tbuckley/cabot-search huggingface dataset:
The Clinical Significance of the Pulmonary Collateral Circulation
Authors: ALFRED P. FISHMAN
Journal: Circulation (1961)

The clinical significance of the normal and the expanded pulmonary collateral circulation is considered from the point of view of its nutrient, hemodynamic, and respiratory functions. In the normal lung, the collateral arterial circulation is too diminutive to serve other than a nutrient function. Its roles in preventing pulmonary infarction after embolization, in producing "ischemic lung disease," and in the direct treatment of pulmonary carcinomas are considered. The expanded collateral arterial circulation associated with localized pulmonary lesions or which occurs after ligation of a pulmonary artery seems to be without appreciable hemodynamic effect on either the pulmonary circulation, the left heart, or the systemic circulation. Only in patients with generalized suppurative disease of the lung has it been shown to affect the pulmonary circulation by diverting mixed venous blood away from diseased areas. The possibility exists that the increment in pulmonary blood flow contributed by the collateral arterial circulation may aggravate pulmonary hypertension in patients with diffuse restriction of the pulmonary vascular bed. The venous portion of the expanded collateral circulation may conceivably contribute to pulmonary hypertension by aggravating systemic arterial hypoxemia in patients with right heart failure from hypoxemic cor pulmonale. The expanded collateral arterial circulation may assume a major respiratory function in subjects with systemic hypoxemia and curtailed pulmonary blood flow. In such cases, the "effective" pulmonary collateral blood flow has been shown to equal normal values for pulmonary arterial blood flow. Different portions of the pulmonary collateral circulation may be responsible for hemoptysis in different diseases: in pulmonary disease, the arterial portion; in mitral stenosis, the venous portion; in pulmonary infarction, an imbalance between the two. The relationship between the pulmonary collateral circulation and clubbing of the digits remains uncertain. The pulmonary collateral circulation is considered, finally, with respet to (1) limitations of present methodoloy, (2) principles involved in the development of collateral circulations in general, and (3) therapeutic implications.
From Program Director to ALS Patient
Authors: Michael T. Flannery
Journal: Annals of Internal Medicine (2014)

On Being a Doctor1 July 2014From Program Director to ALS PatientMichael T. Flannery, MDMichael T. Flannery, MDFrom University of South Florida, Tampa, Florida.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-0051 Audio Reading - “From Program Director to ALS Patient” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "From Program Director to ALS Patient," by M.T. Flannery. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I was diagnosed 2 years ago, at the age of 51. The symptoms had come on slowly: muscle spasms, fatigue, weakness in my left leg and my hands. Once down, I could not get up from the floor.I hid it all from my family, colleagues, and residents for months. There was just no time for this. I had been program director in internal medicine for 10 years, well beyond the tenure of most, because I loved it, loved the residents, and was every bit a father figure to them. I was peaking in my career, giving back to the ... Author, Article, and Disclosure InformationAuthors: Michael T. Flannery, MDAffiliations: From University of South Florida, Tampa, Florida.Corresponding Author: Michael T. Flannery, MD, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, MDC Box 19, Room L1041, Tampa, FL 33612; e-mail, mflann5555@aol.com. PreviousarticleNextarticle Advertisement Audio Reading - “From Program Director to ALS Patient” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "From Program Director to ALS Patient," by M.T. Flannery. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 1 July 2014Volume 161, Issue 1 Page: 80 Keywords Biopsy Bladder Bone marrow Children Disabilities Fatigue Forecasting Motor neurons Muscles Walking ePublished: 1 July 2014 Issue Published: 1 July 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Clustered Environments and Randomized Genes: A Fundamental Distinction between Conventional and Genetic Epidemiology
Authors: George Davey Smith, Debbie A Lawlor, Roger Harbord, Nic Timpson, Ian Day, Shah Ebrahim
Journal: PLoS Medicine (2007)

Background In conventional epidemiology confounding of the exposure of interest with lifestyle or socioeconomic factors, and reverse causation whereby disease status influences exposure rather than vice versa, may invalidate causal interpretations of observed associations. Conversely, genetic variants should not be related to the confounding factors that distort associations in conventional observational epidemiological studies. Furthermore, disease onset will not influence genotype. Therefore, it has been suggested that genetic variants that are known to be associated with a modifiable (nongenetic) risk factor can be used to help determine the causal effect of this modifiable risk factor on disease outcomes. This approach, mendelian randomization, is increasingly being applied within epidemiological studies. However, there is debate about the underlying premise that associations between genotypes and disease outcomes are not confounded by other risk factors. We examined the extent to which genetic variants, on the one hand, and nongenetic environmental exposures or phenotypic characteristics on the other, tend to be associated with each other, to assess the degree of confounding that would exist in conventional epidemiological studies compared with mendelian randomization studies. Methods and Findings We estimated pairwise correlations between nongenetic baseline variables and genetic variables in a cross-sectional study comparing the number of correlations that were statistically significant at the 5%, 1%, and 0.01% level (α = 0.05, 0.01, and 0.0001, respectively) with the number expected by chance if all variables were in fact uncorrelated, using a two-sided binomial exact test. We demonstrate that behavioural, socioeconomic, and physiological factors are strongly interrelated, with 45% of all possible pairwise associations between 96 nongenetic characteristics (n = 4,560 correlations) being significant at the p < 0.01 level (the ratio of observed to expected significant associations was 45; p-value for difference between observed and expected < 0.000001). Similar findings were observed for other levels of significance. In contrast, genetic variants showed no greater association with each other, or with the 96 behavioural, socioeconomic, and physiological factors, than would be expected by chance. Conclusions These data illustrate why observational studies have produced misleading claims regarding potentially causal factors for disease. The findings demonstrate the potential power of a methodology that utilizes genetic variants as indicators of exposure level when studying environmentally modifiable risk factors.
The Treatment of Chemical Dependence
Authors: Robert J. Clark
Journal: JAMA (1989)

To the Editor.—  I was amazed and dismayed after reading the brief communication by Dr Weiss entitled Relapse to Cocaine Abuse After Initiating Desipramine Treatment. 1 I was amazed that the article, tantamount to the reporting of reactions in patients with known penicillin allergy given penicillin, would be published in a reputable medical journal. What is reported is precisely what can be expected in most patients who are diagnosed incorrectly as cocaine abusers and not as having the disease of chemical dependence. The three patients described are typical chemically dependent 2 individuals who have a primary disease that requires primary treatment.  I am dismayed because what is common knowledge among those of us involved in the medical model treatment of chemical dependence has yet to be embraced by the general medical and psychiatric community. The psychiatric model is one in which substance abuse and dependence are treated as secondary to
ACIDIFIED WHOLE MILK AS A ROUTINE INFANT FOOD
Authors: W. McKIM MARRIOTT
Journal: JAMA (1923)

Some young infants may be satisfactorily fed on whole undiluted cow's milk given in the same amounts as human breast milk. The majority, however, when so fed fail to thrive in a normal manner and develop gastro-intestinal and nutritional disturbances. This fact has led to the common practice of feeding infants lesser amounts of cow's milk than of breast milk, and making up the deficiency in calories by the addition of some form of carbohydrate. The total volume of the food is made up by the addition of water. In other words, the milk is diluted and sugar is added. Various theoretical explanations for the necessity of such modifications of cow's milk have been given. It has been assumed, for example, that the infant is incapable of digesting protein when it occurs in a concentration of 3.5 per cent., as in cow's milk, but can digest it when its concentration
PROSPECTIVE STUDY OF ULTRA-LOW DOSE STRESS-ONLY SOLID-STATE SPECT: COMPARISON OF EFFICIENCY, DOSIMETRY AND OUTCOMES VERSUS TRADITIONAL-DOSE ATTENUATION-CORRECTED STRESS-ONLY ANGER SPECT (NCT01373944)
Authors: Timothy M. Bateman, Arthur McGhie, Staci Courter, Eric Burgett, S. James Cullom, James Case
Journal: Journal of the American College of Cardiology (2012)
USE OF A SEPTAL FLAP IN CLOSURE OF UNILATERAL CLEFTS OF THE PALATE
Authors: J. E. THOMPSON
Journal: JAMA (1926)

One of the simplest and most rational classifications of congenital clefts of the lip and palate was suggested by Ritchie and Staige Davis in 1922. Taking the alveolar border as a fixed point, they divide the clefts into three groups: (1) prealveolar; (2) postalveolar, and (3) alveolar.  Every cleft of the alveolar border is placed in the third group, whether the lip in front or the palate behind is open or closed. It is divided into three varieties: (1) the unilateral, in which the cleft lies between the premaxilla and the maxilla of one or other side; (2) the bilateral, in which clefts are present on each side between the contiguous margins of the premaxilla and maxillae, and (3) the median, in which, owing to faulty development or absence of the premaxilla, the cleft lies between the anterior ends of the maxillae.  It is my intention to base the description
Contamination of metronidazole discs with penicillin.
Authors: C J Hall, D Tharagonnet, H R Ingham
Journal: BMJ (1979)

although haemolysis is to be expected if copper is indeed involved in the aetiology of Indian childhood cirrhosis, its presence has yet to be adequately documented and we are grateful to Professor Ozsoylu for the opportunity of discussing this point.Neither caeruloplasmin nor reduced glutathione was measured in our patient, although the former (as copper oxidase) was elevated in the patients of Kapoor et al.2
403 TO RULE OUT HEPATOCELLULAR CARCINOMA IN HIGH RISK PATIENTS: A NOVEL INDEX FOR EXCLUDING HEPATOCELLULAR CARCINOMA IN CENTRAL EUROPEAN IN-PATIENTS WITH LIVER DISEASE
Authors: M. Quante, A. Erhardt, V. Schmitz, W. Caselmann, T. Sauerbruch, C. Rabe
Journal: Journal of Hepatology (2008)
GP suspended for six months after prescribing drug to hasten patient's death
Authors: O. Dyer
Journal: BMJ (2008)

A Glasgow GP has been suspended for six months by the General Medical Council after a disciplinary panel ruled that he prescribed sodium amytal (Amytal) to an elderly patient “solely for the purpose of ending her life.”

Iain Kerr, aged 61, was also found to have inappropriately prescribed sodium amytal to three other patients, in breach of guidelines laid down by the Committee on Safety of Medicines, which limit the drug’s use to cases of severe intractable insomnia.

Dr Kerr was first investigated after telling a colleague during an appraisal interview in 2004 that he sometimes prescribed sodium amytal to help patients who …
Derivation of Nephrogenic Adenomas from Renal Tubular Cells in Kidney-Transplant Recipients
Authors: Peter R. Mazal, Roland Schaufler, Romana Altenhuber-Müller, Andrea Haitel, Bruno Watschinger, Christian Kratzik, Georg Krupitza, Heinz Regele, Franz T. Meisl, Othmar Zechner, Dontscho Kerjaschki, Martin Susani
Journal: New England Journal of Medicine (2002)

Nephrogenic adenomas are benign, tumor-like lesions within the urothelial mucosa of the urinary tract that are not uncommon in renal-transplant recipients. We investigated the origin of nephrogenic adenomas in renal-transplant recipients.Tissue sections were analyzed by fluorescence in situ hybridization with the use of probes for the X and Y chromosomes, by immunohistochemical methods with the use of antibodies to renal tubular antigens, and by lectin histochemical methods. Forty-six nephrogenic adenomas from 29 patients were analyzed.All nephrogenic adenomas in 14 female recipients of transplants from male donors and 10 male recipients of transplants from female donors showed the same sex-chromosome status as the donor kidney, but not the same sex-chromosome status as the recipient's surrounding bladder tissue. The nephrogenic adenomas from all 6 female recipients of transplants from female donors showed female chromosomes, and those from the 16 male recipients of transplants from male donors showed male chromosomes. The presence of aquaporin 1, PAX2, and lectin-binding capacity for peanut agglutinin, Lotus tetragonolobus agglutinin, and Sophora japonica agglutinin in nephrogenic adenomas indicated an origin from renal tubular cells.Nephrogenic adenomas in renal-transplant recipients are derived from tubular cells of the renal transplants and are not metaplastic proliferations of the recipient's bladder urothelium.
Endoscopic Diagnosis of Ascites in Assiut Province, Upper Egypt
Authors: M.A. Nafeh, M.M. Shahwan, S.S. Mohammed, N.M. Rashwan
Journal: Endoscopy (1983)

Fifty-nine case of ascites not due to cardiac or renal disease were subjected to clinical, endoscopic and laboratory investigations, including bacteriology and histopathology. Provisional diagnosis divided the cases into 38 patients with ascites as the main finding, and 21 patients with liver cirrhosis and ascites. After investigation, the final diagnosis was totally different from the provisional in 15 cases. Predominance of tuberculosis of the peritoneum per se or in addition to liver cirrhosis was striking, and its documentation was possible only through laparoscopy and biopsy. Oesophagoscopy, a simple procedure, revealing varices in undiagnosed ascites, points to liver cirrhosis. Laparoscopy confirms the diagnosis and reveals other additional factors for ascites as malignancy or tuberculosis.
Leiomyosarcoma in a Renal Allograft Recipient Treated With Immunosuppressive Drugs
Authors: David Walker, Thomas J. Gill, J. Mackie Corson
Journal: JAMA (1971)

A highly malignant gastric leiomyosarcoma developed in a renal allograft recipient. This was the first primary malignant tumor observed in 247 patients at the Peter Bent Brigham Hospital who received immunosuppressive therapy following renal transplantation. Among the 3,614 patients listed in the Human Kidney Transplant Registry as receiving allografts, 37 primary malignant tumors have been reported. This incidence of malignancy is 4.7 times greater than expected. Examination of the therapy employed in the 37 cases suggests that azathioprine is a major factor in the development of the tumors and that prednisone may act in a subsidiary role by suppressing the cellular immune response.
Who needs to see the psychiatrist?
Authors: G F Goddard
Journal: BMJ (1980)

In the past 13 years I have had referred to me some 2600 new patients and have undertaken some 10 400 psychothera peutic sessions with these children, usually with both their parents, and not infrequently with the rest of the family as well. My analysis brought to light no euphoric children. Child and adolescent psychiatry is quite different from adult psychia try. Children do not suffer from schizophrenia, paraphrenia, paranoid psychoses, mania, sexual neuroses, arteriosclerotic dementia, or chronic alcoholism. They do, however, suffer from various emotional conflicts?from fears, phobias, forms of hysteria, boredom, frustration, suppression, shame, humiliation, feelings of rejection (often justified), temper tantrums, feelings of inadequacy and of vulnerability, self-consciousness, and varying degrees of unhappincss up to utter despair and a wish that they could die; just the same feelings as normal adults, in fact, although their vocabulary limits their ability to express themselves. Being a child is hard, much harder than being an adult. Children are utterly dependent on adults for their bare survival, let alone their civil liberties. The well-adjusted child must be
Euro MPs refuse to approve medicines agency's accounts until they tighten rules on conflicts of interest
Authors: R. Watson
Journal: BMJ (2012)

The European Parliament is refusing to sign off the European Medicines Agency’s financial accounts for 2010 until the London based organisation shows that it has effective procedures in place to handle potential conflicts of interest among its scientific experts.

MEPs overwhelmingly backed a resolution on 10 May prepared by the Romanian Christian Democrat member Monica Luisa Macovei postponing their approval and confirming that they were “seriously concerned by the failure of the agency and its management board to effectively address the matter of conflict of interests.”

They acknowledged that the agency had adopted a new policy last month to tackle conflicts of interest and breaches of trust involving scientific committee members …
TRPM7-Mediated Ca <sup>2+</sup> Signals Confer Fibrogenesis in Human Atrial Fibrillation
Authors: Jianyang Du, Jia Xie, Zheng Zhang, Hiroto Tsujikawa, Daniel Fusco, David Silverman, Bruce Liang, Lixia Yue
Journal: Circulation Research (2010)

Cardiac fibrosis contributes to pathogenesis of atrial fibrillation (AF), which is the most commonly sustained arrhythmia and a major cause of morbidity and mortality. Although it has been suggested that Ca(2+) signals are involved in fibrosis promotion, the molecular basis of Ca(2+) signaling mechanisms and how Ca(2+) signals contribute to fibrogenesis remain unknown.To determine the molecular mechanisms of Ca(2+)-permeable channel(s) in human atrial fibroblasts, and to investigate how Ca(2+) signals contribute to fibrogenesis in human AF.We demonstrate that the transient receptor potential (TRP) melastatin related 7 (TRPM7) is the molecular basis of the major Ca(2+)-permeable channel in human atrial fibroblasts. Endogenous TRPM7 currents in atrial fibroblasts resemble the biophysical and pharmacological properties of heterologous expressed TRPM7. Knocking down TRPM7 by small hairpin RNA largely eliminates TRPM7 current and Ca(2+) influx in atrial fibroblasts. More importantly, atrial fibroblasts from AF patients show a striking upregulation of both TRPM7 currents and Ca(2+) influx and are more prone to myofibroblast differentiation, presumably attributable to the enhanced expression of TRPM7. TRPM7 small hairpin RNA markedly reduced basal AF fibroblast differentiation. Transforming growth factor (TGF)-beta1, the major stimulator of atrial fibrosis, requires TRPM7-mediated Ca(2+) signal for its effect on fibroblast proliferation and differentiation. Furthermore, TGF-beta1-induced differentiation of cultured human atrial fibroblasts is well correlated with an increase of TRPM7 expression induced by TGF-beta1.Our results establish that TRPM7 is the major Ca(2+)-permeable channel in human atrial fibroblasts and likely plays an essential role in TGF-beta1-elicited fibrogenesis in human AF.
STEM CELL THERAPY FOR TENDINOPATHY: LESSONS FROM A LARGE ANIMAL MODEL
Authors: R K W Smith
Journal: British Journal of Sports Medicine (2013)

Introduction Tendon disorders compromise pain-free activity and often progress to chronic pain with a major impact on quality of life. Achilles tendinopathy (AT) is particularly common with many proposed therapies. However, apart from eccentric loading exercises, none have been shown to be more effective than placebo.1 Even the recent popular use of platelet-rich plasma has shown poor efficacy.2 3 There is therefore a clear need for new effective non-surgical treatments. Mesenchymal stem cells (MSCs) offer the potential for tendon regeneration and improved functional outcome via either direct or paracrine effects. We have therefore investigated the efficacy of bone marrow-derived MSCs (BM-MSCs) implanted into naturally-occurring over-strain injury of the equine superficial digital flexor tendon (SDFT), a commonly-injured weight-bearing tendon with many similarities to human AT. We hypothesised that autologous implanted MSCs would survive in the tendon and induce normalisation of the tendon matrix and reduce re-injury rates. Methods Labelling MSCs with technetium99m linked to HMPAO enabled non-invasive monitoring of cell fate in clinical cases (n=13). This revealed high initial cell loss (∼75% over 24 h). Longer term labelling with a fluorescent cytoplasmic dye showed the retention of small numbers of labelled cells for up to 5 months, similar to that reported for shorter term studies.4 5 Results In a controlled experimental study of naturally-occurring SDFT injuries (n=12), MSC-treated tendons had greater elasticity, reduced cross-sectional area, and cellularity, improved organisational scores, and lower GAG content compared to saline-treated tendons, although not all parameters were statistically significant. In 113 treated racehorses, the re-injury percentage was 27.4%, which was significantly less than published for racehorses treated in other ways (p&lt;0.05 vs 56% 6; p&lt;0.01 vs 50% 7). These findings in a large animal model of naturally-occurring tendinopathy provide supportive evidence for the efficacy and safety for the use of MSCs for the treatment of tendinopathy in humans.
Mechanical Properties of the Lung and Upper Airways in Patients with Sleep-disordered Breathing
Authors: Eve L. Bijaoui, Victoria Champagne, Pierre F. Baconnier, R. John Kimoff, Jason H. T. Bates
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

We studied the changes in lung and upper airway mechanics in adult human subjects with obstructive sleep apnea/hypopnea syndrome (OSAHS) during wakefulness, sleep, and at arousal from sleep. We used two numerical methods that we have previously developed specifically for dealing with inspiratory flow limitation during sleep: the modified Mead-Whittenberger method, and information-weighted histograms obtained using recursive least squares. Full polysomnography including esophageal pressure and airflow measurements was performed in seven men with OSAHS (respiratory disturbance index: 55.8 ± 23.2 events/h). Pharyngeal pressure was recorded in four of the subjects to partition lung mechanics into its upper airway and lower lung components. Both techniques showed that total lung resistance and elastance increased significantly (p < 0.05) during obstructed breathing and that this increase was reversed at the end of the obstruction. The partitioning of mechanics showed that upper airway collapse was primarily responsible for the increase in lung resistance. Our results suggest that OSAHS may lead to transient abnormalities in the recruitment of lung units and the gas exchanging capacity of the lungs.