tbuckley/cabot-search huggingface dataset:
A New Definition of Primary Care
Authors: Neal A. Vanselow
Journal: JAMA (1995)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Noninflammatory Entities and the Differential Diagnosis of Positive Three Phase Bone Imaging
Authors: DOMINIQUE DELBEKE, M REZA HABIBIAN
Journal: Clinical Nuclear Medicine (1988)

The greater sensitivity of skeletal imaging over radiography (93% vs. 50%) for the detection of early osteomyelitis is well known. The introduction of the three phase protocol has improved the specificity of skeletal imaging by eliminating various noninfectious entities; however, the occurrence of false-positive studies is not unusual. Four such cases have been observed by the authors in a group of 34 patients suspected of having osteomyelitis and who had positive three phase skeletal imaging. These includes a patient with giant cell tumor, synovial cell sarcoma, gouty arthritis, and Reiter's syndrome. A description of these cases and a brief review of several other entities associated with positive three phase bone imaging is the subject of this atlas article, which should serve as an aid in the differential diagnosis of this commonly performed scintigraphic procedure.
Description of a New Stricture-Dilator on the Dovetail Principle
Authors: B. W. Richardson
Journal: BMJ (1868)

the Mlledical Press acd Circular for April 3rd, 1867, I directed the attention of the profession to a stricture-dilator, constructed upon the dovetail principle, which appeared to me to be adapted for meeting the objectionis that have becn advanced against dilators, in which the for- cer is conidtucted home upon a rod, soldered at the vesical end only, as in the I'crrvec instrument.Uinder the name of Perr6ve, I include all dilators constructed upon his princilple-i.e., hlaving the conducting- ro(l soldered and fixed at the vesical cxtreinity.The com- parison, howccr, may be wuifair with respect to Perrlve's dilator, inasmuch as the projecting of its conduictor for a few inches beyond the handle very much dinminishes the chance of buckling w-hen the blades are in process of divarication by the forcer.In tlli instrument I desr.uibedand.illurdrsied
A CONTRIBUTION TO THE STUDY OF THE SYMPTOMS OF CHRONIC URETHRITIS.
Authors: FERD. C. VALENTINE
Journal: JAMA (1898)

The fact that a patient observes a persistent or occasional drop at the meatus, by no means proves that gonorrhea exists. On the other hand, the absence of discharge does not exclude the presence of chronic gonorrhea. This fact alone warrants a detailed study of the symptoms of this disease. At the outset, it is well to say that no attempt at considering the urethrites in general is made. To extend this paper to the urethrites of a non-gonorrheal character would expand it beyond its intended dimensions. Moreover, the urethrites, other than gonorrheal, merit exhaustive study by themselves. The separate consideration of gonorrhea infecting the region before or behind the compressor is due, like the vast majority of other advances in the study and treatment of genito-urinary diseases, to the great master, Felix Guyon.<sup>1</sup>This division into anterior and posterior urethritis is not only rational, but also the most
IPF: new insight on pathogenesis and treatment
Authors: S. Harari, A. Caminati
Journal: Allergy (2010)

To cite this article: Harari S, Caminati A. IPF: new insight on pathogenesis and treatment. Allergy 2010; 65 : 537–553. Abstract Recent years have seen a robust influx of exciting new observations regarding the mechanisms that regulate the initiation and progression of pulmonary fibrosis but the pathogenesis remains poorly understood. The search for an alternative hypothesis to unremitting, chronic inflammation as the primary explanation for the pathophysiology of idiopathic pulmonary fibrosis (IPF) derives, in part, from the lack of therapeutic efficacy of high‐dose immunosuppressive therapy in patients with IPF. The inflammatory hypothesis of IPF has since been challenged by the epithelial injury hypothesis, in which fibrosis is believed to result from epithelial injury, activation, and/or apoptosis with abnormal wound healing. This hypothesis suggests that recurrent unknown injury to distal pulmonary parenchyma causes repeated epithelial injury and apoptosis. The resultant loss of alveolar epithelium exposes the underlying basement membrane to oxidative damage and degradation. Emerging concepts suggest that IPF is the result of epithelial–mesenchymal interaction. The initiation of this fibrotic response may depend upon genetic factors and environmental triggers; the role of Th1 or Th2 cell‐derived cytokines may also be important. This process appears to be unique to usual interstitial pneumonia/IPF. It is clear that IPF is a heterogeneous disease with variations in pathology, high‐resolution computed tomography findings, and patterns of progression. Idiopathic pulmonary fibrosis is a complex disorder, and no unifying hypothesis has been identified at present that explains all the abnormalities.
Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother‐to‐infant transmission of hepatitis B virus
Authors: Huey‐Ling Chen, Chien‐Nan Lee, Chin‐Hao Chang, Yen‐Hsuan Ni, Ming‐Kwang Shyu, Shih‐Ming Chen, Jen‐Jan Hu, Hans Hsienhong Lin, Lu‐Lu Zhao, Shu‐Chi Mu, Ming‐Wei Lai, Chyi‐Long Lee, Hsien‐Ming Lin, Ming‐Song Tsai, Jenn‐Jeih Hsu, Ding‐Shinn Chen, K. Arnold Chan, Mei‐Hwei Chang
Journal: Hepatology (2015)

The efficacy and safety of maternal tenofovir disoproxil fumarate (TDF) in reducing mother‐to‐infant hepatitis B virus (HBV) transmissions is not clearly understood. We conducted a prospective, multicenter trial and enrolled 118 hepatitis B surface antigen (HBsAg)– and hepatitis B e antigen–positive pregnant women with HBV DNA ≥7.5 log 10 IU/mL. The mothers received no medication (control group, n = 56, HBV DNA 8.22 ± 0.39 log 10 IU/mL) or TDF 300 mg daily (TDF group, n = 62, HBV DNA 8.18 ± 0.47 log 10 IU/mL) from 30‐32 weeks of gestation until 1 month postpartum. Primary outcome was infant HBsAg at 6 months old. At delivery, the TDF group had lower maternal HBV DNA levels (4.29 ± 0.93 versus 8.10 ± 0.56 log 10 IU/mL, P &lt; 0.0001). Of the 121/123 newborns, the TDF group had lower rates of HBV DNA positivity at birth (6.15% versus 31.48%, P = 0.0003) and HBsAg positivity at 6 months old (1.54% versus 10.71%, P = 0.0481). Multivariate analysis revealed that the TDF group had lower risk (odds ratio = 0.10, P = 0.0434) and amniocentesis was associated with higher risk (odds ratio 6.82, P = 0.0220) of infant HBsAg positivity. The TDF group had less incidence of maternal alanine aminotransferase (ALT) levels above two times the upper limit of normal for ≥3 months (3.23% versus 14.29%, P = 0.0455), a lesser extent of postpartum elevations of ALT ( P = 0.007), and a lower rate of ALT over five times the upper limit of normal (1.64% versus 14.29%, P = 0.0135) at 2 months postpartum. Maternal creatinine and creatinine kinase levels, rates of congenital anomaly, premature birth, and growth parameters in infants were comparable in both groups. At 12 months, one TDF‐group child newly developed HBsAg positivity, presumably due to postnatal infection and inefficient humoral responses to vaccines. Conclusions : Treatment with TDF for highly viremic mothers decreased infant HBV DNA at birth and infant HBsAg positivity at 6 months and ameliorated maternal ALT elevations. (H epatology 2015;62:375–386
Central serotonergic stimulation of aldosterone secretion.
Authors: Y Shenker, M D Gross, R J Grekin
Journal: Journal of Clinical Investigation (1985)

Serotonin stimulates aldosterone secretion both in vitro and in vivo, and serotonin antagonism decreases plasma aldosterone levels in patients with idiopathic aldosteronism. This study was designed to assess the effects of the serotonin precursor, 5-hydroxytryptophan (5HTP), upon aldosterone secretion in man, and to determine whether stimulatory effects of 5HTP are mediated through the central nervous system. Oral 5HTP, administered as a single 200-mg dose, increased plasma aldosterone levels from 4.7 +/- 0.6 to 13.3 +/- 2.8 ng/dl in dexamethasone-pretreated, normal volunteers. Peripheral inhibition of decarboxylation of 5HTP, achieved by pretreatment with carboxydopa, 25 mg three times daily for 3 d, significantly increased the stimulatory effects of 5HTP on aldosterone levels (P less than 0.001). No change in aldosterone levels occurred in subjects who received placebo after pretreatment with dexamethasone and carboxydopa. Increased aldosterone was not accompanied by increases in plasma levels of renin activity, potassium, or ACTH. Plasma levels of 5HTP were markedly increased by carboxydopa pretreatment, but peak plasma levels of serotonin were not significantly altered. Four patients with idiopathic aldosteronism all had an increase in plasma aldosterone levels after 5HTP administration, whereas the response in four patients with aldosterone-producing adenoma was variable. Incubation of isolated human and rat adrenal glomerulosa cells with serotonin resulted in increased aldosterone secretion by both sets of cells, whereas 5HTP was ineffective in stimulating aldosterone secretion in vitro. We conclude that central serotonergic pathways are involved in the stimulation of aldosterone induced by administration of 5HTP. This mechanism may be an important etiologic factor in the hypersecretion of aldosterone that occurs in patients with idiopathic aldosteronism.
Comparison of LE Cell Tests
Authors: Edmund L. Dubois
Journal: JAMA (1973)

To the Editor.—  Lederle Diagnostics recently introduced the Systemic Lupus Erythematosus (SLE) Latex Test Kit for detection of SLE by the latex agglutination slide method. The reagent consists of polystyrene latex particles coated with deoxyribonucleoprotein (DNP) extracted from fetal calf thymus. The test is similar to the  Test Kit 1 marketed by Hyland Laboratories in 1961.  We compared the results of the Lederle test in 230 patients with various diseases with a rotary LE cell test 2 (performed in all cases), a rotatedwashed clot LE cell test 2 (in 171 cases), and an antinuclear antibody (ANA) determination, utilizing a leukocyte substrate 3 (in 132 cases). The latex test was quite specific as shown in the Table. No false positives were seen. Twenty-one of 121 known SLE patients with varying degrees of disease activity had positive latex tests; 16 of these 21 had positive rotary LE cell tests while three
Primary care trusts to take lead on public health
Authors: R. Dobson
Journal: BMJ (2001)

Government plans to give the new primary care trusts a key role in attacking health inequalities have been heavily criticised by a leading epidemiologist as “downsizing” public health.

Professor Michael Clarke, professor of epidemiology at Leicester University, warned the proposals would mean much smaller teams covering bigger areas: “[The government's response] talks about each strategic health authority having its own director or public health, which sounds terrific.

“But Leicestershire, for example, will be merged with Northamptonshire and massively downsized. We now have two directors of public health, …
Calcification of the Auricular Cartilage in a Patient with Hypopituitarism
Authors: Russell E. Randall, Frederick W. Spong
Journal: New England Journal of Medicine (1963)

CALCIFICATION of the auricular cartilage has been reported infrequently, generally in association with conditions that produce local injury to tissue such as frostbite,1 2 3 4 5 6 7 trauma1 , 2 and inflammation.1 , 2 , 5 , 8 Metabolic disorders implicated in other reported cases include ochronosis,9 , 10 hypercalcemia,11 acromegaly4 , 12 and adrenal insufficiency.13 This report describes the only known case in which the calcifications occurred in association with prolonged untreated hypopituitarism.Case ReportA 49-year-old warehouse worker was in good health until pneumonia of the right upper lobe developed 16 years before this study. This responded well to sulfapyridine, but since that time, he had noticed increasing lethargy, fatigue, intolerance to cold, decreased . . .
Barium Impaction as a Complication Of Gastrointestinal Scleroderma
Authors: Melish A. Thompson
Journal: JAMA (1976)

Two patients with scleroderma of the bowel experienced life-threatening barium impaction after upper intestinal x-ray studies. Although the frequency of this complication is unknown, the difficulty of managing it when it occurs makes prevention imperative. X-ray studies should be performed only after careful consideration of the risks and benefits. When x-ray studies are performed, the patient should be vigorously purged soon thereafter, and a follow-up roentgenogram should be obtained to confirm adequate removal of barium. (<i>JAMA</i>235:1715-1717, 1976)
ICOS-dependent extrafollicular helper T cells elicit IgG production via IL-21 in systemic autoimmunity
Authors: Jared M. Odegard, Benjamin R. Marks, Leah D. DiPlacido, Amanda C. Poholek, Dwight H. Kono, Chen Dong, Richard A. Flavell, Joe Craft
Journal: The Journal of Experimental Medicine (2008)

The role of specialized follicular helper T (TFH) cells in the germinal center has become well recognized, but it is less clear how effector T cells govern the extrafollicular response, the dominant pathway of high-affinity, isotype-switched autoantibody production in the MRL/MpJ-Faslpr (MRLlpr) mouse model of lupus. MRLlpr mice lacking the Icos gene have impaired extrafollicular differentiation of immunoglobulin (Ig) G+ plasma cells accompanied by defects in CXC chemokine receptor (CXCR) 4 expression, interleukin (IL) 21 secretion, and B cell helper function in CD4 T cells. These phenotypes reflect the selective loss of a population of T cells marked by down-regulation of P-selectin glycoprotein ligand 1 (PSGL-1; also known as CD162). PSGL-1lo T cells from MRLlpr mice express CXCR4, localize to extrafollicular sites, and uniquely mediate IgG production through IL-21 and CD40L. In other autoimmune strains, PSGL-1lo T cells are also abundant but may exhibit either a follicular or extrafollicular phenotype. Our findings define an anatomically distinct extrafollicular population of cells that regulates plasma cell differentiation in chronic autoimmunity, indicating that specialized humoral effector T cells akin to TFH cells can occur outside the follicle.
Withdrawal Convulsions: Epileptic or Not?
Authors: Frederic A. Gibbs
Journal: JAMA (1964)

<h3>To the Editor:—</h3> Communications have appeared and others are being submitted for publication (I have seen several finished manuscripts) which report a single case wherein withdrawal of meprobamate has caused convulsions in (and here is the catch) an epileptic. Such reports would be innocuous if they did not add to the hysterical outcry of those who now view with alarm the use of even a mild tranquilizer. As one who has treated epileptics for years, I know that seizures are likely to occur with a reduction in dosage of many agents, or for that matter, with any change in medication. Meprobamate is not contraindicated in epilepsy. On the contrary, it is often helpful and is used to advantage in combination with anticonvulsants, particularly in patients who are tense or somewhat hyperactive. It can be discontinued with less risk of precipitating seizures than that involved in reduction of barbiturate dosage.
Exaggerated Renal Vasoconstriction During Exercise in Heart Failure Patients
Authors: Holly R. Middlekauff, Egbert U. Nitzsche, Carl K. Hoh, Michele A. Hamilton, Gregg C. Fonarow, Antoine Hage, Jaime D. Moriguchi
Journal: Circulation (2000)

During static exercise in normal healthy humans, reflex renal cortical vasoconstriction occurs. Muscle metaboreceptors contribute importantly to this reflex renal vasoconstriction. In patients with heart failure, in whom renal vascular tone is already increased at rest, it is unknown whether there is further reflex renal vasoconstriction during exercise.Thirty-nine heart failure patients (NYHA functional class III and IV) and 38 age-matched control subjects (controls) were studied. Renal blood flow was measured by dynamic positron emission tomography. Graded handgrip exercise and post-handgrip ischemic arrest were used to clarify the reflex mechanisms involved. During sustained handgrip (30% maximum voluntary contraction), peak renal vasoconstriction was significantly increased in heart failure patients compared with controls (70+/-13 versus 42+/-1 U, P=0.02). Renal vasoconstriction returned to baseline in normal humans by 2 to 5 minutes but remained significantly increased in heart failure patients at 2 to 5 minutes and had returned to baseline at 20 minutes. In contrast, during post-handgrip circulatory arrest, which isolates muscle metaboreceptors, peak renal vasoconstriction was not greater in heart failure patients than in normal controls. In fact, the increase in renal vasoconstriction was blunted in heart failure patients compared with controls (20+/-5 versus 30+/-2 U, P=0.05).During sustained handgrip exercise in heart failure, both the magnitude and duration of reflex renal vasoconstriction are exaggerated in heart failure patients compared with normal healthy humans. The contribution of the muscle metaboreceptors to reflex renal vasoconstriction is blunted in heart failure patients compared with normal controls.
Tumour necrosis factor antagonists and early postoperative complications in patients with inflammatory joint disease undergoing elective orthopaedic surgery
Authors: S C Talwalkar
Journal: Annals of the Rheumatic Diseases (2005)

In conclusion, infliximab can be used safely in daily clinical practice, but both doctors and patients should be aware of the (infection) risks, especially in patients receiving a higher dose (.3 mg/kg) of infliximab, in order to anticipate and minimise these risks.
An Evaluation of Wedge Pressures in Dogs under Conditions of Normal and Elevated Pulmonary Vascular Pressures
Authors: F. J. HADDY, J. F. ALDEN, A. L. FERRIN, D. W. HANNON, W. L. ADAMS, I. D. BARONOFSKY
Journal: Circulation Research (1953)

Fifty-six combined right and left heart catheterizations in normal dogs and dogs with experimental mitral stenosis failed to show a significant positive correlation between pulmonary artery wedge pressure and pulmonary vein pressure when the latter was below approximately 17 mm. Hg. Evidence is presented which suggests that the wedged catheter outlets are totally occluded in many instances in the dog. Pulmonary vein wedge pressure reflected a pressure nearer the pulmonary artery pressure than the expected capillary pressure. One instance of mitral regurgitation revealed large pulmonary vein and pulmonary artery wedge pulse pressures.
Inflammatory bowel disease: re-evaluation of the diagnosis in a prospective population based study in south eastern Norway.
Authors: B Moum, A Ekbom, M H Vatn, E Aadland, J Sauar, I Lygren, T Schulz, N Stray, O Fausa
Journal: Gut (1997)

BACKGROUND: The incidence figures for ulcerative colitis (UC) and Crohn9s disease (CD) have been difficult to interpret, and geographical variations may be due to differences in classification criteria and study design. Few studies have based the incidence on prospective systematic follow up to confirm the initial diagnosis. METHODS: Between 1990 and 1993, in a prospective incidence study of inflammatory bowel disease (IBD) in south eastern Norway, 527 cases of UC, 228 cases of CD, 36 cases of indeterminate colitis (IND), and 55 cases of possible IBD were identified, yielding an annual incidence of 13.6, 5.9, 0.9, and 1.4 per 10(5) respectively. The diagnosis and all clinical data were reviewed by two gastroenterologists independently of each other. One to two years after diagnosis, all patients were offered a clinical follow up in which the initial diagnosis was assessed. RESULTS: Between the time of diagnosis and the follow up, 16 patients had died, four of complications related to IBD. Of the remaining 830 patients, 98% (814/830) were available for follow up, 93% (772/830) attended a clinical examination which included a colonoscopy in 77% (637/830), and the remainder had had a telephone interview, or reassessment based on hospital records, or both. Twenty seven patients were reclassified as not having IBD (3%), and 65 patients were characterised as possible IBD (8%). Of the patients initially classified as UC, 88% had their diagnosis confirmed, compared with 91% with an initial diagnosis of CD. In patients with indeterminate colitis, 33% were classified as definite UC and 17% as CD. This reclassification of patients yielded a corrected annual incidence of 12.8 for UC and 6.0 for CD. CONCLUSION: At follow up one to two years after the diagnosis of IBD, the initial incidence was only marginally altered. This is probably due to uniform inclusion criteria and careful diagnostic methods. The study also illustrates the importance of the re-evaluation of the initial diagnosis as close to 10%, both among patients with UC and CD, were reclassified at follow up.
Recent Developments in Pulmonary Edema
Authors: EDWARD D. CRANDALL
Journal: Annals of Internal Medicine (1983)

Research on lung fluid balance and pulmonary edema has increased during the last decade. New approaches have led to insights into the role of each component of the alveolar-capillary barrier. The capillary endothelium is the first line of defense against lung fluid accumulation. The interstitium may play a more important role in lung fluid balance than previously appreciated. Active and passive transport properties of alveolar epithelium may be important in the pathogenesis and resolution of alveolar edema. New methods for the determination of epithelial permeability and lung water are being evaluated. The developments reviewed here may have an impact on the institution of new diagnostic and therapeutic approaches to pulmonary edema during the next decade.
Overbilling and Informed Financial Consent — A Contractual Solution
Authors: Barak D. Richman, Mark A. Hall, Kevin A. Schulman
Journal: New England Journal of Medicine (2012)

U.S. hospitals and physicians may charge uninsured patients and patients receiving care outside of their health-plan networks far more than their actual costs or what most health insurers pay. The theory of implied contracts offers a useful approach to this problem.