tbuckley/cabot-search huggingface dataset:
The ???Mucous Plug Syndrome??? A Pulmonary Embolism Mimic
Authors: STUART T. BRAY, WILLIAM H. JOHNSTONE, PAUL M. DEE, THOMAS L. POPE, CHARLES D. TEATES, CHARLES J. TEGTMEYER
Journal: Clinical Nuclear Medicine (1984)

Reported are ten instances of major bronchial obstruction by mucous plugs in eight patients during which the clinical features resembled pulmonary embolism. Perfusion lung studies showed significantly diminished perfusion of the involved portions of the lungs. The chest radiographs generally did not, however, reflect the severity of the airway obstruction and in some instances were completely normal. The ventilation studies indicated the extent and severity of the obstruction and matched with the perfusion scans. Pulmonary arteriograms were performed in three patients and gave direct evidence of focally diminished lung perfusion without embolism. The physiologic mechanisms underlying the condition are discussed.
Scientists attack Bush over U turn on climate change treaty
Authors: P. Ghazi
Journal: BMJ (2001)

Health experts this week joined world leaders in condemning President George Bush's rejection of the Kyoto global climate treaty. They warned that there would be profound implications for human health in the decades ahead if the United States, by far the world's greatest polluter, failed to reduce its output of greenhouse gases. “This is an extraordinary move by President Bush—short sighted and extremely worrying,” said Professor Andy Haines, the dean of the London School of Hygiene and Tropical Medicine.

“All the indications …
Signs of shock and raised jugular venous pressure
Authors: D. Keene, A. Gopinath, W. Watson, C. Maart, A. Bokhari
Journal: BMJ (2012)

A 38 year old white man presented to the emergency department with a three month history of progressively worsening shortness of breath. He had also experienced other vague symptoms over the same period, including muscle aches, weakness, pains associated with fatigue, and noticeable weight loss. Having previously been fit and well, he was now struggling to climb the stairs at home. The onset of symptoms coincided with an episode of food poisoning; he denied any recent travel.

On clinical examination he had quiet heart sounds, with a raised jugular venous pressure, which rose on inspiration. He showed signs of haemodynamic compromise and shock, with a heart rate of 115 beats/min, blood pressure of 105/75 mm Hg but no postural drop, respiratory rate of 24 breaths/min, and oxygen saturations of 95% on room air. Chest radiography (fig 1⇓) and electrocardiography showed classic changes. The results of these investigations prompted immediate point of care transthoracic echocardiography (fig 2⇓). After consent, he was promptly admitted to the cardiac catheterisation laboratory for immediate intervention.







### 1 What abnormalities can be seen on the chest radiograph and echocardiogram?

#### Short answer

The chest radiograph shows a globular cardiac silhouette (fig 1), possibly as a result of fluid surrounding the heart. The echocardiogram shows a large pericardial effusion (fig 3⇓).



Fig 3 Echocardiogram showing evidence of a pericardial effusion …
Intestinal transport of water and electrolytes during extracellular volume expansion in dogs
Authors: James T. Higgins, Norman P. Blair
Journal: Journal of Clinical Investigation (1971)

The effects of extracellular fluid volume expansion on intestinal transport of salts and water were studied in dogs by perfusing loops of bowel in vivo. Saline loading caused depression of duodenal and jejunal absorption with net secretion of salt and water into the lumen. Studies of unidirectional transport of (22)Na(+) revealed that the negative net sodium flux was due primarily, and perhaps exclusively, to increased serosal to mucosal transport, for mucosal to serosal sodium transport was not changed during volume expansion. Net transport of water and potassium paralleled net sodium flux. Administration of deoxycorticosterone did not affect the intestinal response to saline loading. Hemodilution, accomplished by equilibrating the dogs' blood with a reservoir of saline, did not affect intestinal absorption, but isotonic, iso-oncotic expansion of the extracellular fluid produced by reinfusing the saline-blood mixture from the reservoir resulted in negative net transport of water, sodium, and potassium by the duodenum. It is suggested that the small bowel is capable of secreting salts and water through intercellular spaces, and that this process is stimulated by extracellular fluid volume expansion.
Observations on Aberrant Renal Arteries Curving Around and Compressing the Renal Vein
Authors: HILEL NATHAN
Journal: Circulation (1958)

Some conditions, considered idiopathic or of only partially known etiology, may have an anatomic basis. Among such conditions are possibly certain postural or orthostatic syndromes related to the kidney such as orthostatic proteinuria and orthostatic hypertension. In the present work some anatomic observations on the renal pedicle are presented that seem to give support to this concept.
Treatment of muscular dystrophy.
Authors: W G Bradley, J G Polgar, M H Williams, H G Boddie
Journal: BMJ (1972)

few warts with the drug often results in a spontaneous regression of all.We instruct all patients to wash off the paint four to six hours after its application and thereafter to apply hydrocortisone lotion 1% twice a day for several days.These two measures prevent local reactions without interfering with anti- mitotic activity.When extensive wart growths are found after the thirtieth week of pregnancy we do no more than treat any coexisting condition -for example, trichomoniasis, candidiasis, or gonorrhoea.Experience shows that even ex- tensive warts disappear spontaneously after delivery.This happened even in two cases in which intragenital and extragenital warts were so widespread that caesarian section was seriously considered.-Weare, etc.,
Imaging specificity of MR-optical imaging agents following the masking of surface charge by poly(ethylene glycol)
Authors: Shou-Cheng Wu, Kun-Liang Lin, Tzu-Pin Wang, Shey-Cherng Tzou, Gyan Singh, Ming-Hung Chen, Tian-Lu Cheng, Chiao-Yun Chen, Gin-Chung Liu, Te-Wei Lee, Shao-Hwa Hu, Yun-Ming Wang
Journal: Biomaterials (2013)
Long-Term Oxygen Therapy
Authors: Stephen P. Tarpy, Bartolome R. Celli
Journal: New England Journal of Medicine (1995)

The concept of oxygen as a therapeutic agent was introduced in the 1920s by Alvin Barach.1 Since then, a better understanding of the effects of hypoxemia, and of their reversal with oxygen supplementation, has enhanced the treatment of patients with pulmonary diseases. There are close to 800,000 patients receiving long-term oxygen therapy in the United States, at a yearly cost of $1.8 billion.2,3 We need to understand the effects of oxygen therapy, the indications for it, and its modes of delivery in order to make the most appropriate use of this effective therapeutic resource. In this article, we discuss . . .
Fatal Haemoptysis Induced by Invasive Pulmonary Aspergillosis in Patients with Acute Leukaemia During Bone Marrow and Clinical Remission: Report of Two Casesand Review of the Literature
Authors: O. Gorelik, N. Cohen, I. Shpirer, D. Almoznino-Sarafian, I. Alon, M. Koopfer, R. Yona, D. Modai
Journal: Journal of Infection (2000)
Insulin and steatonecrosis: Are they related?
Authors: John M. Amatruda, Arthur I. Salhanick
Journal: Hepatology (1989)

Hepatic steatosis and steatonecrosis occur in non–alcoholic individuals, usually in a setting of obesity, type II diabetes mellitus, and after jejunoileal bypass. We propose an hypothesis for the pathogenesis of these hepaic lesions based on an observation in peritoneal dialysis patients. Hepatic histology was examined at autopsy in eleven patients with type I diabetes mellitus and renal failure who had received intraperitoneal insulin in conjunction with continuous ambulatory perritoneal dialysis (CAPD). Steatosis in a unique subcapsular distribution occurred in 10 of 11 patients treated with intraperitoneal insulin and in none of 9 controls receiving CAPD without insulin. Three of the 11 had steatonecrosis, 2 of whom had Mallory bodies. We suggest that isulin has an important role in the pathogenesis of steatosis and steatoncrosis. In CAPD patients the lesions occurred only under the capsule where concentrations of insulin are high secondary to its intraperitoneal administration. In obese patients the lesions occur throughhout the liver where insulin concentrations are high because of elevated levels in the portal vein. Free fatty acids (FFA) are oxidized in the liver by a pathway that is blocked by insulin. In the presence of insulin, FFA are preferentially esterified into triglycerides which accumulate in large quantities leading to steatosis; small amounts of FFA escaping local control may lead to membrane injury and steatonecrosis. Steatosis and/or steatonecrosis will occur when there is insulin secretion sufficient to block FFA oxidation but not sufficient to block FFA mobilization from adipose tissue. This situation occurs in obesity associated with type II diabetes where adipose tissues are resistant to insulin, and in obesity after jejunoileal–bypass where continued eating and insulin secretion occurs in the face of marked weight loss.
Abuse of Pentazocine and Tripelennamine
Authors: Craig V. Showalter
Journal: JAMA (1978)

<h3>To the Editor.—</h3> Pentazocine abuse is commonly believed to be largely confined to the medical community and to patients iatrogenically addicted. We would like to call attention to the widespread and increasing abuse of pentazocine among "street" addicts. In this situation the user most often crushes pentazocine tablets and combines this with crushed tripelennamine (Pyribenzamine). The mixture is then dissolved in water and injected intravenously. The origin of this combination is unknown but produces a desired effect for the user not obtained from either drug alone. Referred to as "T's and Blues," these two drugs have achieved considerable popularity among illicit drug users. A frequently reported effect of this abuse is tonic-clonic seizures, which are possibly due to central excitation from tripelennamine. The user is careful to establish the correct ratio of the two drugs (usually two pentazocine to one tripelennamine tablet) to get the sought after high while avoiding
General practice fundholding Fundholders not to blame for fast tracking
Authors: M H Armstrong, S Iliffe, U Freudenstein
Journal: BMJ (1994)

EDITOR, - More and more people who think that they know about fundholding seem to be trying to blame fundholders for creating a two tier system. They also complain that fundholders have too much money and are starving the district health authorities and commissions of funds to cater for the patients of non-fundholders. A recent article by Hart is a prime example of people talking without checking the facts.1

In our area some practices are underfunded by up to 15% for inpatient and day case procedures. Fast tracking for them is potentially disastrous, but it is still happening. Practices in some parts of the region are having to institute contractual changes to combat this problem and prevent uncontrolled overspends.

This occurs because the providers are tagging the fundholders' patients and then processing them quickly, not because the …
Comparison of continuous and intermittent papaveretum after cholecystectomy
Authors: P J Slattery, M D Vickers
Journal: BMJ (1980)

norphine 3 ,tg and fentanyl 1 t±g/kg body weight peroperatively with minimal intra- venous induction agents and halogenated vapours.Postoperatively I give papaveretum 10-20 mg intramuscularly as soon as full consciousness returns but before severe pain is felt.3Occasionally severe spasms of pain require injection of orphenadrine.4This technique provides analgesia comparable, as assessed by hourly pain scores, with continuous infusion.There was no detectable depression of respiration measured by counting, by Wright's respirometer, or by random blood gas samples.
Ultrasound surveillance of tips?why bother?
Authors: Jeanne LaBerge, Vickie A. Feldstein
Journal: Hepatology (1998)

Background and Aims:A prospective double-blinded study with preset sonographic criteria has not been performed to assess the accuracy of duplex ultrasonography in determining the patency of transjugular intrahepatic portosystemic shunts (TIPS).The purpose of this study was to determine the sensitivity and specificity of duplex ultrasonography in predicting shunt malfunction using accepted preset sonographic criteria.Methods: Sixty ultrasonographic and venographic follow-up comparisons were made on 38 cirrhotic patients who had undergone TIPS placement for variceal bleeding (n ‫؍‬ 28) or intractable ascites (n ‫؍‬ 10).Ultrasonographic results were analyzed by one of two board-certified ultrasonographers without knowledge of venographic findings.Results: Of the 31 occluded (n ‫؍‬ 8) and stenotic (n ‫؍‬ 23) shunts, ultrasonography accurately predicted a shunt malfunction (occlusion or stenosis) in only 11 studies and incorrectly predicted patency in 20.Compared with venography, ultrasonography had a sensitivity of 35% and a specificity of 83% in predicting TIPS stenosis or occlusion.Conclusions: These results suggest that duplex sonography is not a sensitive test in predicting the presence of a hemodynamically significant stenosis and that shunt status should be assessed by venography and direct portal pressure measurements until a more reliable and proven noninvasive ultrasonographic criterion is devised.
Hemoglobin Jamaica Plain — A Sickling Hemoglobin with Reduced Oxygen Affinity
Authors: Alon Geva, Jennifer J. Clark, Yuxun Zhang, Anthony Popowicz, James M. Manning, Ellis J. Neufeld
Journal: New England Journal of Medicine (2004)

A baby girl presented with symptomatic sickle cell disease exacerbated by mild hypoxemia, despite a newborn-screening diagnosis of sickle cell trait. DNA sequencing of the beta globin gene revealed that her maternal beta globin allele was normal. Her paternal allele had not only the expected sickle-trait mutation, betaGlu6Val, but also a second, charge-neutral mutation, betaLeu68Phe. Analysis of the patient's hemoglobin revealed that the double-mutant protein, which we called "hemoglobin Jamaica Plain," had severely reduced oxygen affinity. Structural modeling suggested destabilization of the oxy conformation as a molecular mechanism for sickling in a heterozygote at an ambient partial pressure of oxygen.
Tryptophan metabolism in rheumatoid neuropathies.
Authors: F E Bruckner, H G Smith, C Lakatos, M A Chamberlain
Journal: Annals of the Rheumatic Diseases (1972)

Peripheral neuropathy is an established complication of rheumatoid arthritis (Pallis and Scott, 1965).The clinical, electrophysiological, and histological fea- tures have been described previously (Chamberlain and Bruckner, 1970; Weller, Bruckner, and Cham- berlain, 1970).The underlying aetiology of the neuropathy is usually ascribable to a vascular lesion, but an occasional case is reported in which no vascu- litis is found in spite of extensive post mortem histo- logical search (Hart and Golding, 1960).It is tempting to speculate that other factors, such as metabolic disturbances, might contribute to the pathogenesis of the neuropathy.Abnormalities of tryptophan metabolism have been found to occur in patients with rheumatoid arthritis (Bett, 1962;McMillan, 1960; Spiera, 1966), and to cause an increased urinary excretion of kynurenine, xanthurenic acid, and 3-hydroxy- anthranilic acid after L-tryptophan loading.These results have been interpreted as indicating a functional pyridoxine deficiency, one of the features ofwhich is a peripheral neuropathy (McKusick, Sherwin, Jones, and Hsu, 1964).Thus it is possible that a peripheral neuritis in rheumatoid arthritis may result from this functional pyridoxine deficiency; alternatively the metabolite 3-hydroxyanthranilic acid may have an effect on the neuropathy, as it has been shown to inhibit mitochondrial respiration (Quagliariello, Papa, Saccone, and Alifano, 1964).We therefore set out to investigate tryptophan metabolism in patients with rheumatoid neuro- pathies, and to see if the metabolic abnormality and clinical neuropathy were affected by a 6-month course of oral pyridoxine. Patients and methodsOf 32 patients with rheumatoid neuropathies who had been previously evaluated clinically, electrophysiologic- ally, and histologically (Chamberlain and Bruckner, 1970; Weller and others, 1970), ten were available for further study.There were two males and eight females
Strabismus; symposium, New Orleans Academy of Ophthalmology.
Authors: Peter C. Kronfeld
Journal: JAMA (1963)

For 11 years, the New Orleans Academy of Ophthalmology has conducted annual conferences centered around single major ophthalmologic topics. The material presented at several of these conferences has appeared in book form. The volume under review, entitled<i>Strabismus</i>, represents the transactions of the 1962 conference. Six speakers, all recognized authorities in the field of ocular motility, presented 14 formal papers and participated in a roundtable discussion of questions submitted by the audience. The editor, George Haik, of the Department of Ophthalmology of Louisiana State University, has molded the material into a compact, neat book. Despite the multiplicity of authors, the style of the book is uniformly lucid, the illustrations are of excellent quality, and the bibliographies are adequate. The book sets rather high standards for the treatment of strabismus, standards which have been attained by specialists in the subspeciality of ocular motility, with the help of experienced orthoptists. The book,
THE EFFECT OF A PRE-BIND ENGAGEMENT TECHNIQUE ON THE BIOMECHANICAL CHARACTERISTICS OF RUGBY SCRUMMAGING ACROSS MULTIPLE PLAYING LEVELS
Authors: D Cazzola, E Preatoni, KA Stokes, M England, G Trewartha
Journal: British Journal of Sports Medicine (2014)

Background The Rugby Union scrum has evolved into a highly dynamic activity, particularly during engagement. Although catastrophic spinal injuries in rugby are extremely rare, approximately 40% of these are associated with the scrum. Repeated scrum engagement may also contribute to premature chronic degeneration of the cervical spine in rugby players. Objective To compare the biomechanical stresses experienced by rugby forward players during live contested scrummaging under different scrum engagement processes, taking into account different playing standards. Design A cross-sectional design, where teams from five different playing levels performed live scrums under three engagement processes: 1) CTPE (Crouch-Touch-Pause-Engage, 2011–2012); 2) CTS (Crouch-Touch-Set, 2012–2013); and 3) PreBind (Crouch-Bind-Set, 2013–2014). Measures were made via body-worn sensors and video analysis. Setting Outdoors, natural turf rugby pitches. Participants 27 rugby teams (i.e. 54 forward packs, n=432 players) from five playing levels - International, Elite, Community, Women and University. Risk factor assessment The three engagement processes. PreBind differs from CTS/CTPE with a legal bind that is taken at the “Bind” call and maintained through the “Set” action. Main outcome measurements Biomechanical stresses (force, acceleration) and kinematics (engagement speed, joints angles) characterising the scrum motion. Results The PreBind process reduced biomechanical stresses by 15–25% with respect to both CTPE and CTS during the engagement phase without reducing force during the sustained push phase. For front row players, peak cervical acceleration was reduced from 8.2 g (CTPE) and 7.9 g (CTS) to 6.8 g (PreBind), and peak compression forces decreased from 8.4 kN (CTPE) and 8.3 kN (CTS) to 6.3 kN (PreBind). Players' movements/postures did not differ significantly between engagement processes. The mixed design ANOVA did not evidence any significant interaction effect (engagement type-playing level) in any variable. Conclusions The PreBind process reduced the mechanical stresses on front row players and may lead to safer conditions without affecting performance.
Inhibition of Phosphodiesterase 2 Augments cGMP and cAMP Signaling to Ameliorate Pulmonary Hypertension
Authors: Kristen J. Bubb, Sarah L. Trinder, Reshma S. Baliga, Jigisha Patel, Lucie H. Clapp, Raymond J. MacAllister, Adrian J. Hobbs
Journal: Circulation (2014)

Pulmonary hypertension (PH) is a life-threatening disorder characterized by increased pulmonary artery pressure, remodeling of the pulmonary vasculature, and right ventricular failure. Loss of endothelium-derived nitric oxide (NO) and prostacyclin contributes to PH pathogenesis, and current therapies are targeted to restore these pathways. Phosphodiesterases (PDEs) are a family of enzymes that break down cGMP and cAMP, which underpin the bioactivity of NO and prostacyclin. PDE5 inhibitors (eg, sildenafil) are licensed for PH, but a role for PDE2 in lung physiology and disease has yet to be established. Herein, we investigated whether PDE2 inhibition modulates pulmonary cyclic nucleotide signaling and ameliorates experimental PH.The selective PDE2 inhibitor BAY 60-7550 augmented atrial natriuretic peptide- and treprostinil-evoked pulmonary vascular relaxation in isolated arteries from chronically hypoxic rats. BAY 60-7550 prevented the onset of both hypoxia- and bleomycin-induced PH and produced a significantly greater reduction in disease severity when given in combination with a neutral endopeptidase inhibitor (enhances endogenous natriuretic peptides), trepostinil, inorganic nitrate (NO donor), or a PDE5 inhibitor. Proliferation of pulmonary artery smooth muscle cells from patients with pulmonary arterial hypertension was reduced by BAY 60-7550, an effect further enhanced in the presence of atrial natriuretic peptide, NO, and treprostinil.PDE2 inhibition elicits pulmonary dilation, prevents pulmonary vascular remodeling, and reduces the right ventricular hypertrophy characteristic of PH. This favorable pharmacodynamic profile is dependent on natriuretic peptide bioactivity and is additive with prostacyclin analogues, PDE5 inhibitor, and NO. PDE2 inhibition represents a viable, orally active therapy for PH.