tbuckley/cabot-search huggingface dataset:
Holding the mirror.
Authors: P Underwood
Journal: BMJ (1986)

In 1983 I received an unusual invitation to speak at a conference. The conference was the fourth annual conference of the Australian and New Zealand Association of Psychodramatists, Sociodramatists, Role Trainers, and Sociometrists. This group, whose work is based on the teachings of the American therapist Moreno, has exerted a lively influence on a growing group of Australian teachers, health professionals, and social workers, as well as therapists and even the odd administrator and doctor. (For those of you who are unaware of Moreno and psychodrama the essence of the method is the use of a dramatic setting in which participants move in and out of the roles of people in their lives: a sort of exalted role play.) The theme of the conference was The Journey. I was asked to talk about my own journey in medicine: the following talk resulted. The peculiar demands of the theme and the audience inspired an individual response; for this reason I have decided here not to change the original style. I hope that by leaving the piece as a talk you, the reader, will allow me to talk to you.
Day care for patients with psychiatric disorders.
Authors: G Wilkinson
Journal: BMJ (1984)

hormone therapy or chemotherapy should be prescribed.Many clinicians, particularly those in North America, recommend prophylactic chemotherapy routinely for all patients with any spread to the axillary nodes-and they may be deemed negligent not to do so.Doubts are now being expressed about this policy, however, and the more conservative approach adopted in Britain is gaining ground.The problem that clinicians have to face is that adjuvant chemotherapy has not been proved to "cure" patients with micrometastases.In some patients it may be important to prolong the disease free interval, but in others systemic treatment may better be reserved for the time when the metastases cause symptoms.Prognostic indicators are only a guide.Some patients with a poor index live out a normal life span and never develop clinically apparent secondary disease.Meanwhile the hope for the future is that with better drugs and perhaps better ways ofusing the available drugs-adjuvant chemotherapy may improve the results in breast cancer in the same way as the improvement in the outcome of treatment of lymphomas and teratomas.Clinical research must continue-both to assess new agents and to optimise the use of those currently available.Further research on the biological characteristics of breast cancer with its metastasing potential should help our understanding of the disease, and if markers and simple detectors of hormone sensi- tivity can be found there should be great strides in the development of potentially curative treatment.At present the use of cytotoxic drugs as adjuvant therapy should be in the hands ofclinicians in specialist units, and when possible patients should be included in studies and clinical trials.Non-toxic adjuvant treatment with tamoxifen will un- doubtedly be used widely, but research is still needed on the place of this agent used in this way.There is no reliable in- formation on how much is required or for how long it should be given.These questions should be answered by further clini- cal trials, and the studies on immunotherapy need repeating and developing.It can only be an advantage to have as much information as possible on a patient with primary breast cancer.The data collected will given an indication of the pattern and extent of the disease and of the course it is likely to take and will be of help in planning a treatment programme, but the place of adjuvant therapy must still be the subject of research.Many questions remain unanswered.Which patients ?What type of treatment?For how long?
UK will reserve bird flu vaccine for health workers
Authors: Michael Day
Journal: BMJ (2006)

H5N1 bird flu vaccine will be for the exclusive use of NHS staff and other key public workers, ministers in the United Kingdom have confirmed. Contracts were announced with Baxter International and Chiron Corporation for about 3.5 million doses of the jab.

Some experts have warned that British poultry workers might need the vaccine as the virus continues its move eastwards. Last week, H5N1 infection was confirmed in a turkey farm in France.

But after announcing that the two batches were scheduled to arrive in May and October 2006, health minister Rosie Winterton made it clear that the vaccine was for …
Abstract 1439: Clinical significance of KISS1 protein expression in breast cancer metastasis to brain
Authors: Ilya V. Ulasov, Natalya Kaverina, Bart Thaci, Peter Pytel, Husain Sattar, Dingcai Cao, Douglas R. Hurst, Danny R. Welch, Olufunmilayo I. Olopade, Zaira G. Kadagidze, Maciej S. Lesniak
Journal: Cancer Research (2011)

Abstract Aim: The present study was aimed to investigate whether KISS1 suppressor protein could be used as a prognostic marker in development of breast cancer metastases. Methods: To test whether breast cancer brain metastases (BMHB) have altered expression of KISS1, we created a TMA (tissue microarray) recipient block containing 136 specimens: 103 specimens of primary breast cancer cells (invasive ductal carcinoma, IDC), 7 specimens from draining lymph nodes (LN), 39 brain metastases and 14 samples of normal breast tissue (NBreast). Each core was duplicated. Sections from this block were stained with antibodies that recognize KISS1. Immunoassays were graded based on: A) intensity of immunoreactive cells staining (Negative, 0% of the cells have staining; 1+, 5-20% of total cells have staining (Mild); 2+, 20-50% of total cells have staining (Moderate); 3+, 50% or more of total cells have staining(High)) and B) score calculated by ACIS system (Chromavision/Clarient, Aliso Viejo, CA). Positive staining in the present study was defined as visibility at low magnification (10x) and was confirmed by two pathologists. To validate the IHC findings, relative expression of KISS1 was evaluated by real time PCR technique. Results: Based on TMA expression results, we found that breast cancer metastases exhibited statistically significant less KISS1 expression vs. primary specimens (Kruskal-Wallis p value = 0.011). In validation set, 84.2% of IDC samples had either moderate (38/76) or high (26/76) expression of KISS1 protein whereas weak (negative or mild) expression was observed in 15.8% cases (12/76). In contrast, metastatic cases demonstrated weak expression in 100% cases (19/19). The real time PCR data confirmed IHC findings. We analyzed the correlation between the level of KISS1 expression and breast cancer prognosis based on the IHC data. The group of patients with high expression of KISS1 protein (1x and more) was found to have a trend toward slower disease progression. Those patients developed brain metastases 51.0+15.0 (CI: 17.7-84.3) months after tumor resection whereas the group of patients with no KISS1 expression had metastases after only 27.0+4.93 (CI: 15.39-38.69) months. Conclusions: These results suggest that high level of KISS1 protein expression is advantageous for breast cancer patients and that low levels correlate with metastases towards secondary organs such as brain. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1439. doi:10.1158/1538-7445.AM2011-1439
A CASE OF TRIPLETS.
Authors: C. W. COOPER
Journal: JAMA (1884)

About 8:30 on the morning of May 13, 1882, I was called to attend Mrs. N. in confinement. She was a Swede, age 40, a multipara. I found the membranes protruding from the vagina, and a foot just within. Her pains were not very severe. From all appearances I was satisfied there were twins. I ruptured the membranes, when a large quantity of fluid escaped. The pains now became stronger, but the foot did not descend much. The mother was weak from the burden she had been carrying, and from her inability to lie down, which had now existed nearly a month. By pressure upon the abdomen and slight traction upon the foot I assisted the delivery, which was accomplished a few minutes after nine. The child was a boy weighing 6½ pounds. The second child presented the vertex and was delivered naturally at 9:45. This also was a boy,
Experiences in a Vaginitis Clinic
Authors: Warren R. Lang
Journal: JAMA (1960)

A clinic devoted mainly to the diagnosis and treatment of vaginal infections dealt with more than 6,000 patients (12,500 patient-visits) in a period of 13 years. An exact initial diagnosis was found necessary in choosing specific therapy, and included cultures for trichomonads, fungi, and bacteria. At subsequent visits, both clinical and microbiologic reappraisals were necessary in order to tell whether therapy needed to be prolonged or changed. The management of vaginitis in children was based on the same principles as in adults, and treatment was undertaken only after complete pelvic investigation.
Miscellanea: Survey of nameplates in a well known London Street
Authors: R. C Bickerton, C. M Milton
Journal: BMJ (1986)

In 1951 a well known otolaryngologist recorded 798 brass nameplates in a well known London street. In the 35 years since this last survey was conducted the number has decreased by 23. This surprising finding is attributed to the communal entryphone and to the emergence of the shoddy plate. A definition of a plate is proposed, the concentration described, and the geographical distribution of plates summarised. A new phenomenon is encountered, the ghost plate, type A and type B. Further study is required to elucidate the significance of ghost plates.
PREDICTORS OF POOR RESPONDERS FOR EXERCISE CAPACITY IN EXERCISE TRAINING PROGRAM FOR HEART FAILURE
Authors: Mari Sakamoto, Reon Kumasaka, Tetsuo Arakawa, Hiroyuki Takahama, Michio Nakanishi, Masanobu Yanase, Teruo Noguchi, Naohiko Aihara, Hiroshi Takaki, Yoichi Goto
Journal: Journal of the American College of Cardiology (2011)
Clinical Experience with a New Anticoagulant, Dipaxin (2-diphenylacetyl-l,3-indandione)
Authors: LUKE R. PASCALE, JOHN H. OLWIN
Journal: Circulation (1954)

Prothrombin levels as measured by the one-stage whole-plasma and the two-stage technics were followed in 80 patients receiving Dipaxin. The induction period is similar to that for Tromexan, namely, 48 to 60 hours and the recovery period 10 to 15 days which is somewhat longer than in the case of either Tromexan or Dicumarol. This recovery period is hastened to some degree by the administration of water-soluble vitamin K preparations and materially accelerated by vitamin K 1 . The prothrombin level during maintenance therapy is unusually stable. Transient bleeding occurred in two patients. No other toxic effects were observed.
Liberal Democrats pledge to pay for long term personal care
Authors: J. Revill
Journal: BMJ (2001)

The Liberal Democrats, with an ambitious “tax and spend” programme, can afford to put improvements in the health service at the heart of their manifesto. Critics say that it is easy for them to promise the earth because they have such a small chance of forming a government; they have 47 MPs in all. But as their leader, Charles Kennedy, has pointed out, they can influence and shape policies and reflect the grassroots concern, as they did over the proposed—and now (temporarily) abandoned—attempts to abolish community health councils.

A central plank of the Liberal Democrats' manifesto is to cut waiting times by increasing the number of staff, by providing training places …
Organotypic slice culture from human adult ventricular myocardium
Authors: Matthias Brandenburger, Jan Wenzel, Roman Bogdan, Doreen Richardt, Filomain Nguemo, Michael Reppel, Jürgen Hescheler, Heinrich Terlau, Andreas Dendorfer
Journal: Cardiovascular Research (2011)

AimsCardiovascular research requires complex and functionally intact experimental models. Due to major differences in the cellular and subcellular composition of the myocardium between species, the use of human heart tissue is highly desirable. To enhance the experimental use of the human myocardium, we established methods for the preparation of vital tissue slices from the adult ventricular myocardium as well as conditions for their long-term preservation in organotypic culture.
Quantitative PET Imaging of Tryptophan Accumulation in Gliomas and Remote Cortex
Authors: Csaba Juhász, Diane C. Chugani, Geoffrey R. Barger, William J. Kupsky, Pulak K. Chakraborty, Otto Muzik, Sandeep Mittal
Journal: Clinical Nuclear Medicine (2012)

PET studies with α[C-11]methyl-L-tryptophan (AMT) have shown decreased serotonin synthesis based on a decrease of the unidirectional uptake rate (K-complex) in neuropsychiatric conditions such as autism and depression. Increased AMT K-complex in tumors can indicate increased tryptophan metabolism via the immunosuppressive kynurenine pathway. Moreover, apparent AMT volume of distribution (VD') reflects net tryptophan transport from blood to tissue. We evaluated if kinetic parameters (K-complex, VD') of AMT, measured by PET, can predict the proliferative activity of glioma, and if these AMT parameters are altered in the remote cortex.We evaluated dynamic AMT PET images of 30 adult patients with grade 2 to 4 gliomas according to the World Health Organization's classification to determine tumoral AMT VD' and K-complex values, which were correlated with tumor proliferative activity as assessed by the Ki-67 labeling index in resected tumor specimens. We also compared cortical VD' and K-complex values between patients with glioma and healthy controls.Both VD' and K-complex values were significantly higher in gliomas than in the contralateral cortex (VD', P < 0.001; K-complex, P < 0.001). Tumoral VD' values and tumor/cortex VD' ratios, but not the K-complex, showed strong positive correlations with the proliferative activity of glioma (P ≤ 0.001). The contralateral frontal cortex showed decreased AMT VD' and K-complex in patients with glioma compared with those in controls (P ≤ 0.01).Increased net amino acid transport into tumor tissue, quantified by PET, can serve as an imaging marker of the proliferative activity of glioma. The data also suggest a glioma-induced down-regulation of cortical serotonin synthesis, likely mediated by shunting of tryptophan from serotonin synthesis to kynurenine metabolism.
Supplementary Creatine as a Treatment for Gyrate Atrophy of the Choroid and Retina
Authors: Ilkka Sipilä, Juhani Rapola, Olli Simell, Antti Vannas
Journal: New England Journal of Medicine (1981)

Gyrate atrophy of the choroid and retina is a disease characterized by progressive constriction of visual fields, a 10-fold to 20-fold elevation in plasma ornithine, and depressed activity of L-ornithine:2 oxoacid aminotransferase. Morphologically conspicuous but clinically unimportant atrophy of Type II muscle fibers progresses concomitantly with the eye disease. A pathogenic component of the disease may be deficient formation of creatine, caused by hyperornithinemia, which leads to a shortage of cellular phosphocreatine energy stores. To test the therapeutic value of replenishing the postulated deficiency of creatine, we supplemented the diet of seven patients with 1.5 g of creatine daily. During one year of this treatment the diameters of Type II muscle fibers increased from 34.1 ±7.1 to 49.9±7.0 μm (mean ±S.D.) (P<0.001). There was no significant increase in the diameters of Type I fibers. The visual-field tests showed no further constriction during the therapy. Fundus photography revealed slow impairment at an age otherwise associated with rapid progression of the disease. These promising preliminary results need further evaluation with long-term follow-up studies. (N Engl J Med. 1981; 304: 867–70.)
BIODIBTRIBUTION AND DRAIN SPECT IRAQINO WITH TC99M ECD IN HUHANS: A NEW RADIOCHEHICALLY STABLE BRAIN FERTUSION AGENT
Authors: J Leveille, P Rigo, G. Domonceau, B A Burgess, R A Morgan, R C Walovitch
Journal: Clinical Nuclear Medicine (1988)

s of the 20th Annual Meeting of the New England Chapter of the Society of the Nuclear Medicine: PDF Only
Bacteriology of Aspiration Pneumonia
Authors: BENNETT LORBER
Journal: Annals of Internal Medicine (1974)

We prospectively studied 24 cases of community-acquired aspiration pneumonia and 23 cases of hospital-acquired aspiration pneumonia, with special attention to their microbiology. Specimens were obtained by transtracheal aspiration or thoracentesis and were processed with appropriate anaerobic and standard bacteriologic methods. Quantitative cultures were done, and numbers of 106/ml or greater were considered significant. Anaerobic bacteria were isolated from 21 of 24 community-acquired infections and, in 13 cases, were the only isolates. In the hospital-acquired infections anaerobes were found in 8 of 23 cases and were the only isolates in 2 cases. Gram-negative facultative anaerobes and aerobes were common in the hospital-acquired infections. Community- and hospital-acquired aspiration pneumonias are bacteriologically different. The causative organisms reflect the oropharyngeal flora, and the anaerobic bacteria seem to be important pathogens in both community- and hospital-acquired cases.
Venous and arterial endothelia: different dilator abilities in dog vessels.
Authors: C L Seidel, J LaRochelle
Journal: Circulation Research (1987)

It has been demonstrated by other investigators that endothelium-dependent vasodilators are more effective on arterial tissue than on venous tissue. The purpose of this study was to determine if this was due to a difference in the sensitivity of arterial and venous smooth muscle to the endothelial dilator (EDRF) or to a difference in the ability of arterial and venous endothelia to release EDRF. To differentiate between these two possibilities, an in vitro "sandwich" preparation was used in which the mechanical response to endothelium-dependent dilators of a de-endothelialized vessel was determined when "sandwiched" with an endothelialized vessel. Using dog femoral artery and saphenous vein, it was determined that acetylcholine (ACh), the ionophore A23187, and thrombin were endothelium-dependent dilators of the femoral artery, but their dilatory ability was significantly less in the saphenous vein. However, if the de-endothelialized saphenous vein was "sandwiched" with an endothelialized femoral artery, both ACh and A23187 significantly relaxed the vein. No relaxation of the de-endothelialized femoral artery occurred when it was "sandwiched" with an intact saphenous vein. Sodium nitroprusside, thought to act by a mechanism similar to EDRF, relaxed equally the saphenous vein and femoral artery. These observations suggest that the difference in responsiveness between femoral arteries and saphenous veins to endothelium-dependent dilators is due more to differences in the ability of their endothelia to release EDRF than to an inability of their smooth muscle to respond to EDRF.
ABC of eyes. Squint.
Authors: A. R. Elkington, P. T. Khaw
Journal: BMJ (1988)

Blurred imageClear image 4< 4Image suppressed Clear image resulting in amblyopia ' Eye wanders Eye stays straight A squint may be a sign of impaired visual acuity.The subject of squint (strabismus) is one that many practitioners approach with great trepidation, sometimes with justification.If, however, it is approached systematically much ofthe myth and mystery can be dispelled.What is a squint?The word is used in many different ways.Some people mean by squint that the eyelids are screwed up; the patient is creating a pinhole effect to reduce the effect ofany refractive error in order to see better.The true definition ofsquint, however, is that one ofthe eyes is not directed towards the object under scrutiny.It should be noted that when the eyes converge for close work there is no squint.* A squint may show that the acuity ofthe eye is impaired because ofocular disease.The eyes are kept straight by the drive to keep the image of the object being viewed in the centre ofthe macular area.The tone in the extraocular muscles is constantly being readjusted to maintain this fixation.If the vision is impaired in one or both eyes this constant readjustment cannot occur and one eye may wander.This is important, as the cause of impaired vision may be eminently treatable, as in the case ofa cataract or a refractive error.It is especially important in a child because-unlike an adult-a child's vision may be irreversibly impaired iftreatment is not given in time: the visual pathway on the side ofthe impaired eye fails to develop normally, causing amblyopia or a "lazy" eye.It is important to realise that a child does not complain that the sight ofone eye is poor, and the prevention ofpermanent blindness in a child's eye may require treatment as simple as a pair ofglasses to correct a refractive error.* The squint may itselfcause amblyopia in a child-Misalignment of the eyes may be the primary problem; presumably double vision results.In a child the vision ofone eye may be suppressed to avoid this diplopia and the visual pathways then fail to develop properly.This leads to amblyopia ofthe eye that is otherwise organically sound.* A squint may be a sign ofa life threatening condition-Squint is a common presentation in a child with a retinoblastoma.The resulting squint is non-paralytic and therefore the angle ofdeviation is the same irrespective ofthe direction of the gaze.The eye deviates because vision is impaired and this may occur in any eye with visual impairment.A squint may also be caused by a sixth nerve palsy resulting from a tumour that is causing raised intracranial pressure.In this case the squint will be paralytic and the angle ofsquint will vary depending on the direction ofgaze.Myasthenia gravis may first present with squint and diplopia._~R etinoblastoma in a child presenting with a squint.
The Hospitalist: New Boon for Internal Medicine or Retreat from Primary Care?
Authors: Steven A. Schroeder
Journal: Annals of Internal Medicine (1999)

The growing reliance on hospitalists in the United States has implications for several areas of internal medicine, including patient care, administration, clinical practice, and medical education. This paper discusses some of the potential advantages and disadvantages of the use of hospitalists in each of these areas. The new hospitalist practice mode highlights long-standing tensions about the role and direction of internal medicine, tensions that affect generalist and specialty care in both outpatient and hospital settings. The career trajectory of hospitalists will depend on whether burnout is a problem and on whether hospitalists will be able to compete effectively with sub-specialists, such as cardiologists and physicians specializing in AIDS. Clearly, hospitalism meets a clinical need and expands opportunities for internists, but it is important that it not overreach, forfeiting primary care turf and distorting medical education. This new field warrants close monitoring because of its potential effects and because-unlike related fields, such as emergency medicine and intensive care--its birth was strongly influenced by system-wide financial considerations.
Intermittent Cystocele Diagnosed on 18F-FDG PET/CT Scan
Authors: James M. Mountz, Gonca G. Bural
Journal: Clinical Nuclear Medicine (2012)

A 78-year-old woman was diagnosed with stage III diffuse large B-cell lymphoma, and treated with chemotherapy in 2004. Imaging follow-up was performed by serial 6-month diagnostic PET/CT scans. A PET/CT scan performed in June 2011 showed an unusual hourglass appearance of activity in the pelvis that prompted further investigation. Retrospective review of the prior diagnostic PET/CT scans revealed that the patient had a sliding bladder, located either above or below the pubococcygeal line at different imaging times, but during this scan, the bladder was "caught" moving up to its normal position.