tbuckley/cabot-search huggingface dataset:
Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer.
Authors: J. L. Haybittle, D. Brinkley, J. Houghton, R. P. A'Hern, M. Baum
Journal: BMJ (1989)

To identify any excess mortality caused by adjuvant radiotherapy for early breast cancer.Prospective randomised clinical trial. Two thousand subjects needed for study to have a 90% chance of detecting a difference in survival rate of 7% with 95% significance. Patients were followed up until June 1988, giving follow up of 158-216 months.A multicentre trial mainly drawing patients from centres in the United Kingdom.2800 Women presenting with clinical stage I or II carcinoma of the breast from June 1970 to April 1975.One group of women (n = 1376) had simple mastectomy followed by immediate postoperative radiotherapy (1320 to 1510 rets). The remaining women (n = 1424) had simple mastectomy with subsequent careful observation of the axilla, radiotherapy being delayed until there was obvious progression or recurrence of disease locally.Increased mortality in patients treated with radiotherapy from causes other than breast cancer.Survival was measured from time of first treatment to death or last follow up. Deaths from any cause and from specified causes were counted as events. Comparison over the whole follow up showed a slight excess mortality in the group treated with radiotherapy (relative risk 1.04; 95% confidence interval 0.94 to 1.15). The relative risk of death from breast cancer was 0.97 (0.87 to 1.08) but that of death from other causes was 1.37 (1.09 to 1.72), the increase mainly being in women who had had tumours of the left breast (1.61 (1.17 to 2.24)) and had been treated with orthovoltage (1.85 (1.27 to 2.71)). Analysis of causes of death after five years showed a relative risk of 2.11 (1.25 to 3.59) for new malignancies and of 1.65 (1.05 to 2.58) for cardiac disease, the increase in cardiac mortality being most pronounced in patients who had had tumours of the left breast and whose treatment had included orthovoltage radiation (relative risk 2.67 (1.28 to 5.55)).Adjuvant radiotherapy after simple mastectomy for early breast cancer produces a small excess late mortality from other cancers and cardiac disease. The risk has to be balanced against the higher risk of local recurrence when immediate postoperative radiotherapy is not given. The balance has to be assessed for each patient, and for many patients radiotherapy will still be desirable in the initial treatment of their early breast cancer.
Dislocated and dislocatable hip in the newborn.
Authors: D M Dunn, S M O'Riordan
Journal: BMJ (1980)

What the fetus feels SIR,-I welcomed Dr H B Valman's excellent summary of early fetal awareness (26 January, p 233).In addition to simple sensory modalities, I am sure that the fetus responds to admixtures of complex sensations and of those hormones that derive from mother-for example, in singing, dancing, and vomiting.When a mother undergoes ultrasound scann- ing of the fetus, this seems a great opportunity for her to meet her child socially and in this way, one hopes, to view him as a companion aboard rather than as a parasite responsible for the symptoms of pregnancy.Doctors and technicians scanning mothers have a great opportunity to enable mothers to form an early affectionate bond to their child by demonstrating the child to the mother.This should help mothers to behave concernedly towards the fetus throughout pregnancy and may be expected to increase the bond on childbirth.
Safety Issues on Metformin Use
Authors: Saleh A. Aldasouqi, Daniel S. Duick
Journal: Diabetes Care (2003)

We read with interest the letter by Faichney and Tate (1) in the May issue of Diabetes Care . We would like to comment on metformin and the risk of lactic acidosis; however, we do not have data to refute the hypothetical relevance of diabetic ketoacidosis to the risk of lactic acidosis (1). We believe that the aforementioned letter and relevant reports (2–4) may negatively affect the future use of metformin, not only in type 1 (1) but also in type 2 diabetic patients. In this regard, the report by Horlen et al. (2), which addressed physicians’ lack of adherence to …
Second malignant neoplasms after cancer in childhood or adolescence. Nordic Society of Paediatric Haematology and Oncology Association of the Nordic Cancer Registries.
Authors: J H Olsen, S Garwicz, H Hertz, G Jonmundsson, F Langmark, M Lanning, S O Lie, P J Moe, T Moller, R Sankila
Journal: BMJ (1993)

To assess the relative risk of developing a second malignant neoplasm in people with a diagnosis of cancer in childhood and adolescence.Register based follow up study.Populations of Nordic countries.30,880 people under the age of 20 with a first malignant neoplasm diagnosed during the period 1943-87.Relative and attributable risks of second malignant neoplasms by type of first cancer, age at first diagnosis, calendar period, sex, and country. Expected figures were based on the appropriate national incidence rates for cancer.247 cases of second malignant neoplasms were observed in 238 patients, yielding a relative risk for cancer of 3.6 (95% confidence interval 3.1 to 4.1). The risk changed significantly from 2.6 in people first diagnosed during the 1940s and 1950s to 6.9 among cohort members included in the late 1970s and 1980s. Increases were observed for most types of cancer. Highest levels of the relative risk were seen during the 10 years immediately after first malignant diagnosis. The incidence of second malignant neoplasms attributable to the first cancer and associated treatments, however, showed a consistent rise throughout the 45 years of follow up.The estimated risks for a second malignant neoplasm were significantly lower than those found in most large hospital based studies but compatible with the results from a similar population based study in the United Kingdom. Extent of risk and cancer pattern were similar among the Nordic countries and are believed to be representative for a large part of the European population.
CCKB/gastrin receptors mediate changes in sodium and potassium absorption in the isolated perfused rat kidney
Authors: Tammo Von Schrenck, Maike Ahrens, Andreas De Weerth, Christoph Bobrowski, Gunter Wolf, Ludwig Jonas, Thomas Jocks, Martina Schulz, Michael Bläker, Michael Neumaier, Rolf A.K. Stahl
Journal: Kidney International (2000)
Unusually Elevated Liver Radioactivity on F-18 FDG PET in Hodgkinʼs Disease
Authors: Sandip Basu, Narendra Nair
Journal: Clinical Nuclear Medicine (2004)

Increased focal concentration of FDG in the background of relatively lower normal hepatocyte uptake is usually regarded as the hallmark of metastatic involvement of the liver from a known primary. The authors present the clinical, radiologic, and laboratory profile of a very unusual hepatic uptake pattern in a case of Hodgkin disease, in which the FDG PET showed intensely diffuse hepatic tracer uptake and was the earliest indicator of extensive hepatic involvement by the disease process. The diagnosis of hepatic involvement with lymphoma was inferred. As experience with FDG PET is growing, it is important to become familiar with the various physiological and pathologic FDG uptake patterns. The term “hepatic superscan”, demonstrating intense diffuse hepatic tracer uptake coupled with surprisingly low brain and cardiac FDG uptake, owes its origin from its apparent similarity with the superscan seen in conventional skeletal scintigraphy and represents an entity hitherto undescribed.
Rubella Epidemic on St. Paul Island in the Pribilofs, 1963
Authors: John L. Sever
Journal: JAMA (1965)

Indications from intensive clinical and laboratory observations of 23 male and 23 female children under age 19 were as follows: (1) Rubella may occur without rash in a significant proportion of children. (2) Posterior auricular or occipital adenopathy may be indicative of rubella without rash. (3) Children may be infectious several days before and after clinical disease. (4) Throat swabs for virus isolation should be obtained at or near the onset of rash. (Additional confirmation can be provided by antibody determinations with paired serum specimens when the first specimen is obtained near the onset of symptoms.) (5) "Rubella with nodes only" may be difficult to confirm by virus isolation studies and is probably best identified by serum titer changes, the first serum specimen being taken near th onset of symptoms or at the time of known exposure.
Misuse of Laboratory Tests and Diagnostic Procedures
Authors: Paul F. Griner, Robert J. Glaser
Journal: New England Journal of Medicine (1982)

Diagnostic tests and procedures serve many purposes. They screen for the presence of occult disease. They help to confirm some diagnoses and reject others. Occasionally, they uncover diagnostic possibilities that would explain elusive symptoms. Once clinical problems have been defined they assist in treatment. They often provide helpful prognostic information. Beyond these explicit purposes, they have reassurance value both for the patient and the physician. They also generate income.That the use of diagnostic tests and procedures is excessive has been shown in numerous studies.1 2 3 Excessive use can have a number of undesirable effects. It contributes to inflation of hospital . . .
Early Diagnosis of Pulmonary Tuberculosis
Authors: K. M. Citron
Journal: BMJ (1966)

The earlier the diagnosis of pulmonary tuberculosis is made the better for the patient and the community.Patients with early tuberculosis need suffer little interruption of their normal activities during treatment, in contrast to the prolonged stay in hospital and absence from work which may be required for those with advanced disease.The community benefits both economically and in health, since the sooner the sources of infection are diagnosed and treated the fewer the contacts they are likely to have infected.Diagnosis of pulmonary tuberculosis before it becomes infectious is therefore desirable and is often possible.General practitioners in Britain have a variety of facilities available to help them diagnose pulmonary tuberculosis.These include the use of miniature radiography, chest clinics, tuberculosis home visitors, tuberculin testing in schools, and contact examination.Widespread knowledge among the public and their medical attendants of the best way to use these facilities is an essential step forward towards finally getting rid of tuberculosis.Ignorance, fear, or prejudice may prevent people seeking medical advice early.Unreasonable fear of tuberculosis and of its social, domestic, and financial consequences are still all too prevalent.The co-operation of the public in the campaign against tuberculosis needs to be maintained by continuing to inform them about the success of modern methods of treatment and prevention.
Deaths from volatile substance misuse fall
Authors: S. Chaudhry
Journal: BMJ (2002)

New figures released by St George's Hospital Medical School show the lowest number of deaths associated with volatile substance misuse since 1983.

The report, compiled for the Department of Health, shows that in the United Kingdom 64 deaths were associated with volatile substance misuse in 2000, compared with 75 in 1999. Over half the deaths were associated with gas fuels, mainly butane …
Does transfusion practice affect mortality in critically ill patients? Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials Group.
Authors: P C Hébert, G Wells, M Tweeddale, C Martin, J Marshall, B Pham, M Blajchman, I Schweitzer, G Pagliarello
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

In 4,470 critically ill patients, we examined the impact of transfusion practice on mortality rates. As compared with survivors, patients who died in intensive care units (ICU) had lower hemoglobin values (95 +/- 26 versus 104 +/- 23 g/L, p < 0.0001) and were transfused red cells more frequently (42.6% versus 28.0%, p < 0.0001). In patients with cardiac disease, there was a trend toward an increased mortality when hemoglobin values were < 95 g/L (55% versus 42%, p = 0.09) as compared with anemic patients with other diagnoses. Patients with anemia, a high APACHE II score (> 20), and a cardiac diagnosis had a significantly lower mortality rate when given 1 to 3 or 4 to 6 units of allogeneic red cells (55% [no transfusions] versus 35% [1 to 3 units] or 32% [4 to 6 units], respectively, p = 0.01). Adjusted odds ratio (OR) predicting survival were 0.61 (95% CI; 0.37 to 1.00, p = 0.026) after 1 to 3 units and 0.49 (95% CI; 0.23 to 1.03, p = 0.03) after 4 to 6 units compared with nontransfused anemic patients. In the subgroup with cardiac disease, increasing hemoglobin values in anemic patients was associated with improved survival (OR = 0.80 for each 10 g/L increase, p = 0.012). We conclude that anemia increases the risk of death in critically ill patients with cardiac disease. Blood transfusions appear to decrease this risk.
The potential role of abnormal E-cadherin and alpha-, beta- and gamma-catenin immunoreactivity in the determination of the biological behaviour of keratoacanthoma
Authors: E. Papadavid, M. Pignatelli, S. Zakynthinos, T. Krausz, A.C. Chu
Journal: British Journal of Dermatology (2001)

Failure of E-cadherin and its associated proteins alpha-, beta- and gamma-catenin is believed to lead to disruption of cell-cell adhesion and to contribute to neoplasia.To determine the pattern of E-cadherin and alpha-, beta- and gamma-catenin immunostaining in keratoacanthoma (KA) and to evaluate its potential value in routine histopathology in differentiating KA with benign from that with malignant biological behaviour.We examined the expression of E-cadherin and alpha-, beta- and gamma-catenin in KA and correlated the histopathological features with the immunohistochemical findings. Next, we compared the immunohistochemical findings of KA with those found in malignant (squamous cell carcinoma, SCC) and benign (warts) lesions. In addition to the established histopathological criteria we used the Ki-67 index, a well-known marker of cell proliferation. Immunoperoxidase staining of E-cadherin and alpha-, beta- and gamma-catenin, and Ki-67 determination, were performed in paraffin-embedded sections of 12 KAs taken from archival material. On reviewing the histology, seven of the 12 KAs were characterized as 'classical' KA, and the rest as 'borderline' KA or KA resembling SCC. Additionally, 28 well, nine moderately and five poorly differentiated SCCs and 20 warts were examined.Most 'classical' KAs (79-86%) showed normal membranous immunostaining and a low Ki-67 index. The remaining 'classical' KAs showed abnormal expression, in a staining pattern resembling that of well-differentiated SCC. All 'borderline' KAs showed a high Ki-67 index (> 40%) and abnormal expression of the adhesion molecules studied, identical to that of poorly differentiated SCC. Expression of E-cadherin and alpha-, beta- and gamma-catenin was found to be more frequently abnormal in 'borderline' KA compared with that in 'classical' KA (P < 0.05). Among E-cadherin and alpha-, beta- and gamma-catenin expression and Ki-67 index, only the expression of beta-catenin was more frequently found to be abnormal in total SCC than in total KA (P < 0.05). Expression of E-cadherin and alpha-, beta- and gamma-catenin was more frequently found to be abnormal in well-differentiated SCC than in 'classical' KA (P < 0.05). In total, as well as in 'classical' or 'borderline' KA, an agreement between expression of E-cadherin and of catenins was seen.These findings suggest that E-cadherin and catenins may be very helpful in distinguishing between 'classical' and 'borderline' KA, as the expression of these adhesion molecules in 'classical' KA is identical to that found in normal epidermis, overlapping with well-differentiated SCC in some cases. In 'borderline' KA, expression of adhesion molecules is identical to that in poorly differentiated SCC.
Lack of Cutaneous Hyperemia in Response to Insulin-Induced Hypoglycemiain IDDM
Authors: Jan Åman, Christian Berne, Uwe Ewald, Torsten Tuvemo
Journal: Diabetes Care (1990)

Cutaneous blood flow was measured with the laser Doppler technique and by recording cutaneous O2 tension on the forearm and forehead in nine young adult patients with insulin-dependent diabetes mellitus (IDDM) andnine sex- and age-matched healthy control subjects after induction of hypoglycemia. In the healthy subjects, cutaneous blood flow measured with the laser Doppler technique was increased by 120 ± 26% in the forehead (P &amp;lt; 0.01) and 196 ± 50% in the forearm (P &amp;lt; 0.01) at the glucose nadir (blood glucose 1.8 ±0.2 mM) compared with basal blood flow. In contrast, in diabetic patients, cutaneous blood flow was unchanged. The corresponding changes, at the glucose nadir, with cutaneous O2 tension recordings were 286 ± 131% (P &amp;lt; 0.05) in control subjects and −22 ± 15% (NS) in diabetic patients. An impairment of sympathetic nervous function, not detectable by simple cardiovascular tests, could be responsible for the lack of cutaneous hyperemia and sweating and could contribute to unawareness of hypoglycemia in diabetic patients.
Restoration of Sinus Rhythm After Mitral Valve Replacement
Authors: R. DARRYL FISHER, DEAN T. MASON, ANDREW G. MORROW
Journal: Circulation (1968)

Factors relating to the successful and sustained restoration of sinus rhythm were examined in 100 patients following mitral valve replacement. Of the 30 patients who established sinus rhythm in the postoperative period, 24 were in sinus rhythm before operation and 6 converted spontaneously. All 30 had normal mean left atrial pressure at rest and only mild or moderate roentgenographic evidence of left atrial enlargement. All 70 patients with atrial fibrillation following valve replacement had been in atrial fibrillation preoperatively; in 24 of them cardioversion was not attempted. In the other 46 patients, electrical conversion was attempted on one or more occasions; in 31 (68%), sinus rhythm was maintained for at least 24 hours, but only 9 were in sinus rhythm 18 months later. Two additional patients maintained sinus rhythm on a long-term basis after conversion with maintenance quinidine. Among the 15 patients refractory to countershock, the mean left atrial pressure averaged 11.1 ± 1.3 mm Hg, and among the 22 patients who reverted to atrial fibrillation it was 13.3 ± 0.9 mm Hg. In contrast, mean left atrial pressure was significantly less (8.1 ± 0.9 mm Hg) and left atrial enlargement only moderate in the patients who maintained sinus rhythm after cardioversion. Importantly, all patients with mean left atrial pressures greater than 12 mm Hg and/or marked left atrial enlargement were refractory to countershock or relapsed to atrial fibrillation, while 64% of patients with normal mean left atrial pressures sures and only moderate left atrial enlargement maintained sinus rhythm permanently. Right atrial pressures were normal in both groups. Thus, elevated left atrial pressure and increased left atrial size both militate against the chronic establishment of sinus rhythm. This study indicates that following mitral valve replacement permanent maintenance of sinus rhythm can be anticipated in about two of three patients in whom the mean left atrial pressure is normal and in whom left atrial enlargement is only moderate.
Occupational asthma and rhinoconjunctivitis caused by senna
Authors: T. Helin, S. Mäkinen‐Kiljunen
Journal: Allergy (1996)

Occupational sensitization to senna is seldom reported. We describe a 21‐year‐old male atopic factory worker who developed IgE‐mediated asthma and rhinoconjunctivitis 5 months after exposure to senna while he was working for a company manufacturing hair dyes. In the bronchial challenge test with senna, he exhibited a strong reaction. The skin prick test gave a 12‐mm wheal reaction. The radioallergosorbent test (RAST) with senna was highly positive (33.6 PRU/ml, class 4), and could not be inhibited with pollens or foods. In protein staining with SDS‐PAGE, two heavy bands were detected in senna at about 14 and 25 kDa, and two faint bands were visible at 19 and 21 kDa. In IgE immunoblotting with the patient's serum, one heavy band was detected at about 16 and four faint bands at 23, 25, 28, and 38 kDa. The patient became symptom free after he had changed his job within the same company.
Phosphorylation status of transcription factor C/EBPα determines cell-surface poly-LacNAc branching (I antigen) formation in erythropoiesis and granulopoiesis
Authors: Yuh-Ching Twu, Chuang-Yi Hsieh, Marie Lin, Cheng-Hwai Tzeng, Chien-Feng Sun, Lung-Chih Yu
Journal: Blood (2010)
JAMA editorial position and US health system reform
Authors: M. G. Jacoby
Journal: JAMA (1994)

To the Editor.  —The Editorial 1 by Dr Lundberg suggests that in his ideal world referral to a specialist or subspecialist be made only by the primary care physician. This is completely impracticable. Under most health maintenance organization plans, the primary care physician is supposed to act as a gatekeeper, but in fact this does not work. It merely means more effort wasted in purely bureaucratic administration, making out referral slips and calling up a clerk at the insurance company to get permission. Even if the specialist referral is unnecessary, no sensible physician would refuse a patient's request. If he or she did so, the patient would lose confidence and go to another primary care physician who would accede to the patient's wishes.  The suggestion that primary care physicians not be given hospital admitting privileges is unsatisfactory. Often, a hospitalized patient does not require the care of the specialist, apart
A 4-marker model predicted a complicated course in normotensive patients with acute symptomatic PE
Authors: Andrew Dunn
Journal: Annals of Internal Medicine (2014)

Source Citation Jiménez D, Kopecna D, Tapson V, et al; the PROTECT Investigators. Derivation and validation of multimarker prognostication for normotensive patients with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med. 2014;189:718-26. 24471575
Quantitative multiparametric immunophenotyping in acute lymphoblastic leukemia: correlation with specific genotype. I. ETV6/AML1 ALLs identification
Authors: L De Zen, A Orfao, G Cazzaniga, L Masiero, MG Cocito, M Spinelli, A Rivolta, A Biondi, L Zanesco, G Basso
Journal: Leukemia (2000)