tbuckley/cabot-search huggingface dataset:
A Randomized Clinical Trial of High-Dose Epinephrine and Norepinephrine vs Standard-Dose Epinephrine in Prehospital Cardiac Arrest
Authors: Michael Callaham
Journal: JAMA (1992)

To determine the relative efficacy of high- vs standard-dose catecholamines in initial treatment of prehospital cardiac arrest.Randomized, prospective, double-blind clinical trial.Prehospital emergency medical system of a major US city.All adults in nontraumatic cardiac arrest, treated by paramedics, who would receive epinephrine according to American Heart Association advanced cardiac life support guidelines.High-dose epinephrine (HDE, 15 mg), high-dose norepinephrine bitartrate (NE, 11 mg), or standard-dose epinephrine (SDE, 1 mg) was blindly substituted for advanced cardiac life support doses of epinephrine.Restoration of spontaneous circulation in the field, admission to hospital, hospital discharge, and Cerebral Performance Category score.Of 2694 patients with cardiac arrests during the study period, resuscitation was attempted on 1062 patients. Of this total, 816 patients met study criteria and were enrolled. In the entire cardiac arrest population, 63% of the survivors were among the 11% of patients who were defibrillated by first responders. The three drug treatment groups were similar for all independent variables. Thirteen percent of patients receiving HDE regained a pulse in the field vs 8% of those receiving SDE (P = .01), and 18% of HDE patients were admitted to the hospital vs 10% of SDE patients who were admitted to the hospital (P = .02). Similar trends for NE were not significant. There were 18 survivors; 1.7% of HDE patients and 2.6% of NE patients were discharged from the hospital compared with 1.2% of SDE patients, but this was not significant (P = .37; beta = .38). There was a nonsignificant trend for Cerebral Performance Category scores to be worse for HDE (3.2) and NE patients (3.7) than for SDE patients (2.3) (P = .10; beta = .31). No significant complications were identified. High-dose epinephrine did not produce longer hospital or critical care unit stays.High-dose epinephrine significantly improves the rate of return of spontaneous circulation and hospital admission in patients who are in prehospital cardiac arrest without increasing complications. However, the increase in hospital discharge rate is not statistically significant, and no significant trend could be determined for neurological outcome. No benefit of NE compared with HDE was identified. Further study is needed to determine the optimal role of epinephrine in prehospital cardiac arrest.
Breast Cancer: Minimalists, Maximalists, Other Neoplasms-Reply
Authors: David V. Schapira
Journal: JAMA (1991)

<h3>In Reply.—</h3> In response to Drs Cohen and Somers, we did not suggest that a minimalist policy would not include screening for second primary tumors. We agree that these screening procedures should be done in a routine fashion in patients with cancer. In response to Dr Liberati et al, we do not argue for a minimalist policy based on opinion and belief. The studies that we cited1-4 are all in agreement that laboratory and radiological testing are the initial modes of discovery in only 15% of cases. Additionally, the study we cited by Zwaveling et al<sup>5</sup>demonstrated that surveillance of patients with breast cancer did not affect time from diagnosis to recurrence or time from diagnosis to death when compared with patients who were not followed up. Thus, according to currently available data, these additional laboratory and radiological tests do not significantly facilitate detection of recurrence or prolong survival.
Terminal Transferase and Lymphoblastic Neoplasms
Authors: Sharon B. Murphy, Alvin M. Mauer
Journal: New England Journal of Medicine (1977)

The need for an improved classification scheme for leukemias and lymphomas is evident. Recent studies with a battery of technics beyond conventional light microscopy and morphology, and encompassing cytochemical findings, surface markers, enzymic activity and serologic detection of associated antigens, have clearly demonstrated rather remarkably heterogenous findings in lymphoid neoplasia. Acute lymphoblastic leukemia (ALL) of childhood, once thought to be one of the more uniform neoplasms, can now readily be subtyped as "null," T cell or B cell on the basis of presence or absence of spontaneous rosette formation with sheep erythrocytes or demonstration of surface immunoglobulins.1 Investigations of the . . .
Magnitude and economic burden of sports and physical activity-related injuries in dutch 10-12 year old children
Authors: W van Mechelen, D C M Collard, M Chinapaw, E A L M Verhagen
Journal: British Journal of Sports Medicine (2011)

Background The several health benefits of regular physical activity (PA) in children are well known. Participation in PA, however, also increases the risk of adverse effects, such as injuries. However, reliable descriptive data on PA injuries in younger children is lacking. Objective Describe the incidence, severity and cost of injuries resulting from physical education (PE), sports and leisure time PA in 10–12 year old children. Design Prospective cohort study. Setting Primary schools. Participants 995 children aged 10–12 years. Interventions Weekly exposure to sports, PE and leisure time PA was estimated for each participant during the 2006–2007 school year. An injury was recorded if it caused the child to at least stop the current activity. The parents of the injured child reported all associated direct and indirect costs in a cost diary. Main outcome measures Injury incidence density (ID) and related costs. Results A total of 119 injuries were reported by 104 children, resulting in an overall injury ID of 0.48 per 1000 h of exposure (95% CI 0.38 to 0.57). ID was lowest for leisure time PA, followed by PE and sports, respectively. Overall for girls (ID 0.60; 95% CI 0.45 to 0.75) a higher injury ID was reported than for boys (ID 0.37; 95% CI 0.26 to 0.48). The mean direct and indirect costs were, respectively, 131€ (SD 213€) and 57€ (SD 159€). The highest costs were found for upper extremity injuries, as in general these were the more severe injuries. Conclusion PA-related injuries are common in children and result in high associated costs. Girls require special attention as they seem to be at higher injury risk. Even so intervention programmes that prevent upper extremity injuries will have the greatest short-term impact for public health.
Review: Restrictive RBC transfusion strategies reduce nosocomial infections compared with liberal strategies
Authors: Thomas G. DeLoughery
Journal: Annals of Internal Medicine (2014)

ACP Journal Club16 September 2014Review: Restrictive RBC transfusion strategies reduce nosocomial infections compared with liberal strategiesThomas G. DeLoughery, MD, FACP, FAWMThomas G. DeLoughery, MD, FACP, FAWMOregon Health Sciences University, Portland, Oregon, USA (T.G.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-161-6-201409160-02011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationRohde JM, Dimcheff DE, Blumberg N, et al. Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis. JAMA. 2014;311:1317-26. https://pubmed.ncbi.nlm.nih.gov/24691607Clinical Impact RatingsHospitalists: Cardiology: Hematology: Infectious Disease: Critical Care: References1 Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409-17. [PMID: 9971864] Google Scholar2 Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012;4:CD002042. [PMID: 22513904] Google Scholar3 Salpeter SR, Buckley JS, Chatterjee S. Impact of more restrictive blood transfusion strategies on clinical outcomes: a meta-analysis and systematic review. Am J Med. 2014;127:124-31. [PMID: 24331453] Google Scholar4 Hod EA, Zhang N, Sokol SA, Wojczyk BS, et al. Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation. Blood. 2010;115:4284-92. [PMID: 20299509] Google Scholar Author, Article, and Disclosure InformationAffiliations: Oregon Health Sciences University, Portland, Oregon, USA (T.G.D.)This article was published at Annals.org on 2 September 2014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByA Systematic Review and Meta-Analysis of the Clinical Appropriateness of Blood Transfusion in China 16 September 2014Volume 161, Issue 6Page: JC11KeywordsCritical careHemoglobinInfectious diseasesRed blood cellsRisk managementRiversSepsisSystematic reviews ePublished: 16 September 2014 Issue Published: 16 September 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Positively Labeled White Blood Cell Scan with Eosinophilia and Absence of Infection
Authors: MINAL S. VASANAWALA, MICHAEL L. GORIS
Journal: Clinical Nuclear Medicine (2003)

Purpose The authors describe the variability of Tc-99m exametazime–labeled leukocyte distribution as a function of the relative frequency of white cell types in the labeled blood. Materials and Methods A 76-year-old man who was hospitalized with fever and possible postoperative osteomyelitis underwent scintigraphic imaging with Tc-99m exametazime–labeled leukocytes. Results The white cell scan excluded any discrete focus of infection and revealed diffuse involvement of the lymph nodes and skin. The pathologic diagnosis was angioimmunoblastic T-cell lymphoma. The atypical infiltrates seen on the white cell scan can be explained by the severe eosinophilic blood count on the day of leukocyte labeling (total leukocyte count: 8,100 cells/μl with 63% neutrophils, 8.9% lymphocytes, and 22.2% eosinophils). Conclusion In the labeling of the leukocyte moiety, a higher presence of any leukocyte subpopulation will modify the biodistribution and thus the image interpretation.
Call for Papers on Medical Education
Authors: Charlene Breedlove
Journal: JAMA (1992)

Every year since 1901,The JOURNALhas devoted an issue to medical education in the United States. The history recorded in these education issues presents the expanded scope and increased complexity of the data collected by the American Medical Association (AMA) in undergraduate, graduate, and continuing medical education and reflects the AMA's more than 100-year commitment to medical education and more than 50 years of support for education in allied health professions. The first education issue<sup>1</sup>encompassed in six pages the AMA's database on each of the 156 US medical schools; the bulk of the issue contained articles on such perennial concerns as the aims of medical education, how best to integrate didactic instruction with laboratory and clinical teaching, the risk of a physician surplus, and an inquiry into who the medical students should be and what motivates them to become physicians. Later issues have revisited these topics, but
Localization of Occult Testicular Tumor With Scrotal Thermography
Authors: Yeu-Tsu N. Lee
Journal: JAMA (1976)

TESTICULAR tumors commonly appear as a painless enlargement of the testis accompanied by a feeling of scrotal heaviness or pain. However, in 4% to 14% of patients with malignant testicular disease, the first manifestations are those resulting from metastatic deposits.<sup>1</sup>In most of these patients, physical examination of the testicles shows an obvious tumor, but in a small group, no primary tumor can be detected even by repeated examinations. Rudnick and Odell<sup>2</sup>reported the case of a young man with excessive serum gonadotropin levels, but an extensive search, including surgical exploration of both testes, failed to disclose a malignant neoplasm. The patient died one year later, and at autopsy, the primary tumor was found in the left testis. These authors proposed that in the absence of signs or symptoms suggesting a neoplasm elsewhere, the most likely site of a gonadotropin-producing neoplasm in a man is the testes, one
Vitamin A Intoxication-Reply
Authors: John B. Selhorst
Journal: JAMA (1985)

In Reply.—  Dr Underwood's remarks are correct. The conversion of carotenoid to vitamin A is rate limited so that vitamin A intoxication from a vegetable source is not possible. However, in patients with vitamin A-induced or suspected pseudotumor cerebri, it seems unwise to select a diet that contains either liver with its abundant amount of vitamin A or vegetables rich in carotenoids that allow for a steady repletion of the daily requirement for vitamin A.
A METHOD OF PRESERVING AND FILING MEDICAL RECORDSBY MEANS OF SPECIAL ENVELOPES OR POCKETS.
Authors: CLIFFORD B. FARR
Journal: JAMA (1907)

No one will deny the advantage, I might even say the necessity, of keeping a careful record of medical cases. Such records are now kept with more or less care in most hospitals and dispensaries, as well as by many physicians in private practice. It is probable, however, that most practitioners are lax in this respect, especially in cases seen away from their offices, largely, no doubt, for the lack of a convenient system. In this paper I will confine myself principally to the methods of preserving clinical records, referring only briefly to the filing of reprints, clippings, etc. Medical accounts should, in my opinion, be kept entirely apart from bedside notes and, therefore, will not be referred to in this connection. The book system of keeping records has a few, and only a few, undeniable advantages: It is safe, i. e., individual histories can not be lost, and it
Swallowed Fluticasone Improves Histologic but Not Symptomatic Response of Adults With Eosinophilic Esophagitis
Authors: Jeffrey A. Alexander, Kee Wook Jung, Amindra S. Arora, Felicity Enders, David A. Katzka, Gail M. Kephardt, Hirohito Kita, Lori A. Kryzer, Yvonne Romero, Thomas C. Smyrk, Nicholas J. Talley
Journal: Clinical Gastroenterology and Hepatology (2012)
Will the lead clinician please stand up?
Authors: Graham Neale, Sisse Olsen
Journal: BMJ (2005)

Managing chronic diseases Palliative care spectrum starts early onEditor-Palliative care does not start when a patient is dying. 1 A whole spectrum of palliation begins from the day of diagnosis of a potentially terminal disease, such as soft tissue sarcoma.Palliation, in the sense of needing to absorb what this means for the patient, becomes even then a medical imperative.The "How long have I got, Doc?" question may not be articulated, but it will be there and needs an empathetic response.Curative treatment is sought, but-with sarcoma-lung metastases signal the end of that phase and the beginning of palliative treatment.The doctor and the patient know the dragon can be disabled but never slain.Palliation is then partnership, working to decide what may be gained at what cost.(This may apply during curative treatment: to take chemotherapy drugs now "just in case," or to keep them for later?)Palliative treatment can be long (in sarcoma up to 20 years or more), or it can be brief.Its ending is not solely a medical judgment.Doctors may decide they can do no more, but active patients use online support groups, seeking new treatment options across the world.Patients may decide to end palliative treatment.Grown weary of painful chemotherapy offering diminishing returns, they may prefer a shorter but better life.Making that choice together is an aspect of palliation.When death is near, palliative care becomes terminal care.If throughout doctors and patients have aligned their understanding of the disease, and have taken decisions jointly, have explored the holistic meaning of disease in life and death, the palliative spectrum may offer healing if not cure.If, however, being palliative begins only when the patient is dying doctors cannot then meet patients, where they are most needed, in the ground of their being and their not being.
LATERAL ST-SEGMENT ELEVATION IS A STRONG PREDICTOR OF IMPAIRED MYOCARDIAL REPERFUSION IN PATIENTS WITH INFERIOR ACUTE MYOCARDIAL INFARCTION
Authors: Masami Kosuge, Toshiaki Ebina, Kiyoshi Hibi, Satoshi Morita, Kengo Tsukahara, Noriaki Iwahashi, Jyun Okuda, Kazuaki Uchino, Toshiyuki Ishikawa, Satoshi Umemura, Kazuo Kimura
Journal: Journal of the American College of Cardiology (2010)
Changes in lymph vessels and portal veins in the portal tract of patients with idiopathic portal hypertension: A morphometric study
Authors: Hiroki Oikawa, Tomoyuki Masuda, Shin-Ichiro Sato, Akiko Yashima, Kazuyuki Suzuki, Shunichi Sato, Ryoichi Satodate
Journal: Hepatology (1998)

Little is known about the effects of the pathological process associated with idiopathic portal hypertension (IPH) on hepatic lymph vessels or lymph flow. We used morphometric analysis to examine IPH-associated changes in lymph vessels and branches of the portal vein, with use of immunohistochemical staining for alpha smooth muscle actin. We also quantitated these changes using an image analysis system. The study was conducted with use of liver wedge biopsy material from 10 patients with advanced IPH and 10 control samples from patients with gastric carcinoma without liver disease. The number of lymph vessels, identified by a lack of smooth muscle layer in the wall, and the ratio of the total area of these vessels to that of the portal tract were higher in IPH samples than in the control samples, but the ratio of the area of a single lymph vessel to that of the portal tract in IPH samples was not different from control samples. The number of portal vein branches, characterized by hypertrophy of the smooth muscle layer in IPH samples was not different from control samples. The ratio of the total area of these branches to that of the portal tract, and the ratio of a single portal vein branch to that of the portal tract, were lower in IPH samples than in the control samples. Our results suggest that these morphometric changes in IPH may be associated with a reduction in portal blood flow and increased lymph flow, and that the latter may in turn reduce the high portal vein pressure in idiopathic portal hypertension.
A Reconsideration of Psychodynamic Mechanisms in Psychosomatic Symptom Formation in View of Recent Clinical Observations
Authors: Peter E. Sifneos
Journal: Psychotherapy and Psychosomatics (1974)

Although it has been generally accepted that psychological factors may influence the onset, complicate the course and may even play an etiological role in the production of psychosomatic diseases, psychodynamic mechanisms have been used by and large to explain the formation of psychosomatic symptoms. Recent clinical observations (<i>Marty</i>, <i>de</i><i>M'Uzan</i>, <i>Nemiah</i>, <i>Sifneos</i>) suggest that certain broad personality characteristics such as an impoverished fantasy life and a constriction in emotional functioning which I call 'alexithymic', may be present in many patients suffering from a variety of psychosomatic diseases. It has been hypothesized that the existence of two different kinds of biological predispositions, one central and another peripheral, may account for the production of psychosomatic symptoms. Finally, it is concluded that for such patients dynamic psychotherapy is contra-indicated. A case example is presented.
Career Choice in Medicine
Authors: I. M. Richardson
Journal: BMJ (1962)

Acute alcoholic hepatitis without jaundice may follow intensified drinking by the chronic alcoholic, who deve- lops anorexia, nausea and vomiting, upper abdominal pain, and fever.A liver biopsy shows evidence of foci of liver-cell degeneration and necrosis surrounded by acute inflammatory changes, also present in the portal tracts, together with the changes of any underlying pre- existing disease.This illness may occur in the absence of cirrhosis.Raised concentrations of the serum transaminases are usually the only biochemical abnormalities indicative of liver-cell damage.Five typical cases are summarized.Although misdiagnoses are apparently common, recovery usually occurs spontaneously.The role of this condition, often recurrent, in the evolution of alcoholic cirrhosis is briefly discussed.Our thanks are due to Dr.
Heart "Size" And Transverse Diameter
Authors: John H. Feist
Journal: JAMA (1968)

To the Editor:—  The recent article, Heart Size in Pulmonary Emphysema by Baratto and Muehsam ( 203 :293, 1968), again raises the question of the significance of measurements of the greatest horizontal transcardiac diameter in the frontal projection, on standard 72-inch chest roentgenograms, whether expressed as absolute linear dimension or in relation to horizontal transpleural dimensions.  First of all, from a purely logical point of view, there is neither mystery nor illusion in the obvious reduction in frontal transcardiac diameter usually noted in uncomplicated obstructive emphysema relative to normal patients of comparable stature, weight, sex, age, etc, in the face of similar postmortem heart weights. A simple glance at a good lateral x-ray film will re= assure one that, allowing for differences in intracardiac blood volume, the total heart volume remains commensurate with its weight. More striking roentgenologically and, perhaps, more pertinent biologically, is the vertical position of the heart, the
Clinical Measure of Enforced Group Psychotherapy
Authors: ROBERT L. SADOFF, HERMANN A. ROETHER, JOSEPH J. PETERS
Journal: American Journal of Psychiatry (1971)

A study of offenders' attitudes toward enforced group psychotherapy revealed that positive attitudes about the experience were correlated with treatment failures. Patients who said the group was helpful were rearrested more often than those who complained about it. The examining psychiatrist was significantly less successful in predicting future criminal behavior than was the psychiatrist who had treated the offender in a group.
Magnetic Resonance Perfusion Measurements for the Noninvasive Detection of Coronary Artery Disease
Authors: Eike Nagel, Christoph Klein, Ingo Paetsch, Sabine Hettwer, Bernhard Schnackenburg, Karl Wegscheider, Eckart Fleck
Journal: Circulation (2003)

With MRI, an index of myocardial perfusion reserve (MPRI) can be determined. We assessed the value of this technique for the noninvasive detection of coronary artery disease (CAD) in patients with suspected CAD.Eighty-four patients referred for a primary diagnostic coronary angiography were examined with a 1.5 T MRI tomograph (Philips-ACS). For each heartbeat, 5 slices were acquired during the first pass of 0.025 mmol gadolinium-diethylenetriamine pentaacetic acid/kg body weight before and during adenosine vasodilation by using a turbo-gradient echo/echo-planar imaging-hybrid sequence. MPRI was determined from the alteration of the upslope of the myocardial signal intensity curves for 6 equiangular segments per slice. Receiver operating characteristics were performed for different criteria to differentiate ischemic and nonischemic segments. Prevalence of CAD was 51%. Best results were achieved when only the 3 inner slices were assessed and a threshold value of 1.1 was used for the second smallest value as a marker for significant CAD. This approach yielded a sensitivity of 88%, specificity of 90%, and accuracy of 89%.The determination of MPRI with MRI yields a high diagnostic accuracy in patients with suspected CAD.