tbuckley/cabot-search huggingface dataset:
Medical Obfuscation: Structure and Function
Authors: Michael Crichton
Journal: New England Journal of Medicine (1975)

Most medical communications are difficult to read. To determine why, contributions to three issues of the New England Journal of Medicine were studied, and the prose analyzed.Materials and MethodsArticles were taken from the Journal issues dated April 4, 1974; February 6, 1975; and October 16, 1975. These issues lay buried under a pile of papers on my desk. Articles were read at random.ResultsI identified 10 recurring faults in the Journal articles I read.1. Poor Flow of IdeasThis is the most common and subtle fault plaguing medical communication. Within a single sentence, or from one . . .
Gallium Imaging in Inflammatory Diseases
Authors: M. Moinuddin, J. F. Rockett
Journal: Clinical Nuclear Medicine (1976)

67Ga-gallium citrate imaging has been found to be a very useful diagnostic modality for the detection and localization of inflammatory lesions. Prior selection of patients who are going to be benefited by this diagnostic procedure is important because of the lack of specificity of this radiopharmaceutical. 67Ga is known to become localized in cerebral infarctions, myocardial infarctions, fracture, Paget's disease of bone, inflammatory and neoplastic processes, and a host of other entities. Hence the need for a better definition and its indications in certain clinical conditions. FUO in the postoperative period and the immunologically deficient patient constitute important situations in addition to the numerous other conditions in which the index of suspicion for an occult septic process is high. In this communication a catalog of inflammatory diseases in various locations is described in which 67Ga imaging is useful.
Frequency Analysis in Different Types of Paroxysmal Atrial Fibrillation
Authors: Yenn-Jiang Lin, Ching-Tai Tai, Tsair Kao, Han-Wen Tso, Satoshi Higa, Hsuan-Ming Tsao, Shih-Lin Chang, Ming-Hsiung Hsieh, Shih-Ann Chen
Journal: Journal of the American College of Cardiology (2006)
Suicide Attempts and the Nicotine Patch
Authors: Charles J. Engel
Journal: JAMA (1993)

To the Editor.  —Within recent months, four pharmaceutical manufacturers have brought nicotine replacement patches onto the US market for the treatment of nicotine dependence. The package inserts for these nicotine patches warn physicians that the risks of nicotine replacement therapy in patients with known cardiovascular or peripheral vascular disease should be weighed carefully against the benefits of smoking cessation. We write to report the case of a patient with known coronary artery disease who attempted suicide by means of nicotine overdose using nicotine patches.  Report of a Case.  —Our patient was a 44-year-old man who presented in October 1992 with a single episode of major depression and recurrent suicidal ideation. Diagnostic evaluation resulted in additional diagnoses of pathological gambling, alcohol dependence syndrome, and nicotine dependence. The patient had undergone coronary angioplasty in August 1992 for coronary artery disease. Two weeks prior to his October hospital admission, he attempted suicide by
Chemotherapy in advanced ovarian cancer.
Authors: L. A. Stewart, D. Guthrie, M. K. Parmar, C. J. Williams
Journal: BMJ (1992)

factors, we suggest that this has two profound implications: firstly, risk factors in the disease will be defined as those that alter expression of the precursor protein gene, and, secondly, effective treatments of Alzheimer's disease will be those targeted at modulating expression of the precursor protein gene.
Boehringer Ingelheim withheld safety analyses on new anticoagulant, The BMJ investigation finds
Authors: Z. Kmietowicz
Journal: BMJ (2014)

The drug company Boehringer Ingelheim withheld from doctors and drug regulators the fact that monitoring the blood level of its new anticoagulant stroke drug and adjusting the dose could substantially reduce major bleeds associated with it, an investigation by The BMJ has found.1

Dabigatran (marketed as Pradaxa) was licensed for stroke prevention in patients with non-valvular atrial fibrillation by the US Food and Drug Administration in 2010 and by the European Medicines Agency a year later. It is one of a new generation of oral anticoagulants that have been marketed as being more convenient than the traditional anticoagulant warfarin because patients do not need regular tests to check concentrations of drug in their blood.

This unique selling point has been used prominently by Boehringer Ingelheim. Dabigatran did not require “regular blood tests to …
An 81 year old man with a blistering rash
Authors: S. Noel, J. Dua, G. Kaushal
Journal: BMJ (2013)

An 81 year old man presented with a 10 day history of an extensive blistering rash that was profoundly itchy. He had a history of hypothyroidism and a deep vein thrombosis. He was receiving carbimazole and warfarin and denied any recent changes in medication.

On examination he had more than 100 blisters over his whole body, although his face was spared (fig 1⇓). Some of the blisters formed a circinate pattern. Nikolsky’s sign was negative. The mucous membranes were not affected.



Fig 1 Rash on patient’s torso



Blood tests including full blood count, urea and electrolytes, and liver function tests were within normal ranges. He had a C reactive protein of 28.8 mg/L (reference range 0-4.9; 1 mg/L=9.52 nmol/L).



### 1 What are the possible causes of this man’s blisters?

#### Short answer

The main differential diagnoses are bullous pemphigoid, linear IgA disease, and epidermolysis bullosa acquisita.1 This patient had bullous pemphigoid, the most common autoimmune subepidermal blistering disorder. It mainly affects older patients and presents with tense fluid filled blisters that can appear anywhere on the body, including the mucous membranes. It typically occurs over the limbs, groin, and abdomen.1 2

#### Long answer

Differential diagnoses for skin blistering disorders include bullous pemphigoid, epidermolysis bullosa acquisita, linear IgA disease, and a bullous drug reaction.1 Localised blisters, particularly those on the feet, may be caused by infections such as bullous tinea pedis. Superficial pemphigus vulgaris can usually be discounted because it rarely leaves more than erosions.3

Linear IgA disease typically produces symmetrical annular collections of papules and bullae on the extensor surfaces.2 It is a rare autoimmune condition. Linear depositions of IgA are seen …
Sustained volume retention in vivo with adipocyte and lipoaspirate seeded silk scaffolds
Authors: Evangelia Bellas, Bruce J.B. Panilaitis, Dean L. Glettig, Carl A. Kirker-Head, James J. Yoo, Kacey G. Marra, J. Peter Rubin, David L. Kaplan
Journal: Biomaterials (2013)
THE RECOVERY OF VACCINE VIRUS AFTER NEUTRALIZATION WITH IMMUNE SERUM
Authors: Perrin H. Long, Peter K. Olitskly
Journal: The Journal of Experimental Medicine (1930)

1. When vaccine virus and its specific antiserum are brought together, no evidence of stable union between them can be determined by the experimental methods employed. 2. A definite relationship exists between the degree of dilution of a neutral vaccine virus-antiserum mixture and the size of the lesion produced by endermic inoculation of rabbits of any given dilution.
Handbook of Pediatric Cardiology
Authors: Teresa E. Berry
Journal: JAMA (1980)

<i>Handbook of Pediatric Cardiology</i>, a practical well-illustrated introductory text for medical students, pediatricians, and general practitioners, offers a concise and accurate summary of the subject. It will be particularly helpful to the noncardiologist approaching the differential diagnosis and treatment of a new patient. Beginning with chapters on anatomy and embryology, Drs Krovetz, Gessner, and Schiebler progress through a description of various congenital heart defects and a survey of acquired heart disease. The chapter on congestive heart failure not only details the most frequent causes in various age groups but contains a useful "how to do it" section on therapy. There is also a chapter entitled "How to Diagnose Congenital Heart Disease in One Easy Lesson," which presents a schema for the diagnosis of congenital heart defects in children older than 1 year. To be sure, some important subjects such as arrhythmias and pericardial diseases are handled somewhat superficially, but that
The Consult Guys - A 23-Year-Old With a Myocardial Infarction: Will You Get the Right Diagnosis?
Authors: Geno J. Merli, Howard H. Weitz
Journal: Annals of Internal Medicine (2013)

Web ExclusivesSeptember 17, 2013The Consult Guys - A 23-Year-Old With a Myocardial Infarction: Will You Get the Right Diagnosis?FREEGeno J. Merli, MD and Howard H. Weitz, MDGeno J. Merli, MDSearch for more papers by this author and Howard H. Weitz, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G13-3002 SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.For more videos from and information on The Consult Guys, visit www.annals.org/ConsultGuys. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Disclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Bayer, sanofi-aventis; Consultancies: Bristol-Myers Squibb, Bayer, sanofi-aventis. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics September 17, 2013Volume 159, Issue 6Page: CG2KeywordsMyocardial infarction ePublished: 17 September 2013 Issue Published: September 17, 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.Loading ...
October—Immunization Action Month
Authors: John C. Alexander
Journal: JAMA (1976)

To the Editor.—  The EDITORIAL, October—Immunization Action Month, (234:416, 1975) states quite well the problem caused by declining immunization levels. The solution, however, will never be found utilizing primarily the news media. The recession and escalation of medical care costs will compound the difficulties for states and communities to expand their immunization activities as federal appropriations decline.  National immunization data are of little help in assessing local needs. We have found that inexpensive immunization surveys 1 pinpoint deficiencies, and campaigns can be organized where necessary. Other approaches such as comprehensive immunization-motivation efforts have also been shown to be effective.  Immunizations are among the most cost effective medical procedures available. It is difficult to believe that with health care expenditures exceeding $118 billion, we are still unable to immunize all our preschool children.
Study of a Kindred Afflicted with Pheochromocytomas, Medullary Carcinoma, Hyperparathyroidism, and Cushing's Syndrome.
Authors: Alton L. Steiner
Journal: Annals of Internal Medicine (1967)

s1 May 1967Study of a Kindred Afflicted with Pheochromocytomas, Medullary Carcinoma, Hyperparathyroidism, and Cushing's Syndrome.Alton L. Steiner, M.D., A. David Goodman, M.D., Samuel R. Powers Jr., M.D.Alton L. Steiner, M.D.Search for more papers by this author, A. David Goodman, M.D.Search for more papers by this author, Samuel R. Powers Jr., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-66-5-1030_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptEleven cases of pheochromocytoma, four of medullary thyroid carcinoma, two of parathyroid adenoma, and one of Cushing's syndrome have been demonstrated in a family that we have traced through seven generations.The pheochromocytomas have been of adrenal origin, and all have been bilateral. In the majority of cases, there has been paroxysmal hypertension. However, two affected patients had recurrent, severe paroxysms of tachycardia, tremor, and headache during which the blood pressure was normal, illustrating one of the difficulties in the diagnosis of paroxysmal pheochromocytomas.Provocative testing was performed in several patients. Intravenous histamine and glucagon proved to be about equally... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Alton L. Steiner, M.D.; A. David Goodman, M.D.; Samuel R. PowersJr., M.D.Affiliations: Albany, New York PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1967Volume 66, Issue 5Page: 1030-1030KeywordsBlood pressureGlucagonHeadachesHistamineHyperparathyroidismHypertensionMedullary thyroid carcinomaParathyroid tumorsPheochromocytomaTachycardia ePublished: 1 December 2008 Issue Published: 1 May 1967 PDF downloadLoading ...
Childhood cancer and proximity to mobile phone masts
Authors: J. F. Bithell
Journal: BMJ (2010)

Epidemiological studies show no increased risk

Radiofrequency fields are now ubiquitous, and several studies have assessed their potential health effects,1 with predominantly negative results. The two main areas of research are exposure associated with the use of mobile phones—for example, the recently published INTERPHONE study2—and risks associated with transmitters, including mobile phone masts.

The linked case-control study by Elliott and colleagues (doi:10.1136/bmj.c3077), assesses whether proximity to masts during pregnancy raises the risk of children developing leukaemia or a tumour in the brain or central nervous system.3 The study identified 1397 British children registered with leukaemia or a tumour in the brain or central nervous system between 1999 and 2001, and it compared each of these children with four controls sampled from the national birth registers who were matched for sex and date of birth. The study found no association between the risk of cancer in early childhood and exposure to a mobile phone base station during pregnancy.

The levels of individual …
Acquired reactive perforating collagenosis: four patients with a giant variant treated with allopurinol
Authors: S.R. Hoque, M. Ameen, C.A. Holden
Journal: British Journal of Dermatology (2006)

Reactive perforating collagenosis (RPC) is one of the four essential acquired perforating dermatoses. The condition is characterized by the transepidermal elimination of altered collagen. This paper describes four patients with a giant variant of RPC which has not previously been documented. Three of the patients had associated diabetes mellitus and one had chronic renal failure secondary to fetal scarring. Three of the four patients had a significant improvement in their lesions and symptoms following treatment with allopurinol.
Graduate Medical Education and Physician Practice Location
Authors: Sarena D. Seifer
Journal: JAMA (1995)

To determine the relationship between graduate medical education and physician practice location.Cross-sectional analysis of physicians in active practice in 1993, classified by state of graduate medical education and stratified by specialty and professional activity. Logistic regression analysis was used to examine predictors of physicians remaining to practice in the same state in which they trained.There were 82,871 allopathic physicians (national random sample) and 15,076 osteopathic physicians (universe) who completed graduate medical education between 1980 and 1992.Practice location in the same state as graduate medical education.Overall, 51% of physicians are practicing in the state in which they obtained their graduate medical education (range among states, 6% to 71%). Generalist physicians are more likely than specialists to remain in their state of graduate medical education (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.33 to 1.40) There is a weak negative association between the number of physicians in training per capita in a state and the likelihood of a physician remaining in the state to practice (OR, 0.90; 95% CI, 0.90 to 0.91, for an increment in resident supply of 10 per 100,000 population). New York and Massachusetts, the states with the highest numbers of residents per capita, retained 51% and 49%, respectively, of their graduates, placing them near the median among states.Most physician training and practice locations function as a national market, with physicians dispersing relatively widely after completing graduate medical education. States that produce high numbers of physicians per capita do not appear to play a unique role in training physicians to serve a national market. These findings pose challenges for states attempting to modify their physician supply and specialty mix.
Management of Organic Hypoglycemia with Thiazide Derivatives.
Authors: Sheldon J. Bleicher
Journal: Annals of Internal Medicine (1966)

s1 May 1966Management of Organic Hypoglycemia with Thiazide Derivatives.Sheldon J. Bleicher, M.D., Martin G. Goldner, M.D., F.A.C.P.Sheldon J. Bleicher, M.D.Search for more papers by this author, Martin G. Goldner, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-64-5-1172_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptDuring the past 12 months, five patients with organic hypoglycemia were treated with diazoxide (200 to 400 mg/day), either alone or in combination with chlorothiazide (500 mg/day), utilizing the thiazide hyperglycemia as a therapeutic modality. One patient suffered from glycogenosis, the four others from functioning islet cell tumors. In three of these four patients, the diagnosis had been confirmed surgically: two patients had been operated upon previously, and their recurrent symptoms were due to metastases; one patient underwent surgical removal of the tumor after the treatment period. Plasma glucose and insulin levels (immunoassayable insulin), the excretion of catecholamines, 17-ketosteroids and... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Brooklyn, New York PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1966Volume 64, Issue 5Page: 1172-1172KeywordsBlood plasmaCatecholaminesExcretionGlucoseGlycogen storage diseasesHyperglycemiaHypoglycemiaInsulin Issue Published: 1 May 1966 PDF DownloadLoading ...
P91 Development And Implementation Of A Structured, Annual 'comprehensive Respiratory Assessment' For Individuals With Advanced Copd
Authors: N. Toms, N. Greening, R. Free, J. Williams, R. Evans, M. Steiner
Journal: Thorax (2014)

<h3>Introduction</h3> Disease burden, polypharmacy, co-morbidities and complex social needs are significant in patients with advanced COPD and predict morbidity, mortality and health care utilisation. Our first aim was to develop a structured annual assessment for patients with advanced COPD: the ‘Comprehensive Respiratory Assessment (CRA)’ to systematically assess disease burden, co-morbidities and social care needs akin to the ‘Comprehensive Geriatric Assessment’. The second aim was to use the CRA in an out-patient setting to inform an individualised care plan. We report our first year experience of implementing an Advanced COPD Clinic with an annual CRA. <h3>Methods</h3> A multi-disciplinary team developed the Comprehensive Respiratory Assessment (CRA) for patients with advanced COPD which was defined as an FEV<sub>1</sub> of &lt;50% predicted with one of the following: MRC ≥ 4, Respiratory Failure, ≥2 hospital admissions with an acute exacerbation of COPD, current smoking history, and a low BMI or significant weight loss. A bespoke electronic patient record (the airways disease database [ADD]) was developed to support the CRA. The CRA was performed annually by an advanced COPD nurse and subsequently reviewed in an out-patient clinic by a respiratory physician supported by a multi-disciplinary team whereby an individualised care plan was agreed with the patient. Ethical approval was sought and written consent provided. <h3>Results</h3> The Advanced COPD service and CRA was established in June 2013 in Leicester, UK. The CRA is categorised into four principal domains which are: (1) exercise and activity, (2) exacerbations, (3) co-morbidities and extra-pulmonary manifestations, and (4) prognostic indicators and end of life care needs. At one year 155 referrals have been made with 71 annual CRAs completed to date. The baseline data of the patient cohort are described in Table 1. <h3>Conclusion</h3> The innovation of an advanced COPD service, with a multi-disciplinary team, supported by an annual Comprehensive Respiratory Assessment and bespoke electronic patient record is feasible and allows systematic assessment, development of individualised treatment plans, and further characterisation of this cohort.
REST AND EXERCISE RIGHT VENTRICULAR FUNCTION IN PATIENTS WITH CHRONIC CORONARY ARTERY DISEASE
Authors: G. H. Hendrix, S.C. Charleston, D. S. Dymond, D. L. Stone, A. T. Elliott
Journal: Clinical Nuclear Medicine (1983)

Medical University of South Carolina, Charleston, S.C., D.S. Dymond, D.L. Stone, and A.T. Elliott, Departments of Cardiology and Nuclear Medicine, St. Bartholomew's Hospital, London, U.K.
Two Cases of Pediatric Bone Disease (Eosinophilic Granuloma and Brodie’s Abscess) Showing Similar Scintigraphic and Radiographic Findings
Authors: MIHO YOSHIKAWA, YOSHIFUMI SUGAWARA, TAKANORI KIKUCHI, SHIGERU NAKATA, TERUHITO MOCHIZUKI, JUNPEI IKEZOE, KENSHI SAKAYAMA
Journal: Clinical Nuclear Medicine (2000)

Two 9-year-old patients with femoral bone lesions were referred to the authors' institution within a few days of each other. Both showed similar radiographic, magnetic resonance imaging, and scintigraphic findings. The radiographs showed osteolytic lesions in the right femoral diaphyses, and gadolinium-DTPA–enhanced magnetic resonance imaging revealed inhomogeneous enhancement. Tc-99m HMDP showed marked linear accumulation with relatively low central uptake in the right femoral shafts, and Tl-201 scintigraphy showed considerable uptake corresponding to the area seen with Tc-99m HMDP. Histologic analysis confirmed eosinophilic granuloma in the first patient and Brodie's abscess in the second. The radiographic and scintigraphic findings in Brodie's abscess may be similar to those in eosinophilic granuloma.