tbuckley/cabot-search huggingface dataset:
Memorable patients: Loss of examination status
Authors: S. M Shalet
Journal: BMJ (2000)

Lennie was a teacher; knowingly or otherwise, he certainly taught me a lot. It was my first medical firm attachment as a clinical student. Lennie wasn't the first patient who I was responsible for, but he was the most memorable. He had a multitude of diagnoses, some of which I had barely heard of and others not at all. Large multinodular goitre, mixed mitral stenosis and reflux, bronchiectasis, hereditary elliptocytosis, glaucoma, and an old Bell's palsy. He rattled off the list as you would a supermarket shopping list. Even if possessed, diagnostic skills were not required for Lennie's pathologies. His pride in the number and variety of the conditions and the obvious awe on the faces of the students who came to his bedside and hung on every word meant that diagnoses were blurted out instantly rather than revealed painfully slowly by a student historian.

He was in hospital on this occasion for a review of his current medical state. He, of course, was a regular as he volunteered his body on every conceivable occasion that student exams were held.

By nature he was a cheerful, optimistic man, who was happiest discussing his medical conditions and how their complexity and interaction had perplexed several consultants for many years. After a couple of weeks it transpired that decisions had been taken for Lennie to undergo mitral valve surgery and a thyroidectomy. He seemed calm about the impending operations. So I was all the more surprised when he returned to the medical ward several days after the second operation to find him distraught and tearful. He denied that he was in any pain or that there was anything wrong with his children or beloved grandchildren. Furthermore, his favourite team, West Ham, had won its last couple of matches. I pushed him a little harder about the cause of his distress, and then he blurted it out in little bursts.

“I'm finished, it's all over.”

“Don't be silly, Lennie, you are fine and will live many years yet.”

“I am not worried about how long I have to live.”

“Then what troubles you?”

“They have stripped me of my physical signs. They will never use me again for student finals—no goitre, no mitral valve murmurs. I'm finished.”

I fought hard and emphasised that he still had the bronchiectasis and the old Bell's palsy up his sleeve (so to speak), but I was in trouble trying to sell the physical signs associated with hereditary elliptocytosis. In truth, he was probably right, he never had the same cachet again as the star patient at the student exams.

It was then I realised that operative morbidity could have a wider meaning and that some patients have a greater commitment to a hospital than many doctors.

As for Lennie, he died nine months later; cause of death unknown, but I knew.
More coffee, fewer gallstones
Authors: S. Gottlieb
Journal: BMJ (1999)

Men who drink two to three cups of coffee a day have a 4% lower risk of developing gallstones than those who do not drink coffee regularly, and men who drink four or more cups a day have a 45% lower risk, according to a new study.

But only coffee with caffeine, which is known to stimulate contractions in the gallbladder and lower cholesterol concentrations in bile, was associated …
Bassini's Operation for Inguinal Hernia
Authors: T. L. Gordon
Journal: BMJ (1945)

The purpose of this study was to prospectively evaluate the role of <sup>18</sup>F-FDG PET/CT in patients with stage IIA, IIB, or IIIA breast cancer. <b>Methods:</b> During 56 mo, 131 consecutive patients with large (&gt;2 cm) breast cancer and clinical stage IIA, IIB, or IIIA (based on clinical examination, mammography, breast MRI, and ultrasonography) underwent <sup>18</sup>F-FDG PET/CT. The nuclear physician was unaware of the results of any other procedure (bone scan, chest radiography, liver ultrasound, or thoracoabdominal CT scan). <b>Results:</b> Of the 131 examined patients, 36 had clinical stage IIA (34 T2N0 and 2 T1N1), 48 stage IIB (20 T3N0 and 28 T2N1), and 47 stage IIIA (29 T3N1, 9 T2N2, and 9 T3N2). <sup>18</sup>F-FDG PET/CT modified staging for 5.6% of stage IIA patients, for 14.6% of stage IIB patients, and for 27.6% of stage IIIA patients. However, within stage IIIA, the yield was specifically high among the 18 patients with N2 disease (56% stage modification). When considering stage IIB and primary operable IIIA (T3N1) together, the yield of <sup>18</sup>F-FDG PET/CT was 13% (10/77); extraaxillary regional lymph nodes were detected in 5 and distant metastases in 7 patients. In this series, <sup>18</sup>F-FDG PET/CT outperformed bone scanning, with only 1 misclassification versus 8 for bone scanning (<i>P</i> = 0.036). <b>Conclusion:</b><sup>18</sup>F-FDG PET/CT provided useful information in 13% of patients with clinical T3N0, T2N1, or T3N1 disease. The yield was more modest in patients with stage IIA. The high yield in the case of N2 disease demonstrates that stage IIIA comprises 2 quite distinct groups of patients.
Hepatic microcirculation in the perfused cirrhotic rat liver.
Authors: F Varin, P M Huet
Journal: Journal of Clinical Investigation (1985)

Liver microcirculation in the perfused rat liver was assessed by the multiple indicator dilution technique. Comparative studies were carried out in noncirrhotic rats and in rats with cirrhosis secondary to chronic exposure to phenobarbital and carbon tetrachloride. The alterations of the sinusoidal bed were characterized by changes in the displacement of hepatic venous outflow curves of various diffusible substances (labeled albumin, sucrose, and water) relative to that of labeled erythrocytes (vascular reference). Outflow recoveries of lidocaine (a substance that penetrates the liver cell membrane freely and completely) and of labeled microspheres (15 microns diam) were also appraised. In all cirrhotic rats, unimodal erythrocytes and albumin curves were obtained. The sinusoidal space was significantly decreased when compared with normal rats (P less than 0.001) and the total space accessible to albumin became progressively restricted. In seven cirrhotic rats, the profiles of labeled sucrose and water curves were compatible with a flow-limited diffusion and the total distribution volumes were not significantly different from values found in noncirrhotic rats (P = NS), which indicates that sucrose and water were still able to diffuse into an extravascular space not accessible to albumin. In the other cirrhotic rats, labeled sucrose and water curves showed progressive bimodal changes not compatible with a flow-limited diffusion. Such alterations were not due to large intrahepatic shunts, since only 0.25% of the 15-microns microspheres were recovered in the outflow of cirrhotic rats. However, an early lidocaine outflow peak related in time to the peak erythrocyte curve was observed in cirrhotic, but not in noncirrhotic, rats. Lidocaine recovery varied greatly in cirrhotic rats and appeared to increase as the liver disease progressed. These data can be explained by capillarization of sinusoids and/or by the development of channels with poor permeability. Electron microscopic observations of these rat livers favored the latter. Thus, in cirrhotic rat liver, two kinds of alteration are likely: (a) the vascular space is decreased with collagenization of the extravascular space, limiting the diffusion of large molecules such as albumin; and (b) small channels with poorly permeable walls develop, limiting the diffusion of small molecules such as lidocaine, sucrose, and water. Large intrahepatic shunts are not a common feature.
Improvement in the cutaneous disease activity of patients with dermatomyositis is associated with a better quality of life
Authors: E.S. Robinson, R. Feng, J. Okawa, V.P. Werth
Journal: British Journal of Dermatology (2014)

Cutaneous dermatomyositis (DM) disease activity is associated with decreased quality of life.To assess if an improvement in quality of life, as measured by the Skindex-29 and patient-reported itch and pain on a 10-point visual analogue scale (VAS), correlated with an improvement in cutaneous DM disease activity.Patients with a completed cutaneous DM disease area and severity index [Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI)] at two visits separated by at least 2 months were classified into responder (n = 15) and nonresponder (n = 30) groups according to the point change in the CDASI activity scores between visits. Responders had at least a four-point improvement in CDASI activity, indicating clinically relevant improvement.The change from baseline to the follow-up visit of the Skindex-29 subscale scores for the responders vs. the nonresponders were significantly different for emotions (P < 0·01), functioning (P < 0·01) and symptoms (P < 0·01). The change in VAS score between responders and nonresponders was also significant for itch (P = 0·01) and pain (P = 0·04). There was no significant difference between the groups in terms of disease subtype, sex, race, age, treatment for DM, smoking history or a history of malignancy within 5 years of a diagnosis of DM.This is the first study to demonstrate that the quality of life of patients with DM improved as their cutaneous disease activity decreased.
Determinants of alcohol use and abuse: Impact of quantity and frequency patterns on liver disease
Authors: Samir Zakhari, Ting-Kai Li
Journal: Hepatology (2007)

More than 70% of alcohol is consumed by 10% of the population in the United States. Implicit in this statistic is that tremendous variation in the pattern of drinking (quantity, frequency, and duration) exists among alcohol consumers. Individuals who are binge or chronic drinkers will have different health outcomes than social drinkers. Therefore, knowing the pattern of drinking will shed light on how severely individuals are alcohol-dependent and on the extent of liver damage. Thus, these parameters assume particular relevance for the treatment-providing physician. Genetic factors contribute substantially to differences in alcohol metabolism. Variations in the activities of the alcohol-metabolizing enzymes, cytosolic alcohol dehydrogenase and mitochondrial aldehyde dehydrogenase, in part determine blood alcohol concentration, thereby contributing to the predisposition to becoming alcohol-dependent and to susceptibility to alcohol-induced liver damage. Chronic alcohol consumption induces cytochrome P450 2E1, a microsomal enzyme that metabolizes alcohol at high concentrations and also metabolizes medications such as acetaminophen and protease inhibitors. Alcohol metabolism changes the redox state of the liver, which leads to alterations in hepatic lipid, carbohydrate, protein, lactate, and uric acid metabolism. The quantity and frequency of alcohol consumption severely impact the liver in the presence of comorbid conditions such as infection with hepatitis B or C and/or human immunodeficiency virus, type 2 diabetes, hemochromatosis, or obesity and thus have implications with respect to the extent of injury and response to medications. Conclusion: Knowledge of the relationships between the quantity, frequency, and patterns of drinking and alcoholic liver disease is limited. A better understanding of these relationships will guide hepatologists in managing alcoholic liver disease. (Hepatology 2007;46:2032–2039.)
Is Altruism a Vice?-Reply
Authors: George M. Adams
Journal: JAMA (1988)

In Reply.—  To respond to Dr Dykers' comments, Auguste Comte indeed coined the termaltruism. He stated that man must be selfless and renounce egoism.1John Stuart Mill rejected the concept of individual freedom.2Thus, the evolution of the dangerous concept of the greatest good for the greatest number, a logical fallacy, the first corollary of which is the least good for the least number, a concept skillfully manipulated by Adolf Hitler, resulting in the extermination of 6 million Jews. As an objectivist, recognizing the supremacy of reason, I am proud to be rejected by the positivist school.  Dr Fung struggles with the definition of altruism. As he states, I do present altruism as a vice. Webster defines vice as (1) a defect, (2) an immoral practice or habit, and (3) evil conduct. All three definitions fit altruism precisely, since we have seen where altruism has led. Dr
Chromosomal lesions and uniparental disomy detected by SNP arrays in MDS, MDS/MPD, and MDS-derived AML
Authors: Lukasz P. Gondek, Ramon Tiu, Christine L. O'Keefe, Mikkael A. Sekeres, Karl S. Theil, Jaroslaw P. Maciejewski
Journal: Blood (2007)

Using metaphase cytogenetics (MC), chromosomal abnormalities are found in only a proportion of patients with myelodysplastic syndrome (MDS). We hypothesized that with new precise methods more cryptic karyotypic lesions can be uncovered that may show important clinical implications. We have applied 250K single nucleotide polymorphisms (SNP) arrays (SNP-A) to study chromosomal lesions in samples from 174 patients (94 MDS, 33 secondary acute myeloid leukemia [sAML], and 47 myelodysplastic/myeloproliferative disease [MDS/MPD]) and 76 controls. Using SNP-A, aberrations were found in around three-fourths of MDS, MDS/MPD, and sAML (vs 59%, 37%, 53% by MC; in 8% of patients MC was unsuccessful). Previously unrecognized lesions were detected in patients with normal MC and in those with known lesions. Moreover, segmental uniparental disomy (UPD) was found in 20% of MDS, 23% of sAML, and 35% of MDS/MPD patients, a lesion resulting in copy-neutral loss of heterozygosity undetectable by MC. The potential clinical significance of abnormalities detected by SNP-A, but not seen on MC, was demonstrated by their impact on overall survival. UPD involving chromosomes frequently affected by deletions may have prognostic implications similar to the deletions visible by MC. SNP-A-based karyotyping shows superior resolution for chromosomal defects, including UPD. This technique further complements MC to improve clinical prognosis and targeted therapies.
Coronary-Artery Fistula with a Giant Aneurysm
Authors: Hideshi Niimura, Chuwa Tei
Journal: New England Journal of Medicine (2002)

Figure 1. A 77-year-old woman was referred for the evaluation of an abnormal shadow on the left cardiac border on chest x-ray films that had gradually developed over a seven-year period (arrow in Panel A). She had no history of Kawasaki's disease or chest trauma and had no chest symptoms. A loud, continuous murmur could be heard at the upper left parasternal area. A selective left coronary arteriogram (Panel B) revealed a fistula, the middle of which formed an aneurysm measuring 52 by 46 mm. There was also severe stenosis of the left main coronary artery. The fistula originated from . . .
Separating a septum sandwich
Authors: A C Leong
Journal: BMJ (2006)

A 7 year old boy had inquisitively removed two small circular magnets attached to the bottom of his toy car. He then inserted one up each nostril. The magnets were immediately drawn to each other, clamping firmly on to either side of his nasal septum.

On his arrival in the accident and emergency department, various manual manoeuvres with metal instruments were attempted, but these were attracted to each magnet with a resounding “clunk,” provoking squeals of pain from the child as doctors grappled to remove the adherent instruments. Plastic instruments failed to provide sufficient grip on the slippery edges of the magnets. …
Steve Jobs Wrestles With the Electronic Health Record
Authors: Gary S. Marshall
Journal: JAMA Pediatrics (2013)

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 Pediatrics 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 Pediatrics journal
Inoculation Recording by Tattooing
Authors: N. C. Lake
Journal: BMJ (1959)

Sickle-cell anaemia, together with other' genetically determined haemoglobinopathies, is becoming an increasingly important cause of childhood mortality in the tropics as deaths from other tropical diseases steadily decrease in number.So far no treatment has been of any avail, and the only supportive measure of any real value during a crisis has been blood transfusion.Recently, however, it has been suggested that acetazolamide (" diamox") might be a valuable therapeutic agent, since it acts as a carbonic anhydrase inhibitor and was shown in one case to diminish intravascular sickling (Hilkovitz, 1957).We would therefore like to record our experiences of the use of.this drug in three children, with' sickle-cell anaemia admitted to King George VI Hospital, Nairobi.Case Reports Case 1.-A child age 3 months was admitted with a chest infection and diarrhoea.The haemoglobin was 6.1 g./
Proctocolitis and Crohn's disease of the colon: a comparison of the clinical course.
Authors: J E Lennard-Jones, J K Ritchie, W J Zohrab
Journal: Gut (1976)

This study suggests that proctocolitis is an illness with an acute and potentially dangerous onset but which appears to become less severe after survival for one year, whereas Crohn9s colitis tends to be a more chronic and progressive illness over several years with a greater need for surgical treatment and a greater tendency to anal complications.
Beta adrenoceptor blockade and responses of serum lipids to a meal and to exercise.
Authors: N R Peden, R J Dow, T E Isles, B T Martin
Journal: BMJ (1984)

During a randomised placebo controlled trial of the effects of nadolol in hypertensive patients serum lipid profiles were obtained while the patients were fasting and during and after a meal and an exercise test. Treatment with nadolol was associated with a significant reduction in high density lipoprotein cholesterol at all time points. Serum triglyceride concentrations during treatment with nadolol were higher in the fasting state, though not significantly so, increased further postprandially, and were significantly higher during and after exercise. The changes in high density lipoprotein cholesterol and triglyceride concentrations during beta adrenoceptor blockade may be secondary to a reduction in lipoprotein lipase activity.
Abstract 2267: Inhibition of autophagy in hypoxic HT29 cells reverses hypoxia-induced resistance to oxaliplatin
Authors: Irina A. Vasilevskaya, Muthu Selvakumaran, David Roberts, Peter J. O'Dwyer
Journal: Cancer Research (2012)

Abstract BACKGROUND: We have shown previously that inhibition of JNK1 renders HT29 colon adenocarcinoma cells more sensitive to hypoxia and/or oxaliplatin due, in part, to impaired autophagy induction. We also showed that the autophagy inhibitor chloroquine sensitizes HT29 to oxaliplatin in vitro and in mouse xenograft model. PURPOSE: Here we investigate further by molecular approaches, including modulation of signaling through JNK, how inhibition of autophagy affects sensitivity of hypoxic colon cancer cells to oxaliplatin. We employed a panel of HT29-derived cell lines: lines stably expressing dominant negative constructs for either JNK1 (HTJ1.3) or JNK2 (HTJ2.2) singly, derivatives of these lines in which the other JNK gene is silenced by viral delivery of shRNA construct (HTJ1s2 and HTJ2s1), as well as HT29-derived lines with down-regulated BclX (HTBX) or Beclin-1 (HTB). RESULTS: We found that down-regulation of JNK1 leads to inhibition of autophagy accompanied by increase in apoptotic (versus necrosis) cell death. Clonogenic assays revealed higher resistance of HTJ1s2 cells to oxaliplatin under hypoxia, whereas HTJ2s1 cells demonstrated slight increase in sensitivity to the drug in this setting. Down-regulation of either Beclin-1 or BclX resulted in significant sensitization to oxaliplatin in oxic and, even more so, in hypoxic conditions (three-folds on average), while exerting differing effects on autophagy induction. CONCLUSIONS: Our data demonstrate that JNK1 plays an important role in autophagy induction under hypoxic conditions in the HT29 colon adenocarcinoma cell line and that its inhibition increases apoptotic cell death in this setting. Inhibition of autophagy induction by down-regulation of JNK1 and knock-down of Beclin-1 or BclX resulted in reversal of oxaliplatin resistance in hypoxic HT29 cells. These findings suggest that targeting these proteins may be of value in colon cancer treatment. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2267. doi:1538-7445.AM2012-2267
Management of Rubella Outbreaks in Hospitals-Reply
Authors: Walter A. Orenstein
Journal: JAMA (1983)

<h3>In Reply.—</h3> Drs Schrock and Rhame suggest a reasonable approach for dealing with a rubella outbreak in institutions that adopt a limited rubella immunization policy. The "rubella-safe" ward could protect potentially susceptible pregnant patients while some or all other staff can be tested and immunized. However, as helpful as the rubella-safe ward might be, it is not an ideal solution for controlling rubella. Rubella transmission could still continue among staff other than those associated with the safe ward. In a recent rubella epidemic in an area of a California hospital where rubella vaccination was voluntary, transmission continued among hospital staff of both sexes for three generations.<sup>1</sup>Two of the pregnant personnel elected therapeutic abortions as a result of infection acquired in hospitals. The rubella-safe ward protects only patients after rubella is recognized in the hospital and does not necessarily protect hospital personnel. Staff with inapparent infection could still transmit