tbuckley/cabot-search huggingface dataset:
Multiple annular lesions on the legs
Authors: C. McCourt, C. Feighery, K. McKenna
Journal: BMJ (2012)

A 65 year old woman presented with a six week history of an asymptomatic eruption on her thighs. She described a “50 pence” sized area of redness on her right thigh that had gradually expanded in size. Within two weeks of the initial lesion, a second expanding area of erythema developed on the left thigh. She was systemically well, with no fevers, lethargy, or arthralgia. Her only medical history of note was breast carcinoma, which had been treated with a mastectomy, and she had been taking oral tamoxifen for six months. When the eruption first occurred in the summer, she was on holiday in the Limousin region of France (a woodland area), although she did not remember having tick bites. On examination, three 15-20 cm non-scaly patches with a macular erythematous edge were noted on her thighs (fig 1⇓).





### 1 What is the most likely diagnosis?

#### Short answer

Given the history of travel in an area endemic for Lyme disease and the history of asymptomatic expanding annular lesions, the most likely diagnosis is multiple lesions of erythema migrans associated with Lyme disease.

#### Long answer

The figure⇑ shows large macular non-scaly patches on the anterior and posterior thighs, with central clearing and an advancing erythematous edge. The history of travel in an area that is endemic for Lyme disease (Limousin, France) and the gradually expanding plaques should alert doctors to the possibility of a diagnosis of erythema migrans in Lyme disease.

Lyme disease is the most common tick borne disease in Europe and North America,1 and it is caused by transmission of the spirochaetes of …
ETIOLOGY AND SIGNIFICANCE OF PERICOLIC MEMBRANES
Authors: DAVID CHEEVER
Journal: JAMA (1913)

The cecum and its near relatives and coadjutors, the ascending and transverse colons, have recently received a generous share of attention from surgeons, internists and roentgenologists, displacing in this respect the appendix, whose lesions, symptoms and treatment have by common consent been received into the accepted dogma of the profession. Among the interesting questions before us is that concerning the etiology and significance of certain membranous structures which are frequently found enveloping these organs in whole, or in part, and are designated by such terms as pericolic membranes, membranous pericolitis, parietocolic membranes and Jackson's membrane. Whatever degree of importance may be assigned to these structures in the future by our riper judgment, it must always be a source of pride that the American profession has contributed so largely to their elucidation. Many times must they have been observed in the post-mortem and dissecting-room before Virchow in 1853 described them and
Preoperative Factors Associated With Adverse Outcome After Tricuspid Valve Replacement
Authors: Yan Topilsky, Amber D. Khanna, Jae K. Oh, Rick A. Nishimura, Maurice Enriquez-Sarano, Yang B. Jeon, Thoralf M. Sundt, Hartzell V. Schaff, Soon J. Park
Journal: Circulation (2011)

Preoperative factors associated with increased mortality and worse outcome after tricuspid valve replacement in patients with severe tricuspid regurgitation are poorly understood.We retrospectively analyzed 189 patients (37% men; age, 67.5±11.3 years) who underwent tricuspid valve replacement for severe tricuspid regurgitation. Operative mortality rate was 10%, and was associated with intra-aortic balloon pump (odds ratio, 3.2; 95% confidence interval, 1.9 to 5.6; P<0.0001) or the presence of severe symptoms (New York Heart Association class IV relative to classes II and/or III) at the time of surgery (1.7; 95% confidence interval, 1.05 to 2.8; P=0.02). At the end of follow-up (29.3±27.1 months), 70 patients (37%) died, 6 (3%) needed tricuspid reoperation, and 41 (21.7%) were readmitted for heart failure. Seventy-eight patients (41.3%) were free from cardiovascular events (death, tricuspid reoperation, or heart failure admissions). The only echocardiographic parameter independently associated with adverse outcomes was a decrease in the right index of myocardial performance ratio. All-cause mortality was independently associated with a higher Charlson index (hazard ratio, 1.18; 95% confidence interval, 1.01 to 1.36; P=0.03), shorter right index of myocardial performance ratio (0.91; 95% confidence interval, 0.87 to 0.96; P=0.005), and preoperative New York Heart Association IV class (1.71; 95% confidence interval, 1.3 to 2.2; P<0.0001). In 68 patients with isolated tricuspid valve replacement, the associations between short right index of myocardial performance ratio, high Charlson index, New York Heart Association class IV, and increased mortality remained significant.Tricuspid valve replacement for severe tricuspid regurgitation can be performed with an acceptable operative mortality if patients undergo surgery before the onset of advanced heart failure symptoms. Late mortality is associated with a high preoperative Charlson index, short right index of myocardial performance ratio, and advanced New York Heart Association class.
Electrical Burns During Laparoscopy
Authors: Gordon R. Neufeld
Journal: JAMA (1973)

<h3>To The Editor.—</h3> Design faults in the operating laparoscope manufactured by Richard Wolf Instrument Company make it electrically hazardous when used with electrocautery. Other laparoscopes apparently have similar faults. During routine tubal ligations with the operating laparoscope, gynecologic surgeons at the University of Pennsylvania have received third-degree burns. Hand burns occur frequently and singed eyebrows are common. One surgeon burned his malar prominence, and one burned his face in a bilateral circular pattern when he touched the hot laparoscope to his wire-framed glasses. After these dramatic incidents, several other surgeons recalled hand shocks during laparoscopic tubal ligations; they claimed double-gloving was usually sufficient to avoid them. Investigation of the laparoscope (Fig 1) disclosed the entire instrument to be electrically hot. The positive electrocautery lead clips onto the metallic grasping forceps, making the grasping handle hot. Friction and heat from the electrocautery break down insulation surrounding the forceps (Fig 2), allowing
Geography of U.S. Biomedical Publications, 1990 to 1997
Authors: Dennis F. Thompson
Journal: New England Journal of Medicine (1999)

Sasazuki et al. (Oct. 22 issue) 1 report increased survival at one year among patients who underwent transplantation of hematopoietic stem cells from unrelated donors that was associated with matching of HLA-A alleles.They do not report the effect of isolated HLA-A mismatches.Thus, the effect of HLA-A mismatches could be due to multiple mismatches of linked HLA-C, B, and DRB1 alleles.
Active and Passive Euthanasia
Authors: James Rachels
Journal: New England Journal of Medicine (1975)

Abstract The traditional distinction between active and passive euthanasia requires critical analysis. The conventional doctrine is that there is such an important moral difference between the two that, although the latter is sometimes permissible, the former is always forbidden. This doctrine may be challenged for several reasons. First of all, active euthanasia is in many cases more humane than passive euthanasia. Secondly, the conventional doctrine leads to decisions concerning life and death on irrelevant grounds. Thirdly, the doctrine rests on a distinction between killing and letting die that itself has no moral importance. Fourthly, the most common arguments in favor of the doctrine are invalid. I therefore suggest that the American Medical Association policy statement that endorses this doctrine is unsound. (N Engl J Med 292:78–80, 1975)
The Pathology of Hypertensive Pulmonary Vascular Disease
Authors: DONALD HEATH, JESSE E. EDWARDS
Journal: Circulation (1958)

Progressive histologic changes occur in the pulmonary arteries and arterioles, as a complication of chronically elevated pulmonary arterial blood pressure, in patients with congenital septal defects of the heart. This progression is so stereotyped as to allow a division of the structural effects into 6 grades. The histologic features of each grade are described in detail in this communication. These results afford a basis for comparing the magnitude of these changes to the clinical findings.
The "Military Verb"-Reply
Authors: Alexander Gode
Journal: JAMA (1962)

Dr. Sinaly's frank frontal attack charms and disarms me, for I am a great admirer of  succinctness. I note with satisfaction, however, that Dr. Sinaly does not deny the existence of the verbal malfunction which I tried to hold up to ridicule. Dr. Sinaly merely objects to my calling the entity the military verb. Here I am prepared to compromise and suggest the substitute term paramilitary verb. Since neither is likely to get into future grammars and manuals of style, it really does not matter much.  I am particularly interested in Dr. Sinaly's implied suggestion that the military-paramilitary verb owes its existence to the pernicious influence of Ph.D.'s. This possibility bears further scrutiny, for it cannot be denied that most  medical writers have at some time been exposed to Ph.D. influence. I happen to have spotted the condition only in the writings of  medical men, but I
Importance of immunoglobulin isotype in human antibody-dependent, cell-mediated cytotoxicity directed by murine monoclonal antibodies.
Authors: T J Kipps, P Parham, J Punt, L A Herzenberg
Journal: The Journal of Experimental Medicine (1985)

Using the fluorescence activated cell sorter to select rare IgG2a- and IgG2b-producing variants, we developed switch variant families of hybridomas from IgG1-producing hybridomas, ME1 and MA2.1. The IgG2a and IgG2b antibodies produced by such switch variants have the same binding activities for HLA as the IgG1 antibodies produced by the parent hybridomas. Using these antibodies, we directly compared the IgG1, IgG2a, and IgG2b murine Ig isotypes for their capacities to direct human peripheral blood lymphocytes (PBL) in antibody-dependent cell-mediated cytotoxicity (ADCC) against a B lymphoblastoid cell line. We demonstrate that, for antibodies of identical binding affinity and specificity, the murine IgG2a isotype is the most effective in directing ADCC by human effector cells. The murine IgG2b directs intermediate levels of ADCC activity while IgG1 is inactive. We identified the effector cells in human PBL that mediate IgG2a or IgG2b ADCC as nonadherent killer (K) cells. These cells express the C3bi receptor and have cytolytic activity which is specifically blocked by a monoclonal antibody (anti-Leu-11a) that binds the Fc receptor (FcR) of such cells. Finally, FcR-bearing K cells bind to target cell-bound, rather than free, IgG2a or IgG2b molecules.
Sympathetic cross-innervation of SHR and genetic controls suggests a trophic influence on vascular muscle membranes.
Authors: P W Abel, K Hermsmeyer
Journal: Circulation Research (1981)

We have attempted to differentiate neural from humoral environmental factors as the cause of altered arterial muscle membrane properties in spontaneously hypertensive rats (SHR). This laboratory has previously reported that alterations in membrane electrical properties appear to be responsible for increased NE sensitivity in caudal arteries from SHR. In this study, caudal arteries were transplanted into innervated or denervated anterior eye chambers of the same (KNR in KNR, SHR in SHR) or the opposite (KNR in SHR, SHR in KNR) strain. Seven weeks later, we measured membrane potential (Em) and norepinephrine (NE) contractile sensitivity (EC50) in both transplanted and host caudal arteries. Caudal arteries from 2-week-old donor animals transplanted into hosts reinnervated and developed Em and NE EC50 values characteristic of the host strain, interconverting between SHR and KNR characteristics in cross-transplantations. In other experiments, the superior cervical ganglion ipsilateral to the transplanted eye chamber was removed 1 day before transplantation to eliminate the influence of sympathetic nerves. Em values were the same in transplants denied sympathetic innervation whether the arteries were transplanted into the same or opposite strains. Although denervation increased NE sensitivity of KNR caudal arteries, sensitivity of arteries from the SHR strain was unchanged. Therefore, without sympathetic reinnervation, there was no interconversion of Em or NE EC50 characteristics between SHR and KNR by cross-transplantation. These results suggest that neural factors control the development of membrane properties of vascular muscle. It appears that the sympathetic nervous system of the SHR has altered trophic influences that contribute importantly to altered membrane properties in hypertension.
Therapy for persistent hyperinsulinemic hypoglycemia of infancy. Understanding the responsiveness of beta cells to diazoxide and somatostatin.
Authors: C Kane, K J Lindley, P R Johnson, R F James, P J Milla, A Aynsley-Green, M J Dunne
Journal: Journal of Clinical Investigation (1997)

The neonatal disorder persistent hyperinsulinemic hypoglycemia of infancy (PHHI) arises as the result of mutations in the subunits that form the ATP-sensitive potassium (KATP) channel in pancreatic beta cells, leading to insulin hypersecretion. Diazoxide (a specific KATP channel agonist in normal beta cells) and somatostatin (octreotide) are the mainstay of medical treatment for the condition. To investigate the mechanism of action of these agents in PHHI beta cells that lack KATP currents, we applied patch clamp techniques to insulin-secreting cells isolated from seven patients with PHHI. Five patients showed favorable responses to medical therapy, and two were refractory. Our data reveal, in drug-responsive patients, that a novel ion channel is modulated by diazoxide and somatostatin, leading to termination of the spontaneous electrical events that underlie insulin hypersecretion. The drug-resistant patients, both of whom carried a mutation in one of the genes that encode KATP channel subunits, also lacked this novel K+ channel. There were no effects of diazoxide and somatostatin on beta cell function in vitro. These findings elucidate for the first time the mechanisms of action of diazoxide and somatostatin in infants with PHHI in whom KATP channels are absent, and provide a rationale for development of new therapeutic opportunities by K+ channel manipulation in PHHI treatment.
ON SEPTICAEMIC INFECTION FOLLOWING OPERATIONS FOR APPENDICITIS: A PROPHYLACTIC SERUM
Authors: H. H. Brown
Journal: BMJ (1923)

K 59 I almost to dryness; and (5) solution in water for at least three days.Consideration of the known rebztions of y glucose renders it unlikely tbst such a labile substance would remain unaffected by tungatic acid.Since no strict proof is available
A biphasic pattern of anti-pre-s responses in acute hepatitis B virus infection
Authors: Agata Budkowska, Pascal Dubreuil, Patrick Maillard, Thierry Poynard, Jacques Pillot
Journal: Hepatology (1990)

The clinical relevance of the immune response to the translation products of the pre-S1 and pre-S2 regions of hepatitis B virus was examined by testing sequential serum samples from 17 patients with acute self-limited hepatitis B and from two patients in whom chronic liver disease developed. Anti-pre-S antibodies were determined by enzyme immunoassays based on the inhibition of binding of monoclonal antibodies to epitopes in the pre-S1 and pre-S2 sequence. In acute, self-limited infection, anti-pre-S antibodies appeared in a biphasic pattern. The early antibodies were detected at the time of clinical signs of acute disease when HBsAg and often HBeAg were present, but hepatitis B virus DNA was no longer detectable in serum. Anti-pre-S levels then fell, but subsequently reappeared as the late antibody during the recovery phase, after development of anti-HBe, but before anti-HBs. Anti-pre-S responses were detected in 15 of 17 patients who recovered (88.2%) and in both patients with acute hepatitis B virus infection evolving to chronic liver disease. Although the early antibodies to pre-S1 and pre-S2 proteins appeared at the time of decreasing levels of infectious virus in serum in cases of self-limited infection, these antibodies also were transiently or continuously present with high levels of serum hepatitis B virus DNA in patients in whom chronic hepatitis B infection developed. Thus the anti-pre-S response in acute hepatitis is not a prognostic marker for clinical resolution.(ABSTRACT TRUNCATED AT 250 WORDS)
Effects of experience and commercialisation on survival in Himalayan mountaineering: retrospective cohort study
Authors: J. L. Westhoff, T. D. Koepsell, C. T. Littell
Journal: BMJ (2012)

<b>Objectives</b> To determine whether previous Himalayan experience is associated with a decreased risk of climbing death, and whether mountaineers participating in commercial expeditions differ in their risk of death relative to those participating in traditional climbs. <b>Design</b> Retrospective cohort study. <b>Setting</b> Expeditions in the Nepalese Himalayan peaks, from 1 January 1970 to the spring climbing season in 2010. <b>Participants</b> 23 995 non-porters venturing above base camp on 39 038 climbs, 23 295 on 8000 m peaks. <b>Outcome</b> Death. <b>Results</b> After controlling for use of standard route, peak, age, season, sex, summit success, and year of expedition, increased Himalayan experience was not associated with a change in the odds of death (odds ratio 1.00, 95% confidence interval 0.96 to 1.05, P=0.904). Participation in a commercial climb was associated with a 37% lower odds of death relative to a traditional venture, although not significantly (0.63, 0.37 to 1.09, P=0.100). Choice of peak was clearly associated with altered odds of death (omnibus P&lt;0.001); year of expedition was associated with a significant trend toward reduced odds of death (0.98, 0.96 to 0.99, P=0.011). <b>Conclusions</b> No net survival benefit is associated with increased Himalayan experience or participation in a traditional (versus commercial) venture. The incremental decrease in risk associated with calendar year suggests that cumulative, collective knowledge and general innovation are more important than individual experience in improving the odds of survival.
SOME NEW ASPIRATING DEVICES
Authors: L. K. Ferguson
Journal: JAMA (1926)

In an effort to increase the neatness and dispatch of an operation, to reduce infection, and to minimize the trauma and manipulation, especially in operations under local anesthesia, these aspirating devices were made. They have proved so useful that I feel justified in publishing a description of them. The aspirator is not a new apparatus in the surgical clinic, but its application is daily becoming more general and its use, once one becomes accustomed to it, is nearly indispensable. By its use, fluids in the wound or in a cavity may be quickly removed from the field, thus keeping the operating table neat and tidy. Since the aspirator can be used in a wound to remove obscuring fluids while the operator proceeds with his manipulations, nearly obviating the necessity for sponging, the speed of an operator can be materially increased. By removing pus from cavities without spilling, a large amount
High Incidence of Prostate Cancer Detected by Saturation Biopsy after Previous Negative Biopsy Series
Authors: Jochen Walz, Markus Graefen, Felix K.-H. Chun, Andreas Erbersdobler, Alexander Haese, Thomas Steuber, Thorsten Schlomm, Hartwig Huland, Pierre I. Karakiewicz
Journal: European Urology (2006)
Association of melanoma and neurocutaneous melanocytosis with large congenital melanocytic naevi-results from the NYU-LCMN registry
Authors: E.K. Hale, J. Stein, L. Ben-Porat, K.S. Panageas, M.S. Eichenbaum, A.A. Marghoob, I. Osman, A.W. Kopf, D. Polsky
Journal: British Journal of Dermatology (2005)

Background Large congenital melanocytic naevi (LCMN), which develop in utero and are present in approximately one in 20 000 newborns, are associated with markedly increased risks of cutaneous melanoma, leptomeningeal melanoma and neurocutaneous melanocytosis (NCM). Objectives This study examined clinical characteristics associated with melanoma and NCM among patients with LCMN, and estimated the risk of developing melanoma and NCM in these patients. Methods Two hundred and five LCMN patients enrolled in the New York University registry were studied. One hundred and seventy of these patients were followed prospectively. The remaining 35 patients had either melanoma at the time of entry into the registry (n = 6), or had insufficient follow‐up information (n = 29). The outcome measures were the occurrence of melanoma and NCM. The associations between these outcomes and the clinical covariates (anatomical location of the LCMN, size of the LCMN, number of satellite lesions, family history of melanoma, patient sex and treatment) were assessed. Results Four of 170 (2·3%) prospectively followed patients developed melanomas, representing a standardized morbidity ratio of 324. Among the entire cohort (n = 205), there were associations between increasing numbers of satellite naevi and the occurrence of melanoma (P = 0·04), and the presence of NCM (P = 0·06). Compared with patients who did not develop these diseases, median LCMN diameters were larger among patients who developed melanoma (49 vs. 39 cm) and NCM (55 vs. 46 cm). Conclusions In LCMN patients, increasing numbers of satellite lesions and larger LCMN diameters are associated with melanoma and NCM.
Environmental impact of journal distribution is complex
Authors: S. Ginn
Journal: BMJ (2011)

Inglis contends that the BMJ ’s print run and thus carbon footprint can be reduced by a combination of increased reader sharing of print issues and greater embrace of digital distribution.1

The whole picture is less straightforward. The BMJ is a commercial publication, albeit not an aggressively capitalist one,2 and it must pay its way. Part …