tbuckley/cabot-search huggingface dataset:
Medical Problems in the Trenches
Authors: Walter H. C. Burgdorf, Leonard J. Hoenig
Journal: JAMA Dermatology (2015)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
Optic Disc and Peripapillary Morphology in Unilateral Nonarteritic Anterior Ischemic Optic Neuropathy and Age- and Refraction-Matched Normals
Authors: Hitomi Saito, Atsuo Tomidokoro, Goji Tomita, Makoto Araie, Masato Wakakura
Journal: Ophthalmology (2008)
Doctors on the ropes
Authors: R. Hayward
Journal: BMJ (2001)

Apart from some well publicised cases, public opinion of doctors as individuals seems to be holding up well at a time when the medical profession as a whole is increasingly portrayed as paternalistic, out of control, and self serving ( BMJ 2001;322:694). There have been gleeful media reports of doctors in uproar over General Medical Council recommendations for reform, cynicism over clinical governance, and passionate resistance to any restrictions on doctors' rights to private practice.

> By getting angry on behalf of our patients, our status as a profession is assured 

But there is more than a measure of truth in the charges. Why did it have to be the audit commission that lambasted hospitals for being filthy and unhygienic? Why did it have to be a government initiative that targeted the excessive numbers of patients on waiting lists? Why did it take so long for the cancer specialists on Strathclyde to go public about the unacceptable waiting times for radiotherapy in that region? How many letters to MPs are from doctors …
Is longevity a sustainable goal?
Authors: I. Loefler
Journal: BMJ (2002)

Survival is the measure of evolutionary success. Evolution is concerned with the species, not the individual. Therefore, in biological terms, longevity is not of primary importance, even though all living things are endowed with strategies aimed at postponing death.

> The pursuit of longevity can be regarded as a form of hedonism 

Humankind has striven throughout its history to extend the limits—that is why it invented technology. We have had the agricultural revolution, the industrial revolution, and—in the past 50 years—the medical revolution, which has increased the human lifespan. Long life used to be seen as a gift, a matter of luck, or a result of good genes and a clement environment. As a rule, longevity presupposed good health.

The medical revolution has broken the link between lifespan and health. Much of contemporary health care consists of chronic disease management, lifelong medication, props, prostheses, replacements—whether implants or transplants—and of continuous care of varying intensity. Until recently there were only two …
Hypertension in the Elderly: Correction and Clarification
Authors: Nemat O. Borhani
Journal: JAMA (1995)

To the Editor.  —I read with great interest the article by Dr Mulrow and colleagues.1I congratulate both the editors ofJAMAand the authors for bringing the results of this excellent work to the attention of the medical community. There is, however, an error and an oversight in the article.  The legend to Figure 11(p1934)indicates that HTN Coop stands for  Detection and Follow-up Program Cooperative  Yet the reference next to HTN Coop given in the body of Figure 1 is number 3. This is not one of the Hypertension Detection and Follow-up Program (HDFP) articles as they appear in the author's reference list (eg, references 4,31, and 48). Rather, their reference number 3 is an article from the Hypertension-Stroke Cooperative Study Group.2The question is whether the data in Figure 1 represent results from the HDFP or the Hypertension-Stroke Cooperative Study Group.  Furthermore, in
Resection of Pulmonary Metastasis of Non-small Cell Lung Cancer
Authors: Kenichi Okubo, Toru Bando, Ryo Miyahara, Hiroaki Sakai, Tsuyoshi Shoji, Makoto Sonobe, Takuji Fujinaga, Kiyoshi Sato, Hiromi Wada, Toru Tanaka
Journal: Journal of Thoracic Oncology (2009)
Waiting Room Problems Solved
Authors: G. Holmes
Journal: BMJ (1971)

1ll carcinoma patients the serum calcium was raised to around the 16 mg/100 ml level and that the classical symptoms of hyper- calcaemia were present; there were no skeletal metastases.It would appear that the low incidence of the hypercalcaemic syndrome in Locks's series and its absence in the Jersey study would tend to support the comments of Drs.von Wichert and Mitchell-Heggs.-Iam, etc.,
Genomic analysis of diffuse intrinsic pontine gliomas identifies three molecular subgroups and recurrent activating ACVR1 mutations
Authors: Pawel Buczkowicz, Christine Hoeman, Patricia Rakopoulos, Sanja Pajovic, Louis Letourneau, Misko Dzamba, Andrew Morrison, Peter Lewis, Eric Bouffet, Ute Bartels, Jennifer Zuccaro, Sameer Agnihotri, Scott Ryall, Mark Barszczyk, Yevgen Chornenkyy, Mathieu Bourgey, Guillaume Bourque, Alexandre Montpetit, Francisco Cordero, Pedro Castelo-Branco, Joshua Mangerel, Uri Tabori, King Ching Ho, Annie Huang, Kathryn R Taylor, Alan Mackay, Anne E Bendel, Javad Nazarian, Jason R Fangusaro, Matthias A Karajannis, David Zagzag, Nicholas K Foreman, Andrew Donson, Julia V Hegert, Amy Smith, Jennifer Chan, Lucy Lafay-Cousin, Sandra Dunn, Juliette Hukin, Chris Dunham, Katrin Scheinemann, Jean Michaud, Shayna Zelcer, David Ramsay, Jason Cain, Cameron Brennan, Mark M Souweidane, Chris Jones, C David Allis, Michael Brudno, Oren Becher, Cynthia Hawkins
Journal: Nature Genetics (2014)
Leukemic thyroiditis as the initial relapsing sign in a patient with acute lymphocytic leukemia and blast expression of the neural cell adhesion molecule
Authors: John C. Byrd, Nancy S. Dow, Erich Gaertner, Jeffrey B. Hargis, Tracy R. Raber, Linda Burrell, Raymond B. Weiss
Journal: American Journal of Hematology (1997)

We report a patient with a history of T-cell ALL in remission who presented with symptoms and laboratory values consistent with subacute thyroiditis but was found to have leukemic thyroiditis as the first clinical manifestation of leukemic relapse. Bone marrow examination at this time demonstrated recurrent ALL. After successful re-induction with chemotherapy and an allogeneic bone marrow transplant this patient developed an isolated recurrence of her ALL manifested by symptomatic thyromegaly and a new mediastinal mass that was treated with irradiation. Despite no medullary recurrence of ALL, the patient developed pleuritic chest pain and shortness of breath and succumbed to pericardial extramedullary leukemia 9 months later. This to our knowledge is the third reported case of symptomatic ALL involvement of the thyroid gland and the first to be confirmed histologically. Furthermore, this patient had blast expression of the neural cell adhesion molecule (CD56), a cell surface marker that has not been studied in ALL but has previously been identified as a risk factor for extramedullary leukemia (EML) in acute non-lymphocytic leukemia. The authors hypothesize that CD56 expression in this patient might have contributed to her predisposition to EML.
THE TREATMENT OF SERUM SICKNESS OCCURRING IN DIPHTHERIA
Authors: J. R. Keith
Journal: BMJ (1911)

JUY 5,1II1 IR NMEDICAL JOURNAL I0above, was begun, and except for the two rises of tempera- *ture occurring with the other symptoms of poisoning, no fevers have occurred, and trypanosomes have not been 'found in the peripheral blood or in animals inoculated with blood and spinal fluid.That is, parasites and fever have been absent for one and a half years.
Clonal diversity in the B cell repertoire of patients with X-linked agammaglobulinemia.
Authors: R Anker, M E Conley, B A Pollok
Journal: The Journal of Experimental Medicine (1989)

Ig protein and mRNA expression was examined in a collection of 18 monoclonal EBV-transformed B cell lines derived from five patients with X-linked agammaglobulinemia (XLA). A diversity of H and L chain isotypes were synthesized by these lines: the majority (12 lines) expressed mu kappa chains, while mu lambda (two lines), gamma kappa (one), gamma lambda (one), delta lambda (one), and alpha kappa (one) isotype expression was also observed. For all the mu kappa-producing XLA B cell lines, the mu and kappa mRNA transcripts were of native size, and sequence analysis across the regions of VHDJH and V kappa J kappa gene joining showed that Ig gene rearrangements occurred in a typical manner. A variety of VHDJH and V kappa J kappa gene rearrangements were observed, not only within the set of mu kappa+ XLA B cells as a whole, but also among the cell lines derived from single patients. Southern blot analysis for genomic Ig H chain gene rearrangements was done to fully assess the extent of clonal heterogeneity among multiple mu kappa+ XLA B cell lines derived from two patients; all the B cell lines possessed distinct gene rearrangement patterns demonstrating their clonal unrelatedness. Our findings indicate that the B cell repertoire in individual XLA patients is clonally diverse and that it is unlikely that the defect in B cell differentiation in XLA is the result of inefficient or ineffective rearrangement of Ig H or L chain genes. Rather, this study provides support for the idea that the XLA defect relates to a more generalized cellular function, such as regulating the proliferation and/or clonal expansion of cells of the B lymphoid lineage.
Progress in Cancer Care: The Hope, the Hype, and the Gap Between Reality and Perception
Authors: Leonard B. Saltz
Journal: Journal of Clinical Oncology (2008)

Many of the recent advances that have been made in cancer care have been, although arguably important, relatively modest. Sometimes, however, these modest, incremental advances have been presented, discussed, or at least perceived by medical and lay audiences alike, as major advances or so-called breakthroughs. Discussions of the actual data and frank delineation of the limits of the true contribution of a new agent are often met with responses such as “Is that all it does?” or “Why did I think it did so much more?” Why are perceptions and reality so frequently disparate? One important, and correctable, reason is a widely accepted use of terminology that inadvertently facilitates, and at times even encourages, an overly optimistic interpretation of stated results. Although adopted with the best of intentions to instill optimism into a difficult situation, to provide for gentle and compassionate communication of devastating news, or to provide statistical and technical accuracy, still the effect in too many cases has been, in the long run, exactly the opposite of what was originally intended. Under the guise of scientific or statistical rigor, the use of certain terms in fact serves to regularly permit us to hear, whether said or not, an overstatement of accomplishments. The terms are technically correct, and an expert in the field will have no problem accurately understanding what is being stated. However, when these terms are used to communicate the same information to a less specialized medical audience, or, even more so, to the public, misunderstandings frequently occur. We are not discussing here the objective results of the trials, nor the relative merits of various metrics used to report those trials but, rather, the subjective interpretations and common misinterpretations of those data, based not on what the numbers said, but on what was said about the numbers. This article does not represent a systematic review of publications to address the frequency of specific concerns, but rather offers some general qualitative observations for consideration. Outlined herein are several examples of such terminologies with potential for ambiguity and recommendations for modifications of these terms that would diminish these opportunities for misunderstanding. Such changes would encourage a more direct accounting of our successes and failures and would facilitate more rational expectations on the part of patients, more accurate understanding on the part of clinicians, and more accurate representation of the relative benefits of a therapy versus its costs and its risks. SUBSTANTIAL SIGNIFICANCE OF THE DIFFERENCE BETWEEN SUBSTANTIAL AND SIGNIFICANT
A New European Edition
Authors: Arnold S. Relman
Journal: New England Journal of Medicine (1979)

When our name was changed from the Boston Medical and Surgical Journal to the New England Journal of Medicine in 1928, it was in recognition of the fact that our orbit had by then extended well beyond the city of our birth. Although the Journal had become national by most standards, it seemed at the time unnecessary, even extravagant, to assert titular identification with regions west of the Hudson or east of Maine because we still drew most of our subscribers from the northeastern corner of the United States.But that was over half a century ago, and our horizons . . .
ELECTRO-VIBRATION OF THE TURBINATED TISSUE.
Authors: J. MOUNT BLEYER
Journal: JAMA (1895)

In this paper I shall attempt to present the useful purpose of faradism, as observed by me, in treating this form of disease involving certain conditions of the turbinated tissues, which from time to time we have been treating according to the prevailing fashion of the moment, now medically, then again by the more radical means of surgery, the cautery, the saw, the snare, involving a tissue destruction to which, in some instances I have been for a long time opposed; and which I also availed myself of in the hope that some day I would hit upon a better plan of procedure, more physiological and less often accompanied with results ranging from beneficial to positively bad, if not, to say the least, lastingly harmful. I believe, from the results of two hundred cases treated by the method as I shall describe without going into the details of each individual
Interhepatic Oily Contrast Material
Authors: Takashi Kanematsu
Journal: JAMA (1984)

<h3>To the Editor.—</h3> We read with great interest the article, "New Contrast Material Improves Detection of Liver and Spleen Metastases." Dr Michael Vermess and colleagues deserve congratulations for their meaningful work. The etiodized oil emulsion 13 they developed selectively opacifies the normal liver and spleen—but not tumors in these organs—for computed tomographic (CT) examination. Conversely, we administer an oily contrast material—iodized oil (Lipiodol)—via the hepatic artery, using the Seldinger technique.<sup>2</sup>This approach has proved to be most useful for the diagnosis and treatment of primary and secondary liver tumors. Given through the hepatic artery, this oily contrast medium remains only in the neoplastic tissue for an extended time. There is no evidence of deposits in liver parenchyma on the plain x-ray film, and CT and ultrasound examinations clearly demonstrate the tumor itself and its extension. This feature is prominent particularly in cases of vascular-rich tumors, such as are seen
Resting energy expenditure and oxygen cost of breathing in patients with cystic fibrosis.
Authors: S. C. Bell, M. J. Saunders, J. S. Elborn, D. J. Shale
Journal: Thorax (1996)

Resting energy expenditure (REE) is often increased and may contribute towards energy imbalance in patients with cystic fibrosis. Several mechanisms may lead to increased REE including the gene defect, the effect of chronic infection, and abnormal pulmonary mechanics. Increased oxygen cost of breathing (OCB) has been demonstrated in patients with chronic obstructive pulmonary disease (COPD), but has not been the subject of extensive study in cystic fibrosis.Ten clinically stable patients with cystic fibrosis and 10 healthy control subjects were studied. OCB was estimated using the dead space hyperventilation method. Mixed expired gas fractions were measured by online gas analysers and ventilation by a pneumotachograph. After measurement of resting ventilation and gas exchange, minute ventilation (VE) was stimulated by 6-10 1/min by the addition of a dead space and OCB calculated from the slope of the differences in oxygen uptake (VO2) and VE. REE and the non-respiratory component of REE were calculated from gas exchange data. To assess the repeatability of OCB all subjects had a further study performed one week later.The patients had lower weight, fat free mass (FFM), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and transfer factor for carbon monoxide (TLCO) than controls. Resting respiratory rate, VE, and oxygen uptake per kilogram of FFM (VO2/kg FFM) were higher in patients (20 (7), 10.4 (1.4) 1/min and 5.5 (0.8) ml/kg FFM/min) than in controls (13 (4), 7.0 (1.2), and 4.2 (0.5), respectively.) The error standard deviation for replicated measures of OCB was 0.5 ml O2/l VE in controls and 0.8 ml O2/l VE in patients with coefficients of variation of 24% in controls and 28% in patients. The mean OCB in patients was 2.9 (1.4) ml O2/l VE and 2.1 (0.7) ml O2/l VE in controls. OCB, expressed as ml/min (VO2resp) was 28.5 (11.7) in patients and 14.0 (3.6) in controls. REE was higher in patients (125.9 (14.0)% predicted) than in controls (99.0 (9.4)%). The estimated non-respiratory component of REE was 112.1 (14.9)% for patients and 93.0 (10.0)% for controls.In clinically stable patients with cystic fibrosis the OCB at rest is increased but is not the sole explanation for increased metabolic rate. This contrasts with the finding in COPD where the increase in REE is largely explained by increased OCB. This study also showed poor repeatability and OCB measurements similar to earlier studies, which indicates that the technique is not suitable for longitudinal studies.
In vivo kinetics of insulin action on peripheral glucose disposal and hepatic glucose output in normal and obese subjects.
Authors: R Prager, P Wallace, J M Olefsky
Journal: Journal of Clinical Investigation (1986)

To determine whether abnormal kinetics of insulin's biologic actions contribute to the overall insulin resistance in obesity, we compared the rate of activation and deactivation of insulin's effects to stimulate glucose disposal rate (Rd) and inhibit hepatic glucose output (HGO) in 12 nonobese and 10 obese subjects using the euglycemic clamp technique at insulin infusion rates of 15, 40, 120, and 1,200 mU/M2 per min. In both groups, stimulation of Rd was faster the higher the insulin infusion rate and the time to reach half maximal stimulation (A50 value) in normals was 52 +/- 4, 44 +/- 2, 29 +/- 3, and 21 +/- 2 min at infusion rates of 15, 40, 120, and 1,200 mU/M2 per min, respectively. In the obese subjects, the rate of activation was slower (higher A50 values) with A50 values of 74 +/- 6, P less than 0.001 (compared to normal), 64 +/- 8 min, P less than 0.001, and 28 +/- 3 min, P less than 0.01, at the 40, 120, and 1,200 mU/M2 per min insulin infusions. Deactivation of the insulin effect to stimulate glucose disposal rate (Rd) was faster in the obese group compared with normal individuals after all comparable insulin infusions. In summary: for both groups, the higher the insulin infusion rate, the higher the steady state Rd value, the faster the rate of activation and the slower the subsequent rate of deactivation. In insulin-resistant obese subjects, the rate of activation of insulin action was slower and the rate of deactivation faster at comparable insulin infusion rates. The rate of suppression of HGO was comparable in normal and obese subjects, but the rate of recovery of HGO back to basal values was faster in the obese group. And in view of the phasic manner in which insulin is normally secreted following meals, steady state insulin action is not normally achieved. Therefore, the abnormal kinetics of insulin action in insulin-resistant obese individuals may represent functionally important manifestations of the insulin resistance in this condition.
Audiovisual feedback and quality of CPR
Authors: P. Leman
Journal: BMJ (2011)

Evidence so far shows no improvement in clinical outcomes

Effective cardiopulmonary resuscitation (CPR) is essential to maximise the chance of a successful outcome after cardiac arrest. In the linked cluster randomised trial (doi:10.1136/bmj.d512), Hostler and colleagues assess the effect of real-time audio and visual feedback in people with an out of hospital cardiac arrest on whom resuscitation was attempted by emergency medical services⇓.1



BSIP, Theobald/Science Photo Library

In October 2010, the International Liaison Committee on Resuscitation (ILCOR) published international consensus recommendations on CPR and emergency cardiovascular care.2 This review concluded that a strong emphasis on delivering high quality chest compressions was essential. Specific recommendations included placing the hands in the centre of the chest; giving at least 100 compressions a minute; and pressing to a depth of at least 5 cm. Unfortunately, although the recommendations used the term “at least,” no clear evidence exists that pushing faster than 100 compressions per minutes or deeper than 5 cm is associated with better or worse outcomes.

The European Resuscitation Council (ERC) published its updated guidelines at the same time and stressed the importance of feedback to rescuers in maintaining high quality CPR.3 The council acknowledged …
Chronic lymphocytic leukemia B cells contain anomalous Lyn tyrosine kinase, a putative contribution to defective apoptosis
Authors: Antonella Contri, Anna Maria Brunati, Livio Trentin, Anna Cabrelle, Marta Miorin, Luca Cesaro, Lorenzo A. Pinna, Renato Zambello, Gianpietro Semenzato, Arianna Donella-Deana
Journal: Journal of Clinical Investigation (2005)

B cell chronic lymphocytic leukemia (B-CLL) is a neoplastic disorder characterized by accumulation of B lymphocytes due to uncontrolled growth and resistance to apoptosis. Analysis of B cells freshly isolated from 40 patients with chronic lymphocytic leukemia demonstrated that the Src kinase Lyn, the switch molecule that couples the B cell receptor to downstream signaling, displays anomalous properties. Lyn is remarkably overexpressed at the protein level in leukemic cells as compared with normal B lymphocytes, with a substantial aliquot of the kinase anomalously present in the cytosol. Whereas in normal B lymphocytes Lyn activation is dependent on B cell–receptor stimulation, in resting malignant cells, the constitutive activity of the kinase accounts for high basal protein tyrosine phosphorylation and low responsiveness to IgM ligation. Addition of the Lyn inhibitors PP2 and SU6656 to leukemic cell cultures restores cell apoptosis, and treatment of malignant cells with drugs that induce cell apoptosis decreases both activity and amount of the tyrosine kinase. These findings suggest a direct correlation between high basal Lyn activity and defects in the induction of apoptosis in leukemic cells. They also support a critical role for Lyn in B-CLL pathogenesis and identify this tyrosine kinase as a potential therapeutic target.