tbuckley/cabot-search huggingface dataset:
Would Accommodating Some Conscientious Objections by Physicians Promote Quality in Medical Care?
Authors: Douglas B. White
Journal: JAMA (2011)

MORAL PLURALISM IS A VALUABLE ASPECT OF A free society but sometimes creates conflicts in medical care when individual physicians object to providing certain legal but morally controversial services, such as abortion, physician-assisted suicide (where it is legal), and palliative sedation to unconsciousness. Genuine conscience-based refusals (CBRs) are refusals in which a physician believes that providing the requested service would violate his or her core moral beliefs (religious or secular), thereby causing personal moral harm. Conscience-based refusals should be a “shield” to protect individual physicians from being compelled to violate their core moral beliefs rather than a “sword” to force their beliefs onto patients. This partially explains why many physicians who invoke CBRs refer their patients to physicians willing to provide the requested care. Savulescu has characterized CBRs as self-serving acts accomplished at the expense of patients. Others accept CBRs as legitimate acts to protect moral integrity despite the potential negative consequences for patients. Both characterizations neglect a complexity: society may obtain higherquality medical care in aggregate by accommodating some CBRs. In this Commentary, CBRs are addressed from this societal perspective.
Blood and Its Derivatives
Authors: Sam T. Gibson
Journal: New England Journal of Medicine (1948)

Albumin (Fraction V) Shock. As the product whose preparation was responsible for the initiation of the entire fractionation program,9, 11, 213 214 215 216 217 albumin remains of first importance, but its use in the treatment of shock has become secondary. Tested successfully in civilian cases215 216 217 218 219 220 221 222 of shock, it proved to be a satisfactory therapeutic agent under field conditions.11, 223 , 224 Unless extra fluid was given, however, dehydrated patients received less benefit from the concentrated material than normally hydrated patients did.214 , 218 , 221 Various investigators have reported plasma-volume increases due to albumin of 8 to 18 cc. per gram under different conditions. These are summarized in Table 4. Albumin uniformly . . .
Vascular anomalies compressing the oesophagus and trachea
Authors: J. C. R. Lincoln, P. B. Deverall, J. Stark, E. Aberdeen, D. J. Waterston
Journal: Thorax (1969)

Vascular rings formed by anomalies of major arteries can compress the trachea and oesophagus so much as to cause respiratory distress and dysphagia. Twenty-nine patients with this condition are reviewed and discussed in five groups. The symptoms and signs are noted. Radiological examination by barium swallow is the most useful diagnostic aid. Symptoms can only be relieved by operation. The trachea is often deformed at the site of the constricting ring. Only infrequently is there immediate relief from the pre-operative symptoms. Two babies were successfully treated for an aberrant left pulmonary artery.
Pertussis Vaccines
Authors: Eugene D. Shapiro
Journal: JAMA (1992)

Immunization against communicable diseases is one of the great successes of modern medicine. Smallpox has been eradicated. In developed countries, diseases such as polio, diphtheria, and tetanus, which once ravaged populations, have been virtually eliminated. Newer vaccines, such as the polysaccharide-protein conjugate vaccines against<i>Haemophilus influenzae</i>type b, are likely to have a similar impact. Work continues on many new vaccines that are developed and produced using sophisticated techniques of modern molecular biology. Already, we are using genetically engineered vaccines against hepatitis B. Why then, in this age of genetic cloning, do we still use a crude, whole-cell vaccine against<i>Bordetella pertussis</i>(a vaccine that essentially is a preparation of killed, whole bacteria) to prevent whooping cough? The excellent study by Onorato et al<sup>1</sup>published in this issue ofThe Journalreminds us of a major reason that we use whole-cell pertussis vaccine: it works! See also p 2745.
Winners and losers
Authors: M. E. Black
Journal: BMJ (2012)

Bodies, bodies everywhere—each one the kind of specimen you wish had been on display during anatomy tutorials in medical school. Wearing unforgiving Lycra sportswear or nothing but a strategically placed hockey stick, it seems as though every Olympian is getting his or her kit off for charity or to promote a perfume. Step aside effete supermodels: aspirational physiques now come in all (but still clearly well honed) shapes and sizes. Bodies that …
Factor VIII-East Hartford (arginine 1689 to cysteine) has procoagulant activity when separated from von Willebrand factor.
Authors: A M Aly, L W Hoyer
Journal: Journal of Clinical Investigation (1992)

Factor VIII East Hartford (FVIII-EH) procoagulant activity is reduced because the substitution of cysteine for arginine 1689 abolishes an essential Factor VIII light chain thrombin cleavage site. Incubation of FVIII-EH plasma with penicillamine or DTT causes a five- to sixfold increase in FVIII-EH VIII:C, at 80 and 1 mM, respectively. While there is no FVIII-EH light chain cleavage when thrombin is added in the presence of penicillamine or DTT, these reducing agents disrupt the FVIII-vWf complex. For example, the addition of 5 mM DTT to normal or FVIII-EH plasma causes a 50% reduction in Factor VIII binding to vWf. These observations suggested that DTT increases FVIII-EH VIII:C by partial dissociation of FVIII-EH from vWf. This was verified by showing that vWf-free FVIII-EH had VIII:C activity of 21 U/dl, while the starting plasma level was 2.5 U/dl. Removal of other FVIII-EH plasma proteins by agarose gel filtration had no effect on VIII:C activity. The demonstration that this mutant Factor VIII has cofactor function when separated from vWf indicates that the dissociation of Factor VIII from vWf is an essential effect of Factor VIII light chain cleavage at arginine-1689.
Autoepitope mapping and reactivity of autoantibodies to the dihydrolipoamide dehydrogenase-binding protein (E3BP) and the glycine cleavage proteins in primary biliary cirrhosis
Authors: Laurence Dubel, Atsushi Tanaka, Patrick S. Leung, Judy Van de Water, Ross Coppel, Thomas Roche, Catherine Johanet, Yutaro Motokawa, Aftab Ansari, Eric M. Gershwin
Journal: Hepatology (1999)

Primary biliary cirrhosis (PBC) is an autoimmune liver disease characterized by the presence of antimitochondrial antibodies (AMA) directed primarily against the E2 subunits of the pyruvate dehydrogenase complex, the branched chain 2–oxo–acid dehydrogenase complex, the 2–oxoglutarate dehydrogenase complex, as well as the dihydrolipoamide dehydrogenase–binding protein (E3BP) of pyruvate dehydrogenase complex. The autoantibody response to each E2 subunit is directed to the lipoic acid binding domain. However, hitherto, the epitope recognized by autoantibodies to E3BP has not been mapped. In this study, we have taken advantage of the recently available full–length human E3BP complementary DNA (cDNA) to map this epitope. In addition, another lipoic binding protein, the H–protein of the glycine cleavage complex, was also studied as a potential autoantigen recognized by AMA. Firstly, the sequence corresponding to the lipoic domain of E3BP (E3BP–LD) was amplified by polymerase chain reaction and recombinant protein and then purified. Immunoreactivity of 45 PBC sera (and 52 control sera) against the purified recombinant E3BP–LD was analyzed by enzyme–linked immunosorbent assay (ELISA) and immunoblotting. Secondly, reactivity of PBC sera was similarly analyzed by immunoblotting against H–protein. It is interesting that preabsorption of patient sera with the lipoic acid binding domain of E3BP completely removed all reactivity with the entire protein by immunoblotting analysis, suggesting that autoantibodies to E3BP are directed solely to its lipoic acid binding domain. Fifty–three percent of PBC sera reacted with E3BP–LD, with the majority of the response being of the immunoglobulin G (IgG) isotype (95%). Surprisingly, there was little IgM response to the E3BP–LD suggesting that the immune response was secondary because of determinant spreading. In contrast, H–protein does not appear to possess (or expose) autoepitopes recognized by PBC sera. This observation is consistent with structural data on this moiety.
Remarks ON APPENDIX DYSPEPSIA
Authors: B. G. A. Moynihan
Journal: BMJ (1910)

THB term " dyspepsia " was used by the older writers to indicate a variety of conditions, believed to be always functional in character, in which disturbances of " digestion" were the main features.If the older works on medicine, such as Budd's, Trousseau's, Brinton's, and Sir Thomas Watson's, are consulted-and this may profitably be done, and will indeed prove a delightful anca absorbing recreation-it is seen that a considerable space is devoted to a description of the various forms of " dyspepsia."The work of the surgeon, human vivisector as he is, has enabled him to make an intimate study of the " Pathology of the Living," and has newly conferred upon him the power of discovering that the term " dyspepsia " has been used to denote a group of symptoms which can now positively he ascribed to demonstrable lesions in other organs than the F'lomach.The " acid dyspepsia" in its
INSURANCE EXAMINATION FEES.A Protest from Dr. McCormack, and a Plea That Physicians Stand Together in Opposition to a Gross and Unnecessary Injustice.
Authors: J. N. McCormack.
Journal: JAMA (1906)

Bowling Green, Ky., April 30, 1906.  To the Editor:  —The simultaneous and uniform reduction of fees for medical examinations recently made by the Mutual Life of New York, the Equitable and several other old line life and accident insurance companies, and the other information bearing on the same point, leaves little room for doubt that this was done as the result of a carefully prearranged and concerted understanding. Sprung on us midway between the meetings of our national and state associations, without even the courtesy of a notice, or an opportunity for conference or protest, as employers would not now attempt to do in dealing with miners or bricklayers, the profession was taken completely by surprise. Expecting some official action by their organizations, many quietly put the formal acceptance of the reduction requested by the companies in the waste-basket, while many others, without advisors, and not knowing what their competitors
Entomopathogens: ecological manipulation of natural associations.
Authors: R Engler, M H Rogoff
Journal: Environmental Health Perspectives (1976)

The control of insect pests with entomopathogens is unique, in that naturally occurring host-pathogen relations are manipulated to the benefit of man: protecting agricultural crops and forests or controlling insect vectors of disease. The isolation and identification of a virulent pathogen is the initial step in the development of a potential control agent. Production of the pathogen in adequate quantities must be possible either in vivo (insects) or in vitro (artificial medium). To insure usefulness, the pathogen must remain viable in the formulated form and after application in the field. Since inactivation rather than persistence is a problem, the pathogens must be formulated, protected, and applied to insure satisfactory pest control action. Studying the natural host--pathogen interactions will be necessary in order to manipulate the pathogen effectively, by introducing it at the most opportune time in the life cycle of the target pest. Generally, insect pathogens are more selective than conventional pesticides; this will limit their use and industrial development. Development, at least in part, by the public sector may be necessary and desirable. The most promising areas for the use of pathogens are in integrated pest management and in situations where pests have developed resistance to chemical control.
The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia
Authors: Leslee J. Shaw, Rory Hachamovitch, Daniel S. Berman, Thomas H. Marwick, Michael S. Lauer, Gary V. Heller, Ami E. Iskandrian, Karen L. Kesler, Mark I. Travin, Howard C. Lewin, Robert C. Hendel, Salvador Borges-Neto, D.Douglas Miller
Journal: Journal of the American College of Cardiology (1999)
Valvotomy in Mitral Stenosis Complicated by Pregnancy
Authors: J. B. Das, J. T. Chesterman
Journal: BMJ (1958)

INTRAPERITONEAL BLOOD TRANSFUSIONS MBIcJOaplastic or chronic haemolytic anaemia in children who require repeated small transfusions over a period of years.Under such circumstances the transfusion could be given in the out-patient department and the child spared the neces- sity of repeated admissions to hospital.In no case in the present series was death directly attributable to the administration of intraperitoneal blood, and, provided a stringent aseptic technique is employed and there is no evidence of intra-abdominal disease or injury, there is no reason to anticipate a greater risk of infection from this route than from the intravenous one.As no record of an acute peritonitis or abscess formation following intraperitoneal transfusion can be traced in the literature or the pre- sent series, it is felt that this " potential danger " is not a real one.Intra-abdominal injury has been recorded in three cases (Ravenel, 1933), but again it is felt that, with care and the correct choice of site for insertion of the needle, these accidents might have been avoided.In the case of a collapsed infant with a lax abdomen the danger of a direct and uncontrolled puncture through the abdominal wall is very rcal, and for this reason the neces- sity to control the depth of penetration by countertraction on the skin has been stressed by Carter (1953).Similarly, to avoid possible puncture of unobliterated hypogastric arteries or a full bladder in small infants the site chosen for injection was f-I in. (1.3 to 2.5 cm.) above the umbilicus.In the course of several thousand intraperitoneal saline infusions and the present series of blood transfusions, no damage to an intra-abdominal organ or blood vessel has been encountered.From experimental and post-mortem findings there is no doubt whatever that such blood is absorbed ; and in all cases, except the four patients who died within 24-48 hours, a rise in haerroglobin the day after transfusion was recorded.From the present series it has been impossible to arrive at a conclusion regarding the optimum amount of blood to -(1943b).Ibid., p. 112.
Coxsackie Bi Pneumonia in an Adult
Authors: Charles L. Jahn, Owen L. Felton, James D. Cherry
Journal: JAMA (1964)

VIRAL PNEUMONIA is a well known entity with a variety of viral agents etiologically implicated.<sup>1,2</sup>However, enteroviruses have only occasionally been related to lower respiratory tract infection.<sup>1-3</sup>The Coxsackie B viruses have been associated with many clinical syndromes including pleurodynia, pleural effusion, pericarditis, and myocarditis.<sup>2,4</sup>With such frequent cardiorespiratory involvement it might be suspected that pneumonitis would be a more common occurrence with Coxsackie B infection. However, there are relatively few reports concerning Coxsackie virus infection with pulmonary involvement.<sup>1,3-6</sup>This report is about an adult with pneumonitis and a Coxsackie B<sub>1</sub>isolate from the involved lungs. <h3>Report of a Case</h3> The patient was a 21-year-old white woman with a history of rheumatic fever and rheumatic heart disease which were diagnosed when she was 11. Three weeks prior to her present admission, she developed cough, chills, and fever. One week prior to admission, penicillin and sulfonamide
The absence of apoeccrine glands in the human axilla has disease pathogenetic implications, including axillary hyperhidrosis
Authors: D.L. Bovell, A.D. Corbett, S. Holmes, A. MacDonald, M. Harker
Journal: British Journal of Dermatology (2007)

Background The existence of a third type of sweat gland in human axillary skin, the apoeccrine gland, with a capacity to produce much higher sweat output than the eccrine gland, was proposed from examination of microdissected glands. However, previous studies of axillary skin glands did not examine the entire individual glandular structure via serial sections and the markers used to identify the different glands gave conflicting results and, hence, the existence of the apoeccrine gland remains controversial. Objectives To investigate human axillary sweat glands by serial section histology and immunofluorescence. Methods Human axillary sweat glands were investigated by serial sectioning of paraffin wax-embedded skin samples taken by biopsy from four male and six female volunteers (age range 20–35 years). Sections were examined by light microscopy and immunofluorescence, using antibodies to antigens reported to be markers for discriminating between eccrine and apocrine gland cells: CD15, CD44, S100 and human milk fat globulin. Results Light microscopy demonstrated that there were hair follicles and a mean ± SD of 76 ± 14 sweat glands cm−2. Eccrine and apocrine glands were found to be present; however, no glands resembling the apoeccrine glands were detected. Both types of sweat gland exhibited signs of being active, with segments of the secretory coils displaying flattened cells and dilated glandular lumina; however, this dilation did not extend to obvious changes in the width of the gland. None of the eccrine glands exhibited evidence of the presence of apocrine cells or vice versa. Immunofluorescence markers were found not to be specific and did not discriminate between the different types of glands or demonstrate the presence of apoeccrine glands. Conclusions This is the first time that serial sections of axillary skin have been examined by histology and immunofluorescence. The markers reported to discriminate between apocrine and eccrine glands were found to be nonspecific. No evidence of apoeccrine glands was found either by histology or by immunofluorescence.
Inhibition of glycolysis modulates prednisolone resistance in acute lymphoblastic leukemia cells
Authors: Esther Hulleman, Karin M. Kazemier, Amy Holleman, David J. VanderWeele, Charles M. Rudin, Mathilde J. C. Broekhuis, William E. Evans, Rob Pieters, Monique L. Den Boer
Journal: Blood (2008)
Nonclostridial gas gangrene. Report of 48 cases and review of the literature
Authors: A. N. Bessman
Journal: JAMA (1975)

Gangrenous lesions accompanied by evidence of subcutaneous gas usually are diagnosed as "clostridial gas gangrene." The occurrence of nonclostridial gas gangrene has been infrequently reported and is thought to be relatively rare. Review of 278 admissions of diabetic patients with orthopedic vascular problems disclosed a 17% (48 patients) incidence of nonclostridial gas infections and a 3% (one patient) occurrence of clostridial gas gangrene. Clinical characteristics ranged from severe to benign toxicity. Appreciation of the causative organisms (usually mixed Gram-negative rod and enterococcus) of this syndrome is essential, especially in the diabetic patient, since appropriate antibiotic therapy and surgery can result in a low mortality (4%) and a high incidence (80%) of ambulatory, independent patients.
Testis and Antler Dysgenesis in Sitka Black-Tailed Deer on Kodiak Island, Alaska: Sequela of Environmental Endocrine Disruption?
Authors: D.N. Rao Veeramachaneni, Rupert P. Amann, James P. Jacobson
Journal: Environmental Health Perspectives (2005)

It had been observed that many male Sitka black-tailed deer (Odocoileus hemionus sitkensis) on Kodiak Island, Alaska, had abnormal antlers, were cryptorchid, and presented no evidence of hypospadias. We sought to better understand the problem and investigated 171 male deer for phenotypic aberrations and 12 for detailed testicular histopathology. For the low-lying Aliulik Peninsula (AP), 61 of 94 deer were bilateral cryptorchids (BCOs); 70% of these had abnormal antlers. Elsewhere on the Kodiak Archipelago, only 5 of 65 deer were BCOs. All 11 abdominal testes examined had no spermatogenesis but contained abnormalities including carcinoma in situ-like cells, possible precursors of seminoma; Sertoli cell, Leydig cell, and stromal cell tumors; carcinoma and adenoma of rete testis; and microlithiasis or calcifications. Cysts also were evident within the excurrent ducts. Two of 10 scrotal testes contained similar abnormalities, although spermatogenesis was ongoing. We cannot rule out that these abnormalities are linked sequelae of a mutation(s) in a founder animal, followed by transmission over many years and causing high prevalence only on the AP. However, based on lesions observed, we hypothesize that it is more likely that this testis-antler dysgenesis resulted from continuing exposure of pregnant females to an estrogenic environmental agent(s), thereby transforming testicular cells, affecting development of primordial antler pedicles, and blocking transabdominal descent of fetal testes. A browse (e.g., kelp) favored by deer in this locale might carry the putative estrogenic agent(s).
Children's champion
Authors: D. Smithers
Journal: BMJ (1990)

Mutual Friends is the story of Dickens's connection with the Hospital for Sick Children, Great Ormond Street. There are multitudes of books dealing with all aspects of Dickens's life and work containing a great deal about his special feeling for children in distress and the diversity of his relationships with doctors. Not before this, however, has there been a collection of material, some of it from the hospital
Effects of acute hormone therapy on recurrent ischemia in postmenopausal women with unstable angina
Authors: Steven P Schulman, David R Thiemann, Pamela Ouyang, Nisha C Chandra, Douglas S Schulman, Steven E Reis, Michael Terrin, Sandra Forman, Cicero Piva de Albuquerque, Raymond D Bahr, Susan N Townsend, Rosalie Cosgriff, Gary Gerstenblith
Journal: Journal of the American College of Cardiology (2002)
The Role of Microembolism in Anaphylactic Shock.
Authors: Herbert J. Robb
Journal: Annals of Internal Medicine (1964)

s1 October 1964The Role of Microembolism in Anaphylactic Shock.Herbert J. Robb, M.D., Prescott Jordan, M.D., Lyle F. Jacobson, M.D.Herbert J. Robb, M.D.Search for more papers by this author, Prescott Jordan, M.D.Search for more papers by this author, Lyle F. Jacobson, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-61-4-810_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptWhile making high magnification observations of the bowel, mesentery, and lung, we have observed that microemboli commonly develop in association with hemorrhagic shock, trauma, and endotoxin shock. These same platelet and cellular aggregates can be consistently produced and observed in anaphylactic shock. Once these aggregates develop they break loose causing a mechanical blockage of the circulation at distal points of narrowing.Cinephotomicrography has been used to record the formation and embolization of the platelet aggregates during the production of anaphylactic shock. Clear pictures are available of the emboli as they lodge in the lung producing a slowing and blockage of... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Detroit, Mich. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 October 1964Volume 61, Issue 4Page: 810-810KeywordsAcute respiratory distress syndromeEndotoxinsLungsPlateletsShock Issue Published: 1 October 1964 PDF DownloadLoading ...