tbuckley/cabot-search huggingface dataset:
Systemic Lupus Erythematosus with Deficiency of the T4 Epitope on T Helper/Inducer Cells
Authors: William Stohl, Mary K. Crow, Henry G. Kunkel
Journal: New England Journal of Medicine (1985)

Three black Jamaicans with systemic lupus erythematosus (SLE) were identified whose T helper/inducer cells lacked the T4 epitope (T4 epitope–deficient phenotype). All three patients had lymphadenopathy as part of their syndromes. The asymptomatic and otherwise healthy T4 epitope–deficient brother of one of these patients also had lymphadenopathy in a distribution identical to that of his sister with SLE. Family studies pointed to an autosomal codominant mode of inheritance not linked to the HLA locus for the T4 epitope phenotype. Cultures of peripheral-blood mononuclear cells revealed impaired B-cell differentiation upon stimulation with pokeweed mitogen in cells originating from the T4 epitope–deficient family members as compared with those originating from their T4 epitope–intermediate relatives. Ratios of T helper/inducer cells to T suppressor/cytotoxic cells, the presence of various autoantibodies, and proliferation in response to mitogens and in the mixed lymphocyte reactions did not correlate with T4 epitope phenotype. We suggest that SLE in association with the T4 epitope–deficient phenotype may represent a unique subset of patients with SLE that has distinct clinical and immunologic properties. (N Engl J Med 1985; 312:1671–8.)
Differential Distribution of Australia-Antigen-Associated Particles in Patients with Liver Diseases and Normal Carriers
Authors: Jens O. Nielsen, Morten H. Nielsen, Preben Elling
Journal: New England Journal of Medicine (1973)

Electron microscopy of Australia antigen particles was carried out on 80 serum specimens from 42 patients with various liver diseases and from six "normal" carriers. Dane particles were found in the serum of 11 of 13 patients with persistent antigenemia and chronic hepatitis, but in only seven of 24 patients with uncomplicated acute hepatitis and transient antigenemia. No Dane particles were found in the specimens of six healthy carriers. The ratio between the small spherical particles and the rod-shaped particles was on an average 18.4 in patients with uncomplicated acute hepatitis and 3.8 in those with persistent antigenemia and chronic hepatitis. In eight patients serum samples were available from both the acute and the chronic phase of hepatitis, and, initially, the particle-pattern was similar to the pattern seen in patients with chronic hepatitis. Thus, electron microscopy of Australia antigen particles in serum may be of prognostic value in acute hepatitis.
Diffuse Calcification of the Cornea in Hypercalcemia
Authors: David G. Cogan, Philip H. Henneman
Journal: New England Journal of Medicine (1957)

BAND keratopathy with hypercalcemia of whatever cause is a well established entity.1 2 3 4 It presents as a gray, granular and superficial opacity limited to the paralimbal region on either side of the cornea. The keratopathy is usually inconspicuous and asymptomatic. Most cases are easily overlooked unless examined with the slit lamp or with strong focal illumination. Its usual significance is that, like nephrocalcinosis, it is one of the few physical signs of hypercalcemia. Diffuse generalized calcification of the cornea due to hypercalcemia has not been reported previously. In the following case the corneal opacity involved the entire cornea, in contrast to . . .
Lack of Clinical Usefulness of the Limulus Test in the Diagnosis of Endotoxemia
Authors: Ronald J. Elin, Richard A. Robinson, Arthur S. Levine, Sheldon M. Wolff
Journal: New England Journal of Medicine (1975)

Studies of the clinical value of the limulus amebocyte lysate test for the detection of endotoxemia are inconsistent. In an attempt to define the value of this test, a total of 237 plasma samples from 111 patients were tested for endotoxin with seven different lysate preparations. A total of 48 plasma samples yielded a positive test with one or more of the seven preparations. Two of eight samples positive with all seven preparations were from ambulatory patients. A significant positive correlation of the test with bacteremia, neutrophilia and elevated serum alkaline phosphatase was found. Only three of the 48 positive tests occurred by four hours of incubation, and only 12 were associated with positive blood cultures (eight contained gram-negative bacteria). The test now available has no clinical usefulness in the detection of endotoxemia or gram-negative septicemia.
Case 33-1989
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Elliott D. Kieff, R. Paul Johnson, Eugene J. Mark
Journal: New England Journal of Medicine (1989)

Presentation of CaseA 26-year-old woman was admitted to the hospital because of persistent fever, with diarrhea, leukopenia, thrombocytopenia, and hypoxemia.The patient was well until approximately four weeks earlier, when nausea, headache, myalgia, and watery diarrhea developed, and her temperature rose as high as 40°C. After symptoms of four days' duration she consulted a physician, who made a diagnosis of a "viral syndrome" and prescribed symptomatic treatment. Fever and diarrhea persisted, and vomiting occurred, with a sore throat and enlarged, tender cervical lymph nodes. Twenty days before admission she returned to her physician, who found that the temperature was . . .
Pen a 1 Improves Clinical Predictability of Shrimp Allergy Compared to Skin Prick Testing
Authors: Karen Thursday S. Tuano, Adrian M. Casillas, Sara Anvari, Joud Hajjar, I. Celine Hanson, Filiz O. Seeborg, Lenora M. Noroski, Grace Kang, Danielle Guffey, Carla M. Davis
Journal: Journal of Allergy and Clinical Immunology (2016)
Does Visual Interpretation of the Coronary Arteriogram Predict the Physiologic Importance of a Coronary Stenosis?
Authors: Carl W. White, Creighton B. Wright, Donald B. Doty, Loren F. Hiratza, Charles L. Eastham, David G. Harrison, Melvin L. Marcus
Journal: New England Journal of Medicine (1984)

To assess visual interpretation of the coronary arteriogram as a means of predicting the physiologic effects of coronary obstructions in human beings, we compared caliper measurements of the degree of coronary stenosis with the reactive hyperemic response of coronary flow velocity studied with a Doppler technique at operation, after 20 seconds of coronary arterial occlusion. In 39 patients (44 vessels) with isolated, discrete coronary lesions varying in severity from 10 to 95 per cent stenosis, measurement of the percentage of stenosis from coronary angiograms was not significantly correlated (r = -0.25) with the reactive hyperemic response. Results were the same for obstructions in the left anterior descending, diagonal, and right coronary arteries. Underestimation of lesion severity occurred in 95 per cent of vessels with greater than 60 per cent stenosis of the diameter by arteriography. Both overestimation and underestimation of lesions with less than 60 per cent stenosis were common. These results, together with the high interobserver and intraobserver variability of standard visual analysis of angiograms, suggest that the physiologic effects of the majority of coronary obstructions cannot be determined accurately by conventional angiographic approaches. The need for improved analytical methods for the physiologic assessment of angiographically detected coronary obstructions is apparent.
Soundings: Give reorganisation a chance
Authors: Colin Douglas
Journal: BMJ (2005)

Here in Auchendreich we like to think that reorganisation brings out the best in us. The recent integration and resulting joint accountability of acute and primary care (the pride of Scotland and, we are told, the envy of NHS Englandshire) have together offered us the greatest opportunity for radical health service reform in the Greater Auchendreich Health Board Area since at least 2003.

In the true spirit of Auchendreich we have given this latest reorganisation our best efforts; and our positive experience in transcending the clumsy, dysfunctional heritage of the status quo—so truly no longer an option—ought now to inspire all healthcare systems facing similar challenges.

The key to it all was the insight that the traditional grouping of ear, nose, and throat was no longer defensible in the 21st century. So at an enjoyable and productive NHS Auchendreich awayday in the five star Castle Dreich Hilton Resort Complex it was determined that ear and nose would join maxillofacial surgery, neurosurgery, and psychiatry in a new pan-Auchendreich Directorate of Cranial and Mental Health; with throat to sit alongside thoracic medicine, cardiothoracic surgery, and our acclaimed GORD service in another pioneering pan-Auchendreich directorate, Chest Health Auchendreich.

The rest, of course, was easy. Most surgeons will be left alone; but a new, powerful and wide-ranging Holistic Health Directorate will unite various mainly non-surgical entities such as general practice, community services, geriatric medicine, rheumatology, and hence—inevitably—orthopaedics. It is hoped that fierce competition for what is surely the key post in our whole reconfigured health system will result in it going to a truly remarkable NHS leader.

But interest so far seems to have been limited. Applications are coming in only slowly, and rumour has it that they are generally somewhat disappointing. Our area aromatherapist may have misunderstood the nature of the post, as may a number of outside applicants. So if you are an experienced clinical manager perhaps already contemplating a move to the Auchendreich area and feel your skills might match the challenges of this post, our HR director here at NHS Auchendreich would very much like to hear from you.
OC-061 Acid-induced oesophageal hypersensitivity is inhibited by pregabalin treatment: Abstract OC-061
Authors: Y C Chua, K S Ng, A Sharma, J Jafari, S Surguy, E Yazaki, P O Julu, C H Knowles, Q Aziz
Journal: Gut (2010)

<h3>Introduction</h3> Oesophageal acid infusion in humans induces primary and secondary hyperalgesia due to peripheral and central sensitisation, respectively.1 Pregabalin is a centrally acting modulator of voltage-sensitive calcium channels which reduces neuropathic pain by attenuating the release of multiple neurotransmitters2 in the CNS. Its efficacy in reducing acid-induced oesophageal hypersensitivity has not been explored. <h3>Methods</h3> Single-centre, placebo-controlled, double-blind, randomised, two-period, cross-over study of 15 healthy volunteers (21–52 years, 9 males) attending on three visits. On visit 1, after oesophageal manometry, pain thresholds (PTs) to oesophageal electrical stimulation were determined using bipolar ring electrodes positioned in the proximal and distal oesophagus. Thereafter, a 30 min infusion of HCL was performed in the distal oesophagus. PT was measured again at both sites at 30 and 90 min after the acid infusion. The same methods were repeated for three visits. Participants were then given either pregabalin or placebo after visits 1 and 2. The intervals were at least; 1 week between visits 1 and 2, and 2 weeks between visits 2 and 3 (to allow time for drug washout). The dose of pregabalin used was 75 mg bd for 3 days, 150 mg bd for 1 day and 150 mg od. <h3>Results</h3> The median decrease in PT at 30 min after acid, compared to baseline in the proximal oesophagus was significantly less after treatment with pregabalin. This pattern was maintained even at 90 min after acid, but to a lesser degree (Abstract 061). The subjective score of pain to acid infusion was also reduced while on placebo compared to pregabalin (VAS median of 3 vs 1, p=0.0270). The baseline PTs before acid infusion at placebo and pregabalin visits were not significantly different (p=0.42). There were no differences in the change in post-acid PT between pregabalin and placebo in the distal oesophagus. <h3>Conclusion</h3> Pregabalin prevents the development of secondary hyperalgesia in the proximal oesophagus after distal oesophageal acidification, both on objective and subjective assessments of pain. It has no significant effect on the site of acid exposure, indicating that it acts to reduce central sensitisation and is not analgesic. Studies of pregabalin in patients with acid-induced oesophageal hypersensitivity are warranted.
In Search of the Subcutaneous-Insulin-Resistance Syndrome
Authors: David S. Schade, William C. Duckworth
Journal: New England Journal of Medicine (1986)

In numerous patients with diabetes mellitus, a defect in the absorption of subcutaneously injected insulin has been suspected as an explanation for diabetic instability. The common clinical characteristic of these patients is poor metabolic control when insulin is injected subcutaneously, but good metabolic control when the insulin is infused intravenously. We have used three approaches to attempt to identify patients with "subcutaneous-insulin resistance." First, we performed a series of studies of subcutaneous-insulin absorption in 16 patients referred to us with a presumptive diagnosis of resistance to subcutaneous insulin; in none of these patients did we detect an abnormal response of blood glucose levels to insulin administered subcutaneously. Plasma free-insulin levels rose normally after injection. Second, we assayed insulin-degrading activity in subcutaneous biopsy specimens obtained from 25 patients throughout North America and Europe who had been diagnosed as resistant to subcutaneous insulin. In none of these patients did the insulin-degrading activity of subcutaneous tissue exceed the mean value (+/- 2 SD) of eight subcutaneous biopsy specimens obtained from control patients with diabetes. Third, we performed studies of tritiated-insulin absorption in three additional diabetic patients and three control patients with nonbrittle diabetes. These studies also suggested normal absorption of insulin. In none of the patients we studied were we able to confirm the clinical diagnosis of subcutaneous-insulin resistance. We therefore conclude that this syndrome is extremely rare and that misdiagnosis is common.
Adrenergic Modulation of Extrarenal Potassium Disposal
Authors: Robert M. Rosa, Patricio Silva, James B. Young, Lewis Landsberg, Robert S. Brown, John W. Rowe, Franklin H. Epstein
Journal: New England Journal of Medicine (1980)

We studied the role of catecholamines in the regulation of potassium homeostasis in nine healthy subjects given intravenous potassium chloride (0.5 meq per kilogram of body weight) in the presence and absence of propranolol. Potassium infusion elevated serum potassium 0.6±0.09 meq per liter (mean ±S.E.M.). Addition of propranolol augmented the rise (0.9±0.05 meq per liter) and prolonged the elevation in serum potassium without decreasing urinary potassium excretion. In a separate study, the same potassium load was administered with a concomitant infusion of epinephrine in five subjects. Epinephrine markedly blunted the increment in serum potassium (0.1±0.06 meq per liter) while reducing renal potassium excretion. Plasma aldosterone was not altered by the experimental procedures. Serum insulin fell minimally in the presence of propranolol but was unaffected by epinephrine. β-Adrenergic blockade impairs and epinephrine enhances extrarenal disposal of an acute potassium load. These findings suggest that in patients with impaired potassium disposal, the risk of hyperkalemia may be increased when sympathetic blockade is induced. (N Engl J Med. 1980; 302:431–434.)
Abstract 29: Changes in Three Diet Quality Scores and Total and Cause-specific Mortality
Authors: Mercedes Sotos-Prieto, Shilpa N Bhupathiraju, Josiemer Mattei, Teresa T Fung, Yanping Li, An Pan, Walter C Willett, Eric B Rimm, Frank B Hu
Journal: Circulation (2016)

Background: The latest 2015 Dietary Guidelines Advisory Committee Report has recommended healthy dietary patterns as an easier way for the public to understand and act upon. Despite the latest evidence supporting the association of the adherence to diet quality and lower mortality risk, few studies have evaluated changes in diet quality over time in relation to mortality risk. Therefore, we examined changes in diet quality and subsequent risk of total and cause-specific mortality in two large cohort studies. Objective: To evaluate the association between 12-y changes (1986-1998) in three diet quality indices assessed by the Alternative Healthy Eating Index (AHEI), the Alternate Mediterranean Diet (AMED), and the Dietary Approach to Stop Hypertension (DASH)) with total and cause-specific mortality in the Nurses’ Health Study (NHS) and Health Professionals Follow-up Study (HPFS) from 1998-2010. Methods: We followed 44,501 women in the NHS and 23,100 men in the HPFS, both from 1986 to 2010. The AHEI, AMED and DASH were defined from validated food frequency questionnaires and updated every 4 years. Cox proportional hazards models were used to calculate hazard ratios (HR) with adjustment for potential confounders (both at baseline and changes over time). Results across cohorts were pooled by an inverse variance-weighted, random-effect meta-analysis. Results: During 758,683 person-years of follow-up, we documented 9,772 deaths, including 2,292 CVD deaths and 3,314 cancer deaths. The pooled HR comparing participants with the greatest improvement in diet quality (14%-33%) vs. participants whose diet quality remained relatively stable (no change, 0-3%) in the 12-year period was 0.89 (95% confidence interval [CI], 0.83 to 0.95) for AHEI; 0.83 (95 CI%, 0.65 to 1.05) for AMED; and 0.88 (95% CI 0.83 to 0.94) for DASH. In contrast, a decrease in diet quality was significantly associated with increased total mortality. In continuous analyses, a 20th-percentile increase in the three diet quality scores was associated with a 9%-20% lower total mortality (AHEI, 20% [15% to 24%]; AMED, 9% [6% to 12%]; DASH, 13% [9% to17%]). The results were largely similar when evaluated risk of death from CVD and cancer as outcomes. Notably, maintaining a higher vs lower adherence to any of the three dietary patterns during the 12 years was significantly associated with a 23-24% lower total mortality, a 19-27% lower risk of CVD deaths, and a 13-20% lower risk of cancer death. Conclusions: In two large, independent cohorts of U.S. women and men we found consistent associations between increasing diet quality over 12 years and decreased total, CVD, and cancer mortality. These results underscore the importance of the strategies to promote and sustain a healthy diet in improving longevity among middle-aged and older adults.
Soundings: The end
Authors: Colin Douglas
Journal: BMJ (2003)

Hospital parking has never been easier, in itself a sure sign of the terminal phase. It has been a long time coming, but reefs of packed boxes have accumulated in wards, offices, and corridors, and most have now been taken away. As with a home, the process of removal uncovers ever more grime and shabbiness. It is time to go.

In its prime, perhaps from 1870 to 1920, it led the way: a teaching hospital famed across the world. The advent of the NHS in 1948 took away its charitable status: a loss it mourned in a vast public memorial service in the Usher Hall. Thereafter it declined with all the dignity it could muster, but since the 1960s has been left far behind: in a usefully dismissive phrase, beyond economic repair.

The last decades have been a protracted embarrassment; now the last days are like a long anticipated but still uncomfortable death.

Much, almost everything that matters, has gone already. The few staff left have more time for each other, and talk together like acquaintances brought closer by the passing of a friend. “Terrible, isn't it, even though you know it's for the best... But I still can't believe it.”

Admissions stopped five days ago, surgery not long after. What must be done now is necessary but still seems brutal: the termination of the remaining services; the transfer of the last of the staff and equipment, and of the few remaining patients.

In the unit I know best numbers are down from the customary 80 to a dozen or so. Two of the frailest have slipped away overnight: the last deaths in a roll of more than 120 years that might run now to hundreds of thousands. The nurses seem relieved. “It wouldn't have been right to put them in an ambulance... Not the way they were.”

In a ward for once quite generously staffed the remaining patients are well—even lovingly—cared for: the last duties of an institution whose origins stretch back to the age of Florence Nightingale. Some of the patients know about the move and are calm. They trust the nurses. Others are less in touch, a few frankly confused.

With doctors thin on the ground—a locum senior house officer holds the fort—the nurses matter more than ever. A consultant ward round ends, the last of many thousands in more than 120 years of hospital history. The ritual “Thank you, staff nurse,” however sincerely meant, seems a little inadequate.
Hypernephroma with Erythrocythemia
Authors: James S. Hewlett, George C. Hoffman, Donald A. Senhauser, John D. Battle
Journal: New England Journal of Medicine (1960)

THE reports of erythrocythemia occurring with renal tumor are sufficiently numerous to suggest more than a fortuitous association. It appears from the literature that the disease occurs in approximately 2 per cent of patients with hypernephroma.1 2 3 4 In a review of 135 consecutive proved cases of hypernephroma at the Cleveland Clinic 4 cases (3 per cent) of erythrocythemia were found. Benign tumors,5 unilateral hydronephrosis6 , 7 and polycystic kidneys8 have also been found in association with erythrocythemia. A cause- and-effect relation is further suggested by the fact that the erythrocythemia is corrected by removal of the tumor or diseased kidney, and may reappear . . .
136O: Osimertinib combined with durvalumab in EGFR-mutant non-small cell lung cancer: Results from the TATTON phase Ib trial
Authors: M.-J. Ahn, J. Yang, H. Yu, H. Saka, S. Ramalingam, K. Goto, S.-W. Kim, L. Yang, A. Walding, G.R. Oxnard
Journal: Journal of Thoracic Oncology (2016)
Evidence for the Placental Transfer of Tri-Iodothyronine in Human Beings
Authors: S. Raiti, G. B. Holzman, R. L. Scott, R. M. Blizzard
Journal: New England Journal of Medicine (1967)

TRANSFER of 131I-tagged thyroxine (T4) from the human mother to the fetus at term occurs slowly and is possibly incomplete. Even with infusion seven days before parturition, equilibrium is not reached between the maternal and umbilical-cord blood at delivery.1 The same investigators infused tri-iodothyronine (T3) tagged with 131I and suggested from this study that T3 might cross the placenta more readily than T4. In a similar study Kearns and Hutson2 injected 131I-tagged T4 and T3 into pregnant women two to eight hours before inducing delivery. Approximately 5 per cent of levo-T4 . . .