tbuckley/cabot-search huggingface dataset:
Autopsy Diagnoses of Malignant Neoplasms
Authors: Elizabeth C. Burton, Dana A. Troxclair, William P. Newman III
Journal: JAMA (1998)

Autopsy often reveals new diagnoses of malignant neoplasms, but as technological advances to improve diagnosis during life have improved, autopsy rates have declined dramatically.To determine if there is still a high discordance rate between clinical and autopsy diagnoses of malignant neoplasms despite increasing technological advances in diagnostic methods.A 10-year retrospective study (1986-1995) of all autopsies performed at the Medical Center of Louisiana at New Orleans.All patients autopsied, excluding preterm fetuses, at the Medical Center of Louisiana at New Orleans, by both Tulane and Louisiana State University Schools of Medicine in which consent was obtained or authorization given from the Orleans Parish Coroner's Office.Discordance between clinical and autopsy diagnoses of malignant neoplasms.A total of 1625 cases were reviewed of which 520 preterm fetuses were excluded. Of the remaining 1105 cases, 654 were male and 451 were female. The mean age was 48.3 years (range, 1-98 years). A total of 433 neoplasms were diagnosed, 250 of which were malignant. One hundred eleven malignant neoplasms in 100 patients had been either undiagnosed or misdiagnosed, and in 57 patients, the immediate cause of death could be attributed to the malignant neoplasm. The discordance between clinical and autopsy diagnoses of malignant neoplasms in this study is 44%, which is similar to previously reported studies.The discordance rate between clinical and autopsy diagnoses of malignant neoplasms is large and confirms the importance of the postmortem examination.
Evidence for a regulatory idiotypic network in the in vivo response to H-2 antigens.
Authors: R Rabinowitz, J A Bluestone, D H Sachs
Journal: The Journal of Experimental Medicine (1985)

Treatment of BALB/c mice with purified pig antiidiotype to 11-4.1 (anti-H-2Kk) monoclonal antibody has been found previously to induce the appearance of idiotype-bearing molecules (Id') in the serum of these mice, in the absence of detectable antigen-binding activity. In the present study we examined the effect of subsequent immunization of such antiidiotype-primed mice with the original H-2Kk antigen. Skin grafting of virgin BALB/c mice with BALB.K skin did not generate any detectable Id' antibodies when tested by enzyme-linked immunosorbent assay (ELISA). In contrast, grafting of antiidiotype-primed mice with BALB.K skin specifically boosted ther serum level of Id' molecules. Challenge of antiidiotype-primed mice with either B10.D2 or rat skin had no effect on the production of such Id' molecules. Absorption studies demonstrated that the majority of Id' molecules induced by H-2Kk antigenic stimulus and detected in ELISA are antigen-nonbinding molecules, thus indicating specific restimulation by the original H-2Kk antigen of nonbinding idiotype-positive B cell clones. The relevance of these findings to the existence of network interactions in the immune response to H-2 antigens is discussed.
Calcium and Phosphate Metabolic Studies in Patients with Urinary Calculi
Authors: G. L. Mouzas
Journal: BMJ (1958)

MEDICAL JOURNALiThe difficulty of feeding the patients and the frequency of respiratory complications when tube feeding was em- ployed led to the practice of withholding food by mouth and maintaining hydration and electrolyte balance by parenteral fluid administration without regard to calorie or protein requirements.Respiratory complications accounted for a number of deaths.Recent writers stress the importance of maintaining a good airway, if necessary by tracheotomy.It is likely that some of the deaths could have been avoided if this operation had been carried out.My thanks are due to Professor A. W. Woodruff for his advice on the preparation of this paper, to Mr. D. L.
Genomic Medicine: A Decade of Successes, Challenges, and Opportunities
Authors: Jeanette J. McCarthy, Howard L. McLeod, Geoffrey S. Ginsburg
Journal: Science Translational Medicine (2013)

This State of the Art Review highlights the ways in which genomic tools and information are being used in clinical medicine, the big challenges in their uptake and implementation, and the forces that will shape genomic medicine in the future.
William Bruce Thomson
Authors: J. Kelleher
Journal: BMJ (2010)

As a student, William Bruce Thomson (“Bruce”) won the Cheadle medal in clinical medicine. He qualified with honours in pathology and obtained his MD a year later. After national service he trained at Hammersmith and then St Mary’s, where he was one of the pioneers of the introduction of peritoneal dialysis for renal and severe cardiac failure. At that time dialysate had to be shipped from America at about £20 per bottle. Initially he found it difficult to persuade UK manufacturers who could produce it at £3 that there was a ready market and the …
MENTAL SYMPTOMS ASSOCIATED WITH HEAD INJURY
Authors: J. P. Martin
Journal: BMJ (1937)

viii) Residual symptoms having at least the severity of those termed traumatic psychasthenia are very common.The con- dition is of good prognosis up to about two years, but any change which persists longer than this is apt to be permanent.In assessing the degree and importance of residual defect standardized tests are of little value.Symptoms that are reported by a reliable and unbiased witness as occurring but which cannot be detected at interview must be accepted.Many of the minor changes of this condition-such as lack of initiative, retardation, loss of memory for engagements, inde- cision-which need not transpire at interview, may destroy the usefulness of anybody doing responsible work.(ix) While the syndromp traumatic psychasthenia may remain stationary, it may, on the other hand, be the starting-point of a progressive deterioration into dementia.(x) Permanent change is more likely (a) at the extremes of life; (b) when organic disease exists-for example, arterio- sclerosis; (c) when there is a constitutional psychopathic ten- dency.It must be recognized, however, that even in young adLIlts, and even in absence of any of the grosser psychotic sequels, traumatic psychasthenia may persist.
An Approach to the Control of Carcinoma of the Endometrium
Authors: S. B. Gusberg
Journal: CA A Cancer Journal for Clinicians (1973)

Because of the advent of the Papanicolaou smear as a diagnostic test, cervical cancer rates have declined due to early detection and therapy. The same cannot be said of endometrial cancer, and this article outlines some possible diagnostic tests and indications for them in the hope of reducing incidence of and severity of endometrial cancer in peri- and postmenopausal women. Women at high risk of endometrial carcinoma are those with adenomatous hyperplasia, which must be recognized as a precursor of invasive endometrial cancer: carcinoma in situ of the endometrium also qualifies as a true precursor. This author recommends histologic sampling of high-risk menopausal patients, with or without the presence of dysfunctional uterine bleeding. A discussion of the technology of obtaining histological specimens follows, with emphasis on the need to devise a means of obtaining histologic samples in all menopausal women on an ambulatory basis without anesthesia for screening purposes. Vacuum curettage may be a part of such a screening. The need to adopt a regular staging formula to characterize clinically the virulence of endometrial cancer is underscored, and such a formula is presented. Other factors, in addition to screening, which will help control the incidence of endometrial cancer are recognition of the place for radiation and surgical intervention, recognition of menopause as the time of life when high risk patients may get identified, and caution in hormonal treatment in perimenopausal and postmenopausal women until evidence of its efficacy supercedes evidence of possible etiological roles in endometrial aberrations.
Pocket Companion to Robbins Pathologic Basis of Disease
Authors: Ashton B. Morrison
Journal: JAMA (1991)

This is a diminutive traveling companion for the student who already has a copy of the fourth edition of<i>Robbins Pathologic Basis of Disease</i>by Cotran, Kumar, and Robbins. The authors refer to the latter with noteworthy pride as the "big book." While Robbins, Cotran, and Kumar are the lead authors, seven other contributors are associated with them and individually assume responsibility for some portions of the book in the area of systemic pathology. A combination of succinct outlines of major concepts, short definitions, and listings of salient topics provides a lean summary of the "big book." The<i>Pocket Companion</i>is most useful in combination with the main text and is, as noted in the preface, clearly designed for preview and review, with enhanced learning by the student in mind. The cross-referencing to pages in the main text is a further clue to the aims of the<i>Pocket Companion</i>. The
Bromocriptine in Parkinsonism.
Authors: I Pearce, J M Pearce
Journal: BMJ (1978)

A review of the effects of using bromocriptine in Parkinson9s disease showed that it rarely helps patients not primarily improved by levodopa. Patients who show late failure with levadopa and whose response to treatment is declining are helped by combining the two drugs. High cost and severe psychosis are the main disadvantages of bromocriptine, and, although it is not recommended for patients who are doing well on levodopa, it is the best available drug for hospital use in patients who show late failure with levodopa.
Differential Activation of Signal Transduction Pathways in Human Hearts With Hypertrophy Versus Advanced Heart Failure
Authors: Syed Haq, Gabriel Choukroun, Hae Lim, Kevin M. Tymitz, Federica del Monte, Judith Gwathmey, Luanda Grazette, Ashour Michael, Roger Hajjar, Thomas Force, Jeffery D. Molkentin
Journal: Circulation (2001)

Background —Left ventricular failure is commonly preceded by a period of hypertrophy. Intriguingly, many of the signaling pathways that have been implicated in the regulation of hypertrophy, including the 3 mitogen-activated protein kinases (MAPKs: extracellular signal-regulated kinase, stress-activated protein kinase, and p38), protein phosphatase, calcineurin, and the protein kinase Akt and its target glycogen synthase kinase-3 (GSK-3), also regulate the apoptotic response. Methods and Results —To understand the mechanisms that might regulate the progression of heart failure, we analyzed the activity of these signaling pathways in the hearts of patients with advanced heart failure, patients with compensated cardiac hypertrophy, and normal subjects. In patients with hypertrophy, neither the MAPK nor the Akt/GSK-3 pathways were activated, and the dominant signaling pathway was calcineurin. In failing hearts, calcineurin activity was increased but less so than in the hypertrophied hearts, and all 3 MAPKs and Akt were activated (and, accordingly, GSK-3β was inhibited), irrespective of whether the underlying diagnosis was ischemic or idiopathic cardiomyopathy. Conclusions —In the failing heart, there is a clear prohypertrophic activity profile, likely occurring in response to increased systolic wall stress and neurohormonal mediators. However, with the activation of these hypertrophic pathways, potent proapoptotic and antiapoptotic signals may also be generated. Therapies directed at altering the balance of activity of these signaling pathways could potentially alter the progression of heart failure.
Use of the Title "Doctor"
Authors: Walter Chizinsky
Journal: JAMA (1964)

<h3>To the Editor:—</h3> I am entirely in agreement with the views presented by Meddoctor J. F. Montague in the Oct 12 issue ofThe Journal(<b>186</b>:-166). I, too, wish that an end could be made to the indiscriminate and confusing use of the title "Doctor." My own students, for example, soon learn to live with one of my eccentricities, and say "physician" or "surgeon" rather than the ambiguous "doctor" when they refer to medical personnel. However, the third paragraph in Montague's letter aroused me to a high degree (no pun intended!) of anger and resentment, for there he confers upon the MD degree an unwarranted superiority, and upon the PhD degree an equally unjustified inferiority. His attitude indicates a lack of knowledge and objectivity and a bias which are, to say the least, unprofessional. I would like to assure Meddoctor Montague that I have also labored hard and long
In-111 DTPA Ommayagrams in Leptomeningeal Carcinomatosis
Authors: MELIHA KORKMAZ, E. EDMUND KIM, FRANKLIN C-L WONG, DONALD A. PODOLOFF, THOMAS P. HAYNIE, ALFRED YUNG
Journal: Clinical Nuclear Medicine (1995)

Radionuclide Ommayagrams in 25 patients with leptomeningeal carcinomatosis were performed after injection of 0.5 mCl of In-111 DTPA into Ommaya shunt reservoirs to evaluate cerebrospinal fluid-shunt communication, detect the blockage of the cerebrospinal fluid pathway, evaluate the cerebrospinal fluid flow pattern, and predict the distribution of the chemotherapeutics. All results were correlated with MRI evaluations of the brain and spine, as well as clinical findings. Radionuclide Ommayagrams were found to be 73% sensitive and 100% specific in the evaluation of cerebrospinal fluid space disease. MRI of the spine and head was found to be 100% sensitive, but 86% specific for obstructive cerebrospinal fluid space disease.
Testing Strategies in the Initial Management of Patients with Community-Acquired Pneumonia
Authors: Joshua P. Metlay, Michael J. Fine
Journal: Annals of Internal Medicine (2003)

The initial management of patients suspected of having community-acquired pneumonia is challenging because of the broad range of clinical presentations, potential life-threatening nature of the illness, and associated high costs of care. The initial testing strategies should accurately establish a diagnosis and prognosis in order to determine the optimal treatment strategy. The diagnosis is important in determining the need for antibiotic therapy, and the prognosis is important in determining the site of care. This paper reviews the test characteristics of the history, physical examination, and laboratory findings, individually and in combination, in diagnosing community-acquired pneumonia and predicting short-term risk for death from the infection. In addition, we consider the implications of these test characteristics from the perspective of decision thresholds. The history and physical examination cannot provide a high level of certainty in the diagnosis of community-acquired pneumonia, but the absence of vital sign abnormalities substantially reduces the probability of the infection. Chest radiography is considered the gold standard for pneumonia diagnosis; however, we do not know its sensitivity and specificity, and we have limited data on the costs of false-positive and false-negative results. In the absence of empirical evidence, the decision to order a chest radiograph needs to rely on expert opinion in seeking strategies to optimize the balance between harms and benefits. Once community-acquired pneumonia is diagnosed, a combination of history, physical examination, and laboratory items can help estimate the short-term risk for death and, along with the patient's psychosocial characteristics, determine the appropriate site of treatment.
Beyond Tort Reform
Authors: Kirk B. Johnson
Journal: JAMA (1987)

It has been 2 1/2 years since the American Medical Association created national headlines by describing the professional liability situation facing physicians in this country as a "crisis." The American Medical Association's assertion touched off a national debate and signaled the beginning of a wave of medical malpractice tort reform efforts that hit Congress and virtually every state legislature. By the end of 1986 over 30 states had passed legislation that, bluntly stated, made it more difficult to sue physicians for large amounts of money. That is a remarkable record considering that, unlike the crisis of a decade ago, insurance has generally remained available at some price for the vast bulk of physicians. But few believe that this second wave of tort reform will permanently contain the problem. Even with the ardent support of nearly every organization in America that produces a product or provides a service—from the Boy Scouts
PET Scanning Used for Monitoring Treatment Response in Mycobacterium avium Complex Infection Mimicking Malignancy
Authors: Jesse Drijkoningen, Harry van der Pol, Michiel de Vries
Journal: Clinical Nuclear Medicine (2009)

F-18 fluoro-deoxy-glucose- positron emission tomography (FDG-PET) scanning is commonly used for the diagnosis and staging of lung cancer. PET scanning has proved to be useful in differentiating between benign and malignant pulmonary nodules. In oncology, PET scanning is also widely used in post therapy evaluation. We report a case of a 69-year-old woman with high F-18 FDG uptake with PET/computed tomography (CT) related to disseminated Mycobacterium avium complex infection, mimicking malignancy. A second PET scan was performed for monitoring response after therapy. PET scanning seems to be a valid method for monitoring treatment response in mycobacterial respiratory infections.
PTU-267 Training in gastroenterology in severn: implementation of change improves training
Authors: U Chelvaratnam, E Arthurs, T Mehta, S Pugh, M Lockett
Journal: Gut (2012)

<h3>Introduction</h3> Feedback on training posts is collected by a variety of different bodies. The Quality Panel was developed to review the quality of gastroenterology training in the region. Feedback on training posts was found to be of variable quality, incomplete, and difficult to analyse. The aim was to create a specific, reproducible method of assessing gastroenterology and general internal medicine (GIM) training, to provide feedback on individual posts and facilitate improvements in training. In 2010 we conducted a survey of training within the region which identified specific areas for improvement which were fed back to individual trusts. This survey was repeated in 2011 to assess for changes. <h3>Methods</h3> The 2010 survey comprised of 55 questions within seven domains of gastroenterology and GIM training. Questions were determined based on previous surveys and areas of importance according to consultant and trainee opinion. It was emailed to all registrars in the Severn deanery. Data were collected for the last 3 years of training (2007–2010); preserving anonymity and eliminating bias. Answers correlated to numerical scores, with high scores correlating with high quality. Mean scores were calculated per domain, per trust; a total score was then calculated. The data were presented to the Quality Panel and training committee. Individualised feedback was given to each trust. The survey was repeated in 2011 (with 18 additional questions) to monitor improvements and was analysed with data from 2008 to 2010. <h3>Results</h3> The 2010 survey included 37 anonymised responses from 21 trainees at nine hospitals within the Severn region. Responses by trust varied from 3 to 9. Mean overall numerical score was 26.1 (range 24.4–28.6). All trusts scored lowest in providing GIM training with a mean score of 3.1 (range 2.7–3.6); educational support scored highest with a mean score of 4.4 (range 3.4–4.8). The 2011 survey included 46 anonymised responses from 21 trainees at nine hospitals. Responses by trust varied from 3 to 8. Mean overall numerical score was 26.8 (range 24.7–28.7) and 34.2 (range 31–36.8) with the additional questions. All trusts either improved or retained the same score. All trusts scored lowest in providing GIM training with a mean score of 3.3 (range 2.9–3.8); educational support scored highest with a mean score of 4.5 (range 4–4.8). <h3>Conclusion</h3> Creation of a new survey achieved a good response rate and generated speciality specific outcomes and relevant data. This method of assessing training facilitates informed feedback to trusts. Repetition of the survey has shown that feedback-led implementation of change has improved training in Severn. By collecting data on 3 years of training, improvements may have been underestimated. The methodology is reproducible and may benefit training in other specialities. <h3>Competing interests</h3> None declared.
A prospective cohort study on the absolute incidence of venous thromboembolism and arterial cardiovascular disease in asymptomatic carriers of the prothrombin 20210A mutation
Authors: Michiel Coppens, Marlene H. van de Poel, Ivan Bank, Karly Hamulyak, Jan van der Meer, Nic J. Veeger, Martin H. Prins, Harry R. Buller, Saskia Middeldorp
Journal: Blood (2006)
Patients Association deems hospitals' care of older patients "unacceptable"
Authors: I. Torjesen
Journal: BMJ (2011)

Care delivered to older patients by many hospitals in England is “unacceptable” and “deeply concerning,” the Patients Association claims in a report published on 9 November.

The report details 16 shocking accounts of poor hospital care provided in English hospitals recounted by patients’ families to the association’s helpline in the last year.

The cases seem to show that care is falling down in four fundamental areas—care communication, access to pain relief, assistance with toileting, and help with eating and drinking.

One of the cases outlined in the report involves a woman whose daughter despaired at the failure of nurses to attend to her mother’s basic hygiene needs when she was a patient at Frimley Park Hospital. Another concerns …
Manual of Urology
Authors: Rodney A. Mannion
Journal: JAMA (1975)

Mr. Badenoch is known in American clinical urology mainly as the originator of an intricate operation for posterior urethral stricture, which is little used in this country. The preface to the first edition of this "manual" is dated 1952, so this present effort represents a modernization of the first edition. Is it truly updated while retaining the best of the old knowledge? I believe it is, in many ways, of enduring interest, although the most modern chapters were written by the other contributors, most notably Mr. J. E. A. Wickham who wrote what I consider a masterful summary of renal function in the chapter on physiology of the kidney. The 26 chapters provide an overview of urological information from basic science to surgical pathology and operative sugery. The authors have a fine sense of rhetoric, and this book is replete with interesting narrative and "pearls." The British seem to have
Risk of missing a retinal tear in patients with vitreous detachment
Authors: E. N. Herbert
Journal: BMJ (2013)

Khan and colleagues highlight that up to one in six patients with acute symptomatic posterior vitreous detachment have a resultant retinal tear and that dilated funduscopy is needed in all cases.1 Untreated tears can result in retinal detachment and sight loss. It is important to ensure that whoever performs funduscopy is adequately trained and uses the appropriate …
Organelles as Organisms
Authors: Lewis Thomas
Journal: New England Journal of Medicine (1972)

WE seem to be living through the biologic revolution, so far anyway, without being upheaved or even much disturbed by it. Even without being entirely clear about just what it is, we are all learning to take it for granted. It is a curious, peaceful sort of revolution, in which there is no general apprehension that old views are being outraged and overturned. Instead, whole, great new blocks of information are being brought in almost daily and put precisely down in what were previously empty spaces. The news about DNA and the genetic code did not displace an earlier dogma; . . .