tbuckley/cabot-search huggingface dataset:
Adults with Tetralogy of Fallot -- Repaired, Yes; Cured, No
Authors: Amnon Rosenthal
Journal: New England Journal of Medicine (1993)

There are approximately 500,000 adults with congenital heart disease in the United States, and each year another 10,000 children who have undergone surgical repair reach adulthood1. The largest diagnostic category among patients undergoing repair is isolated ventricular septal defect, followed by tetralogy of Fallot. In classic tetralogy of Fallot, an anterior displacement of the infundibular septum results in a large ventricular septal defect and the development of infundibular pulmonary stenosis. Right ventricular hypertrophy is caused by right ventricular hypertension associated with both the ventricular septal defect and the pulmonary stenosis. Aortic override onto the right ventricle is the fourth . . .
Treatment of Heroin Dependence
Authors: Mark H. Hyman
Journal: Annals of Internal Medicine (2001)

Letters17 April 2001Treatment of Heroin DependenceMark H. Hyman, MDMark H. Hyman, MDUniversity of California, Los Angeles; Los Angeles, CA 90049 (Hyman)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-8-200104170-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:O'Connor and Fiellin (1) raised practical questions for primary care physicians (the target audience) on short-term heroin withdrawal treatment.In our community experience, we are finding that most health plans are unwilling to support inpatient detoxification or to locate hospital units that are even dedicated to this discipline. Thus, we are seeing a stronger need for primary care physicians to be adept at managing short-term withdrawal therapy on an outpatient basis. Furthermore, buprenorphine, which is mentioned as one option in maintenance prevention, is available in a parenteral formulation that is very useful in short-term detoxification. The medications ...Reference1. O'Connor PG, Fiellin DA. Pharmacologic treatment of heroin-dependent patients. Ann Intern Med. 2000;133:40-54. [PMID: 0010877739] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Mark H. Hyman, MDAffiliations: University of California, Los Angeles; Los Angeles, CA 90049 (Hyman) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPharmacologic Treatment of Heroin-Dependent Patients Patrick G. O'Connor and David A. Fiellin Treatment of Heroin Dependence Patrick G. O'Connor and David A. Fiellin Metrics 17 April 2001Volume 134, Issue 8Page: 714KeywordsDetoxificationHeroinInpatientsOutpatientsPrimary care physiciansSelective serotonin reuptake inhibitors ePublished: 17 April 2001 Issue Published: 17 April 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
The importance of friendship
Authors: C. Grebenik
Journal: BMJ (1995)

She was my oldest friend, my first real friend. We met aged 3 1/2 at nursery school. I remember that I had a tail made of string and we played a game of cats and mice. We lived less than a mile apart, went to the same schools, and for the next nine years or so we were best friends. Most of our time was spent together, both in school and out. Then my family moved house and although we kept in touch we did not see each other often.

We went to different medical schools and …
Management of Esophageal Disease
Authors: Robert E. Hermann
Journal: JAMA (1989)

This book on esophageal disease represents a comprehensive and monumental review by two surgeons of great experience in esophageal problems. The book is almost entirely authored by Drs Skinner and Belsey, except for 4 of the 57 chapters contributed by other members of the departments of anesthesiology, gastroenterology, radiology, and psychiatry at the University of Chicago (Ill). The book begins with a section on the normal esophagus, including embryology, anatomy, and physiology, and then goes on to the investigation of esophageal disease, including radiological studies, endoscopy, and esophageal function tests. The next sections deal with medical therapy and esophageal manifestations of psychiatric disease and with principles and techniques of surgical treatment. A section on congenital problems of the esophagus is included, followed by a section on neuromuscular functional disorders, a long section (12 chapters) on hiatal hernia and reflux esophagitis, a section on benign strictures, sections dealing with neoplasms of
NEW SEPTUM FORCEPS.
Authors: A. J. ERWIN
Journal: JAMA (1895)

Having long felt the want of an implement for the correction of the deviated septum, I had these forceps made by Truax, Greene &amp; Co., which I find to be very useful and convenient. The male blade being 4 m.m. less in its diameter than the inside of the ring blade, it does not cut the cartilage while reversing its convexity; it produces at most, a kind of green stick fracture of the septal periphery, which makes it easy of support. In most cases a hard pledget of cotton will keep it in place as required for a few days. Sometimes you will find it better to use the pin. One size, just as large again as this cut, will answer for every case, except for children, and they do not need it. <h3>Dear Doctor:</h3> —Please direct the attention of your friends to<i>our</i>Journal. We will be pleased to
Abstract 2036: MicroRNA-137 reverse the malignant phenotypes of colorectal cancer cells by targeting small GTPase Cdc42
Authors: FENG BI, Ming Liu, Nan Lang, Qiuling Tang
Journal: Cancer Research (2010)

Abstract MicroRNAs have emerged as post-transcriptional regulators that are critically involved in the pathogenesis of a number of human cancers. Cdc42, one of the best characterized members of the Rho GTPase family, is found to be up-regulated in several types of human tumors, and has been implicated in cancer initiation and progression. In the present studies, we have identified miR-137 as a potential regulator of Cdc42 expression. A bioinformatics search revealed a target-site for miR-137 within the Cdc42 3’ UTR at nt 792-798, which is highly conserved across different species. Expression of miR-137 in colorectal cancer cell lines was found inversely correlated with Cdc42 expression. MiR-137 could significantly suppress Cdc42 3’ UTR luciferase-reporter activity, while this effect was not detectable when the putative target-site for miR-137 was mutated. Consistent with the results of reporter assay, ectopic expression of miR-137 reduced both mRNA and protein expression levels of Cdc42 and mimicked the effect of Cdc42 knockdown in inhibiting proliferation, inducing G1 cell cycle arrest, and blocking invasion of the colorectal cancer cells. Furthermore, expression of miR-137 suppressed the immediate downstream effector of Cdc42, PAK signaling in colorectal cancer cell lines. Our results suggest that miR-137 may have a tumor suppressor function by directly targeting the Rho GTPase Cdc42 to inhibit the proliferation and invasion activities of colorectal cancer cells. They raise an interesting possibility that Cdc42 activity and function can be controlled by microRNAs in addition to the classic regulators such as guanine nucleotide exchange factors and GTPase-activating proteins. Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2036.
Photodynamic therapy for bowenoid papulosis using a novel incoherent light-emitting diode device
Authors: C.H. Yang, J.C. Lee, C.H. Chen, C.Y. Hui, H.S. Hong, H.W. Kuo
Journal: British Journal of Dermatology (2003)

Sir, Bowenoid papulosis (BP) is a rare condition characterized by single or multiple reddish‐brown warty papules and plaques in the anogenital region. Histologically, BP displays features of Bowen's disease. Most lesions follow a benign course and eventually resolve. However, in persistent BP lesions can transform into squamous cell carcinoma, a phenomenon that may be related to infection by high‐risk human papillomavirus (HPV).1 Popular treatment modalities for BP include electrocoagulation, cryotherapy, topical 5‐fluorouracil cream, topical imiquimod cream, laser ablation and surgical excision.2, 3 Photodynamic therapy (PDT) using topical 5‐aminolaevulinic acid (ALA) and subsequent irradiation with an appropriate light source is effective for treating certain skin cancers and precancerous conditions including Bowen's disease, superficial basal cell carcinomas and actinic keratosis.4 Topical PDT is also effective in treating erythroplasia of Queyrat, which is identical to Bowen's disease located on the glans penis.5 Notably, topical PDT has also effectively treated HPV‐induced skin diseases such as warts and condyloma acuminatum.4 BP thus is a potential candidate for PDT as it is recognized as an HPV‐related genital in situ carcinoma. We report two patients with BP who experienced clinical clearing following a single ALA‐PDT session using a high‐intensity light‐emitting diode (LED) light source.
Research versus the patient
Authors: B. Roehr
Journal: BMJ (2013)

Bob Roehr looks at the challenges of applying research averages to individual patients

> “If it were not for the great variability among individuals, medicine might be a science and not an art.” Sir William Osler, 1892

Tension between the science and art of healthcare has never been greater. On the one hand is the certainty of P values generated by well designed double blinded randomized controlled trials. Means and medians from these studies are used as the foundation for treatment guidelines and insurance coverage.

But physicians know from experience that patients seldom comport with the statistics of pristine trials. Patients are messy, they come with comorbidities, differing biologies, their own desires and preferences that seldom match up exactly with what is seen on the clean pages of the scientific literature.

“There is probably no issue more exciting than this scientific notion that treatments—be they pharmaceutical treatments or system level interventions—may have differential effects depending on who the patient is,” says Joe V Selby. He is executive director of the Patient-Centered Outcomes Research Institute (PCORI), the independent organization established under the Affordable Care Act (ACA).

It might be frustrating that answers for individual patients are so slow in coming, but Selby points to advances that have been made over the past decades using averages. He adds, “Treatment heterogeneity is something real that we can study and act on.”

“As you increase the number of subgroups that you are able to include in your analysis, you zero in on the individual,” according to Selby.

“There has to be an important role for observational studies in an exploratory analysis looking for treatment heterogeneity,” he says. “If there is a lot of it, and it is common across a number of diseases, we are generally not going to find it in the kind of …
Retrograde Activation of the His Bundle During Intermittent Paired Ventricular Stimulation in the Human Heart
Authors: CESAR A. CASTILLO, AGUSTIN CASTELLANOS
Journal: Circulation (1970)

Intermittent paired ventricular pacing was performed in five patients, one of them with Wolff-Parkinson-White (WPW) syndrome. Retrograde activation of the His bundle and of the atria was observed in all patients. Bipolar leads with interelectrode distances of 1 mm seemed to be slightly better than the conventional ones (10 mm apart) for the identification of His (H) deflections buried inside the QRS complexes. Diagnosis of retrograde atrial activation was enhanced by the use of a high bipolar right atrial lead. In cases 1 and 2, V 2 -A 2 and V 2 -H 2 intervals consistently lengthened as the V 1 -V 2 interval was reduced. In two other patients, previously present retrograde P waves disappeared as the V 1 -V 2 interval was reduced. Yet at even shorter intervals, retrograde conduction to the His bundle and to the atria was seen. Ventricular echoes occurred in two cases, and reciprocating tachycardia in one. In these instances the His bundle was engaged in both retrograde and forward conduction. Finally in the patient with WPW syndrome A 2 preceded H 2 at a given coupling interval, suggesting retrograde atrial pre-excitation through an extra-Hisian pathway.
Multiple sclerosis: a review.
Authors: D McAlpine
Journal: BMJ (1973)

While basic research on multiple sclerosis has underlined the complex nature of its immunological background (the clinician, and the neurologist in particular, has become aware of a lack of unanimity on the subject of diagnostic criteria and of its effect on the validity of recent studies on the course of this ubiquitous disease.With the general practitioner especially in mind an attempt is made here to summarise certain aspects of a disease whose origins and behaviour continue to defy clini- cian, epidemiologist, and laboratory worker alike.
SUGGESTION AS AN IDEO-DYNAMIC FORCE.
Authors: W. XAVIER SUDDUTH
Journal: JAMA (1896)

Among the many curative agents that have been brought forward during the last few years none is attracting wider attention at the present time than the subject before us. Technically speaking suggestion is the active principle of all psycho-thera-therapeutic measures. Its discovery was the result of years of labor in the laboratories of the biologist and experimental psychologist. In the fullest sense it is therefore the legitimate child of science and not an outcast as some would try to make out. With such parentage it behooves us to look well into its claims and study the phenomena of its manifestations. Like many other curative agents discovery of suggestion came about through close observation of pathologic conditions. Just as the study of bacteriology in its relation to pathology resulted in the formulation of the germ theory of disease and the subsequent discovery of antisepsis and serum therapy, so has the study
Mechanism of Pacing-Induced Ventricular Fibrillation in the Infarcted Human Heart
Authors: Anthony W.C. Chow, Oliver R. Segal, D. Wyn Davies, Nicholas S. Peters
Journal: Circulation (2004)

The mechanisms by which ventricular fibrillation (VF) is initiated in the infarcted human heart have not been defined.Left ventricular noncontact mapping of 8 episodes of pacing-induced VF in 6 patients (age 64.8+/-7.9 years, with previous myocardial infraction and left ventricular ejection fraction of 36+/-4%) undergoing ventricular tachycardia (VT) ablation revealed a consistent mechanism of VF induction. Whether during VT or sinus rhythm, the first of a train of paced extrastimuli to capture the LV produced an arc or arcs of functional block at regions bordering scar. With subsequent extrastimuli, the arcs elongated to circumscribe an enlarging area of increasingly late activation, with reentry through part of this functional (unidirectional) block leading to wavefront fragmentation and VF. These regions had longer fibrillation intervals (263+/-63 ms) than remote LV regions (209+/-23.4 ms; P<0.0001), implying longer refractory periods, and in 6 of the 8 VF episodes, these regions correlated with VT exit sites. In each of the 2 patients with 2 episodes of VF, both episodes formed arcs of functional block in the same location, despite pacing from different sites.Pacing-induced VF in the infarcted human heart is initiated by the development of functional lines of block dictated by the properties of a particular region of myocardium characterized by longer refractory periods, at or near VT circuit exit sites. Identification of these characteristic properties may help stratify risk of arrhythmic death and explain the potential for VT ablation to modify risk of VF in the infarcted heart.
Abstract P1-14-04: Subsequent endocrine therapy after becoming to resistance of ‘estrogen therapy’ is beneficial as a salvage treatment for the late stage metastatic breast cancer
Authors: H Iwase, Y Yamamoto, M Yamamoto-Ibusuki, K-I Murakami, T Inao, Y Okumura, Y Omoto
Journal: Cancer Research (2013)

Abstract BACKGROUND: Aromatase inhibitor (AI) is a most commonly used as the endocrine therapy in postmenopausal hormone-dependent breast cancer. Paradoxically, estrogen additive therapy, high-dose estrogen using ethinylestradiol, can be useful after long-term estrogen deprivation therapies with AI. Furthermore, there is a possibility of the beneficial effect of AI or fulvestrant as a subsequent endocrine therapy after EE2 failure. METHODS: Ethinylestradiol (EE2; 3mg/day, TID) therapy was performed in 22 patients with metastatic breast cancer (median; 62 years-old, the mean observation time: 13.6 months.), who were heavily treated by sequential endocrine therapies (3rd or more line) including cytotoxic chemotherapies. We examined the efficacy of a subsequent endocrine therapy using aromatase inhibitor or fulvestrant after becoming resistance to the EE2 therapy in the patients who got the disease control by the prior EE2 therapy. The primary endpoint was clinical benefit rate (CBR) and the secondary endpoint was time to treatment failure (TTF). (Registration number; UMIN 000002831, additional analysis) RESULTS: Median of TTF of EE2 treatment was 46 weeks (23-62+, 2 cases were ongoing). The response rate was 41% (9/22), the clinical benefit rate was 50% (11/22). The stable disease (&amp;lt; 6 months) was 18% (4/22) and another 3 cases were judged as progressive disease. Four cases withdrew due to nausea, fatigue and muscle-skeletal pain. In 13 cases progressed after disease control (SD or more) of EE2, a subsequent endocrine therapy, fulvestrant for 6 cases and AI for 7 cases, was performed. Fulvestrant group showed 50% (3 in 6) of CBR and 15 weeks (5-55+) of TTF, and AI-treated group showed 43% (3 in 7) of CBR and 19 weeks (5-33+) of TTF. Two in three cases, who became resistance to anti-estrogen treatment, got long SD by further EE2 re-therapy. DISCUSSION: EE2 therapy could be beneficial for heavily treated metastatic breast cancer. Some cases showed clinical benefits of a subsequent therapy by AI or fulvestrant after becoming to EE2 failure. Taken together, sequential use of estrogen and anti-estrogen therapy (vice versa) could be one of the options as a salvage endocrine therapy for the end stage breast cancer. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-14-04.
An Objective Study of Lumbar Sympathectomy--II. Skin Ischaemia
Authors: K. A. Myers, W. T. Irvine
Journal: BMJ (1966)

Lumbar sympathectomy is often performed for ischaemia of the foot in patients in whom direct arterial surgery is not desir- able.In contrast to the muscle circulation, there is a high level of sympathetic vasoconstrictor tone of skin vessels in the foot, and their sympathetic denervation initially results in marked vaso- dilatation in both the experimental animal (L6fving and Mel- lander, 1956) and the normal human (Walker et al., 1950).However, in practice, the operation often fails to provide relief of peripheral nutritional insufficiency.Clinical studies indicate that rest pain is relieved in only 40 to 60% of cases (Berry et al., 1955 ; Thimmig et al., 1958 ; Gillespie, 1960a; Taylor and Calo, 1962).The risk of development of gangrene appears to be reduced by sympathectomy (Edwards and Crane, 1961), but the efficacy for established gangrene is disputed: whereas Berry et al. (1955) claimed that sympathectomy allowed successful conservative amputation in 40% of patients, Taylor and Calo (1962) considered that it was rarely of benefit.The factors resulting in ischaemic rest pain are not entirely clear.The pain appears to be of two types (Ross, 1953).One type is characterized by severe, deep, unremitting pain, and it may be that this results from ischaemic neuritis with demyelination of nerve fibres as described by Gairns et al. (1960).In the other type there is superficial burning pain which usually occurs when the foot is warmed in bed at night and is relieved by cooling and by dependency.Possibly, in this type heating causes an increase of skin metabolism greater than can be dealt with by the hyperaemic response to warming the foot, resulting in accumulation of metabolites causing pain.Alternatively, the development of rest pain with heating could result from diver- sion of flow, in the presence of a limited inflow, from nutritive pathways to arteriovenous channels, though this does not occur in normal subjects (Davis and Greene, 1959), or from super- ficial to deep pathways.Subsequent development of gangrene results from an inadequate inflammatory hyperaemic response to local trauma or infection.The severity of the trauma neces- sary to produce death of tissue will depend on the degree of ischaemia, but clearly the development of gangrene does not necessarily imply gross ischaemia of the whole foot.From these considerations it would appear that the symptoms (Walker et al., 1950).2. Flows at the ankle and forefoot measured first during the reactive hyperaemia after a five-minute period of arterial occlusion, then following local heating of the leg by electric blankets to a temperature of 42' C. for 30 minutes, and finally during a com- bination of the two.For the reactive hyperaemia tests, measure- ments were made of the peak flow and time at which it occurred after release of the tourniquet.The peak flow during the combiua- on 15 July
Kallmann syndrome gene on the X and Y chromosomes: implications for evolutionary divergence of human sex chromosomes
Authors: B. Incerti, S. Guioli, A. Pragliola, E. Zanaria, G. Borsani, R. Tonlorenzi, B. Bardoni, B. Franco, D. Wheeler, A. Ballabio, G. Camerino
Journal: Nature Genetics (1992)
Adherent-invasive<i>Escherichia coli</i>target the epithelial barrier
Authors: Eytan Wine, Juan C. Ossa, Scott D. Gray-Owen, Philip Sherman
Journal: Gut Microbes (2010)

Involvement of intestinal microbes in the pathogenesis of chronic inflammatory bowel diseases (IBD, including Crohn disease and ulcerative colitis) is well established. However, the mechanisms by which bacteria lead to intestinal injury in IBD remain unclear and are the focus of current research. Using adherent-invasive Escherichia coli (AIEC) strain LF82, which is linked to Crohn disease, we recently demonstrated the ability of these intestinal microbes to disrupt the integrity of epithelial cells in an in vitro cell model. This disruption provides the bacteria a capacity to penetrate into and beyond the epithelial monolayer, replicate in cells, disseminate within the host, and induce a chronic immune response. These findings provide a link between microbes related to IBD, disruption of the intestinal epithelial cell barrier, and disease pathogenesis.In this addendum, we provide a synopsis on current data concerning the role of AIEC in the pathogenesis of intestinal inflammation, summarise our recent findings, and highlight the central role of the epithelium in mucosal defence. We also discuss, in more detail, the potential implications of our findings and present ideas for future studies and targets for intervention.