tbuckley/cabot-search huggingface dataset:
Caesarean section for fetal distress
Authors: D. James
Journal: BMJ (2001)

Papers pp 1330, 1334 

Intrapartum hypoxia complicates about 1% of labours and results in death in about 0.5 in 1000 pregnancies and cerebral palsy in 1 in 1000 pregnancies.1 When it is diagnosed clinically as “fetal distress” swift delivery is the aim, and the standard has become delivery within 30 minutes of diagnosing fetal distress. As two papers in this week's BMJ illustrate , however, this standard is hard to achieve. Is it actually necessary?

The pathogenesis of intrapartum hypoxia is often multifactorial but poorly understood. Processes such as uteroplacental vascular disease, reduced uterine perfusion, fetal sepsis, reduced fetal reserves, and cord compression can be involved alone or in combination, and gestational and antepartum factors can modify the fetal response.2 Methods of screening and diagnosing the condition have limitations.3 Thus when the condition is thought to be present, diagnosed clinically as “fetal distress,” clinicians aim for a swift delivery because they lack a clear understanding of the severity of the hypoxia.

Audit of the speed with which such caesarean sections are performed is important for clinical …
Loss of bone mineral density in premenopausal women with systemic lupus erythematosus.
Authors: F Formiga, I Moga, J M Nolla, M Pac, F Mitjavila, D Roig-Escofet
Journal: Annals of the Rheumatic Diseases (1995)

OBJECTIVE--To evaluate bone mineral density (BMD) in premenopausal patients with systemic lupus erythematosus (SLE). METHODS--We measured BMD by dual energy x ray absorptiometry at lumbar vertebrae L2-4 and at the right femoral neck in 74 premenopausal white patients (mean age 30.8 years) with SLE who were receiving glucocorticoid therapy, and in a control group. RESULTS--The mean cumulative dose of prednisone was 32.5 (SD 28) g. The mean dose at the time of absorptiometry was 13.7 (6.9) mg. BMD was significantly reduced at the spine and at the femoral neck in SLE patients when compared with the control group: L2-4 = 0.943 (0.1) g/cm2 v 1.038 (0.1) g/cm2 (p &lt; 0.001); femoral neck = 0.766 (0.09) g/cm2 v 0.864 (0.1) g/cm2 (p &lt; 0.001). Nine patients (12.1%), but none of the control group, had a BMD less than the reference range. CONCLUSION--BMD in premenopausal patients with SLE was less than that in a control group and less than the reference range of values defining the presence of osteoporosis in 12.1%. We did not find a relationship between BMD and either cumulative or baseline dose of corticosteroid therapy.
Vitamin D supply to the rat fetus and neonate.
Authors: M R Clements, D R Fraser
Journal: Journal of Clinical Investigation (1988)

The prevention of neonatal rickets by oral supplementation with vitamin D2 (ergocalciferol) has tended to obscure our ignorance of the natural mechanism by which young mammals receive an adequate supply of vitamin D. To investigate the possibility of specific intrauterine transfer and storage of vitamin D in fetal tissues, vitamin D-deficient female rats were given depot injections of 3H- or 14C-labeled vitamin D3 (cholecalciferol) before mating and the 3H-labeled animals were killed at stages during the last third of gestation. Analysis of lipid extracts from whole fetuses revealed a linear increase in the concentration of 25-hydroxyvitamin D3, 24,25-dihydroxyvitamin D3, and D3 itself between days 14 and 19 of gestation. During this period the elimination half-time of 3H-labeled molecules in maternal plasma fell from 27.1 to 4.4 d, suggesting that a specific mechanism was transferring vitamin D molecules into the fetuses. The vitamin was stored predominantly as 25-hydroxyvitamin D3 and 24,25-dihydroxyvitamin D3, with the highest concentrations in fetal muscle. Immediately after birth, pups from 3H- and 14C-labeled mothers were exchanged and later killed after 1-3 wk of suckling. Analysis of total lipid extracts for 3H and 14C content determined the relative contributions of vitamin D supplied before birth via the placenta and after birth in the maternal milk. The vitamin D content of the rat milk was relatively high, between 1.0 and 3.5 micrograms/liter. Nevertheless, the supply of vitamin D in utero, rather than from milk, was the main determinant of vitamin D status in early neonatal life. This is the first indication in a mammal of a specific transfer mechanism that allows the fetus to accumulate vitamin D from the mother during the last third of gestation.
Oldest old are not just passive recipients of care
Authors: Desmond O'Neill, Hannah McGee
Journal: BMJ (2007)

We select the letters for these pages from the rapid responses posted on bmj.com favouring those received within five days of publication of the article to which they refer.Letters are thus an early selection of rapid responses on a particular topic.Readers should consult the website for the full list of responses and any authors' replies, which usually arrive after
Scrotal cancer continues.
Authors: H A Waldron
Journal: BMJ (1972)

Unquiet Rest SIR,-Chauvinism in medical research is to be deplored, but your leading article on unquiet rest (23 September, p. 715) does less than justice to the pioneering British work of Masterton& on sleep patterns of junior medical staff.As early as 1965 he drew attention to both the lack of sleep obtained by busy residents on a surgical service and the effects this could have on the feelings they had about themselves and their work.The experiments of Friedman and his col- leagues2 referred to in your leading artie now confirm objectively for medical per- formance what has been known for some time in other fields-namely, that in pro- longed intellectual tasks ability declines with acute sleep lack.3However, doctors are not yet sufficiently impressed with this to order their lives properly and, as Masterton showed, the pressure of extenal affairs in a hospital environment may be the overriding factor which produces the sleep lack state.The lack of sleep in intensive care units has also been recognized since 1964, when Edgerton and Kay4 and Kornfield, Zimberg, and Malm5 first postulated that it might be of importance in the acute delirium-like states that can occur during incarceration in the intensive care environment.This hypothesis, which was extended by one of us (Dudley6) to include other problems of sensory barrage and deprivation, has proved somewhat too simplistic.While by definition we can regard sleep lack as bad and from observation recognize that it may contribute to the patient's disturbed convalescence, its aetiological im- portance in delirium and its influence on the physiology of recovery require much further study.-Weare, etc.,
Usefulness of SPECT in the Early Detection of Avascular Necrosis of the Knees
Authors: SHIV M. GUPTA, CRAIG R. FOSTER, NAILA KAYANI
Journal: Clinical Nuclear Medicine (1987)

Single photon emission computerized tomography (SPECT), was performed on a female with an acutely painful knee. She had been on corticosteroids just before the onset of symptoms. Radiographs and planar scintigraphic views of the knees were unremarkable. SPECT images of the knees were instrumental in the diagnosis of avascular necrosis of the knee. The cases illustrates the usefulness of SPECT in the early detection of avascular necrosis of the knees.
The proteinpolysaccharides of human costal cartilage
Authors: Lawrence Rosenberg, Blanche Johnson, Maxwell Schubert
Journal: Journal of Clinical Investigation (1969)

Water-soluble proteinpolysaccharides, called PPL, can be extracted from bovine nucleus pulposus in yields of 45%, and from bovine nasal cartilage in yields of 37% of the dry tissue weight. From human costal cartilage only 7% can be extracted. The method used to separate PPL from each of the first two tissues into four distinct fractions separates the PPL of human costal cartilage into four fractions called PPL 3, PPL 4, PPL 5, and PPL 6, which show an increase in protein content, a decrease in chondroitin sulfate content, a nearly constant keratan sulfate content, and an increase in ease of sedimentability and molecular weight. From each of the three tissues mentioned. PPL 3 has a similar amino acid profile and so does PPL 5, but PPL 5 differs from PPL 3 in having a lower content of serine and higher contents of aspartic acid, tyrosine, and arginine. A more extensive effort to characterize these products has been made by analytical ultracentrifugation, and this has led to a further fractionation of PPL 5. Treatment of the cartilage residue or the water-insoluble protein polysaccharide called PPH, with neutral NH(2)OH solution releases water-soluble protein polysaccharides which in composition resemble PPL 4. The water-insoluble residue left after NH(2)OH treatment, when treated with collagenase, yields two soluble products, one resembling PPL 5 in composition, the other with a much lower chondroitin sulfate and much higher keratan sulfate content. The possibility is suggested that in human costal cartilage, binding of some forms of PPL to collagen may occur.
Preferential binding of vasoactive intestinal polypeptide to basolateral membrane of rat and rabbit enterocytes.
Authors: K Dharmsathaphorn, V Harms, D J Yamashiro, R J Hughes, H J Binder, E M Wright
Journal: Journal of Clinical Investigation (1983)

Binding of radioiodinated vasoactive intestinal polypeptide (VIP) to intestinal cell membranes of the rabbit ileum and rat jejunum was investigated. Specific binding of 125I-labeled VIP could be demonstrated only on the basolateral membrane and not on the brush border membrane. This corresponded with the lack of an effect on ion transport when VIP was applied to the mucosal side of an in vitro preparation of rabbit ileum. VIP altered ion transport only when it was applied to the serosal side. The binding of 125I-VIP was specific and dependent upon incubation temperature. There was a close correlation between the potency of VIP for inhibition of 125I-VIP binding and that for increasing adenylate cyclase activity. These observations demonstrate that VIP receptors are located on the basolateral membrane.
Antibody to E- and L-Selectin Does Not Prevent Lung Injury or Mortality in Septic Baboons
Authors: MARTHA SUE CARRAWAY, KAREN E. WELTY-WOLF, STEPHEN P. KANTROW, YUH-CHIN T. HUANG, STEVEN G. SIMONSON, LORETTA G. QUE, TAKASHI K. KISHIMOTO, CLAUDE A. PIANTADOSI
Journal: American Journal of Respiratory and Critical Care Medicine (1998)

Recruitment of polymorphonuclear leukocytes (PMN) through upregulation of cellular adhesion molecules is a proposed mechanism of injury in sepsis and acute respiratory distress syndrome (ARDS). We hypothesized that pretreatment of baboons with a monoclonal antibody to human E- and L-selectin (EL-246) during sepsis would decrease PMN influx into tissues and result in less organ injury during gram-negative sepsis. We studied 14 anesthetized, ventilated adult baboons; six animals received 1 mg/kg of EL-246 before infusion of an LD100 of live Escherichia coli and six received the E. coli infusion without antibody therapy. Two other animals received 1 mg/kg of EL-246 intravenously without an infusion of bacteria. Intermittent measurements were made of circulatory pressures, cardiac output, urine output, arterial blood gases, ventilation:perfusion ratio (V˙ a/Q˙), and hematologic status. The experiments were ended at 48 h or at the time of death. Tissues were harvested for pathology and biochemical measurements. The E. coli infusions were associated with a hyperdynamic state, pulmonary hypertension, systemic hypotension, decreased urine output (UOP), and metabolic acidosis. The antibody partly blocked PMN migration, but there were few significant physiologic or biochemical differences between the EL-246-treated and untreated animals. In the antibody-treated animals, UOP was decreased, metabolic acidosis was worsened, and median survival time was decreased significantly. We conclude that treatment with an antibody to E- and L-selectin in gram-negative sepsis does not improve gas exchange or protect against lung injury, and is associated with decreased survival time in primates.
HSP90β Regulates Rapsyn Turnover and Subsequent AChR Cluster Formation and Maintenance
Authors: Shiwen Luo, Bin Zhang, Xian-ping Dong, Yanmei Tao, Annie Ting, Zheng Zhou, James Meixiong, Junjie Luo, F.C. Alex Chiu, Wen C. Xiong, Lin Mei
Journal: Neuron (2008)
The transport of colonic contents in the irritable colon syndrome
Authors: J. A. Ritchie
Journal: Gut (1970)

The mean distance of travel and hourly incidence of propulsive and retropulsive movements of colonic contents have been assessed by means of time-lapse cinefluorography and compared in 98 patients with the irritable colon syndrome and in 90 control subjects.Net propulsion in patients with the irritable colon syndrome was less than in the controls at rest, similar to the controls after feeding, and greater than in the controls after an injection of carbachol. In both clinical groups, food and carbachol increased the incidence of propulsive and retropulsive movements but did not alter the average distance over which they travelled.The figures suggest that at least two-thirds of all net propulsion of colonic contents in the irritable colon syndrome takes place under circumstances not reproduced in the present study.
Angiotensin-converting enzyme inhibitor and danazol increase sensitivity of cough reflex in female guinea pigs.
Authors: T Ebihara, K Sekizawa, T Ohrui, H Nakazawa, H Sasaki
Journal: American Journal of Respiratory and Critical Care Medicine (1996)

To examine the mechanisms of an angiotensin-converting enzyme (ACE) inhibitor-induced cough in perimenopausal and postmenopausal women, cough responses to aerosols of capsaicin and citric acid were examined in four groups of female guinea pigs treated orally with danazol (D) (an agent decreasing plasma estrogen levels), cilazapril (C) (an inhibitor of ACE), both danazol and cilazapril (C+D), or without either drug (control group) for 4 to 5 wk. Capsaicin caused dose-dependent increases in the number of coughs in all four groups. C or D alone shifted dose-response curves to capsaicin (from 10(-7) M to 10(-3) M) to lower concentrations compared with the control, and C+D further shifted them. Likewise, the number of coughs induced by citric acid (3 x 10(-1) M; 2 min) was highest in animals treated with C+D and significantly higher in animals treated with C or D than in the control group. Aerosols of a selective substance P (SP) receptor antagonist FK 888 (10(-5) M; 2 min) inhibited capsaicin-induced cough in all four groups, and dose-response curves to capsaicin did not differ significantly at any concentrations among the four groups in the presence of FK 888 (p > 0.10). D decreased cyclic AMP levels in the trachea, irrespective of the combination of C. A beta 2-adrenoceptor agonist, procaterol, which is thought to inhibit SP release by elevation of cyclic AMP in sensory nerves, dose-dependently inhibited the number of coughs induced by capsaicin (10(-3) M) in animals treated with D. The present study suggests that SP is a common mechanism mediating increases in the sensitivity of cough reflex induced by both ACE inhibition and a decrease in plasma estrogen levels, and the additive effects of the two events may explain the high incidence of cough during ACE inhibitor therapy in perimenopausal and postmenopausal women.
Managing cancer treatment-induced bone loss: 24-month results from the Study of Anastrozole with the Bisphosphonate RisedronatE (SABRE).
Authors: C Van Poznak, R Hannon, G Clack, M Campone, JR Mackey, J Apffelstaedt, R Eastell
Journal: Cancer Research (2009)

Abstract Abstract #1137 Aim: To investigate the management of bone health in postmenopausal women with early breast cancer (BCA) scheduled to receive anastrozole.&amp;#x2028; Methods: Postmenopausal women with hormone receptor-positive early BCA were assigned to 1 of 3 strata depending on their pre-existing risk of fragility fracture. Patients (pts) with a bone mineral density (BMD) T-score &amp;lt;-2.0 for either spine or hip, or those pts deemed by the investigator to be at increased risk of fracture, were designated higher-risk (H) for fracture and received anastrozole 1 mg/day plus risedronate 35 mg/week orally. Moderate-risk (M) pts (T-score &amp;lt;-1.0 for spine or hip but ≥-2.0 at both sites) were randomized in a double-blind manner to receive anastrozole plus risedronate (A+R) or anastrozole plus placebo (A+P). Pts with T-scores ≥-1.0 at both spine and hip were designated lower-risk (L) and received anastrozole alone. All pts received calcium and vitamin D. Lumbar spine and total hip BMD were assessed at baseline, 12, and 24 months.&amp;#x2028; Results: BMD changes at 24 months are shown in the table. In M, a significant difference in favor of the A+R group compared with the A+P group was seen for both lumbar spine and total hip (both p&amp;lt;0.0001). In H, risedronate therapy was associated with increases in BMD at the lumbar spine (p=0.0006) and total hip (p=0.01). In L, no bisphosphonate therapy was associated with a significant decrease in BMD at the lumbar spine (p=0.01) but not at the total hip. Pts who withdrew did not appear to have an impact on the results. The safety and tolerability profile of anastrozole was similar to that already established and was not significantly altered by the addition of risedronate.&amp;#x2028; Conclusions: In postmenopausal women at risk for fragility fracture receiving adjuvant anastrozole for BCA, the addition of risedronate at doses established for preventing and treating osteoporosis resulted in favorable affects in BMD over 24 months.&amp;#x2028; &amp;#x2028; Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1137.
Nocturnal polyuria and saluresis in renal allograft recipients.
Authors: M K Chan, Z Varghese, O N Fernando, J F Moorhead
Journal: BMJ (1980)

The evolution of nocturnal polyuria and saluresis in renal allograft recipients was studied by comparing the day to night (D:N) ratios of urine volume and sodium excretion in 15 patients who had undergone transplantation less than one year previously (recent-transplant group) with those in 11 patients who had undergone transplantation at least one year previously. Eleven patients with chronic renal failure and 12 normal subjects served as controls. Patients in the recent-transplant group had significantly lower D:N ratios of urine volume and sodium excretion than the patients who had undergone transplantation at least a year before, while the ratios in this last group did not differ significantly from those in the normal subjects. Nocturnal polyuria and saluresis gradually subsided in five patients studied for three months. Chronic renal failure and uraemic autonomic neuropathy were unlikely causes of the nocturia. The patients in the recent-transplant group had significantly lower D:N ratios of urine volume than the controls with chronic renal failure, and the mean Valsalva ratio in eight of them was not significantly different from that in the normal subjects. An undue sensitivity of renal allografts to postural influences was proposed.
Additional Corrections: Interferon for Hemangiomas of Infancy
Authors: Alan Ezekowitz, John Mulliken, Judah Folkman
Journal: New England Journal of Medicine (1995)

To the Editor: Inaccuracies in our paper “Interferon Alfa-2a Therapy for Life-Threatening Hemangiomas of Infancy”1 prompted a careful review. On the basis of our reanalysis and an interim review by a standing faculty committee of the Harvard Medical School, we submitted a revised Table 1, published as a correction notice.2 The final review of this committee concluded that ambiguities in method, presentation, and conclusions should be clarified and that errors remained that should be corrected. In our original description of the assessment of outcomes, we never stated that lesions were measured; however, the use of the terms “dimensions” in the . . .
Phlegmasia Cerulea Dolens After Aorto-Iliac Operations
Authors: John L. Ochsner, Ronald J. Knudson
Journal: JAMA (1962)

COMPLICATIONS of surgical procedures involving the abdominal aorta and iliac arteries are relatively common, although, as experience has increased, the incidence of these sequelae has progressively decreased. A wide variety of complications, some common to any abdominal operation and others specific to operations on the great vessels, has been reported. Yet, thrombosis of the accompanying veins is an uncommon complication. This is particularly puzzling in view of the intimate relation of veins to arteries and the possibility of inadvertent trauma. In fact, we have been unable to find any reports of thrombosis of the inferior vena cava or iliac veins after aorto-iliac operations. For this reason, 2 cases are reported of phlegmasia cerulea dolens, occurring 2 and 3 weeks, respectively, after aorto-iliac operations in which there was no known trauma to the iliac veins. Both cases were successfully treated by different methods. Report of Cases Case1.—A 63-year-old man was
High serum transferrin receptor level in anemia of chronic disorders indicates coexistent iron deficiency
Authors: Amar Das Gupta, Alpana Abbi
Journal: American Journal of Hematology (2003)

Blood transferrin receptor (TR) level is largely determined by the quantum of erythropoiesis and by intracellular iron content of the cells of the erythroid lineage. Hence, a high serum TR level has been found to be useful in distinguishing iron deficiency anemia (IDA) from anemia of chronic disorders (ACD). In order to examine its potential role in the diagnosis of concomitant iron deficiency in ACD, we determined serum TR levels in 130 cases of ACD, in 25 cases of IDA, and in 40 normal adults. As expected, all patients of IDA had significantly higher serum TR levels compared to the normal subjects (4.2-19.2 microg/dL vs. 1.3-3.0 microg/dL) (P < 0.002). In 11/25 cases of IDA, the total iron-binding capacity (TIBC) was in the normal range although bone marrow iron store was absent and serum TR levels were high, thereby highlighting the superiority of TR level in the diagnosis of iron deficiency compared to TIBC. Although 54% (70/130) patients of ACD had normal or low serum TR levels (0.9-3.0 microg/dL) as expected, in 46% (60/130) of ACD patients, serum TR levels were high (3.2-11.0 microg/dL). Mean corpuscular volume, red cell distribution width, and transferrin saturation were significantly lower (P < 0.001) in the latter group of patients compared to the former, and these parameters resembled those in IDA patients. Also, serum iron was lower and TIBC was higher in this group of ACD patients compared to those with normal or low serum TR. All these features point to an "IDA-like" profile of ACD patients with high TR and support the possibility of co-existent iron deficiency in this subgroup of ACD patients. In light of these observations it would be prudent to treat ACD patients with high serum TR levels with iron replacement therapy.
CLAMP FORCEPS FOR REMOVAL OF NASOPHARYNGEAL TUMORS.
Authors: E. FLETCHER INGALS
Journal: JAMA (1903)

The report of the following case is made to illustrate the advantage of having a suitable clamp to aid in the removal of nasopharyngeal tumors by the galvano-cautery and to call attention to an instrument which I believe will be found advantageous in very many cases. It would also aid in the removal of some growths by the cold-wire snare. The patient, E. J., a young man 22 years of age, had been troubled with partial occlusion of the nares and the necessity for frequently clearing the throat for about five years. Latterly, there had been complete occlusion of the left naris, but the right was permeable a part of the time. There had also been frequent bleeding of the nose. The patient's personal and hereditary history gave no clew to the cause of the trouble. The thoracic signs were normal. On examination of the nares 1 found the right