tbuckley/cabot-search huggingface dataset:
THE RELIEF OF UREMIC HEMIPLEGIA AND OTHER UREMIC STATES BY LOWERING INTRACRANIAL PRESSURE.TEN CASES.
Authors: ROBERT N. WILLSON
Journal: JAMA (1905)

In a previous communication<sup>1</sup>were published the results of lumbar puncture and drainage of the cerebrospinal canal as evidenced by three suggestive but eventually fatal cases. My conclusions, as stated at that time and based on the experience of these cases, were essentially as follows: Probably several toxins exert an influence in uremia at different times and in different cases. Other portions of the brain than the cortex are also affected by the causal influence in uremia. Intracranial pressure is usually in evidence, either independently or in conjunction with toxic irritation and tissue destruction. In cases in which the intracranial pressure is the main factor, lumbar puncture of itself may save life; it should constitute one of the routine measures in the treatment of uremia. Transfusion of normal salt solution, except in cases presenting anuria or a markedly diminished secretion, is contraindicated. Drainage of the spinal canal will not cure
Therapeutic management of ALK<sup>+</sup>nonsmall cell lung cancer patients
Authors: Boris Duchemann, Luc Friboulet, Benjamin Besse
Journal: European Respiratory Journal (2015)

With therapeutic approaches based on oncogene addiction offering significant anticancer benefit, the identification of anaplastic lymphoma kinase ( ALK ) rearrangements is a key aspect of the management of lung cancers. The EML4-ALK gene fusion is detected in 4–8% of all lung cancers, predominantly in light smokers or nonsmokers. Crizotinib, the first agent to be approved in this indication, is associated with a median progression-free survival of 10.9 months when given as first-line treatment and 7.7 months when administered after chemotherapy. Median overall survival with crizotinib in the second-line setting is 20.3 months. Second-generation ALK inhibitors are currently being evaluated, with early studies giving impressive results, notably in patients resistant to crizotinib or with brain metastases. Among available chemotherapies, pemetrexed appears to be particularly active in this population. Despite this progress, several questions remain unanswered. What detection strategies should be favoured? What underlies the mechanisms of resistance and what options are available to overcome them? What are the best approaches for progressing patients? This review provides an overview of current data in the literature and addresses these questions.
Early Presentation of Type 2 Diabetes in Mexican-American Youth
Authors: Naomi D Neufeld, Leslie J Raffel, Chris Landon, Y -D Ida Chen, Constance M Vadheim
Journal: Diabetes Care (1998)

OBJECTIVE To describe features of pediatric-onset type 2 diabetes in the Hispanic population. RESEARCH DESIGN AND METHODS The medical records of 55 Hispanic subjects with diabetes who were treated from 1990 to 1994 in a pediatric clinic serving lower income Mexican-Americans were reviewed to assess the frequency and clinical features of type 2 diabetes. Additionally, nondiabetic siblings of several patients underwent oral glucose tolerance testing, and a survey of six high schools in the same county was performed. RESULTS Seventeen of 55 (31%) of the diabetic children and adolescents had type 2 diabetes. An additional 4 Hispanic children with type 2 diabetes treated in other clinics were also identified, yielding a total of 21 subjects who were used to describe the characteristics of childhood type 2 diabetes. At presentation, all were obese (mean BMI 32.9 ± 6.2 kg/m2), 62% had no ketonuria, and fasting C-peptide levels were elevated (4.28 ± 3.43 ng/ml). Diabetes was easily controlled with diet, sulfonylureas, or low-dose insulin. No autoantibodies were present in those tested, and family histories were positive for type 2 diabetes. Compliance was poor, and 3 subjects developed diabetic complications. Of the tested siblings, 2 of 8 had impaired glucose tolerance and 5 of 8 had stimulated hyperinsulinemia, correlated with BMI (r = 0.80, P &amp;lt; 0.05). The school survey identified 28 diabetic adolescents, 75% more than expected (P &amp;lt; 0.01). The Hispanic enrollment at each school was highly correlated with the number of diabetic students (r = 0.87, P = 0.011). CONCLUSIONS Genetic susceptibility to type 2 diabetes, when coupled with obesity, can produce type 2 diabetes in Mexican-American children. This diagnosis should be considered in young Hispanic patients, who might otherwise be assumed to have type 1 diabetes, and also when caring for overweight Hispanic youth with a family history of type 2 diabetes, in whom intervention may prevent or delay diabetes onset.
The Application of Multicompartmental Analysis to Problems of Clinical Medicine
Authors: NATHANIEL I. BERLIN
Journal: Annals of Internal Medicine (1968)

This combined Clinical Staff Conference presents the mathematical basis and the investigational techniques and tools of compartmental analysis in the study of calcium, bilirubin, and immunoglobulin metabolism, with examples of studies in disease states and discussion of limitations. The dynamics of bilirubin metabolism are illustrated with data from normals and from patients with Gilbert's disease, Dubin-Johnson syndrome, and cirrhosis. Calcium metabolism and its hormonal regulation are discussed in the light of studies in normals and hypoparathyroid patients. Data from normals and patients with disorders of immunoglobulin catabolism (myotonic dystrophy, ataxia telangiectasia, etc.), loss (for example, intestinal lymphangiectasia), and decreased immunoglobulin synthesis illustrate analysis of immunoglobulin metabolism.
Mutations in Man
Authors: Joe Leigh Simpson
Journal: JAMA (1985)

Physicians seem deluged with claims of mutagenicity, not only for drugs but for ubiquitous environmental agents. This volume, edited by Günter Obe from Berlin, does not attempt to provide clinical answers. It does, however, provide background data that can help physicians appreciate why simple answers to queries about mutagenicity may prove unrealistic. The 13 chapters are individually scholarly; however, the topics chosen for inclusion seem selective. Some represent background, whereas others address specific research topics. Among background topics is a review of the organization of the genome, by M. J. Evans. The principles of gene mutations are discussed by F. Vogel. Various aspects of human cytogenetics are covered by K. Sperling, I. Hansmann, and A. T. Natarajani. Adducts of DNA and DNA repair systems are reviewed as well. All these chapters may well prove useful to many physicians wishing to update their background in this area. Other chapters emphasize more
Delirium at the End of Life
Authors: Peter G. Lawlor, Robin L. Fainsinger, Eduardo D. Bruera
Journal: JAMA (2000)

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
A predischarge unit in a long-stay hospital for subnormality.
Authors: M C Liu, M W Hughes, L M Ashton
Journal: BMJ (1976)

A newly built residential ward in the grounds of a long-stay mental subnormality hospital was converted into a predischarge unit to cater for those patients who could probably be discharged after some special training. So far 31 residents have been trained over the past two years; 18 (58%) have been discharged to community residences, and five were waiting for discharge. The high success rate shows the value and usefulness of a predischage unit in a long-stay hospital, and also shows that a purpose-built building is not necessary so long as the staff have the initiative and will to succeed.
Letter: Diagnostic radiology and the fetus.
Authors: F W Wright
Journal: BMJ (1973)

iportant item in the Declaration of Geneva is "My colleagues will be my brothers."It will be a gross violation of that ethical code if the B.M.A. or any other menber of the W.M.A. supports any move to expel, not the South African Government, but the M.A.S.A.-whose members are all our pro- fessional brethren who have not (as I trust this letter has shown) violated any part of the medical ethical code
Angina in the Analgesic Limb
Authors: J. B. Harman
Journal: BMJ (1951)

In order to explain certain observations on pain reference, Cohen (1947) proposed a special hypothesis.His observations were that referred pain could be abolished or diminished by anaesthesia of the homo- segmental area, and that it could be produced or in- creased by hyperaesthesia.He suggested that there was normally a continual stream of subliminal pain impulses coming from the body.In the case of angina the pain impulses from both the heart and the arm would reach a functionally related area in the sensorium and, when integrated with the cortical pattern of the body image, would be localized selectively in that segment.Cohen admitted that this continual stream of subliminal im- pulses was hypothetical, but claimed that his suggestion had the greatest virtue of a hypothesis-that it could be tested.The following experiments were designed to test it.Argument If a mixed nerve is infiltrated with procaine the various
Regular review: Diagnosis and management of porphyria
Authors: H. Thadani
Journal: BMJ (2000)

Although porphyria is a relatively uncommon condition, it should be considered in patients presenting with an atypical medical, psychiatric, or surgical history. Acute attacks are associated with a substantial morbidity and mortality; there is a need for rapid and accurate diagnosis of the neuropsychiatric porphyrias, particularly because haem arginate can induce a definite remission if given early in an attack. Additionally, porphyrias may present with skin lesions or photosensitivity.

#### Summary points

The porphyrias form a group of inherited disorders of haem biosynthesis of which there are seven main types

Porphyrias can be classified into acute (neuropsychiatric), cutaneous, and mixed forms

Acute forms can be life threatening, but attacks can be aborted by early administration of haem arginate

The acute porphyrias are often misdiagnosed; most commonly they present as acute abdominal pain or as neurological or atypical psychiatric symptoms

Patients with porphyria should be referred to specialist centres and be advised to avoid precipitating factors, such as certain drugs

When a patient is diagnosed with an acute porphyria the whole family needs to be screened

The porphyrias form a heterogeneous group of inherited disorders of haem biosynthesis, and they are often missed or wrongly diagnosed. A partial deficiency of one of the seven enzymes in the pathway causes characteristic clinical and biochemical features. These disorders are due to a specific alteration in the pattern of accumulation of porphyrin and porphyrin precursors (table). Each type of porphyria is defined by a unique pattern of accumulation and excretion of haem precursors, as well as a reduction in the relevant enzyme activity. Correct interpretation of the appropriate biochemical investigations is essential for accurately diagnosing and managing the porphyrias, as clinical features alone are not sufficiently specific either to confirm a diagnosis or to distinguish between the various forms.

View this table:

Summary of diagnosis patterns of overproduction of haem …
National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation
Authors: Jeffrey S. Dlott, Roberta A. George, Xiaohua Huang, Mouneer Odeh, Harvey W. Kaufman, Jack Ansell, Elaine M. Hylek
Journal: Circulation (2014)

Background— Anticoagulation control with warfarin, as assessed by the international normalized ratio (INR), is challenging. Time in the therapeutic range has been inversely correlated with major hemorrhage, thrombosis, and mortality. Quest Diagnostics offers standardized INR laboratory testing services to approximately half of US physician practices. To inform national stroke prevention strategies, we evaluated anticoagulation control in office-based community practices. Methods and Results— We selected individuals with ≥2 months of INR data, INR results of &gt;1.2, and an ICD-9 diagnosis code of atrial fibrillation. Frequency of INR testing and time in the therapeutic range were analyzed by age, sex, length of testing period, number of referred patients per provider, and median household income (based on home ZIP code). We identified 138 319 individuals referred by 37 939 physicians, yielding a total of 2 683 674 INR results. Patients had a mean age of 74 years; 81% were ≥65 years of age, and 55% were ≥75 years of age. The mean time in the therapeutic range was 53.7% overall and improved with time on treatment, increasing from 47.6% for patients with &lt;6 months of testing to 57.5% for those with ≥6 months of testing ( P &lt;0.0001). The number of patients tested per physician practice was positively associated with time in the therapeutic range. Younger age, female sex, and lower income were also independently associated with poorer anticoagulant control. Conclusion— This study demonstrates widespread suboptimal anticoagulation control, suggesting an urgent need to improve oral anticoagulation care for most patient segments in the United States.
Renal β-intercalated cells maintain body fluid and electrolyte balance
Authors: Victor Gueutin, Marion Vallet, Maximilien Jayat, Janos Peti-Peterdi, Nicolas Cornière, Françoise Leviel, Fabien Sohet, Carsten A. Wagner, Dominique Eladari, Régine Chambrey
Journal: Journal of Clinical Investigation (2013)

Inactivation of the B1 proton pump subunit (ATP6V1B1) in intercalated cells (ICs) leads to type I distal renal tubular acidosis (dRTA), a disease associated with salt- and potassium-losing nephropathy. Here we show that mice deficient in ATP6V1B1 (Atp6v1b1-/- mice) displayed renal loss of NaCl, K+, and water, causing hypovolemia, hypokalemia, and polyuria. We demonstrated that NaCl loss originated from the cortical collecting duct, where activity of both the epithelial sodium channel (ENaC) and the pendrin/Na(+)-driven chloride/bicarbonate exchanger (pendrin/NDCBE) transport system was impaired. ENaC was appropriately increased in the medullary collecting duct, suggesting a localized inhibition in the cortex. We detected high urinary prostaglandin E2 (PGE2) and ATP levels in Atp6v1b1-/- mice. Inhibition of PGE2 synthesis in vivo restored ENaC protein levels specifically in the cortex. It also normalized protein levels of the large conductance calcium-activated potassium channel and the water channel aquaporin 2, and improved polyuria and hypokalemia in mutant mice. Furthermore, pharmacological inactivation of the proton pump in β-ICs induced release of PGE2 through activation of calcium-coupled purinergic receptors. In the present study, we identified ATP-triggered PGE2 paracrine signaling originating from β-ICs as a mechanism in the development of the hydroelectrolytic imbalance associated with dRTA. Our data indicate that in addition to principal cells, ICs are also critical in maintaining sodium balance and, hence, normal vascular volume and blood pressure.
"Free" Time for the Practicing Physician
Authors: Irving A. Beychok
Journal: JAMA (1971)

<h3>To the Editor.—</h3> If it is intellectually granted that physicians need more time for the management of more sick people, does this support the use of medically trained assistants to "free" the physician to better utilize his special knowledge and talents? It would be more consistent to train secretaries capable of extracting information once recorded or dictated by the physician for purposes of filing for insurance forms and for front sheets of hospital admissions. Surely it would be more consistent to work out a method whereby hospital laboratory, x-ray, and other diagnostic reports could be reduced to a sequential small-print type of reproduction available to the physician's office and for transfer of records than it is for physicians to pick out and report this information in long discharge summaries. Is there any way to consider it consistent to train "partial" physicians to practice "some" medicine while "full" physicians lose valuable
Tradition is better than technology
Authors: M Divers
Journal: BMJ (1994)

Cardiotocography could never be described as an exact science, even by the most ardent enthusiast, and for most junior hospital doctors its hidden meaning is seldom revealed. It does, however, account for more disturbed nights for those called on to interpret the importance of the trace than will ever be experienced by the parents of those babies in whose intrapartum care its use has been deemed essential. A simple guide to the basic steps in interpretation should benefit everyone. Furthermore, I will attempt to show how the introduction of a simple low cost instrument could improve sensitivity and specificity with major cost-benefit implications for the NHS.

Traditional midwifery skills placed reliance on a midwife auscultating the fetal heart diligently, using a Pinard stethoscope, during and after a contraction every 15 minutes in the first stage of labour. This provided close contact between the care giver and her charge …
The Color Cover Annual Report
Authors: F. Vizzi
Journal: JAMA (1967)

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
Identification of somatostatin receptor subtypes and an implication for the efficacy of somatostatin analogue SMS 201-995 in treatment of human endocrine tumors.
Authors: A Kubota, Y Yamada, S Kagimoto, A Shimatsu, M Imamura, K Tsuda, H Imura, S Seino, Y Seino
Journal: Journal of Clinical Investigation (1994)

The presence of somatostatin receptors has been demonstrated in various endocrine tumors as well as in normal tissues. We recently have cloned five human somatostatin receptor subtypes (SSTR1-SSTR5). These mRNAs are expressed in a tissue-specific manner. In this study, we have determined the somatostatin receptor subtypes expressed in various endocrine tumors using a reverse transcriptase polymerase chain reaction method. In two cases of glucagonoma and its metastatic lymph nodes in one case, all the SSTR subtype mRNAs except SSTR5 mRNA were expressed. In four cases of insulinoma, SSTR1 and SSTR4 mRNAs were detected, but SSTR2 mRNA was not detected in one case and SSTR3 mRNA was not detected in two cases, indicating a heterogeneous expression of SSTR subtypes in insulinomas. Interestingly, SSTR3 mRNA, which is highly expressed in rat pancreatic islets, is not expressed in normal human pancreatic islets, while SSTR1, SSTR2, and SSTR4 mRNAs are expressed. In three cases of pheochromocytoma, SSTR1 and SSTR2 mRNAs were detected, showing an expression pattern identical to that of normal adrenal gland. In a carcinoid, SSTR1 and SSTR4 mRNAs were detected. We have also found that human SSTR2 shows a high affinity for SMS 201-995, which has been used clinically for the treatment of endocrine tumors. Since SMS 201-995 was effective in the treatment of a patient with glucagonoma in which SSTR2 mRNA was present, but had no effect in a patient with carcinoid in which SSTR2 mRNA was not detected, this study suggests that the efficacy of SMS 201-995 may depend, at least in part, on the expression of SSTR2 in tumors.
HAVE LVADS RENDERED FIXED PULMONARY HYPERTENSION IN HEART FAILURE A VESTIGE OF THE PAST?
Authors: Barry A. Boilson, John A. Schirger, Yan Topilsky, Lucian A. Durham, Sudhir S. Kushwaha, Lyle D. Joyce, Richard C. Daly, Soon J. Park
Journal: Journal of the American College of Cardiology (2010)
Extraosseous calcification. Evidence for abnormal pyrophosphate metabolism in uremia.
Authors: A C Alfrey, C C Solomons, J Ciricillo, N L Miller
Journal: Journal of Clinical Investigation (1976)

The inorganic constituents and crystalline features of extraosseous calcium-phosphate deposits obtained from dialyzed uremic and hypercalcemic patients were studied. Visceral calcification (heart, lung, and kidney) in hypercalcemic patients exhibited either an amorphous or apatitic X-ray diffraction pattern. Uremic visceral calcification consistently gave an amorphous diffraction pattern. Although the calcium content of uremic and hypercalcemic visceral deposits was similar, other inorganic constituents were different. The mean pyrophosphate was 11 +/- 11.8 and magnesium 4.91 +/- 3.86 mg/g in the uremic group as compared to 0.92 +/- 0.24 and 1.36 +/- 1.26 mg/g in the hypercalcemic group (P less than 0.025). After incineration hypercalcemic visceral deposits having an amorphous diffraction pattern were found to generate pyrophosphate supporting the presence of brushite in these deposits. The small amount of pyrophosphate in apatitic deposits from both uremic and hypercalcemic patients actually decreased after incineration and the pyrophosphate content of uremic visceral deposits was unchanged by incineration. It is concluded that in hypercalcemic patients the initial visceral deposit is brushite which is subsequently transformed to apatite. Arterial and tumoral calcium-phosphate deposits in uremic patients were also apatite. Uremic visceral calcium-phosphate deposits are an unique mineral high in magnesium with approximately 30% of the phosphorus present as pyrophosphate. The high pyrophosphate content of these deposits could alter their crystalline structure and prevent the transformation to apatite. The infrared features, high magnesium content of the deposit, and resistance of pyrophosphate in the deposit to hydrolysis by pyrophosphatase suggests that the pyrophosphate may be deposited as the magnesium salt.