tbuckley/cabot-search huggingface dataset:
Generalists and Specialists-Reply
Authors: Thomas J. Ruane
Journal: JAMA (1984)

In Reply.—  As a family physician and family practice educator, I have no quarrel with Dr McMillen's assessment of medical care in the real world and, in fact, share his enjoyment of office and community hospital medical practice. Both he and Dr Davidson 1 have taken my letter as a criticism of the competence and viability of the primary care internist when it was intended as a commentary on the traditional academic perspective.  Although I trained in family practice, a good deal of my time was spent in contact with internal medicine residents, practitioners, and faculty. In this academic setting, residents aspired to the knowledge, skills, and roles of their faculty mentors—academic subspecialty internists who themselves pursued the goal of becoming Dr Petersdorf's 2 triple threat academicians. Although often acknowledged as good physicians and sometimes as astute clinicians, practitioners of general internal medicine were not the role models for these residents.
Increased Nitrotyrosine in the Diabetic Placenta: Evidence for oxidative stress
Authors: Fiona Lyall, Janice L Gibson, Ian A Greer, Diane E Brockman, Annie L Eis, Laslie Myatt
Journal: Diabetes Care (1998)

To evaluate the presence of nitrotyrosine (NT) residues in placental villous tissue of diabetic pregnancies as an index of vascular damage linked to oxidative stress.Villous tissue was collected and flash frozen after delivery from 10 class C and D IDDM patients (37.9+/-3.2 weeks) and 10 normotensive pregnant individuals (37.5+/-3.8 weeks). Serial sections of tissue were immunostained with specific antibodies to NT, endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), and manganese superoxide dismutase (MnSOD). Sections were scored for intensity of immunostaining (0-3) by three observers blinded to the identity of tissue.All tissues demonstrated immunostaining for eNOS in both syncytiotrophoblast and stem villous vascular endothelium with no apparent differences between groups. Immunostaining for iNOS was seen in the villous stroma, but again was not different between the two groups. Significantly more intense NT staining was apparent in vascular endothelium and villous stroma (both P < 0.02) of diabetic placentas. The endothelium of large villous vessels of diabetic tissues also showed more intense immunostaining for MnSOD (P < 0.01).In these diabetic pregnancies, we were unable to show increased eNOS, unlike previous findings in preeclamptic pregnancies. The presence of NT may indicate vascular damage in the diabetic placenta due to peroxynitrite action formed from increased synthesis/interaction of nitric oxide and superoxide. The apparently paradoxical increase in MnSOD expression may be an adaptive response to increased superoxide generation.
The Mechanism of Synchronization in Isorhythmic A-V Dissociation
Authors: MATTHEW N. LEVY, JOSEF EDFLSTEIN
Journal: Circulation (1970)

The electrocardiographic patterns recorded from seven patients with isorhythmic A-V dissociation fall into two distinct groups. In pattern I, the P wave fluctuates cyclically back and forth across the QRS complex. The mechanism responsible for this type of A-V synchronization represents a typical biologic feedback control system. The P-R interval is a determinant of stroke volume, which in turn influences the arterial blood pressure. The blood pressure has an inverse effect on the discharge frequency of the S-A node through the baroreceptor reflex. The S-A nodal frequency then affects the P-R interval, to close the feedback loop. In pattern II, the P wave is in a fairly constant position relative to the QRS complex. It is usually coincident with the QRS complex or appears on the ST segment or first half of the T wave. The mechanism producing synchronization in pattern II type of isorhythmic dissociation has not been established conclusively.
Tuberculosis experts pin hopes of controlling disease on 12 vaccines in development
Authors: G. Watts
Journal: BMJ (2012)

The advent of more effective vaccines against tuberculosis is an increasingly realistic possibility, say public health experts with an interest in the illness. Tuberculosis is currently the world’s second deadliest infection, with 8.8 million new cases in 2010.

“In the last decade we’ve gone from having no vaccines in development to now having 12 different candidates at various stages in the clinic and in human trials,” said Ann Ginsberg, vice president of scientific affairs for Aeras, a foundation devoted to the development of vaccines against tuberculosis.

Increasingly concerned over the rise of drug resistant tuberculosis, she and others in the field have long insisted that …
Mid Staffs trust is to face criminal charges over patient's death
Authors: C. Dyer
Journal: BMJ (2013)

Mid Staffordshire NHS Foundation Trust is to be prosecuted by the Health and Safety Executive over the death of a patient with diabetes who fell into a coma after staff failed to give her insulin.

The move is the first criminal prosecution over events at the trust between 2005 and 2008, when there were hundreds of excess deaths and staff delivered “appalling care,” according to …
PTH-125 A New Lower Gastrointestinal 2-Week wait ‘Direct to Test’ Pathway Results in Earlier Diagnosis of Cancer
Authors: A Humphries, J Clarke, G Bhatnagar, I Jenkins, D Burling, S Thomas-Gibson
Journal: Gut (2013)

<h3>Introduction</h3> As part of the National Awareness and Early Diagnosis Initiative (NAEDI)<sup>1</sup>, a symptom awareness campaign for bowel cancer was piloted in the UK in 2010 and 2011. The results suggested that referrals from primary care would increase by up to 30% when extended nationally from 30<sup>th</sup> January 2012. As a result, a new two-week wait (2WW) pathway for suspected colorectal cancer was developed at North West London Hospitals NHS Trust that aimed to decrease the projected burden on colonoscopy and triage the majority of patients direct to an appropriate diagnostic test - ‘direct-to-test’ (DTT), in order to reduce the time and number of appointments before cancer is diagnosed. Previously, patients were triaged to either an out-patient appointment or flexible sigmoidoscopy (FS); the new DTT pathway triaged patients to either FS, colonoscopy, CT colonography (CTC) or an out-patient appointment based on age and symptomatology. <h3>Methods</h3> Outcome data for all patients referred via the old pathway for the months of May 2011 and January 2012, and those seen via the new DTT pathway for March 2012 and May 2012 were audited to assess clinical effectiveness. <h3>Results</h3> There was a 33% increase in patients referred with suspected lower GI cancer following the NAEDI campaign, and this was sustained to May 2012. On the previous pathway the majority (60%) of patients were seen first in out-patients before a diagnostic test was requested, whereas over 85% of patients proceeded DTT with the new pathway. There was no significant difference in the proportion of colonic and extra-colonic cancers diagnosed between the two pathways, however more patients were diagnosed with colorectal polyps using the new pathway. Patients with cancer referred via the DTT pathway had a significantly reduced median time to diagnosis compared to those on the old pathway (10 days vs 15 days respectively, p &lt; 0.05), and patients seen via the new DTT pathway had significantly fewer hospital appointments compared to those seen on the old pathway (1.9 vs 2.8 respectively, p &lt; 0.0001). <h3>Conclusion</h3> Symptom awareness campaigns increase demand for colorectal diagnostic services. We have demonstrated that a new DTT 2WW pathway for suspected colorectal cancer reduces the time to diagnosis of colonic neoplasia, whilst increasing outpatient capacity by involving fewer hospital attendances. Use of CT colonography for older patients decreases the burden on diagnostic colonoscopy, creating more targeted therapeutic endoscopy capacity. <h3>Disclosure of Interest</h3> None Declared. <h3>Reference</h3> Cancer Reform Strategy; Department of Health, December 2007.
TOWARD A REGIONAL PROGRAM IN MEDICAL EDUCATION
Authors: William J. McGlothlin
Journal: JAMA (1952)

If someone had predicted in 1947 that five years later the southern states would be transferring over a million dollars across state lines to help support professional schools in medicine, dentistry, veterinary medicine, and social work, he would have been called visionary or, more likely, idiotic, for there was no precedent for transfer of educational funds to anything like that extent. To be sure, West Virginia and Virginia had executed a contract in 1946 under which the Medical College of Virginia agreed to accept 20 third-year medical students upon payment of $1,000 per student per year. That program, though a beginning, was necessarily small. It could hardly foreshadow the organization of the Southern Regional Education Board, under a 14-state compact, which now guides a program affecting 850 students, 19 public and private universities, and 14 states. The board itself brings together educational and political leaders to help institutions plan programs
Surprising new roles for endothelins
Authors: A. C M Ong
Journal: BMJ (1996)

The use of so called “knockout” mice in scientific research continues to produce surprises. Deficient in a particular molecule as a result of targeted mutagenesis, they allow scientists to study the essential physiological role of the absent molecule. Such has been the case with the endothelins, vasoactive peptide mediators whose discovery in 1988 was a highpoint in vascular biology.1 Humans have three endothelin isoforms, endothelins 1,2, and 3,2 and two endothelin receptor subtypes, endothelins A and B, whose functions remain to be completely elucidated.

Endothelin-1 is the most potent vasoconstrictor substance yet described,1 and the major focus in endothelin research has been to investigate its role in the regulation of normal systemic and regional vascular tone.2 In the intense research activity that followed discovery of endothelin-1 it soon became apparent that endothelins did not function as classical circulating humoral factors, but rather as locally acting autocrine or paracrine factors. Surprisingly, the endothelins were also found to be synthesised by a variety …
UK lags behind in fight against heart disease
Authors: B. Hope
Journal: BMJ (1999)

Coronary heart disease, the leading cause of death in the United Kingdom, is now sufficiently understood that developed countries have been successful in bringing down mortality and morbidity. But, warns a new report by the National Heart Forum, efforts to fight the disease in Britain lag behind several comparable countries—for example, the United States and Australia, and only an unprecedented programme of public health measures will allow the population to benefit from what has …
THE DISCORDANT RELATIONSHIP BETWEEN FRACTIONAL FLOW RESERVE AND CORONARY FLOW RESERVE IS NOT EXPLAINED BY DIFFERENCES IN MICROVASCULAR OR RESIDUAL CULPRIT EPICARDIAL CORONARY DISEASE
Authors: Jamie John Layland, Andrew Wilson, Robert Whitbourn, Andrew Macisaac, Keith Oldroyd, Colin Berry
Journal: Journal of the American College of Cardiology (2013)
Minding the Competition
Authors: Nakela L. Cook
Journal: Circulation (2012)

A lthough we have made great strides in reducing the burden of cardiovascular disease over the past 50 years, blacks in the United States still face increased cardiovascular mortality, along with a disproportionate burden of risk factors. 1-3However, if race-based comparisons become the basis for action, it is essential that they be measured and interpreted accurately.Blacks experience higher mortality rates of noncardiovascular disease (non-CVD). 2Some have argued that without accounting for non-CVD related deaths among blacks, epidemiologists may be overestimating the true comparative rate of incident cardiovascular events among blacks.In other words, by failing to mind the competition, we may be overestimating the race-based gap in CVD. 4,
Late first relapses in APL treated with all-trans-retinoic acid- and anthracycline- based chemotherapy: the European APL group experience (APL 91 and APL 93 trials)
Authors: C Kelaidi, L Ades, S Chevret, M Sanz, A Guerci, X Thomas, S de Botton, E Raffoux, C Rayon, N Fegueux, D Bordessoule, F Rigal-Huguet, H Link, A Stoppa, A Vekhoff, S Meyer-Monard, S Castaigne, H Dombret, L Degos, P Fenaux
Journal: Leukemia (2006)
Toxic Reactions From a Haloperidol Overdose in Two Children
Authors: John V. K. Scialli
Journal: JAMA (1978)

REPORTS of toxic reactions to haloperidol have been scant. Hollister and Ayd have commented about the relative safety of a drug overdose; also, Davis and associates have reported an absence of fatalities and life-threatening reactions. An extensive search of the literature showed only nine reported cases of pediatrics drug overdose. In the series of Gaultier and Fahti,<sup>1</sup>five children were reported to have reversible symptoms, including somnalence and extrapyramidal signs. Debray and Galland<sup>2</sup>report four cases with acute dystonic reactions and convulsions. Fourteen unpublished cases of drug overdose have been reported to the McNeil Laboratories (according to a personal communication with J. C. Maerz, MD, Feb 11, 1977). These include 9 instances of impaired consciousness, 7 of extrapyramidal symptoms, and 2 of hypertension; one child had no ill effects. In all cases, recovery was complete and there was no mention of cardiovascular manifestations. In view of the fact
PD173074, a selective FGFR inhibitor, reverses MRP7 (ABCC10)-mediated MDR
Authors: Nagaraju Anreddy, Atish Patel, Kamlesh Sodani, Rishil J. Kathawala, Eugenie P. Chen, John N.D. Wurpel, Zhe-Sheng Chen
Journal: Acta Pharmaceutica Sinica B (2014)

Multidrug resistance protein 7 (MRP7, ABCC10) is a recently identified member of the ATP-binding cassette (ABC) transporter family, which adequately confers resistance to a diverse group of antineoplastic agents, including taxanes, vinca alkaloids and nucleoside analogs among others. Clinical studies indicate an increased MRP7 expression in non-small cell lung carcinomas (NSCLC) compared to a normal healthy lung tissue. Recent studies revealed increased paclitaxel sensitivity in the Mrp7−/− mouse model compared to their wild-type counterparts. This demonstrates that MRP7 is a key contributor in developing drug resistance. Recently our group reported that PD173074, a specific fibroblast growth factor receptor (FGFR) inhibitor, could significantly reverse P-glycoprotein-mediated MDR. However, whether PD173074 can interact with and inhibit other MRP members is unknown. In the present study, we investigated the ability of PD173074 to reverse MRP7-mediated MDR. We found that PD173074, at non-toxic concentration, could significantly increase the cellular sensitivity to MRP7 substrates. Mechanistic studies indicated that PD173074 (1 μmol/L) significantly increased the intracellular accumulation and in-turn decreased the efflux of paclitaxel by inhibiting the transport activity without altering expression levels of the MRP7 protein, thereby representing a promising therapeutic agent in the clinical treatment of chemoresistant cancer patients.
A family with primary protrusio acetabuli.
Authors: K D'Arcy, B M Ansell, E G Bywaters
Journal: Annals of the Rheumatic Diseases (1978)

The family of a child who developed symptoms and flexion contractures with protrusio acetabuli rapidly between the age of 8 and 11 was examined. The mother and one sib showed limitation of hip movements, while radiological criteria for protrusio were found in the mother and 4 of the proband9s 8 sibs; only one had complained of pain. At the age of 16 the proband underwent bilateral total replacement arthroplasty; histologically the changes were those of fibrocartilaginous replacement and osteophyte formation.
BMA's patient confidentiality rules are deemed unlawful
Authors: C. Dyer
Journal: BMJ (1999)

New BMA guidelines on patient confidentiality have been branded unlawful by the Association of Community Health Councils for England and Wales, the statutory body representing patients interests in the NHS.

The disagreement centres on the use of anonymised patient data for audit, research, or commercial purposes. Guidance from the BMA says that the disclosure of “truly anonymous information does not breach confidentiality,” whereas the association of community health councils disagrees, claiming that it is extremely difficult to “completely anonymise patient information,” so that individuals may still end up being identified.

It claims that the BMA should have awaited the outcome …
An Alleged Unauthorized Statement by an Optician.
Authors: O. A. Griffin
Journal: JAMA (1902)

Ann Arbor, Mich., Aug. 11, 1902. <h3>To the Editor:</h3> —I have recently been informed by members of the medical profession in northern Michigan that a traveling "Optician Specialist," Prof. J. Wilson Edmonds by name, is doing that section of the state and advertising that he has taken a course of instruction under my direction. I wish to say that Mr. Edmonds recently came under my care as a patient, but no course of instruction was given him, nor did he advertise such a statement with my knowledge or sanction. Hoping that you will publish this communication that the profession will understand the matter, I am, Fraternally yours,
Antibiotics in Endocarditis due to Nutritionally Deficient Streptococci-Reply
Authors: A. W. Karchmer
Journal: JAMA (1989)

In Reply.—  Drs Stein and Libertin assert, quite accurately, that endocardial infections due to nutritionally deficient streptococci appear to be more difficult to eradicate than are those due to other viridans streptococci. For this reason, the American Heart Association ad hoc writing group recommended that such infections be treated with a combination of intravenous aqueous crystalline penicillin G plus either streptomycin or gentamicin and that the  of aminoglycoside therapy should be at least two   Drs Stein and Libertin question these recommendations on two counts. First, they suggest that the duration of aminoglycoside therapy should be for 4 to 6 weeks. We do not believe that existing data are adequate to settle this issue. Because such infections occur relatively infrequently, there is no large series of unselected cases of endocarditis caused by nutritionally deficient streptococci. Case reports and compilations of small numbers of patients are likely to be biased
Loss of JAK2 regulation via a heterodimeric VHL-SOCS1 E3 ubiquitin ligase underlies Chuvash polycythemia
Authors: Ryan C Russell, Roxana I Sufan, Bing Zhou, Pardeep Heir, Severa Bunda, Stephanie S Sybingco, Samantha N Greer, Olga Roche, Samuel A Heathcote, Vinca W K Chow, Lukasz M Boba, Terri D Richmond, Michele M Hickey, Dwayne L Barber, David A Cheresh, M Celeste Simon, Meredith S Irwin, William Y Kim, Michael Ohh
Journal: Nature Medicine (2011)
A Major Pitfall in the Interpretation of "Central Blood Volume"
Authors: HENRY D. MCINTOSH, WILLIAM L. GLEASON, D. EDMOND MILLER, JAMES M. BACOS
Journal: Circulation Research (1961)

During reactive hyperemia of the legs of normal subjects, the "central blood volume" increased 569 ml. when measured from a hrachial arterial sampling site but decreased 144 ml. when measured from the femoral artery. This study demonstrates that changes occurring within the peripheral arterial system can profoundly influence "central blood volume" measurements which are made from a peripheral arterial sampling site. Failure to recognize the inconstancy and the potential magnitude of the arterial contribution is a major pitfall in the interpretation of the calculated "central blood volume." It is suggested that changes in either arterial volume or arterial flow distribution may alter the "central blood volume" but that the distribution effect is the more probable cause of the changes seen in this study. Alterations in "central blood volume," which result from changes within the peripheral vasculature, cannot be readily distinguished from those caused by changes in the volume of blood in the heart and lungs. Peripheral effects can be avoided if the indicator is injected into the right auricle and sampling is done from the root of the aorta.
F-18 FDG PET Demonstrates Crossed Cerebellar Diaschisis 20 Years After Stroke
Authors: Wei-Jen Shih, Wen-Sheng Huang, Primo P. Milan
Journal: Clinical Nuclear Medicine (2006)

Stroke produces an area of focal damage and distant areas of reduced blood blow and metabolism termed diaschisis. Tc-99m ECD and HMPAO brain SPECT have demonstrated crossed cerebellar diaschisis (CCD) in patients with cerebral cortical infarct. SPECT findings reflect abnormal cerebral blood flow. CCD as shown on F-18 FDG PET reflects abnormal reflects glucose metabolism. We present the case of a patient with laryngeal cancer who also had a stroke in the left cerebral hemisphere involving the territory of the middle cerebral artery 20 years ago. This patient underwent PET, including the head and neck. A current brain F-18 FDG PET exhibited hypometabolism in the contralateral cerebellum (CCD) as well as hypometabolism of the primary insult in the left cerebral hemisphere. These findings reflect partial impairment or diminished glucose metabolism in the primary insult to the cerebrum and contralateral cerebellum. In addition, this patient illustrates that on PET imaging, CCD could be demonstrated 20 years after a stroke.
Effect of oral hypoglycaemic agents on glucose tolerance in pancreatic diabetes
Authors: B. I. Joffe, W. P. U. Jackson, S. Bank, A. I. Vinik
Journal: Gut (1972)

The short-term therapeutic effect of oral hypoglycaemic agents has been assessed in 12 patients with symptomatic diabetes secondary to chronic pancreatitis (pancreatic diabetes). In six patients who had moderate to severe carbohydrate intolerance, associated with severe insulinopaenia during arginine infusion, the potent sulphonylurea chlorpropamide produced no change in the fasting blood glucose level after two weeks of treatment. This contrasted with the significant reduction produced in a matched group of maturity-onset primary diabetics. The six patients with milder diabetes, and a greater (although still subnormal) insulin secretory capacity, showed an improvement in oral glucose tolerance during the first hour following glucose administration while on chlorpropamide. When the biguanide phenformin was substituted for chlorpropamide in five of these patients, a statistically insignificant improvement in glucose tolerance was observed during treatment. Applications of these findings to the practical management of pancreatic diabetes are briefly considered.
Health problems of anaesthetists and their families in the West Midlands.
Authors: P J Tomlin
Journal: BMJ (1979)

A survey of all anaesthetists in the West Midlands region--that is, 10% of all the anaesthetists in England and Wales--showed that one in 10 of their children had been referred to a consultant because of a congenital or nonacquired anomaly. Abortions among anaesthetists9 families were also common but more so when the mother was an anaesthetist. The anomalies were concentrated particularly in the central nervous system and musculoskeletal system, and girls were worst affected. The mean birth weights were below normal, more so when the mothers were anaesthetists. Girls with anomalies were particularly underweight. Other effects observed were unexpected infertility, cancer both in the adults and in the children, and, possibly, impaired intellectual development in the children. Many anaesthetising areas were inadequately ventilated, and scavenging devices despite their inefficiency are recommended as a stopgap measure. The results of the study closely resemble those of other studies with similar high response rates to requests for information.
Evidence-based recommendations for bowel cleansing before colonoscopy in children: a report from a national working group
Authors: D. Turner, A. Levine, B. Weiss, A. Hirsh, R. Shamir, R. Shaoul
Journal: Endoscopy (2010)

See also: Commentaire de travail de D. Turner et al., pp. 1063Endoscopy 2010; 42(12): 1121-1121DOI: 10.1055/s-0032-1306714