tbuckley/cabot-search huggingface dataset:
Ethical Implications of Rejecting Patients for Clinical Trials
Authors: Wendy Chavkin
Journal: JAMA (1990)

<h3>To the Editor.—</h3> The excellent editorial by Dr Chalmers<sup>1</sup>neglects to mention a critically important group generally excluded from clinical trials: the population of fertile women. The Food and Drug Administration specifies their categorical exclusion because of the possibility of inadvertent exposure of an embryo to an experimental medication.<sup>2</sup> This stance relies on assumptions with which we disagree and has serious adverse consequences. The implicit underlying assumption is that an adult woman is not competent to participate in the informed decision-making process that leads to enrollment in a clinical trial, one in which she understands the risks and benefits for her own health and the theoretical risks to an embryo, and agrees to contracept for the duration of the clinical trial. The second assumption is that if she then experiences a contraceptive failure and conceives, she cannot responsibly and intelligently weigh the available information and decide whether to
DRGs and the Future of Surgical Practice
Authors: Helen L. Smits, Rita E. Watson
Journal: New England Journal of Medicine (1984)

DIAGNOSIS-related groups (DRGs) have been used as the basis for prospective payment to hospitals under Medicare since October 1983.1 The grouping method uses diagnoses and surgical procedures to classify every hospital discharge in 1 of 467 DRGs.2 , 3 Each DRG is assigned a weight that is then converted to a price. The use of surgical procedures to price hospital care makes surgical practice particularly vulnerable to any untoward effects of the new pricing mechanism.DRG-based payments provide the Health Care Financing Administration (HCFA) with a simple, easily enforceable mechanism to prevent payment for surgical procedures considered experimental or otherwise undesirable. DRG . . .
Diagnosis of trichomoniasis. Comparison of conventional wet-mount examination with cytologic studies, cultures, and monoclonal antibody staining of direct specimens
Authors: J. N. Krieger
Journal: JAMA (1988)

The accuracy of (1) conventional wet-mount examination, (2) Papanicolaoustained gynecologic smears, (3) a direct slide test using fluorescein-conjugated monoclonal antibodies against<i>Trichomonas vaginalis</i>, and (4) two different culture media for the diagnosis of trichomoniasis in a high-risk population of 600 women was compared. Use of Feinberg-Whittington or Diamond's culture medium resulted in a diagnosis of 82 and 78 cases, respectively, and the combination of two cultures identified 88 infected women. In comparison, wet-mount examination detected only 53 (60%) of the cases. Cytologic smears were interpreted as positive for<i>T vaginalis</i>in 49 (56%) of the 88 cases but also resulted in seven false-positive smears, and specimens from 18 women with negative cultures were interpreted as "suspicious" for trichomoniasis. Monoclonal antibody staining detected 76 (86%) of the 88 positive specimens, including 27 (77%) of the 35 cases missed by wet-mount examination. In summary, wet-mount and cytologic studies were insensitive, and cytology study was the least specific method for diagnosis of trichomoniasis. Direct immunofluorescence with monoclonal antibodies holds promise as a sensitive and specific alternative to cultures for rapid detection of<i>T vaginalis</i>in clinical specimens. (<i>JAMA</i>1988;259:1223-1227)
Chemical Properties of Air Pollutants and Cause-Specific Hospital Admissions among the Elderly in Atlanta, Georgia
Authors: Helen H. Suh, Antonella Zanobetti, Joel Schwartz, Brent A. Coull
Journal: Environmental Health Perspectives (2011)

Health risks differ by fine particle (aerodynamic diameter ≤ 2.5 μm) component, although with substantial variability. Traditional methods to assess component-specific risks are limited, suggesting the need for alternative methods.
A Fatal Case of Progressive Vaccinia
Authors: J. H. Connolly, G. W. A. Dick, C. M. B. Field
Journal: BMJ (1962)

Eight adult patients with acute transient arthritis of the hip are described.Follow-up periods varied from 9 to 54 months; average, 24 months.It is important to exclude acute bacterial arthritis by aspiration of the hip-joint.Two patients are diagnosed confidently, and one provisionally, as cases of rheumatoid arthritis.One patient is diagnosed as a case of rheumatoid arthritis (palindromic) and one as "palindromic rheumatism."One patient possibly suffered from Reiter's syndrome.As yet two patients remain undiagnosed.We thank Dr. R. M. Mason for kindly reading this paper and for several helpful suggestions.
The Relationship between Cardiac Massage and Pupil Size in Cardiac Arrest in Dogs
Authors: P. F. Binnion, R. J. McFarland
Journal: Cardiovascular Research (1968)

When normal cardiac action in dogs was replaced by cardiac compression in the presence of aconitine-induced ventricular fibrillation, there was a 70% reduction in cardiac output. This low cardiac output was capable of constricting previously dilated pupils produced when ventricular fibrillation occurred, and hypoxic paralysis of the oculomotor nucleus is considered responsible for the pupillary dilatation.
The Correlation of Pathology, Physical Signs, and X-ray Appearances in Development of Lung Cavitation
Authors: R. R. Trail
Journal: BMJ (1941)

The correlation of pathological findings with physical and radiological signs is an unfailing source of interest to the diagnostician.In diseases of the chest such a study is a fascinating game.It is still a game, in the nature of a jigsaw puzzle, in that the answer we continue to seek assiduously in most of the problems set is the individual living pathology, the pathogenesis at the moment of diagnosis, which shall act as the basis of that wider problem of individual treatment, ever the ultimate aim and true reward of the happy' physician.Not every player plays the game with the same pieces.Some claim ability to find the answer with a limited number; some even despise certain sets of pieces.Controversial articles on the value of mass radiography recently appearing in the medical press serve to illustrate this point.Certain writers have professed to be indepen- dent of x-ray aids in the diagnosis of tuberculosis; they say that to them clinical hist8ry and stethoscopic signs are all-sufficient.Some have gone to the other extreme and have relegated the stethoscope to the scrap-heap.Both classes may, as individuals, be entirely truthful in their statements, the first having ears to hear and the second eyes to see.We do well, however, to ignore deaf advocates of perpetual ear stops, however well they can see, and' preachers of permanent blinkers, however well they can hear.The "useless" club in our golf outfit is too often the one we have never learnt to use.The truth is, we still require every possible aid-pathological, radiological, and stethoscopic-in the diagnosis of chest disease if we would belong to the class of the happy physician " who stops, and who looks, and who' listens."Let us consider how these principles affect the discovery of cavitation, throughout its development, in bronchiec- tasis, abscess of lung, and tuberculosis. BronchiectasisWe will leave aside the much-discussed subject of con- genital bronchiectasis and confine ourselves to the disease in its acquired form.Even here there is controversy on the intrabronchial or extrabronchial origin, but it is gener- ally accepted that the first recognizable pathological change is dilatation of the bronchus, due to obstruction plus infec- tion, and that this dilatation is the first step in the production of the bronchiectatic abscess cavity.In children the process is usually'very acute, taking the form of ulcerative bronchitis, which breaks down the bronchial wall and invades the lung substance so rapidly that all the clinical and radiological findings of an advanced stage of adolescent and adult forms of the disease present almost from the first symptomatic evidences.
Mechanisms of Folic Acid Deficiency in Nontropical Sprue
Authors: Herman Baker, Oscar Frank, Harry Sobotka
Journal: JAMA (1964)

THE ANEMIA seen in nontropical sprue is commonly associated with folic (pteroylglutamic) acid deficiency which seems to be due to unknown interferences with absorption of this vitamin. In nontropical sprue there is impaired absorption of orally-administered folic acid as measured by urinary excretion or circulating levels after saturating the tissues with folic acid.<sup>1,2</sup>This malabsorption may be related to an enzyme defect in the intestinal mucosal cells.<sup>3</sup>The latter supposition initiated the studies reported here. We have developed an oral folic acid tolerance test using a microbial method which directly correlates serum folate activity with folate absorption and hemopoietic activity. This enabled us to study the absorption of folic acid and two folylglutamate conjugates, pteroyldiglutamic acid (pteroylglutamyl-α-glutamic acid) (Diopterin) and sodium pteroyl triglutamate (pteroylglutamyl-γ-glutamyl-γ-glutamic acid) (Teropterin), in normal subjects, patients with nontropical sprue, and patients with nutritional folate-deficiency anemia. <h3>Materials and Methods</h3> Absorption of a synthetic glutamyl conjugate,
Dimethylarginine Dimethylaminohydrolase Overexpression Suppresses Graft Coronary Artery Disease
Authors: Masashi Tanaka, Karsten Sydow, Feny Gunawan, Johannes Jacobi, Phil S. Tsao, Robert C. Robbins, John P. Cooke
Journal: Circulation (2005)

Background— Graft coronary artery disease (GCAD) is the leading cause of death after the first year of heart transplantation. The reduced bioavailability of endothelium-derived nitric oxide (NO) may play a role in endothelial vasodilator dysfunction and the structural changes that are characteristic of GCAD. A potential contributor to endothelial pathobiology is asymmetric dimethylarginine (ADMA), an endogenous NO synthase inhibitor. We hypothesized that lowering ADMA concentrations by dimethylarginine dimethylaminohydrolase (DDAH) overexpression in the recipient might suppress GCAD and long-term immune responses in murine cardiac allografts. Methods and Results— In one series, donor hearts of C-H-2 bm12 KhEg (H-2 bm12 ) wild-type (WT) mice were heterotopically transplanted into C57BL/6 (H-2 b ) transgenic mice overexpressing human DDAH-I or WT littermates and procured after 4 hours of reperfusion (WT and DDAH-I recipients, n=6 each). In a second series, donor hearts were transplanted into DDAH-I–transgenic or WT mice and procured 30 days after transplantation (n=7 each). In DDAH-I recipients, plasma ADMA concentrations were lower, in association with reduced myocardial generation of superoxide anion (WT versus DDAH-I, 465.7±79.8 versus 173.4±32.3 μmol · L −1 · mg −1 · h −1 ; P =0.02), inflammatory cytokines, adhesion molecules, and chemokines. GCAD was markedly reduced in cardiac allografts of DDAH-I–transgenic recipients as assessed by luminal narrowing (WT versus DDAH, 79±2% versus 33±7%; P &lt;0.01), intima-media ratio (WT versus DDAH, 1.1±0.1 versus 0.5±0.1; P &lt;0.01), and the percentage of diseased vessels (WT versus DDAH, 100±0% versus 62±10%; P &lt;0.01). Conclusions— Overexpression of DDAH-I attenuated oxidative stress, inflammatory cytokines, and GCAD in murine cardiac allografts. The effect of DDAH overexpression may be mediated by its reduction of plasma and tissue ADMA concentrations.
741-1 Clinical Experience with Heparin-Coated Stents–The Benestent II Pilot Phase 1
Authors: Håkan Emanuelsson, Patrick W. Serruys, Jorge Belardi, Hans Bonnier, Antonio Colombo, Jean Fajadet, Jean-Jacques Goy, Guy Heyndrickx, Peter de Jaegere, Victor Legrand, Cadas Macaya, Pierre Materne, Wolfgang Rutsch, Ulrich Sigwart, Harry Suryapranata
Journal: Journal of the American College of Cardiology (1995)
Munchausen Cases with Connections
Authors: CHARLES R. RETHY
Journal: Annals of Internal Medicine (1977)

Comments and Corrections1 March 1977Munchausen Cases with ConnectionsCHARLES R. RETHY, M.D.CHARLES R. RETHY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-86-3-368_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Within a 6-month period, I have observed three cases of Munchausen syndrome all of whom claimed important academic and political ties.Case 1. A 40-year-old mildly obese white man with chest pain was brought to New Gouverneur Hospital Emergency Room. The patient stated that he was a professor of sociology at Chico State University in California. Following a talk on "Patterns of Social Aberrancy" at Stony Brook University, New York, he developed chest pain. His medical history showed that a splenic artery implant into the left coronary artery had been done by Dr. Shumway. Physical examination was...References1. IRELANDSAPIRATEMPLETON PJB: Munchausen syndrome. Am J Med 43:579-592, 1967 CrossrefMedlineGoogle Scholar2. CHENGMEYERKELSER TJG: "Munchausen" coronary artery disease. Ann Intern Med 82:593-594, 1975 LinkGoogle Scholar3. SIMONSKATZ SM: Munchausen syndrome cases. Ann Intern Med 82:123-124, 1975 LinkGoogle Scholar4. FIALKMURRAY MH: Cardiac Munchausen syndrome. Ann Intern Med 81:562, 1974 LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByCase 28-1984Somatoform and Factitious DisordersLes maladies factices et le syndrome de MünchausenA review of the Munchausen syndromeMunchausen’s syndrome revisited 1 March 1977Volume 86, Issue 3Page: 368-368KeywordsEmergency departmentIschemiaLeft coronary arteryOverweight Issue Published: 1 March 1977 PDF DownloadLoading ...
Misadventure During Endotracheal Anesthesia
Authors: Joannes H. Karis
Journal: JAMA (1973)

<h3>To the Editor.—</h3> InThe Journal(225:524, 1973), an accident caused by impaction of a suction catheter in an endotracheal tube was reported. The catheter had become disconnected from its adapter during suctioning, while the thorax was open and the patient in the left lateral position. When attempts to remove the catheter with clamps failed, extubation and reintubation with a new tube were performed. This, as the author states was a hazardous procedure since the patient was "in the lateral position... obscured by drapes and his chest... open." Indeed, under the described conditions, intubation may be impossible and emergency tracheostomy too late. A faster and safer method is to slowly withdraw the endotracheal tube (with its impacted catheter) and then to cut 1.27-cm sections of the endotracheal tube until the catheter becomes visible. At this time, the catheter is grabbed and pulled back for 5.08 cm. A new endotracheal tube
Disulfide bond formation between dimeric immunoglobulin A and the polymeric immunoglobulin receptor during hepatic transcytosis†
Authors: Koteswara R. Chintalacharuvu, Anthony S. Tavill, Loizos N. Louis, Jean-Pierre Vaerman, Michael E. Lamm, Charlotte S. Kaetzel
Journal: Hepatology (1994)

The polymeric immunoglobulin receptor on rat hepatocytes binds dimeric IgA on the sinusoidal surface and mediates its transport to the canaliculus, where the complex of dimeric IgA and secretory component, the cleaved extracellular domain of polymeric immunoglobulin receptor, is secreted into bile. This process is unique in that disulfide bonds are formed between dimeric IgA and polymeric immunoglobulin receptor during transcytosis, permanently preventing their dissociation. Here we present three lines of evidence that disulfide bonding between dimeric IgA and polymeric immunoglobulin receptor occurs predominantly in a late transcytotic compartment and that hepatic transcytosis can proceed in the absence of disulfide bond formation. First, throughout the course of transcytosis the percentage of intracellular dimeric IgA disulfide bonded to polymeric immunoglobulin receptor is less than half that in bile, suggesting that disulfide bond formation is a late event in transcytosis. Second, dimeric IgA that recycles from early endocytotic compartments into the circulation is mostly noncovalently bound to secretory component. Finally, the rate of transcytosis of dimeric IgA and its appearance in bile are not affected when disulfide bond formation with polymeric immunoglobulin receptor is inhibited by blocking of free thiol groups on dimeric IgA with iodoacetamide. These results are consistent with other findings in the literature and indicate that the main physiological role of disulfide bond formation between dimeric IgA and polymeric immunoglobulin receptor is not to facilitate transcytosis but, rather, to stabilize the dimeric IgA-secretory component complex after its release into external secretions such as bile and intestinal secretions.
Hepatic Abscess in Liver Transplantation Accurate Diagnosis and Treatment
Authors: RICHARD K. J. BROWN, LESLIE D. F. MEMSIC, ELIZABETH J. PUSEY, ROSALIND B. DIETRICH, RONALD W. BUSUTTIL, RANDALL A. HAWKINS, HOOSHANG KANGARLOO
Journal: Clinical Nuclear Medicine (1986)

Serial HIDA scanning was performed on a patient following liver transplantation. During the patient's course he developed biliary obstruction that manifested as a photopenic region in the liver, on the HIDA scan which filled in on the delayed views. The patient subsequently developed a region in the superior portion of the right lobe of the liver that did not fill in with activity on delayed views. The patient was experiencing low-grade fevers and was clinically believed to have either an abscess or an episode of rejection. A gallium scan was performed revealing a photopenic defect in the same region as the HIDA. Because of the clinical suspicion of abscess, a percutaneous transhepatic drainage study was performed, revealing a large abscess cavity in the suspect area within the liver. Following the drainage the patient did well. This case illustrates the usefulness of serial HIDA scanning in patients who have received liver transplants. It also is important to note that the gallium scan was negative in this hepatic abscess. In the authors' opinions, the finding of an intrahepatic fluid collection in a septic patient that does not fill with activity on the HIDA study, should be considered the source of the infection, until proven otherwise, and should be drained regardless of the findings of other studies.
Endothelial function and slow coronary flow
Authors: Alpay Sezgin, Ahmet Sigirici, Irfan Barutcu, Ergun Topal, Nurzen Sezgin, Ramazan Ozdemir, Hakan Gullu, Ertan Yetkin, Izzet Tandogan
Journal: Journal of the American College of Cardiology (2003)
Acanthosis Nigricans and Endocrine Disease
Authors: Helen Ollendorff Curth
Journal: JAMA (1961)

<h3>To the Editor:—</h3> It is of the greatest importance to differentiate malignant acanthosis nigricans, which is one of the best external clues to internal adenocarcinoma, from benign and pseudo acanthosis nigricans, which do not threaten the patient's life. The paper by Winkelmann, Scheen, Jr., and Underdahl (The JournalOct. 29, 1960, p. 1145), however, does not decrease the difficulties of differentiating the various types. Winkelmann<i>et al</i>. apply to the benign type, which is present at birth or begins in childhood or at puberty, the term "congenital," which they do not use in its strict sense, meaning present at birth, but as "referring to the state [of acanthosis nigricans] having been present since infancy." What they call benign post-pubertal acanthosis nigricans is either malignant or pseudo acanthosis nigricans, since the benign type does not begin after puberty. It seems difficult to connect, as they do, acanthosis nigricans with so many
DNA methylation patterns of the γδβ‐globin genes in human fetal and adult erythroid tissues
Authors: L. S. L. Loo, M. N. Cauchi
Journal: American Journal of Hematology (1992)

Abstract An investigation of the correlation between the γ→β‐globin switch and DNA methylation was carried out. The restriction patterns obtained with methylation‐sensitive and ‐insensitive enzymes indicated hypomethylation in the promoter region of the γ‐globin genes in fetal liver DNA but high methylation of the same region in all other samples (except in the presence of an elevated erythroblast count or leukemia). All samples appeared to be partially hypomethylated at the 5′ end of the δ‐globin gene and hypomethylated at the 3′ region of the β‐globin gene. Although consistent with a role for DNA methylation in globin gene regulation, the results also suggest that other factors besides methylation may be required for regulation of the level of expression, and switching of the globin genes. © 1992 Wiley‐Liss, Inc.
Neurogenic mechanisms in bronchial inflammatory diseases
Authors: D. A. Groneberg, D. Quarcoo, N. Frossard, A. Fischer
Journal: Allergy (2004)

Neurogenic inflammation encompasses the release of neuropeptides from airway nerves leading to inflammatory effects. This neurogenic inflammatory response of the airways can be initiated by exogenous irritants such as cigarette smoke or gases and is characterized by a bi‐directional linkage between airway nerves and airway inflammation. The event of neurogenic inflammation may participate in the development and progression of chronic inflammatory airway diseases such as allergic asthma or chronic obstructive pulmonary disease (COPD). The molecular mechanisms underlying neurogenic inflammation are orchestrated by a large number of neuropeptides including tachykinins such as substance P and neurokinin A, or calcitonin gene‐related peptide. Also, other biologically active peptides such as neuropeptide tyrosine, vasoactive intestinal polypeptide or endogenous opioids may modulate the inflammatory response and recently, novel tachykinins such as virokinin and hemokinins were identified. Whereas the different aspects of neurogenic inflammation have been studied in detail in laboratory animal models, only little is known about the role of airway neurogenic inflammation in human diseases. However, different functional properties of airway nerves may be used as targets for future therapeutic strategies and recent clinical data indicates that novel dual receptor antagonists may be relevant new drugs for bronchial asthma or COPD.
Healthcare costs hit older Americans
Authors: F. Charatan
Journal: BMJ (2002)

Elderly Americans are being hit hardest by rising healthcare costs, and doctors are beginning to refuse Medicare patients because the payments from the government do not cover the costs, the doctors say.

In the last two years US spending on health care rose by more than 8% each year ( BMJ 2001;322:692). Medicare covers either fee-for-service care with a private doctor or membership in a health maintenance organisation for people aged over 65. But many older Americans were dropped when health …
What's so great about collaboration?
Authors: M. Zwarenstein
Journal: BMJ (2000)

General practice pp 1038, 1043, 1048, 1053 

A recent white paper on the NHS strongly recommended improved teamwork between professionals.1 On what basis? How well do nurses and doctors collaborate? Does it matter to anyone? And if it matters, can it be improved? The short answer to all of these questions is: We don't know.

The modern concern with interactions between doctors and nurses began with an opinion piece in a psychiatric journal in 1967. It likened the relationship to a …
Newborn screening for severe combined immunodeficiency and T-cell lymphopenia in California: Results of the first 2 years
Authors: Antonia Kwan, Joseph A. Church, Morton J. Cowan, Rajni Agarwal, Neena Kapoor, Donald B. Kohn, David B. Lewis, Sean A. McGhee, Theodore B. Moore, E. Richard Stiehm, Matthew Porteus, Constantino P. Aznar, Robert Currier, Fred Lorey, Jennifer M. Puck
Journal: Journal of Allergy and Clinical Immunology (2013)