tbuckley/cabot-search huggingface dataset:
Reducing variation in surgical care
Authors: David R Urbach, Nancy N Baxter
Journal: BMJ (2005)

Requires innovative methods for getting evidence into surgical practice 

V ariations in surgical care have been recognised since the early 1980s and are generally interpreted as evidence of uncertainty among practitioners regarding optimal care. The prescription for remedying variations in surgical practice has generally included development of better medical evidence to identify best practices, dissemination of medical evidence to surgeons, and use of practice guidelines and care pathways to streamline care. More than 20 years later, there is still abundant evidence that surgical care varies substantially. Why do variations in surgical care persist? And what can be done about them?

In this issue of BMJ , Lassen et al (p 1420) report the results of a survey of lead surgeons in five north European countries regarding processes of care for colorectal surgery.1 These processes included use of preoperative bowel preparation, routine postoperative nasogastric decompression, and use of epidural analgesia in the …
Primary Cardiac Osteosarcoma: Multidisciplinary Aspects Applicable to Extraskeletal Osteosarcoma Generally
Authors: H. Schneiderman, E. W. Fordham, C. C. Goren, A. R. McCall, M. S. Rosenberg, S. Rozek
Journal: CA A Cancer Journal for Clinicians (1984)

An osteosarcoma, primary in the right ventricular epicardium, produced pericardial constriction. Intense activity on technetium-99m bone scinTIGraphy led to a correct preoperative diagnosis. Biopsy of unrepresentative tissue clouded the diagnosis, and autopsy resolved the issue. Several clinicopathologic correlations are presented. Major therapeutic advances mandate early recognition of extraskeletal osteosarcoma, and the topic is reviewed in regard to cardiac cancers in general. The need to biopsy both hard and fleshy areas of unusual tumors is reviewed.
5-Aminosalicylic acid inhibits the impaired epithelial barrier function induced by gamma interferon.
Authors: M C Di Paolo, M N Merrett, B Crotty, D P Jewell
Journal: Gut (1996)

Gamma interferon (IFN gamma) impairs epithelial barrier function and induces HLA-DR expression on colonic cancer cell lines. Salicylates have been shown to reduce IFN gamma induced HLA-DR expression. The effect of 5-aminosalicylic acid (5-ASA) on IFN gamma induced changes in transepithelial resistance and permeability was investigated in HT29 clone 19A and Caco 2 monolayers. Monolayers were incubated with different concentrations of IFN gamma (100, 500, 1000, and 3000 U/ml) and 5-ASA. IFN gamma induced class II expression in a time and dose dependent manner in HT29:19A but not Caco 2 cells. HT29:19A monolayers incubated with both IFN gamma and 5-ASA showed lower HLA-DR expression compared with monolayers incubated with IFN gamma alone. Electrical resistance and 14C-mannitol flux across HT29:19A monolayers were significantly changed by IFN gamma. Addition of both IFN gamma and 5-ASA to the basolateral surface of the monolayers significantly reduced paracellular permeability compared with addition of IFN gamma alone. These data show that IFN gamma is able to induce HLA-DR expression and to impair the barrier function of HT29:19A monolayers, and that 5-ASA reduces IFN gamma induced HLA-DR expression and inhibits the effects of IFN gamma on epithelial barrier function.
Use of Intracavitary Contrast Media in Patients With Neoplastic Effusions
Authors: Anthony J. Piro
Journal: JAMA (1968)

Instillation of water soluble contrast media into the pleural, peritoneal, or tumor cavities of 24 patients with neoplastic effusion was demonstrated to be a simple, safe, and useful technique. The determination of the extent of intracavitary loculation was reasonably accurate if care was exercised in the placing of the needle or catheter, if an adequate volume of dye was used, and if the patient's position was manipulated to insure adequate mixing of dye in the serous fluid. Since this method may be used to assure the correct position of the needle or catheter and to confirm adequate distribution, serious local reactions secondary to the use of intracavitary radioactive compounds or vesicant drugs may be avoided. Large intracavitary masses were demonstrated by this technique, but small tumors were not seen easily.
Effects on Foetal Weight of Growth-hormone-containing Anterior Pituitary Extracts Given to Pregnant Rats
Authors: H. H. F. Barns, G. I. M. Swyer
Journal: BMJ (1952)

SKIN MANIFESTATIONS OF MALIGNANT DISEASEMEDICLJORA of hormone levels with pregnancy may explain the telangiectasia of the face and chest, reversible after parturition.Disease of the liver, with disturbance of its ability to regulate oestrogen and androgen blood levels, has been known to be associated with telangiectasia of the face and palms, and occasionally with enlargement of the male breasts.A myositis may be an early sign of thyrotoxicosis.At some stage in their course malignant tumours of the genital organs-for example, the ovaries-may themselves produce steroids capable of affecting vessels and connective tissue.Acanthosis nigricans in which there is hypertrophy and pigmentation of the skin, in adults, is in most cases associated with malignancy.The maximum incidence of the benign cases is at puberty, and in one case quoted there was additional evidence of endocrine disturbance (acromegaly and virilism).
RADIUM THERAPY IN CARCINOMA OF THE LIP
Authors: EDMUND KELLY
Journal: JAMA (1933)

Dr. William Halsted once remarked that it would be a great day for surgery when all malignant disease was removed from its field of operation. That day bids fair to be at hand for certain groups of carcinoma, notably carcinomas of the lip, in which radium therapy stands preeminently as the method of choice.  This paper offers for analysis records of the Howard A. Kelly Hospital for the years 1913-1931, during which period 535 patients suffering from carcinoma of the lip presented themselves. It is interesting to note here that the first of these patients, treated in July, 1913, was entirely well when last seen in 1918. I have taken as representative of the success of irradiation those cases treated during the years 1921-1929, inclusive. The material previous to 1921 has not been included for two reasons: first, because nearly all cases referred to this hospital prior to that time
Gene therapy cures two men of immune system disorder
Authors: Annette Tuffs
Journal: BMJ (2006)

A multinational team of researchers led by Germans has reported the first successful use of gene therapy to treat two adult patients with an immunesystem disorder that could not otherwise be treated.

The researchers' study was published online ahead of print publication on 2 April in Nature Medicine (www.nature.com/nm, doi:10.1038/nm1393). The researchers—from Germany, the United Kingdom, United States, and Switzerland—said that they were able to cure the two men, aged 25 and 16, who had the genetic disorder chronic granulomatous disease (CGD). The illness results form …
Animal-type melanoma: a clinical and histopathological study of 22 cases from a single institution
Authors: M.W. Ludgate, D.R. Fullen, J. Lee, R. Rees, M.S. Sabel, S.L. Wong, T.M. Johnson
Journal: British Journal of Dermatology (2009)

Background Animal-type melanoma is a rare distinct melanoma subtype, characterized by proliferation of heavily pigmented epithelioid and spindled melanocytes that resembles the heavily pigmented melanomas seen in grey horses. While animal-type melanoma is generally considered to be more indolent than conventional melanoma, only a limited number of cases have been reported and, as such, the clinical characteristics of animal-type melanoma are incompletely understood. Objectives To characterize the clinical and histopathological features of animal-type melanoma, and determine any features that may predict outcome. Patients/Methods Data was extracted from a prospectively collected melanoma database (1994–2008), and a retrospective pathology database (1991–2008) for all patients with a diagnosis of both equivocal (8) and unequivocal (14) malignant animal-type melanoma. We reviewed the clinical and histopathological features, including the sentinel lymph node biopsy (SLNB) status. Results A total of 22 patients were identified, with a median age of 35 years. The median Breslow depth was 2·22 mm. A SLNB was performed in 17 patients, eight (47%) were positive. Younger age was associated with: (i) animal-type melanoma with features equivocal for malignancy (median age of 7 vs. 48 years, P = 0·01), and (ii) a negative SLNB (median age 12 vs. 53 years, P = 0·03). Four patients with unequivocal animal-type melanoma developed recurrent metastatic disease, with one patient death. No patient with an equivocal animal-type melanoma or negative SLNB developed recurrent disease; however, this did not reach statistical significance (P = 0·13 and P = 0·09, respectively). Conclusions Animal-type melanoma has a propensity for regional lymphatic metastasis and is rarely capable of disseminated metastatic disease and death. Animal-type melanoma appears to exhibit a spectrum of biological behaviour, with young patient age associated with more indolent disease.
Papanicolaou Smear Testing in Elderly Women
Authors: Gary Kochersberger
Journal: JAMA (1986)

<h3>To the Editor.—</h3> In a recent article,<sup>1</sup>the results of Papanicolaou smear screening in a large group of elderly women were reviewed. The authors addressed the important issue of screening as part of health maintenance in the elderly. A 65-year-old woman has an 18-year life expectancy and should not be considered "too old" for preventive medicine. Potential biases in the study were discussed by the authors, and the important outcomes of the screening were included in their analysis. Of 816 Papanicolaou smears obtained, 11 were reported to be abnormal, with the authors concluding that cervical cancer screening should continue beyond the age of 65 years, especially in the group that has underutilized screening in the past. While pelvic examinations should be a part of regular physical examinations for elderly women, the utility of Papanicolaou smears for this age group remains questionable, even in the large cohort that has never
Child death expert is accused of dishonesty and failing to work within competence
Authors: C. Dyer
Journal: BMJ (2014)

One of the United Kingdom’s leading paediatric neuropathologists, who has testified in dozens of cases in which parents have been accused of harming their babies by shaking, has been accused of dishonesty by the General Medical Council.

The GMC alleges that Waney Squier, 66, who works part time for Oxford University Hospitals NHS Trust, “failed to discharge her duties as an expert in that she failed to work within the limits of her competence, to be objective and unbiased, and to pay due regard to the views of other experts.”

The regulator claims that her actions as an expert witness in civil and criminal cases between 2007 and 2010 were “deliberately misleading, dishonest, and brought the reputation of the medical profession into disrepute.” …
TEMPORAL TRENDS IN CORONARY RISK FACTORS IN PATIENTS UNDERGOING MYOCARDIAL PERFUSION IMAGING: RESULTS FROM A LARGE MULTICENTER STUDY
Authors: Tokir Mujtaba, Mridula Rai, Alan Ahlberg, Deborah Katten, Milena Henzlova, William Duvall
Journal: Journal of the American College of Cardiology (2014)
In-flight Emergencies: Doc Riders in the Sky
Authors: P. K. Underwood
Journal: JAMA (1990)

<h3>To the Editor.—</h3> In response to the article entitled "The Accidental Tourist: Medical Emergencies in the Air," I can assure Dr Dan<sup>1</sup>that flight attendants do receive basic life support training in addition to first aid. I worked as a flight attendant for Pan American World Airways in 1973, when I had my first introduction to the "Resusci-Annie" doll. In my experience with the airline, I assisted an in-flight passenger who sustained a closed fracture of the radius. My roommate helped deliver a baby. I knew of two attendants who gave mouth-to-mouth resuscitation for several hours to a stricken passenger on a transatlantic flight before landing was possible. In addition, there have been countless incidents of attendants saving passengers from choking. I agree that it would make an excellent television series. May I suggest "Doc Riders in the Sky"?
Test for Lyme Disease in a Prepaid Health Plan
Authors: Victor P. Berardi
Journal: JAMA (1994)

<h3>To the Editor.</h3> —The article entitled "The Use of Serologic Tests for Lyme Disease in a Prepaid Health Plan in California" by Ms Ley and colleagues reports a total lack of correlation between patients' clinical condition and serologic test results. The authors' discussion includes what appears to have become an obligatory statement in every article on Lyme disease: "The currently available serologic tests have both relatively poor specificity and low sensitivity." Like most truisms, the statement is only partially true; the study's findings stem in large part from its use of an obsolete (albeit inexpensive) method of Lyme serology, ie, indirect immunofluorescent antibody (IFA), clearly and repeatedly documented to be the least sensitive and least specific of commonly used assays for antibody to<i>Borrelia burgdorferi</i>.<sup>2</sup>Enzyme-linked immunosorbent assay (ELISA) is somewhat better than IFA, but the detection of<i>B burgdorferi</i>—specific IgM, IgG, and IgA by antibody capture has
Requiem for an Unknown Leper-Reply
Authors: Ralph Crawshaw
Journal: JAMA (1992)

<h3>In Reply.</h3> —Drs Chester and Ryan attribute to me an unwarranted animus toward ECT. I have prescribed and used ECT in my practice, finding it effective in the treatment of recurrent, severe, major depression with agitation. My qualifications for judging this therapy are based on 35 years of psychiatric practice, board certification, and my position as clinical professor of psychiatry at the Oregon Health Sciences University, Portland. At issue is my use of the term<i>iatrogenic numbness</i>. One documented side effect of ECT is temporary amnesia with confusion, which makes it an appropriate example of iatrogenic numbness. However, the point is not a particular treatment procedure, but Ida's perception of physicians in their insensitivity and technological arrogance. It is the unfeeling manner in which some physicians apply their "scientific" power in the name of therapy that is the subject of the essay. Interestingly, no internists protested the reference to mind-numbing
Synergistic airway gland mucus secretion in response to vasoactive intestinal peptide and carbachol is lost in cystic fibrosis
Authors: Jae Young Choi, Nam Soo Joo, Mauri E. Krouse, Jin V. Wu, Robert C. Robbins, Juan P. Ianowski, John W. Hanrahan, Jeffrey J. Wine
Journal: Journal of Clinical Investigation (2007)

Cystic fibrosis (CF) is caused by dysfunction of the CF transmembrane conductance regulator (CFTR), an anion channel whose dysfunction leads to chronic bacterial and fungal airway infections via a pathophysiological cascade that is incompletely understood. Airway glands, which produce most airway mucus, do so in response to both acetylcholine (ACh) and vasoactive intestinal peptide (VIP). CF glands fail to secrete mucus in response to VIP, but do so in response to ACh. Because vagal cholinergic pathways still elicit strong gland mucus secretion in CF subjects, it is unclear whether VIP-stimulated, CFTR-dependent gland secretion participates in innate defense. It was recently hypothesized that airway intrinsic neurons, which express abundant VIP and ACh, are normally active and stimulate low-level gland mucus secretion that is a component of innate mucosal defenses. Here we show that low levels of VIP and ACh produced significant mucus secretion in human glands via strong synergistic interactions; synergy was lost in glands of CF patients. VIP/ACh synergy also existed in pig glands, where it was CFTR dependent, mediated by both Cl(-) and HCO(3) (-), and clotrimazole sensitive. Loss of "housekeeping" gland mucus secretion in CF, in combination with demonstrated defects in surface epithelia, may play a role in the vulnerability of CF airways to bacterial infections.
Clopidogrel Dosing Based on Genotype
Authors: Dimitrios Alexopoulos, Ioanna Xanthopoulou
Journal: JAMA (2012)

To the Editor: Dr Mega and colleagues1 presented a study showing that increasing the clopidogrel dose resulted in platelet inhibitory effects in patients heterozygous for the CYP2C19*2 loss-of-function allele, but not in homozygotes. We consider a few points that require clarification.
Tryptophan metabolism in cirrhotic patients with and without manifestations of overt hepatic encepahlopathy
Authors: K. Dabos, I. H. Sadler, John Plevris, P. C. Hayes
Journal: Gut (2011)

<h3>Introduction</h3> Patients with hepatic encephalopathy have an altered sleep pattern. Tryptophan metabolism produces two sedative compounds oxindole and melatonin. Altered tryptophan metabolism in patients with hepatic encephalopathy could have some role in the pathogenesis of the disease. <h3>Aim</h3> The study aim was to study differences in the concentrations of oxindole and melatonin between various parts of the body in cirrhotics with and without hepatic encephalopathy. <h3>Methods</h3> During a check for patency on a previously constructed transjugular intrahepatic portosystemic stent shunt (TIPSS) blood was collected from the splenic, portal, hepatic and internal jugular veins and right atrium in 10 cirrhotic patients without evidence of overt hepatic encephalopathy and 10 patients with Hepatic encephalopathy grade A or B. <sup>1</sup>H Nuclear Magnetic Resonance Spectroscopy was used to measure concentrations of oxindole and melatonin in plasma. <h3>Results</h3> In cirrhotic patients oxindole levels were significantly higher in portal vein than hepatic vein (408±63 vs 280±58 μmol/dl (p&lt;0.05)) and also significantly lower in the right atrium compared to the internal jugular vein (377±42 vs 521±73 μmol/dl (p&lt;0.03)). In encephalopathic patients oxindole levels were significantly lower in the right atrium compared to the internal jugular vein (389±61 vs 768±77 μmol/dl (p&lt;0.01)). Levels in the internal jugular vein in encephalopathics were significantly higher than cirrhotics (521±73 vs 768±77 μmol/dl (p&lt;0.043))2. Melatonin levels in cirrhotics were significantly higher in the right atrium compared to the internal jugular vein (603±54 vs 288±39 μmol/dl (p&lt;0.01)). In encephalopathic patients melatonin levels were also significantly higher in the right atrium compared to the internal jugular vein (889±80 vs 533±57 μmol/dl (p&lt;0.03)). Levels in portal vein and hepatic vein in encephalopathics were significantly higher than cirrhotics (1251±73 vs 772±77 μmol/dl (p&lt;0.01)) for portal vein and (1448±102 vs 706±93 μmol/dl (p&lt;0.007)) for hepatic vein. <h3>Conclusion</h3> All metabolites had significant hepatic extraction both in cirrhotics and encephalopathics. Melatonin had brain clearance in encephalopathy while oxindole clearance was lower in encephalopathy.
CD49d expression identifies a chronic-lymphocytic leukemia subset with high levels of mobilized circulating CD34+ hemopoietic progenitors cells
Authors: F M Rossi, A Zucchetto, E Tissino, M Dal Bo, R Bomben, C Caldana, F Pozzo, G Del Poeta, D Rossi, G Gaidano, V Gattei
Journal: Leukemia (2013)
Observations on SOME SKIN AFFECTIONS DUE TO YEAST-LIKE FUNGI
Authors: J. M. H. MacLeod
Journal: BMJ (1930)

WITHIN recent years comsiderable advances lhave been ma(le in tlte etiology of skin diseases by tIre disc-overy that certain veast-like " fuingi, previouslv believed to be saproPhytic and lhas'mless ill the skin, are' pathogenic and responsible foIr various forms of (lermatitis of wlhich the causation has lon0g been a matter of controversy.As these affections are comnmonly met witlh in general practice, and since oti tire .recognition of their cauise (lepends their rational and stre- cessful treatment, I have chloscii theni as the 'natter of this a(ldress.I propoS+ to illustrate it by a series of lantern sli(les, wlhich have b}een specially pr epared from photo- graplhs of cases in my ownl practice or whicll htave bleen kUi1lY lent me by my-colleagues, and from specimens antI- Ctlltur-es made in thte St. John's labaratory.It is onlv 'within tlte last few vears that the yeast-like fuingi pathogenic in tlte skin have attracted mutelt attention it this country, and most of tire literatutie is American, FIrericlt, or Gerimlatn.I do not I)trop)ese to discuuss the different mycotic findcings in' their chronological order, or to attempt to ap)portion tre crte-dit dru3 to tlte var'ious woriket's oni th,e subject, bhrt sintrl)ly to describe in a general way the l)resenit positicn.At thle same time, hroweve', 1 shourld like to express ouir indebtedness to all the worker's oti tIre subject-to Gilchrist, Stokes, Ricketts, Ornmsbv, Shtielrire, Weidmian, Finn-erud, and(1 others in America, to Duibrenill and Ravaut in Fraince, to various workers irn Germiany and Austr ia, an(l tor Castellani, Chtalmers, and my colleag;ue J. B. Do-hling its tltis country.As a l)relimiinai'v it will lie stecessary to consider briefly tIre group kniowni as tlhc yeast-like fllrugi flromll tleir( close Irelatiolnslhip) and mrorprhological sinsiilar'itv to tIre yeast ftnrgus (Sacclironitooces (ererisiac).The fungi in question belong to the group of the " fungi imr)erfceti," an(i are of a lower or-der thslia the yeasts, in that reproduction takes lplte its the simnlespt xiranrner by budding, withoutt the forir iation of asci (receptacles containingt spores).Tlhey 0otiSist of the Moniiias,.the Pityrospoartn of Malassez, anct, of a higher order' aird more neatlv relatod to yeasts, the Blastotuve.es and Coccidioides.riliese fuingi are mP2embers of
Adrenal Venography in Patients with Virilization.
Authors: Jose E. Yanez
Journal: Annals of Internal Medicine (1969)

s1 May 1969Adrenal Venography in Patients with Virilization.Jose E. Yanez, M.D., Stewart R. Reuter, M.D., A. James Blair Jr., M.D., F.A.C.P.Jose E. Yanez, M.D.Search for more papers by this author, Stewart R. Reuter, M.D.Search for more papers by this author, A. James Blair Jr., M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-70-5-1065_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAdrenal venography is becoming an essential diagnostic aid in the assessment of adrenal disease. We have used it in evaluating 36 patients with virilization—by which we mean women with male hair distribution, frequently associated with menstrual irregularities, acne, and obesity but not necessarily showing defeminization. Their ages ranged from 16 to 77 years, and their weight ranged from 112 to 264 lb.Twenty-six patients had a normal adrenal venous pattern while seven had adrenal hypertrophy. Three had patterns suggestive of adrenal tumor; one was confirmed at surgery. In patients with normal adrenals 11 had elevated urinary 17-ketosteroids. In those patients... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Eloise, Michigan PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1969Volume 70, Issue 5Page: 1065-1065KeywordsAcneAdrenal tumorsObesitySurgery Issue Published: 1 May 1969 PDF DownloadLoading ...