tbuckley/cabot-search huggingface dataset:
Dissecting aortic aneurysm associated with congenital bicuspid aortic valve.
Authors: W DEdwards, D SLeaf, J EEdwards
Journal: Circulation (1978)

Among 119 cases of fatal dissecting aneurysm of the aorta, exclusive of those iatrogenically caused or associated with arachnodactyly or aortic stenosis, there were observed 11 cases of congenital bicuspid aortic valve (9%). The ages ranged from 17 to 69 years, five of the patients being 29 years old or younger. Among the latter, three had coarctation of the aorta and one had Turner's syndrome without coarctation. In one of the older patients, aortic insufficiency was present. Hypertension was either established or inferred from cardiac weight in 73% of the cases. In each case, cystic medial necrosis of the aorta was present. Prolapse of valves other than the aortic was observed in 45% of the cases with bicuspid aortic valve. Compared to an estimated incidence of bicuspid aortic valve of about 1 to 2% in the population, the high incidence among subjects with dissecting aneurysm suggests a causative relationship between bicuspid aortic valve and aortic dissecting aneurysm.
Response by Bohula et al to Letters Regarding Article, “Prevention of Stroke With the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)”
Authors: Erin A. Bohula, Stephen D. Wiviott, Robert P. Giugliano, Jeong-Gun Park, Sabina A. Murphy, Christopher P. Cannon, Eugene Braunwald
Journal: Circulation (2018)
Glucocorticoid-Induced Osteoporosis
Authors: Lenore Buckley, Mary B. Humphrey
Journal: New England Journal of Medicine (2018)

Fracture-risk screening is indicated with initiation of glucocorticoids. If the risk is high because of age, bone mineral density, or the fracture risk assessment tool score, pharmacologic treatment is recommended; bisphosphonates are recommended as first-line treatment.
IS Eus-Guided Hepaticogastrostomy Efficient In Hilar Biliary Stricture Induced By Bile Duct Cancer?
Authors: A Schoch, A Lisotti, F Fumex, S Leblanc, P Artru, J Desrame, J Marsot, JC Souquet, B Napoleon
Journal: Endoscopy (2021)

Aims To evaluate the clinical outcomes of patients affected by bile duct cancers (BDC) involving the liver hilum treated with EUS-guided hepaticogastrostomy (EUS-HGS).
A clutch of new syndromes
Authors: M G Berry
Journal: Journal of the Royal Society of Medicine (2002)

In the ENT subsection of his paper (March 2002 JRSM1) Dr Le Fanu quotes a patient's description of sore ear, affecting a ‘line of rigid muscle alongside the soft outer ear’. Whilst there exist fine muscles on the posterior, or cranial, surface the skin adheres closely to the anterior, or lateral, surface of the auricle, which has very little subcutaneous tissue2. Seemingly the patient refers to a fold in the elastic cartilage known as the antihelix.

The symptoms in this case closely resemble those of chondrodermatitis nodularis helicis. Histologically such lesions show focal degenerative change with surrounding perichondritis and overlying hyperkeratosis and acanthosis3. The usual treatment is simple excision, but a patient who declined surgery later told me how he had invented his own method to avoid discomfort at night—cutting a hollow into his foam pillow to reduce pressure on the ear.
Usefulness of oral mucosal transudate for HIV antibody testing
Authors: K. Ryder
Journal: JAMA (1997)

To the Editor.  —The article by Ms Gallo and colleagues 1 on an oral mucosal transudate (OMT) system for human immunodeficiency virus type 1 (HIV-1) antibody testing cites sensitivity as an important characteristic of this type of test. The authors demonstrate that in the general population this test will perform well, with a negative predictive value of 99.9%. Little disease will escape undetected.  However, the general population has a much lower prevalence of HIV than their study population, in which 673 of 3570 subjects were positive for disease. The positive predictive value of the enzyme immunoassay (EIA) component of this test decreases from 97.5% in their sample to only 40% when applied to the general population. The OMT Western blot performs better, since none of the 2897 HIV-negative subjects in the study had a positive Western blot test result. Some still had an indeterminate test result, though, so the positive
Importance of internal controls, statistical methods, and side effects in short-term trials of vasodilators: a study of hydralazine kinetics in patients with aortic regurgitation.
Authors: C RMcKay, MNana, D TKawanishi, UElkayam, P AChandraratna, J NWeiss, S HRahimtoola
Journal: Circulation (1985)

We determined that the spontaneous changes in cardiac output (CO) over 12 hr in 21 patients with chronic severe aortic regurgitation averaged +/- 8.9% (p = .03). We then measured changes in CO over time after administering incremental doses of oral hydralazine (50, 100, 150, and 200 mg) every 12 hr and analyzed these changes by several methods. Changes over time of only + 14% were highly significant (p less than .001) when analyzed by t test, but were not significant by repeated-measures analysis of variance (ANOVA). When changes in CO were compared with internal control values (spontaneous changes over 12 hr), only changes of 20% or more were significant (p less than .05). Transient peak  markedly overestimated the maximum effects after all doses. We then compared the incremental doses of hydralazine, given either every 8 or every 12 hr, with respect to (1) the hemodynamic changes induced, and (2) the relative incidence of acute side effects. Maximal increases in CO were similar when hydralazine...
Treatment of Amyotrophic Lateral Sclerosis
Authors: Jon D. Dorman
Journal: JAMA (1969)

<h3>To the Editor:—</h3> In the Jan 13, 1969, issue ofThe Journala MEDICAL NEWS report (p 249) appeared entitled, "Drug May Arrest or Slow ALS," in which it is claimed that amitriptyline (Elavil) hydrochloride beneficially modifies the course of amyotrophic lateral sclerosis (ALS). Although this report claims amelioration in the clinical course of ALS, no acceptable evidence is presented to support this assertion. Although weight gain might indicate a real increase in muscle bulk and arrest of the disease, it might also represent increased fatty tissue or fluid. A true decrease in fasciculations could indicate change in the course of the disease, but one requires a quantitative technique to demonstrate that the fasciculation rate has indeed changed. In the presence of weight gain a thicker mantle of fatty tissue may obscure the observation of fasciculations. It was not mentioned in the report whether objective measurements of strength, functional performance
Antiplatelet treatment with ticlopidine in unstable angina. A controlled multicenter clinical trial. The Studio della Ticlopidina nell'Angina Instabile Group.
Authors: FBalsano, PRizzon, FVioli, DScrutinio, CCimminiello, FAguglia, CPasotti, GRudelli
Journal: Circulation (1990)

We conducted a controlled multicenter trial with central randomization and evaluation of events under blind conditions involving 652 patients with unstable angina. Patients were treated either with conventional therapy alone (group C) (n = 338) or with conventional therapy combined with an inhibitor of platelet aggregation, ticlopidine 250 mg b.i.d. (group C + T) (n = 314). Patients were assigned randomly within 48 hours of admission and followed up for 6 months. With the intention-to-treat approach, the primary end points, vascular death and nonfatal myocardial infarction, were observed in 13.6% of the patients in group C and in 7.3% of the patients in group C + T, which is a reduction in risk of 46.3% (p = 0.009). Vascular mortality was 4.7% in patients in group C and 2.5% in patients in group C + T, which is a reduction in risk of 46.8% (p = 0.139). The risk of nonfatal myocardial infarction was reduced by 46.1% (p = 0.039), with a frequency of 8.9% in patients in group C and 4.8% in patients in grou...
Carbon Monoxide Poisoning
Authors: C A Piantadosi
Journal: New England Journal of Medicine (2002)

Carbon monoxide poisoning is the most common type of accidental poisoning in the United States, accounting for thousands of emergency department visits and some 800 deaths annually. Carbon monoxide, an insidious byproduct of incomplete hydrocarbon combustion, is generated in toxic amounts by internal-combustion engines, fossil-fuel furnaces, and fires. Carbon monoxide emissions from modern automobiles, though controlled by regulatory standards, are still highly toxic in poorly ventilated spaces. A stable gas at physiologic temperatures, carbon monoxide diffuses rapidly across the alveolar capillary membrane and binds tightly to iron centers in hemoglobin and other hemoproteins.Claude Bernard first proposed in 1865 that . . .
Dynamics of right heart flow in patients after Fontan procedure.
Authors: MNakazawa, TNakanishi, HOkuda, GSatomi, SNakae, YImai, ATakao
Journal: Circulation (1984)

In seven patients who underwent Fontan procedures but in whom no valves were inserted, dynamics of right heart flow were evaluated with the use of  catheter-tipped velocity transducer, pulsed Doppler echocardiography, and angiocardiography. Right atrial (RA) contraction caused  forward flow to the pulmonary artery (PA) and  backward flow to the inferior vena cava (IVC). Backward flow to the superior vena cava (SVC) was minimal. As the right atrium relaxed,  rapid forward flow occurred at the IVC and SVC that filled the atrium and  small amount of pulmonary regurgitant flow was observed. Subsequently,  forward flow was observed at the IVC, SVC, and PA during RA diastole. Angiographically determined RA stroke volume (SV) was less than 40% of the left ventricular (LV) SV in three patients in whom the postoperative increase in atrial a wave pressure (delta p) was greater than 8 mm Hg, while it was similar to or greater than LVSV in four patients in whom delta p was 6 mm Hg or less. In all patients LV ...
Proarrhythmic effects of flecainide. Experimental evidence for increased susceptibility to reentrant arrhythmias.
Authors: JBrugada, LBoersma, CKirchhof, MAllessie
Journal: Circulation (1991)

BACKGROUNDThe goal of this study was to investigate the nature and electrophysiological mechanisms of the proarrhythmic effects of flecainide in Langendorff-perfused rabbit hearts.METHODS AND RESULTSA thin layer of epicardium was obtained by an endocardial cryotechnique in 10 Langendorff-perfused rabbit hearts. Six other hearts were kept intact. Programmed electrical stimulation using up to three closely coupled premature stimuli and burst pacing was used to test the inducibility of arrhythmias both during control and administration of 1 micrograms/ml flecainide. During control, in the thin layer of epicardium, application of one to three premature stimuli induced nonsustained ventricular tachycardia in out of 10 hearts, and burst pacing induced nonsustained ventricular tachycardia in four hearts and sustained ventricular tachycardia in two hearts. During administration of 1 microgram/ml flecainide, application of one to three premature stimuli induced sustained ventricular tachycardia in five hearts, and...
Effect of the geometry of the left ventricle on the calculation of ejection fraction.
Authors: J GDumesnil, R MShoucri
Journal: Circulation (1982)

We used a cylindrical model for the left ventricle contracting both radially and longitudinally to show how the ejection fraction is related to different variables that describe the ventricular geometry. The relations during ventricular contraction between wall thickening, midwall radius shortening and longitudinal shortening are used to derive precise formulas for the calculation of ventricular blood flow velocity and ejection fraction. Validation of the model is given by results from the literature and by a study of 40 patients. The formulas derived can be used to validate angiographic measurements or to assess more precisely blood flow velocity and ejection fraction from the M-mode echocardiogram. Ejection fraction is determined not only by the extent of myocardial shortening, but also by the relationship of ventricular wall thickness to ventricular cavity size.
Incremental value of the exercise test for diagnosing the presence or absence of coronary artery disease.
Authors: LGoldman, E FCook, NMitchell, MFlatley, HSherman, RRosati, FHarrell, KLee, P FCohn
Journal: Circulation (1982)

To determine the incremental value of the exercise test (ETT) for diagnosing coronary artery disease (CAD), we derived a multivariate logistic regression model for the pre-ETT prediction of CAD using data from 3840 patients at Duke University. We then applied the model to 324 patients at the Brigham and Women's Hospital. Using seven clinical factors, the multivariate model had an 84% overall predictive accuracy on both the training (Duke) and the validation (Brigham) sets of patients. Three ETT factors (ST-segment change in patients not taking digitalis, absence of ST-segment change in patients taking digitalis, ETT stopped because of ECG or blood pressure changes) had incremental, significant predictive power, but overall predictive accuracy based on both clinical and ETT factors improved only to 87%. When the ETT result was important enough to move the probability of CAD across a potential therapeutic threshold, the direction of the change in probability was correct only two-thirds of the time. Thus, th...
Validation of attenuation-corrected equilibrium radionuclide angiographic determinations of right ventricular volume: comparison with cast-validated biplane cineventriculography.
Authors: L JDell'Italia, M RStarling, R AWalsh, F RBadke, J CLasher, RBlumhardt
Journal: Circulation (1985)

To determine the accuracy of attenuation-corrected equilibrium radionuclide angiographic determinations of right ventricular volumes, we initially studied 14 postmortem human right ventricular casts by water displacement and biplane cineventriculography. Biplane cineventriculographic right ventricular cast volumes, calculated by a modification of Simpson's rule algorithm, correlated well with right ventricular cast volumes measured by water displacement (r = .97, y = 8 + 0.88x, SEE = 6 ml). Moreover, the mean volumes obtained by both methods were no different (73 +/- 28 vs 73 +/- 25 ml). Subsequently, we studied 16 patients by both biplane cineventriculography and equilibrium radionuclide angiography. The uncorrected radionuclide right ventricular volumes were calculated by normalizing background corrected end-diastolic and end-systolic counts from hand-drawn regions of interest obtained by phase analysis for cardiac cycles processed, frame rate, and blood sample counts. Attenuation correction was perform...
Effects of amrinone on myocardial energy metabolism and hemodynamics in patients with severe congestive heart failure due to coronary artery disease.
Authors: J RBenotti, WGrossman, EBraunwald, B ACarabello
Journal: Circulation (1980)

Amrinone has been shown to exhibit a potent inotropic effect in patients with heart failure secondary to congestive cardiomyopathy, but its effects on myocardial oxygen consumption (MVO2) and coronary blood flow (CBF) are unknown. Accordingly, the hemodynamic, myocardial metabolic and ECG responses to amrinone (2.5 mg/kg i.v. over 1 hour) were measured in nine patients with congestive heart failure secondary to coronary artery disease. Increases were observed in cardiac index (1.3 +/- 0.4 to 2.2 +/- 0.7 l/min/m2) and left ventricular stroke work (10.6 +/- 3.0 to 19.2 +/- 6.3 g-m/m2), and decreases in mean pulmonary wedge (31 +/- 5 to 26 +/- 4 mm Hg), mean pulmonary artery (44 +/- 8 to 36 +/- 7 mm Hg) and mean right atrial pressures (18 +/- 4 to 10 +/- 4 mm Hg), myocardial arteriovenous oxygen difference (129 +/- 19 to 109 +/- 17 ml/l), CBF (215 +/- 117 to 178 +/- 84 ml/min) and MVO2 (27 +/- 14 to 19 +/- 9 ml/min). All changes were significant (p less than 0.01). No significant changes occurred in aortic m...
Lymphatic pumping in response to changes in transmural pressure is modulated by erythrolysate/hemoglobin.
Authors: R MElias, GWandolo, N SRanadive, JEisenhoffer, M GJohnston
Journal: Circulation Research (1990)

Red blood cells and lysate products (erythrolysate) are observed consistently in lymph draining acute and chronic inflammatory reactions and from tissues subjected to trauma or surgical procedures. Using hemoglobin as a marker for erythrolysate, we have measured hemoglobin in lymph up to the 10(-6) M range in a number of pathophysiological states. Data demonstrate that erythrolysate alters the pumping characteristics of lymphatic vessels. To test the effects of erythrolysate on lymphatic pumping, bovine lymphatics were suspended in an organ bath preparation with the vessels cannulated at both inflow and outflow ends. By raising the heights of the Krebs reservoir and the outflow catheters appropriately, a transmural pressure that stimulated pumping activity could be applied to the vessels. With a fixed transmural pressure of 6 cm H2O applied to the ducts, sheep erythrolysate depressed pumping activity between 40% and 100%, with dilutions containing between 10(-8) and 10(-5) M hemoglobin. Although the activ...
Inhibition of endothelium-derived relaxing factor enhances myocardial stunning in conscious dogs.
Authors: NHasebe, Y TShen, S FVatner
Journal: Circulation (1993)

BACKGROUNDImpaired endothelial-dependent vascular responses after coronary artery occlusion (CAO) and reperfusion (CAR) have been investigated extensively. However, it is not known whether impaired endogenous endothelium-derived relaxing factor production affects postischemic myocardial dysfunction, ie, myocardial stunning.METHODS AND RESULTSEight dogs were instrumented with an intracoronary catheter and an hydraulic occluder on the left circumflex coronary artery. The effects of a 10-minute CAO randomized with and without intracoronary administration of NG-nitro-L-arginine (L-NA), a nitric oxide (NO) synthesis inhibitor, were compared in the same conscious dogs. Postischemic regional contractile dysfunction in subendocardial and subepicardial as well as transmural wall thickening was measured with ultrasonic dimension crystals, and myocardial blood flow was measured with radioactive microspheres. Intracoronary infusion of L-NA did not affect systemic hemodynamics, and transmural myocardial blood flow was...
Treatment of infective endocarditis: a 10-year comparative analysis.
Authors: J VRichardson, R BKarp, J WKirklin, W EDismukes
Journal: Circulation (1978)

The results of surgical and non-surgical treatment of active infective endocarditis in 182 patients over a 10-year period were analyzed. Heart failure, annular and myocardial abscesses, heart block, and coronary embolism, seen most frequently with staphylococcal and fungal endocarditis, were the primary causes of death in both native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). In NVE, surgery significantly improved the survival in patients with moderate or severe heart failure (P less than 0.05) and in all patients with staphylococcal endocarditis (P less than 0.03). In PVE, surgery significantly influenced survival in patients with moderate or severe heart failure (P less than 0.05) and in the entire group with late PVE (P less than 0.01). Early surgery is recommended for patients with native valve endocarditis and moderate or severe heart failure; those patients with staphylococcal NVE, regardless of hemodynamic state, should undergo early valve replacement. Early surgery is recomm...
Advantages and disadvantages of neonatal circumcision
Authors: R. Goldman
Journal: JAMA (1997)

To the Editor.  —Circumcision depends on the perpetuation of American cultural beliefs that support it. One way to justify inflicting pain and harm on others is to believe that otherwise more pain and harm will follow. Using this strategy to defend circumcision requires minimizing or denying the harm caused by circumcision and producing medical claims about protection from potential future pain and harm. Circumcision advocates claim that the surgery has prophylactic effects. Laumann et al1provide another response to this belief.  For some people, claims of medical benefits are sufficient justification for circumcision partly because circumcision is a surgical procedure that is done on someone else. Using medical claims and studies to defend circumcision may be an unconscious way for some physicians to avoid the emotional discomfort of questioning their own circumcision. A survey of primary care physicians showed that circumcision was supported more often by physicians who were older, male, and
Re-entrant ventricular arrhythmias in the late myocardial infarction period. 3. Manifest and concealed extrasystolic grouping.
Authors: NEl-Sherif, RLazzara, R RHope, B JScherlag
Journal: Circulation (1977)

Re-entrant beats with regular extrasystolic grouping were seen in 44- of dogs 3--7 days following ligation of the anterior descending coronary artery. Utilizing direct recording of the re-entrant pathway (RP) from the epicardial surface of the infarction zone, we found extrasystolic grouping to be based on the infarction tachycardia-dependent conduction disorders in a potentially RP. Trigeminy and quadrigeminy were related, respectively, to a 3:2 and 4:3 Wenckebach-like conduction cycle in a RP. However, quadrigeminy could also be due to an underlying bigeminal rhythm with concealment of alternate re-entrant beats, i.e., concealed bigeminy. A bigeminal rhythm was the result of a 2:1 conduction pattern in a re-entrant pathway with a sufficient degree of conduction delay during the conducted beat of the 2:1 cycle to result in re-entry. A trigeminal or quadrigeminal rhythm could change to a bigeminal rhythm on critical shortening of the cardiac cycle. Fixed and variable coupling were related, respectively, t...
<i>Helicobacter pylori</i>resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community
Authors: Francis Megraud, Robin Bruyndonckx, Samuel Coenen, Linda Wittkop, Te-Din Huang, Martin Hoebeke, Lucie Bénéjat, Philippe Lehours, Herman Goossens, Youri Glupczynski
Journal: Gut (2021)

Objective Our aim was to prospectively assess the antibiotic resistance rates in Helicobacter pylori strains in Europe in 2018 and to study the link between antibiotic consumption in the community and H. pylori resistance levels in the different countries. Design The proportion of primary antibiotic resistance cases of H. pylori and their corresponding risk factors were investigated in 24 centres from 18 European countries according to a standardised protocol. Data on antibiotic consumption in the community were collected for the period 2008–2017. The link between antibiotic consumption and resistance data was assessed using generalised linear mixed models. The model with the best fit was selected by means of the Akaike Information Criterion. Results H. pylori resistance rates for the 1211 adult patients included were 21.4% for clarithromycin, 15.8% for levofloxacin and 38.9% for metronidazole and were significantly higher in Central/Western and Southern than in the Northern European countries. The best model fit was obtained for the Poisson distribution using 2013 consumption data. A signiﬁcant association was found between H. pylori clarithromycin resistance and consumption in the community of macrolides (p=0.0003) and intermediate-acting macrolides (p=0.005), and between levoﬂoxacin resistance and consumption of quinolones (p=0.0002) and second-generation quinolones (p=0.0003). Conclusion This study confirms the positive correlation between macrolide and quinolone consumption in the community and corresponding H. pylori resistance in European countries. Hence, H. pylori treatment with clarithromycin and levofloxacin should not be started without susceptibility testing in most European countries.