tbuckley/cabot-search huggingface dataset:
Die and let live
Authors: A. Pittard
Journal: BMJ (2003)

Today I did something I swore I would never do. In fact it was something I felt so strongly about that I had previously considered changing my job plan to avoid the issue. However, this afternoon I did it. I helped three people to live. What's so strange about that? After all, I am a doctor. Well, these three patients each received a life saving transplant from a non-heart beating donor.

Most of my working week is spent on an intensive care unit in a large teaching hospital. I have been directly involved with many patients who have become brain stem dead and ultimately organ donors. The number of organ donors fell from 876 in 1992 to 773 in 2002, while the number of patients on the waiting list for a transplant has steadily risen. In response to this the national transplantation support service, UK Transplant, has looked at new initiatives to reduce the number of people who die while waiting for an organ. One initiative is the retrieval of organs from non-heart beating rather than …
Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema
Authors: J G Edwards, D J R Duthie, D A Waller
Journal: Thorax (2001)

<h3>BACKGROUND</h3> Guidelines on patient selection for lung cancer resection identify a predicted postoperative forced expiratory volume in 1 second (ppoFEV<sub>1</sub>) of &lt;40% as a predictor of high risk. Experience with lung volume reduction surgery suggests that ppoFEV<sub>1</sub>may be underestimated in those with concomitant emphysema. <h3>METHODS</h3> Anatomical lobectomy was performed in 29 patients with a resectable lung cancer within a poorly perfused, hyperinflated emphysematous lobe identified by radionuclide perfusion scintigraphy and computed tomographic scanning. Perioperative changes in spirometric parameters at 3 months were compared in 14 patients (group A) of mean age 69 years (range 48–78) with ppoFEV<sub>1</sub> &lt;40% (mean (SD) 31.4 (7)%) and 15 patients (group B) with ppoFEV<sub>1</sub> &gt;40% (mean (SD) 47 (5)%). The correlation between predicted and actual postoperative FEV<sub>1</sub> was also assessed. <h3>RESULTS</h3> In group B there was a significant perioperative reduction in FEV<sub>1</sub>(p=0.01) but in group A FEV<sub>1</sub> did not change significantly after lobectomy (p=0.87); mean difference in perioperative change between groups A and B 331 ml (95% CI 150 to 510). Despite the difference in ppoFEV<sub>1</sub> between the groups, there was no difference in actual FEV<sub>1</sub> at 3 months. In-hospital mortality was 14% in group A and zero in group B, but at a median follow up of 12 (range 6–40) months there was no difference in survival between the groups. <h3>CONCLUSIONS</h3> Selection for lung cancer resection in patients with emphysema using standard calculations of ppoFEV<sub>1</sub> may be misleading. The effect of lobar volume reduction allows for an extension of the selection criteria.
Effects of Microtubule-Depolymerizing Agents on the Transfection of Cultured Vascular Smooth Muscle Cells: Enhanced Expression with Free Drug and Especially with Drug–Gene Lipoplexes
Authors: Li Wang, Robert C MacDonald
Journal: Molecular Therapy (2004)

The microtubule-depolymerizing agents colchicine, vinblastine (VB), vincristine, nocodazole, and podophyllotoxin were found to increase dramatically the transfection of cationic phospholipid-DNA (CMV-beta-gal) complexes on cultured vascular smooth muscle cells (VSMCs). Pretreatment of cells with free colchicine before addition of lipoplexes increased transgene expression both in the presence and in the absence of serum. Free vinblastine had similar effects; however, vinblastine was more effective (approximately 30-fold maximal stimulation) when incorporated into the lipoplexes. Under optimal conditions, vincristine, nocodazole, and podophyllotoxin produced 25- and 39-, 31- and 14-, and 26- and 14-fold increases in the absence and presence of serum, respectively. Taxol, which stabilizes microtubules, had no effect on transfection, but it blocked the positive effect of colchicine. Cytochalasin B, which inhibits microfilament polymerization, had no effect on transgene expression. By fluorescence microscopy, normal lipoplexes colocalized with lysosomes. In contrast, there was little, if any, colocalization of VB lipoplexes with lysosomes. Because depolymerization of microtubules induces NF-kappaB-dependent gene expression, the effects of pyrrolidinedithiocarbamate and Nalpha-p-tosyl-L-lysine chloromethyl ketone, inhibitors of NF-kappaB activation, were tested; inhibition of vinblastine stimulation of transfection was 85 and 66%, respectively. Also, immunofluorescence microscopy showed that vinblastine induced the translocation of NF-kappaB from the cytoplasm to the nucleus. It is concluded that microtubule-depolymerizing agents, especially when incorporated into lipoplexes, dramatically increase transfection of VSMCs, probably by two mechanisms: (i) inhibition of transport of lipoplexes to lysosomes and (ii) activation of transcription (via NF-kappaB). There have been some reports on the use of pharmaceutical agents to enhance gene expression, but generally these have involved separate applications of drug and gene. The ability to deliver a drug and a gene in a single therapeutic formulation could have significant clinical implications.
The prevalence of quadriceps weakness in COPD and the relationship with disease severity
Authors: J.M. Seymour, M.A. Spruit, N.S. Hopkinson, S.A. Natanek, W.D-C. Man, A. Jackson, H.R. Gosker, A.M.W.J. Schols, J. Moxham, M.I. Polkey, E.F.M. Wouters
Journal: European Respiratory Journal (2009)

Quadriceps strength relates to exercise capacity and prognosis in chronic obstructive pulmonary disease (COPD). We wanted to quantify the prevalence of quadriceps weakness in COPD and hypothesised that it would not be restricted to patients with severe airflow obstruction or dyspnoea. Predicted quadriceps strength was calculated using a regression equation (incorporating age, sex, height and fat-free mass), based on measurements from 212 healthy subjects. The prevalence of weakness (defined as observed values 1.645 standardised residuals below predicted) was related to Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage and Medical Research Council (MRC) dyspnoea score in two cohorts of stable COPD outpatients recruited from the UK (n = 240) and the Netherlands (n = 351). 32% and 33% of UK and Dutch COPD patients had quadriceps weakness. A significant proportion of patients in GOLD stages 1 and 2, or with an MRC dyspnoea score of 1 or 2, had quadriceps weakness (28 and 26%, respectively). These values rose to 38% in GOLD stage 4, and 43% in patients with an MRC Score of 4 or 5. Quadriceps weakness was demonstrable in one-third of COPD patients attending hospital respiratory outpatient services. Quadriceps weakness exists in the absence of severe airflow obstruction or breathlessness.
Opportunistic Infections in Endogenous Cushing's Syndrome
Authors: Graham Bs, Tucker Ws
Journal: Annals of Internal Medicine (1984)

The cases of 6 patients with endogenous Cushing's syndrome and opportunistic infections were studied, and compared with those of 17 similar patients reported in the literature. Cushing's syndrome was caused by ectopic adrenocorticotrophic hormone production or adrenal tumors in most patients, and hypercortisolism was extreme. Four infectious processes were preponderant: Cryptococcosis, aspergillosis, nocardiosis, or Pneumocystis carinii pneumonia occurred in 21 patients. Signs and symptoms of infection were often masked by the hypercortisolism. Morning plasma cortisol levels correlated with the infection type (rank-order Spearman correlation coefficient = 0.78, p less than 0.01): Levels of less than 70 micrograms/dL or greater than 121 micrograms/dL were associated with cryptococcosis or pneumocystis, respectively, by discriminant analysis. Of the 9 patients who survived their infection, 8 had evidence that cortisol production was reduced to near normal. In contrast, all 14 patients died in whom cortisol production went uncontrolled. In patients with hypercortisolism from endogenous Cushing's syndrome (especially of nonpituitary origin), opportunistic infections should be anticipated and prompt control of cortisol overproduction should be initiated.
Composition of gastro-oesophageal refluxate.
Authors: D C Gotley, A P Morgan, D Ball, R W Owen, M J Cooper
Journal: Gut (1991)

Fifty two patients with abnormal acid gastro-oesophageal reflux were studied by simultaneous oesophageal pH monitoring and continuous aspiration for 16 hours. Aspirates (from discrete two hour periods) were analysed for volume, pH, bile acids (conjugated and unconjugated), trypsin, and pepsin. The results were compared with pH changes and degree of oesophagitis. Patients with oesophagitis had greater acid reflux than those without, but patients with stricture and Barrett9s oesophagus had similar acid reflux to those with uncomplicated erosive oesophagitis. Pepsin concentrations were highest in patients with stricture and Barrett9s oesophagus particularly during nocturnal periods. Conjugated bile acids were detected in 75% of patients, mainly during the night, but only 2% of aspirates contained concentrations likely to be cytotoxic. Unconjugated bile acids were not detected, and trypsin was seldom found. Reflux oesophagitis is caused by acid and pepsin. Bile acids and trypsin are probably unimportant.
Asymptomatic Significant Bacteriuria in the Non-pregnant Woman: I. Description of a Population
Authors: M. Sussman, A. W. Asscher, W. E. Waters, J. A. S. Evans, H. Campbell, K. T. Evans, J. E. Williams
Journal: BMJ (1969)

The clinical, laboratory, and radiological findings in a group of 107 non-pregnant bacteriuric women and 88 controls have been compared. A previous history of urinary tract infection was more commonly obtained from the bacteriuric women. The means of the diastolic blood pressures, serum ureas, and erythrocyte sedimentation rates were significantly higher in the bacteriuric group, and acquired renal abnormalities were demonstrated in 18% of the bacteriuric women as compared with 4% of the controls. It is concluded that screening for asymptomatic bacteriuria in the adult non-pregnant female population in many instances fails to detect urinary tract infection at an early and reversible stage.
Histologic diagnosis based on forceps biopsy is not adequate for determining endoscopic treatment of gastric adenomatous lesions
Authors: Y. Kim, J. Park, J.-H. Kim, S. Shin, S. Lee, Y. Lee, J. Chung
Journal: Endoscopy (2010)

See also: Commentaire de travail de Y. J. Kim et al., pp. 620Endoscopy 2010; 42(08): 994-994DOI: 10.1055/s-0032-1306702
1028-166 Association of coronary heart disease with interleukin-1 gene variants in the atherosclerosis risk in communities study
Authors: Steven Offenbacher, James D Beck, James Pankow, Lloyd Chambless, Molly Bray, David Couper, Paul M Martha, Kenneth Huttner, John Rogus, Gordon W Duff
Journal: Journal of the American College of Cardiology (2004)
"Meticulous" cleaning of duodenoscopes may not eliminate infection risk, US watchdog warns
Authors: M. McCarthy
Journal: BMJ (2015)

Because of their complex design, even meticulous cleaning of the specialized endoscopes used in endoscopic retrograde cholangiopancreatography (ERCP) procedures may fail to prevent transmission of infection, the US Food and Drug Administration has warned.

In its warning1 the FDA said that it had received multiple reports of infections in patients who had procedures with these specialized endoscopes (duodenoscopes), including infections with multidrug resistant carbapenem resistant Enterobacteriaceae (CRE) such as Klebsiella species and Escherichia coli .

The warning came a day after the Ronald Reagan UCLA Medical Center in Los Angeles, California, announced that it had notified …
Randomized Crossover Study of Effect of Resistance Training on Glycemic Control, Muscular Strength, and Cholesterol in Type I Diabetic Men
Authors: Eric P Durak, Lois Jovanovic-Peterson, Charles M Peterson
Journal: Diabetes Care (1990)

The goal of this study was to evaluate a program of resistance weight training on cardiovascular risk factors, blood glucose management, and overallstrength in diabetic subjects. A randomized crossover design was performed on eight male type I (insulin-dependent) diabetic subjects (mean ± SD age 31 ± 3.5 yr, height 176 ± 5.6 cm, body wt 80 ± 15 kg, duration of diabetes 12.3 ± 9.8 yr, and insulin dose 24 U NPH/day and 21 U regular/day). The program consisted of heavy-resistance weight training 3 days/wk for 10 wk, concentrating on the strengthening of major muscle groups through progressive resistance. Blood tests included total cholesterol, triglycerides, very-low-density lipoprotein and high-densitylipoprotein cholesterol, and HbA1c. These tests were repeated atthree time points during the program. Field-strength testing was performed before and after training. An improvement was seen in the squat (93.6% increase, P &amp;lt; 0.0001) and bench press (58% increase, P &amp;lt; 0.005). HbA1c and triglyceride levels showed no change during the resting portion ofthe experiment but showed a significant change with the training program: HbA1c 6.9 ± 1 . 4 vs. 5.8 ± 0.9% (P = 0.05) and triglyceride 5.044 ± 1.06 vs. 4.628 ± 0.88 mM (P = 0.01). Self-monitored glucose (taken pre- and postexercise) showed a decrease from 7.85 ± 3.13 to 7.05 ± 2.91 mM (P = 0.0001). Very-low-density lipoprotein cholesterol and triglycerides did not change after training. Analysis of variance showed no significant differences over time from the three time points with regard to reductions in cardiovascular risk factors or HbA1c. Heavy-resistance strength training may be associated with a decrease inglycosylated hemoglobin and cholesterol in type I diabetic men after training, in addition to increasing overall strength.
Variation in the pH of faeces in disease
Authors: N. Madanagopalan, S. A. Nadar, R. Subramaniam
Journal: Gut (1970)

Although it is highly unlikely that a disease can be definitively diagnosed from a study of the <i>p</i>H of the faeces alone, the present study has helped to dispel the past belief that the <i>p</i>H of faeces in acute amoebic dysentery is more likely to be acidic. Culture for other pathogenic organisms has not been done in the present series of cases, but the chances of the coincidence of bacillary dysentery in this group would probably not have been significant. Further, in the past a simple litmus paper test was suggested to differentiate an amoebic dysentery from a bacillary dysentery, a procedure which can no longer hold good.
Regional Variations in the Incidence of End-Stage Renal Failure in Japan
Authors: Takeshi Usami
Journal: JAMA (2000)

Despite recent medical advances, the number of patients beginning dialysis annually is increasing in both the United States and Japan. The ethnically homogeneous population of Japan presents an opportunity to study the presence of factors other than race/ethnicity that might contribute to incidence of end-stage renal disease (ESRD).To determine if and where regional differences exist in ESRD in Japan.Analysis of data reported by the Japanese Society for Dialysis Therapy based on the annual number of patients with ESRD beginning maintenance dialysis therapy in all 47 prefectures of Japan from 1982 to 1998.Mean annual ESRD incidence and increasing rate of ESRD in each of 11 predefined areas making up the entire country.Incidence of ESRD increased approximately 3-fold in Japan during the study years, from 81.3 per 1 million in 1982 to 237.6 per 1 million in 1998. Significant regional differences were found in both measures. The mean (SEM) annual ESRD incidence (P<.01) and increasing rate of ESRD (P<.01), respectively, were significantly different across Japan. Koshinetsu (140 [11] per 1 million and 9.1 [0.6] per 1 million/y) and Hokuriku (141 [12] per 1 million and 9.7 [0.5] per 1 million/y) were the areas with the lowest incidence and increasing rate of incidence, while Okinawa (188 [17] per 1 million and 13.4 [0.6] per 1 million/y) and Kyushu (179 [15] per 1 million and 12.0 [0.6] per 1 million/y) were the areas with the highest incidence and increasing rate of incidence.We found definite and significant regional differences in incidence and increasing rate of incidence of ESRD in Japan. Further analyses are needed to identify factors that contribute to these regional differences and thereby improve strategies for treatment of renal disease. JAMA. 2000;284:2622-2624.
Renal failure in fulminant hepatic failure and terminal cirrhosis: a comparison between incidence, types, and prognosis.
Authors: H Ring-Larsen, U Palazzo
Journal: Gut (1981)

Forty patients with terminal cirrhosis and 40 patients with fulminant hepatic failure-all consecutively admitted-were studied with regard to incidence, types, and prognosis of complicating renal insufficiency. Renal failure was considered present when the serum creatinine was greater than 0.20 mmol/l. Of the patients with cirrhosis 26 (65%) developed renal failure. In 15 the type was functional, in three due to acute tubular necrosis, and in eight indeterminable. Of the patients with fulminant hepatic failure 22 (55%) had renal insufficiency; of these 13 had functional renal failure, five acute tubular necrosis, and in four the type was indeterminable. In both categories of patients, renal failure was equally frequent among patients with or without gastrointestinal bleeding and with or without ascites or diuretic therapy. The biochemical tests of liver function were similar in patients with or without renal failure in both categories. The mean renal blood flow in seven unselected patients with fulminant hepatic failure was reduced in the same order as previously observed in patients with cirrhosis. In terminal cirrhosis the mortality rate was 88% in the presence of renal failure, 71% in its absence (p greater than 0.05), while the same figures in fulminant hepatic failure were 100% and 67% (p less than 0.05). The incidence, relative frequency, and prognosis of renal failure were not different in the two conditions, indicating identical pathophysiological circumstances.
Complications in Surgery and Their Management
Authors: Alvin M. Cotlar
Journal: JAMA (1982)

Dr James D. Hardy's fourth presentation of<i>Complications</i>lists among its numerous contributors the best-known writers in the American surgical literature—William Altemeier, Frank Glenn, George Jordan, Lloyd Nyhus, Hiram Polk, Normal Rich, Watts Webb, and Claude Welch, to name but a few. This latest effort is so current in its application as to include complications of such innovative procedures as organ transplants and major cardiac operations (coronary artery bypass, resection of ventricular aneurysm). The book contains the classic sections on postoperative fever and infection, wound complications, hemorrhage, and shock. There is an informative chapter on anesthesia and an excellent discussion of cardiac arrest and resuscitation by the discoverer of closed-chest massage, James Jude. "Nutritional Complications" includes discussion of parenteral hyperalimentation with the technique of subclavian vein catheterization. The outstanding value of the book is in its treatment of subjects related to general surgery. Hardy's own chapter on gastric operations is
Effects of Mepartricin (S&amp;ndash;160) on Spontaneous Canine Benign Prostatic Hyperplasia
Authors: Yasunobu Yoshinaka, Hideyuki Kobayasi, Junko Kirihara, Fumiyasu Sato, Shuuji Shakutou, Hidetoshi Yamanaka
Journal: European Urology (2000)
Reciprocal change in ST segment in acute myocardial infarction
Authors: R A Henderson
Journal: BMJ (1985)

When I was conducting my study one of the few doctors who performed satisfactorily was a recently qualified house officer.I was impressed by her performance and asked her where she had learnt her resuscitation skills.She told me she had been taught resuscitation many years before when she had been a Girl Guide.Surely it is not too much to ask that British medical schools teach resuscitation skills to the same standard as the Girl Guides.
New vaccines and screening can reduce cervical cancer incidence in poor countries
Authors: R. Watson
Journal: BMJ (2008)

New vaccines and screening tests can help to achieve a major reduction in the incidence of cervical cancer in developing countries, concludes research presented last week at the world cancer congress of the International Union Against Cancer.

Francesc Xavier Bosch of the Catalan Institute of Oncology in Barcelona, Spain, coordinated a monograph that brings together research analysing the cost effectiveness of introducing human papillomavirus (HPV) vaccination and new screening methods into poorer countries in the world (www.kaizo.net/releases/cervicalmonograph/).

“The discovery of HPV as the cause of cervical cancer has shaken a field that was stagnating,” he said, “and …
Topical minoxidil in alopecia areata: a double-blind trial
Authors: J.P. Vestey, J.A. Savin
Journal: British Journal of Dermatology (1985)

Early reports of the success of topical minoxidil in alopecia areata have been followed by a mixture of enthusiasm and disappointment. Our double‐blind trial was prompted by remaining doubts about its effectiveness and safety. Fifty adult patients (22 male, 28 females) with longstanding alopecia areata (mean age at onset 20 years, mean duration 16 years) took part in the trial. The severity of their disease was categorised as universalis (23 patients), totalis (10), ophiasiform (6) and severe patchy alopecia (11). Thirty‐eight per cent had a personal history of atopy and 14% had circulating thyroid antibodies. For the first 2 months patients were randomly allocated to treatment wjth i % minoxidil in Unguentum Merck® or Unguentum Merck® alone. At the end of this period the same treatment was continued if hair growth was observed; if not, the alternative treatment was used. After 4 months, if no hair growth had occurred, 1% minoxidil was prescribed. Forty‐eight patients were treated for at least 6 months, 46 for 10 months and 13 for longer periods. Equal proportions of the patients treated with minoxidil or with placebo experienced regrowth, but this was substantial only in seven patients and cosmetically acceptable in only two. No patient felt able to stop wearing a wig. Many patients disliked the greasy nature of the preparation. Patients with alopecia universalis had the highest prevalence of nail changes, and the worst response to treatment.