tbuckley/cabot-search huggingface dataset:
A clinical and radiological review of 204 hiatal hernia operations
Authors: E. Hoffman, M. C. Sumner
Journal: Thorax (1973)

Two hundred and four patients with reflux oesophagitis and hiatal hernia were operated on by a modified Allison's technique and followed up for one to 10 years. To avoid surgical bias, the clinical and radiological findings were assessed by the co-author, a radiologist. Ages, type of hernia, symptoms, coexisting pathology, and operative technique are described. The late follow-up includes an assessment of patients' opinions of their operation and residual symptoms and a review of the radiological findings. The management of 25 patients with fibrous strictures is described. Factors preventing reflux are discussed. Current operative procedures for reflux oesophagitis are reviewed. In this series of 204 cases, five patients, that is 2·5%, were surgical failures. They were all dissatisfied with their operation and their symptoms had not improved; radiologically three of them showed reflux or an irreducible hiatal hernia. This failure rate is not considered unreasonable and the modified Allison's procedure is therefore recommended for patients with reflux oesophagitis.
Implementation of a Safe and Effective Insulin Infusion Protocol in a Medical Intensive Care Unit
Authors: Philip A. Goldberg, Mark D. Siegel, Robert S. Sherwin, Joshua I. Halickman, Michelle Lee, Valerie A. Bailey, Sandy L. Lee, James D. Dziura, Silvio E. Inzucchi
Journal: Diabetes Care (2004)

In a recent randomized controlled trial, lowering blood glucose levels to 80-110 mg/dl improved clinical outcomes in critically ill patients. In that study, the insulin infusion protocol (IIP) used to normalize blood glucose levels provided valuable guidelines for adjusting insulin therapy. In our hands, however, ongoing expert supervision was required to effectively manage the insulin infusions. This work describes our early experience with a safe, effective, nurse-implemented IIP that provides detailed insulin dosing instructions and requires minimal physician input.We collected data from 52 medical intensive care unit (MICU) patients who were placed on the IIP. Blood glucose levels were the primary outcome measurement. Relevant clinical variables and insulin requirements were also recorded. MICU nurses were surveyed regarding their experience with the IIP.To date, our IIP has been employed 69 times in 52 patients admitted to an MICU. Using the IIP, the median time to reach target blood glucose levels (100-139 mg/dl) was 9 h. Once blood glucose levels fell below 140 mg/dl, 52% of 5,808 subsequent hourly blood glucose values fell within our narrow target range; 66% within a "clinically desirable" range of 80-139 mg/dl; and 93% within a "clinically acceptable" range of 80-199 mg/dl. Only 20 (0.3%) blood glucose values were <60 mg/dl, none of which resulted in clinically significant adverse events. In general, the IIP was readily accepted by our MICU nursing staff, most of whom rated the protocol as both clinically effective and easy to use.Our nurse-implemented IIP is safe and effective in improving glycemic control in critically ill patients.
Randomised controlled trial of effect of hands and knees posturing on incidence of occiput posterior position at birth
Authors: Azar Kariminia, Marie E Chamberlain, John Keogh, Agnes Shea
Journal: BMJ (2004)

Objective To evaluate the efficacy of hands and knees position and pelvic rocking exercises on the incidence of fetal occiput posterior position at birth. Design Multicentre randomised controlled trial. Setting Seven maternity units in New South Wales, Australia, encompassing teaching hospitals and district general hospitals. Participants 2547 pregnant women at 37 weeks' gestation; 1292 randomised to the intervention group and 1255 to the control group. Intervention Hands and knees position and pelvic rocking exercises from 37 weeks' gestation until the onset of labour. Main outcome measure Incidence of fetal occiput posterior position at birth. Results 1046 women in the intervention group and 1209 women in the control group remained in the study until they went into labour. No significant difference existed between the groups for the incidence of occiput posterior position at birth: 105 (8.1%) women in the intervention group and 98 (7.8%) in the control group had a baby in a posterior position at delivery (difference in risk 0.3%, 95% confidence interval −1.8 to 2.4). The incidence of fetal transverse arrest was 3.4% (44 women) in the intervention group and 3.0% (38 women) in the control group (difference in risk 0.4, −1 to 1.7). No differences occurred between intervention and control groups for induction of labour, use of epidural, duration of labour, mode of delivery, use of episiotomy, or Apgar score. Conclusion Hands and knees exercise with pelvic rocking from 37 weeks' gestation to the onset of labour did not reduce the incidence of persistent occiput posterior position at birth.
<b> <i>BRCA</i> </b> Mutations and Risk of Prostate Cancer in Ashkenazi Jews
Authors: Tomas Kirchhoff, Noah D. Kauff, Nandita Mitra, Kedoudja Nafa, Helen Huang, Crystal Palmer, Tony Gulati, Eve Wadsworth, Sheri Donat, Mark E. Robson, Nathan A. Ellis, Kenneth Offit
Journal: Clinical Cancer Research (2004)

Abstract Purpose: The Breast Cancer Linkage Consortium and other family-based ascertainments have suggested that male carriers of BRCA mutations are at increased risk of prostate cancer. Several series looking at the frequency of BRCA mutations in unselected patients with prostate cancer have not confirmed this finding. To clarify this issue, we conducted a large case-control study. Experimental Design: Blood specimens from 251 unselected Ashkenazi men with prostate cancer were screened for the presence of one of the three common Ashkenazi founder mutations in BRCA1 and BRCA2. The incidence of founder mutations was compared with the incidence of founder mutations in 1472 male Ashkenazi volunteers without prostate cancer using logistic regression analysis after adjusting for age. Results: Thirteen (5.2%) cases had a deleterious mutation in BRCA1 or BRCA2 compared with 28 (1.9%) controls. After adjusting for age, the presence of a BRCA1 or BRCA2 mutation was associated with the development of prostate cancer (odds ratio, 3.41; 95% confidence interval, 1.64–7.06; P = 0.001). When results were stratified by gene, BRCA2 mutation carriers demonstrated an increased risk of prostate cancer (odds ratio, 4.78; 95% confidence interval, 1.87–12.25; P = 0.001), whereas the risk in BRCA1 mutation carriers was not significantly increased. Conclusions: BRCA2 mutations are more likely to be found in unselected individuals with prostate cancer than age-matched controls. These results support the hypothesis that deleterious mutations in BRCA2 are associated with an increased risk of prostate cancer.
Acute headache and visual field defect
Authors: M. D. Wilkie, R. Al-Mahfoudh
Journal: BMJ (2012)

A 79 year old woman developed a sudden onset severe bifrontal headache accompanied by an acute loss of peripheral vision, which she described as tunnel vision, and a subsequent transient reduction in her level of consciousness six days after an elective right total hip arthroplasty. Postoperatively she had experienced mild generalised headaches and erratic blood pressure control, with a tendency to marked hypertension.

Her medical history included type 2 diabetes, poorly controlled hypertension, and osteoarthritis, for which she regularly took co-codamol 30/500, metformin, and bisoprolol; no recent changes had been made to these drugs.

On initial examination, her blood pressure was 105/68 mm Hg, pulse 85 beats/min, and temperature 37.8°C. Her Glasgow coma scale score was 10/15 (E3, M5, V2) but rapidly improved to 14/15 (E4, M6, V4) over about 15 minutes. Further neurological examination showed visual acuities of 6/9 bilaterally and a marked bitemporal hemianopia, which was confirmed on formal visual fields assessment. Notably, fundoscopy was normal and she had no signs of meningism.

Initial blood tests showed hyponatraemia (119 mmol/L), with otherwise normal biochemistry and random glucose of 10.2 mmol/L. Calcium profile, full blood count, and coagulation screen were normal. Serum and urine osmolalities were 274 mosmol/kg and 581 mosmol/kg, respectively. Magnetic resonance imaging (MRI) was performed (figs 1⇓ and 2⇓).



Fig 1 T1 weighted sagittal magnetic resonance imaging performed three days after symptom onset 





Fig 2 T2 weighted axial magnetic resonance imaging performed three days after symptom onset 





### 1 On the basis of the clinical and radiological findings what is the diagnosis?

#### Short answer

This presentation of sudden onset headache, visual disturbance, and altered consciousness is typical of pituitary apoplexy, a clinical …
Current opinion of muco-active drug research: strategies and problems
Authors: T Miyata, H Kai, Y Isohama, K Takahama
Journal: European Respiratory Journal (1998)

In general, mucoactive drugs are classified into several groups. However, since many drugs have overlapping effects, it is difficult to classify the drugs into groups based on their major actions. It has been reported that many mucoactive drugs have antioxidant effects. It is reasonable to suggest that an anti-inflammatory property is crucial to demonstrate effectiveness in a clinical context. From this point of view, we have evaluated several mucoactive drugs over two decades. Of these, we will consider the following drugs with anti-inflammatory properties: sodium aceneuramate; glucocorticoids; traditional Chinese medicines; and new cysteine derivatives. On the basis of these findings, we believe that the efforts to seek for compatible actions between glucocorticoids and oriental medicines may provide new opportunities for development of ideal mucoactive drugs with specified actions, i.e. suppression of gene expression.
Comorbidity: Cognition and biology count!
Authors: Orly Rubinsten, Avishai Henik
Journal: Behavioral and Brain Sciences (2010)

We agree with Cramer et al. that pure cases of behavioral disorders with no symptom overlaps are rare. However, we argue that disorders do exist and the network idea is limited and limiting. Networks of symptoms are observed mainly at behavioral levels. The core deficit is commonly at the cognitive or brain levels, and there the story is completely different.
Organochlorine Pesticides and Risk of Endometriosis: Findings from a Population-Based Case–Control Study
Authors: Kristen Upson, Anneclaire J. De Roos, Mary Lou Thompson, Sheela Sathyanarayana, Delia Scholes, Dana Boyd Barr, Victoria L. Holt
Journal: Environmental Health Perspectives (2013)

Background: Endometriosis is considered an estrogen-dependent disease. Persistent environmental chemicals that exhibit hormonal properties, such as organochlorine pesticides (OCPs), may affect endometriosis risk.Objective: We investigated endometriosis risk in relation to environmental exposure to OCPs.Methods: We conducted the present analyses using data from the Women’s Risk of Endometriosis (WREN) study, a population-based case–control study of endometriosis conducted among 18- to 49-year-old female enrollees of a large health care system in western Washington State. OCP concentrations were measured in sera from surgically confirmed endometriosis cases (n = 248) first diagnosed between 1996 and 2001 and from population-based controls (n = 538). We estimated odds ratios (OR) and 95% CIs using unconditional logistic regression, adjusting for age, reference date year, serum lipids, education, race/ethnicity, smoking, and alcohol intake.Results: Our data suggested increased endometriosis risk associated with serum concentrations of β-hexachlorocyclohexane (HCH) (third vs. lowest quartile: OR = 1.7; 95% CI: 1.0, 2.8; highest vs. lowest quartile OR = 1.3; 95% CI: 0.8, 2.4) and mirex (highest vs. lowest category: OR = 1.5; 95% CI: 1.0, 2.2). The association between serum β-HCH concentrations and endometriosis was stronger in analyses restricting cases to those with ovarian endometriosis (third vs. lowest quartile: OR = 2.5; 95% CI: 1.5, 5.2; highest vs. lowest quartile: OR = 2.5; 95% CI: 1.1, 5.3).Conclusions: In our case–control study of women enrolled in a large health care system in the U.S. Pacific Northwest, serum concentrations of β-HCH and mirex were positively associated with endometriosis. Extensive past use of environmentally persistent OCPs in the United States or present use in other countries may affect the health of reproductive-age women.Citation: Upson K, De Roos AJ, Thompson ML, Sathyanarayana S, Scholes D, Barr DB, Holt VL. 2013. Organochlorine pesticides and risk of endometriosis: findings from a population-based case–control study. Environ Health Perspect 121:1319–1324; http://dx.doi.org/10.1289/ehp.1306648
Acute Helicobacter pylori infection: clinical features, local and systemic immune response, gastric mucosal histology, and gastric juice ascorbic acid concentrations.
Authors: G M Sobala, J E Crabtree, M F Dixon, C J Schorah, J D Taylor, B J Rathbone, R V Heatley, A T Axon
Journal: Gut (1991)

The symptomatology of a case of acute infection with Helicobacter pylori is described, together with the accompanying changes in gastric mucosal histology, local and systemic humoral immune response, and gastric ascorbic acid concentration. The patient was an endoscopist, previously negative for the carbon-14 urea breath test, who had a week of epigastric pain and then became asymptomatic. H pylori was detected by culture of antral biopsy specimens and was still present after 74 days. Five days after infection the histological findings showed acute neutrophilic gastritis; by day 74 changes of chronic gastritis were evident. The patient seroconverted by IgG enzyme linked immunosorbent assay by day 74, but a mucosal IgM and IgA response was evident as early as day 14. Infection was accompanied by a transient hypochlorhydria but a sustained fall in gastric juice ascorbic acid concentration.
Phase II Study of ET-743 in Advanced Soft Tissue Sarcomas: A European Organisation for the Research and Treatment of Cancer (EORTC) Soft Tissue and Bone Sarcoma Group Trial
Authors: A. Le Cesne, J.Y. Blay, I. Judson, A. Van Oosterom, J. Verweij, J. Radford, P. Lorigan, S. Rodenhuis, I. Ray-Coquard, S. Bonvalot, F. Collin, J. Jimeno, E. Di Paola, M. Van Glabbeke, O.S. Nielsen
Journal: Journal of Clinical Oncology (2005)

This nonrandomized multicenter phase II study was performed to evaluate the activity and safety of Ecteinascidin (ET-743) administered at a dose of 1.5 mg/m(2) as a 24-hour continuous infusion every 3 weeks in patients with pretreated advanced soft tissue sarcoma.Patients with documented progressive advanced soft tissue sarcoma received ET-743 as second- or third-line chemotherapy. Antitumor activity was evaluated every 6 weeks until progression, excessive toxicity, or patient refusal.One hundred four patients from eight European institutions were included in the study (March 1999 to November 2000). A total of 410 cycles were administered in 99 assessable patients. Toxicity mainly involved reversible grade 3 to 4 asymptomatic elevation of transaminases in 40% of patients, and grade 3 to 4 neutropenia was observed in 52% of patients. There were eight partial responses (PR; objective regression rate, 8%), 45 no change (NC; > 6 months in 26% of patients), and 39 progressive disease. A progression arrest rate (PR + NC) of 56% was observed in leiomyosarcoma and 61% in synovialosarcoma. The median duration of the time to progression was 105 days, and the 6-month progression-free survival was 29%. The median duration of survival was 9.2 months.ET-743 seems to be a promising active agent in advanced soft tissue sarcoma, with no cumulative toxicities. The 6-months progression-free survival observed in advanced soft tissue sarcoma compares favorably with those obtained with other active drugs tested in second-line chemotherapy in previous European Organisation for the Research and Treatment of Cancer trials. The median overall survival was unusually long in these heavily pretreated patients mainly due to the high number of patients who benefit from the drug in terms of tumor control.
The wide spectrum of sport and exercise medicine: an Australasian College of Sports Physicians theme issue
Authors: Andrew P Garnham
Journal: British Journal of Sports Medicine (2012)

Turn off the TV! Too often this is the advice parents give to their children simply because they feel children should be doing other things, or the noise is annoying. Are there good reasons to turn it off? And what about adults—surely some relaxation is good? For some time we have known just how dangerous sitting down in front of the television can be in terms of cardiovascular mortality. Indeed, simply sitting in front of the television, even if it is turned off, is risky. Now we have the figures to tell us just what those risks are.1

Scarily, half an hour in front of the box once over the age of 25 may shorten life by just as much as a cigarette. Typical viewing behaviours of several hours per day can reduce life expectancy by years. The question remains, what is the really dangerous content? Does watching sport, particularly a nail-biting contest, reduce or increase the risk?

Having taken on board the straightforward and potent message that television is dangerous, we then should consider alternative activities. For the children, desirable options may include playing sport or a …
(10) Lymphangiectasia of the vulva following hysterectomy and radiotherapy
Authors: C.T.C. Kennedy
Journal: British Journal of Dermatology (1990)

Journal Article (10) Lymphangiectasia of the vulva following hysterectomy and radiotherapy Get access C.T.C. Kennedy C.T.C. Kennedy Bristol Royal Infirmary, Bristol BS2 8HW. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 123, Issue s37, 1 July 1990, Pages 92–93, https://doi.org/10.1111/j.1365-2133.1990.tb04496.x Published: 01 July 1990
Maternal Absence and Stability of Individual Differences in CSF 5-HIAA Concentrations in Rhesus Monkey Infants
Authors: Courtney Shannon, Melanie L. Schwandt, Maribeth Champoux, Susan E. Shoaf, Stephen J. Suomi, Markku Linnoila, James D. Higley
Journal: American Journal of Psychiatry (2005)

OBJECTIVE: Early life events often lead to deficits in CNS serotonin function, which underlie a number of reoccurring psychopathological disorders. Studies using rhesus macaques have demonstrated that early maternal deprivation reduces CNS serotonin turnover, as measured by cisternal CSF 5-HIAA concentrations. In addition, individual differences in CSF 5-HIAA remain stable from the first year of life through adulthood. The purpose of this study was to assess 1) the impact of rearing environment on the early development (<6 months of age) of the serotonin system, and 2) at what stage of early development individual differences in CSF 5-HIAA concentrations stabilize. METHOD: The subjects were 256 infant rhesus macaques reared in three different conditions (mother-reared, peer-reared, and surrogate/peer-reared). Cisternal CSF was obtained at 14, 30, 60, 90, 120, and 150 days of age. RESULTS: No differences in CSF 5-HIAA concentrations were observed between peer only- and surrogate/peer-reared infants, and these groups combined exhibited lower 5-HIAA concentrations than mother-reared infants throughout early development. CSF 5-HIAA concentrations declined with increasing age regardless of rearing condition. Within each rearing condition, individual differences in CSF 5-HIAA concentrations remained stable from 14 to 150 days of age. CONCLUSIONS: Early maternal deprivation reduces CNS serotonin turnover, and individual differences in CSF 5-HIAA concentrations are trait-like and appear to stabilize in infancy.
Medicine is not a club
Authors: Liam Farrell
Journal: BMJ (2006)

There is a small hospital in Drogheda in Ireland, where, between 1974 and 1998, 188 peripartum hysterectomies were performed, most of them caesarean hysterectomies, and most by the same doctor; most obstetricians would carry out less than 10 in their whole career.

That a doctor should deviate from normal practice is not exceptional; we can all get set in our ways, and nowadays change occurs so rapidly that it is easy to fall behind. But …
On the mechanism of rhabdomyolysis in potassium depletion
Authors: James P. Knochel, Edward M. Schlein
Journal: Journal of Clinical Investigation (1972)

Rhabdomyolysis and myoglobinuria occur commonly in men who sustain environmental heat injury during intensive physical training in hot climates. These also occur in patients with potassium depletion. Since physical training in hot climates may be accompanied by serious losses of body potassium, the possibility was considered that performance of strenuous exercise when potassium deficient might enhance susceptibility to rhabdomyolysis. Potassium is released from contracting skeletal muscle fibers and its rising concentration in interstitial fluid is thought to dilate arterioles thereby mediating the normal rise of muscle blood flow during exercise. If potassium release from deficient muscle were subnormal, exercise would not be accompanied by sufficient muscle blood flow and rhabdomyolysis could occur by ischemia. This hypothesis was examined by comparing the effect of electrically stimulated exercise on muscle blood flow, potassium release, and histology of the intact gracilis muscle preparation in normal and potassium-depleted dogs. In normal dogs, muscle blood flow and potassium release rose sharply during exercise. In contrast, muscle blood flow and potassium release were markedly subnormal in depleted dogs despite brisk muscle contractions. Although minor histologic changes were sometimes observed in nonexercised potassium-depleted muscle, frank rhabdomyolysis occurred in each potassium-depleted animal after exercise. These findings support the hypothesis that ischemia may be the mechanism of rhabdomyolysis with exercise in potassium depletion.
Intervention to Lower Household Wood Smoke Exposure in Guatemala Reduces ST-Segment Depression on Electrocardiograms
Authors: John McCracken, Kirk R. Smith, Peter Stone, Anaité Díaz, Byron Arana, Joel Schwartz
Journal: Environmental Health Perspectives (2011)

A large body of evidence suggests that fine particulate matter (PM) air pollution is a cause of cardiovascular disease, but little is known in particular about the cardiovascular effects of indoor air pollution from household use of solid fuels in developing countries. RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects) was a randomized trial of a chimney woodstove that reduces wood smoke exposure.We tested the hypotheses that the stove intervention, compared with open fire use, would reduce ST-segment depression and increase heart rate variability (HRV).We used two complementary study designs: a) between-groups comparisons based on randomized stove assignment, and b) before-and-after comparisons within control subjects who used open fires during the trial and received chimney stoves after the trial. Electrocardiogram sessions that lasted 20 hr were repeated up to three times among 49 intervention and 70 control women 38-84 years of age, and 55 control subjects were also assessed after receiving stoves. HRV and ST-segment values were assessed for each 30-min period. ST-segment depression was defined as an average value below -1.00 mm. Personal fine PM [aerodynamic diameter ≤ 2.5 μm (PM₂.₅] exposures were measured for 24 hr before each electrocardiogram.PM₂.₅ exposure means were 266 and 102 μg/m³ during the trial period in the control and intervention groups, respectively. During the trial, the stove intervention was associated with an odds ratio of 0.26 (95% confidence interval, 0.08-0.90) for ST-segment depression. We found similar associations with the before-and-after comparison. The intervention was not significantly associated with HRV.The stove intervention was associated with reduced occurrence of nonspecific ST-segment depression, suggesting that household wood smoke exposures affect ventricular repolarization and potentially cardiovascular health.