tbuckley/cabot-search huggingface dataset:
Loop diathermy excision of the cervical transformation zone in patients with abnormal cervical smears.
Authors: D M Luesley, J Cullimore, C W Redman, F G Lawton, J M Emens, T P Rollason, D R Williams, E J Buxton
Journal: BMJ (1990)

OBJECTIVE--To determine the efficacy and morbidity of fine loop diathermy excision of the cervical transformation zone as applied to the management of outpatients with abnormal cervical smears. DESIGN--Prospective programme trial with six month follow up. SETTING--Two hospital based colposcopy clinics. PATIENTS--616 Patients aged 16-60 with abnormal cervical smears. INTERVENTIONS--After colposcopic and cytological assessment excision of the cervical transformation zone by fine loop diathermy under local anaesthesia in the outpatient department. MAIN OUTCOME MEASURES--Time to complete the treatment, immediate morbidity in terms of discomfort and bleeding, and cytological and colposcopic findings at six months. RESULTS--Treatment was completed in a mean of 3.47 minutes (SD 1.99). Immediate morbidity was minimal, and histological specimens were adequate in over 90% of cases. Almost two thirds of patients were treated at their first visit to the clinic. 58 Patients (9.4%) failed to attend for follow up at six months and one had had a hysterectomy. Of the 557 patients who attended for colposcopic and cytological follow up at six months, 506 (91%) were normal cytologically and 19 (3.4%) had histologically confirmed persistence of cervical intraepithelial neoplasia. The overall confirmed failure rate of the technique was 4.4%. CONCLUSION--Loop diathermy excision is an effective treatment with low morbidity and is an appropriate modality for patients with abnormal cervical smears.
Appropriate staging renders ablative therapy safe for high grade dysplasia in barrett's oesophagus
Authors: P. Sellaturay, R. Haidry, J. Dunn, S. Green, M. Rodriguez-Justo, A. Winstanley, M. Novelli, M. Banks, L. Lovat
Journal: Gut (2011)

<h3>Introduction</h3> NICE approval of ablative therapy for high grade dysplasia (HGD) in Barrett9s oesophagus (BE) means more patients will want this treatment. Concerns remain regarding the risk of missing cancer at initial staging and the reliability of detecting dysplasia at repeat endoscopies. It is not clear whether dysplasia recurring after ablation is at the same or different locations. <h3>Aims</h3> To assess the likelihood of cancer and reliability of detecting dysplasia prior to therapy and the site of recurrence of dysplasia after ablation. <h3>Methods</h3> 64 patients with HGD arising in BE were entered into a randomised controlled trial of Photofrin (n=29) versus ALA (n=31) photodynamic therapy between February 2006 and March 2010. All patients underwent 2 staging endoscopies prior to initial therapy with endoscopic ultrasound and quadrantic biopsies taken every 2 cm throughout the BE segment. These procedures were carried out 2–3 months apart. Presence of HGD was confirmed by 2 independent specialist GI pathologists. Endoscopic follow-up after PDT was at 3, 6, 12, 18, 24 months and yearly thereafter. Residual or recurrent HGD was retreated with PDT and follow-up continued as before. Comparison was made between original biopsies and those taken at follow-up endoscopy. Any site within 2 cm of the original biopsy was considered as the same location. <h3>Results</h3> 4 patients (6%) were withdrawn prior to therapy as they developed invasive cancer. Of the remaining 60, 32 (53%) had a single PDT, 19 (32%) had 2 treatments and 9 (15%) had 3 PDT sessions. 11 patients (18%) had EMR prior to first PDT and a further 3 (5%) required EMR between PDT treatments for new nodules. Although dysplasia is supposed to be patchy and the authors only took 2 cm quadrantic biopsies, the authors still found the dysplasia at the second endoscopy in 85% of patients with no difference between unifocal and multifocal dysplasia. When patients needed more than a single treatment, over half had less extensive dysplasia than at baseline and this had better final outcome. When dysplasia recurred after PDT, it was at the same location in 50% of cases and in the distal oesophagus in the other 50%. <h3>Conclusion</h3> After accurate staging and repeat endoscopy, less than 10% of patients were shown to have invasive cancer. The authors were also able to accurately locate dysplasia at a second endoscopy, even when it was apparently unifocal. Repeat treatments were frequently needed and a marker of likely success was the decreasing number of areas of dysplasia remaining after each treatment. Metachronous lesions tended to occur at the original site of dysplasia or in the distal oesophagus, in line with evidence published by other groups. This findings offer reassurance that first line ablative therapy is a safe option.
The Impact of Narrow Band Imaging in Screening Colonoscopy: A Randomized Controlled Trial
Authors: Silvia Paggi, Franco Radaelli, Arnaldo Amato, Gianmichele Meucci, Giovanni Mandelli, Gianni Imperiali, Giancarlo Spinzi, Natalia Terreni, Nicoletta Lenoci, Vittorio Terruzzi
Journal: Clinical Gastroenterology and Hepatology (2009)
Social drug policies for sport
Authors: M Turner, P McCrory
Journal: British Journal of Sports Medicine (2003)

<b>Aims:</b> To describe a large series of children with anoxic-epileptic seizures (AES)—that is, epileptic seizures induced by syncopes. <b>Methods:</b> Retrospective case-note review in a tertiary paediatric neurology unit. For all 27 children seen with a definite diagnosis of AES between 1972 and 2002, a review of clinical histories, videotapes, and EEG/ECG studies was undertaken. Main outcome measures were: age of onset, frequency and type of syncopes; age of onset and frequency of AES; type and duration of induced epileptic seizures; effect of treatment of syncopal and epileptic components. <b>Results:</b> Median age of onset of syncopes was 8 months (range 0.2–120), frequency 2 in total to 40/day, median total ∼200. Syncopes were predominantly reflex asystolic (RAS), prolonged expiratory apnoea (cyanotic breath-holding spells), or of mixed or uncertain origin; there was one each of ear piercing and hair grooming vasovagal syncope and one of compulsive Valsalva. Median age of onset of AES was 17 months (range 7–120), frequency from total 1 to 3/day, median total 3. The epileptic component was almost always bilateral clonic; three had additional epilepsy, one each with complex partial seizures, myoclonic absences, and febrile seizures plus. Median duration of epileptic component was 5 minutes (range 0.5–40, mean 11). Cardiac pacing prevented RAS in two patients: most other anti-syncope therapies were ineffective. Diazepam terminated the epileptic component in 6/8. Valproate or carbamazepine abolished AES in 5/7 without influencing syncope frequency. <b>Conclusions:</b> Although uncommon compared with simple syncopes, syncope triggered epileptic seizures (AES) are an important treatable basis of status epilepticus.
Cholescintigraphy for Assessing the Separation Potential of Thoracoomphalopagus Twins
Authors: STEPHEN M. ODDO, HARVEY A. ZIESSMAN
Journal: Clinical Nuclear Medicine (1990)

This case report describes the use of cholescintigraphy in the preoperative evaluation of ventrally conjoined twin girls. Sonography and magnetic resonance imaging disclosed an anatomically conjoined heart and a single apparently fused liver. Cholescintigraphy demonstrated that the hepatic system functioned as two independent livers, gallbladders, and biliary drainage systems that were susceptible to separation.
Canadian academic health sciences centres must evolve to survive, taskforce warns
Authors: B. Kermode-Scott
Journal: BMJ (2010)

Canada’s 17 medical schools should evolve from individual academic health sciences centres into academic health sciences networks to better integrate patient care, research, and training, says a Canadian national task force.

The National Task Force on the Future of Canada’s Academic Health Sciences Centres, created by 22 of Canada’s national health provider and academic healthcare organisations and funded by Health Canada, comprises 19 leaders from the Canadian and international academic health science community.

In its report Three Missions: One Future—Optimising the Future of Canada’s Academic Health Sciences Centres, the task force provides a “roadmap” for the future of individual networks across Canada as well as a network of networks.

It lays out the work that must happen …
Testing the Metal of ERCC2 in Predicting the Response to Platinum-Based Therapy
Authors: John J. Turchi, Derek S. Woods, Pamela VanderVere Carozza
Journal: Cancer Discovery (2014)

Abstract Summary: DNA repair has been shown to affect the cellular response to platinum-based therapy in a variety of cancers; however, translating this knowledge to the clinic has proven difficult and yielded mixed results. In this issue of Cancer Discovery, Van Allen and colleagues have analyzed responders and nonresponders to neoadjuvant platinum-based therapy with locally advanced urothelial cancer and identified a series of mutations in the nucleotide excision repair (NER) gene ERCC2 that correlate with the response to platinum-based therapy. This work provides evidence that defects in NER can be exploited to maximize the efficacy of conventional platinum-based chemotherapy. Cancer Discov; 4(10); 1118–9. ©2014 AACR. See related article by Van Allen and colleagues, p. 1140
Cerebral mass in HIV infection
Authors: H. Taha, S. Das
Journal: BMJ (2013)

A 34 year old woman from the Republic of Congo with known HIV infection presented with a one day history of sudden weakness of the right arm and mild headache. She had a history of cardiomyopathy, hypertension, and epilepsy. She had not travelled abroad since she had moved to the United Kingdom 10 years ago. Other than weakness in the extensor muscles of the right arm grade 4/5 on the Medical Research Council scale, the physical examination was unremarkable. 

Her CD4 lymphocyte count was 750×106 cells/L and her differential white cell count and C reactive protein concentration were normal, as was the chest radiograph. Cultures for blood, urine, stool, and sputum were negative. She regularly took atazanavir, ritonavir, phenytoin, carbamazepine, carvedilol, and a fixed dose combination of tenofovir and emtricitabine. Magnetic resonance imaging (MRI) of the brain was performed (fig 1⇓)



Fig 1 Sagittal T1 weighted enhanced magnetic resonance image of the brain, with contrast





### 1 Describe the findings on MRI

#### Short answer

The image shows a 13 mm diameter ring enhancing lesion in the left superior frontal gyrus with peri-lesional oedema. Two similar lesions, with some enhancement in their walls but no surrounding oedema, are also seen in the left occipital and left parietal lobes.

#### Long answer

The sagittal T1 weighted MRI scan shows a cystic ring enhancing lesion in the left superior frontal gyrus and two similar lesions in the left occipital and left parietal lobes, both of which show some enhancement in their wall but no surrounding oedema (fig 2⇓). A coronal T2 weighted FLAIR (fluid attenuated inversion recovery) image without contrast showed a cystic lesion within the left superior frontal …
Treatment of a Chronic Typhoid Carrier with Chloromycetin
Authors: C. A. Rumball, L. G. Moore
Journal: BMJ (1949)

rhage was controlled by a pack, and after a stormy convalescence the patient recovered.In this case hypertension was thought to be the cause.Rademaker submits the interesting suggestion that sudden death during eclampsia may sometimes be due to a ruptured liver.We doubt, however, whether this specula- tion can be sustained, for, although scattered areas of necrosis and small subcapsular haemorrhages are not infrequently found in eclampsia, severe haemorrhages of the liver are not a feature of this disease.Links (1946) describes a case of rupture of the liver during the fourth month of pregnancy.The patient developed
An N-linked high-mannose type oligosaccharide, expressed at the major outer membrane protein of Chlamydia trachomatis, mediates attachment and infectivity of the microorganism to HeLa cells.
Authors: C Kuo, N Takahashi, A F Swanson, Y Ozeki, S Hakomori
Journal: Journal of Clinical Investigation (1996)

The structure of the carbohydrate of the 40-kD major outer membrane component of Chlamydia trachomatis and its role in defining infectivity of the organism were investigated. The oligosaccharides were released from the glycoprotein by N-glycanase digestion, coupled to a 2-aminopyridyl residue, and subjected to two-dimensional sugar mapping technique. The major fractions consisted of "high-mannose type" oligosaccharides containing 8-9 mannose residues. Bi- and tri-antennary "complex type" oligosaccharides having terminal galactose were detected as minor components. These oligosaccharides were N-linked and contained no sialic acid. This structural profile is consistent with our previous characterization based on lectin-binding and glycosidase digestion. Functional specificity of identified chlamydial oligosaccharides was analyzed using glycopeptides fractionated from ovalbumin and structurally defined oligosaccharides from other sources. The glycopeptide fraction having high-mannose type oligosaccharide, as compared to those having complex or hybrid-type, showed a stronger inhibitory effect on attachment and infectivity of chlamydial organisms to HeLa cells. Among high-mannose type oligosaccharides, the strongest inhibition was observed with mannose 8 as compared with mannose 6, 7, or 9. These results indicate that a specific high-mannose type oligosaccharide linked to the major outer membrane protein of C. trachomatis mediates attachment and infectivity of the organism to HeLa cells.
Dieting and Depression Reexamined
Authors: ALBERT J. STUNKARD
Journal: Annals of Internal Medicine (1974)

A survey of the literature on untoward responses to dieting has established that [1] there is a high incidence of symptoms of emotional illness in outpatients treated for obesity; [2] such responses occur also during prolonged inpatient treatment, whether by fasting or by caloric restriction; and [3] short-term fasting of inpatients is far less frequently associated with untoward responses. Three variables may affect the incidence of untoward responses: [1] persons with childhood onset of obesity seem more vulnerable than those with adulthood onset of obesity; [2] severe caloric restriction may produce symptoms more readily than total fast; and [3] outpatient treatment may be more stressful than inpatient treatment. These variables should be controlled during evaluation of new methods of treating obesity, and further controlled studies of their influence are needed.
Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review
Authors: A. Repici, C. Hassan, D. De Paula Pessoa, N. Pagano, A. Arezzo, A. Zullo, R. Lorenzetti, R. Marmo
Journal: Endoscopy (2012)

<b>Background and study aims:</b> Endoscopic submucosal dissection (ESD) has been proposed for large colorectal lesions, due to the high risk of recurrence following endoscopic mucosal resection. However, data on the efficacy and safety of colorectal ESD are still controversial. The aim of the current systematic review was to assess the efficacy and safety of colorectal ESD. <b>Methods:</b> A detailed Medline search of papers published during the period 1999 – 2010 was performed, using the search terms "Endoscopic submucosal dissection," "Colorectal neoplasia," "Colon," or "Rectum." Published studies that evaluated ESD for colorectal lesions were assessed using well-defined inclusion/exclusion criteria, including histological confirmation and surgery for complications. The process was independently performed by two authors. Forest plots on primary (i. e. histologically verified R0 resection and surgery for ESD complications) and secondary end-points were produced based on random-effect models. Heterogeneity was assessed using the I<sup>2</sup> statistic. Risk for within-study bias was also ascertained. <b>Results:</b> A total of 22 studies (20 Asian, two European) provided data on 2841 ESD-treated lesions. The per-lesion summary estimate of R0 resection rate was 88 % (95 %CI 82 % – 92 %; I<sup>2</sup> = 91 %). At meta-regression, carcinoid vs. non-carcinoid series (R0 93 % vs. 87 %; <i>P </i> = 0.04) and Asian vs. European series (R0 88 % vs. 65 %; <i>P </i> = 0.03) appeared to explain the detected heterogeneity. The per-lesion summary estimate of surgery for ESD complications was 1 % (95 %CI 0 % – 1 %) with a moderate degree of heterogeneity (I<sup>2</sup> = 49 %). However, subgrouping of these results according to histological tumor types was not available in the reviewed studies. <b>Conclusions:</b> ESD appeared to be an extremely effective technique to achieve R0 resection of large colorectal lesions. The very low rate of surgery for complications also shows the potential safety of this approach.
One-Year Follow-up of Tension-free Vaginal Tape (TVT) and Trans-obturator Suburethral Tape from Inside to Outside (TVT-O) for Surgical Treatment of Female Stress Urinary Incontinence: A Prospective Randomised Trial
Authors: Marzio Angelo Zullo, Francesco Plotti, Marco Calcagno, Elettra Marullo, Innocenza Palaia, Filippo Bellati, Stefano Basile, Ludovico Muzii, Roberto Angioli, Pierluigi Benedetti Panici
Journal: European Urology (2006)
Endocardectomy for the surgical treatment of endocardial fibrosis of the left ventricle.
Authors: P A Russo, J E Wright, S Y Ho, J R Maneksa, D Clitsakis
Journal: Thorax (1985)

Two patients with endomyocardial fibrosis of the left ventricle were treated by endocardectomy plus mitral valve replacement. In both cases the results of surgery were satisfactory. No consequences related to eosinophilia, which was present before operation in one of them, were noted. The poor prognosis of this progressive disease and the inefficiency of medical treatment compared with the good surgical results already reported from various centres encourage early operation for all patients with endomyocardial fibrosis who have symptoms. Because of the pathophysiology of the disease, endocardectomy should be attempted in all cases and anti-coagulant treatment continued for life.
Prognostic Implications of Myocardial Perfusion Single-Photon Emission Computed Tomography in the Elderly
Authors: Rory Hachamovitch, Xingping Kang, Aman M. Amanullah, Aiden Abidov, Sean W. Hayes, John D. Friedman, Ishac Cohen, Louise E.J. Thomson, Guido Germano, Daniel S. Berman
Journal: Circulation (2009)

The goal of this study was to assess the clinical value of stress myocardial perfusion scintigraphy (MPS) in elderly patients (> or =75 years of age).We followed up 5200 elderly patients (41% exercise) after dual-isotope MPS over 2.8+/-1.7 years (362 cardiac deaths [CDs], 7.0%, 2.6%/y) and a subset with extended follow-up (684 patients for 6.2+/-2.9 years; 320 all-cause deaths). Survival modeling of CD revealed that both MPS-measured ischemia and fixed defect added incrementally to pre-MPS data in both adenosine and exercise stress patients. Modeling a subset with gated MPS (n=2472) revealed that ejection fraction and perfusion data added incrementally to each other, further enhancing risk stratification. Unadjusted, annualized post-normal MPS CD rate was 1.3% but <1% in patients with normal rest ECG, exercise stress, or age of 75 to 84 years and was 2.3% to 3.7% in patients > or =85 years of age or undergoing pharmacological stress. However, compared with age-matched US population CD rates (75 to 84 years of age, 1.5%; > or =85 years, 4.8%), normal MPS CD rates were approximately one-third lower than the baseline risk of US individuals (both P<0.05). Modeling of all-cause death in 684 patients with extended follow-up revealed that after risk adjustment, an interaction between early treatment and ischemia was present; increasing ischemia was associated with increasing survival with early revascularization, whereas in the setting of little or no ischemia, medical therapy had improved outcomes.Stress MPS effectively stratifies CD risk in elderly patients and may identify optimal post-MPS therapy. CD rates after normal MPS are low in all subsets in relative terms compared with the age-matched US population.
Papworth Hospital can resume heart transplantations, says watchdog
Authors: Caroline White
Journal: BMJ (2007)

Zosia Kmietowicz� LondonPractice based commissioning is failing to deliver the benefit for patients envisaged by the government because of a lack of incentives to get GPs on board, says the public spending watchdog.The policy to devolve responsibility for commissioning services from primary care trusts to general practices at the local level was introduced in 2005-6 and is a main plank of the NHS reform programme.But the Audit Commission says it is suffering from poor support from primary care trusts for GPs to develop projects-including accurate information on budgets, what savings have been made, and how these savings could be used to develop other services."Unless you get the financial infrastructure right it [practice based commissioning] won't work," said Andy McKeon, managing director for health at the Audit Commission.For its new report the commission interviewed staff at 16 primary care trusts and three general practices and conducted a survey of 623 general practices, to which 122 GPs and practice managers (20%) replied."The scale of service redesign achieved through PBC [practice based commissioning] has been modest so far," says the report.Most practices reported that they had neither the resources nor the time to implement commissioning; only 18% of practices responded positively to both questions.Nearly three quarters of survey respondents said that their primary care trust was not supporting them in building capacity to implement commissioning. Putting Commissioning intoPractice is available at www.
Can I-123-FP-CIT Images Give Us a Clue That Implies a Vascular Parkinsonism?
Authors: M Milà, G Cuberas, A Rovira, F Porta, M Negre, S Rossi, F Miquel, J Castell-Conesa
Journal: Clinical Nuclear Medicine (2007)

A 59-year-old man, with a history of several years of parkinsonism and multiple vascular risk factors, presented to our unit to undergo I-123-Ioflupane (I-123-FP-CIT) and cerebral perfusion SPECT studies. Parkinson disease usually shows abnormal uptake in the striatum, which progresses from putamen to caudate and matches contralaterally the clinically more affected side. On the other hand, several reports have shown that normal I-123-FP-CIT images is the common pattern in vascular parkinsonism. Nevertheless, our case did not follow any of these models; we present a case of vascular parkinsonism with a concordant defect on I-123-Ioflupane and perfusion brain imaging. Further studies are needed to determine the different image patterns in this entity.
Man win (pounds sterling)1m compensation 28 years after operation
Authors: C Dyer
Journal: BMJ (1994)

A British man who was severely brain damaged during an operation for cleft lip and palate at the age of 6 months has won more than pounds sterling1m in compensation 28 years later. The High Court this week approved a £1050 000 settlement for Andrew Hatchley, whose mother, Margaret, accepted at the time that his injuries were “just fate.” It was only in 1989, after Andrew kept asking her to explain what had happened to him, that she consulted …
Managing the third stage of labour: Nausea is a fair price for preventing haemorrhage
Authors: N Dwyer, H V Hogerzeil, G J A Walker, M J De Goeje, M C M MacIntosh, K J Erskine, J Rawles
Journal: BMJ (1994)

necessary to allow the patient's transfer elsewhere -for rehabilitation, for example.In conclusion, the cornerstone of control of methicillin resistant S aureus is good infection control practice, as I stated in my review.Infection control teams wish to prevent and control the spread of any multiresistant organism as the antimicrobial armamentarium against these organisms is reduced.Additionally, the few available antibiotics tend to be expensive and may be toxic.Unfortunately, epidemic strains of methicillin resistant S aureus still exist, and un- affected hospitals should remain vigilant to prevent their arrival and spread.