tbuckley/cabot-search huggingface dataset:
Management of venous ulcer disease
Authors: Wijnand Bert van Gent, Esther Dorine Wilschut, Cees Wittens
Journal: BMJ (2010)

#### Summary points

A venous leg ulcer represents the severe end of the spectrum of chronic venous disease. Venous ulcers are the most common form of leg ulcer. Observational studies have reported the prevalence of venous leg ulcers to be 1-1.5%.1 2 A cross sectional study of a random sample of 1566 people aged 18-64 years from an urban Scottish population estimated the prevalence of venous leg ulcers to be around 1%.3 The estimated total treatment costs of venous leg ulcers are 1% of the total annual healthcare budget in western European countries.4 In the United States, treatment costs for venous ulcers in more than 6 million patients approach $2.5bn (£1.6bn; €1.8bn), and two million work days are lost annually because of venous ulcer disease.5 A recent prospective study performed in 23 specialised wound centres throughout Germany calculated the mean total cost of a venous ulcer per patient per year to be €9569 (€8658 (92%) direct costs and €911 (8%) indirect costs).6

Treatment is either conservative (bed rest, leg elevation, local treatment, and compression) or surgical (superficial and perforating vein ablation and deep vein reconstruction).

This review examines the prevention and treatment of venous leg ulcers and is based mostly on evidence from observational studies and some reviews and meta-analyses.

#### Sources and selection criteria

We searched PubMed and the Cochrane Library with the medical subject headings ”venous leg ulcers”, “venous leg ulcer”, “venous ulcers”, and “leg ulcers” combined …
Depression Occurring During the Course of Recovery from Schizophrenic Symptoms
Authors: HARRY R. STEINBERG, RICHARD GREEN, JACK DURELL
Journal: American Journal of Psychiatry (1967)

Schizophrenic patients followed longitudinally from an acute psychotic phase to a remission were rated as more depressed during the period following improvement of schizophrenic symptoms than during the hospital course as a whole. The period following remission of symptoms may be a period of relatively high risk of suicide in schizophrenic patients. One patient treated with phenothiazines after a period of severe psychosis showed no elevation of 17-hydroxycorticosteroids during the depressed periods as compared with a preceding nonpsychotic and nondepressed period. 17-hydroxycorticosteroids were elevated during the psychotic phase both as compared with normal values and as compared with the remainder of the hospital stay.
Subcutaneous phaeohyphomycosis caused by Exophiala oligosperma in a renal transplant recipient
Authors: M.A. González-López, R. Salesa, M.C. González-Vela, H. Fernández-Llaca, J.F. Val-Bernal, J. Cano
Journal: British Journal of Dermatology (2007)

Conflicts of interest: none declared. Sir, Phaeohyphomycosis encompasses a heterogeneous group of infections caused by dematiaceous (darkly‐pigmented) fungi, which grow in tissue as hyphae, pseudohyphae or yeast‐like forms. They have been classified as: (i) superficial, (ii) cutaneous and corneal, (iii) subcutaneous and (iv) systemic forms.1 The aetiological agents of phaeohyphomycosis are numerous species belonging to different genera such as Alternaria, Phialophora and Exophiala, among others.2 We report an unusual case of subcutaneous phaeohyphomycosis caused by the recently recognized species Exophiala oligosperma.3 A 72‐year‐old woman presented in March 2005 with a 3‐month history of progressive, asymptomatic cutaneous lesions on her right leg. She did not recall having any previous injury of that area. The patient had undergone renal transplantation 7 years previously. She was receiving immunosuppressive therapy with mycophenolate mofetil 500 mg daily, prednisone 15 mg daily and tacrolimus 1 mg daily. Examination revealed multiple, tender, reddish‐brown subcutaneous nodules measuring 0.5–1 cm in diameter grouped in the affected zone (Fig. 1). There was no lymphadenopathy. A skin biopsy specimen was obtained for histopathological study and microbiological cultures. The histopathology revealed a suppurative granulomatous inflammation in the deep dermis and hypodermis composed of lymphocytes, epithelioid macrophages, multinucleated giant cells and aggregations of neutrophils in the centre of the granulomas (Fig. 2a). Periodic acid‐Schiff (PAS) stain showed round‐shaped fungal structures within a clear space in the cytoplasm of some giant cells, associated with extracellular fungal hyphae (Fig. 2b). Polymerase chain reaction (PCR)–enzyme‐linked immunosorbent assay (ELISA) for the IS6110 gene region of Mycobacterium tuberculosis was negative. Cultures for bacteria and acid‐fast bacilli were both sterile. Fungal cultures were performed on Sabouraud chloramphenicol agar and Sabouraud chloramphenicol cycloheximide agar (Bio‐Rad, Hercules, CA, U.S.A.), and incubated at 30 °C. After 10 days of incubation, velvety colonies developed on all media which were olive–black with a blackish reverse. Microscopic examination of these colonies revealed brown septate hyphae, annellidic conidiogenous cells and oval conidia. Molecular identification was performed by amplification and sequencing of the internal transcribed spacer (ITS) region defined by primers ITS5 and ITS4 (incorporating ITS1, the 5.8S gene and ITS2). The sequence obtained (552 bp) was compared with those in the GenBank DNA database. This sequence showed a 98% similarity with a strain of E. oligosperma misidentified as Exophiala jeanselmei (accessionno.AJ866273).
My Brother's Keeper?
Authors: Curtis Prout
Journal: New England Journal of Medicine (1975)

A recent publication1 reviewing four projects aimed at improving medical care in jails and prisons in Massachusetts, San Francisco, New York City, and Dade County (Florida) points out the few successes and many shortcomings of these projects and makes some excellent recommendations. The book is particularly timely, since the A.M.A. Committee to Improve Medical Care and Health Services in Correctional Institutions was recently awarded a grant from the Law Enforcement Assistance Administration to begin a "pilot" prison program in six states. In addition, the American Correctional Association and the American Public Health Association have committees actively engaged in drawing up . . .
A Short History of Medicine
Authors: John H. Talbott
Journal: JAMA (1962)

The preparation of a long or a short history of medicine is an undertaking of considerable magnitude. Poynter, of the Wellcome Historical Medical Library, and Keele, President of the Section of History of Medicine of the Royal Society of Medicine, have collaborated in the preparation of this excellent volume. It is one in a series devoted to science in society, which has been designed to interrelate the humanities and the sciences. Familiar physicians of the past —Hippocrates, Galen, Vesalius, Harvey, da Vinci, Boyle, Sydenham, and others— are discussed in considerable detail for such a brief treatise. Until the 17th century it was possible for a physiciansurgeon to be, in addition, an anatomist and botanist, even a mathematician and a philosopher. The accumulation of encyclopedic knowledge by one person became impossible thereafter, and, in recent centuries, concentration of interest has been inevitable. Not usually given much attention in a history of
The Death of a Clinician-Educator
Authors: Kimberly D. Manning
Journal: Annals of Internal Medicine (2008)

On Being a Doctor19 August 2008The Death of a Clinician-EducatorKimberly D. Manning, MDKimberly D. Manning, MDFrom Emory University School of Medicine, Atlanta, GA 30303.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-4-200808190-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I sat quietly in the auditorium as my colleague clipped a microphone to the lapel of his white lab coat. He would be the speaker for grand rounds that day, and I looked forward to hearing his lecture. He did not look particularly nervous, although I noticed a fine tremor in his hands while he tested the laser pointer. As a junior faculty member, I know that tremor well. It only gets coarser as the audience grows, but then it regresses as each slide goes by.He was clearly well prepared for this talk, and he left no stone unturned. ... Author, Article, and Disclosure InformationAffiliations: From Emory University School of Medicine, Atlanta, GA 30303.Corresponding Author: Kimberly D. Manning, MD, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals On Call - The Importance of Clinician–Educators Robert M. Centor and Kimberly D. Manning Metrics Cited byGuiding Academic Clinician Educators at Research-Intensive Institutions: a Framework for Chairs, Chiefs, and Mentors 19 August 2008Volume 149, Issue 4Page: 281-282KeywordsArmed forcesComputersHappinessHearingHeartMedical educationMotivationReasoning ePublished: 19 August 2008 Issue Published: 19 August 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Adult and paediatric size bronchoscopes for bronchoalveolar lavage in mechanically ventilated patients: yield and side effects.
Authors: B Ricou, S Grandin, L Nicod, J B Thorens, P M Suter
Journal: Thorax (1995)

Bronchoalveolar lavage is considered a safe procedure. When performed in the mechanically ventilated patient, however, potentially harmful effects on respiratory and haemodynamic functions have been reported in which the size of the bronchoscope may play a part. Two different size bronchoscopes (adult and paediatric) were therefore investigated with regard to bronchoalveolar lavage yield and side effects.Twenty mechanically ventilated patients underwent bronchoalveolar lavage with both adult and paediatric bronchoscopes in a randomised sequential manner.In a total of 45 pairs of bronchoalveolar lavage procedures no difference was noted between adult and paediatric bronchoscopes with regard to total cell yield, differential cell count, and microbiological results. Peak intratracheal pressure increased with the adult bronchoscope only. Systemic arterial pressures increased more with the adult than with the paediatric bronchoscope. PaO2 decreased with the adult but not with the paediatric bronchoscope.The paediatric bronchoscope offers a comparable bronchoalveolar lavage yield in mechanically ventilated patients to the adult bronchoscope, while the respiratory and haemodynamic side effects are significantly lower than with the adult size instrument.
Corticosteroid injection worsened recovery and recurrence of tennis elbow; physiotherapy had no effect
Authors: Timothy S. Carey
Journal: Annals of Internal Medicine (2013)

Source Citation Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013;309:461-9. 23385272
778. A Novel Genetically Modified Adenovirus Vector Shows Enhanced Infectivity towards Ex Vivo Pancreatic Cancer
Authors: Michael van Geer, Piter Bosma, Koert Kuhlmann, Conny Bakker, Dirk Gouma, Ronald Oude Elferink
Journal: Molecular Therapy (2006)

Top of pageAbstract
Conditionally replicating adenovirus (CRAd) represents a potential therapeutic option for pancreatic cancer (PC). Clinical trials have shown safety and specificity of such adenovirus (Ad) vectors. However, transduction of tumor cells is limited by the low expression of the primary Adenovirus Receptor (CAR) on PC. To overcome this problem, Ad vectors were developed with peptides in the fiber that should allow targeting to PC. A peptide ligand for the Ephrin A2 receptor was incorporated and this vector (Ad-YSA) showed an increase of tumor cell transduction in vitro. Ad-RGD served as a positive control. Since animal models have proven to be of little value in predicting the outcome of oncolytic virotherapy, we used the tissue slice system to explore modified Ad behavior in human tissue.

Fresh tissue from normal pancreas and pancreatic adenocarcinoma was obtained from surgical specimens (Whipple procedure). Slices, generated with the Krumdieck tissue slicer, were cultured in medium supplemented with growth factors in a 5/95% CO2/O2 environment. The slices were infected with 1e8 to 5e8 viral particles (wildtype and fiber modified virus harboring the green fluorescent reporter protein (GFP) gene under control of a CMV promoter (Ad.CMV.GFP). As an internal control, to correct for slice size, viability and CAR expression, an equivalent amount of wildtype Ad.CMV.dsRED per slice was added. Three days later reporter protein production was measured by fluorimetry. Morphologic features were determined by HE-staining. These experiments were performed both with primary pancreatic tissue and with tumor tissue.

According to morphology, pancreas and tumor tissue could be kept alive for at least three days. Normal pancreas did not show increased transduction efficacy with Ad-RGD or Ad-YSA. Compared to wildtype Ad, Ad-RGD and Ad-YSA revealed a 1.5 to 8.6 and 1.8 to 7.6-fold increase in transduction of pancreatic cancer, respectively (n=7). We observed persistent interpatient variability of infection profiles, which may be related to differential receptor expression. We currently examine CAR, integrin and EphA2 receptor expression in the tissue slices. Our results demonstrate that targeting to the ephrin A2 receptor can augment pancreatic cancer transduction. The tissue slicer technology appears to be of great value to study host-virus interactions. (See Figure)
Crosstalk of regulatory T cells and tolerogenic dendritic cells prevents contact allergy in subjects with low zone tolerance
Authors: Ulrike Luckey, Talkea Schmidt, Nikolai Pfender, Maike Romer, Nadine Lorenz, Stefan F. Martin, Tobias Bopp, Edgar Schmitt, Alexey Nikolaev, Nir Yogev, Ari Waisman, Thilo Jakob, Kerstin Steinbrink
Journal: Journal of Allergy and Clinical Immunology (2012)
Psychosomatic Aspects of Patients on Hemodialysis
Authors: Isao Fukunishi
Journal: Psychotherapy and Psychosomatics (1990)

The clinical usefulness of alexithymia in dialysis patients was examined from psychosomatic aspects. Before hemodialysis (HD), primary alexithymia was present in 50–53% of HD patients with diabetes. After 2 years' HD therapy, an additional 32–36% of HD patients without diabetes developed secondary alexithymia. In contrast, the prevalence of alexithymia was low in patients receiving continuous ambulatory peritoneal dialysis (CAPD), which requires a higher self-control ability than HD. Alexithymia may reflect dialysis patients' ability to take care of themselves and therefore serve as a useful index in (1) selecting the type of dialysis, either HD or CAPD, and (2) identifying patients on dialysis likely to develop somatic complications due to lack of adequate self-control.
“Ebb Phenomenon” - Diagnosis of Submucosal Diffuse Invasion of Esophageal Cancer -
Authors: Y. Kumagai, H. Makuuchi, H. Fujita, H. Miyoshi, Y. Suguro
Journal: Endoscopy (1982)

The discovery of the "ebb phenomenon" in 1973 made it possible to detect submucosal diffuse invasion endoscopically. In 23 cases out of 74 cases, submucosal diffuse invasion was recognized. In 18 cases, submucosal diffuse invasion was recognized. In 18 cases, submucosal diffuse invasion was less than 30 mm from the margin of the main tumor but in 5 cases, invasion extended beyond 30 mm and in 2 cases, it extended almost 100 mm. It is very important to know of the existence of submucosal diffuse invasion and the range of its extent for the selection or combination of therapeutic modalities to improve the prognosis of these cases.
The optimal use of bexarotene in cutaneous T-cell lymphoma
Authors: R. Gniadecki, C. Assaf, M. Bagot, R. Dummer, M. Duvic, R. Knobler, A. Ranki, P. Schwandt, S. Whittaker
Journal: British Journal of Dermatology (2007)

The management goal in cutaneous T-cell lymphomas (CTCLs) is to improve symptoms and induce remission. Early-stage disease is generally treated with skin-directed therapies. However, if these do not control the disease, systemic therapy becomes necessary. Bexarotene, a novel rexinoid, is an oral, noncytotoxic drug that has been approved in Europe for the treatment of refractory advanced-stage CTCL and in the U.S.A. for refractory CTCL. We provide guidance on the use of bexarotene in the management of CTCL, based on data from phase II/III clinical trials and the authors' clinical experience, and suggest how the potential of the drug can be maximized. The clinical trial results with bexarotene are reviewed, especially in comparison with interferon-alpha, which is the other commonly used noncytotoxic systemic therapy for CTCL. A treatment algorithm for bexarotene in refractory CTCL is suggested. As bexarotene may take time to achieve a maximum response, this algorithm recommends that therapy should be continued for a sufficient period to allow for a delayed onset of action. In addition, possible combination therapies with bexarotene are discussed. We conclude that bexarotene is effective in the management of CTCL, and has the advantage of oral administration. An on-going randomized clinical trial comparing psoralen plus ultraviolet A (PUVA) with PUVA plus bexarotene will provide valuable information about this combination regimen in early-stage disease, but further data are needed on the relative efficacies of other combination therapies with bexarotene in CTCL.
Cytosolic Alkalinization of Vascular Endothelial Cells Produced by an Abrupt Reduction in Fluid Shear Stress
Authors: Roy C. Ziegelstein, Paul S. Blank, Linda Cheng, Maurizio C. Capogrossi
Journal: Circulation Research (1998)

Reductions in fluid shear stress produce endothelium-dependent vasoconstriction and promote neointimal hyperplasia, but the intracellular signaling mechanisms involved in these processes are poorly understood. To examine whether decreases in fluid shear stress affect endothelial cytosolic pH, carboxy-seminaphthorhodafluor-1-loaded rat aortic endothelial cells were cultured in glass microcapillary tubes and examined during abrupt reductions in laminar flow. After a 30-minute exposure to a shear stress of 2.7 dyne/cm2 in bicarbonate buffer, the acute reduction of fluid shear stress from 2.7 to 0.3 dyne/cm2 transiently increased cytosolic pH from 7.20+/-0.02 to 7.47+/-0.07 (mean+/-SEM, P<.05 versus control). This was not affected by prior inhibition of the Na+-H+ exchanger with 10 micromol/L ethylisopropylamiloride but was abolished in bicarbonate-free buffer. Recovery from an ammonium chloride prepulse-induced acid load occurred more rapidly when fluid shear stress was abruptly reduced from 2.7 to 0.3 dyne/cm2 after maximal acidification (+0.04+/-0.02 pH unit at 2 minutes) than when shear stress was maintained at 2.7 dyne/cm2 continuously (0.00+/-0.00 pH unit at 2 minutes, P<.05). This accelerated cytosolic pH recovery was dependent on the presence of bicarbonate ion and was blocked by the addition of the exchange inhibitors DIDS (100 micromol/L) and ethylisopropylamiloride or by removal of buffer Na+, indicating that the acute reduction in fluid shear stress activates the extracellular Na+-dependent Cl(-)-HCO3- exchanger and the Na+-H+ exchanger and increases cytosolic pH in vascular endothelial cells.
Splenic Injury as a Complication of Endoscopy: Two Case Reports and a Literature Review
Authors: E. Ong, U. Böhmler, D. Wurbs
Journal: Endoscopy (1991)

Two cases of splenic injury - one after a difficult colonoscopy and the other after routine ERCP - are reported. Splenic injury as a complication of endoscopic procedures is relatively rare, but over the past several years this complication has been increasingly reported. Review of the literature revealed 11 cases occurring after colonoscopy and one after ERCP. Although most of the patients presented with acute abdominal symptoms, some had mild vague symptoms. In two cases the injury was overlooked entirely. Diagnosis was established at laparotomy in four cases, by CT in four, by ultrasonography in two, by chance observation in two, by angiography in one and by paracentesis in one. All patients except the most recent three reported underwent surgery, with one mortality occurring three weeks after the operation.
Cardiac Troponin After Percutaneous Coronary Intervention and 1-Year Mortality in Non–ST-Segment Elevation Acute Coronary Syndrome Using Systematic Evaluation of Biomarker Trends
Authors: Pierluigi Tricoci, Sergio Leonardi, Jennifer White, Harvey D. White, Paul W. Armstrong, Gilles Montalescot, Robert P. Giugliano, C. Michael Gibson, Frans Van de Werf, Robert M. Califf, Robert A. Harrington, Eugene Braunwald, Kenneth W. Mahaffey, L. Kristin Newby
Journal: Journal of the American College of Cardiology (2013)
A 15 amino acid fragment of influenza nucleoprotein synthesized in the cytoplasm is presented to class I-restricted cytotoxic T lymphocytes.
Authors: K Gould, J Cossins, J Bastin, G G Brownlee, A Townsend
Journal: The Journal of Experimental Medicine (1989)

A recombinant vaccinia has been designed to express amino acids 366-379 of influenza nucleoprotein, previously shown to be the minimal epitope recognized by a class I-restricted cytotoxic T cell clone. Target cells infected with the recombinant vaccinia virus expressing this peptide are recognized by CTL as efficiently as target cells expressing the complete nucleoprotein. The results imply the existence of a peptide transport system that constitutively passes the products of degraded proteins from the cytoplasm into a membrane-bound compartment of the cell.
Gastric mucosal histamine and histamine methytltransferase in patients with duodenal ulcer.
Authors: N R Peden, H Callachan, D M Shepherd, K G Wormsley
Journal: Gut (1982)

Histamine and histamine methyltransferase (HMT) have been measured in gastric mucosa from 110 patients with duodenal ulcer and 62 control subjects. Both antral and fundic mucosa had similar levels of HMT activity despite antral mucosa containing significantly less histamine. Patients with duodenal ulcer had significantly lower levels of fundic mucosal HMT activity and lower concentrations of fundic mucosal histamine than control subjects. An additional finding was that men who were cigarette smokers had significantly lower concentrations of fundic mucosal histamine (but not HMT) than non-smokers and, as there was an excess of cigarette smokers among patients with duodenal ulcer, this may be the explanation for the reduced concentrations of fundic mucosal histamine in these patients.
Survey of Advertising for Nutritional Supplements in Health and Bodybuilding Magazines
Authors: Rossanne M. Philen
Journal: JAMA (1992)

The use of food supplements by the general public is poorly quantified, and little information on this subject is available in the medical literature. We surveyed 12 recent issues of popular health and bodybuilding magazines (1) to quantify the number of advertisements for food supplements, the number of products advertised, and the number and type of ingredients in these products; (2) to identify the purported health benefits of these products; and (3) as a preliminary effort to identify areas for future research. We counted 89 brands, 311 products, and 235 unique ingredients, the most frequent of which were unspecified amino acids; the most frequently promoted health benefit was muscle growth. We also found many unusual or unidentifiable ingredients, and 22.2% of the products had no ingredients listed in their advertisements. Health professionals may not be aware of how popular food supplements are or of a particular supplement's potential effects or side effects. In addition, patients may be reluctant to discuss their use of these products with traditional medical practitioners. We recommend that routine history taking include specific questions about patients' use of food supplements and that any possible adverse effects or side effects be reported to public health authorities.