tbuckley/cabot-search huggingface dataset:
Katharine Neil Maxwell (née Brittain)
Authors: Ian W Campbell
Journal: BMJ (2005)

Founder of the modern hospice movementCicely Saunders founded the first modern hospice and, more than anybody else, was responsible for establishing the discipline and the culture of palliative care.She introduced effective pain management and insisted that dying people needed dignity, compassion, and respect, as well as rigorous scientific methodology in the testing of treatments.St Christopher's Hospice opened in south west London in 1967.It is now one of many but is still the leader in the field.It was her personal achievement and has been imitated all over the world.She raised the funds for the hospice and contributed some of her own money.Saunders introduced the idea of "total pain," which included the physical, emotional, social, and spiritual dimensions of distress.A good listener, she paid systematic attention to patient narratives.One St Christopher's patient, transferred from another hospital, said, "They used to see how long I could go without an injection.I used to be pouring with sweat because of the pain.I couldn't speak to anyone and I was having crying fits.I think I've only cried once since I've been here . . .The biggest difference is feeling so calm.I don't get worked up or upset."Cicely Mary Strode Saunders was born in Barnet, Hertfordshire, in 1918.She was sent to Roedean School when she was 10.Taller than the other girls, she felt she never fitted in, which, she said, gave her a feeling for people who were outsiders.She also suffered from a painful and slightly crooked spine, and was made to lie flat on the floor for 40 minutes a day.Her father disapproved of her desire to be a nurse, and so instead she went to study at Oxford.After the outbreak of the second world war she abandoned her course and defied her parents' advice, enrolling as a student nurse at St Thomas' Hospital in 1944.However, her back was still painful, and she was advised to quit nursing.After returning to Oxford for a year she gained a "war degree" and qualified as a social worker, or what was then called a lady almoner, in 1947.Saunders was originally an agnostic, but, while on holiday in Cornwall with some
Histopathology of blistering diseases: With clinical, electron microscopic, immunological, and molecular biological correlations
Authors: Walter H.C. Burgdorf
Journal: Journal of the American Academy of Dermatology (2004)

There are some minor errors and shortcomings in the book, which might be unavoidable in a compact book like this.Some illustrative clinical pictures are not clear (for example, it is not clear what the picture on panel B shows on p. 25).Some of the terms are not fully explained (see ''atopic dermatitis diet,'' p. 86).Some inclusions in the diagrams are not described in the text.These, though, are minor problems, and they do not detract from the usefulness of the book.Overall, this is a very well edited atlas and will appeal to allergists and dermatologists alike.
Continuing Education: More or Better?
Authors: Scott Aj
Journal: New England Journal of Medicine (1976)

Programs of continuing education in medicine are less than optimally effective. Why should this be? Teachers speak of "conditions for learning," and in adult education it has been suggested that the conditions necessary to encourage learning are the following1: the student must be adequately motivated to change his behavior; he must be aware of the inadequacy of his present behavior (and the superiority of the behavior he is required to adopt); he must have a clear picture of the new behavior; he must have opportunities to practice the new behavior with a sequence of appropriate materials; and he must . . .
Kidney Function after Renal Revascularization for Hypertension
Authors: NORMAN M. SIMON, FRANCESCO DEL GRECO
Journal: Circulation (1964)

Kidney function was evaluated in 53 patients with renal arterial hypertension before and after renal revascularization and was correlated with changes in blood pressure. Data were derived from an analysis of personal observations and of findings reported by others. Revascularization produced a significant decrease in blood urea nitrogen and serum creatinine in 13 azotemic patients. It did not significantly affect glomerular filtration rate when normal in 20 patients, but caused a rise in renal blood flow in three patients. Improvement in renal function was more closely correlated with preoperative functional status than with cure of hypertension. Glomerular filtration rate and renal blood flow increased significantly in the revascularized kidney, but decreased in the contralateral kidney. Urine flow and sodium concentration in the revascularized kidney rose to levels equal to, or greater than, those in the contralateral kidney. The preoperative disparity in urine osmolality between kidneys was narrowed, whereas the concentration of nonresorbable urine solute became equal to, or lower than, that of its mate postoperatively. In most cases, the Howard test reverted to negative. The tubular rejection fraction ratio of sodium became normal or suggested contralateral renal arterial disease. The only functional differences between patients whose hypertension was cured and those whose blood pressure failed to respond to revascularization related to glomerular filtration rate and the Howard test. Impairment of function of the contralateral uninvolved kidney was rarely observed after surgery. The revascularized kidney frequently exhibited excessive natriuresis and diuresis, independent of changes in systemic blood pressure or glomerular filtration rate.
Opposing Effects of Plasma Epinephrine and Norepinephrine on Coronary Thrombosis In Vivo
Authors: Huabao Lin, David B. Young
Journal: Circulation (1995)

Background It is well known that plasma catecholamines and myocardial infarction have a close relation and that coronary artery thrombosis is a major cause of myocardial infarction. In addition, epinephrine is known to be a prothrombogenic agent in vivo. However, the role of the other major circulating catecholamine, norepinephrine, in the development of coronary thrombosis is somewhat uncertain, although the role of norepinephrine is often considered analogous to the role of epinephrine. Therefore, the present study was designed to investigate the effect of norepinephrine and its interaction with epinephrine on coronary thrombosis. Methods and Results To compare the effects of epinephrine and norepinephrine on coronary thrombosis, we analyzed the frequency of cyclic blood flow reductions (CFRs) in an anesthetized canine model of coronary thrombosis (n=25). Three experiments were used in the present study. In the first experiment with epinephrine infusion, plasma epinephrine was elevated from 0.46±0.25 to 27.7±1.85 nmol/L. The frequency of CFRs increased by more than 60%, from 7.1±0.5 to 11.5±0.7 in 40 minutes ( P &lt;.01). The second experiment included three experimental periods: control, norepinephrine infusion, and norepinephrine infusion plus epinephrine infusion. Norepinephrine was infused to raise plasma norepinephrine from 1.3±0.2 to 32.4±4.3 nmol/L. The frequency of CFRs in the dogs was markedly reduced, from 7.89±0.42 to 2.41±1.08 in 40 minutes ( P &lt;.01), whereas arterial pressure was elevated from 88±3 to 118±5 mm Hg ( P &lt;.01). However, when epinephrine infusion was added to the norepinephrine infusion, the frequency of CFRs increased from 2.41±1.08 to 7.74±1.12 in 40 minutes ( P &lt;.01). In the third experiment, a servocontrol device was used during the norepinephrine infusion to prevent rises in coronary arterial pressure. As a result of the norepinephrine infusion, the frequency of CFRs was reduced from 7.47±0.71 to 0.83±0.65 in 40 minutes ( P &lt;.01), even though the coronary arterial pressure was not altered. Conclusions The present study demonstrated that infusion of epinephrine stimulated coronary artery thrombosis, whereas infusion of norepinephrine inhibited coronary artery thrombosis. In addition, the inhibitory effect of norepinephrine on coronary thrombosis is independent of increases in coronary arterial pressure. Therefore, the present findings suggest that epinephrine and norepinephrine have opposing effects on coronary thrombosis in dogs.
Malnutrition, Measles, Mortality, and the Humanitarian Response During a Famine in Ethiopia
Authors: Peter Salama
Journal: JAMA (2001)

The World Food Programme estimated that 10 million people were at risk of starvation in Ethiopia in 2000 but later reported that a famine had been averted. However, no population-based data on mortality or nutrition existed for Gode district, at the epicenter of the famine in the Somali region of Ethiopia.To estimate mortality rates, determine the major causes of death, and estimate the prevalence of malnutrition among children and adults for the population of Gode district.Two-stage cluster survey conducted from July 27 through August 1, 2000, which included anthropometric measures and 8-month retrospective mortality data collection.A total of 595 households comprising 4032 people living in Gode district of Ethiopia.Crude mortality rates and mortality rates for children younger than 5 years, causes of death, weight for height of less than -2 z scores among children aged 6 months to 5 years, and body mass index of less than 18.5 kg/m(2) among adults and older persons.Of the 595 households, 346 (58.2%) were displaced from their usual places of residence. From December 1999 through July 2000, a total of 293 deaths occurred in the sample population; 159 (54.3%) deaths were among children younger than 5 years and 72 (24.6%) were among children aged 5 to 14 years. The crude mortality rate was 3.2/10 000 per day (95% confidence interval [CI], 2.4-3.8/10 000 per day), which is 3 times the cutoff used to define an emergency. The mortality rate for children younger than 5 years was 6.8/10 000 per day (95% CI, 5.4-8.2/10 000 per day). Approximately 77% of deaths occurred before major relief interventions began in April/May 2000. Wasting contributed to 72.3% of all deaths among children younger than 5 years. Measles alone or in combination with wasting accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5 to 14 years. The prevalence rate for wasting (weight for height of <-2 z score) among children aged 6 months to 5 years was 29.1% (95% CI, 24.7%-33.4%). Using a method to adjust body mass index for body shape, the prevalence of undernutrition (body mass index <18.5 kg/m(2)) among adults aged 18 to 59 years was 22.7% (95% CI, 17.9%-27.5%).To prevent unnecessary deaths, the humanitarian response to famine needs to be rapid, well coordinated, and based on sound epidemiological evidence. Public health interventions, such as mass measles vaccination campaigns with coverage extended to children aged 12 to 15 years should be implemented as the first priority. The prevalence of wasting and undernutrition among children and adults, respectively, should be assessed in all prolonged, severe famines.
The Innocent Supraclavicular Arterial Bruit — Utility of Shoulder Maneuvers in Its Recognition
Authors: William P. Nelson, Robert J. Hall
Journal: New England Journal of Medicine (1968)

SOCIOECONOMIC considerations, and the availability of satisfactory surgical procedures for the correction of significant cardiovascular lesions, have increased the need for careful clinical assessment of patients with cardiac murmurs. It has become increasingly important to distinguish patients who have cardiovascular murmurs without heart disease. Included among such a group are a large number of children and young adults with early and mid-systolic bruits heard maximally in the supraclavicular fossae and over the carotid vessels. These murmurs have been identified under a variety of names, but perhaps the most satisfactory is the supraclavicular arterial bruit.1 , 2 Frequently, such murmurs are well heard . . .
Nonsurgical Management of Obstructive Jaundice in the Patient With Advanced Cancer
Authors: Robert L. MacCarty
Journal: JAMA (1980)

CAUSES of malignant biliary obstruction include carcinoma of the pancreas, metastasis to portal lymph nodes, bile duct carcinoma, and carcinoma of the gallbladder. Unfortunately, most patients with such obstructions have incurable disease, so the physician's skills must be directed to prolonging and improving the quality of life. Pruritus, loss of weight, lipid malabsorption, hypoprothrombinemia, and sepsis are all manifestations of biliary obstruction. Adequate drainage of the obstructed biliary system can result in reversal of nutritional deficiencies, relief of pruritus, and clearing of infection. Untreated biliary obstruction leads to progressive hepatic failure, coma, and death. <h3>Surgical Biliary Drainage</h3> Choledochojejunostomy, cholecystojejunostomy, choledochoduodenostomy, hepaticojejunostomy, and operative placement of stent tubes and catheters have been used as palliative surgical drainage procedures. Unfortunately, patients with malignant biliary obstruction often poorly tolerate surgery and recuperate slowly. The operative mortality has been reported to be 10% to 20%.<sup>1,2</sup>Postoperative recovery may be prolonged by pneumonia, intra-abdominal
Forward Signaling Mediated by Ephrin-B3 Prevents Contralateral Corticospinal Axons from Recrossing the Spinal Cord Midline
Authors: Nobuhiko Yokoyama, Mario I. Romero, Chad A. Cowan, Pedro Galvan, Françoise Helmbacher, Patrick Charnay, Luis F. Parada, Mark Henkemeyer
Journal: Neuron (2001)
UNEXPECTED IDENTIFICATION OF FABRY DISEASE AMONG PATIENTS WITH THE CLINICAL DIAGNOSIS OF HYPERTROPHIC CARDIOMYOPATHY IN ICELAND
Authors: Berglind Adalsteinsdottir, Polakit Teekakirikul, Barry Maron, Michael Burke, Ragnar Danielsen, Marianna Gardarsdottir, Runolfur Palsson, Robert Desnick, Christine Seidman, Jonathan G. Seidman, Gunnar Gunnarsson
Journal: Journal of the American College of Cardiology (2014)
Rapid Interpretation of Heart Sounds and Murmurs
Authors: Peter T. Kuo
Journal: JAMA (1997)

In<i>Rapid Interpretation of Heart Sounds and Murmurs</i>the emphasis is on clinical applicability of these signs in the diagnosis of heart disease. The current edition also contains two new sections on "dynamic cardiac auscultation"specific hemodynamic maneuvers to alter heart sounds and murmurs—and on their value in the evaluation and diagnosis of specific cardiac lesions. The text of the heart sound section in the fourth edition has been rewritten and expanded to include the tricuspid opening snap, diastolic "knocks," "tumor plop" sounds, and new illustrations. The heart murmur section has also been rewritten and expanded. For the various sections objectives, pretest questions and posttest questions (including answers) are provided. Drs Stein and Delman have greatly advanced understanding of the basic mechanisms and clinical applications of heart sounds and murmurs. Thomas Xenakis has provided readers with superb illustrations. The book and audiotapes will be invaluable to medical students and
NOTES ON A CASE OF CYCLOPHORIA
Authors: A. A. Bradburne
Journal: BMJ (1910)

This operation having proved unsuccessful I decided to alter the procedure, and in the following June the left eye was operated upon.As in the other eye, an anterior scierotomy was performed, but the incision was extended so as to cut entirely through the upper part of the intercalary re- gion.The knife as it -I emerged through the sclera above the cornea was not allowed to cut through the conjunctiva, but this membrane was undermined for a few millimetres, A C, producing a bridge of tissue which held the flap-like portion of the cornea in position.The idea of this operation was to obtain a scar at the filtration angle, which would be sufficiently loose and porous to allow the intraocular fluid to escape through it under the con- Fig.l1.-Diagran showing extent junctiva, and so produce a Fof incision.A. B.C, Incisionn rain.The re- through sclera; B, point at which permanent dan The my cystoid cicatrix developed; D. D, sut more than fulfilled my bridge of conjunctival tissue.
The Effect of Diaper Type and Overclothing on Fecal Contamination in Day-care Centers
Authors: Rory Van
Journal: JAMA (1991)

Fecal coliform contamination of environmental surfaces and hands in the daycare center is common. This study evaluated the effect of two diaper types on fecal contamination. Ten rooms in four day-care centers containing 141 children were studied in a prospective, randomized, crossover study. A total of 2946 samples were cultured during the 9-week study. Fecal coliforms were isolated from 307 inanimate objects (15%), 73 toy balls (46%), and 131 hands (17%). The number of contaminated inanimate objects was significantly less in rooms where paper diapers were worn when compared with that in rooms where double cloth diapers with plastic overpants were worn and in rooms where clothes were worn over diapers. Inanimate object cultures had more contamination in rooms in which diarrhea had occurred. Containment of feces by overclothes and diaper type may be important in decreasing transmission of enteric pathogens in day-care environments. (<i>JAMA</i>. 1991;265:1840-1844)
Some Experiences in Managing Sickle-cell Anaemia in Children and Young Adults, Using Alkalis and Magnesium
Authors: K. Hugh-Jones, H. Lehmann, J. M. McAlister
Journal: BMJ (1964)

that one is probably dealing with a changing situation and that the absence of venous abnormalities at any time in the natural history of the disease does not imply their absence throughout its development. SummaryIn 23 patients with clinical primary lymphoedema starting in youth (lymphoedema praecox) the venous drainage of the affected leg has been investigated by venography and by venous- flow and venous-pressure studies.Eleven of the patients showed evidence of obstruction of the left common iliac vein, probably by the right common iliac artery.Lymphangiography was performed in 10 cases, and clinical lymphoedema was seen with both abnormal and normal lymphangiographic appearances.The manner in which a raised venous pressure could influence the onset of lymphoedema is discussed.It is a pleasure to acknowledge the technical assistance of Mrs.
Care of the Vaccinated.
Authors: H. L. Green
Journal: JAMA (1894)

Mt. Pleasant, Iowa, Feb. 16, 1894. <h3>To the Editor:</h3> —Smallpox being now so prevalent and vaccination the order of the day, may it not be well to consider at this time a seemingly little matter in connection with the latter subject? Those vaccinated go about and mingle freely with others in the usual way. The latter do not know the former are vaccinated, and subject them to roughness which they would not do if they knew they had a vaccine spot on their arm or body. They seize them, grasp or stroke them at this very spot, ignorant of the damage they are doing,<i>and having no means of knowing it</i>until the person cries out, and then the pain and damage has been done—most frequently, perhaps, among school children and other young persons. Something to distinguish and forewarn, and protect the vaccinated person from this pain and unpleasantness, and
Spontaneous oesophageal rupture
Authors: N. S. Blencowe, S. Strong, A. D. Hollowood
Journal: BMJ (2013)

A 50 year old man presented to his local emergency department complaining of central chest pain and breathlessness that had begun after an episode of vomiting. Physical examination revealed diminished breath sounds at the left lung base and a temperature of 38°C. An erect chest radiograph showed a small, left sided pleural effusion. An initial diagnosis of pneumonia was made, and the patient was started on intravenous antibiotics. The next morning he had deteriorated, and a repeat chest radiograph showed an increase in the pleural effusion and pneumomediastinum. Computed tomography with oral and intravenous contrast revealed contrast in the left pleural cavity, suggesting a diagnosis of oesophageal rupture. The patient was stabilised and subsequently underwent thoracotomy and wash-out, placement of an oesophageal stent, and insertion of a feeding jejunostomy. Spontaneous rupture of the oesophagus (Boerhaave's syndrome) is a complete disruption of the oesophageal wall in the absence of pre-existing pathology and occurs with a sudden rise in intraoesophageal pressure, typically during vomiting. The left posterolateral lower oesophagus is most often affected, about 2-3 cm from the gastro-oesophageal junction. #### How common is spontaneous oesophageal rupture?
Biomedical Research in the 1980s
Authors: Donald S. Fredrickson
Journal: New England Journal of Medicine (1981)

THE new administration could be the most fiscally constrained in half a century, and yet it must endeavor to provide full support to a revolution. That is the best word to describe the present state of the biologic sciences. Their economic foundation, however, has rarely been more precarious.Never has there been a comparable period of growth in the knowledge of living things. The current revolution in the life sciences is not a simple, linear projection of the growth curve in knowledge for the past century. A striking perturbation of that growth has occurred, amounting to a geometric progression of . . .
An immunohistological study of desmosomal components in pemphigus
Authors: S.M. BURGE, C.L. WILSON, D. DEAN, F. WOJNAROWSKA
Journal: British Journal of Dermatology (1993)

Journal Article An immunohistological study of desmosomal components in pemphigus Get access S.M. BURGE, S.M. BURGE Department of Dermatology, Slade Hospital, Oxford, U.K. Dr S.M. Burge, Department of Dermatology, Stoke Mandeville Hospital, Aylesbury, Bucks, U.K. Search for other works by this author on: Oxford Academic Google Scholar C.L. WILSON, C.L. WILSON Department of Dermatology, Slade Hospital, Oxford, U.K. Search for other works by this author on: Oxford Academic Google Scholar D. DEAN, D. DEAN Department of Dermatology, Slade Hospital, Oxford, U.K. Search for other works by this author on: Oxford Academic Google Scholar F. WOJNAROWSKA F. WOJNAROWSKA Department of Dermatology, Slade Hospital, Oxford, U.K. Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 128, Issue 4, 1 April 1993, Pages 363–370, https://doi.org/10.1111/j.1365-2133.1993.tb00192.x Published: 01 April 1993 Article history Accepted: 25 October 1992 Published: 01 April 1993
Unusual Tc-99m MDP and 1-123 MIBG Images in Focal Pyelonephritis
Authors: A JACOBS, P LENOIR, M DELREE, J RAMET, A PIEPSZ
Journal: Clinical Nuclear Medicine (1990)

A 6-year-old boy presented with an inflammatory syndrome. Because Tc-99m MDP bone scintigraphy revealed increased tracer uptake at the upper pole of the right kidney, further studies were oriented towards a diagnosis of renal or adrenal pathology. I-123 metaiodobenzylguanidine (MIBG) accumulated at the site of the abnormal MDP uptake. The diagnosis of neuroblastoma or allied disorder was excluded on the basis of other investigations and further evaluation, suggesting that the MIBG uptake was a false-positive. Findings on clinical imaging, laboratory findings, Tc-99m DMSA imaging, sonography, and CT scanning were highly suggestive of acute focal pyelonephritis.
Drinking drivers: the needs for research and rehabilitation.
Authors: A Clare, M Bristow
Journal: BMJ (1987)

It is suggested that not enough is known about the history of drivers convicted of drink-driving offences. It is not known, for example, what proportion are alcohol dependent, how many are being treated and what effect convictions have. Examples are given from other countries eg Sweden and Canada, where 10% were found to be alcohol dependent and the USA where the figure was 57%. Such findings have resulted in rehabilitation programmes in many countries and these have provided subjects for valuable research. Attempts at similar research in Britain are outlined but on the whole there is a lack of cooperation. It is suggested that screening and rehabilitation of offenders could produce more valuable results than the current government education programme which lacks enforcement and the 'back extrapolation' of blood alcohol concentrations favoured by the police. (TRRL)