tbuckley/cabot-search huggingface dataset:
Fetal Retroperitoneal Fibrosis Associated With Hydramnios
Authors: John L. Duffy
Journal: JAMA (1966)

Idiopathic retroperitoneal fibrosis developed in a fetus and was associated with acute second-trimester hydramnios. Glomerulosclerosis, histologically similar to glomerulonephritis, was also found and is felt to be due to increased renal vein pressure secondary to involvement of the inferior vena cava by the retroperitoneal fibrosis. It is postulated that fetal proteinuria also resulted and caused the hydramnios by increasing the osmolarity of the amniotic fluid. This case seems to give additional credence to the theory that, during the second half of pregnancy at least, amniotic fluid volume is regulated by the osmotic effect of protein introduced into the fluid by the fetal kidney and removed by the fetal gastrointestinal tract.
A CASE OF TRAUMATIC RUPTURE OF THE SIGMOID COLON: OPERATION: RECOVERY
Authors: W. Sheen
Journal: BMJ (1909)

1289'the case recorded by Mr. Roper, of Exeter, whose patient recovered with a gastric fistula and underwent some o)seryations similp to those made in the famous case of Alexis St. Martin.' We would submit that our cases suggest that-1.If stitches cut' through at the' operation' no further time should be wasted in trying to close a perforation.2. That such a perforation be covered by omentum, anchored in place by one or two sutures.3. That a gauze drain be conducted to the perforation and removed under an anaesthetic in forty-eight hours.4. That the chance of recovery under this treatment is unlikely to be less than if the ulcer is sutured.5. That the rdmote results of these cases, as regards pyloric obstruction, are no worse than when the ulcer is closed.6.That 'in these, as in many other cases, a primary gastro-enterostomy is unnecessary for the recovery of the majority of cases.CASE I. G., female, single, aged 35, a patient of Dr. W. B. Winston of Bowes Park.Eistory (September, 1906) of fourteen days' pain and tenderness in epigastrium, followed by signs of perforation ; operation fifteen hours after perforation.A large perforation was found on the anterior wall of the stomach near the pyloric end and the lesser curvature.The surrounding stomach wall was thickened, sodden, and inflamed, rendering it impossible to sew up the perforation, as stitches would not hold.A tag of omentum was drawn over the perforation and anchored in position by two stitches.A gauze plug was arranged arpund.The, peritoneal cavity was dry sponged through epigastric and suprapubic incisions and drainage tubes left in.At the end of forty-eight hours the plug was removed under chloroform by Dr. Winston.There was no escape of gastric contents.No food was given by mouth for twenty-four hours.At the end of twenty-four hours water was given for two days, and milk at the end of three days.The patient made an uninterrupted convalescence, and is very much better as a result of operation, at the end of two years showing no indication of any pyloric obstruction.CASE II.
Futility in Context
Authors: Stuart J. Youngner
Journal: JAMA (1990)

Two articles in this issue of<i>JAMA</i><sup>1,2</sup>make an important contribution to the growing debate about medical futility. The authors present a strong case that futile resuscitation need not be offered to patients and their families and may be denied when they request it. I have argued elsewhere that physicians might unreasonably diminish patient autonomy by acting on poorly defined notions of futility.<sup>3</sup>These articles make an equally important observation: by offering life-sustaining treatment that they consider futile, physicians may actually undermine patient and family autonomy. Such offers send a mixed message, implying a real choice when none exists. Furthermore, physicians have a socially sanctioned responsibility to evaluate, promote, and, when necessary, protect patients' best interests. As Tomlinson and Brody note, this role inevitably involves making value judgements as the physician weighs the potential harms and benefits of any given intervention. If such value judgments are "socially validated,"
Mental health in children
Authors: P. Mcardle, A. Thompson
Journal: BMJ (1993)

Summary: We present five cases of intraparotid facial nerve schwannoma. In four of the five cases, tumors arising from the main facial nerve trunk were centered just below the skull base near the stylomastoid foramen and had a small cranial extension into the lower facial nerve canal. In three cases, each tumor had higher signal intensity around the periphery on T2-weighted images (target sign). These findings may be highly suggestive of an intraparotid facial nerve schwannoma.
Glycemic Variability
Authors: Louis Monnier, Claude Colette
Journal: Diabetes Care (2008)

Diabetes is characterized by glycemic disorders that include both sustained chronic hyperglycemia and acute glucose fluctuations. There is now cogent evidence for the deleterious effects of sustained chronic hyperglycemia that results in excessive protein glycation and generation of oxidative stress. The role of glucose variability from peaks to nadirs is less documented, but there are many reasons to think that both upward (postprandial) and downward (interprandial) acute fluctuations of glucose around a mean value activate the oxidative stress. As a consequence, it is strongly suggested that a global antidiabetic strategy should be aimed at reducing to a minimum the different components of dysglycemia (i.e., A1C, fasting and postprandial glucose, as well as glucose variability). All the therapeutic agents that act on postprandial glucose excursions seem of particular interest for reducing the latter parameter (i.e., the glucose instability). Particular attention should be paid to such emerging therapeutic agents as the glucagon-like peptide 1 agonists and the dipeptidyl peptidase (DPP)-IV inhibitors that act through the incretin pathway.
A Case in which Movable Kidney Produced the usual Symptoms of Hepatic Colic: Successfully Treated by Nephrorrhaphy
Authors: M. Lawrie
Journal: BMJ (1901)

MEDICAL *OURNJL~~~~~~.which had been gradually increasing in severity for twenty years.There wAs xiothing rema.rkable'il her fahlily history, nor had she prev,iohsly had any serious illness.Her family consisted of ten children, including Atwins, and the youngest was xS years of age.The patient was of a very nervous temperament and, despite the atiacks described below, had been too diffident to consult a medical man.
Methyldibromoglutaronitrile allergy: relationship between patch test and repeated open application test thresholds
Authors: L.A. Fischer, J.D. Johansen, T. Menné
Journal: British Journal of Dermatology (2008)

Background Methyldibromoglutaronitrile (MDBGN) is a preservative, which was approved for use in cosmetics in the mid-1980s. The incidence of allergy to MDBGN rose during the 1990s, but is now decreasing due to regulatory intervention. Experimental studies with other allergens have shown a significant relationship between the patch test and the repeated open application test (ROAT) reactivity. Objectives To study the relationship between elicitation threshold doses at single occluded exposure and repeated open application, using MDBGN as the allergen. Methods Eighteen subjects allergic to MDBGN were tested with a dilution series of MDBGN in a patch test and a ROAT (duration up to 21 days). Seventeen people with no MDBGN allergy were included as a control group for the ROAT. Results The response frequency for the ROAT (in μg MDBGN cm−2 per application) was significantly higher than the response frequency for the patch test, while the response frequency for the accumulated ROAT dose, at 1, 2 and 3 weeks was very similar to the patch test response frequency; indeed there was no statistical significant difference. Conclusions For elicitation of MDBGN allergy the response frequency for the patch test is lower than the response frequency (per application) for the ROAT, but approximately the same as the response frequency for the accumulated ROAT doses. This is important for risk assessment in general.
Imaging Features in a Rare Case of MALTOMA of the Thyroid
Authors: Ramesh Agrawal, Archi Agrawal
Journal: Clinical Nuclear Medicine (2010)

A 54-year-old male patient was referred to us for a mass in the anterior neck. On examination, he had a solitary thyroid nodule in his right lobe, measuring 5 × 5 cm, approximately. A Tc-99m pertechnetate thyroid scan revealed a cold nodule in the lower two-third of the right lobe of the thyroid. Ultrasonography revealed a markedly hypoechoic lesion in the right lobe and isthmus. The left lobe was normal and there were no enlarged lymph nodes. FDG PET scan showed intense FDG uptake in the right lobe nodule. Fine needle aspiration cytology suggested Hashimoto thyroiditis. But due to the enlarging mass, the surgeons chose to perform a right hemithyroidectomy. The histopathology revealed a dense lymphoid infiltrate composed of small monomorphous lymphocytes, plasma cells, and occasional eosinophils. Lymphoid cells were seen infiltrating the thyroid follicles and at places destroying the follicles, resulting in formation of lymphoepithelial lesions, with features suggesting a MALTOMA (Mucosa-Associated Lymphoid Tissue Lymphoma)—a low grade non-Hodgkin lymphoma, arising in the background of Hashimoto thyroiditis. This case highlights the fact that marked hypoechogenicity in a thyroid nodule, seen on sonography—which is usually seen in lymphoma, should always be evaluated appropriately. It also reiterates the fact that a MALT lymphoma in the thyroid shows intense FDG accumulation on FDG PET scan, whereas MALT lesions elsewhere in the body are not hypermetabolic.
Health Insurance and Preventive Care
Authors: William K. Taylor
Journal: JAMA (1988)

<h3>To the Editor.</h3> —The Feb 5, 1988, issue of<i>JAMA</i>featured a review by Dr Arnold<sup>1</sup>of the textbook<i>The Preventive Approach to Patient Care</i>. The first sentence of his review reads, "Do you really harbor any doubts that preventive medicine is a worthwhile clinical activity for physicians?" I find this ironic coming from a person apparently affiliated with an insurance company. As a general internist I find my attempts to practice preventive medicine in my patients continually frustrated by insurance companies who refuse to pay for such procedures as screening physical examinations and mammograms. I have on my desk at this moment a letter from a patient asking me to write to her insurance company to explain why a mammogram was ordered for the patient since the company does not pay for "routine" mammograms. I believe it is time for third-party payers to help provide preventive medical care
Persistent remission of adult chronic autoimmune thrombocytopenic purpura after treatment with high‐dose intravenous immunoglobulin
Authors: Philippe Bierling, Marine Divine, Jean‐Pierre Farcet, Patrick Wallet, Najib Duedari
Journal: American Journal of Hematology (1987)

Abstract Transient efficacy of high‐dose intravenous immunoglobulin infusions (HDI) is widely demonstrated in autoimmune thrombocytopenic purpura (AITP). A trial involving repeated injections of HDI was conducted in two adult patients with chronic AITP in order to evaluate their long‐term efficacy in refractory forms and their ability to obviate splenectomy. Both patients received 2 g/kg body weight of polyvalent intact intravenous immunoglobulin followed by seven and eight boosters (0.8 to 1.2 g/kg body weight) when the platelet count decreased. It was found that the injections could be spaced progressively. The platelet count remained normal 200 and 800 days after the end of the treatment. The demonstration of the possible long‐term efficacy of repeated injections of intravenous immunoglobulin encourages us to recommend this safe therapy for patients with chronic AITP.
Bias in awarding research grants.
Authors: B Martin
Journal: BMJ (1986)

in this report, showed a desire for an increase in consultant physicians by about 126 (12%) over the next two years. This is considerably more than the figure quoted by the DHSS in its guidelines of August 1984, in which a net increase of 27 posts a year was predicted for the next four years. The numbers of other supporting staff?hospital practitioners, associate specialists, and clinical assistants?were not inconsiderable, amounting to 557 sessions a week, the equivalent of 50 whole time physicians. One should question whether 4'7% of the total workforce (and this is probably an underestimate) should be so constituted while consultant expansion is constrained. Further information on the role of these grades, particularly in technique oriented specialties such as endoscopy is required. What is the future for general medicine? Whatever the trends towards increasing specialisation the need to care for acute medical admissions, which account for an overwhelming proportion of the inpatient workload, will continue. Even if specialty transfer becomes more common in teaching hospitals logistics will make it impossible in all but the largest district hospital. The development of special interests is likely to continue at all grades, and to cover the wide range of different interests in the smaller hospital doctors may need to develop more than one interest. Other alternatives include cross district contracts and the development of a special interest by geriatrician colleagues. What is clear from this survey is that the general physician remains an essential component of hospital staff in the United Kingdom, and future training programmes must be structured with this in mind.
Quantitative Angiocardiography
Authors: J. WARD KENNEDY, STEPHEN R. YARNALL, JOHN A. MURRAY, MELVIN M. FIGLEY
Journal: Circulation (1970)

Quantitative angiocardiographic methods have been used to determine left ventricular volume and left ventricular mass (LVM) in 100 patients with isolated mitral valve disease. Thirty-six patients had mitral stenosis (MS), 29 had mitral regurgitation (MR), and 35 had combined stenosis and regurgitation (MS + MR). Data on volume and LVM from these patients are presented and are related to standard flow and intracardiac pressure determinations and compared with normal values. In patients with MS, the mean end-diastolic volume per square meter of body surface area (EDV/m 2 ) was 72 ml/m 2 and was increased to 148 ml/m 2 in those with MR. EDV/m 2 correlated closely with the severity of regurgitation and less well with LV end-diastolic pressure. The mean LV stroke volume was slightly smaller than normal in patients with MS (38 ml/m 2 ) and was greatly increased in those with MR (88 ml/m 2 ). The LV stroke volume correlated closely with the severity of regurgitation, r = 0.928. The ejection fraction (EF) was low in 37% of patients with MS and in 22% of those with MS + MR and MR alone. Left atrial volume was larger than normal in all patients and, although generally larger in those with regurgitation, did not correlate with its severity. In contrast, cyclic left atrial volume change was correlated with the severity of mitral regurgitation, r = 0.785. The data are presented with cumulative distribution curves suitable for reference standards.
Experimental hypersensitivity pneumonitis in the mouse: Histologic and immunologic features and their modulation with cyclosporin A
Authors: Hajime Takizawa, Matsunobu Suko, Nobuyuki Kobayashi, Shunsuke Shoji, Ken Ohta, Makoto Nogami, Hirokazu Okudaira, Terumasa Miyamoto, Junji Shiga
Journal: Journal of Allergy and Clinical Immunology (1988)
Perineural Invasion Is an Independent Predictor of Outcome in Colorectal Cancer
Authors: Catherine Liebig, Gustavo Ayala, Jonathan Wilks, Gordana Verstovsek, Hao Liu, Neeti Agarwal, David H. Berger, Daniel Albo
Journal: Journal of Clinical Oncology (2009)

Purpose Perineural invasion (PNI) is associated with decreased survival in several malignancies, but its significance in colorectal cancer (CRC) remains to be clearly defined. We evaluated PNI as a potential prognostic indicator in CRC, focusing on its significance in node-negative patients. Patients and Methods We identified 269 consecutive patients who had CRC resected at our institution. Tumors were rereviewed for PNI by a pathologist blinded to the patients' outcomes. Overall and disease-free survivals were determined using the Kaplan-Meier method, with differences determined by multivariate analysis using the Cox multiple hazards model. Results were compared using the log-rank test. Results PNI was identified in less than 0.5% of the initial pathology reports. On rereview, 22% of tumors in our series were found to be PNI positive. The 5-year disease-free survival rate was four-fold greater for patients with PNI-negative tumors versus those with PNI-positive tumors (65% v 16%, respectively; P &lt; .0001). The 5-year overall survival rate was 72% for PNI-negative tumors versus 25% for PNI-positive tumors. On multivariate analysis, PNI was an independent prognostic factor for both cancer-specific overall and disease-free survival. In a subset analysis comparing patients with node-negative disease with patients with stage III disease, the 5-year disease-free survival rate was 56% for stage III patients versus 29% for patients with node-negative, PNI-positive tumors (P = .0002). Similar results were seen for overall survival. Conclusion PNI is grossly underreported in CRC and could serve as an independent prognostic factor of outcomes in these patients. PNI should be considered when stratifying CRC patients for adjuvant treatment.
Reasons for and outcome of upper gastrointestinal endoscopy in patients aged 85 years or more: retrospective study
Authors: L Seinela, J Ahvenainen, J Ronneikko, M Haavisto
Journal: BMJ (1998)

Upper gastrointestinal endoscopy has proved to be safe and gives a high diagnostic yield in elderly people. 1-5The prevalence of gastrointestinal diseases increases with age, and elderly people are also more vulnerable to the complications of these diseases.We retrospectively studied 154 gastroscopies performed in patients aged 85 years or more to clarify the indications for and clinical findings of gastroscopy in very old people.We also studied the influence of the examination on treatment and symptoms.
Individual managers are liable for record discrimination award as well as trust
Authors: C. Dyer
Journal: BMJ (2012)

The record £4.5m (€5.4m; $7m) awarded by an employment tribunal last week to the sacked doctor Eva Michalak ( BMJ 2011;343:d8265, 20 Dec, doi:10.1136/bmj.d8265) is enforceable not only against the NHS trust that employed her but also against three senior employees who played key roles in the …
Children's Drawings and Nuclear War
Authors: Alfred Brauner
Journal: JAMA (1986)

<b>Background: The Children of War</b>Certain experiences are never forgotten. During the Spanish Civil War (1936-1939), one of us (F.B.) worked as a physician and the other (A.B.) organized homes for children who had been evacuated from combat zones. Many of these children were pathetically shocked and grieved. Although we are neither "art therapists" nor psychologists, we felt that describing their experiences, in words or pictures, might help release the children from their memories. We offered them paper and pencils, but it was only several months later that they had recovered enough to be able to draw.<sup>1</sup>We attempted to hide these 10 000 drawings when the German army invaded Paris in 1940, but almost all were discovered and destroyed by the Gestapo. Fifty-six hidden by F.B. were rediscovered in a demolished house 30 years later.<sup>2</sup> In 1939, we cared for 130 Jewish children from Germany and Austria
Leukemoid Reaction Due to Hypernephroma
Authors: Oscar Reiss
Journal: JAMA (1962)

IN THE PAST 10 years there has been no report in the English literature of a leukemoid reaction due to renal cancer. Textbooks of medicine list the signs and symptoms of renal malignancy as flank mass, flank pain, and hematuria. However, according to the Squier Urological Clinic of the Presbyterian Hospital in New York City, approximately 32% of tumors do not present with these findings. Hypercalcemia, weight loss, weakness, anorexia, metastatic lesions, hypertension, and varicocele may be the presenting manifestations of the malignancy. In addition to these findings, a review of 273 cases from the Mt. Sinai Hospital in New York City shows 15% of their cases presenting with fever only. This was low grade or as high as 105° F (40.56° C). In some cases the fever lasted between 2 and 6 months. Almost 3% had amyloid disease. The amyloid was either restricted to the involved kidney or distributed
Functional characterization of polymorphisms in DNA repair genes using cytogenetic challenge assays.
Authors: William W Au, Salama A Salama, Carlos H Sierra-Torres
Journal: Environmental Health Perspectives (2003)

A major barrier to understanding the role of polymorphic DNA repair genes for environmental cancer is that the functions of variant genotypes are largely unknown. Using our cytogenetic challenge assays, we conducted an investigation to address the deficiency. Using X-rays or ultraviolet (UV) light, we irradiated blood lymphocytes from 80 nonsmoking donors to challenge the cells to repair the induced DNA damage, and we analyzed expression of chromosome aberrations (CA) specific to the inducing agents. We have genotyped polymorphic DNA repair genes preferentially involved with base excision repair (BER) and nucleotide excision repair (NER) activities (XRCC1, XRCC3, APE1, XPD) corresponding to the repair of X-ray- and UV light-induced DNA damage, respectively. We expected that defects in specific DNA repair pathways due to polymorphisms would cause corresponding increases of specific CA. From our data, XRCC1 399Gln and XRCC3 241Met were associated with significant increases in chromosome deletions compared with the corresponding homozygous wild types (18.27 1.1 vs 14.79 1.2 and 18.22 0.99 vs 14.20 1.39, respectively); XPD 312Asn and XPD 751Gln were associated with significant increases in chromatid breaks compared with wild types (16.09 1.36 vs 11.41 0.98 and 16.87 1.27 vs 10.54 0.87, respectively), p < 0.05. The data indicate that XRCC1 399Gln and XRCC3 241Met are significantly defective in BER, and the XPD 312Asn and XPD 751Gln are significantly defective in NER. In addition, the variant genotypes interact significantly, with limited overlap of the two different repair pathways.