tbuckley/cabot-search huggingface dataset:
Thromboses and thromboemboli in patients with lymphoma during cytotoxic chemotherapy.
Authors: B. M. Cantwell, J. Carmichael, S. E. Ghani, A. L. Harris
Journal: BMJ (1988)

<h3>Introduction</h3> Occult cancer is present in 4%–9% of patients with unprovoked venous thromboembolism (VTE). Screening for cancer may be considered in these patients, with the aim to diagnose cancers in an early, potentially curable stage. Information is needed about the risk of occult cancer, overall and in specific subgroups, additional risk factors and on the performance of different screening strategies. <h3>Methods and analysis</h3> MEDLINE, Embase and CENTRAL databases were searched from November 2007 to January 2016 for prospective studies that had evaluated protocol-mandated screening for cancer in patients with unprovoked VTE and with at least 12 months’ follow-up. Two reviewers independently assessed articles for eligibility. Ten eligible studies were identified and individual patient data were obtained from each of them. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool . Generalised linear mixed-effects models was used to calculate estimates in a one-stage meta-analytic approach, overall and in a number of subgroups, including patients undergoing limited screening only, elderly patients, patients with previous VTE, smokers and patients using oestrogens. <h3>Ethics and dissemination</h3> Ethical approval is not required for this systematic review and individual patient data meta-analysis. Findings have been submitted for publication in peer-reviewed journals and presentations at national and international conferences to provide clinicians and other decision-makers with valid and precise risk estimates of occult cancer, overall and in specific clinical subgroups, with risk factors for occult cancer, with estimates of the diagnostic performance of limited screening and with an exploration of the benefit of extensive screening strategies.
16. Immunologic lung disease
Authors: Joseph E. Prince, Farrah Kheradmand, David B. Corry
Journal: Journal of Allergy and Clinical Immunology (2003)

This review summarizes the recent advances regarding pathogenesis, diagnosis, and treatment of immunological diseases of the lung. Rather than attempt a comprehensive analysis, we have focused on selected diseases that are of particular relevance to the practicing physician, and the material has been organized according to the dominant immunologic mechanisms underlying the disease. Because of the redundancy that characterizes the mammalian immune repertoire, this system of classification inevitably produces overlap but facilitates acquisition of what is otherwise a disparate collection of facts. The principal lung immunologic mechanisms are most broadly classified as innate or adaptive immune processes. Innate immunity includes neutrophils and complement that are important in diseases, such as pneumonia and the acute respiratory distress syndrome. Adaptive immunity involves T and B cells capable of recognizing discrete antigens. T(H)1- and T(H)2-dependent adaptive immune responses underlie some of the most common and important of lung diseases, including tuberculosis and asthma, respectively. Other important immunopathologic processes include granulomatous inflammation that characterizes sarcoidosis and Churg-Strauss vasculitis, and autoimmunity, which is characteristic of antiglomerular basement membrane disease and others.
Prognostic significance of sentinel nodes metastases in breast cancer patients without axillary node dissection or axillary radiotherapy: CBCSG-001 trial.
Authors: Y Wang, C Wang, L Fan, D Mu, Y Gao, J Li, W Zhong
Journal: Cancer Research (2009)

Abstract Abstract #1015 Background: China multicenter study of sentinel lymph node biopsy (SLNB) substituting axillary lymph node dissection (ALND) in breast cancer– CBCSG-001 trial was conducted from Jan. 2002 to Jun. 2007, with 1,970 SLNB pts recruitment. One of the second objectives of the CBCSG–001 trial was to evaluate the optimal methods and intervals for the detection of SLN macrometastases, MMs and isolated tumor cells (ITCs) and their prognostic significance in patients received SLNB without ALND or axillary radiotherapy.&amp;#x2028; Material and Methods: Two hundred and forty-five continuous breast cancer patients with 569 SLNs identified “negative” with routine standard HE stain carried on initial 4 levels were retrospectively analyzed. All the patients received SLNB only, without ALND or axillary radiotherapy after the diagnoses of metastases in their SLNs later. All SLNs were step sectioned (SS) at 100µm interval, and for each level both HE and IHC with AE1/AE3 were performed. Forty-nine patients were identified to have metastases, with macrometastases of 12.2%, micrometastases of 61.2%, and isolated tumor cells of 26.5%. All patients had received SLNB only, with no ALND and axillary radiotherapy.&amp;#x2028; Results: Of the 245 patients, breast conserved surgery and SLNB were performed on 106 patients (43.3%), and mastectomy and SLNB in 139 patients. With a median follow up of 50 months, there were 20 breast related events occurred. The disease free survival (DFS) of patients with routine negative SLNs was 91.6%, and 93.9% for patients with positive SLNs after SS with HE+IHC (p&amp;gt;0.05). The overall survival (OS) were 97.4% and 98.0 for each group, respectively (p&amp;gt;0.05). The results were the same for patients with macrometastases, micrometastases, and isolated tumor cells. Due to the relatively less events occurred, the DFS and OS had not been calculated for macrometastases, micrometastases, and isolated tumor cells, separately.&amp;#x2028; Discussion and Conclusions: Without ALND and axillary radiotherapy, there were no significant differences of DFS and OS between patients with routine negative SLNs and patients with positive SLNs after SS with HE+IHC. It might be safe for these patients to receive SLNB only. The possible reasons might include: SLNs were the only positive lymph nodes in more than 60% patients, effective adjuvant systemic therapy for regional lymph nodes just as neoadjuvant chemotherapy, axillary coverage of radiotherapy in patients with breast conserved therapy, and the relatively less events occurred during the 50 months follow up period. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1015.
Survival of the richest
Authors: Fiona Godlee
Journal: BMJ (2005)

My brother raised an ethical dilemma over lunch last week. Should he give his private patients a prescription for Tamiflu (oseltamivir) if they ask for one while his NHS patients don't have that option? At the time I didn't have an answer, but Michael Jefford and colleagues provide some help in this week's BMJ (p 1075). Although the principle of distributive justice suggests he shouldn't offer something to some patients that others can't have, two other principles guiding medical ethics—beneficence (acting in the patient's best interests) and respect for autonomy—dictate that he should. “Doctors should be committed to the individual patient's interests and autonomy …
Effect of Combined Therapy (Dihydrostreptomycin and PAS) on the Emergence of Streptomycin-Resistant Strains of Tubercle Bacilli
Authors: S. J. Shane, J. H. Laurie, Clifford Riley, Mary Boutilier
Journal: New England Journal of Medicine (1952)

AMONG students of tuberculosis the opinion is generally held that the addition of PAS to streptomycin regimens will delay or actually prevent the emergence of resistant strains of tubercle bacilli. The value of combined therapy (streptomycin and sulfonamides) had been amply demonstrated in the case of nontuberculous infections such as brucellosis1 as early as 1948, although the exact modus operandi had not then been defined. It seemed possible to us at that time that a similar line of reasoning might be applied to the therapy of pulmonary tuberculosis, but it was not until February, 1949, that Karlson and his co-workers . . .
Cancer of the gastrointestinal tract. Diagnostic radiology
Authors: M. L. Janower
Journal: JAMA (1974)

THE PRESENCE of an early carcinoma of the stomach is usually first documented by the radiologist and remains one of his greatest daily challenges. While recent technical advances such as televised fluoroscopy, cineradiography, and 70-mm and 100-mm spot films have become available, no examination requires more skill and diligence than the upper gastrointestinal roentgenographic series. The following discussion will review the more common x-ray film findings seen in this disease. Carcinoma of the stomach occurs in four major forms: an ulcer, a polypoid mass, an infiltrating lesion, or a combination of these.<sup>73</sup>The role of the radiologist is twofold: first, to document the presence of the lesion including the demonstration of its roentgenographic characteristics, and second, to differentiate correctly the case of cancer from the more common forms of benign disease. The ulcer in carcinoma usually does not project beyond the wall of the stomach; it has irregular margins,
Abstract 3344: Akt1 and Akt3 exert opposing roles in the regulation of vascular tumor growth
Authors: Thuy L. Phung, Qi Xue, Sokha Nhek, Damien Gerald, Carole Perruzzi, Sriram Ayyaswamy, Wa Du, Sandaruwan Geeganage, Laura Benjamin
Journal: Cancer Research (2014)

Abstract Vascular tumors are endothelial cell neoplasms with a wide spectrum of clinical presentations, ranging from benign infantile hemangiomas in children to low-grade malignant hemangioendotheliomas and highly aggressive angiosarcomas in adults. To date, the cellular and molecular mechanisms leading to vascular tumor formation are poorly understood, and current therapies, particularly those for malignant vascular tumors, have not significantly improved the clinical outcome. We examined the growth regulatory pathways in vascular tumors, and showed that human vascular tumors have increased Akt activation, and constitutive activation of Akt1 in endothelial cells is sufficient to drive de novo vascular tumor formation in a transgenic mouse model. Importantly, we have uncovered the opposing functions of Akt isoforms in this regulation, in which Akt1 promotes, whereas Akt3 inhibits tumor endothelial cell migration and growth in in vitro and in vivo tumor models. Consistent with these findings, we observed reduced levels of Akt3 expression in human vascular tumors. Mechanistically, Akt3 blocks tumor cell migration and growth by inhibiting p70 S6-Kinase (S6K) activation, and Akt3 does so in part by modulating the levels of Rictor, a component of the mammalian target of rapamycin complex-2. S6K in turn exerts negative feedback regulation on Akt3 expression. Moreover, vascular tumor cells with Akt3 knockdown have increased S6K signaling, and are sensitized to a novel S6K inhibitor. Our findings provide a new perspective on Akt signaling, in which there are “check-and-balance” functions by different Akt isoforms to modulate the overall Akt signaling output. These studies also highlight the potential clinical utility of treating malignant vascular tumors, such as angiosarcomas, with agents that effectively block the S6K pathway. Citation Format: Thuy L. Phung, Qi Xue, Sokha Nhek, Damien Gerald, Carole Perruzzi, Sriram Ayyaswamy, Wa Du, Sandaruwan Geeganage, Laura Benjamin. Akt1 and Akt3 exert opposing roles in the regulation of vascular tumor growth. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3344. doi:10.1158/1538-7445.AM2014-3344
DVLA senior medical adviser's reply
Authors: E. Rowse
Journal: BMJ (1995)

EDITOR,--The problem that Jo Alexander describes--of an aunt who continued to drive into her 90th year--is one of general concern.1 We will always make medical inquiries if a health condition is declared, but some elderly people refuse to accept that they may be unfit and omit to declare a medical condition even when specifically asked to do so on renewal of their driving licence. Advice about …
A Rare Complication after Häring-Tube Implantation
Authors: K. Schwamberger, E. Bodner
Journal: Endoscopy (1982)

This is a report of a patient with subtotal obstruction of a Häring endoprosthesis due to the continuous growth of tumor tissue through the wall of the tube. Using a diathermic wire loop the obstructing tumor tissue was removed, and the esophageal passage cleared.
Subjects Sensitized to Sunflower Seed (Helianthus annuus) Are Tolerant in a High Proportion of Cases
Authors: Ana Aranda Guerrero, Maria Luisa Macias, Francisca Gomez, Natalia Blanca-López, Elena Seoane, Gabriela Canto, Miriam Osorio, Cristina Gomez-Casado, Araceli Diaz-Perales, Miguel Blanca
Journal: Journal of Allergy and Clinical Immunology (2013)
Prevention in Psychiatry
Authors: R. Ramsay
Journal: BMJ (1995)

Ed Eugene S Paykel, Rachel Jenkins, Gaskell/Royal College of Psychiatrists, pounds sterling12.50, pp 215 ISBN 0 902241 72 9

Despite the distress and disability that mental illness causes, attempts at prevention have until recently been rather tentative. However, prevention is now emerging as an “attractive and powerful concept”; already there have been one or two small but spectacular successes in psychiatry—for example, the identification of the fragile X gene, responsible …
Outcome of Prophylactic Therapy for Idiopathic Anaphylaxis
Authors: Sansan Wong, Paul R. Yarnold, Cynthia Yango, Roy Patterson, Kathleen E. Harris
Journal: Annals of Internal Medicine (1991)

Objective: To determine the efficacy of a prophylactic regimen (prednisone, H1 blockade, and sympathomimetic amine therapy) in patients with idiopathic anaphylaxis. Design: Clinical trial before and after treatment. Setting: Referral-based allergy clinic at a major medical center. Patients: Fifty-three patients with a history compatible with idiopathic anaphylaxis for at least 6 months before presentation to the allergy service and with subsequent management by the service for at least 6 months. Interventions: Patients with frequent life-threatening symptoms were treated with a prophylactic regimen. Patients with infrequent episodes of idiopathic anaphylaxis were only treated acutely for each episode of anaphylaxis. Measurements and Main Results: The results favored prophylactic treatment with prednisone for patients who were classified as generalized-frequent in the clinical outcome measures of frequency (per patient per year) of episodes (mean before treatment, 7.31 ± 6.46; after treatment, 3.61 ± 4.73; P < 0.02) and emergency room visits (mean before treatment, 1.94 ± 3.42; after treatment, 0.21 ± 0.44; P < 0.005) and for patients classified as angioedema-frequent in the frequency of episodes (mean before treatment, 14.93 ± 15.89; after treatment, 2.58 ± 2.18; P < 0.003) and emergency room visits (mean before treatment, 0.76 ± 1.01; after treatment, 0.07 ± 0.11; P < 0.025). No statistically significant difference was found for patients classified as generalized-infrequent in the frequency of episodes (mean before treatment, 2.01 ± 1.30; after treatment, 1.36 ± 1.79) or of the emergency room visits (mean before treatment, 0.56 ± 0.71; after treatment, 0.32 ± 0.75) or for patients classified as angioedema-infrequent in the frequency of episodes (mean before treatment, 1.94 ± 1.55; after treatment, 2.03 ± 2.16) or of emergency room visits (mean before treatment, 0.27 ± 0.44; after treatment, 0.37 ± 0.59). Conclusions: Prophylactic treatment with prednisone and H1 antihistamines with or without sympathomimetic amines improves clinical outcome in patients who are classified as idiopathic anaphylaxis-angioedema frequent and idiopathic anaphylaxis-generalized frequent.
The history of St Mary's
Authors: E A Heaman
Journal: Journal of the Royal Society of Medicine (2004)

I was pleased to see John Ballantyne’s review of my history of St Mary’s Hospital (August 2004 JRSM1). I would, however, like to correct one remark, where he questions my assertion that the 1988 merger with Imperial College achieved ‘minimal change with maximum protection’. My point was rather different. I suggest that, at least initially, the merger ‘seemed to have achieved minimal change with maximum protection’. But the paragraph continues, though the change seemed nominal, in fact ‘St Mary’s had relinquished real power to Imperial College. If it were to change its mind about leaving St Mary’s be, the school would find it difficult to resist. This was precisely what happened during the 1990s. With another change of rector, with new political pressures given focus by Sir Bernard Tomlinson’s shake-up of the hospitals, and not least, with a change of opinion at St Mary’s itself, the school did lose its name, its dean, and more besides’.
Theiler's virus infection of 129Sv mice that lack the interferon alpha/beta or interferon gamma receptors.
Authors: L Fiette, C Aubert, U Müller, S Huang, M Aguet, M Brahic, J F Bureau
Journal: The Journal of Experimental Medicine (1995)

The Daniels strain of Theiler's virus causes a persistent infection of the white matter of spinal cord of susceptible mice, with chronic inflammation and primary demyelination. Inbred 129Sv mice are resistant to this infection; they present with mild encephalomyelitis and clear the infection within a matter of days. A very different outcome was observed with inbred 129Sv mice whose receptors for interferon alpha/beta or interferon gamma had been inactivated by homologous recombination. The former presented severe encephalomyelitis with acute infection of neurons, particularly in brain and hippocampus, and extensive infection with necrosis of the choroid plexus. Most animals died of this acute disease. The latter, presented the same early encephalomyelitis as the control 129Sv mice. However, they remained persistently infected and developed a very severe late infection of the white matter with extensive primary demyelination. This late disease looked like an exacerbated form of the chronic demyelinating disease observed in susceptible inbred mice such as the SJL/J or FVB strains. Our results show that the two interferon systems play nonredundant roles in the resistance of the 129Sv mouse to the infection by Theiler's virus. They also lend support to the notion that the Ifg gene is involved in the resistance/susceptibility of inbred strains of mice to persistent infection by this picornavirus.
Psychoanalysis and Psychotherapy: 36 Systems
Authors: Frida G. Surawicz
Journal: JAMA (1974)

<b>Active Psychotherapy</b>, edited by Harold Greenwald, 384 pp, with illus, $12.50, Jason Aronson, 1974. When Harper's<i>Psychoanalysis and Psychotherapy: 36 Systems</i>was first published in 1959, it deservedly became a classic. Among the numerous books on psychotherapy, it served its function as a guide to the constantly expanding smorgasbord of psychotherapies. By now, almost a generation of psychiatrists, psychologists, and counselors of other disciplines have benefited from the instructive and clear chapters that discuss the development of psychoanalysis and its practice, as well as from the rest of the book that presents a "what's what in psychotherapy" in the past and present. The last chapter contains an overview, organizing the different schools into affective- or emotionallyoriented therapies and cognitive- or intellectually-oriented therapies. The author points out some major changes in the mental health field, such as the gradual erosion of psychoanalysis as the one and only therapy, by such upstarts
Long-Term Developmental Outcome of Infants with Iron Deficiency
Authors: Betsy Lozoff, Elias Jimenez, Abraham W. Wolf
Journal: New England Journal of Medicine (1991)

Iron-deficiency anemia has been associated with lowered scores on tests of mental and motor development in infancy. However, the long-term developmental outcome of infants with iron deficiency is unknown, because developmental tests in infancy do not predict later intellectual functioning.
How the cycle of poverty and ill health can be broken
Authors: R. Guerrero, M. Jancloes, J. D Martin, A. Haines, D. Kaseje, M. P Wasserman
Journal: BMJ (1998)

EDITOR—To paraphrase a well known remark—wars are too serious to be entrusted to generals—public health, especially among poor people in developing countries and in the inner cities of industrialised countries, is too serious to be left to doctors and nurses alone.

We say this quite deliberately as medical doctors on the staff of the World Health Organisation, of the Maryland department of health and mental hygiene, of universities, and of non-governmental organisations in Britain, Colombia, and Kenya. Our conviction is based on many years of work in the field in Africa, Asia, and Latin America, as well as in inner cities of the developed countries of Europe and North America. The number one health problem is poverty. For the poorest countries, the health sector alone cannot ensure better health even if it were able to function at maximum effectiveness. We have to accept that we can no longer deal with health …
Detection of Distant Medullary Thyroid Carcinoma Metastases by Tc-99m Arcitumomab Scintigraphy
Authors: PIO P. HOCATE, CARLOS E. JIMÉNEZ, INKU HWANG, JAVIER I. TORRENS
Journal: Clinical Nuclear Medicine (2000)

A 54-year-old woman with a history of medullary thyroid carcinoma after total thyroidectomy in 1992 was examined and found to have increasing serum carcinoembryonic antigen and calcitonin levels. Imaging with Tc-99m DMSA, neck and mediastinal MRI, and In-111 octreotide failed to reveal any recurrence or metastasis. Tc-99m arcitumomab scintigraphy showed increased uptake in the left lateral pelvis indicative of a metastatic focus. Follow-up pelvic MRI and whole-body bone scintigraphy revealed a correlative focal abnormality in the left anterior iliac bone. A CT-guided biopsy of this region revealed metastatic medullary thyroid carcinoma. FIGURE 1Fig. 1: A 3-hour delayed whole-body planar anterior CEA-Scan (Immunomedics, Morris Plains, NJ) study shows normal tracer biodistribution in the heart, blood vessels, liver, kidneys, bladder, and nasopharynx. Mild activity in the breasts and uterus are also apparent. An abnormal focus of increased uptake is noted in the left lateral pelvis. CEA-Scan is an anti-carinoembryonic antigen murine antibody Fab’ fragment, arcitumomab, which is commonly used to detect recurrent or metastatic colorectal carcinoma. This immunologic scan has also been used to detect cervical metastases in patients with thyroid medullary carcinoma who have elevated serum calcitonin and carcinoembryonic antigen levels (1).FIGURE 2Fig. 2: A 3-hour delayed anterior whole-body planar bone scan using 25 mCi Tc-99m MDP reveals abnormal asymmetric increased uptake in the left inferior iliac bone, which corresponds to the site of abnormal uptake on the CEA-Scan. There is also mild increased uptake in the lumbar spine at the level of L3. MRI of the lumbar spine showed metastatic lesions at L3.FIGURE 3Fig. 3: An axial inversion recovery MRI of the pelvis reveals a high signal lesion in the left anterior inferior iliac bone. This lesion had low intensity on T1, high intensity on T2, and enhanced after gadolinium administration. A CT-guided biopsy of this lesion was positive for medullary thyroid carcinoma.
Differential Diagnosis of Hypercalcemia
Authors: Ralph S. Goldsmith
Journal: New England Journal of Medicine (1966)

ALTHOUGH hypercalcemia may occur in a wide variety of diseases, differential diagnosis in any given patient, although sometimes difficult, is usually limited to but a few possibilities. Foremost among these is hyperparathyroidism, the most easily curable of the entities listed in Table 1. Until an assay technic for parathyroid hormone becomes readily available and practical for clinical use indirect approaches to diagnosis must be utilized. This review will be concerned with an evaluation of these approaches, but it is quite clear that there can be no substitute for sound clinical judgment, It should be noted incidentally that, although this review is . . .