tbuckley/cabot-search huggingface dataset:
Coronary Embolism: Review of the Literature and Report of a Unique Case
Authors: VINCENT MORAGUES, MALCOLM B. BAWELL, E. LEE SHRADER
Journal: Circulation (1950)

This is a brief review of the literature on coronary embolism and a case report of a very unique type of coronary embolus—a piece of calcium from a calcified aortic valve. Microscopic sections revealed that the calcium plaque was covered by endothelium which had grown out from the vessel wall, thus attaching it to the coronary artery. The patient lived approximately two months after the embolism occurred.
Treatment and Prognosis for Patients With Intrahepatic Cholangiocarcinoma
Authors: Michael N. Mavros, Konstantinos P. Economopoulos, Vangelis G. Alexiou, Timothy M. Pawlik
Journal: JAMA Surgery (2014)

Data on outcomes following surgical management of intrahepatic cholangiocarcinoma (ICC) are limited. The incidence of ICC is increasing and it has a poor prognosis. No consensus has been reached regarding the optimal treatment modalities.To systematically review and synthesize the available evidence regarding treatment and prognosis in patients with ICC.The PubMed database was searched for relevant articles published between January 1, 2000, and April 1, 2013.Only studies assessing predictors of survival or recurrence in patients undergoing curative-intent surgical treatment of ICC were included. Small series, studies reporting on mixed types of cholangiocarcinoma, or exclusively on hepatolithiasis-associated cholangiocarcinoma, and those published in a language other than English, French, German, Italian, or Greek, were excluded. Fifty-seven of 960 articles were therefore analyzed.Data on preoperative, intraoperative, and postoperative variables were extracted by 3 independent reviewers. Multiple studies reporting on the same population were excluded. Data were pooled using a random-effects model.We hypothesized that preoperative variables and tumor characteristics affect patient survival. The outcomes of the study were overall survival and recurrence-free survival. The hypothesis was formulated before data collection.Fifty-seven studies (4756 patients) were included in the review. Median patient age ranged from 49 to 67 years, and 57% were male. Most patients had a solitary (69%), large (median size, 4.5-8.0 cm) tumor of the mass-forming type (86%). Approximately one-third of the patients had lymph node metastasis (34%) or vascular (38%), perineural (29%), or biliary invasion (29%). Most underwent a major hepatectomy (82%), often accompanied by lymphadenectomy (67%) and sometimes by extrahepatic bile duct resection (23%). Median and 5-year overall survival (OS) generally were approximately 28 months (range, 9-53 months) and 30% (range, 5%-56%), respectively; factors predicting shorter OS included large tumor size, multiple tumors, lymph node metastasis, and vascular invasion. Adjuvant chemotherapy or radiotherapy did not appear to be beneficial. Seven studies (2132 patients) provided data for the meta-analysis. Factors associated with shorter OS included older age (pooled hazard ratio, 1.10; 95% CI, 1.03-1.17), larger tumor size (1.09; 1.02-1.16), presence of multiple tumors (1.70; 1.43-2.02), lymph node metastasis (2.09; 1.80-2.43), vascular invasion (1.87; 1.44-2.42), and poor tumor differentiation (1.41; 1.17-1.71).The prognosis of ICC is dictated mainly by tumor factors. Future research could focus on the usefulness of adjuvant treatment as well as other multidisciplinary treatment modalities.
The Language of Medicine
Authors: Alessandra Colaianni
Journal: Annals of Internal Medicine (2012)

On Being a Doctor17 July 2012The Language of MedicineAlessandra Colaianni, BAAlessandra Colaianni, BAFrom The Johns Hopkins University School of Medicine, Baltimore, MD 21224.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-157-2-201207170-00016 Audio Reading - “The Language of Medicine” Audio. Listen to a reading of "The Language of Medicine" by Alessandra Colaianni, BA. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For the first year, I felt that I hadn't so much enrolled in medical school as foreign language immersion. Erythema, epistaxis, ecchymosis, bronchiectasis—there were hundreds of words, some new terms for things I'd already heard of but most completely unfamiliar. As an unabashed logophile, I cherished the lecturers who delved, however briefly, into the comforting territory of etymology. From the Greek root staphyle, meaning grape, and the Latin aurum, meaning gold, comes Staphylococcus aureus, a round bacterium that grows in golden clusters and can kill when it colonizes a heart valve or the blood. From athero, meaning porridge, and sclerosis, ... Author, Article, and Disclosure InformationAffiliations: From The Johns Hopkins University School of Medicine, Baltimore, MD 21224.Corresponding Author: Alessandra Colaianni, BA, The Johns Hopkins University School of Medicine, Baltimore, MD 21224; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “The Language of Medicine” Audio. Listen to a reading of "The Language of Medicine" by Alessandra Colaianni, BA. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 17 July 2012Volume 157, Issue 2Page: 146-147KeywordsHeavy metalsHematology and oncologyHemolytic anemiaInstinctLungsRectal cancerRed blood cellsStaphylococcus aureusTouchUlcers ePublished: 17 July 2012 Issue Published: 17 July 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Course of Acquired Aplastic Anemia in Children Treated With Supportive Care
Authors: Ruth M. Heyn, Inta J. Ertel, David G. Tubergen
Journal: JAMA (1969)

Of 33 children with acquired aplastic anemia, 15 have recovered and two still require transfusions. Sixteen (48.4%) have died. All of these children received supportive care but no androgenic treatment. Although the initial picture in the bone marrow can be correlated with death or survival, no present parameters of measurement indicate how long recovery will take. The course of the disease to recovery is a widely variable one but is similar to that reported by others in patients who receive androgenic therapy. Further experience with the natural course of the disease seems warranted.
On a Case of Double Hemiplegia, with Cerebral Symmetrical Lesions
Authors: T. Barlow
Journal: BMJ (1877)

ease.In this chapter (on the nervous symptoms of fever), the whole question of uraemia is fully discussed.Spxial.-The special objections to Dr. Mahomed's theory may be noted as follows.Granting the existence of -minute capillary htemorrhages (which has yet to be demonstrated), and granting their competence to produce convulsions, how do they act?There are only two possible ways: (a) by loss of blood, and (b) by physical pressure on the cerebral substance (for such minute bnemarrhages could not lacerate the brain-tissue as do larger ones).But the hemorrhages, as described by Dr. Mahomed, are so minute that the loss of blood cannot be felt by the brain.They must, therefore, act by compressing the brain-tissue.Now, if one or two minute haemorrhagic points can produce convulsions in this way, we ought frequently to find such symptoms in those cases, first described by Charcot and Bouchard, in which minute capillary aneurisms exist in large numbers in the brain, producing, in virtue of their number, greater pressure than could be caused by a few haemorrhages not exceeding in size the individual aneurisms.But such is not the case.If Dr. Mahomed will refer to the published observations of the French pathologists, he will find that miliary aneurisms, which differ from his hlemorrhages only in having the blood surrounded by the aneurismal covering, may exist in the brain in dozens, and even in hundreds, without causing any such symptoms as those which he attributes to minute capillary hzemorrhage.A certain allowance, I am aware, must be made for the more sudden occurrence of the htemor.rhagic pressure; but this I believe to be more than counterbalanced by the large number of the aneurisms.These aneurisms, too, occur in all parts of the brain: the optic thalami, the corpora striata, the convolutions, the pons Varolii, the cerebellum, the centrum ovale, the middle peduncles of the cerebellum, the peduncles of the brain, and the bulb.To sum up: the objections, to Dr. Mahomed's views are, first, that they lay aside as inadequate an agency which is at work in every case of uraemia, and which has been proved to be a potent cause of convulsions-viz., malnutrition of the nervous centres; and, second, that they substitute for this an agency whose existence has not been proved, and whose competence to produce convulsions is, at the least, doubtful.
Cultivation of Whipple bacillus: the irony and the ecstasy
Authors: David N Fredricks, David A Relman
Journal: The Lancet (1997)

For 90 years investigators (including George Whipple) have been unable to propagate the microbe responsible for Whipple's disease, despite many published and probably many more unpublished attempts. 1 Whipple GH A hitherto undescribed disease characterized anatomically by deposits of fat and fatty acids in the intestinal and mesenteric lymphatic tissues. Johns Hopkins Hosp Bull. 1907; 18: 382-391 Google Scholar Evidence that a bacterium causes Whipple's disease has accumulated in recent decades. Light and electron microscopy show rod-shaped bacilli in the affected tissues of these patients, usually free in the lamina propria of the small bowel but also as partly degraded structures within macrophage vacuoles. 2 Trier JS Phelps PC Eidelman S Rubin CE Whipple's disease: light and electron microscopic correlation of jejunal mucosal histology with antibiotic treatment and clinical status. Gastroenterology. 1965; 48: 684-707 PubMed Scopus (95) Google Scholar On the basis of histology, investigators have suggested that these organisms propagate extracellularly, 3 Silva MT Macedo PM Moura NJ Ultrastructure of bacilli and the bacillary origin of the macrophagic inclusions in Whipple's disease. J Gen Microbiol. 1985; 131: 1001-1013 PubMed Google Scholar although intact organisms have been detected within several types of cells. 4 Dobbins W Kawanishi H Bacillary characteristics in Whipple's disease: an electron microscopic study. Gastroenterology. 1981; 80: 1468-1475 PubMed Scopus (77) Google Scholar A molecular phylogenetic approach provides evidence that the Whipple bacillus is a member of the actinomycete taxon of bacteria. 5 Relman DA Schmidt TM MacDermott RP Falkow S Identification of the uncultured bacillus of Whipple's disease. N Engl J Med. 1992; 327: 293-301 Crossref PubMed Scopus (1031) Google Scholar , 6 Wilson KH Blitchington R Frothingham R Wilson JA Phylogeny of the Whipple's-disease-associated bacterium. Lancet. 1991; 338: 474-475 Summary PubMed Scopus (302) Google Scholar DNA from this microbe, unofficially named Tropheryma whippelii, is almost invariably present in patients who have Whipple's disease, but disappears with effective antibiotic treatment. 7 Ramzan NN Loftus EJ Burgart LJ et al. Diagnosis and monitoring of Whipple disease by polymerase chain reaction. Ann Intern Med. 1997; 126: 520-527 Crossref PubMed Scopus (209) Google Scholar Using both histological and molecular data, G Schoedon and colleagues 8 Schoedon G Goldenberger D Forrer R et al. Deactivation of macrophages with IL-4 is the key to the isolation of Tropheryma whippelii. J Infect Dis. 1997; 176: 672-677 Crossref PubMed Scopus (156) Google Scholar now provide evidence of the successful propagation of T whippelii in cell culture. Interleukin-4 (IL-4) was critical for rendering peripheral blood monocytes and monoblastic cell-lines permissive for intracellular growth of the organism.
Effect of ulcerative colitis and smoking on rectal blood flow.
Authors: E D Srivastava, M A Russell, C Feyerabend, J Rhodes
Journal: Gut (1990)

Rectal blood flow was measured by laser doppler flowmetry over 60 minutes in eight patients with colitis in remission and eight healthy male non-smokers. Ten smokers were also examined on two occasions, one of which included smoking a cigarette. Plasma nicotine concentrations were measured in smokers. All subjects showed a pronounced fall in rectal blood flow in the first 30 minutes and patients with colitis had significantly higher values compared with smokers (p less than 0.002; p less than 0.04) and non-smokers (p less than 0.007; p less than 0.002) during the first and second 30 minutes respectively. Values in smokers and non-smokers were similar, but smoking a cigarette was associated with a significant fall in blood flow (p less than 0.04) and this change was inversely related to the rise in plasma nicotine concentration (r = -0.63; p less than 0.05). The findings may be relevant to the association between colitis and the smoking history.
Potential Obesogen Identified: Fungicide Triflumizole Is Associated with Increased Adipogenesis in Mice
Authors: Valerie J. Brown
Journal: Environmental Health Perspectives (2012)

A new way to efficiently estimate human intake of a chemical based on its production and how it is used demonstrates that people's "exposure intimacy" with widely used chemicals varies dramatically [EHP 120(12):1678-1683; Nazaroff et al.].For example, the plasticizer bisphenol A (BPA) is one of the world's most heavily used chemicals, but its U.S. intake-to-production ratio (IPR) is over 100,000 times less than that of methyl paraben, a food preservative and antifungal agent.IPR estimates for human exposure to five commonly used phthalate plasticizers, the disinfectant p-dichlorobenzene, and the antibacterial agent triclosan fall in between these two extremes.The IPR, reported as ppm, quantifies the fraction of the total amount of a chemical used in a country each year that gets into the country's population.The metric is calculated by dividing the population's estimated total intake of a chemical by the rate at which that chemical is produced or imported.So, for example, diethyl phthalate's rating of 7,700 ppm indicates that for every 1 million g of the chemical entering U.S. commerce, approximately 7,700 g is taken up by the aggregate population.The metric does not reflect the distribution of exposures within the population.For this study, intake estimates for the nine chemicals assessed were based on urinary excretion data from the U.S. Centers for Disease Control and Prevention.The chemical manufacture and import data came from the U.S. Environmental Protection Agency's Chemical Data Reporting system.The nine chemicals yielded a broad span of IPRs, which the researchers believe is a result of the variable opportunities for exposure associated with different chemical uses.For example, although the presence of BPA in the linings of food cans has a high potential for human exposure, its low IPR of 0.6 ppm likely reflects the fact that most BPA is used in polycarbonate plastics, where its potential for transfer to humans is relatively low.In contrast, methyl paraben's IPR of over 180,000 ppm is consistent with its presence in products with which people have close contact-foods, cosmetics, and pharmaceuticals.The authors acknowledge that the limited availability of biomonitoring data currently hinders widespread use of the IPR.They nonetheless foresee that the metric could contribute to a framework for rapidly estimating human exposure to untested chemicals based on the chemicals' intended uses and anticipated production volumes.For more than a dozen years Kellyn S. Betts has written about environmental contaminants, hazards, and technology for solving environmental problems for publications including EHP and Environmental Science & Technology.
Phase I to II Multicenter Study of Oblimersen Sodium, a Bcl-2 Antisense Oligonucleotide, in Patients With Advanced Chronic Lymphocytic Leukemia
Authors: Susan M. O'Brien, Charles C. Cunningham, Anatoliy K. Golenkov, Anna G. Turkina, Steven C. Novick, Kanti R. Rai
Journal: Journal of Clinical Oncology (2005)

Purpose To determine the maximum-tolerated dose (MTD), efficacy, safety, and pharmacokinetics of oblimersen sodium in patients with advanced chronic lymphocytic leukemia (CLL). Patients and Methods Eligible patients had relapsed or refractory CLL after treatment with fludarabine. Oblimersen was administered at doses ranging from 3 to 7 mg/kg/d as a 5-day continuous intravenous infusion in cycle 1 and as a 7-day continuous intravenous infusion in subsequent cycles every 3 weeks in stable or responding patients. Results Forty patients were enrolled and treated (14 patients in phase I and 26 patients in phase II). Dose-limiting reactions in phase I included hypotension and fever, and the MTD for phase II dosing was established at 3 mg/kg/d. Two (8%) of 26 assessable patients achieved a partial response. Other evidence of antitumor activity included ≥ 50% reduction in splenomegaly (seven of 17 patients; 41%), complete disappearance of hepatomegaly (two of seven patients; 29%), ≥ 50% reduction of lymphadenopathy (seven of 22 patients; 32%), and ≥ 50% reduction in circulating lymphocyte counts (11 of 22 patients; 50%). Adverse events included transient hypotension, fever, fatigue, night sweats, diarrhea, nausea, vomiting, hypokalemia, and cough. Plasma concentrations of oblimersen (parent drug) and its major metabolites were variable. Renal clearance represented only a small portion of total parent drug clearance. Conclusion Dosing with oblimersen sodium in patients with CLL is limited by development of a cytokine release syndrome that is characterized by fever, hypotension, and back pain. Oblimersen sodium has modest single-agent activity in heavily pretreated patients with advanced CLL, and further evaluation of its activity in combination with cytotoxic drugs is warranted.
THE DECENTERING OF LENSES FOR NEAR WORK.
Authors: G. C. SAVAGE
Journal: JAMA (1902)

The ideal position of lenses, when there is perfect muscle adjustment of the eyes, is such that the visual axes may cut their optical centers, and that the planes of the lenses may be parallel with the equatorial planes of the eyes. When the visual axes cut the optical centers of the lenses there can be no prismatic effect; and when the plane of the lens is parallel with the equatorial plane of the eye there can be no cylindrical effect. A want of parallelism between the plane of the lens and the equatorial plane of the eye means that there will be a cylindrical effect, for, as is well known, the strength of the lens, at right angles to the axis of tilting, is increased, while along the axis of tilting its power is unchanged. Tilting a lens 45 degrees practically doubles its refractive power for the rays that
Outlook for Treating Patients with Self-Destructive Habits
Authors: JOHN F. BURNUM
Journal: Annals of Internal Medicine (1974)

Among 1000 patients, 219 had seriously harmed themselves through the abuse of tobacco, alcohol, food, or drugs. Of these, 25% complied with treatment advice and corrected the abuse. Cooperation, when obtained, was prompt, whereas repeated counseling was ineffective. The follow-up period averaged 4.9 years. Men outnumbered women and were more compliant. Compliance related poorly to socioeconomic status and education but was greater in stable than in unstable personalities. Habits were reinforced by social custom, habituation, psychologic and physiologic dependency, pleasure, perversity, and style of living. Results from other studies are similarly poor. Improving health behavior lies generally outside medicine proper. Physicians have a pivotal responsibility for guiding patients toward health but have a limited voice in improving patients' health habits.
THE DIET OF THE NEGRO MOTHER IN NEW YORK CITY
Authors: ALFRED F. HESS
Journal: JAMA (1918)

in some cases, it would seem advisable, when deter¬ mining the cause of urticaria, to exclude all protein substances with which the patient may come in con¬ tact, as well as the food proteins.The same reasoning' would seem to apply to cases of angioneurotic edema.During the desensitization of patients with proteins, the appearance of eczema, urticaria or angioneurotic edema should make one suspect that the treatment was the cause of such symptoms.Although such experi¬ ences are not serious, yet they are sufficiently alarming to warrant great care in the desensitization of patients with proteins.
The use of complementary medicine in children with atopic dermatitis in secondary care in Leicester
Authors: G.A. Johnston, R.M. Bilbao, R.A.C. Graham-Brown
Journal: British Journal of Dermatology (2003)

Background The use of 'complementary' or 'alternative' medicine continues to rise in patients with skin disease, especially in those with chronic, inflammatory dermatoses. Objectives To qualify and quantify the usage of complementary medicine (CM) in children with atopic dermatitis (AD) in secondary care. Methods A face‐to‐face structured questionnaire study of 100 consecutive children with AD and their parent or guardian. Results The mean age of the children interviewed was 7·3 years (median age 6·0 years, range 0·6–17·1) and ethnic origin was 59% white, 35% Indian, 3% Afro‐Caribbean and 3% mixed race. Forty‐six of 100 patients (46%) had used, or were currently using, CM. Of the 54 patients who had not yet used CM, 17 of 54 (31%) said they intended to try this in the future. The most commonly used CM was Chinese herbal medicine by 20 of 46 patients (43% of those who had used CM), followed by herbal medicine (41%) and homeopathy (35%). Of 74 patients using CM, 26 (35%) felt their AD had improved while 39 of 74 (53%) reported that it had remained unchanged. Twenty‐six of 46 (56%) CM users in this study would not recommend CM to other patients with AD. There was a strong association between the use of CM and ethnicity (P = 0·01). Half of the patients who had used CM (23 of 46) had used it on the recommendation of family or friends with skin disease, 17 of 46 (37%) from family or friends without skin disease and three of 46 (6%) each from health professionals or from the media or internet. Twenty‐five of 46 (54%) of CM users did so because conventional treatment was not working, and eight of 46 (17%) because they were worried about the side‐effects of conventional treatment. While 39 of 100 (39%) of all patients felt that CM was safer than conventional medicine, only 14 of 100 felt it was more efficacious. Fifty‐one of 100 were happy to combine both types of treatment and 66 of 100 felt that CM should be available from the National Health Service. Conclusions In a population of children with AD attending a teaching hospital clinic in Leicester, U.K., 63% use or intend to use CM. This use is associated with ethnicity.