tbuckley/cabot-search huggingface dataset:
Ethical Dilemmas for House Staff Physicians
Authors: William Winkenwerder
Journal: JAMA (1985)

THE LIFE-SUSTAINING capability of modern medicine, coupled with its difficult ethical choices, has become the physician's most challenging moral dilemma<sup>1-5</sup>(<i>US News and World Report</i>, Dec 6, 1982, p 53;<i>Time</i>, April 9, 1984, p 68). Caring for critically ill and dying patients is a difficult task that often vacillates between the rational and the absurd, the uplifting and the morbid. Conflicts in values among caretakers are frequently present, and uncertainty is pervasive. This article addresses the issue of distinctive ethical dilemmas faced by residents in caring for critically ill and dying patients, a problem that springs from the increasing capabilities of medicine and the peculiar role of residents in our medical hierarchy. Residents are fully licensed to practice medicine, but they are not totally autonomous. They have heavy responsibilities in patients' care, but they are not independent in making many decisions. They are usually the primary caretakers, but
Biological Foundations of Psychiatry
Authors: Sidney Malitz
Journal: JAMA (1977)

Biological psychiatry is an interdisciplinary science that studies the basic foundations of behavior, including the abnormal behavior of the mentally ill. It brings to bear on psychiatric problems the armamentaria of physics, chemistry, cell biology, neurophysiology, psychopharmacology, and genetics. The individual authors are, for the most part, outstanding in their respective fields. The first volume deals with the broad aspects of genetics and behavior in psychiatry, followed by a review of physiology and behavioral data. The excellent overview of genetics and behavior in psychiatry in the first volume touches on material in the second volume regarding genetic factors in schizophrenia and the genetics of affective disorder. Some of the topics covered in the first volume include hemispheric specialization, sensory and perceptive factors in emotional functions of the brain, drive and motivation, and the neurobiology of motivated behavior. Also discussed are hunger and thirst, the neural basis of threatened attack, the
Human T-Cell Leukemia Virus Type I at Age 25: A Progress Report
Authors: Masao Matsuoka, Kuan-Teh Jeang
Journal: Cancer Research (2005)

Abstract It has been 25 years since the discovery of human T-cell leukemia virus type I (HTLV-I) and its role in adult T-cell leukemia. Here, in brief, we review the current state of our understanding of HTLV-I epidemiology, viral biology, pathogenesis, and treatment. We discuss how HTLV-I may transform cells through destabilization of cellular genomic integrity and induction of cellular tolerance for chromosomal errors.
Elevated blood pressure in norwegian elite football players is associated with both increased sympathetic activity and LV mass
Authors: H Berge, G Gjerdalen, T E Andersen, K Steine, E Solberg
Journal: British Journal of Sports Medicine (2011)

Background UEFA requires that all male players of the elite teams undergo cardiovascular screening, which was conducted as a research project in Norway. Objective To study the prevalence of elevated blood pressure (BP), and test if there were any relation to consequences of hypertension as increased left ventricle (LV) mass or diastolic dysfunction. Design Cross-sectional study. Setting Training-camp, La Manga, Spain, 2008. Participants All football players in the two elite-divisions in Norway were invited, 28 of 30 teams participated. 594 of 636 players finished the study. Assessment of risk factors Standard BP measurements, high BP is defined &gt;=140/90 mm Hg according to ESC standards. Height and weight were self reported, body mass index (BMI), body surface area and pulse pressure (PP) were calculated. Main outcome measurements The echocardiographic parameters were indexed LV mass, relative wall thickness (RWT), heart rate (HR), and peak early (E) and late (A) diastolic transmitral velocities. The E/A ratio was calculated as an index for LV diastolic function. Results Mean age: 25 years (range 18–38), mean BMI: 23.7 kg/m2 (20–29) and mean BP: 122/69 mm Hg. 38 players (6.4%) had hypertension grade 1, and two had hypertension grade 2. There was a significant linear relationship between mean arterial pressure (MAP) and indexed LV mass, HR and PP with regression coefficient 0.26 (95% CI 0.08 to 0.44), 0.20 (95% CI 0.10 to 0.29), and 0.18 (95% CI 0.07 to 0.29), p&lt;0.01. No such correlation was found between RWT, E/A ratio and MAP. Conclusion Elevated BP was associated with increased PP and HR, indicating increased sympathetic activity. Those with elevated BP had significantly increased indexed LV mass, indicating an early start of end organ damage. Considering that detection of elevated BP at one single occasion in young age may predict manifest hypertension later in life, our data support BP screening of athletes.
Human forearm metabolism during progressive starvation
Authors: O. E. Owen, George A. Reichard
Journal: Journal of Clinical Investigation (1971)

Forearm muscle metabolism was studied in eight obese subjects after an overnight, 3 and 24 day fast. Arterio-deep-venous differences of oxygen, carbon dioxide, glucose, lactate, pyruvate, free fatty acids, acetoacetate, and beta-hydroxybutyrate with simultaneous forearm blood flow were measured. Rates of metabolite utilization and production were thus estimated. Oxygen consumption and lactate and pyruvate production remained relatively constant at each fasting period. Glucose, initially the major substrate consumed, showed decreased consumption after 3 and 24 days of fasting. Acetoacetate and beta-hydroxybutyrate consumption after an overnight fast was low. At 3 days of fasting with increased arterial concentrations of acetoactate and beta-hydroxybutyrate, consumption of these substrates rose dramatically. At 24 days of fasting, despite further elevation of arterial levels of acetoacetate and beta-hydroxybutyrate, the utilization of acetoacetate did not increase further and if anything decreased, while five out of eight subjects released beta-hydroxybutyrate across the forearm. Acetoacetate was preferentially extracted over beta-hydroxybutyrate. At 24 days of starvation, free fatty acids were the principal fuels extracted by forearm muscle; at this time there was a decreased glucose and also ketone-body consumption by skeletal muscle.
Cosmetic-Related Changes on 18F-FDG PET/CT
Authors: Linh Ho, John Seto, Vincent Ngo, Harvard Vuu, Heidi Wassef
Journal: Clinical Nuclear Medicine (2012)

We present 4 cases of cosmetic-related changes on 18F-FDG PET/CT. These cases represent post-treatment changes from facial juvederm injection, silicone injection in the chest wall and gluteal areas, paraffin injection in the gluteal region, and liposuction. Recognition of cosmetic-related changes and their appearance on PET and CT will help to avoid potential false-positive interpretations.
Diagnostic Duodenal Bulb Biopsy in Celiac Disease
Authors: H. Vogelsang, S. Hänel, B. Steiner, G. Oberhuber
Journal: Endoscopy (2001)

Background and Study Aims: Duodenal or jejunal biopsies are needed to establish the diagnosis of celiac disease. It is widely advocated that these biopsies be taken from the distal duodenum.
Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis
Authors: Ciarán O'Driscoll, Jennifer Laing, Oliver Mason
Journal: Clinical Psychology Review (2014)

Many individuals with schizophrenia are reported to have maladaptive expression and processing of emotion. This may take the form of conscious and implicit processes. Potential regulatory processes underlying schizophrenia are reviewed. We aimed to estimate effect sizes, potential heterogeneity and publication bias across three areas of measurement: a range of cognitive emotion regulation strategies(1) (CERS), alexithymia and dissociation.Data were pooled from 47 case-control studies involving measures of experiential avoidance, attentional deployment, cognitive reappraisal, emotion management, dissociation and alexithymia. All studies were rated for quality, risk of bias and publication bias.The following effect sizes (g) were observed: emotion management: 0.96 [0.77, 1.14] and cognitive reappraisal: 0.49 [0.32, 0.66] were negatively associated with schizophrenia. Experiential avoidance: -0.44 [-0.59, -0.29], attentional deployment -0.96 [-1.18, -0.75], dissociation: -0.86 [-1.13, -0.60] and alexithymia: -1.05 [-1.45, -0.65] were positively associated with schizophrenia. Subgroups of dissociation and attentional deployment were also analysed. Meta-analyses revealed potential publication bias and heterogeneity in the study of CERS in schizophrenia.A marked difference in the implementation of CERS is associated with schizophrenia compared to controls. Dissociation variables and alexithymia are also indicated and may be implicated in adaptive cognitive emotional regulation. Theoretical and research implications are discussed.
Effect of High Perioperative Oxygen Fraction on Surgical Site Infection and Pulmonary Complications After Abdominal Surgery
Authors: Christian S. Meyhoff, Jørn Wetterslev, Lars N. Jorgensen, Steen W. Henneberg, Claus Høgdall, Lene Lundvall, Poul-Erik Svendsen, Hannah Mollerup, Troels H. Lunn, Inger Simonsen, Kristian R. Martinsen, Therese Pulawska, Lars Bundgaard, Lasse Bugge, Egon G. Hansen, Claus Riber, Peter Gocht-Jensen, Line R. Walker, Asger Bendtsen, Gun Johansson, Nina Skovgaard, Kim Heltø, Andrei Poukinski, André Korshin, Aqil Walli, Mustafa Bulut, Palle S. Carlsson, Svein A. Rodt, Liselotte B. Lundbech, Henrik Rask, Niels Buch, Sharafaden K. Perdawid, Joan Reza, Kirsten V. Jensen, Charlotte G. Carlsen, Frank S. Jensen, Lars S. Rasmussen, for the PROXI Trial Group
Journal: JAMA (2009)

Use of 80% oxygen during surgery has been suggested to reduce the risk of surgical wound infections, but this effect has not been consistently identified. The effect of 80% oxygen on pulmonary complications has not been well defined.To assess whether use of 80% oxygen reduces the frequency of surgical site infection without increasing the frequency of pulmonary complications in patients undergoing abdominal surgery.The PROXI trial, a patient- and observer-blinded randomized clinical trial conducted in 14 Danish hospitals between October 2006 and October 2008 among 1400 patients undergoing acute or elective laparotomy.Patients were randomly assigned to receive either 80% or 30% oxygen during and for 2 hours after surgery.Surgical site infection within 14 days, defined according to the Centers for Disease Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality.Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.72-1.22; P = .64). Atelectasis occurred in 54 of 685 patients (7.9%) assigned to receive 80% oxygen vs 50 of 701 (7.1%) assigned to receive 30% oxygen (OR, 1.11; 95% CI, 0.75-1.66; P = .60), pneumonia in 41 (6.0%) vs 44 (6.3%) (OR, 0.95; 95% CI, 0.61-1.48; P = .82), respiratory failure in 38 (5.5%) vs 31 (4.4%) (OR, 1.27; 95% CI, 0.78-2.07; P = .34), and mortality within 30 days in 30 (4.4%) vs 20 (2.9%) (OR, 1.56; 95% CI, 0.88-2.77; P = .13).Administration of 80% oxygen compared with 30% oxygen did not result in a difference in risk of surgical site infection after abdominal surgery.clinicaltrials.gov Identifier: NCT00364741.
CALCIUM AND INORGANIC PHOSPHORUS IN THE BLOOD OF RABBITS
Authors: Wade H. Brown
Journal: The Journal of Experimental Medicine (1928)

Determinations of calcium and inorganic phosphorus were made on the blood of a large series of rabbits as they were received from the dealer for the purpose of determining whether results obtained under these conditions differed from those obtained by repeated observations on animals living in the laboratory. It was found that the results differed in the two cases, due largely to a decided difference in the inorganic phosphorus content of the blood; but the values for calcium were also affected.
Indications, patient selection and timing of referral for lung transplantation
Authors: A.R. Glanville, M. Estenne
Journal: European Respiratory Journal (2003)

Lung transplantation (LTx) is now generally accepted as a useful modality of care for patients with severe life-threatening respiratory diseases that are refractory to other medical or surgical therapies. With the huge development of LTx over the last 15 yrs, the disparity between the number of potential recipients and the number of donor organs available has become a major constraint, with many patients dying on the waiting lists. Therefore, it is of primary importance to control and optimise the use of this limited organ resource by weighting the risks and benefits of transplantation in individual patients, and to identify those patients who have a better chance of having a favourable outcome with transplantation. This article discusses the selection process of potential candidates and the currently accepted absolute and relative contraindications, and proposes general and disease-specific recommendations for optimising the timing of referral. Early referral for consideration of lung transplantation is highly desirable as it enhances the patient's chance of surviving to transplant and allows the transplant team to actively manage identified comorbidities during the waiting period.
Treatment of Cytomegalovirus Pneumonia with Ganciclovir and Intravenous Cytomegalovirus Immunoglobulin in Patients with Bone Marrow Transplants
Authors: Elizabeth C. Reed, Raleigh A. Bowden, Paula S. Dandliker, Kathryn E. Lilleby, Joel D. Meyers
Journal: Annals of Internal Medicine (1988)

Study Objective: To determine if the combination of ganciclovir and intravenous cytomegalovirus immunoglobulin is effective in patients with cytomegalovirus pneumonia after bone marrow transplant. Design: Consecutive entry trial with treatment for a minimum of 14 days. Patients: Consecutive sample of 25 patients with bone marrow transplants and cytomegalovirus pneumonia after transplant proven by open lung biopsy or bronchoalveolar lavage. Patients with abnormal renal function or concomitant infectious causes of pneumonia, or who were respirator-dependent at diagnosis, were not eligible. Interventions: Induction treatment consisted of ganciclovir, 2. 5 mg/kg body weight every 8 hours for 14 days, and cytomegalovirus immunoglobulin, 400 mg/kg on days 1, 2, and 7 and 200 mg/kg on day 14. Ganciclovir dosage was adjusted for renal function. Patients who were improved but still symptomatic after 14 days were given maintenance treatment consisting of ganciclovir, 5 mg/kg once daily for an additional 14 days, and immunoglobulin, 200 mg/kg on day 21. Patients with clinical deterioration continued to receive induction doses. Ganciclovir therapy was discontinued if the neutrophil count fell below 500 X 106/L for 2 consecutive days. Measurement and Main Results: Serial tests of renal and liver function, blood counts, and viral cultures of blood, throat, and urine were obtained 3 times a week. Thirteen of twenty-five (52%) patients (95% CI, 31 to 72) survived the initial episode of pneumonia. Viral excretion ceased in 17 of 23 (74%) patients treated more than 96 hours. Proven recurrences of pneumonia occurred in 3 patients and possible recurrences in 2 after treatment was stopped. Three patients developed neutropenia during induction therapy and 6 patients during maintenance therapy. Conclusions: Survival of 13 (52%) of 25 patients from the initial episode of cytomegalovirus pneumonia with the regimen of ganciclovir and cytomegalovirus immunoglobulin is significantly better (P < 0. 001) than the survival of 13 of 89 (15%) patients using previous antiviral regimens.
A Comparison of Brand-Name Drug Prices between Canadian-Based Internet Pharmacies and Major U.S. Drug Chain Pharmacies
Authors: Bradley S. Quon, Rafael Firszt, Mark J. Eisenberg
Journal: Annals of Internal Medicine (2005)

Background: Many Americans have been purchasing their medications from online Canadian pharmacies. Although it is commonly perceived that medications are less expensive in Canada than in the United States, little research has been done to quantify this difference. Objective: To compare the prices of retail brand-name medications between Canadian Internet pharmacies and major U.S. drug chain pharmacies with online pricing. Design: Cross-sectional study. Setting: 12 Canadian Internet pharmacies and 3 major online U.S. drug chain pharmacies. Measurements: The authors calculated the per unit and annual savings (in U.S. dollars) for an American if he or she were to buy the 44 brand-name medications most commonly purchased through the Internet from Canadian Internet pharmacies instead of from an online U.S. drug chain pharmacy. Results: Americans can save a mean of approximately 24% per unit of drug if they purchase their medications from Canadian Internet pharmacies instead of from major online U.S. drug chain pharmacies. Forty-one of the 44 brand-name medications examined were less expensive in Canada. The medications offering the largest mean yearly savings were Zyprexa (olanzapine) (Eli Lilly, Indianapolis, Indiana) ($1159), Actos (pioglitazone) (Eli Lilly, Indianapolis, Indiana) ($852), and Nexium (esomeprazole) (AstraZeneca, Wilmington, Delaware) ($772). Only 3 medications, all in the erectile dysfunction category, were more expensive in Canada. Limitations: Potential savings may vary because of temporal fluctuations in drug prices. Conclusions: Brand-name medications are often substantially less expensive when purchased from Canadian Internet pharmacies instead of from major online U.S. drug chain pharmacies.
Lyme disease with acute purulent meningitis.
Authors: S. J. Bourke, A. G. Baird, F. J. Bone, D. R. Baird, R. D. Stevenson
Journal: BMJ (1988)

ticularly when the preparation contains povidone.Unfortunately, our patient died from complications of unnecessary treatment given because the unfamiliar molar units used to report the phenobarbitone concentration were misinterpreted.ADDENDUM-Since writing this report we have en- countered a further case of serious but eventually reversible respiratory failure in a 46 year old man after aspiration of Medicoal.I Anonymous.Repeated oral activated charcoal in acute poistning.
Look at ME
Authors: T Delamothe
Journal: BMJ (1994)

The supporters of myalgic encephalomyelitis as a discrete entity with an organic cause have brought off some spectacular coups. They have landed a Myalgic Encephalomyelitis Act on to the British statute books, requiring an annual report to be made to parliament on its causes, effects, and treatment. And they succeeded in getting the latest revision of the International Classification of Diseases to include myalgic encephalomyelitis under diseases of the nervous system. Only doctors now remain sceptical about the condition and wary of accepting “encephalomyelitis” as the cause of symptoms without evidence of inflammation of the brain and spinal cord.

Doctors sometimes believe what they read in medical journals. Could journals be partly to blame for their doubts? Action for ME, a patient support group, thinks so. After reviewing the coverage of the illness in the BMJ, Lancet, and three weekly newspapers sent to British general practitioners for the 18 months up to August 1993, it concluded that “medical journals keep doctors in the dark” with their “biased reporting.” The main complaints were that journals confused the chronic fatigue syndrome, myalgic encephalomyelitis, and the post viral fatigue syndrome and that they …
Multiple Phlebectasia Involving Jejunum, Oral Cavity, and Scrotum
Authors: Irving Rappaport
Journal: JAMA (1963)

Concomitant multiple phlebectasia of the jejunum, oral mucosa, tongue ("caviar spots"), and scrotum (Fordyce lesion) was seen in 3 patients at the Long Beach Veterans Administration Hospital. Gastrointestinal bleeding from the phlebectasia occurred in one of the patients. In our study of 100 consecutive patients, the mucocutaneous lesions occurred most often after the age of 40. Normal connective tissue support is lost as the tissues of the body age and a tendency for capillary and venous dilatation in the form of phlebectasia occurs. Duodenal ulcer or symptoms of peptic ulceration occurred in all 3 patients. Vascular malformations of the lips have been reported to occur more frequently in patients with peptic ulcer. If the mucocutaneous manifestations are present, multiple phlebectasia of the jejunum should be included in the differential diagnosis of obscure gastrointestinal bleeding.
Jogging. An adult exercise program
Authors: W. E. Harris
Journal: JAMA (1967)

Although it is accepted that regular moderate exercise is beneficial to health,<sup>1</sup>a large segment of the male population of the United States over the age of 30 leads a relatively sedentary life. In many professions and occupations, the amount of exercise obtained depends upon the opportunity to engage in leisure activities. These activities, such as golf, bowling, fishing, hunting, handball, volleyball, tennis, and physical-education classes, often have major drawbacks in respect to time involved, convenience, expense, reservation of facilities, possession of adequate skills, and regularity of participation. Some types of physical exertion have serious disadvantages for older age groups. Competitive sports and hunting may involve short periods of intensive effort undesirable for those in poor physical condition. Other activities provide a questionable amount of actual physical exertion. Exercise that is intermittent, such as golf, bowling, and fishing, may fail to provide the desirable degree of body stress found
Adverse Reactions in Changing From Phenformin Therapy
Authors: Roger Leonard
Journal: JAMA (1978)

To the Editor.—  Since the recent ban on the use of phenformin hydrochloride by the Food and Drug Administration, we have observed two major adverse drug reactions in patients being switched to tolazamide (Tolinase).  Report of Cases.—  Case1.—An 83-year-old man was previously treated with phenformin hydrochloride (DBI-TD), 50 mg orally three times a day for four years. Four days after changing to tolazamide, 250 mg orally three times a day, he came to the emergency room of the Medical Center Hospital of Vermont with a history of profuse diaphoresis, confusion, slurred speech, and severe shaking (possibly grand mal seizure, although verification is lacking). While being transported to the emergency room, rescue squad attendants gave the patient a glucose solution to drink. On arrival, the patient was oriented with irregular pulse of 88 beats per minute and blood pressure of 250/120 mm Hg. Monitoring by ECG showed frequent premature ventricular
Trafficking and health
Authors: Joanna Busza, Sarah Castle, Aisse Diarra
Journal: BMJ (2004)

Attempts to prevent trafficking are increasing the problems of those who migrate voluntarily Trafficking in women and children is now recognised as a global public health issue as well as a violation of human rights.The UN Protocol to Prevent, Suppress, and Punish Trafficking in Persons, especially Women and Children states that trafficking involves force, threat, or fraud and intent to exploit individuals. 1Intermediaries often smuggle victims across international borders into illegal or unsafe occupations, including agriculture, construction, domestic labour, and sex work.A recent study identified trafficking to be associated with health risks such as psychological trauma, injuries from violence, sexually transmitted infections, HIV and AIDS, other adverse reproductive health outcomes, and substance misuse. 2 These risks are shaped by lack of access to services in a foreign country, language barriers, isolation, and exploitative working conditions.However, as this article shows, efforts to reduce trafficking may be making conditions worse for voluntary migrants.