tbuckley/cabot-search huggingface dataset:
Quantitative Assessment of Procedural Competence: A Prospective Study of Training in Endoscopic Retrograde Cholangiopancreatography
Authors: Paul S. Jowell
Journal: Annals of Internal Medicine (1996)

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a technically demanding procedure that can cause substantial complications. Competence in performing ERCP and the learning curve for achieving competence are poorly understood. Objective: To evaluate the number of supervised ERCPs that physicians must do to achieve procedural competence. Competence was defined as a 0.8 probability of successfully completing specific technical components of ERCP and an overall grading of competence as judged by the attending physician. Design: Prospective study. Setting: University training program for gastroenterologists. Participants: 17 gastroenterology fellows at various stages of training. Measures: Experienced therapeutic endoscopists prospectively graded gastroenterology fellows during 1796 consecutive ERCPs. Fellows were graded on their overall level of competence for the procedure and on specific technical components of ERCP. Results: Grading data were available for 1450 ERCPs (81%). The number of ERCPs done before adequate skill was achieved was 160 for cholangiography, 140 for pancreatography, 160 for deep cannulation of the pancreatic duct, 120 for stone extraction, and 60 for stent insertion. Fellows achieved overall competence after completing 180 to 200 ERCPs. The predicted probability of overall competence was 0.8 after 137 ERCPs and 0.9 after 185 ERCPs. Conclusions: At least 180 ERCPs were required before these gastroenterology fellows could be considered competent in ERCP. This number is much greater than that previously recommended, and these findings have substantial implications for training guidelines and issues of competence and certification in ERCP. The methods used to define and evaluate competence in ERCP could also be used to assess competence in other medical procedures.
RELATION OF URIC ACID TO MIGRAINE.
Authors: JOHN A. LICHTY
Journal: JAMA (1899)

It is not strange that the causal relation of uric acid to migraine has repeatedly suggested itself to the minds of physicians, for the etiology of migraine has always been to the clinician what the origin and significance of uric acid has been to the physiologic chemist—a matter of speculation. The enthusiasm which has arisen in the past decade or more in the study of the secretions and excretions of the living organism, has again awakened investigations referring to the effect of uric acid on the human body, and its relations to disease. So thorough has been this awakening that the foundation principles of pathology and therapeutics seem to have been threatened. Diseases, the etiology and pathology of which were thought to be beyond question, are now considered with reference to uric acid formation. Remedies which were formerly given because they overcame disease, are now given because they counteract the
Propylthiouracil-Induced Agranulocytosis in Four Patients Previously Treated With the Drug
Authors: Avinoam Shiran
Journal: JAMA (1991)

<h3>To the Editor.</h3> —Agranulocytosis is a well-known major complication of antithyroid drug treatment. Most studies emphasize the initial period of drug treatment (1 to 3 months), as that in which agranulocytosis is most likely to happen.<sup>1-3</sup>We found only one case report of agranulocytosis in the second course of propylthiouracil (PTU) treatment,<sup>4</sup>and a few more cases on methimazole.<sup>3,5</sup>We report here four cases of agranulocytosis on second exposure to PTU. We think it is important to draw attention to the possibility of agranulocytosis in patients who were previously treated successfully with PTU. <h3>Study.</h3> —The records of all our patients who were treated with PTU for thyrotoxicosis in the years 1985 through 1990 were reviewed. The diagnosis of thyrotoxicosis was made on the basis of symptoms, physical findings, elevated thyroid function tests (total thyroxine [T<sub>4</sub>], triiodothyronine uptake [T<sub>3</sub>U], and free thyroxin index), and suppressed
Non‐steroidal treatment of pollen‐induced conjunctivitis: comparison of different pharmacological protocols
Authors: G. Ciprandi, P. M. Cerqueti, S. Sacca, G. Ciurlo, M. A. Tosca, G. W. Canonica
Journal: Allergy (1991)

Pharmacological treatment of allergic conjunctivitis may be based on the therapeutic use of topical steroids; however, because of the side effects, steroids are not clinically suitable in either prolonged treatment, or pollinosis. Because non-steroidal topical drugs are suitable in prolonged treatment, this single-blind study evaluated the following topical drugs: cromoglycate plus chlorphenamine, cromoglycate plus tetryzolin and imidazolin plus nafazolin, compared with placebo. The results confirm significant clinical efficacy of these drugs on signs and symptoms compared with placebo. Thus, "non-steroidal" topical drugs should be the preferred choice in prolonged forms of pollen-induced (e.g. Parietaria and/or grasses) conjunctivitis.
Myocyte and myogenic stem cell transplantation in the heart
Authors: J Dowell
Journal: Cardiovascular Research (2003)

Cellular transplantation is emerging as a potential mechanism with which to augment myocyte number in diseased hearts. To date a number of cell types have been shown to successfully engraft into the myocardium, including fetal, neonatal, and embryonic stem cell-derived cardiomyocytes, skeletal myoblasts, and stem cells with apparent cardiomyogenic potential. Here we provide a review of studies wherein myocytes or stem cells with myogenic potential have been transplanted into the heart. In addition, issues pertaining to the tracking and functional consequences of cell transplantation are discussed.
Diminutive Colonic Polyps – Clinical Significance and Management
Authors: S. Granqvist, N. Gabrielsson, P. Sundelin
Journal: Endoscopy (1979)

Of 300 diminutive polyps (up to 5 mm) found at colonoscopy, 114 were neoplastic (37 per cent) and thus possible precursors of carcinoma. This suggests that all colonic polyps, regardless of size, should if possible be extirpated or coagulated. As polyps of this small size often escape detection roentgenologically, especially by conventional technique, colonoscopy should be extended to involve the entire colon. This is because diminutive polyps, especially of neoplastic type, are common also in the proximal part of the colon.
Antibiotic use in otitis media: patient simulations as an aid to audit.
Authors: D M Chaput de Saintonge, N R Hathaway
Journal: BMJ (1981)

Diagnostic and prescribing practices in otitis media vary, and audit is difficult because doctors may not see comparable cases. Seven general practitioners took part in a pilot study to discover if simulated patients evoked the same diagnostic and treatment responses as reveal patients. Forty-eight patients entered the study over three weeks and provided data for two simulations; one included the doctor's description of the ear and the other a photograph instead. Each doctor was shown the two sets of simulations and asked to state his diagnosis and treatment. The diagnoses each doctor reached agreed significantly with those reached on the simulations of the same patients. The decisions to prescribe antibiotics also showed good agreement.
Low Power Diode Laser Treatment Using Indocyanine Green for Eradication of Esophageal Varices
Authors: S. Hino, H. Kakutani, K. Ikeda, H. Yasue, K. Sumiyama, Y. Uchiyama, A. Kuramochi, K. Matsuda, H. Arakawa, M. Kawamura, K. Masuda, H. Suzuki, T. Hayashi, N. Nakamura, T. Arai, M. Kikuchi
Journal: Endoscopy (2001)

Endoscopic variceal ligation (EVL) is an alternative to sclerotherapy for the treatment of esophageal varices, but is associated with higher rates of recurrence and subsequent bleeding than sclerotherapy. To prevent recurrence of varices after EVL, we have developed a low-dose diode laser therapy combined with the injection of indocyanine green, which allows enhanced tissue absorption of the laser beam selectively around varices. In this study we investigated the efficacy and safety of this technique.Eight patients with F2 or F3 esophageal varices were enrolled. At 1 week after EVL, indocyanine green solution (1 mg/ml) was injected submucosally around the remaining varices. A diode laser (power 10 watts) was applied to the surface from the esophagogastric junction to 5 cm above it. The spot size was kept to 5 mm in diameter.Laser irradiation was performed safely, without bleeding from the varices, or perforation. There were no major complications. Endoscopy 1 month later showed F0 forms in seven patients, F1 in one patient, and no red color sign in any patient. No recurrence of varices has been observed in any of the patients during the follow-up period of at least 12 months.This technique may provide a simple, safe and effective procedure, as an additional treatment to EVL, for the prevention of recurrence of esophageal varices.
Research into meningococcal disease is too fragmented
Authors: S Hoare
Journal: BMJ (1999)

EDITOR—Continuing research into meningococcal disease has reached a crossroads. A meeting last year on this subject, hosted by the Royal College of Physicians of London and sponsored by the Meningitis Research Foundation, presented an overview of the many treatment modalities currently being explored in an attempt to reduce a still unacceptable morbidity and mortality. So diverse and sometimes contradictory were these modalities that there was a plea for the audience not to leave disheartened and confused, …
Kaposi's Sarcoma in Homosexual Men
Authors: MICHAEL MARMOR
Journal: Annals of Internal Medicine (1984)

The cases of 20 male homosexuals with Kaposi's sarcoma and the acquired immunodeficiency syndrome were compared with those of 40 age- and race-matched male homosexual controls. Patients with Kaposi's sarcoma had lower OKT4/OKT8 (T-helper/T-suppressor) ratios than controls, due to smaller numbers of OKT4 cells. Serum IgG concentrations and antibody titers to cytomegalovirus in patients exceeded those in controls, but patients had lower antibody titers to Epstein-Barr virus. Logistic regression analysis comparing patients with controls showed significant relative risks for Kaposi's sarcoma associated with the number of partners per month in receptive anal-genital intercourse, occasions per month of " fisting ," and cytomegalovirus antibody titers. Cytomegalovirus titers also were inversely correlated with OKT4 cell concentrations in the control group. Significantly greater OKT4 cell concentrations were found at diagnosis in HLA-DR5-positive patients than in HLA-DR5-negative patients. Patients who have HLA-DR5 may express disease at lesser degrees of immunodeficiency than HLA-DR5-negative patients.
P08.15 * RELEVANCE OF GAMMA KNIFE RADIOSURGERY ALONE FOR THE TREATMENT OF NON-SMALL CELL LUNG CANCER BRAIN METASTASES
Authors: F. Zairi, E. Le Rhun, Y. Ouammou, R. Aboukais, M. Vermandel, S. Blond, P. Devos, N. Reyns
Journal: Neuro-Oncology (2014)

BACKGROUND AND PURPOSE: Stereotactic radiosurgery (SRS) followed by close follow-up is becoming a popular strategy for the management of brain metastases (BM) since cancer patients live longer and late adverse effects of whole brain radiotherapy (WBRT) are increasingly reported. The authors report their experience in consecutively treated patients with limited brain metastases from non-small cell lung cancer (NSCLC), who underwent SRS in isolation followed by a close follow-up. METHODS: This study is the retrospective analysis of prospectively collected data. We included 89 consecutive patients (80 men and 19 women; mean age 59.7 years) with a KPS score of 60 or greater at BM diagnosis, who underwent Gamma Knife SRS for 1-4 metastases, at Lille University Hospital between January 2004 and December 2010. The mean radiation dose was 23.41 Gy (range 18-26 Gy) and the mean tumor volume was 2.47 cm3 (range 0.3-6.7 cm3). After treatment, clinical and radiological (MRI) monitoring was scheduled at 2, 4, 8 and 12 months in the first year and at 4-month intervals thereafter. RESULTS: Overall survival was 70.8% at 1 year and 50% at 2 years. The actuarial local control rate was 91.5% at 1 year and 85.5% at 2 years. Ten of 89 patients experienced a local failure, which required a salvage treatment. The distant brain control rate was 79.2% at 1 year, and 67.1% at 2 years. A total of 25 patients developed new brain metastases, 10 patients were treated with a new radiosurgical procedure, 12 underwent a WBRT while 3 patients developed a leptomeningeal disease. We reported an overall complication rate of 10.1% per patient and 7.8% per treated tumor; all complications were classified grade 1 or 2. CONCLUSION: In patients with limited brain metastases from NSCLC, SRS is an effective treatment associated with high local control rate with low morbidity. When performed in isolation, close follow-up is mandatory and radiosurgery can be renewed as salvage treatment for distant brain progression, limiting the use of WBRT.
Age-Specific Advantages of Continuous Subcutaneous Insulin Infusion as Compared With Multiple Daily Injections in Pediatric Patients
Authors: Olga Kordonouri, Reinhard Hartmann, Renate Lauterborn, Christine Barnekow, Julia Hoeffe, Dorothee Deiss
Journal: Diabetes Care (2006)

In the past years, treatment with continuous subcutaneous insulin infusion (CSII) has been increasingly used in younger age-groups of patients with type 1 diabetes, and several studies have reported advantages of CSII, but little information is based on case-controlled analyses (1,2). Although short-term effects of CSII were described (3), there is no clear evidence whether its use leads to a continuous improvement of glycemic control. In order to evaluate long-term effects, we performed a matched-pair analysis comparing the outcome in young patients with CSII versus multiple daily injection (MDI) over 1 year of treatment under routine conditions representative of a pediatric diabetes clinic.

Fifty-nine of 85 patients starting on CSII from 2001 to 2004 with treatment duration of at least 1 year were eligible. The control cohort was comprised of 580 patients treated with MDI within the same time period. Fifty-two matched pairs could be identified fulfilling the matching criteria: sex, age (± 1 year), diabetes duration (± 1 year), and HbA1c (A1C) level (± 0.3%) at study entry (start of CSII). In the case of multiple matched MDI subjects, only the subject closest to A1C and diabetes duration was selected.

Patients with MDI received treatment based on the basal-bolus principle and had 3.5 ± 0.9 injections per day. Forty-one patients (79%) used NPH, eight …
Recombinant Receptor Protein May Block HIV Infection Process
Authors: Beverly Merz
Journal: JAMA (1988)

A NEW APPROACH to blocking the human immunodeficiency virus (HIV) in vitro may be a harbinger of successful therapy for acquired immunodeficiency syndrome (AIDS). Investigators at Genentech, South San Francisco, have announced that they have produced CD4—the protein that is the primary cellular receptor for HIV—through genetic engineering. The membrane-bound CD4 provides the HIV virus passage into human cells when it binds to the virus' envelope protein, p120. Originally thought to be unique to helper T cells, CD4 has been located on a variety of cells of other lineages including monocytes, macrophages, glial cells, and Langerhans' cells, cementing its position as the major portal for HIV infection. In collaboration with a team of investigators led by Jerome Groopman, MD, at New England Deaconess Hospital in Boston, the Genentech group has determined that in cell cultures recombinant CD4 can intercept the virus before it connects to the cellular receptor, thus preventing
Successful resuscitation of two near simultaneous cases of cardiac arrest with a review of fifteen cases occurring during supervised exercise.
Authors: W F Mead, H R Pyfer, J C Thrombold, R C Frederick
Journal: Circulation (1976)

Two men with coronary heart disease experienced cardiac arrests during a recent exercise rehabilitation session. Fifteen cases of ventricular fibrillation have occurred in this program since 1968, making an average of one per six-thousand man hours of supervised exercise training. All were successfully resuscitated with no sequelae. Analysis of the patients who experience ventricular fibrillation suggests that treating patients with exercise-induced premature ventricular contractions with anti-arrhythmic drugs, proper attention to serum potassium levels, strict adherence to training pulse rates, and proper warm-up might help to prevent future similar events in an exercise program. Due to the unpredictability of ventricular fibrillation it seems preferable that individuals who have known coronary heart disease participate in exercise training under proper supervision with appropriate emergency equipment available.
INSULIN AS AN INVESTMENT FOR THE PATIENT WITH DIABETES MELLITUS
Authors: REGINALD FITZ
Journal: JAMA (1924)

A broad-minded physician conserves the money as well as the health of his patients; in a sense, he is a trustee both of their bodily welfare and of their finances. In other words, a physician is not justified in prevailing on sick people to go to a great expense for diagnostic tests or therapeutic procedures which are unnecessary or of theoretical interest; rather must he advise those measures which are as safe and certain as possible and which offer the prospect, through relieved symptoms, of a good return for the financial investment involved.  This point of view is particularly sound when applied to the insulin situation. Owing to its widespread publicity in the lay and medical press, physicians are constantly tempted by diabetic patients of all sorts to give their cases a trial with the new preparation. There is no doubt as to the efficiency of the remedy in many
Diagnosis and Treatment of Depression in a 102-Year-Old Woman
Authors: Seymour L. Kushnir
Journal: JAMA (1988)

To the Editor.  —In the very aged, psychiatric diagnosis often poses substantial challenges because symptoms such as confusion, agitation, disorientation, somatization, and dysphoric mood can result from various disorders either functional (eg, depression) or organic (eg, dementia). 1,2 Response to psychopharmacotherapy can give clues to diagnosis, but, as illustrated herein, it may also be deceiving.  Report of a Case.  —On admission to Maimonides Hospital, a chronic care facility, a 95-year-old woman was found to be alert. Myopia and mild hearing loss were her only physical problems, and she took no medication. When she was 99 years old, her fourth son died. With support from her only remaining child, a fifth son, she grieved appropriately and gradually resumed her daily activities. At 100 years of age, she derived satisfaction from congratulatory notes sent by the nation's leaders.  In her 102nd year of life, her last son died of carcinoma. Her intense
Combination Therapy for Myelomatosis
Authors: L. Azam, I. W. Delamore
Journal: BMJ (1974)

Twenty-eight patients with multiple myeloma have been treated with a quadruple chemotherapeutic regimen consisting of 1, 3 bis (2-chloroethyl)-1-nitrosourea (BCNU), cyclophosphamide, melphalan, and prednisolone. Nineteen new patients and nine who had escaped from previous single-agent therapy were included in the study. The results to date, on eight criteria of response, seem to be superior to those obtained from previous chemotherapeutic regimens. The study has been in progress for 18 months and only three patients have died. Only one who had not received previous therapy died, and she had complicating hyperparathyroidism, which almost certainly contributed to her death.
Impact of Geocoding Methods on Associations between Long-term Exposure to Urban Air Pollution and Lung Function
Authors: Bénédicte Jacquemin, Johanna Lepeule, Anne Boudier, Caroline Arnould, Meriem Benmerad, Claire Chappaz, Joane Ferran, Francine Kauffmann, Xavier Morelli, Isabelle Pin, Christophe Pison, Isabelle Rios, Sofia Temam, Nino Künzli, Rémy Slama, Valérie Siroux
Journal: Environmental Health Perspectives (2013)

Errors in address geocodes may affect estimates of the effects of air pollution on health.We investigated the impact of four geocoding techniques on the association between urban air pollution estimated with a fine-scale (10 m × 10 m) dispersion model and lung function in adults.We measured forced expiratory volume in 1 sec (FEV1) and forced vital capacity (FVC) in 354 adult residents of Grenoble, France, who were participants in two well-characterized studies, the Epidemiological Study on the Genetics and Environment on Asthma (EGEA) and the European Community Respiratory Health Survey (ECRHS). Home addresses were geocoded using individual building matching as the reference approach and three spatial interpolation approaches. We used a dispersion model to estimate mean PM10 and nitrogen dioxide concentrations at each participant's address during the 12 months preceding their lung function measurements. Associations between exposures and lung function parameters were adjusted for individual confounders and same-day exposure to air pollutants. The geocoding techniques were compared with regard to geographical distances between coordinates, exposure estimates, and associations between the estimated exposures and health effects.Median distances between coordinates estimated using the building matching and the three interpolation techniques were 26.4, 27.9, and 35.6 m. Compared with exposure estimates based on building matching, PM10 concentrations based on the three interpolation techniques tended to be overestimated. When building matching was used to estimate exposures, a one-interquartile range increase in PM10 (3.0 μg/m3) was associated with a 3.72-point decrease in FVC% predicted (95% CI: -0.56, -6.88) and a 3.86-point decrease in FEV1% predicted (95% CI: -0.14, -3.24). The magnitude of associations decreased when other geocoding approaches were used [e.g., for FVC% predicted -2.81 (95% CI: -0.26, -5.35) using NavTEQ, or 2.08 (95% CI -4.63, 0.47, p = 0.11) using Google Maps].Our findings suggest that the choice of geocoding technique may influence estimated health effects when air pollution exposures are estimated using a fine-scale exposure model.
Delivering Doctor Amelia: The Story of a Gifted Young Obstetrician's Mistake and the Psychologist Who Helped Her
Authors: J. A. Sigmund
Journal: JAMA (2004)

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