tbuckley/cabot-search huggingface dataset:
The Cost of Medical Professional Liability
Authors: Roger A. Reynolds
Journal: JAMA (1987)

The high cost of medical professional liability is a source of growing concern among policymakers, health care consumers, and the medical profession. While the concern is widespread, to date there has been little quantitative evidence on the overall economic impact of the problem. Utilizing data from the American Medical Association's Socioeconomic Monitoring System, the impact of medical professional liability (PL) on the cost of physicians' services has been estimated employing two different methods. Both estimates indicate that the costs of PL are substantial. In particular, the two methods yield estimates of the total cost of PL in 1984 of $13.7 and $12.1 billion, respectively—or approximately 15% of the total expenditures on physicians' services. Furthermore, increased costs associated with PL from 1983 to 1984 alone are estimated under the two methods to have accounted for 63% and 57%, respectively, of the increase in expenditures on physicians' services. These costs include PL insurance premiums, costs of practice changes made in response to increasing PL risk, and costs of incurring claims that are not covered by PL insurance. (<i>JAMA</i>1987;257:2776-2781)
Perforation in Regional Enteritis
Authors: James C. Neely
Journal: JAMA (1960)

Nearly one third of the diagnoses of regional enteritis are made during exploratory laparotomy in acute abdominal disease. It has been contended that regional enteritis does not lead to perforations into the free peritoneal cavity. Four cases reported here, with two others reported previously, show that such perforations sometimes do occur. In each of the six cases, the treatment has been different; a fact which bespeaks the lack of familiarity with the problem. There were no deaths in this series, but since exploration is so common the surgeon should give some forethought to this potentially fatal complication.
459. Long-Term Treatment of Canine Cyclic Neutropenia by G-CSF-Lentivirus
Authors: William Osborne, Margaret Brzezinski, Ofer Yanay, Lanaya Waldon, Jeffrey Christensen, Denny Liggitt, David Dale
Journal: Molecular Therapy (2005)

Cyclic neutropenia (CN) occurs both in man and grey collie dogs and is characterized by recurrent periods of neutropenia leading to bacterial infections and shortened life expectancy. Daily rG-CSF provides therapy for patients and dogs. To treat CN by gene therapy we constructed a VSV-G pseudotyped lentivirus encoding canine G-CSF cDNA regulated by CMV promoter, cPPT from HIV 1 and PRE from human hepatitis B virus. At 7 weeks of age when an affected grey collie dog was weaned, serial blood counts were monitored. These data showed the dog's absolute neutrophil counts (ANC) were cycling and observations over 4 cycles established a 12 day periodicity. The ANC mean|[plusmn]|SD during nadirs and peaks were 560|[plusmn]|787 cells/|[mu]|l and 10,760|[plusmn]|1,120 cells/|[mu]|l respectively and overall counts were 5,240|[plusmn]|4,790 cells/|[mu]|l. Having established that neutrophils were cycling, recombinant canine G-CSF was administered subcutaneously at a dose of 1.5 |[mu]|g/kg per weekday for two months. Although ANC continued to cycle, we observed significant increases in neutrophils both at the nadirs and the peaks of cycles (p<0.0001) with mean values of 4,860|[plusmn]|2,670 cells/|[mu]|l and 28,870|[plusmn]|9,830 cells/|[mu]|l respectively. Over this period the mean count was 17,820|[plusmn]|11,100 cells/|[mu]|l. After demonstrating that rG-CSF elevated neutrophil production cytokine administration was stopped and we administered IM 2|[times]|109 infectious units(IU) of G-CSF-lentivirus. The dog showed no ill effects to the virus injections. Serial monitoring of blood cells showed elevated ANC for over 17 months with mean value of 29,230|[plusmn]|12,930 cells/|[mu]|l (n=217) that was significantly increased over both no treatment and rG-CSF treatment (p<0.0001). The increases in ANC from recombinant G-CSF and lentivirus administration were associated with absence of clinical signs of infection and fever.
Both extrauterine and intrauterine growth restriction impair renal function in children born very preterm
Authors: Justine Bacchetta, Jérôme Harambat, Laurence Dubourg, Brigitte Guy, Aurélia Liutkus, Isabelle Canterino, Behrouz Kassaï, Guy Putet, Pierre Cochat
Journal: Kidney International (2009)
113 MONOCLONAL ANTI-CLAUDIN 1 ANTIBODIES FOR PREVENTION OF HEPATITIS C VIRUS RE-INFECTION IN LIVER TRANSPLANTATION
Authors: I. Fofana, S. Krieger, F. Grunert, S. Glauben, E. Soulier, F. Xiao, C. Royer, S. Fafi-Kremer, C. Schuster, J. Thompson, T.F. Baumert
Journal: Journal of Hepatology (2010)
Successful Treatment of Ulcerative and Diabeticorum Necrobiosis Lipoidica With Intravenous Immunoglobulin in a Patient With Common Variable Immunodeficiency
Authors: Neda Barouti, Amy Qian Cao, Donato Ferrara, Christa Prins
Journal: JAMA Dermatology (2013)

OBSERVATION Deep Labiomental Fold With PseudocomedonesThe labiomental fold is a transverse indentation of the face, which marks the intersection of the lower lip and chin. 1 It plays a significant role in movement of the lower lip and in facial expression.We describe herein a child with a linear pattern of microcomedones located along a deep labiomental fold.
Put all GPs on a salaried contract
Authors: A. Maynard
Journal: BMJ (2015)

If I ruled the NHS I would buy stocks and an ample supply of rotten eggs. I would install one set of stocks outside Richmond House (the Department of Health headquarters in London) and another outside Quarry House (NHS England’s headquarters in Leeds). Evidence free practitioners of NHS “re-disorganisations” and other faith based policies—health secretary Jeremy Hunt, his predecessor Andrew Lansley, and the previous Labour incumbents Andy Burnham and Alan Milburn—would be punished, as an example. Iain Chalmers, Ben Goldacre, and associated “evidence apostles” would be supplied with the eggs. Such public shaming could be avoided if interventions were appropriately piloted and accompanied by well designed evaluations of their cost effectiveness. …
Unexplained Transient Splenic Uptake of Tc-99m MDP in Bronchogenic Carcinoma
Authors: PAUL SIROTTA, WIL B. NELP
Journal: Clinical Nuclear Medicine (1984)

A patient with squamous cell carcinoma of the lung had splenic uptake of Tc-99m MDP on two consecutive bone scans, but not on a third. There was no intervening therapy. At autopsy the spleen was grossly and microscopically normal.
Redistribution of Cardiac Output to the Kidneys during Oral Nadolol Administration
Authors: Stephen C. Textor, Fetnat M. Fouad, Emmanuel L. Bravo, Robert C. Tarazi, Donald G. Vidt, Ray W. Gifford
Journal: New England Journal of Medicine (1982)

ALTHOUGH it has been demonstrated repeatedly that propranolol and other beta-blocking agents diminish heart rate and cardiac output, the role of these effects in determining regional perfusion under clinical conditions is not clear. Several studies have indicated that these agents may decrease renal plasma flow and adversely affect glomerular filtration rate.1 2 3 4 5 Rarely have both systemic and renal hemodynamic changes been evaluated together, leaving open the question of whether changes in renal blood flow passively follow the fall in cardiac output or reflect other mechanisms.In contrast, early studies using intravenous injections of nadolol in sodium-restricted hypertensive subjects demonstrated a rise . . .
Erythroleukemia With Philadelphia Chromosome
Authors: Jaime Pacheco
Journal: JAMA (1973)

<h3>To The Editor.—</h3> The Philadelphia (Ph') chromosome is associated with 85% of patients with chronic myelocytic leukemia,<sup>1</sup>a few cases with polycythemia vera<sup>2</sup>and acute myelocytic leukemia,<sup>3</sup>in some apparently healthy individuals,<sup>4</sup>and also in a man with preleukemic state for almost six years.<sup>5</sup> Chromosomal analysis in patients with erythroleukemia frequently shows either polyploid figures, lack of a chromosome, or one extra chromosome,<sup>6</sup>but it is exceptionally rare to find Ph' chromosome in this condition.<sup>3,7</sup>We herewith report a case of erythrocytic glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Two daughters of the patient had normal levels of the enzyme. On Nov 5,1971, a 73-year-old patient had a hemoglobin concentration of 7.5 gm/100 ml, with a mean corpuscular volume of 85μ; mean corpuscular hemoglobin level, 27μg, and mean corpuscular hemoglobin concentration, 31 gm/100 ml. The peripheral blood film showed moderate erythrocyte fragmentation, with many schistocytes. The white
Volumetric assessment of ulcerated ruptured coronary plaques: A study with three-dimensional intravascular ultrasound in vivo
Authors: Clemens von Birgelen, Mario Gössl, Gary S. Mintz, Dirk Böse, Holger Eggebrecht, Dietrich Baumgart, Till Neumann, Javid Arjumand, Christoph Naber, Raimund Erbel
Journal: Journal of the American College of Cardiology (2003)
US confirms federal authority for safety of medical devices
Authors: Fred Charatan
Journal: BMJ (2008)

In a landmark decision, the US Supreme Court voted by eight to one last month to bar a lawsuit in a state court brought by the widow of a man injured by a cardiac catheter that had been approved for sale by the Food and Drug Administration.

When Congress enacted the Medical Device Amendments of 1976 to the Federal Food, Drug, and Cosmetic Act, it gave the responsibility for overseeing the safety of medical devices to the FDA and over-ruled state oversight laws.

The dispute the Supreme Court had to settle was whether an injured patient could challenge …
Pulse pressure to vascular cells: novel methods for solving pathogenesis in cell migration
Authors: Y. Ishida
Journal: Cardiovascular Research (2008)

Vascular smooth muscle migration is a risk factor for developing atherosclerosis, a major cause of morbidity and mortality. A cohort study carried out over 25 years in seven countries revealed that pulse pressure, diastolic and systolic pressures are the best predictors of cardiovascular disease death.1 In this issue of Cardiovascular Research , Tada et al. (Shimokawa's group) describe a novel method using a newly developed apparatus that enables determination of the pulse pressure-loading onto vascular smooth muscle cells using Boyden chambers.2 This new avenue for in vitro experiments to simulate the in situ pulse pressure in the systemic circulation has now been opened to elucidate the cellular and molecular mechanisms involved in how the pulse pressure affects smooth muscle migration processes.

Tada et al. showed that migration of cultured aortic … 

*Corresponding author. Tel: + 81 49 261 7943; fax: + 81 49 261 8923. E-mail address : ishiday{at}hst.u-bunkyo.ac.jp
Laboratory evaluation of clopidogrel responsiveness by platelet function and genetic methods
Authors: Kristi J. Smock, Peter J. Saunders, George M. Rodgers, Vandita Johari
Journal: American Journal of Hematology (2011)

Clopidogrel is a widely used antiplatelet agent that irreversibly inhibits platelet P2Y12 ADP receptors after conversion to an active metabolite. There are a number of laboratory tests capable of detecting clopidogrel-induced platelet inhibition and published literature correlates suboptimal clopidogrel response to adverse cardiovascular outcomes. Genetic polymorphisms are thought to affect conversion of the prodrug to the active metabolite, and the FDA has recently added a black-box warning to clopidogrel to highlight the effects of these polymorphisms on drug bioavailability and to inform prescribers about the availability of genetic testing. For these reasons, there is growing interest in the use of laboratory tests to monitor patients treated with clopidogrel. This article summarizes the currently available laboratory testing, including platelet function tests and genotyping for CYP2C19 variants.
Bereavement: Reactions, Consequences, and Care
Authors: David Peretz
Journal: JAMA (1985)

This monograph is an important contribution to the growing literature on the interaction between the psychological, social, and biologic. Those of us who have worked in the field of thanatology have known for a long time the enormous stress that loss places on individuals and families and have been concerned with the issue of care and prevention. It has been difficult to communicate this to clinicians, so often overloaded with work and their own emotional responses triggered by their efforts with the dying person. To add a whole new category of persons in need of evaluation, persons going through a "normal" event in the life cycle, seemed somehow more than could be integrated. This highly readable compendium of knowledge and research in the study of bereavement will leave no one in doubt as to the necessity for further efforts in clinical, biologic, and public health research. As an essential reference
Ethnic issues in breast cancer treatment
Authors: K. Winship
Journal: BMJ (1997)

I became aware that there was a problem when someone commented that Asian women are referred late for treatment of a breast lump. Anecdotal evidence suggests that some GPs still believe that Asian women do not develop breast cancer or that it cannot occur in young women. They, therefore, tend to dismiss the symptoms. The word “cancer” spells doom and death to many families and together with “breast” is taboo in Asian communities. As a result many women and sometimes their families become isolated.

When they do reach hospital the lack of empathy and ignorance about minority cultures leads to further isolation. When there is a language problem, made worse by the insufficient use of interpreters, there can be considerable distress. …
Electrocardiographic Changes During Selective Coronary Cineangiography
Authors: REX N. MACALPIN, WILLIAM A. WEIDNER, ALBERT A. KATTUS, WILLIAM N. HANAFEE
Journal: Circulation (1966)

Examination was made of standard lead III of the electrocardiogram recorded during selective right and left coronary artery injections of Hypaque-M 75% in 107 patients. Left coronary artery injection caused the mean frontal plane QRS vector to shift transiently to the left and T wave vector to shift toward the right. Right coronary artery injection caused shifts of the QRS and T wave vectors in the opposite directions. Occlusion of one main coronary artery caused these ECG changes to be minimal or absent. Transient sinus bradycardia was common with injection of either coronary artery. Serious arrhythmias were rare. The electrocardiogram recorded during selective coronary arteriography can give information useful to the angiographer during the procedure itself as well as during the subsequent interpretation of the angiogram.
Twenty-Year Survival After Coronary Artery Surgery
Authors: William S. Weintraub, Stephen D. Clements, L. Van-Thomas Crisco, Robert A. Guyton, Joseph M. Craver, Ellis L. Jones, Charles R. Hatcher
Journal: Circulation (2003)

Coronary artery bypass graft (CABG) surgery has been performed frequently for symptomatic coronary atherosclerotic heart disease for more than 30 years. However, uncertainty exists regarding the relationship between long-term survival after CABG and readily available clinical correlates of mortality.We studied outcome at 20 years by age, sex, and other variables in 3939 patients who had CABG surgery from 1973 to 1979 in the Emory University System of Healthcare. Twenty-year survival, freedom from myocardial infarction, and freedom from repeat CABG were 35.6% (95% confidence interval [CI], 33.9% to 37.3%), 66.6% (95% CI, 64.6% to 68.6%), and 59.1% (95% CI, 56.9% to 61.5%). Multivariate correlates of late mortality were age (hazard ratio [HR], 1.46 per 10 years), female sex (HR, 1.21), hypertension (HR, 1.44), angina class (HR, 1.07 per class increase of 1), prior CABG (HR, 1.72), ejection fraction (HR, 1.07 per 10-point decrease), number of vessels diseased (HR, 1.11 per 1-vessel increase), and weight (HR, 1.04 per 10 kg). Twenty-year survival by age was 55%, 38%, 22%, and 11% for age <50, 50 to 59, 60 to 69, and >70 years at the time of initial surgery. Survival at 20 years after surgery with and without hypertension was 27% and 41%, respectively. Similarly, 20-year survival was 37% and 29% for men and women.Symptomatic coronary atherosclerotic heart disease requiring surgical revascularization is progressive with continuing events and mortality. Clinical correlates of mortality significantly impact survival over time and may help identify long-term benefits after CABG.
Familial risks of squamous cell carcinoma of the head and neck: retrospective case-control study
Authors: W. D Foulkes, J.-S. Brunet, W. Sieh, M. J Black, G. Shenouda, S. A Narod
Journal: BMJ (1996)

<h3>Abstract</h3> <b>Objective</b>: To determine the contribution of inheritance to the incidence of squamous cell carcinoma of the head and neck. <b>Design</b>: Historical cohort study. First degree relatives of cases with squamous cell carcinoma of the head and neck made up the exposed cohort and first degree relatives of spouses of cases made up the comparison unexposed cohort. <b>Setting</b>: Ear, nose, and throat clinic in a large metropolitan teaching hospital. <b>Subjects</b>: 1429 first degree relatives of 242 index cases of squamous cell carcinoma of the head and neck; as controls, 934 first degree relatives of the spouses of 156 index cases. <b>Main outcome measures</b>: Relative risk of developing squamous cell carcinoma in first degree relatives of cases compared with risk in first degree relatives of spouses. <b>Results</b>: The adjusted relative risk for developing head and neck cancer if the index case had squamous cell carcinoma of the head and neck was 3.79 (95% confidence interval 1.11 to 13.0). There were no significantly increased risks associated with a family history of cancer at other sites. The adjusted relative risk for squamous cell carcinoma of the head and neck was 7.89 (1.50 to 41.6) in first degree relatives of patients with multiple primary head and neck tumours. <b>Conclusions</b>: These data suggest that genetic factors are important in the aetiology of head and neck cancer, in particular for patients with multiple primary cancers. Given the prolonged exposure of these subjects to carcinogens, these genetic factors may have a role in modifying carcinogen activity or in host resistance to carcinogens. Inherited factors may be important in persons with environmentally induced cancers. <h3>Key messages</h3> Tobacco and alcohol are established risk factors, but some affected persons are non-smokers and non-drinkers Genetic makeup may determine how individuals respond to carcinogens This study found a significantly increased relative risk of 3.79 for developing head and neck cancer if a first degree relative had squamous cell carcinoma of the head and neck As with other cancers, people with multiple primary cancers of the head and neck may represent a susceptibility group as the familial risks are higher
Malfunction of the Mitral Valve Prosthesis (Cutter-Smeloff)
Authors: SIMON J. K. LEE, A. J. ZARAGOZA, J. C. CALLAGHAN, C. M. COUVES, L. P. STERNS
Journal: Circulation (1970)

Three cases of intermittent obstruction of the mitral prosthesis (Cutter-Smeloff) due to ball variance have been reported. The typical findings were marked variation in the arterial pulse and the intensity of the mitral closing sound and intermittent absence of the opening click. The phonocardiography revealed varying intervals from aortic closing sound to the opening click (A 2 - OC interval). Hemodynamic studies revealed fluctuating aortic and pulmonary artery wedge pressures in spite of normal sinus rhythm, due to impaction of the ball into the prosthetic ring, opening only with severe elevation of the left atrial pressure. At operation, the balls showed yellowish discoloration, but no disruption of sutures nor thrombosis of the prosthesis was found. The incidence of this phenomenon was 9% with the Cutter-Smeloff mitral prosthesis, but no such case was seen among patients with the Starr-Edwards mitral prosthesis.
Distribution and Effects of 4′, 4″-di(2-Imidazolin-2-yl) terephthalanilide Dihydrochloride Hemihydrate and Its 2-Chloro Analogue in Lymphocytic Leukemias L1210 and P388&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: A Sivak, W I Rogers, I Wodinsky, C J Kensler
Journal: JNCI Journal of the National Cancer Institute (1964)

4′4″-di(2-imidazolin-2-yl)terephthalanilide dihydrochloride hemihydrate (NSC-35843) and its 2-chloro analogue (NSC-38280) represent a class of imidazolinylterephthalanilides highly active against a number of rodent neoplasms. Drug uptake by sensitive and resistant lines of the ascites and solid forms of L1210 lymphocytic leukemia has been determined with reference to the time after administration of the drugs to mice bearing the tumors. The resistant lines of the solid form of L1210 accumulated from 30 to 70 percent as much drug equivalents as the sensitive line after a course of delayed therapy. Studies on tumor growth and duration of survival of animals bearing the subcutaneous tumors showed that the phthalanilides increased length of survival but did not inhibit growth of the solid tumors significantly. Resistant lines of L1210 and P388 lymphocytic leukemias growing in the ascites form retained only 10 to 25 percent as much NSC-38280 as the sensitive cells 24 hours after drug administration in vivo. However, ½ hour after drug administration, drug levels were comparable in sensitive and resistant lines, and approximated the 24-hour drug levels in sensitive cells. Experiments in vitro also indicated no significant differences in the initial binding of NSC-38280 to sensitive or resistant ascites L1210 cells. Several lines of evidence suggested that NSC-38280 was not metabolically altered by L1210 or P388 cells. With both C14, abeled and unlabeled phthalanilide, essentially all the drug added in vitro to L1210 or P388 ascites cells was recovered chromatographically. The chromatograms of extracts of solid tumors from mice which had received NSC-38280 revealed no drug-related peak other than that of authentic NSC-38280. However, NSC-35843 appeared to undergo a change in vivo that decreased its basicity as determined chromatographically, but did not change its ultraviolet absorption characteristics. Such a chang was not found after incubation of the drug with sensitive or resistant P388 cells in vitro.
Liver transplantation for hepatocellular carcinoma
Authors: Alan P. Venook
Journal: Hepatology (1993)

Background: Liver transplantation for unresectable hepatocellular carcinoma yields disappointing results. Most cases recur within 2 years, often in the transplanted liver. Methods: A combination of neoadjuvant doxorubicin and orthotopic liver transplantation was used in 20 patients with unresectable hepatocellular carcinoma confined to the liver. Seventeen patients had tumors &gt; 5 cm in greatest diameter, and 11 cases were stage IVA by the TNM classification. Doxorubicin was administered preoperatively, intraoperatively, and postoperatively at a dose of 10 mg/m 2 weekly, totaling 200 mg/m 2 . Results: Chemotherapy was well tolerated although leukopenia was was observed in 70% of patients. Eight patients died, five of recurrent tumor and three of hepatitis B. Three others remain alive 8-22 months after tumor recurrence. One patient had initial tumor recurrence in the allograft. Actuarial survival is 59% and tumor-free survival is 54% at 3 years. For the 17 patients with tumors &gt; 5 cm, overall survival is 63% and tumor-free survival is 49% at 3 years. Conclusion: The results of this pilot study suggest that neoadjuvant doxorubicin chemotherapy favorably alters the post-transplant survival of patients with ehpatocellular carcinoma.