tbuckley/cabot-search huggingface dataset:
Incidence and Clinical Course of Thrombotic Thrombocytopenic Purpura Due to Ticlopidine Following Coronary Stenting
Authors: Steven R. Steinhubl
Journal: JAMA (1999)

Thrombotic thrombocytopenic purpura (TTP) is a rare and often fatal disorder characterized by thrombocytopenia, microangiopathic hemolytic anemia, mental status changes, and renal dysfunction. Ticlopidine hydrochloride is 1 of several drugs that have been associated with this disorder and is currently used routinely in the approximately 500000 patients per year in the United States who undergo a percutaneous coronary intervention involving a stent.To determine the incidence and describe the clinical course of TTP due to ticlopidine therapy following stenting.Retrospective analysis of cohort of all patients undergoing coronary stenting at the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT) study sites.Sixty-three centers throughout the United States and Canada.A total of 43322 patients who underwent a percutaneous coronary intervention and received a coronary stent during a 1-year period from 1996 to 1997.Cases of TTP following stenting during the 1-year period to determine the incidence of TTP due to ticlopidine therapy following coronary stenting. Additional cases were collected from these and other centers across North America to further describe the clinical presentation and course of TTP due to ticlopidine therapy following stenting.Nine cases of TTP following stenting were recognized at the 63 centers during the specified period, giving an incidence of 1 case per 4814 patients treated (0.02%; 95% confidence interval, 1 case per 2533 to 1 case per 10 541 patients treated). Ten additional cases of TTP related to ticlopidine therapy following stenting were identified from other centers, were identified from the primary centers outside the pre-defined period, or involved a noncoronary stent. Four patients (21%) received ticlopidine for 2 weeks or fewer, 14 patients (74%) for 2 to 4 weeks, and 1 patient (5%) for 8 weeks. The mean time of ticlopidine treatment prior to TTP diagnosis was 22 days (range, 5-60 days). The overall mortality rate was 21% (4/19), with all 4 deaths occurring in patients not treated with plasmapheresis, whereas there were no deaths among the 13 patients who received plasmapheresis.The findings of a TTP incidence of 0.02% in our cohort of ticlopidine-treated patients following coronary stenting suggests that TTP occurs much more commonly in this population than the estimated incidence of 0.0004% in the general population. The mortality rate for this rare complication exceeds 20%. Limiting ticlopidine therapy to 2 weeks after stenting does not prevent the development of TTP. Rapid diagnosis and treatment that includes plasmapheresis are critical for improved survival.
Psychosocial Correlates of Survival in Diabetes
Authors: Wayne K Davis, George E Hess, Roland G Hiss
Journal: Diabetes Care (1988)

The goal of this research was to quantify the relationships between patient survival and a set of explanatory variables in a randomly selected sample of community-based patients with non-insulin-dependent diabetes mellitus (NIDDM). The sample included 343 patients with NIDDM initially entered into the study in 1981-1982 and reexamined in 1985-1986. Mortality data were collected on reexamination in 1985 and updated from death-certificate data through 1 January 1986. The data collected from the patients included demographic and clinical variables, psychosocial variables related to diabetes, measures of physiologic control, hospitalization, and mortality. The Cox proportional-hazards model was used to compute a hazard rate for each individual and to determine risk covariates. The results indicated that the variables most associated with the risk of mortality were patient age, social impact of diabetes, renal function, complexity of diet regimen, and history of smoking. Two of these variables (social impact and complexity of diet regimen) were obtained from the Diabetes Educational Profile completed by all patients on entry to the study. The five predictor variables were more closely related to mortality than diabetes control as measured by HbA1, previous hospital admissions, previous heart attacks, and other physiologic measures frequently used as outcome measures. The only physiologic predictor was renal function.
Reply to K. Quan et al, S.P. Collins et al, C.R. King et al, S. Arcangeli et al, D.B. Fuller, and D. Vordermark
Authors: James B. Yu, Laura D. Cramer, Jeph Herrin, Pamela R. Soulos, Arnold L. Potosky, Cary P. Gross
Journal: Journal of Clinical Oncology (2014)
Piliation changes in transformation-defective gonococci.
Authors: J Swanson, S Morrison, O Barrera, S Hill
Journal: The Journal of Experimental Medicine (1990)

Recombination-dependent alterations of their expressed pilin gene (pilE) enable gonococci to synthesize a myriad of structurally/antigenically different pili and to reversibly switch their pilus production on and off. These changes have been ascribed both to DNA transformation and to intragenomic recombination between pilE and silent pilin genes (pilS). We examined the pilus changes in gonococci that are incompetent for transformation because of their DNA uptake deficiency (dud) mutation, pilus- (P-) phenotype, or both. Though incompetent for DNA transformation, dud cells displayed pilus antigenic variation and underwent reversible pilus variations much like their wild-type parent. Wild-type P- with a pilE nonsense mutation were also virtually nontransformable, but they reverted to P+ at high frequencies. The pilin mRNA sequence changes that accompanied pilus transitions in these nontransformable dud and P- gonococci represent insertion of pilS stretches into their respective pilE, apparently via intragenomic recombination.
A National Evaluation of the Effect of Trauma-Center Care on Mortality
Authors: Ellen J. MacKenzie, Frederick P. Rivara, Gregory J. Jurkovich, Avery B. Nathens, Katherine P. Frey, Brian L. Egleston, David S. Salkever, Daniel O. Scharfstein
Journal: New England Journal of Medicine (2006)

Hospitals have difficulty justifying the expense of maintaining trauma centers without strong evidence of their effectiveness. To address this gap, we examined differences in mortality between level 1 trauma centers and hospitals without a trauma center (non–trauma centers).
Familial Renal Tubular Disease with Multiple Phenotypes Including Idiopathic Hypercalciuria and Renal Tubular Acidosis.
Authors: M. L. Purvis
Journal: Annals of Internal Medicine (1973)

Meeting Abstracts1 May 1973Familial Renal Tubular Disease with Multiple Phenotypes Including Idiopathic Hypercalciuria and Renal Tubular Acidosis.M. L. Purvis Jr., M.D., V. M. Buckalew Jr., M.D., M. G. Shulman, M.D., D. R. Rudman, M.D.M. L. Purvis Jr., M.D.Search for more papers by this author, V. M. Buckalew Jr., M.D.Search for more papers by this author, M. G. Shulman, M.D.Search for more papers by this author, D. R. Rudman, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-78-5-829_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHereditary renal tubular acidosis has been previously reported in 17 kindred. We describe a new 64-member family with renal tubular acidosis, the largest to be studied to date. Of the 64 members, 47 have been studied in detail. Six individuals in three consecutive generations (five, male, and one, female), 4 to 36 years of age, have nephrocalcinosis. All of these have hypercalciuria except one, who had hypercalciuria until he required hemodialysis. Four of these six patients have renal tubular acidosis; three have the incomplete and one has the complete form of the disease. Maximum urine osmolality was markedly impaired in... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Atlanta, Georgia. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1973Volume 78, Issue 5Page: 829-829KeywordsPhenotypesRenal diseasesUrine Issue Published: 1 May 1973 PDF DownloadLoading ...
Evidence of Autoimmunity in Male Twins With Neonatal Diabetes
Authors: Massimo Mazzella, Carlo Bellini, Irene M.L. Bertini, Daniela S. Massocco, Mario Cotellessa, Giovanni Serra
Journal: Diabetes Care (2001)

We report male monozygotic twins who presented with neonatal diabetes mellitus (NDM) within an autoimmune context. They were born to unrelated healthy parents after 36 weeks of uncomplicated pregnancy. Family history was unremarkable. The clinical history of the patients was almost identical; both twins were admitted on the 12th and 25th days of life, respectively, because of poor feeding, dehydration, lethargy, metabolic acidosis, severe watery diarrhea, and persistent hyperglycemia (>17 mmol/1). It was very difficult to stabilize diabetes on the conventional subcutaneous insulin schedule, so intravenous treatment was started in both patients. High levels of thyroid-stimulating hormone were found by routine screening tests, …
Evaluating the Clinical Utility of Autoantibodies in Morphea
Authors: Yvonne E. Chiu
Journal: JAMA Dermatology (2013)

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 Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Dermatology journal
Recurrent, severe wheezing is associated with morbidity and mortality in adults with sickle cell disease
Authors: Robyn T. Cohen, Anusha Madadi, Morey A. Blinder, Michael R. DeBaun, Robert C. Strunk, Joshua J. Field
Journal: American Journal of Hematology (2011)

Prior studies of asthma in children with sickle cell disease (SCD) were based on reports of a doctor-diagnosis of asthma with limited description of asthma features. Doctor-diagnoses of asthma may represent asthma or wheezing unrelated to asthma. Objectives of this study were to determine if asthma characteristics are present in adults with a doctor-diagnosis of asthma and/or wheezing, and to examine the relationship between doctor-diagnosis of asthma, wheezing and SCD morbidity. This was an observational cohort study of 114 adults with SCD who completed respiratory symptom questionnaires and had serum IgE measurements. A subset of 79 participants completed pulmonary function testing. Survival analysis was based on a mean prospective follow-up of 28 months and data were censored at the time of death or loss to follow-up. Adults reporting a doctor-diagnosis of asthma (N = 34) were more likely to have features of asthma including wheeze, eczema, family history of asthma, and an elevated IgE level (all P < 0.05). However, there was no difference in pain or ACS rate, lung function, or risk of death between adults with and without a doctor-diagnosis of asthma. In contrast, adults who reported recurrent, severe episodes of wheezing (N = 34), regardless of asthma, had twice the rates of pain and ACS, decreased lung function and increased risk of death compared with adults without recurrent, severe wheezing. Asthma features were not associated with recurrent, severe wheezing. Our data suggest that wheezing in SCD may occur independently of asthma and is a marker of disease severity.
Glucocorticoid treatment reduces exhaled nitric oxide in cystic fibrosis patients
Authors: S.J. Linnane, A.G. Thin, V.M. Keatings, J.B. Moynihan, P. McLoughlin, M.X. FitzGerald
Journal: European Respiratory Journal (2001)

In cystic fibrosis (CF), low concentrations of exhaled nitric oxide (NO) and reduced expression of inducible nitric oxide synthase (iNOS) in airway epithelium have been reported. However, abundant iNOS expression has been found in the subepithelial tissues and elevated concentrations of NO metabolites in breath condensate and sputum. These conflicting results may be explained by increased scavenging of NO by superoxide radicals, resulting in rapid conversion to peroxynitrite, so that only a small proportion of the NO produced in the lung tissue reaches the airway lumen. If iNOS were active in the CF lung, exhaled NO would be further reduced by glucocorticoid treatment. CF patients (n=13) were recruited to a double-blind, placebo-controlled study with crossover. Treatment comprised prednisolone or placebo for 5 days with a 9 day washout. After each treatment, exhaled NO was measured, spirometry performed and blood collected for measurement of serum nitrogen dioxide/nitrous oxide (NO 2 /NO 3 ). Ten patients (8 male) completed the study. Following prednisolone treatment (mean±sd) exhaled NO concentration (3.1±1.6 parts per billion (ppb)) was significantly reduced versus placebo treatment (4.9±4.2 ppb; p&lt;0.05, Wilcoxon signed-rank test). Spirometric indices and serum NO 2 /NO 3 concentration were unchanged. These findings support the hypothesis that glucocorticoids suppress nitric oxide production in cystic fibrosis airways by reducing inducible nitric oxide synthase expression or by inhibiting recruitment of neutrophils, cells which express inducible nitric oxide synthase.
Compliance with Do-Not-Resuscitate Orders for Hospitalized Patients Transported to Radiology Departments
Authors: John E. Heffner
Journal: Annals of Internal Medicine (1998)

Background: Little is known about the effectiveness of do-not-resuscitate (DNR) orders during transport of hospitalized patients away from their rooms. Objective: To determine compliance with DNR orders in radiology departments. Design: Observational study. Setting: 248 hospital-based radiology departments. Participants: 248 radiology department representatives. Measurements: 10-item questionnaire examining the response of radiology personnel to patients with DNR orders who experience cardiopulmonary arrest. Results: Written DNR protocols and structured procedures for communicating DNR status were used by 18.5% (CI, 13.7% to 23.4%) and 18.1% (CI, 13.3% to 23.0%) of departments, respectively. Medical chart review was the only source of information on DNR status for 41.5% (CI, 35.4% to 47.7%) of departments. It was found that 20.2% of respondents (CI, 15.2% to 25.2%) would resuscitate patients with DNR orders and that 38.3% (CI, 32.3% to 44.4%) had resuscitated patients with DNR orders in the past. Conclusions: Most radiology departments do not have formal procedures to prevent patients from undergoing unwanted or inappropriate resuscitative interventions, and DNR orders are frequently overruled.
Measurement of Atropine-Induced Vascular Pooling
Authors: ROBERT D. MILLER, MARTIN H. KALSER, CHARLES W. FRYE, ARCHER S. GORDON
Journal: Circulation (1954)

Postural hypotension resulting from 2 mg. of intramuscular atropine appears to be due to peripheral vascular pooling. Controlled studies on 31 normal adult males are reported here and reveal that external compression of the abdomen and lower extremities allows partial cardiovascular compensation. Simultaneous compression of both legs and abdomen is even more effective in preventing postural hypotension. The effects of 2 mg. of atropine appear to be due to partial vagal block, partial ganglionic block and central excitation.
Preconditioning and reperfusion arrhythmias in the isolated rat heart: true protection or temporal shift in vulnerability?
Authors: C. S Lawson, M. Avkiran, M. J Shattock, D J. Coltart, D. J Hearse
Journal: Cardiovascular Research (1993)

Objective: The relationship between arrhythmia severity during reperfusion and the duration of preceding ischaemia is bell shaped. Although ischaemic preconditioning can protect against reperfusion induced arrhythmias it is not clear if this is achieved by a true reduction in arrhythmia severity or by a temporal shift in the bell shaped relationship occurring as a consequence of increased ischaemic tolerance. Methods: Isolated rat hearts (n = 12 per group) were Langendorff-perfused with whole blood from a support rat. Regional ischaemia and reperfusion were induced using a ligature around the left main coronary artery. Cardiac rhythm was recorded continuously. Results: Repeated cycles of preconditioning (5 min ischaemia and 5 min reperfusion) led to a progressive reduction in the incidence of reperfusion induced ventricular fibrillation following 10 minutes of ischaemia (92%, 66%. 42%, and 8% following 0, 1,2, and 3 cycles respectively). Three cycles of preconditioning reduced the incidence of reperfusion induced ventricular fibrillation after each of 10 (83% to 17%; p < 0.05), 15 (92% to 42%; p < 0.05), 20 (67% to 25%), 30 (33% to 0%), and 40 (25% to 0%) minutes of ischaemia. Preconditioning also led to a reduced incidence of reperfusion induced ventricular tachycardia following 10 minutes of ischaemia (100% to 42%; p < 0.05). There was no evidence of a temporal shift in the bell shaped relationships; peak incidences of reperfusion induced ventricular fibrillation and ventricular tachycardia each occurred after 15 minutes of ischaemia in both control and preconditioned groups. Conclusions: In isolated blood perfused rat hearts serial preconditioning cycles provide cumulative protection against reperfusion induced ventricular arrhythmias. This protection occurs over a wide range of ischaemic durations without altering the temporal relationship between the duration of ischaemia and arrhythmia severity. This may indicate that antiarrhythmic protection is not a consequence of anti-ischaemic mechanisms. Cardiovascular Research 1993;27:2274-2281
Meningitis caused by group R haemolytic streptococci.
Authors: P Hickling, F C Cormack
Journal: BMJ (1976)

Lithium carbonate and breast-feedingLithium carbonate taken during pregnancy has been associated with neonatal hypotonial and congenital heart disease.2There is little information on lithium concentrations in human breast milk or in the serum of breast-fed infants.We have studied such a case. Case reportA 36-year-old woman, gravida 1, para 0+1, had been taking lithium car- bonate for manic depressive psychosis for seven years when pregnancy was confirmed at eight weeks.The pregnancy was allowed to continue.Initially maintained at 800 mg daily, the dose was reduced twice during pregnancy to maintain therapeutic serum levels (see figure).Her mood was more stable than at any previous time, and she needed no other medication apart from routine haematinics.At 38 weeks she went into spontaneous labour last- ing 12 hours and received protective forceps for suspected prematurity.Lithium dose (mq)
Individual or public good
Authors: F. Godlee
Journal: BMJ (2009)

This week, general practitioners’ representatives gave a vote of no confidence in the UK government’s plans for sharing patients’ data. If fully implemented, the NHS summary care record would put basic patient information on a national database. Delegates at the BMA’s annual conference of local medical committees voted overwhelmingly against the idea of implied consent for sharing data with third parties (doi:10.1136/bmj.b2441). Patients should be asked to opt in rather than opt out, they said. 

The failings of the government’s IT programme and concerns about clinical confidentiality must be largely to blame for this lack of confidence in the system. But our report …
The Use of a Metabolic Scale
Authors: Gilbert B. Bradham
Journal: JAMA (1966)

The purpose of a metabolic scale is the ultrafine determination of the weight of patients. The instrument under consideration is constructed in such a manner as to support a hospital bed and a patient weighing up to 200 kg (404.8 lb). By obtaining serial measurement of weight, a determination of weight change can be ascertained. It is felt that weight changes under specific circumstances and during limited periods of time will accurately reflect insensible water loss, intravenous fluid therapy, certain changes in body composition (water retention), and indirectly, a large portion of the body's energy requirements. It is the purpose of this presentation to consider preliminary studies done with the use of the metabolic scale and to explore the possible clinical advantages of such a scale. <h3>Materials and Methods</h3> A metabolic scale was used throughout these studies. This instrument is essentially a hydraulic load system coupled to a mechanical balance
Autocrine growth inhibition by transforming growth factor -1 (TGF -1) in human neuroendocrine tumour cells
Authors: A Wimmel
Journal: Gut (2003)

The role of transforming growth factor beta-1 (TGFbeta-1) in neuroendocrine tumour biology is currently unknown. We therefore examined the expression and biological significance of TGFbeta signalling components in neuroendocrine tumours (NETs) of the gastroenteropancreatic (GEP) tract.Expression of TGFbeta-1 and its receptors, Smads and Smad regulated proteins, was examined in surgically resected NET specimens and human NET cell lines by immunohistochemistry, reverse transcriptase-polymerase chain reaction, immunoblotting, and ELISA. Activation of TGFbeta-1 dependent promoters was tested by transactivation assays. Growth regulation was evaluated by cell numbers, soft agar assays, and cell cycle analysis using flow cytometry. The role of endogenous TGFbeta was assessed by a TGFbeta neutralising antibody and stable transfection of a dominant negative TGFbetaR II receptor construct.Coexpression of TGFbeta-1 and its receptors TGFbetaR I and TGFbetaR II was detected in 67% of human NETs and in all three NET cell lines examined. NET cell lines expressed the TGFbeta signal transducers Smad 2, 3, and 4. In two of the three cell lines, TGFbeta-1 treatment resulted in transactivation of a TGFbeta responsive reporter construct as well as inhibition of c-myc and induction of p21((WAF1)) expression. TGFbeta-1 inhibited anchorage dependent and independent growth in a time and dose dependent manner in TGFbeta-1 responsive cell lines. TGFbeta-1 mediated growth inhibition was due to G1 arrest without evidence of induction of apoptosis. Functional inactivation of endogenous TGFbeta revealed the existence of an autocrine antiproliferative loop in NET cells.Neuroendocrine tumour cells of the gastroenteropancreatic tract are subject to paracrine and autocrine growth inhibition by TGFbeta-1, which may account in part for the low proliferative index of this tumour entity.
Comparison of Coronary-Artery Bypass Surgery and Stenting for the Treatment of Multivessel Disease
Authors: Patrick W. Serruys, Felix Unger, J. Eduardo Sousa, Adib Jatene, Hans J.R.M. Bonnier, Jacques P.A.M. Schönberger, Nigel Buller, Robert Bonser, Marcel J.B. van den Brand, Lex A. van Herwerden, Marie-Angèle M. Morel, Ben A. van Hout
Journal: New England Journal of Medicine (2001)

The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease.