tbuckley/cabot-search huggingface dataset:
Helping Physicians Recognize Bedside Rationing
Authors: Lawrence R. Freedman
Journal: Annals of Internal Medicine (1997)

Letters1 June 1997Helping Physicians Recognize Bedside RationingLawrence R. Freedman, MDLawrence R. Freedman, MDUniversity of California, Los Angeles School of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-126-11-199706010-00031 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Drs. Ubel and Goold [1] recently made a useful contribution to the subject of rationing of medical care at the bedside. I do not dispute the reality of rationing medical care and the reasons that are used to justify it. However, I find it troubling that proponents of rationing seem unwilling to advocate that patients receive an explanation of the conditions under which the physician is working when the physician–patient relationship is first established. In other words, the physician should speak with the patient at the outset about factors, if there are any, that might interfere with ...REFERENCE1. Ubel PA, Goold S. Recognizing bedside rationing: clear cases and tough calls. Ann Intern Med. 1997; 126:74-80. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of California, Los Angeles School of Medicine, West Los Angeles Veterans Affairs Medical Center, Los Angeles, CA 90073 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 June 1997Volume 126, Issue 11Page: 921KeywordsPatient advocacy Issue Published: 1 June 1997 CopyrightCopyright © 1997 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Diagnostic Assessment of Dementia
Authors: David K. Gittelman
Journal: Annals of Internal Medicine (1989)

Letters and Corrections15 April 1989Diagnostic Assessment of DementiaDavid K. Gittelman, DODavid K. Gittelman, DOSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-110-8-669_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor: Dr. A.M. Clarfield has provided a thorough review and critique of the literature on causes of dementia (1). However, I do not believe the conclusions reached are necessarily supported by the evidence presented.Dr. Clarfield convincingly arrives at figures of 3% of dementias completely reversed and 8% partially reversed, by proper evaluation and treatment. Dr. Clarfield asserts that 11 % of dementias reversing is a lesser but truer figure than usually quoted in the literature. However, the author also argues that we should then be more conservative in our diagnostic evaluations of dementia.My real concern with...Reference1. Clarfield A. The reversible dementias: do they reverse? Ann Intern Med. 1988;109:476-86. LinkGoogle Scholar1. MoldStein JH. The cascade effect in the clinical care of patients. N Engl J Med. 1986;314:512-4. CrossrefMedlineGoogle Scholar2. Mulley G. Differential diagnosis of dementia [Editorial]. Br Med J 1986;292:1416-8. CrossrefMedlineGoogle Scholar3. Anderson M. Normal pressure hydrocephalus (Editorial). Br Med J. 1986;293:837-8. CrossrefMedlineGoogle Scholar4. MartinMillerKapoor DJW. Clinical production rules for computed tomographic scanning in senile dementia. Arch Intern Med. 1987;147:77-80. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: University of North Carolina School of Medicine Chapel Hill, NC 27599-7160 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 April 1989Volume 110, Issue 8Page: 669-670KeywordsDementia Issue Published: 15 April 1989 PDF DownloadLoading ...
Pyogenic granuloma of the common bile duct in a patient with choledochoduodenostomy
Authors: C. Lee, S. Dong, S. Jung, J. Jang, H. Kim, B. Kim, Y. Chang, R. Chang, Y. Kim
Journal: Endoscopy (2007)

Pyogenic granuloma is a polypoid form of capillary hemangioma that occurs mostly on the skin and the mucous membranes of the nasal and oral cavities [1]. Although pyogenic granuloma in the digestive tract excluding the oral cavity is a rarity, it can cause significant gastrointestinal bleeding, and curative resection is required for treatment in most cases [2]. We describe a case of pyogenic granuloma of the common bile duct (CBD) that was observed on endoscopy and was successfully treated by endoscopic snare polypectomy.
THE UTILITY OF CORONARY ARTERY CALCIUM IN PREDICTING MORTALITY AT EXTREMES OF AGE: EVALUATION OF AN ASYMPTOMATIC REFERRED COHORT
Authors: Rajesh Tota-Maharaj, Michael J. Blaha, Evan D. Muse, Roger S. Blumenthal, Matthew J. Budoff, Leslee J. Shaw, Daniel S. Berman, Jamal S. Rana, Khurram Nasir
Journal: Journal of the American College of Cardiology (2011)
Necrotizing Fasciitis Due to Group A Streptococcus after an Accidental Needle-Stick Injury
Authors: Carin Hagberg, Adriana Radulescu, John H. Rex
Journal: New England Journal of Medicine (1997)

To the Editor: While inserting a central venous catheter into a patient newly admitted to our hospital with sepsis of unknown cause, a healthy, 27-year-old resident was scratched on the dorsal aspe...
Abstract 2180: Identification of nuclear transcription factor Y (NF-Y) as a novel key transcriptional regulator of the tumor-suppressor gene <i>DAPK1</i>
Authors: Christopher R. Schmidt, Christopher C. Oakes, Michael Boutros, Christoph Plass
Journal: Cancer Research (2012)

Abstract The death-associated protein kinase 1 (DAPK1) belongs to a family of multifunctional Ser/Thr-kinases that plays a crucial role in the mediation of cell death, autophagy and tumor suppression. Loss or reduced expression of DAPK1 occurs in the majority of patients with chronic lymphocytic leukemia (CLL) and many other non-hematological tumors commonly involving epigenetic silencing. To identify novel key DAPK1 transcriptional regulators, we conducted an siRNA screen in HEK293 cells using a custom library targeting over 60 individual genes with known or predicted DNA-binding function and general potential to modulate transcription. Candidate gene selection for siRNA-mediated knock-down was based on previous genome-wide siRNA screening experiments and in silico prediction of binding sites at the DAPK1 promoter region. As endogenous readout, DAPK1 mRNA expression was monitored by qRT-PCR.Using this strategy, we identified nuclear transcription factor Y (NF-Y) as the top positive regulator of DAPK1 that reduces its expression down to 55% of the level determined in untargeted control siRNA-treated cells. NF-Y is a well known transcriptional regulator of genes involved in cell cycle control, apoptosis and stress response. NF-Y consists of 3 subunits, NF-YA, -YB and -YC, forming a trimeric complex which is essential for specific binding of CCAAT boxes located proximal to the transcriptional start sites of genes. In addition to HEK293 cells, we were able to diminish DAPK1 mRNA expression upon siRNA-mediated NF-Y knockdown in a panel of 6 different cancer cell lines. Conversely, co-overexpression of NF-YA,-YB and -YC in HEK293 cells leads to increased expression levels of DAPK1. To investigate whether NF-Y contributes directly or indirectly to DAPK1 transcriptional regulation, DAPK1 luciferase reporter constructs harboring the predicted NF-Y binding site were generated. Point mutation of the reverse CCAAT-box in the DAPK1 promoter constructs significantly reduces the promoter activity down to 60% of the wild-type promoter. Furthermore, NF-Y knockdown significantly reduces the activity of the wild-type DAPK1 luciferase construct down to 55% in reporter assays. Strikingly, the CCAAT-box mutated constructs do not show altered activity after NF-Y depletion, suggesting a direct regulation of DAPK1 by NF-Y. Taken together, these results strongly indicate a direct role for NF-Y in the regulation of basal DAPK1 transcription levels, and also propose a novel mechanism for aberrant transcriptional silencing of DAPK1 in cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2180. doi:1538-7445.AM2012-2180
Epidemiology of AIDS in Women in the United States
Authors: Mary E. Guinan
Journal: JAMA (1987)

An analysis of 1819 cases of acquired immunodeficiency syndrome (AIDS) in women reported between 1981 and 1986 showed that the majority of women with AIDS were intravenous drug users. The second most common risk group was heterosexual contact with a person at risk for AIDS. The proportion of women with AIDS in this risk group increased significantly between 1982 and 1986, from 12% to 26%. This trend may prove to be a good marker for following trends in heterosexual transmission. Since the majority of childhood AIDS cases are a result of perinatal transmission from the mother, trends in AIDS cases in women may also predict future trends for AIDS in children. (<i>JAMA</i>1987;257:2039-2042)
Italian GPs suspended for accepting bribes
Authors: F. Turone
Journal: BMJ (1998)

More than a hundred Italian GPs have been suspended for two months after accusations that they accepted bribes and gifts in return for sending patients to a private centre for unnecessary radiological examinations. Controversially, the radiologist accused of corrupting the GPs has now been reinstated.

The scandal exploded in Milan last May. Two local national health service managers …
Two new studies point to single nucleotide polymorphisms in RUNX1 binding sites as critical events in inflammatory disorders
Authors: Burton Zweiman, Marc E Rotherberg
Journal: Journal of Allergy and Clinical Immunology (2004)

RUNX1 is a transcription factor involved in hematopoietic and endothelial cell development, CD4 silencing, and the development of myelogenous leukemia. Two recent studies have identified single nucleotide polymorphisms (SNPs) in the RUNX1 binding site of distinct genes as the susceptibility loci involved in inflammatory diseases. In one study, Helms et al examined the genetic linkage of psoriasis with chromosome 17q24-25. Two strong linkage peaks separated by 6 Mb were found. One peak was between the genes SLC9A3R1 and NAT9. SLC9A3R1 is a gene encoding for a PDZ domain–containing phosphoprotein that associates with members of the ezrin-radixin-moesin family, which is implicated in T-cell synapse formation and epithelial membrane biology. NAT9 is a new member of the N-acetyltransferase family. The other peak of association is in the gene RAPTOR (p150 target of rapamycin [TOR]–scaffold protein containing WD-repeats). Although the exact gene involved in the disease susceptibility was not demonstrated, evidence was provided that SLC9A3R1 was the most likely candidate. Indeed, SLC9A3R1 was overexpressed in psoriatic skin T cells in comparison with normal tissues and T cells, respectively. A disease-associated SNP lying between SLC9A3R1 and NAT9 leads to loss of a RUNX1 binding site. Indeed, extracts from human T cells (Jurkat cell lines) failed to bind to the mutant RUNX1 binding site. In another study, Tokuhiro et al aimed to define the rheumatoid arthritis genetic susceptibility at the cytokine locus on chromosome 5q31. Significant linkage was found between rheumatoid arthritis and the organic cation transporter gene SLC22A4. The investigators showed that SLC22A4 was specifically expressed in hematologic and immune tissue and overexpressed in the joints of mice with collagen-induced arthritis. In addition, they identified a SNP in the SLC22A4 gene that affected binding of RUNX1 (resulting in depressed SLC22A4 expression). Interestingly, the authors also identified a SNP in RUNX1 that was strongly associated with rheumatoid arthritis as well. The data presented in this later paper provided strong evidence for an epistatic effect of 2 genes promoting the same inflammatory disorder. It is interesting to note that loss of a RUNX1 binding site has recently been associated with susceptibility to another autoimmune disease (systemic lupus erythematosus). Taken together, these studies provide strong evidence that the RUNX1 gene is critically involved in inflammatory disorders. As such, RUNX1 is likely to become an important diagnostic and therapeutic target for disease intervention. These articles, demonstrating the remarkably distinct ways in which RUNX1 contributes to different inflammatory disorders, highlight the complex mechanisms involved in immune-based disorders. (Helms et al. Nat Genet 2003;35:349-56. Tokuhiro et al. Nat Genet 2003;35:341-8.)
p-Nonyl-phenol: an estrogenic xenobiotic released from "modified" polystyrene.
Authors: A M Soto, H Justicia, J W Wray, C Sonnenschein
Journal: Environmental Health Perspectives (1991)

Alkylphenols are widely used as plastic additives and surfactants. We report the identification of an alkylphenol, nonylphenol, as an estrogenic substance released from plastic centrifuge tubes. This compound was extracted with methanol, purified by flash chromatography and reverse-phase high performance liquid chromatography, and identified by gas chromatography-mass spectrometry. Nonylphenol induced both cell proliferation and progesterone receptor in human estrogen-sensitive MCF7 breast tumor cells. Nonylphenol also triggered mitotic activity in rat endometrium; this result confirms the reliability of the MCF7 cell proliferation bioassay. The estrogenic properties of alkylphenols, specifically nonylphenols, indicate that the use of plasticware containing these chemicals in experimental and diagnostic tests may lead to spurious results, and these compounds as well as alkylphenol polyethoxylates may also be potentially harmful to exposed humans and the environment at large.
Obesity: new insight into the anthropometric classification of fat distribution shown by computed tomography.
Authors: M Ashwell, T J Cole, A K Dixon
Journal: BMJ (1985)

Twenty eight women presenting for routine computed tomography had their waist, hip, and thigh circumferences measured. The ratio of the area of intra-abdominal fat to the area of subcutaneous fat shown in the computed tomogram taken at the umbilical level was calculated and found to correlate highly significantly with the ratio of waist to hip circumference. The correlation between these two ratios remained significant after allowing for the degree of obesity (weight (kg)/height (m)2) and age. In contrast, there was no significant correlation between the ratio of intra-abdominal to subcutaneous fat and degree of obesity. A high ratio of waist to hip circumference has been shown to be associated with a high proportion of intra-abdominal fat. Thus women with a centralised distribution of fat (high waist to hip ratio: "apples") tend to have a greater proportion of their fat in the intra-abdominal depot than do women with a peripheral fat distribution (low waist to hip ratio: "pears"). The metabolic complications of obesity, which are associated with a high ratio of waist to hip circumference, may therefore relate specifically to the amount of intra-abdominal fat.
Analysis of ventricular shape by echocardiography in normal fetuses, newborns, and infants.
Authors: A Azancot, T P Caudell, H D Allen, S Horowitz, D J Sahn, C Stoll, C Thies, L M Valdes-Cruz, S J Goldberg
Journal: Circulation (1983)

Qualitative and quantitative changes in left ventricular shapes were analyzed in 14 normal fetuses, 29 normal newborns, and 12 normal infants. Qualitative observations demonstrated that most fetuses and newborns with dominant right ventricles had flattened or even indented interventricular septae, which changed left ventricular shape into an ellipse. In contrast, left ventricular shapes in infants were round, similar to shapes described in older children and adults. When changes in shape or septal distortions were gross, interobserver agreement was 100%; when changes were less altered from a circular shape, interobserver agreement was 78%. To avoid subjective misinterpretations, quantitative analyses were performed, including M mode echocardiographic comparisons of right ventricular/left ventricular dimensions and left ventricular cavity anterior-posterior/lateral diameters, as well as Fourier analysis of digitized tracings of the entire left ventricular shape. The right ventricular/left ventricular ratio, determined by M mode echocardiography, showed significant differences between fetuses (1.07 +/- 0.07) and newborns (0.62 +/- 0.12) (p less than .001). Infants had a significantly lower right ventricular/left ventricular ratio (0.45 +/- 0.01) when compared with newborns (p less than .01). Ratios of left ventricular anterior-posterior/lateral diastolic diameters were significantly lower (p less than .001) in newborns (0.66 +/- 0.08) when compared with those of infants (0.82 +/- 0.10). All diameters tended to increase (toward roundness) with systole and with aging. Fourier analysis allowed evaluation of the entire left ventricle, including that portion of the septum that qualitatively appeared most indented and could not be analyzed by either of the above techniques. Shape factor derived from idealized shapes ranging from a circle to an indented ellipse allowed comparison with digitized left ventricular tracings. This technique allowed accurate quantitation of the observed changes in shape. Fetuses had the highest diastolic shape factor (7.47 +/- 0.92), whereas infants' shape factors were lowest (2.12 +/- 0.41). A tendency toward roundness and loss of distortion occurred with aging. Systolic shape factor was lower with aging in each group studied. The Fourier technique used in this study allows evaluation of an arbitrarily large number of components of a shape, and thus a complete description of that shape is permitted. Comparisons of right ventricular/left ventricular diastolic dimensions and left ventricular anterior-posterior/lateral comparisons are subsets of this technique, which allow evaluation of only two points (circular component-first harmonic) or four points (elliptical component-second harmonic) of an overall shape.(ABSTRACT TRUNCATED AT 400 WORDS)
A fatty neuropeptide. Potential drug for noninvasive impotence treatment in a rat model.
Authors: I Gozes, M Fridkin
Journal: Journal of Clinical Investigation (1992)

Vasoactive intestinal peptide (VIP), a key penile neurotransmitter, induces erection after local injection in man. To augment the therapeutic potential of VIP for impotence treatment and circumvent difficulties of direct penile injections, a strategy was designed to increase peptide hydrophobicity. This was accomplished by the synthesis of a conjugate of VIP and stearic acid (stearyl-VIP). Upon penile topical application, stearyl-VIP, in contrast to native VIP, significantly increased sexual function as measured by copulatory activity and penile reflexes (erections) in testosterone-treated, castrated rats. In addition, stearyl-VIP penetrated the body in amounts severalfold greater than VIP. Pharmacokinetic studies demonstrated 10-fold higher penile concentrations of stearyl-VIP, as compared with that measured in the blood 15 min after application, with a gradual decrease thereafter. The peak of incorporation into peripheral tissues that was observed 30 min after administration was 1,000-fold less than that found in the penile tissue. Tissue extraction and chromatographic analysis revealed that stearyl-VIP remained essentially intact for greater than or equal to 15 min and was cleared after 1 h. Thus, topically administered stearyl-VIP had increased bioavailability in comparison with VIP without apparent toxicity, suggesting significant therapeutic potential.
Landmark perspective. Diffuse collagen disease
Authors: G. E. Ehrlich
Journal: JAMA (1984)

From the perspective of 1984, the concept of diffuse collagen disease may not seem to be such a major advance. After all, rheumatology and clinical immunology are coming of age and assuming an important place in the spectrum of internal medicine, and the diseases that together form this category — today known as the connective tissue disorders or dyscollagenoses in the United States and systemic connectivitis abroad<sup>1</sup>— provide the backbone of these two new specialties. But the holistic viewpoint that groups rheumatoid arthritis with systemic lupus erythematosus, perhaps with Sjögren's syndrome as a bridge, and encompasses progressive systemic sclerosis, polyarteritis nodosa, and variant forms of vasculitis, polymyositis and dermatomyositis, eosinophilic fasciitis, and some rare or disappearing disorders, including perhaps even rheumatic fever, reflects skills in the laboratory and a respectability that could not be claimed in 1942. Thus, the 47th annual meeting of the American Rheumatism Association, held in
TCT-76 Predictive Value of the J-CTO Score in Percutaneous Coronary Interventions for Chronic Total Occlusions
Authors: Giuseppe Ferrante, Yves Louvard, Talal Harb, Thierry Unterseeh, Thomas Hovasse, Marie-Claude Morice, Bernard Chevalier, Thierry Lefèvre, Philippe Garot
Journal: Journal of the American College of Cardiology (2012)
Flank Pain, Hematuria, and Allergy to Intravenous Pyelogram Dye
Authors: Sumner Marshall
Journal: JAMA (1981)

WHEN a patient appears in the emergency room with flank pain, bloody urine, and a history of allergy to intravenous pyelogram (IVP) dye, the physician should be aware of the strong possibility of contrived illness. We have encountered many such patients over the years. However, since every time these patients appear their stories and clinical findings seem so convincing to the hosptal staff, we believe the characteristics that make up this "profile" are worth describing. The following case illustrates many of these characteristics. <h3>Report of a Case</h3> A man in his mid-20s arrived unaccompanied in the emergency room of a Berkeley, Calif, hospital on a Saturday at 2 AM, complaining of severe abdominal and flank pain with grossly bloody urine. He had no identification with him. He stated that, because of a previous severe allergic reaction after ingestion of shellfish, he had been strongly advised never to permit the intravenous