tbuckley/cabot-search huggingface dataset:
PWE-064 Management Of Large Colonic Polyps In The Severn Deanery Hospitals: An Audit Of Current Practice
Authors: SW Dixon, T Valliani, F Fayyaz, D Tate, E Arthurs, L Lim, A Dhanda, M Lockett
Journal: Gut (2014)

<h3>Introduction</h3> Large (&gt;2 cm) colonic polyps present a challenge to the colonoscopist. The British Colorectal Cancer Screening Programme (BCSP) recently drafted guidelines to standardise their management. We compared our current practice with the proposed guidelines. <h3>Methods</h3> This was a retrospective audit in four South-West hospitals with comparison between screening and non-screening patients. Patients were identified using clinical coding. Case notes were reviewed. Polyps were scored using SMSA system to standardise difficulty of endoscopic resection. Data was compared against 9 auditable outcomes. <h3>Results</h3> 104 cases were identified (24 BCSP, 80 symptomatic). There was no significant difference in mean size (2.9 cm BCSP, 2.7 cm symptomatic, p = 0.14) or mean SMSA grading (2.8 BCSP, 2.9 symptomatic, p = 0.46). 6 polyps were malignant (1 BCSP; 5 symptomatic); all had position marked by tattoo. 1 malignant polyp was resected endoscopically in the symptomatic group. Mean time to definitive resection was 34 and 30 days (BCSP and symptomatic respectively). Recurrence of adenoma at EMR site was low at 3 months (0/22 BCSP, 1/37 symptomatic) and 12 months (0/22 BCSP, 2/37 symptomatic). However fewer EMR sites were checked if the index endoscopy was performed by a non-BCS colonoscopist (10/13 vs. 8/24). Complication rates were low: 1 haemorrhage requiring admission (symptomatic group); 0 perforations. 17 benign polyps were referred for surgery (3 BCSP, 14 symptomatic; p = 0.49). In both groups the mode SMSA score was 4. Benign polyps were referred directly for surgery; only those polyps with malignant histology were discussed at a formal mutli-disciplinary meeting. There were no deaths or signficant morbidity associated with surgery for bening polyps. <h3>Conclusion</h3> Overall management was comparable to draft guidelines. The frequency of large polyps outside BCSP indicates that non-BCS endoscopists will gain experience with these lesions. Approximately 17% of benign polyps were referred for surgery, similar to other series. However, none had been discussed with local EMR experts. Consequently a large polyp referral pathway has been established at two centres within the region. <h3>Reference</h3> Gupta S, Miskovic D, Bhandari P, <i>et al</i>. SMSA scoring system: a novel scoring system for determining the level of difficulty of a polypectomy. <i>Gastrointestinal</i><i>Endoscopy</i> 2011;73(4S):AB418–9 <h3>Disclosure of Interest</h3> None Declared.
Death certification and epidemiological research
Authors: T A French, P J H Fletcher, B G Ockenden
Journal: BMJ (1978)

discrepancies turn out to be mainly aberrations which are correctable in their wider context.Over the years death certification has improved with advances in medicine.More information is given and it is more precise.We should tackle administrative weaknesses such as failure of pathologists to state explicitly causes of death, failure to update after necropsy, and relegation of completion to junior doctors without instruction.Over the past 140 years these records (the results of everyday experience of doctors) have contributed a great deal to our knowledge of the health of the nation and to medical research.Of course, there is a continuous need to study their flaws -especially as part of practical research-as was done in the papers by the study group of the Royal College of Physicians.I trust that these papers will be read constructively, otherwise they may have a negative effect, the best becoming the enemy of the good.
Scanning the Solitary Pulmonary Nodule
Authors: PAUL EPSTEIN
Journal: Annals of Internal Medicine (1980)

Editorial Notes1 September 1980Scanning the Solitary Pulmonary NodulePAUL EPSTEIN, M.D.PAUL EPSTEIN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-93-3-502 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNoninvasive diagnosis of the solitary pulmonary nodule continues to be a medically and economically important clinical problem. Radiographic detection of calcium in the center of the lesion is generally recognized as reliably indicating that it is benign. Conventional radiographic methods such as plain roentgenography and standard tomography can detect the calcification in many benign nodules. If the lesion appears uncalcified radiographically, invasive methods must be used to differentiate between benign and malignant disease. Developments in fiberoptic bronchoscopy and transthoracic needle biopsy have been helpful additions to diagnostic assessment, but biopsy, as well as thoracotomy, produce significant morbidity and occasional mortality...References1. HERF S, SURATT P, and ARORA N. Deaths and complications associated with transbronchial lung biopsy. Am Rev Resp Dis. 1977; 115:708-11. MedlineGoogle Scholar2. SINNER W. Pulmonary neoplasms diagnosed with transthoracic needle biopsy. Cancer. 1979;43:1533-40. CrossrefMedlineGoogle Scholar3. SIEGELMAN S, ZERHOUNI E, LEO F, KHOURI N, and STITIK F. CT of the solitary pulmonary nodule. Am J Roentgenol. 1980;135:1-13. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: PAUL EPSTEIN, M.D.Affiliations: Graduate Hospital Philadelphia, Pennsylvania PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLocal excision of pulmonary nodular (coin) lesion with noncontact yttrium-aluminum-garnet laser 1 September 1980Volume 93, Issue 3Page: 502-502KeywordsBiopsyBronchoscopyCalciumDiagnostic radiologyLesionsMorbidityMortalityThoracotomyTomography ePublished: 1 December 2008 Issue Published: 1 September 1980 PDF downloadLoading ...
The hairless gene in androgenetic alopecia: results of a systematic mutation screening and a family-based association approach
Authors: A.M. Hillmer, R. Kruse, F. Macciardi, U. Heyn, R.C. Betz, T. Ruzicka, P. Propping, M.M. Nothen, S. Cichon
Journal: British Journal of Dermatology (2002)

Summary Background Genetic disposition and androgen dependence are important characteristics of the common patterned loss of scalp hair known as androgenetic alopecia (AGA). The genetic factors contributing to AGA are currently unknown. The human hairless gene (HR) has recently been cloned and mutations have been reported in families with autosomal recessive universal congenital alopecia and papular atrichia. The main feature of these disorders is persistent complete absence of hair at or shortly after birth. This suggests that HR is essential and specific for the development of hair. Objectives To test the hypothesis that HR may be involved in AGA. Methods We systematically screened HR for genetic variability by means of single‐strand conformation analysis (SSCA) in 46 unrelated men with AGA. To test for an involvement of HR in the development of AGA, seven common variants were genotyped in 61 families with 93 affected offspring. The results were analysed with the transmission/disequilibrium test (TDT). Results SSCA showed 15 single nucleotide substitutions: eight missense mutations, four silent mutations and three mutations in exon‐flanking intronic sequences. TDT results showed a marginally significant association between AGA and variants 3379–29G/T (P = 0·024) and 2611–68C/T (P = 0·047). These results, however, did not remain significant after applying the conservative Bonferroni correction for multiple testing. Conclusions Our results do not provide evidence for a strong involvement of HR in the development of AGA, although a minor role cannot be fully excluded.
Surgical Patent Foramen Ovale Closure for Prevention of Paradoxical Embolism-Related Cerebrovascular Ischemic Events
Authors: J. A. Dearani, B. S. Ugurlu, G. K. Danielson, R. C. Daly, C. G. A. McGregor, C. J. Mullany, F. J. Puga, T. A. Orszulak, B. J. Anderson, R. D. Brown, H. V. Schaff
Journal: Circulation (1999)

The role of surgical closure of patent foramen ovale (PFO) for cerebral infarction (CI) or transient ischemic attack (TIA) resulting from paradoxical embolism is unclear, and its effect on recurrence is unknown. Our objective was to determine the outcome of surgical closure of PFO in patients with a prior ischemic neurological event, define the rate of CI or TIA recurrence after PFO closure, and identify risk factors for these recurrences.We retrospectively analyzed 91 patients (58 men, 33 women) with >/=1 previous cerebrovascular ischemic events who underwent surgical PFO closure between April 1982 and March 1998. The presence of a PFO with a right-to-left shunt was confirmed with transesophageal echocardiography. Mean age was 44.2+/-12.2 years. The index event was a CI in 59 and a TIA in 32; a Valsalva-like episode preceded the event in 15 patients. Deep venous thrombosis was documented in 9 patients, and a hypercoagulable state was identified in 10. Surgical closure was performed with extracorporeal circulation by either direct suture (n=82) or patch closure (n=9). Limited incisions were used in 18.7% of patients. There was no operative mortality. Morbidity included transient atrial fibrillation (n=11), pericardial drainage for effusion (n=4), exploration for bleeding (n=3), and superficial wound infection (n=1). Follow-up totaled 176.3 patient-years, and mean follow-up was 2.0 years. No one had a CI, and 8 had a TIA during follow-up, with 1 caused by temporal arteritis. Transesophageal echocardiography demonstrated all closures to be intact in these patients. The overall freedom from TIA recurrence during follow-up was 92.5+/-3.2% at 1 year and 83.4+/-6.0% at 4 years. Having multiple neurological events before PFO closure was the only significant risk factor for TIA or CI recurrence after closure by univariate analysis (P=0.05); the small number of post-PFO closure cerebral ischemic events precluded multivariate analysis.Surgical closure of PFO can be performed with minimal morbidity and mortality. PFO closure may decrease the risk of recurrent stroke or TIA and may avoid lifelong anticoagulation in the young adult if there is no other indication. Recurrent cerebrovascular ischemic events after surgery should prompt further evaluation to identify causes other than paradoxical embolism.
Functional Analysis of the Fibrinogen Aα Thr312Ala Polymorphism
Authors: Kristina F. Standeven, Peter J. Grant, Angela M. Carter, Thomas Scheiner, John W. Weisel, Robert A.S. Ariëns
Journal: Circulation (2003)

The fibrinogen Aalpha Thr312Ala polymorphism occurs within the alphaC domain of fibrinogen, which is important for lateral aggregation and factor XIII-induced cross-linking of fibrin fibers. We have previously shown an association of Ala312 fibrinogen with poststroke mortality in subjects with atrial fibrillation and with pulmonary embolism in subjects with venous thrombosis.We studied the properties of clots formed from purified Ala312 and Thr312 fibrinogen and found that Ala312 fibrinogen produces stiffer clots, associated with increased alpha chain cross-linking, as demonstrated by SDS-Page. On electron microscopy analysis, we found larger fiber diameters in the Ala312 clots and observed a lower number of fibers per square micrometer. The number of branch points per square micrometer was similar between genotypes.Our study shows that Ala312 influences clot structure and properties by increased factor XIII cross-linking and formation of thicker fibrin fibers. These findings may provide a mechanism by which Ala312 fibrinogen could predispose to clot embolization.
Points: Roadside resuscitation in freezing weather
Authors: A Inglis
Journal: BMJ (1982)

p 4), I discussed this with the authors.In view of the fact that neither microscopic nor the earliest lymph node invasion is demonstrated by computed tomography, it appeared essential to define the track or volume within which malignant disease spread up the lym- phatics.This has been demonstrated in a series of 35-mm slides covering the lymphatic volume from the pelvis up through the abdomen and thorax to the root of the neck.This surprisingly small volume was agreed for surgical and radiotherapy planning for "cur- able" cancer with around 100 experienced consultants in surgery, radiology, and radio- therapy, on an extensive tour of Europe, Canada, and the United States.
Phenolic Compounds in the Treatment of Rheumatic Fever
Authors: NORMAN E. CLARKE, ROBERT E. MOSHER
Journal: Circulation (1953)

The absorption and excretion of gentisic acid has been studied to help clarify the confusion that exists in the literature. Data are given that support the retarding action of methyl cellulose and Benemid and also the manner in which these compounds are metabolized in the human body. The first metabolic study of the ethanolamide of gentisic acid in human subjects is described. Evidence is presented that the antirheumatic property of certain phenolic compounds may be explained by the phenomena of chelation and the possible existence of a reversible hydroquinone-quinone system in the blood stream.
RIGHT ATRIAL SIZE PREDICTS ARRHYTHMIA AND DEATH IN PATIENTS WITH REPAIRED TETRALOGY OF FALLOT
Authors: Beatrice Bonello, Aleksander Kempny, Anselm Uebing, Wei Li, Philip Kilner, Dudley J. Pennell, Michael Gatzoulis, Gerhard-Paul Diller, Sonya Babu-Narayan
Journal: Journal of the American College of Cardiology (2012)
Ethical issues in endoscopy: patient satisfaction, safety in elderly patients, palliation, and relations with industry
Authors: S. Ladas, B. Novis, K. Triantafyllou, R. Schoefl, T. Rokkas, C. Stanciu, P. Isaacs, S. Willich, O. Ronn, H. Dremel, G. Livadas, B. Egan, S. Boyacioglu, A. Selimovic, R. Pulanic, J. Karagiannis, J. Van Vooren, E. Kouroumalis, C. O’Morain, A. Nowak, J. Deviere, P. Malfertheiner, A. Axon
Journal: Endoscopy (2007)

The explosive development of gastroenterology and gastrointestinal endoscopy over the past few years, with clinical trials of powerful new drugs and top-quality endoscopes and accessories, has led to a huge increase in the diagnostic and therapeutic potential of modern gastroenterology. At the same time the percentage of elderly people in Europe has increased, patients attending gastrointestinal endoscopy units are expecting to undergo painless endoscopy procedures, and palliative endoscopic therapy is increasingly being used for patients with lethal gastrointestinal diseases. This new environment presents a number of ethical issues and necessitates an updated consensus applicable in the clinical practice of gastroenterology.
Physiological Findings in Schizophrenia
Authors: Sanford H. Roth
Journal: JAMA (1964)

In the editorial titled "Psychosis, Biological or Psychological?" reference was made to studies which showed elevated levels of macroglobulins in psychiatric patients and long-term prisoners. It was mentioned that in these particular population groups the macroglobulin had "rheumatoid factor-like activity." We have recently reported<sup>1,2</sup>our results with Rhein's modification of the drop latex fixation test in special population groups including psychiatric state hospital patients and state penitentiary patients. We found a decreased incidence of positive latex fixation tests in both of the incarcerated populations. Of sera from 969 persons admitted consecutively to ten Ohio state hospitals for the insane only ten were latex positive, and of sera from 585 persons admitted consecutively to the Ohio State Penitentiary only five were latex positive. The seropositive incidence therefore was 1.03% and 0.85%, respectively. This is significantly lower than the 3% to 5% seropositive incidence reported for the general population. One might
Factor V Leiden is not responsible for stroke in patients with sickling disorders and is uncommon in African Americans with sickle cell disease
Authors: Marc J. Kahn, Charles Scher, Marta Rozans, Robert K. Michaels, Cindy Leissinger, John Krause
Journal: American Journal of Hematology (1997)

Cerebrovascular accidents in patients with sickle cell anemia are among the most devastating complications of the disease. It has recently been demonstrated that some patients have a hypercoagulable state on the basis of the presence of an abnormal factor V molecule, factor V Leiden. We undertook this study to evaluate the presence of factor V Leiden in sickle cell patients with stroke. Eighty-two patients with either Hgb SS, Hgb SC, or Hgb S(beta+)-thalassemia comprised the study population. Of the 82 patients in the study, 19 of them had a history of stroke. In our study population, none of the stroke patients possessed the factor V Leiden mutation. One of the non-stroke patients was a heterozygote for the mutation (P = 1.00). The overall frequency of the factor V Leiden allele in our population is 0.6%. The estimated prevalence for this mutation is reportedly between 3 and 7% in Caucasian populations. We conclude that the gene frequency for factor V Leiden is less common in Africa Americans with sickle cell disease. Furthermore, factor V Leiden does not appear to be responsible for the development of stroke in sickle cell patients.
Ergebnisse der Laparoskopie im Kindesalter
Authors: E. Wildhirt, H. Selmair
Journal: Endoscopy (1970)

The results of 75 peritoneoscopic examinations of 68 children are presented. The youngest infant was 2œ months old. The analysis of the diagnoses revealed many kinds of interesting observations: among them we observed frequently liver cirrhosis in infancy, chronic hepatitis and in cases of obstructive jaundice not only the expected congenital atresias of bile-ducts but also tumors in four cases. The diagnosis of an unexplored disease of the liver could be determined in 82.5% of the cases by peritoneoscopy. Therefore peritoneoscopy and controlled punction of the liver are extremely important methods of examination far too seldom used in pediatrics.
Duodenal Ulcer and Chronic Gastritis
Authors: R. Cheli, A. Giacosa
Journal: Endoscopy (1986)

The histological aspect of fundic and antral mucosa of patients with endoscopically proven duodenal ulcer was investigated and compared with that observed in asymptomatic controls of similar age. Fundic gastritis was less frequent in ulcer patients than in controls. In contrast the chronic inflammatory lesions of the antral mucosa were more frequent, more severe and appeared at an earlier age in ulcer patients than in controls.
Alcohol policy in the Nordic countries
Authors: L. Chenet, M. McKee, M. Osler, A. Krasnik
Journal: BMJ (1997)

Last month the European Court dealt a potentially fatal blow to alcohol policy in much of Scandinavia.1 A preliminary ruling held that Sweden's retail alcohol monopoly, which has the effect of controlling access to spirits, was illegal under European competition law. If upheld, this policy seems likely also to apply to Finland and, possibly, Norway and Iceland due to their obligations as members of the European Economic Area. All of these countries operate this system, which has been effective–death rates from cirrhosis in Sweden are less than half those in Denmark, where there is no such policy.2

Indeed, in February the Danish daily newspaper Politiken reported new evidence that deaths from alcohol related diseases in Denmark have risen by 120% since 1970,3 contributing to the failure of Denmark to match improvements in life expectancy seen in neighbouring countries.4 The death rate from liver cirrhosis in …
Osteoarthritis and cardiovascular death
Authors: K A Grindulis
Journal: Annals of the Rheumatic Diseases (2003)

We examined the <i>in vivo</i> effects of the hallucinogen 4-iodo-2,5-dimethoxyamphetamine (DOI). DOI suppressed the firing rate of 7 of 12 dorsal raphe (DR) serotonergic (5-HT) neurons and partially inhibited the rest (ED<sub>50</sub> = 20 μg/kg, i.v.), an effect reversed by M100907 (5-HT<sub>2A</sub> antagonist) and picrotoxinin (GABA<sub>A</sub> antagonist). DOI (1 mg/kg, s.c.) reduced the 5-HT release in medial prefrontal cortex (mPFC) to 33 ± 8% of baseline, an effect also antagonized by M100907. However, the local application of DOI in the mPFC increased 5-HT release (164 ± 6% at 100 μm), an effect antagonized by tetrodotoxin, M100907, and BAY × 3702 (5-HT<sub>1A</sub> agonist) but not by SB 242084 (5-HT<sub>2C</sub> antagonist). The 5-HT increase was also reversed by NBQX (AMPA–KA antagonist) and 1<i>S</i>,3<i>S</i>-ACPD (mGluR 2/3 agonist) but not by MK-801 (NMDA antagonist). AMPA mimicked the 5-HT elevation produced by DOI. Likewise, the electrical–chemical stimulation of thalamocortical afferents and the local inhibition of glutamate uptake increased the 5-HT release through AMPA receptors. DOI application in mPFC increased the firing rate of a subgroup of 5-HT neurons (5 of 10), indicating an enhanced output of pyramidal neurons. Dual-label fluorescence confocal microscopic studies demonstrated colocalization of 5-HT<sub>1A</sub>and 5-HT<sub>2A</sub> receptors on individual cortical pyramidal neurons. Thus, DOI reduces the activity of ascending 5-HT neurons through a DR-based action and enhances serotonergic and glutamatergic transmission in mPFC through 5-HT<sub>2A</sub> and AMPA receptors. Because pyramidal neurons coexpress 5-HT<sub>1A</sub> and 5-HT<sub>2A</sub> receptors, DOI disrupts the balance between excitatory and inhibitory inputs and leads to an increased activity that may mediate its hallucinogenic action.
Advance Directives, Due Process, and Medical Futility
Authors: Thomas E. Finucane
Journal: Annals of Internal Medicine (2004)

Letters2 March 2004Advance Directives, Due Process, and Medical FutilityThomas E. Finucane, MDThomas E. Finucane, MDFrom Johns Hopkins Bayview Medical Center, Baltimore, MD 21224.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-5-200403020-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Discussing Texas's legal rules for “resolution of futility by due process,” Fine and Mayo (1) cite 3 legal cases: Wanglie (2), Baby K (3), and Gilgunn (4). They contrast the first 2, where family wishes were upheld over professionals' claims of futility, with the third, where the family's request was not honored.Careful use of the word futility is essential. In the Wanglie and Baby K cases, the patients continued to live because of intensive care unit treatment, albeit with severe, hopeless cognitive impairment. The futility claims were based on quality of life and were supported by ...References1. Fine RL, Mayo TW. Resolution of futility by due process: early experience with the Texas Advance Directives Act. Ann Intern Med. 2003;138:743-6. [PMID: 12729429] LinkGoogle Scholar2. PX-91-283 (Minn 4th Dist Ct, Hennepin Co, July 1, 1991). Reprinted in 2 BioLaw U:2161 (Aug-Sept 1991). Google Scholar3. In re Baby “K,” 832 F3d 590 (4th Cir), cert denied, 513 US 825 (1994). Google Scholar4. Gilgunn v Massachusetts General Hospital, SUCV92-4820 (Mass Super Ct, Suffolk Co, April 21, 1995). Google Scholar Author, Article, and Disclosure InformationAffiliations: From Johns Hopkins Bayview Medical Center, Baltimore, MD 21224. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoResolution of Futility by Due Process: Early Experience with the Texas Advance Directives Act Robert L. Fine and Thomas Wm. Mayo Advance Directives, Due Process, and Medical Futility Anne L. Flamm and Martin L. Smith Advance Directives, Due Process, and Medical Futility Robert L. Fine and Thomas Wm. Mayo Advance Directives, Due Process, and Medical Futility Jeffrey T. Berger Metrics 2 March 2004Volume 140, Issue 5Page: 403KeywordsCognitive impairmentIntensive care unitsQuality of lifeResuscitation ePublished: 2 March 2004 Issue Published: 2 March 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...