I. J. Zeitlin, W. Sircus
Journal: Gut (1974)

In this investigation, the measurement of trypsin levels in duodenal juice following a standard test meal (Lundh test) was evaluated as a test of pancreatic function, and a study was made of diseases and other factors which may influence its diagnostic efficiency. The method of trypsin assay, which required only basic laboratory equipment, gave a linear concentration-activity curve, with a threshold at 50 mug of crystalline trypsin per ml. Intestinal juice could be frozen and stored for up to six weeks with no detectable loss of tryptic activity. The normal control values were very similar to those found by other workers and were unaffected by the sex or age of the subject. When used to assess 32 patients in whom the presence or absence of pancreatic disease had been clearly established, the test had a diagnostic success rate of 94%. Retrospective analysis of results from 98 patients showed that trypsin levels were generally grossly reduced in patients with chronic pancreatitis or carcinoma of the head of the pancreas. Trypsin levels were normal in most patients with steatorrhoea not of pancreatic origin. Levels were generally depressed to intermediate levels in patients with a diabetic glucose tolerance, with or without steatorrhoea, but no other sign of pancreatic insufficiency. Some lowering of trypsin levels was also noted in patients having an obstruction of the common bile duct. A small but significant depression of tryptic activity was noted in patients with villous atrophy and no pancreatic disease.
Inhibition of smooth muscle cell proliferation in injured rat arteries. Interaction of heparin with basic fibroblast growth factor.
Authors: V Lindner, N E Olson, A W Clowes, M A Reidy
Journal: Journal of Clinical Investigation (1992)

Heparin inhibits smooth muscle cell (SMC) proliferation after arterial injury by mechanisms that have yet to be defined. Since the initiation of SMC proliferation is mediated by basic fibroblast growth factor (bFGF), we have investigated the possibility that heparin inhibits SMC proliferation by displacing bFGF from the arterial wall. Using a rat carotid artery model of balloon catheter injury, we demonstrate that a bolus injection of heparin depletes the arterial wall of both systemically administered bFGF and of endogenous bFGF. Heparin, however, does not reduce the bFGF content of unmanipulated arteries. Further, a single injection of heparin given at the time of balloon injury reduces SMC proliferation by 55% but has no effect when given 6 h after injury. SMC proliferation induced in a denuded artery by injection of bFGF is inhibited almost completely by a bolus injection of heparin; however, pretreatment with a bolus of heparin does not prevent SMC from responding to a subsequent bolus of bFGF. These experiments suggest that heparin can inhibit SMC proliferation in part by removal of released bFGF from sites of injury.
NIH Funds Pilot Program to Repurpose Drug Candidates for New Uses
Authors: Bridget M. Kuehn
Journal: JAMA (2013)

A pilot program launched by the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health (NIH) will help researchers probe whether existing pharmaceutical candidate drugs can be repurposed (http://1.usa.gov/1962Sm5).
The Future of Voluntary Prepayment for Health Services
Authors: W. J. McNerney
Journal: New England Journal of Medicine (1965)

WE live in an era of redefinition.Almost every segment of society has undergone rapid change in recent years.New knowledge has pressed in upon us. Automation has put the human brain to work on new relations between employee and employer. Social pressures call for immediate adjustments in patterns of education and human relations. Urban living confronts us with new complexities.It is no wonder, then, that the relations between the Government and the health of the people are also being re-examined. In this relation the most intimate matters are joined with the most deliberate concerns of public policy.Much . . .
Effects of dioxins and furans on liver enzymes, lipid parameters, and thyroid hormones in former thermal metal recycling workers.
Authors: G Triebig, E Werle, O Päpke, G Heim, C Broding, H Ludwig
Journal: Environmental Health Perspectives (1998)

A cross-sectional study was performed to examine the internal exposure of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDF) in former workers in a nonferrous metal recycling facility. Liver enzymes, lipid parameters, and thyroid hormones were measured to check possible biologic effects. Compared to background levels, the international toxicity equivalent levels of exposed workers were slightly elevated (median 42 ppt, range 13-281 ppt). The workers also had higher total PCDF concentrations (median 128 ppt, range 30-1138 ppt). Correlation analyses demonstrate significant associations with only one liver enzyme, alanine aminotransferase. There were no such associations with serum cholesterol levels or with serum thyroid hormones. Because of the cross-sectional design of the study, firm conclusions cannot be drawn. For further evaluation, a follow-up examination appears necessary.
Comparative study of alkaline phosphatase isoenzymes, bone histology, and skeletal radiography in dialysis bone disease.
Authors: R B Naik, P Gosling, C P Price
Journal: BMJ (1977)

Liver, intestinal, and bone alkaline phosphatase isoenzymes were measured using heat stability and L-phenylalanine inhibition techniques in 78 patients on intermittent haemodialysis. Fifty-five patients had abnormalities in one or more of the isoenzymes. Changes in bone and intestinal alkaline phosphatase activities seemed to be related and raised liver isoenzyme activity was associated with the development of liver disease. Abnormal histological and radiological findings were better correlated with bone alkaline phosphatase levels than with total alkaline phosphatase, and serial estimations of bone isoenzyme activity were useful in assessing the response of renal osteodystrophy to treatment with a vitamin D analogue. Serum alkaline phosphatase isoenzyme measurement provides another useful and non-invasive index for monitoring metabolic bone disease in patients with chronic renal failure.
Treatment of Malignant Pleural Mesothelioma with Carboplatin, Liposomized Doxorubicin, and Gemcitabine: A Phase II Study
Authors: Gunnar Hillerdal, Jens Benn Sorensen, Stein Sundström, Henrik Riska, Anders Vikström, Anders Hjerpe
Journal: Journal of Thoracic Oncology (2008)
Current Status and Approaches to Improving Preventive Services for Adolescents
Authors: Vivien Igra
Journal: JAMA (1993)

MUCH of adolescent morbidity and mortality can be attributed to preventable risk factors. These include unhealthy behaviors, such as sedentary life-style, poor nutritional habits, substance abuse, unsafe sexual practices, and risky vehicle use.<sup>1</sup>Potentially health-damaging behaviors established during adolescence can have lasting negative consequences. As a result, effective preventive measures instituted during adolescence can improve quality of life throughout the life span. Primary care physicians are in a unique position to promote adolescent health and prevent behavioral and other morbidities. Over 70% of adolescents are seen by a physician yearly; three visits per year is the average.<sup>2</sup>Adolescents generally view physicians as credible and valued sources of health-related information.<sup>3</sup>Physician visits are thus a potentially important source of health education. As the benefits of incorporating prevention into the practice of medicine have become increasingly apparent over the past 20 or 30 years, efforts to develop comprehensive practice
Cloning may cause health defects
Authors: J. Jones
Journal: BMJ (1999)

Cloning may cause long term health defects, a study by French scientists has suggested. A two month old calf, cloned from genes taken from the ear of an adult cow, died after developing blood and heart problems.

The cloning process seemed to have interfered with the normal genetic functioning of the developing calf, according to the researchers whose findings are reported in the Lancet …
Nature of Oedema in Paralysed Limbs of Hemiplegic Patients
Authors: A. N. Exton-Smith, D. J. Crockett
Journal: BMJ (1957)

The formation of oedema in the paralysed limbs of hemiplegic patients has been a well-recognized pheno- menon for over half a century.Hare (1898) and Allen (1899) each described a case of "unusual oedema" in hemiplegia.In 1936 Luhan reviewed the literature and stated that 28 cases had been recorded; in addition he described in detail seven further cases.Although the mechanism of this type of oedema has not been clearly defined, it has usually been attributed to a disturbance of the blood vascular system in the affected limbs.Weiss and Ellis (1931) believe that the oedema results from an increase in capillary pressure which is in turn due to diminution in arteriolar tone in the paralysed limbs, while Bucy (1949) states that there is an increase in capillary permeability.We now produce new evidence that, in the upper limb at least, a major part in the formation of hemiplegic oedema is played by an impair- ment of lymphatic function.This evidence is based on a critical examination of the protein content of oedema fluids.Clinical Features Oedema in the paralysed limbs, occurring at some time during the clinical course, was noted in 21 patients in a series of 130 cases of hemiplegia.Thirteen of the oedema- tous patients had hemiplegia alone with no other important clinical condition, and in these cases it was noteworthy that the oedema was either confined to the arm or was more pronounced there than in the leg.In the remaining eight patients, who had other pathological processes besides hemi- plegia contributing to oedema formation, the swelling was often more marked in the paralysed leg than in the arm.These clinical features are summarized in Table I.TABLE I I Oedematous Limb Group Clinical No. of Group CoCndition Cases Arm Leg Arm Only Only and Leg 1 Hemiplegia alone ..
Where hypertension happens
Authors: Timothy L. Reudelhuber
Journal: Journal of Clinical Investigation (2013)

Essential hypertension, which accounts for 90%–95% of all cases of hypertension seen in the clinic, is also referred to as idiopathic hypertension, because we simply don’t understand the cause(s). Although many theories have been advanced, in the current issue of the JCI, Gonzalez-Villalobos et al. present further evidence implicating the intrarenal renin-angiotensin system and take us one step further by proposing a mechanism underlying this pathology.
Multiple Imaging Techniques: CSF Shunted Arnold Chiari Malformation with False???negative Brain Death Radionuclide Angiograms
Authors: MICHAEL F. HARTSHORNE, ROSA RAMIREZ, MICHAEL A. CAWTHON, JOHN M. BAUMAN, ROBERT D. KARL
Journal: Clinical Nuclear Medicine (1984)

HARTSHORNE, MICHAEL F. M.D., MAJ, MC; RAMIREZ, ROSA M.D., MAJ, MC; CAWTHON, MICHAEL A. D.O., CPT, MC; BAUMAN, JOHN M. M.D., CPT, MC; KARL, ROBERT D. M.D., LTC, MC Author Information
White Coat Hypertension
Authors: Linda M. Serwatka
Journal: JAMA (1988)

<h3>To the Editor.</h3> —Often, when I take the blood pressure reading of a male patient, the reading is higher early in the appointment and returns to normal later during the same office visit. The women patients in the study by Pickering et al<sup>1</sup>may well be relating to "the stereotype of the physician as a male authority figure," but one might find that men also relate to the female physician as an authority figure by displaying a similar blood pressure elevation. Unless the study is repeated using technicians and physicians of both sexes, the only valid conclusions can be that, while "white coat" hypertension is more pronounced when the blood pressure is measured by a physician than by a technician and while women may have higher blood pressure readings when taken by a male physician than by a female technician, the phenomenon may not be more common in women