tbuckley/cabot-search huggingface dataset:
A man with fever, a productive cough, and a striking chest radiograph
Authors: E. Davies, I. Aziz
Journal: BMJ (2014)

A 41 year old man presented to the emergency department with a two week history of worsening shortness of breath. Associated symptoms included a cough productive of green sputum, intermittent fevers, night sweats, and non-pleuritic pain in the right side of the chest wall. He had a history of chronic pancreatitis secondary to alcohol excess, which was complicated by diet controlled type 2 diabetes. He also smoked 40 cigarettes a day. 

His regular drugs included pancreatin and omeprazole. At triage, his heart rate was 135 beats/min, blood pressure was 133/84 mm Hg, respiratory rate was 24 breaths/min, oxygen saturations were 82% on room air, and temperature was 38.5°C. On examination he did not have finger clubbing, but air entry was reduced in the right mid and lower zones and he had inspiratory crackles at the left base. The rest of the respiratory and general examination was unremarkable. 

A full blood count on admission showed: total white blood cell count 14.8×109/L (reference range 4.0-11.0), neutrophil count 12.1×109/L (1.8-7.8), haemoglobin 124 g/L (130-180), platelets 689×109/L (150-450), and C reactive protein 144 mg/L (<5.0; 1 mg/L=9.52 nmol/L). Electrocardiography demonstrated sinus tachycardia at a rate of 128 beats/min. Figure 1⇓ shows his chest radiograph at admission.



Fig 1 Admission chest radiograph





### 1. What does the chest radiograph show?

#### Short answer

The large thick walled cavitating lesion in the right lower lobe with an air fluid level is in keeping with a pulmonary abscess given the history of fevers, night sweats, productive cough, and raised inflammatory markers.

#### Long answer

The chest radiograph shows a thick walled cavitating …
Recommendations on Stem Cell Research
Authors: Charles Marwick
Journal: JAMA (1999)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Troponin Levels and Mortality After Noncardiac Surgery—Reply
Authors: P. J. Devereaux
Journal: JAMA (2012)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Misoprostol in patients taking non-steroidal anti-inflammatory drugs
Authors: N Maiden, R Madhok
Journal: BMJ (1995)

presumed negligent.'4Though justifiable in terms of improved quality (and uniformity) of clinical care, the experi- mental scheme was in fact adopted in order to retain clinical services such as obstetrics, anaesthetics, and emergency medicine that were under threat because of the high risk of malpractice actions.Common law courts in other jurisdictions have called for the development of practice guidelines,'5 16 whilst also retaining the power to overrule them.'7American fears that guidelines will fuel a bonanza for litigators have so far proved unfounded.A recent survey of American actions for medical malpractice found that guidelines play "a relevant or pivotal role in the proof ofnegligence" in only 6.6% of actions.'8Clinical guidelines offer the courts explicit though not incontestable examples of clinical standards across a wide range of medical practice.Notwithstanding the experience of one doctor before the British General Medical Council's professional conduct committee, who concluded that "guide- lines drawn up by the establishment" were used as a "means of punishing dissenters,"'9 there are grounds for believing that British courts will not be uncritically swayed by these statements but will question their authority and status as embodiments of customary care.20 Nevertheless, it would be sensible to heed the view of a distinguished professor of medical law in Britain who has predicted that "the role of protocols and guidelines will become more and more significant in determining whether a doctor has violated the law.
VPREB1 deletions occur independent of lambda light chain rearrangement in childhood acute lymphoblastic leukemia
Authors: D S Mangum, J Downie, C C Mason, M S Jahromi, D Joshi, V Rodic, M Müschen, N Meeker, N Trede, J K Frazer, Y Zhou, C Cheng, S Jeha, C-H Pui, C L Willman, R C Harvey, S P Hunger, J J Yang, P Barnette, C G Mullighan, R R Miles, J D Schiffman
Journal: Leukemia (2013)
The Relation between the Volume of Coronary Angioplasty Procedures at Hospitals Treating Medicare Beneficiaries and Short-Term Mortality
Authors: James G. Jollis, Eric D. Peterson, Elizabeth R. DeLong, Daniel B. Mark, S. Robert Collins, Lawrence H. Muhlbaier, David B. Pryor
Journal: New England Journal of Medicine (1994)

Previous studies have found that hospitals at which more procedures, such as coronary-artery bypass grafting (CABG) and other vascular surgery, are performed have lower rates of mortality related to these procedures than hospitals where fewer such procedures are performed.
Differential induction of prehepatic and hepatic metabolism of verapamil by rifampin
Authors: M F Fromm, D Busse, H K Kroemer, M Eichelbaum
Journal: Hepatology (1996)

Cytochrome P450 (CYP) enzymes, which metabolize numerous drugs, are expressed both in liver and in extrahepatic tissues. CYP3A4 for example is present and inducible by rifampin in epithelial cells of the gastrointestinal tract. It has been shown that such prehepatic metabolism contributes substantially to total clearance of CYP3A4 substrates (e.g., cyclosporine) before and even more pronounced during enzyme induction. We examined the effect of enzyme induction on prehepatic and hepatic metabolism of the model compound R/S–verapamil after simultaneous oral and intravenous administration using a stable isotope technology. This approach allows us to exclude intraindividual day–to–day variability and is therefore suitable to quantitatively assess prehepatic extraction of high–clearance drugs. Moreover, because verapamil is administered as a race–mate with the S–enantiomer being preferentially metabolized, we investigated the influence of induction on stereoselectivity of prehepatic and hepatic metabolism. Eight male volunteers received 120 mg of racemic verapamil bid for 24 days. Rifampin (600 mg daily) was given from day 5 to day 16. Systemic clearance and bioavailability of the verapamil enantiomers were determined by coadministering deuterated verapamil intravenously on day 4, on day 16, and on day 24. Effects of verapamil on atrioventricular conduction after oral and intravenous (iv) administration were assessed by measuring the maximum PR–interval prolongation Rifampin increased the systemic clearance of the active S–verapamil 1.3–fold ( P &lt; .001). In contrast, rifampin increased the apparent oral clearance of S– verapamil 32–fold ( P &lt; .001) and decreased its bioavailability 25–fold ( P &lt; .001), with partial recovery after rifampin withdrawal ( P &lt; .01). With rifampin, the effect of oral verapamil on atrioventricular conduction was nearly abolished ( P &lt; .01), whereas no significant changes were observed after intravenous administration. Induction caused a considerable reduction of stereoselectivity after both intravenous and oral administration ( P &lt; .001). Rifampin altered the pharmacokinetics and the pharmacological effects of verapamil to a much greater extent after oral administration compared with intravenous administration. These data clearly indicate that prehepatic metabolism of verapamil (presumably in the gut wall) is preferentially induced compared with hepatic metabolism and that stereoselectivity of verapamil metabolism is affected by induction.
Unscrambling the Eggs: Cybrid Research through an Embryonic Stem Cell Research Oversight Committee (ESCRO) Lens
Authors: Audrey Chapman, Anne L. Hiskes
Journal: The American Journal of Bioethics (2008)

Click to increase image sizeClick to decrease image size The views expressed in this commentary do not represent views of the University of Connecticut or the University of Connecticut Embryonic Stem Cell Research Oversight Committee (ESCRO), and are to be attributed only to the authors of this commentary.
Detection of Transplant Coronary Artery Disease Using Multidetector Computed Tomography With Adaptative Multisegment Reconstruction
Authors: Gardar Sigurdsson, Patricia Carrascosa, Mohammad H. Yamani, Neil L. Greenberg, Sergio Perrone, Gustavo Lev, Milind Y. Desai, Mario J. Garcia
Journal: Journal of the American College of Cardiology (2006)
Low-Dose Thiazide and Bone Density
Authors: Andrea Z. LaCroix, Susan M. Ott
Journal: Annals of Internal Medicine (2002)

Letters5 February 2002Low-Dose Thiazide and Bone DensityAndrea Z. LaCroix, PhD and Susan M. Ott, MDAndrea Z. LaCroix, PhDFred Hutchinson Cancer Research CenterSeattle, WA 98109University of WashingtonSeattle, WA 98112Search for more papers by this author and Susan M. Ott, MDFred Hutchinson Cancer Research CenterSeattle, WA 98109University of WashingtonSeattle, WA 98112Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-136-3-200202050-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Kamel that reversal of renal calcium leak may be one mechanism whereby hydrochlorothiazide preserves bone density in older adults, a possibility noted in our discussion. We also noted that evidence supports other mechanisms as well.In our trial, calcium deficiency did not explain the observed beneficial effects of thiazide. Although we did not provide calcium supplements, we did inform participants of their baseline calcium intake. Subsequently, at every visit, we assessed calcium intake and actively encouraged participants to maintain intakes of at least 1000 mg/d. As shown in the Figure, the mean total daily ...Reference1. Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med. 1997;337:670-6. [PMID: 9278463] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Fred Hutchinson Cancer Research CenterSeattle, WA 98109University of WashingtonSeattle, WA 98112 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoLow-Dose Hydrochlorothiazide and Preservation of Bone Mineral Density in Older Adults Andrea Z. LaCroix , Susan M. Ott , Laura Ichikawa , Delia Scholes , and William E. Barlow Low-Dose Thiazide and Bone Density Hosam K. Kamel Metrics 5 February 2002Volume 136, Issue 3Page: 252-253KeywordsBone densityCalciumCreatinineElderlyParathyroid hormonePhosphatesRenal physiologySerum proteinsSodiumUrine ePublished: 5 February 2002 Issue Published: 5 February 2002 CopyrightCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Seroconversion of reticulin autoantibodies predicts coeliac disease in insulin dependent diabetes mellitus.
Authors: M Maki, T Huupponen, K Holm, O Hallstrom
Journal: Gut (1995)

Serum IgA class reticulin autoantibody test was performed prospectively once a year on 238 children and adolescents with insulin dependent diabetes mellitus (IDDM). At the initial testing, within one year after onset of IDDM, five were positive and 233 were negative. During follow up a further 11 of the initially antibody negative children became positive (6.7%). Jejunal biopsy was performed at the appearance of the autoantibodies and silent coeliac disease was shown in nine (3.8%). One of these children showed on initial biopsy after the onset of IDDM to have normal jejunal mucosal architecture deteriorating later to a flat lesion. Jejunal immunohistochemical studies of another of the patients positive for reticulin autoantibodies but normal on routine biopsy showed an increased density of intraepithelially located gamma/delta T cells and aberrant HLA-DR expression in the crypts pointing to ongoing mucosal inflammation and potential coeliac disease. This study shows that in IDDM patients, reticulin autoantibody negative subjects become antibody positive, which may be followed by coeliac disease. Repeated serological screening and rebiopsy should be considered to detect late developing clinically silent coeliac disease among patients with IDDM.
Oxygen Therapy Equipment-Reply
Authors: Alvan L. Barach
Journal: JAMA (1961)

<h3>To the Editor:—</h3> The development of safe transfilling equipment was stimulated by the increasing use of ambulatory and emergency oxygen therapy. In the device referred to in the article cited, the 75- and 150-liter cylinders are equipped with a check valve which closes after the cylinder is filled and the transfilling device is disconnected. Of special importance is the fact that the orifice past the check valve is 0.003 sq. in. in area. The small size of this outlet prevents a projectile effect on the portable cylinders if a break in the connection should occur. The capillary tubing between the small and large cylinders is 0.02 in. in diameter. It has been recommended that a diaphragm check valve also be inserted at the nut connection to the large cylinder, the purpose of which would be to automatically shut off the escape of oxygen should the flow exceed 15 liters per
CORONARY ARTERY OBSTRUCTION AFTER THE ARTERIAL SWITCH OPERATION: IS THERE REALLY A LONG-TERM PROBLEM?
Authors: Mieke MP Driessen, Johannes MPJ Breur, Roland RJ van Kimmenade, Gertjan Tj Sieswerda, Folkert J. Meijboom, Tim Leiner
Journal: Journal of the American College of Cardiology (2013)
Straddling right atrioventricular valves in atrioventricular discordance.
Authors: A E Becker, S Y Ho, G Caruso, S Milo, R H Anderson
Journal: Circulation (1980)

Four hearts are described in which the right atrioventricular valve, draining a morphologically right atrium, straddled and overrode a septum between a right-sided chamber of left ventricular morphology and a left-sided chamber of right ventricular morphology. The degree of override varied between the straddling valve and was committed by 20-45% to the morphologically right ventricle. The ventriculoarterial connections in the hearts were discordant in one, double outlet from the morphologically right ventricle in two and single outlet via an aorta from the morphologically right ventricle with pulmonary atresia in the other. The straddling valve in one of the cases with double outlet had a dual orifice. Pulmonary stenosis was present in three cases, and pulmonary atresia in the fourth. Study of the conduction system in three of the hearts revealed subtle but important differences from the pattern expected in atrioventricular discordance. Each case had an anterior atrioventricular node and penetrating bundle, but the connection thus formed was more lateral than usual, and in the case with ventriculoarterial discordance, the nonbranching bundle was unrelated to the pulmonary outflow tract. A sling of conduction tissue between the anterior node and the regular node was found in the case with single outlet and pulmonary atresia.
THREE-YEAR FOLLOW-UP OF PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION WHO RECEIVED ENDOTHELIAL PROGENITOR CELL CAPTURE STENT WHILE UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION
Authors: Rishi Sethi, Adrian Low, Chi-Hang Lee, Swee-Guan Teo, Mark Chan, Koo Hui Chan, Arthur Mark Richards, Huay-Cheem Tan
Journal: Journal of the American College of Cardiology (2012)
Vitamin B1 in the Urine and Placenta in Toxaemia of Pregnancy
Authors: W. C. W. Nixon, M. D. Wright, E. C. Fieller
Journal: BMJ (1942)

JOURNAL60middle lobe was of uniform diameter throughout its whole length (Fig. iB).The original radiograph, together with the history of night sweats, cough, and pleuritic pain, made it clear that the patient had a low-grade inflammatory lesion of the lung,
Left Heart Volume Characteristics with a Right Ventricular Volume Overload
Authors: THOMAS P. GRAHAM, JAY M. JARMAKANI, RAMON V. CANENT
Journal: Circulation (1972)

Left heart volume characteristics were evaluated by using biplane cineangiocardiography in 18 studies in 15 patients with total anomalous pulmonary venous connection (TAPVC) and in 37 studies on 35 patients with large secundum or sinus venosus atrial septal defects (ASD). Left ventricular end-diastolic volume (LVEDV) was decreased to less than 67% of normal in five of 15 preoperative TAPVC patients, but the average value for the entire group was not significantly different from normal. In ASD patients, the average LVEDV was 87% of normal which was significantly decreased ( P &lt; 0.001). The ejection fraction was decreased from normal in patients with TAPVC and ASD who were less than 2 years of age (0.62 vs. 0.68, P &lt; 0.01), but was normal in older patients. Left ventricular systolic output was significantly decreased from normal in both TAPVC (75% of normal, P &lt; 0.001) and ASD patients (81% of normal, P &lt; 0.001). Left atrial maximal volume was significantly decreased from normal in TAPVC patients averaging only 55% of normal ( P &lt; 0.001), but was normal in eight ASD patients. All volume variables increased following corrective surgery in two TAPVC patients and two ASD patients. These studies document that left heart volumes and outputs in infants and children with TAPVC and large isolated atrial defects can be diminished preoperatively.
Case 43-1965
Authors: Ernest H. Picard, Edward P. Richardson
Journal: New England Journal of Medicine (1965)

Presentation of CaseA six-year-old girl was admitted to the hospital because of coma.She had been well until one week previously, when a brief respiratory infection occurred. Three days before admission she fell from a horizontal bar but did not lose consciousness. A few hours later she complained of blurred vision that prevented reading, and her parents noticed that the left arm appeared weak. On the following morning she appeared "dazed" and tended to look to the right, although the eyes could be deviated to the left. Later in the day weakness of the left leg developed, and her . . .
THE DETERMINATION OF PHENOLSULPHONEPHTHALEIN EXCRETION IN THE PRESENCE OF HEMATURIA
Authors: Edward G. Waters
Journal: JAMA (1923)

The importance of the phenolsulphonephthalein test for kidney function, and its relative simplicity of performance, are now well appreciated by all whose work includes diagnosis of the various nephropathies. More recent work<sup>1</sup>indicating that lowered excretion of phenolsulphonephthalein is practically always the first evidence of renal damage, functional or organic, only enhances its value to the clinician. It is obvious, therefore, that any factor which may inhibit successful use of the test in the presence of certain of the various nephropathies offers a serious handicap. One of the most frequent and objectionable hindrances to the satisfactory use of the dye is the presence of blood in the urine. Another is a urine of high color.<sup>2</sup> Burwell and Jones<sup>3</sup>recently offered a method for rendering the urine free from blood and bile. Previously there had been no successful method for removing the blood pigment without altering the phenolsulphonephthalein
Retracted: The Role of the Extracellular Matrix Protein Mindin in AirwayResponse to Environmental Airways Injury
Authors: Sarah Frush, Zhuowei Li, Erin N. Potts, Wanglei Du, Jerry P. Eu, Stavros Garantziotis, You-Wen He, W. Michael Foster, John W. Hollingsworth
Journal: Environmental Health Perspectives (2011)

Our previous work demonstrated that the extracellular matrix protein mindin contributes to allergic airways disease. However, the role of mindin in nonallergic airways disease has not previously been explored.We hypothesized that mindin would contribute to airways disease after inhalation of either lipopolysaccharide (LPS) or ozone.We exposed C57BL/6J and mindin-deficient (-/-) mice to aerosolized LPS (0.9 μg/m3 for 2.5 hr), saline, ozone (1 ppm for 3 hr), or filtered air (FA). All mice were evaluated 4 hr after LPS/saline exposure or 24 hr after ozone/FA exposure. We characterized the physiological and biological responses by analysis of airway hyperresponsiveness (AHR) with a computer-controlled small-animal ventilator (FlexiVent), inflammatory cellular recruitment, total protein in bronchoalveolar lavage fluid (BALF), proinflammatory cytokine profiling, and ex vivo bronchial ring studies.After inhalation of LPS, mindin-/- mice demonstrated significantly reduced total cell and neutrophil recruitment into the airspace compared with their wild-type counterparts. Mindin-/- mice also exhibited reduced proinflammatory cytokine production and lower AHR to methacholine challenge by FlexiVent. After inhalation of ozone, mice had no detectible differences in cellular inflammation or total BALF protein dependent on mindin. However, mindin-/- mice were protected from increased proinflammatory cytokine production and AHR compared with their C57BL/6J counterparts. After ozone exposure, bronchial rings derived from mindin-/- mice demonstrated reduced constriction in response to carbachol.These data demonstrate that the extracellular matrix protein mindin modifies the airway response to both LPS and ozone. Our data support a conserved role of mindin in production of proinflammatory cytokines and the development of AHR in two divergent models of reactive airways disease, as well as a role of mindin in airway smooth muscle contractility after exposure to ozone.
Lactocepin Secreted By Lactobacillus Exerts Anti-Inflammatory Effects By Selectively Degrading Proinflammatory Chemokines
Authors: Marie-Anne von Schillde, Gabriele Hörmannsperger, Monika Weiher, Carl-Alfred Alpert, Hannes Hahne, Christine Bäuerl, Karolien van Huynegem, Lothar Steidler, Tomas Hrncir, Gaspar Pérez-Martínez, Bernhard Kuster, Dirk Haller
Journal: Cell Host & Microbe (2012)