tbuckley/cabot-search huggingface dataset:
Case Studies in Primary Medical Care: Social, Psychological and Ethical Issues in Family Practice
Authors: Candace Clark
Journal: JAMA (1984)

The authors of this volume attempt to provide medical educators with a vehicle for discussing and devising strategies to cope with ethical dilemmas faced by the family-practice physician—an admirable undertaking. It makes use of the case approach of the Harvard Business School, presenting eight scenarios of fictionalized situations, each accompanied by short journal articles containing information or advice supposedly (but not in all cases actually) relevant to resolving the dilemma. In addition, the author-editors include instructions for leading group discussions and for devising new scenarios. The scenarios that Houts and Leaman present involve problems that the social world creates for physicians to a much greater degree than problems that the medical profession creates for the world. For instance, a patient becomes an adherent of a Christian religious healing group and thereafter does not want to comply with medical orders; a physician supported by a manufacturing company later discovers that company
Failure of oral D-penicillamine to modify adjuvant arthritis or immune response in the rat.
Authors: S P Liyanage, H L Currey
Journal: Annals of the Rheumatic Diseases (1972)

Although the original rationale for testing penicilla- mine in rheumatoid arthritis (depolymerization of preformed rheumatoid factor) is no longer considered valid, this form of therapy continues to be tested, and recent reports (e.g.Jaffe, 1970;Camp, 1971) suggest that it may be clinically effective.For this reason and because previous animal studies have given no clear pointer as to how any such effect may be mediated, we have studied the effect ofD-penicillamine on adjuvant disease and immune responses in the rat.Ten Sprague-Dawley rats (150-230 g.) received 200 mg./kg.D-penicillamine hydrochloride (freshly dissolved in deionized water) daily by mouth from Day -4 to Day + 20.A matched control group received comparable doses of deionized water.On Day 0 all animals were injected both with Freund's complete adjuvant (0-6 mg.dried, heat-killed tubercle bacilli in 0-1 ml.heavy mineral oil) into a hind footpad, and with sheep erythrocytes (1 ml.x 1 per cent.)intraperitoneally.Rats were bled on Day + 7 and the serum tested for total and 2-mercaptoethanolresistant haemagglutinins.Arthritis (excluding the injected limb) was scored daily from Day + 11.Tuberculin hypersensitivity was tested by measuring ear swelling 24 hrs after an injection of 0-02 ml. of Accepted for publication May 2, 1972 1:10 PPD given on Day + 14.The results are shown in the Table.
TCT-801 Outcome after a TAVI procedure with self expanding bioprothesis using Corevalve or Accutrack delivery device: France 2 Registry results
Authors: Gauthier Mouillet, Eric Van Belle, Masanori Yamamoto, Nicolas Lellouche, Delphine Hayat, Jean Luc Monin, Alain Prat, Marc Laskar, Martine Gilard, Emmanuel Teiger
Journal: Journal of the American College of Cardiology (2012)
Diagnostic and genetic studies on fibrin-stabilizing factor with a new assay based on amine incorporation
Authors: L. Lorand, T. Urayama, J. W. C. de Kiewiet, H. L. Nossel
Journal: Journal of Clinical Investigation (1969)

Fibrinoligase, the fibrin cross-linking enzyme, transiently appearing during the course of coagulation in normal blood, was shown to catalyze the incorporation of a fluorescent amine, monodansylcadaverine [or N-(5-aminopentyl)-5-dimethylamino-1-naphthalene-sulfonamide] into casein. The reaction provided the basis of a sensitive fluorimetric method for measuring the activity of the enzyme (and also of similar other transpeptidases, such as transglutaminase). In tests involving plasma, certain difficulties had to be overcome which were mainly due to the fact that the enzyme itself does not occur in citrated plasma. Only its precursor (fibrin-stabilizing factor or factor XIII) is present, still requiring limited proteolytic activation by thrombin. Thus, in order to measure amine incorporation with plasma as a source of the factor, thrombin must be added. This necessitated a differential desensitization of the intrinsic fibrinogen so that the latter could not clot and could not thereby interfere with amine incorporation. Also, the thrombin-inactivating capacity of plasma had to be saturated to enable full conversion of the factor to the transpeptidase. Concentrations of casein, monodansylcadaverine, calcium, and hydrogen ions were chosen to permit almost maximal velocity of amine incorporation. A linear relationship with regard to plasma concentration could be obtained only under such conditions. No similar assay is presently available for quantitatively evaluating fibrin-stabilizing factor levels in plasma.The amine incorporation test was applied to a clinical case of hereditary total fibrin-stabilizing factor deficiency. The effect of transfusion therapy was studied, and some of the patient's relatives were examined. Whereas a paternal aunt and uncle gave values well within the normal range, a brother and the mother proved to be partially deficient and could be considered as heterozygous carriers. The father appeared to have a reduced level of fibrin-stabilizing factor, though not quite as low as the other two relatives. Two infusions (1 liter each) of fresh normal plasma, administered about 26 hr apart, brought levels in the patient's plasma close to those found in the mother and brother. The corrective power of the transfusions, however, rapidly declined within 5-6 days. Futility of the last transfusion could be ascribed to the appearance of a neutralizing antibody directed against the precursor stabilizing factor, a serious complication. General diagnostic versatility and potential of the quantitative amine incorporation assay with plasma is discussed.
Influence of vascular smooth muscle heterogeneity on angiotensin converting enzyme activity in chicken embryonic aorta and in endothelial cells in culture.
Authors: S Topouzis, J D Catravas, J W Ryan, T H Rosenquist
Journal: Circulation Research (1992)

The smooth muscle of the abdominal region of the chicken aorta derives from locally recruited mesenchyme (mesenchymal smooth muscle), whereas that of the thoracic region derives from the neural crest (ectomesenchymal smooth muscle). We hypothesized that this smooth muscle heterogeneity might affect important enzymatic functions of the vessel wall. Therefore, we measured angiotensin converting enzyme (ACE) activity in homogenates of chicken thoracic and abdominal aorta at different embryonic stages (days 10, 14, and 18 of gestation). ACE activity increased in both regions over the time of gestation (p less than 0.001 in both cases); the increase was steeper and ACE activity was higher in thoracic than in abdominal segments (p less than 0.001). Km values were similar (approximately 7 microM) at all times and between the two segments, whereas changes in Vmax values closely paralleled those in enzyme activity, indicating gestation-dependent increases in the amount of enzyme. Neural crest ablation at an early developmental stage resulted in an increase of ACE activity in thoracic homogenates (p less than 0.001), predictably leaving that in abdominal homogenates unaffected. Bovine pulmonary artery endothelial cell monolayers exposed to media conditioned with cultured mesenchymal or ectomesenchymal smooth muscle cells exhibited elevated ACE activity (46% and 83%, respectively, relative to control medium, with p less than 0.01 in both cases; p less than 0.05 between the two media). Increases in endothelial cell ACE activity corresponded to proportional increases in ACE protein determined by enzyme-linked immunosorbent assay (r = 0.99) and were interpreted as indicative of enhanced enzyme synthesis subsequent to exposure of endothelial cells to smooth muscle-conditioned media.(ABSTRACT TRUNCATED AT 250 WORDS)
Transience of Immune Responses to Tumour Antigens in Man
Authors: J. L. Odili, G. Taylor
Journal: BMJ (1971)

By examining serial serum samples from patients undergoing surgical removal of malignant tumours an increased incidence of tumour-specific antibodies has been detected. Antibody responses to tumour neoantigens seem to be transient, and this is held to account for the rarity of detections where a single sample of serum is examined.
Intubation for Acute Respiratory Failure in Guillain-Barré Syndrome
Authors: Jon K. Newsum
Journal: JAMA (1979)

THE Guillain-Barré syndrome (GBS) is a paralytic polyneuropathy of unknown etiology that may occur in epidemic proportions, as experienced in association with swine flu vaccine. Even without the higher rate of GBS associated with influenza vaccines, hundreds of cases of GBS usually occur each year, with 20% to 25% requiring respiratory assistance. Since there is no definitive treatment of GBS, supportive measures are necessary until spontaneous recovery. In severe cases involving respiratory paralysis, tracheostomy and mechanical ventilation have apparently been the standard treatment.<sup>1-3</sup>In three patients admitted to the Children's Hospital Medical Center, Boston, respiratory insufficiency developed secondary to GBS. These patients were ventilated by nasal endotracheal intubation rather than tracheostomy for up to two weeks. This experience indicates that the higher incidence of complications with tracheostomies may be avoided in the treatment of patients with respiratory difficulty secondary to GBS. <h3>Report of Cases</h3><h3>Case 1.—</h3> A 10-year-old, 25-kg
Pleural fluid lysozyme in tuberculous and non-tuberculous pleurisy.
Authors: M Klockars, T Petterson, H Riska, P E Hellstrom
Journal: BMJ (1976)

Pleural fluid lysozyme in tuberculous and non-tuberculous pleurisyIn several diseases the concentration of lysozyme is often high in body fluids.Raised serum lysozyme levels have been reported in such granulomatous diseases as sarcoidosis, pulmonary tuberculosis, and Crohn's disease.1 2 We have extended studies on the diagnostic significance of lysozyme content in body fluids to the pleural fluid in pleurisy of various aetiologies.
Both typical and atypical antipsychotic agents were associated with increased risk for sudden cardiac death
Authors: Steven Marder
Journal: Annals of Internal Medicine (2009)

ACP Journal Club18 August 2009Both typical and atypical antipsychotic agents were associated with increased risk for sudden cardiac deathSteven Marder, MDSteven Marder, MDUS Department of Veterans Affairs, Los Angeles, California, USA (S.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-4-200908180-02012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationRay WA, Chung CP, Murray KT, Hall K, Stein CM. Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med. 2009;360:225-35. https://pubmed.ncbi.nlm.nih.gov/19144938Clinical Impact RatingsGIM/FP/GP: Mental Health: Cardiology: References1 Schneeweiss S, Avorn J. Antipsychotic agents and sudden cardiac death—how should we manage the risk? [Editorial]. N Engl J Med. 2009;360:294-6. [PMID: 19144946] Google Scholar2 Marder SR, Essock SM, Miller AL, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry. 2004;161:1334-49. [PMID: 15285957] Google Scholar Author, Article, and Disclosure InformationAffiliations: US Department of Veterans Affairs, Los Angeles, California, USA (S.M.)This article was published at Annals.org on 4 August 2009. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 August 2009Volume 151, Issue 4Page: JC2-12KeywordsAntipsychoticsDrugsElectrocardiographyHealth care qualityLipidsPsychiatry and mental healthResearch quality assessmentSchizophreniaSudden cardiac death ePublished: 18 August 2009 Issue Published: 18 August 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Survival, liver failure, and hepatocellular carcinoma in obesity-related cryptogenic cirrhosis
Authors: Vlad Ratziu, Luminita Bonyhay, Vincent Di Martino, Frederic Charlotte, Lucas Cavallaro, Marie-Hélène Sayegh-Tainturier, Philippe Giral, André Grimaldi, Pierre Opolon, Thierry Poynard
Journal: Hepatology (2002)

Despite the rising incidence of obesity and diabetes, there is little emphasis on morbidity and mortality from obesity-related cirrhosis, usually considered a rare and asymptomatic condition. Our aim was to assess survival and the occurrence of hepatocellular carcinoma and complications of hepatic insufficiency in obesity-related cryptogenic cirrhosis compared with cirrhosis of other origins. We analyzed retrospectively 27 overweight patients with cryptogenic cirrhosis (CC-O), 10 lean patients with cryptogenic cirrhosis (CC-L) and 391 patients with hepatitis C virus-related cirrhosis (C-HCV). In CC-O patients, cirrhosis was detected later in life than in C-HCV and CC-L patients. Severe liver disease was as frequent in CC-O as in C-HCV patients as indicated by the proportion of Child B or C or of episodes of hepatic decompensation. Survival of CC-O patients was lower than that of untreated, age- and sex-matched C-HCV controls ( P &lt; .02 at 30 months), with a higher mortality of Child B or C patients. Hepatocellular carcinoma was detected in 8 of 27 (27%) CC-O patients versus 21% of matched C-HCV controls with a similar age cumulated incidence, suggesting a comparable carcinogenic potential. In conclusion, obesity-related cirrhosis should now be recognized as a distinct entity that can cause severe liver disease and death. Increased awareness of and better diagnostic strategies for nonalcoholic steatohepatitis in overweight patients are urgently needed.
Angiotensin II Inhibits Neuronal Nitric Oxide Synthase Activation Through the ERK1/2-RSK Signaling Pathway to Modulate Central Control of Blood Pressure
Authors: Wen-Han Cheng, Pei-Jung Lu, Wen-Yu Ho, Che-Se Tung, Pei-Wen Cheng, Michael Hsiao, Ching-Jiunn Tseng
Journal: Circulation Research (2010)

Rationale : Angiotensin (Ang) II exerts diverse physiological actions in both the peripheral and central neural systems. It was reported that the activity of Ang II is higher in the nucleus tractus solitarii (NTS) of spontaneously hypertensive rats (SHRs) and that angiotensin type-1 receptors are colocalized with NAD(P)H oxidase in the neurons of the NTS, resulting in the induction of local reactive oxygen species production by Ang II. However, the signaling mechanisms of Ang II that induce hypertension remain unclear. Objective : The aim of this study was to investigate the possible signaling pathways involved in Ang II–mediated blood pressure regulation in the NTS. Methods and Results : Male SHRs were treated with losartan or tempol for 2 weeks, after which systolic blood pressure was observed to decrease significantly. Dihydroethidium staining showed many cells with high reactive oxygen species in the NTS of SHRs. The addition of losartan or tempol decreased the numbers of reactive oxygen species–positive cells in the NTS. The systemic administration of losartan or tempol reduced the systolic blood pressure and increased NO production. Immunoblotting and immunohistochemical analysis further showed that inhibition of Ang II activity by losartan or tempol significantly increased the expression extracellular signal-regulated kinase (ERK)1/2, ribosomal protein S6 kinase (RSK), and also increased neuronal NO synthase (nNOS) phosphorylation. RSK was also found to bind directly to nNOS and induce phosphorylation at the Ser1416 position. Conclusions : Taken together, these results suggest that the ERK1/2-RSK-nNOS signaling pathway may play a significant role in Ang II–mediated central blood pressure regulation.
South Asian health: what is to be done?
Authors: R N Srivastava
Journal: BMJ (2004)

South Asian health: what is to be done? Amalgamation of South Asia's medical community will benefit allEditor-The BMJ deserves credit for providing the spark necessary to activate the medical community of the South Asian countries, with their limited resources, unstable governments, and uncommitted politicians pitching in with solutions for public health problems.Amalgamation of South Asia's medical community will ensure benefits to all its constituents.Strength will flow from unity of purpose focused on achievable targets with a structured and pragmatic plan of realistic objectives.The impossible can be made possible.There is a wealth of talent and experience in the South Asian countries in traditional and complementary systems of medicine, which have great potential for providing relief to millions of people at minimal or no cost to the exchequer.Ayurveda, the unani system, homoeopathy, herbal medicine, yoga, and meditation are powerful modalities for providing some remedies to the poor and ailing population of South Asia.Education is the bedrock on which all health practices are based.Knowledge of cleanliness, sanitation, clean potable water, and basic amenities for primary health in every village is an admirable beginning.The public and private sectors have distinctive roles.There must be harmony, cooperation, discipline, and monitoring to ensure optimal use of resources.This needs to be orchestrated by the government agencies designated to run a country's health programmes.
The Efficacy of Mammography and Screening for Breast Cancer-Reply
Authors: Karla Kerlikowske
Journal: JAMA (1995)

In Reply.  —Dr Hill argues that all of the randomized screening mammography trials that we pooled are flawed and should not be used to conclude that mammography is not beneficial for women aged 40 to 49 years. However, results from these same trials are used to support screening for women aged 50 to 69 years. Despite some cross-over and variation in type of intervention, all trials show a significant reduction in breast cancer mortality among screened women aged 50 to 74 years beginning at 7 to 9 years of follow-up. In contrast, among women aged 40 to 49 years, no pattern emerges among trials after 7 to 9 years of follow-up.  Hill suggests that what is needed is an analysis of the raw data or a large randomized trial in women aged 40 to 49 years. While pooling raw data might answer some ancillary questions, the overall summary estimate is
Increased Focal Uptake of Tc-99m Stannous Phytate in an Irregular Fatty Liver Demonstrated by SPECT Imaging
Authors: TAKEYOSHI IMAEDA, AKEMI INOUE, HIDETAKA DOI, NAOTOSHI OZAWA
Journal: Clinical Nuclear Medicine (1990)

An area of focally increased uptake of Tc-99m colloid (hot spot) in the liver has been reported in superior vena cava syndrome, Budd-Chiari syndrome, and focal nodular hyperplasia. A case of irregular fatty infiltration in which SPECT imaging clearly demonstrated an area of focally increased uptake in the left lobe of the liver, which was not well visualized by planar imaging, is presented. There have been a few previous reports of this finding on SPECT imaging in patients with irregular fatty infiltration of the liver.
Good doctors are close and aloof with patients
Authors: J.-C. Grange
Journal: BMJ (2014)

Spence says: “Treat others as you would want to be treated yourself. Remember that the patient is someone’s son, daughter, sister, brother, father, or mother.”1

I agree, if you assume that patients want empathy. But are you sure that empathy is their main desire? Some patients want facts. Some just want the drugs. Some want to …
Are Abortions Really Necessary?
Authors: RONALD J. PION
Journal: Annals of Internal Medicine (1971)

Editorials1 December 1971Are Abortions Really Necessary?RONALD J. PION, M.D.RONALD J. PION, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-75-6-961 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough the issue is still one of controversy and debate, conception and childbearing appear to be decisions best left to individual couples. Unfortunately, most such decisions are not prospective. Most conceptions occur as unplanned consequences of coitus. Despite a radical change in delivery of abortion services in the United States during the past 3 years, contraceptive methods are not universally used by sexually active couples anxious to avoid pregnancy. A recent survey of women seeking abortion in the state of Washington showed that 74% had not been using a contraceptive method at the time of conception.Consumer awareness of abortion-service... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: RONALD J. PION, M.D.Affiliations: Population Studies and Family Planning, School of Public Health Family Planning Education Service, Kapiolani Maternity Hospital Honolulu, Hawaii PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 December 1971Volume 75, Issue 6Page: 961-962KeywordsFemale contraceptionHealth surveysPregnancy ePublished: 1 December 2008 Issue Published: 1 December 1971 PDF downloadLoading ...
Bacillus Calmette-Guérin Revaccination Questionable with Low Tuberculosis Incidence
Authors: MARIANNA M. TALA-HEIKKILÄ, JUHANI E. TUOMINEN, EERO O. J. TALA
Journal: American Journal of Respiratory and Critical Care Medicine (1998)

Bacillus Calmette-Guérin (BCG) revaccination was discontinued in Finland in 1990. The objective of this study was to assess the impact of BCG revaccination of tuberculin-negative school-children in prevention of tuberculosis. The tuberculosis cases in 1990–1995 were calculated among age cohorts born 1979–1984 and no longer covered by the BCG revaccination program. Corresponding data were collected for comparison from the period of revaccination in 1980–1985 among age cohorts born in 1969–1974. The National Tuberculosis Register was reviewed in order to observe the tuberculosis trend since 1980 in the age groups of 10–14 and 15–19 yr. Three cases of tuberculosis have been registered among non-BCG-revaccinated children during 6 yr after discontinuation of the program, i.e., 2.23 cases (95% CI 0.72 to 6.90) per million person yr. The control group revealed five cases, 3.78 (95% CI 1.57 to 9.07) per million person yr. The relative risk of tuberculosis in non-BCG-revaccinated children is 0.59 (95% CI 0.14 to 2.47) compared with the control group. The incidence of tuberculosis has continued to decline among adolescents since 1980. The follow-up data confirm that the cessation of BCG revaccination program had no effect on the continuing overall decline of tuberculosis in Finland. The efficacy of BCG revaccination seems to be low or nonexistent in countries with low tuberculosis incidence. Tala-Heikkilä MM, Tuominen JE, Tala EOJ. Bacillus Calmette-Guérin revaccination questionable with low tuberculosis incidence.
Measurement of Side Effects of Drugs
Authors: I. Haslock
Journal: BMJ (1974)

and a control treatment group.This will not mask a drug effect in a treatment group but will permit a more precise estimate of the number of patients in whom the symptom is due to a particular drug.How can the standardization of symptom reporting be achieved?In my opinion the doctor must not ask verbal auestions but should devise a questionnaire which is completed by the patient.He must ensure that the written questions are understood by the patients, that the questions are completed, and that the questionnaire is returned by a high proportion of patients.Similarly, in a non-treated group the repeatability of the answers (positive or negative) should be tested.Continuing the example above, a self- administered questionnaire found that 56% of patients on methyldopa complained of sleepiness3 against 31% in the general population.4By using such questionnaires the results should be reproducible and the side effects of new therapeutic agents (when evaluated by the same technioues) may be referred back to the known and validated control data.-Iam, etc.,