tbuckley/cabot-search huggingface dataset:
A 37-Year-Old Man Trying to Choose a High-Quality Hospital
Authors: Michael D. Howell
Journal: JAMA (2009)

Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes. Evidence for evaluating specific physicians is less robust, though a variety of sources are available. A broad range of detailed quality information, such as Medicare's Hospital Compare (http://www.hospitalcompare.hhs.gov/), is available for selecting a hospital. However, the relationship of these metrics to patient outcomes is variable, and different Web sites provide meaningfully different rankings and data interpretations. For Mr A in particular, a warfarin management team, the hospital's location, and a cardiologist with whom he feels comfortable and who can communicate with his primary care physician are important factors. Nevertheless, hospital quality information and metrics are an important component of the strategy Mr A should take to solve this challenging problem.
Erythrocytes in human transplantation: effects of pretreatment with ABO group-specific antigens
Authors: F. T. Rapaport, J. Dausset, L. Legrand, A. Barge, H. S. Lawrence, J. M. Converse
Journal: Journal of Clinical Investigation (1968)

Erythrocyte group antigens A and B can act as potent and group-specific transplantation antigens in man. ABO group-incompatible recipients pretreated with such antigens have rejected skin allografts obtained from donors incompatible for the same antigens in an accelerated (4-5 days) or white graft manner. Skin grafts applied to the same recipients from ABO-compatible donors were accorded first-set survival times. Intact erythrocyte suspensions and antigens isolated from hog (A substance) and horse (B substance) stomachs, were equally capable of inducing this type of allograft sensitivity. The latter observation broadens the spectrum of heterologous antigens capable of inducing allograft sensitivity in the mammalian host and provides a readily available, heat-stable, and water-soluble source of antigens for further studies of allograft rejection mechanisms in man.
Is After Medic us.
Authors: Emil Bories
Journal: JAMA (1894)

Seattle, Washington, April 4, 1894. <h3>To the Editor:</h3> —Every reader of theJournal of the American Medical Association, and especially every member of theAssociationwho ranks himself a gentleman, will indorse the remarks of Dr. S. Solis-Cohen and treat " Medicus " with contempt. Very truly,
Lung Collapse after Eye Operation under Local Anaesthesia
Authors: R. Lane
Journal: BMJ (1941)

Shambaugh (1929) has given a detailed description of a condition which he has named " blue drum," and of which he reports two cases occurring in adults.Fowler (1939) also quotes a case, but the age of the patient is not specified.In appearance the tympanic membrane is blackish blue over the whole of the pars tensa, which is retracted.The pars flaccida does not share in the discoloration.The land- marks of the drum stand out clearly, and the condition is not associated with any myringitis or bulla formation."Blue drum" Deafness of the conductive type is present.Two instances of " blue drum " have been encountered recently in children, and a summary of the histories may be of some interest. Two Case RecordsCase 1.-This patient, a girl aged 7, had a history of inter- mittent deafness associated with colds, occasional earache, but no otorrhoea.During the fortnight preceding examina,tion the deafness had become much worse, although there were no local or general signs of an inflammatory condition.Slight tinnitus
Platelet Glycoprotein IIIa <b> <i>Pl</i> </b> <sup>A</sup> Polymorphism, Fibrinogen, and Platelet Aggregability
Authors: DaLi Feng, Klaus Lindpaintner, Martin G. Larson, Christopher J. O’Donnell, Izabella Lipinska, Patrice A. Sutherland, Murray Mittleman, James E. Muller, Ralph B. D’Agostino, Daniel Levy, Geoffrey H. Tofler
Journal: Circulation (2001)

Background — Recent data suggest that the Pl A2 allele of the platelet glycoprotein IIIa receptor may be a genetic risk factor for cardiovascular disease. We previously reported that the Pl A2 allele was associated with increased platelet aggregability, as indicated by lower epinephrine threshold concentrations. Paradoxically, however, it has been reported that Pl A2 -positive platelets have reduced fibrinogen binding. Because fibrinogen mediates platelet aggregability, we hypothesized that plasma fibrinogen levels may interact with Pl A genotype in modulating platelet aggregability. Methods and Results — Glycoprotein IIIa Pl A genotype, fibrinogen level, and platelet aggregability were ascertained in 1340 subjects enrolled into the Framingham Offspring Study. Platelet aggregability was evaluated by the Born method. Higher fibrinogen levels were associated with increased epinephrine-induced aggregation ( P =0.002) and a trend for ADP-induced aggregation ( P =0.07). The fibrinogen effect was genotype specific, however, in that the increase in platelet aggregability with higher fibrinogen was present for the Pl A1/A1 genotype ( P =0.0005 and P =0.03 for epinephrine- and ADP-induced aggregation, respectively) but not for the Pl A2 -positive genotype ( P &gt;0.90). Conclusion — Higher fibrinogen levels were associated with increased platelet aggregability. However, the association between fibrinogen and platelet aggregability was genotype specific. This interaction may be responsible for the conflicting findings regarding Pl A genotype and platelet aggregability. Further study of this gene-environment interaction may provide insight into cardiovascular disease risk.
NIH Panel Finds Embryo Research Justifiable, Recommends Support
Authors: Charles Marwick
Journal: JAMA (1994)

THE US GOVERNMENT is being urged to fund research into the beginnings of human life. A panel convened by the National Institutes of Health (NIH), Bethesda, Md, has recommended that carefully guided investigations into the fertilized human embryo can be justified and are worth federal support. Properly designed studies could enlarge scientific knowledge in a variety of reproductive areas, including infertility, genetic diseases, contraception, and cancer, the panel concludes. Research would be limited to embryos 14 days or less from first cell division. At this point, the embryo develops the so-called primitive streak, a faint white trace at the caudal end of the embryonic disk that provides the earliest evidence of the embryonic axis, or spatial orientation. The panel's report is a milestone. It brings the United States into line with other countries that have addressed the issue of human embryo research in one way or another, rather than simply
25 Fibrocystin, the ARPKD protein, is localized to cholangiocyte cilia and is disrupted in the orthologous rat model, PCK
Authors: T MASYUK, B HUANG, A MASYUK, P SPLINTER, C WARD, X WANG, R PUNYASHTHITI, P HARRIS, V TORRES, N LARUSSO
Journal: Hepatology (2003)
Lifelong Learning Tailored to Individual Clinical Practice
Authors: Phil R. Manning
Journal: JAMA (1992)

For decades, critics have contested the value of continuing medical education (CME), as well as the efficacy of many CME studies, pointing to methodologic flaws that preclude valid assessment. Although testing for knowledge before and after participation in a given educational program usually shows that physicians learn facts,<sup>1</sup>the effect of education on performance in practice and ultimately on patient care has been difficult to establish. Nevertheless, direct observations indicate that, after graduation, physicians incorporate new skills and new knowledge into their practices. In 1973, Caplan<sup>2</sup>pointed out, "Scientific proof of effectiveness rests upon varying types of evidence." Citing an old example, he asked, "How many physicians whose formal medical education occurred pre-1940 today treat syphilis with arsphenamine [Salvarsan] or lobar pneumonia with type-specific antisera? Their switch to penicillin (behavior) testifies that somehow they learned something new (education)." Numerous modern examples corroborate such adoption of medical advances. Cardiologists
The reproducibility of patch tests
Authors: None BOURKE, None BATTA, None PRAIS, None ABDULLAH, None FOULDS
Journal: British Journal of Dermatology (1999)

There is conflicting evidence regarding the reproducibility of patch testing. Discordant results have been reported in up to 44% of cases. The clinical relevance of these discordant patch tests has not been previously assessed. We studied 383 consecutive patients receiving simultaneous duplicate patch testing on opposite sides of the upper back with 10 allergens from the European standard series. Completely discordant patch tests-a negative test on one side with a positive test on the opposite side-were recorded in 30 (8%) patients. Two patients had discordant tests to two of the allergens; 28 had discordant reactions to one allergen. Completely discordant tests were recorded for nickel in 10 (3%) patients, balsam of Peru in two (0.5%), thiomersal in one (0.3%), cobalt in four (1%), paraphenylenediamine in three (0.8%), fragrance mix in two (0.5%), formaldehyde in four (1%), potassium dichromate in two (0.5%), lanolin in three (0.8%) and Kathon CG in one (0.3%). Of those patients with completely discordant patch tests, the allergen was deemed to be a true positive in 11 (3% of total) cases and of possible relevance in a further three. The allergen was felt to be relevant to the presenting complaint in seven (2% of total) patients.
Bats as Bedbug Carriers.
Authors: Edwin R. Chadbourne
Journal: JAMA (1906)

Pasadena, Cal., May 18, 1906. <h3>To the Editor:</h3> —The editorial inThe Journal, March 17, 1906, page 804, on "Bedbugs and Disease Possibilities," interested me greatly. The reference to small animals as their source of food supply reminds me that when I resided in New York City a small bat that came into my rooms was covered with genuine bedbugs. These were especially numerous under the wings. It seems to me that this little animal could be a very great source of danger as a carrier of disease, as he has free access to our bedrooms, frequently coming directly from the worst lofts or hovels, or even pesthouses. Since this bug-infected bat came to me I have looked on these animals as a sure means of spreading bedbugs themselves. If these bugs are able to transmit infectious diseases, it causes a little animal otherwise not only harmless but in several
The Response to Acetylstrophanthidin
Authors: Louis A. Soloff, Jacob Zatuchni, Jairo Velasquez
Journal: New England Journal of Medicine (1956)

CARDIAC failure is frequently precipitated by a noncardiac illness. Although digitalis is used to restore and maintain compensation, the self-limiting nature of the precipitating event or its response to specific therapy may make it difficult or impossible to determine the effects of digitalis. To give a so-called digitalizing dose at one time does not answer this problem because almost always no immediate effects are seen.1 , 2 Dissipation of symptoms and signs of cardiac failure requires a variable time, measurable in days, weeks or even months. One rightly hesitates to increase the so-called digitalizing dose for fear of producing prolonged toxicity or . . .
Virus Excretion after Mass Vaccination with Attenuated Polioviruses in Hungary
Authors: I. Domok, E. Molnar, A. Jancso
Journal: BMJ (1961)

~~~~~~~~~~~~~~~~~~~~~~~~MEDICAL JOURNAL and that breast-feeding should not be allowed.The choice of the anticoagulant drug is also to be considered.In a recent case of cerebral embolism occurring two weeks prior to term we used only heparin ; the patient fully recovered, and heparin produced no ill effects in the mother or baby.Obviously, much wider clinical experience is needed in this particular field.The many variab'le factors, including mitral-valve surgery in several patients before or during pregnancy, made an assessment of the remote effects of pregnancy on the course of the heart disease rather difficult.Furthermore, Rowe et al. (1960) suggested that medically treated patients with mitral stenosis probably live longer now than they did ten or twenty years ago.Nevertheless, consideraton of data reported in the literature (Olesen, 1955; Wood, 1956; Rowe et al., 1960) and our own observations relating to the natural history of rheumatic heart disease have led us to believe that pregnancy, if appropriately managed and survived, does not accelerate the course of rheumatic heart disease, save perhaps in exceptional cases.This is also the view of several other workers (Miller and Metcalfe, 1956 Burwell, 1958 ; Gorenberg and Clhesley, 1958). SummaryThe course of 60 pregnancies complicated by rheumatic heart disease and paroxysmal or established atrial fibrillation is analysed, and some of the features are compared with those observed in 700 pregnancies with rheumatic heart disease in which sinus rhythm had been maintained throughout pregnancy and the puerperium.The inzidence of heart failure and embolic episodes was higher in the atrial fibrillation group, resulting in a higher maternal mortality rate and foetal loss.However, improved methods in the care of the pregnant patient with functionally severe heart disease have considerably reduced these risks.The belief is expresFed that if atrial fibrillation appears during pregn-incy or in the puerperium an attempt should be made to restore sinus rhythm.Anticoagulant pro- phylaxis, if judged advisable, is also feasible during pregnancy.Our thanks are due to Mr. G. A. Mason.who performed the mitral-valve operations referred to in the paper.
Dealing with Conflicts of Interest
Authors: Arnold S. Relman
Journal: New England Journal of Medicine (1985)

The medical profession in this country has always had its entrepreneurs and hustling businessmen, but until recently they were on the fringe and in a small minority. Most practicing physicians concentrated on providing or supervising services to their patients, and their professional income was largely limited to the fees or salaries paid for such services.Lately, however, a new entrepreneurial fever has begun to affect the profession, and what was formerly on the fringe seems to be moving into the mainstream. More and more practitioners are seeking profits from business arrangements with hospitals, equipment manufacturers, and most recently, companies providing . . .
It's all right now
Authors: S. Nixon
Journal: BMJ (1995)

Doctors face a daily dilemma, prescribing drugs and performing procedures that have undesirable side effects. Anti-inflammatory drugs can cause peptic ulcer and death; vaccines kill; all medicine carries a health warning, and “keyhole” surgery is no exception. World in Action asked three questions: is minimal access surgery safe? is it an advance on conventional surgery? and, should its introduction have been more closely supervised?

The programme featured patients who had experienced serious, even fatal, complications after minimal access surgery. There was a strong implication that surgeons had not been entirely honest with patients, hiding serious risks of injury. There was also an implication that potential financial savings had encouraged complacency. The programme included interviews with experts whose …
Survival rates in dysvascular lower limb amputees
Authors: J. Kulkarni, S. Pande, J. Morris
Journal: International Journal of Surgery (2006)

To assess the 5-year and 10-year survival rates of major (above ankle disarticulation level) dysvascular lower limb amputees attending a sub-regional Disablement Services Centre (DSC) specialising in amputee rehabilitation. Also to investigate the association between survival rates, cause of dysvascularity, level of amputation, smoking status and occupational status. The study was undertaken in sub-regional DSC for amputee rehabilitation covering a base population of about 3.5 million people. Over 80% of lower limb amputations were done for dysvascularity (peripheral vascular disease, diabetic or combination). All these patients were followed up in the DSC for their prosthetic/amputee rehabilitation. Modular case records of 201 consecutive patients from 1994 to 1995 who had diagnosis of dysvascularity as the cause of major lower limb amputations, were scrutinised regarding their 10-year survival; demographic details, level of lower limb amputations, Above Knee (AK = Transfemoral), Below Knee (BK = Transtibial), smoking status, occupational status, healing of the stump at first assessment, cause of amputation and association of these factors with survival rates. Of 201 individuals with either AK or BK amputations, 60% (121) had AK amputations and 67% (134) were males, the mean age was 69 years of age. Sixty-seven percent (97) had history of smoking, either current 43% (62) or prior 24% (35) smoking, and 59% (68) were skilled or non-skilled manual workers. Fifty-one percent (99) had diagnosis of peripheral vascular disease, whilst 34% (65) had combination of peripheral vascular disease and diabetes, diabetes on its own in 4% (7). In 12% (23) other causes were noted such as embolism, acute ischaemia, venous ulcers, etc. Regarding stumps healing at first assessment, healing was noted in 54% (109) whilst stump was unhealed in 46% (92). The median survival was 48 months. Using Cox proportional hazards regression to identify association with survival, the hazard ratio (HR) was significant regarding level of amputation: HR 2.34; 95% confidence interval (CI) (1.58, 3.47), P < 0.001 (a recent BK amputation increases the risk by 2.3 compared to a recent AK amputation in diabetic cohort and also in the peripheral vascular disease/diabetes cohort). Hazard ratio was less than 1.0 in bilateral amputees: HR 0.35, 95% CI (0.21, 0.60), P < 0.001 (bilateral amputation decreases risk by 0.35). Our study indicates that the median survival remains at 4 years, which is similar to the previously published evidence in the Finish study of 1998 and the earlier study from Scotland in 1992. Unlike the previous data, our study indicates that patients with BK amputations have a higher hazard ratio than the AK amputees, and an association with diabetes has poorer prognosis regarding survival.
Shear Stress Modulates the Vascular Tone in Perfused Livers Isolated From Normal Rats
Authors: Catherine M. Pastor, Antoine Hadengue
Journal: Hepatology (2000)

Fluid shear stress can be increased either by increasing the flow rate or perfusing increasing doses of norepinephrine (NE) at a constant flow rate. Concomitantly, increased fluid shear stress at the surface of endothelial cells releases nitric oxide (NO). To better understand the role of NO released by shear stress in regulating intrahepatic vascular resistances, we increased fluid shear stress either by changing the flow rate or by perfusing increasing doses of NE at a constant flow rate in perfused livers isolated from normal rats. When concentration-response curves to NE were studied at low, mild, and high flow rates, portal pressure increased during NE perfusion. The higher the flow rate, the lower the response to NE. NO synthase inhibition similarly increased the response to NE at each flow rate. Thus, NO was released by NE-induced increased shear stress, but other vasodilators are likely to be responsible for the flow-induced increased shear stress. In additional experiments, when flow rate was decreased while infusing increasing doses of NE to maintain the portal pressure constant, shear stress remained steady and NO was not released. Hepatic NO production in the different conditions of shear stress could not be detected. Our data are consistent with the fact that in the liver, NO released by shear stress decreases the vasoconstriction to NE and regulates the intrahepatic vascular resistances.
Occult Carbon Monoxide Poisoning
Authors: David A. Nardone, Thomas G. Kelsey
Journal: Annals of Internal Medicine (1988)

Letters and Corrections1 January 1988Occult Carbon Monoxide PoisoningDAVID A. NARDONE, M.D., THOMAS G. KELSEY, M.D.DAVID A. NARDONE, M.D.Search for more papers by this author, THOMAS G. KELSEY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-108-1-150 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The article by Heckering and colleagues (1) contains a potentially useful message. Patients with either headache or dizziness, who lack a history of gas stove usage and affected cohabitants, have a probability of carbon monoxide poisoning (4 in 89 patients, 4.5%) in which observation without performance of a carboxyhemoglobin level is indicated. Alternatively, the pretest probability for patients with headache or dizziness, with a history of either gas stove usage or affected cohabitants, is 9.5% (4 in 42 patients). For this latter group carboxyhemoglobin testing is indicated. Thus, the no-test:test threshold for carboxyhemoglobin poisoning is a probability...Reference1. HECKERLING P, LEIKIN J, MATUREN A, and PERKINS J. Predictors of occult carbon monoxide poisoning in patients with headache and dizziness. Ann Intern Med. 1987;107:174-6. LinkGoogle Scholar1. HECKERLING P, LEIKIN J, MATUREN A, and PERKINS J. Predictors of occult carbon monoxide poisoning in patients with headache and dizziness. Ann Intern Med. 1987;107:174-6. LinkGoogle Scholar2. PAUKER S and KASSIRER J. The threshold approach to clinical decision making. N Engl J Med. 1980;302:1109-17. CrossrefMedlineGoogle Scholar3. MYERS R, LINBERG S, and COWLEY R. Carbon monoxide poisoning: the injury and its treatment. JACEP. 1978;8:479-84. CrossrefGoogle Scholar4. GOLDFRANK L, KIRSTEIN R, LEWIN N, and WEISMAN R. Carbon monoxide (the red alert). In: GOLDFRANK LR, ed. Toxicologic Emergencies: A Comprehensive Handbook in Problem Solving. New York: Appleton-Century-Crofts; 1982: 223-30. Google Scholar5. JACKSON D and MENGES H. Accidental carbon monoxide poisoning. JAMA. 1980;243:772-4. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: DAVID A. NARDONE, M.D.; THOMAS G. KELSEY, M.D. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEpidemiology of Acute Carbon Monoxide Poisoning in a Spanish Region 1 January 1988Volume 108, Issue 1Page: 150-151KeywordsCarbon monoxideCarboxyhemoglobinHeadaches ePublished: 1 December 2008 Issue Published: 1 January 1988 PDF downloadLoading ...
Demonstration of an intracellular copper-binding protein by orcein staining in long-standing cholestatic liver diseases.
Authors: M Salaspuro, P Sipponen
Journal: Gut (1976)

Liver biopsies from eight patients with primary biliary cirrhosis, two with chronic active hepatitis of a cholestatic form, three with long-standing alcoholic liver cirrhosis, and one with extrahepatic biliary obstruction were studied. In each case dark brown cytoplasmic material was seen after staining of the tissue sections with Shikata's orcein method. In exactly the same cellular and subcellular locations as the orcein-positive material, and with morphologically equal granules, two different ordinary staining methods for copper (rubeanic acid and Mallory-Parker's haematoxylin) gave positive reactions. The earlier histochemical findings have revealed the protein nature and high sulphydryl content of the orcein-positive material. Its close association with copper in liver sections suggests its copper-binding nature and indicates that a common copper-protein complex accumulates in the cytoplasm of liver cells during longstanding cholestasis in biliary diseases of various pathogenetic origin.