tbuckley/cabot-search huggingface dataset:
Relevance of Recertification for Primary Care Physicians
Authors: Seyed H. Aleali
Journal: Annals of Internal Medicine (2008)

Letters1 April 2008Relevance of Recertification for Primary Care PhysiciansSeyed H. Aleali, MDSeyed H. Aleali, MDFrom Bridgeport, CT 06606.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-7-200804010-00024 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In his recent letter, Volpintesta (1) made a statement about the burden of recertification for generalists. He observed that the scope of knowledge and skill is narrowed after being in practice for many years, and therefore taking examinations is a waste of time and money. Nonetheless, it is important for generalists, even in nonacademic settings (office-based or not), to stay up to date. Generalists focus on the broad field of internal medicine and family practice. At any time, they could see a case of an uncommon disease that has common signs and symptoms. All of us have ...Reference1. Volpintesta EJ. Tailoring to the needs of one's practice: it's about time [Letter]. Ann Intern Med. 2007;147:592. [PMID: 17938403] LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Seyed H. Aleali, MDAffiliations: From Bridgeport, CT 06606.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTailoring to the Needs of One's Practice: It's about Time Edward J. Volpintesta Relevance of Recertification for Primary Care Physicians Edward J. Volpintesta Metrics 1 April 2008Volume 148, Issue 7Page: 565KeywordsConflicts of interestPrimary care physiciansSigns and symptomsSoftware tools ePublished: 1 April 2008 Issue Published: 1 April 2008 Copyright & PermissionsCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Poorly Differentiated Carcinoma or Extragonadal Germ Cell Cancer
Authors: Jose Luis Gonzalez Vela, George Shenouda, Lawrence Carl Panasci
Journal: Annals of Internal Medicine (1987)

Letters and Corrections1 May 1987Poorly Differentiated Carcinoma or Extragonadal Germ Cell CancerJOSE LUIS GONZALEZ VELA, GEORGE SHENOUDA, LAWRENCE CARL PANASCIJOSE LUIS GONZALEZ VELASearch for more papers by this author, GEORGE SHENOUDASearch for more papers by this author, LAWRENCE CARL PANASCISearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-106-5-772_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In a recent article Greco and associates (1) report a series of 71 patients who had at least one characteristic of their definition of the extragonadal germ cell cancer syndrome. Interestingly, the 13 patients reported to have complete responses to chemotherapy with vinblastine, bleomycin, and cisplatin or a modification containing doxorubicin were diagnosed as having poorly differentiated carcinoma, and no patient with poorly differentiated adenocarcinoma obtained a complete response.The authors place special emphasis on the diagnosis using light microscopy and electron microscopy, but it is surprising that they do not report how many complete responders had...References1. GRECOVAUGHNHAINSWORTH FWJ. Advanced poorly differentiated carcinoma of unknown primary site: recognition of a treatable syndrome. Ann Intern Med. 1986;104:547-53. LinkGoogle Scholar2. GRECOOLDHAMFER FRM. The extragonadal germ cell cancer syndrome. Semin Oncol. 1982;9:448-55. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 May 1987Volume 106, Issue 5Page: 772-772KeywordsAdenocarcinomaChemotherapyElectron microscopyGerm cell cancerLight microscopy Issue Published: 1 May 1987 PDF downloadLoading ...
Duration of methotrexate treatment until partial and total remission of refractory juvenile rheumatoid arthritis
Authors: R. BRIK, D. BERKOWITZ, M. BERANT
Journal: Annals of the Rheumatic Diseases (1998)

Methotrexate (MTX) was an effective treatment of resistant juvenile rheumatoid arthritis (JRA) in a double blind, placebo controlled study.1 Its advantages over other second line agents,2 include oral administration, once a week dose, fewer side effects than parenteral gold,3 no known oncogenicity4 or long term effects on fertility.5 Therefore, paediatric rheumatologists tend to consider the use of MTX as a first choice for children with refractory JRA.6 7 

We considered the duration of MTX therapy required for the achievement of partial and total clinical remission of JRA, and conducted a prospective open trial of all patients with JRA who were given MTX treatment at the Paediatric Rheumatology Clinic of the Rambam Medical Centre, between January 1994 and January 1997.

The patients had active JRA according to American College of Rheumatology (ACR) criteria8 and had failed to respond to adequate courses of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids or disease modifying drugs (DMARDs). All the patients who had …
Doctor who was excluded for raising patient safety concerns is entitled to substantial damages
Authors: C. Dyer
Journal: BMJ (2010)

A consultant urologist at a London hospital who was suspended from work for 10 weeks after repeatedly raising concerns about patient safety has won a whistleblowing claim against his hospital trust.

Ramon Niekrash was branded a troublemaker and excluded from Queen Elizabeth hospital in Woolwich, southeast London, in April 2008 after a series of letters to management about the consequences of cuts on patient services.

But London South employment tribunal in Croydon unanimously ruled that he was excluded because of his whistleblowing, entitling him to substantial damages. A separate hearing will decide what damages he …
Analysis of the I&lt;sup&gt;131&lt;/sup&gt; Sodium o-Iodohippurate Renogram
Authors: Sandor H. Wax
Journal: JAMA (1962)

THE ADMINISTRATION of a radioactive compound which is rapidly picked up and excreted by the kidney has been shown to produce a characteristic curve when recorded by duoscintillalor counters. Since Taplin and co-workers' original work in 1956, this phenomenon has been used as a qualitative kidney function test. Certain modifications have appeared which now include the use of the superior vehicle I<sup>131</sup>sodium o-iodohippurate (Hippuran). However, the original description of the components of the curve has been essentially unchanged. Winter has described the curve as follows: "The initial spike represents the vascular capacity of the kidney plus that of the background tissue. . . . The secondary rise in the tracing beginning during the second or third minute and lasting three to five minutes is due to tubular cell secretion of the contrast medium. . . . The third and final leg in the normal renogram is the descent in
Fundamentals of Roentgenology
Authors: Luther W. Brady
Journal: JAMA (1965)

Radiology is an important extra dimension in medicine, complementing all aspects of medicalschool training from anatomy to physical diagnosis, pathology, medicine, and surgery. It is a specialty which explores and illuminates details of the patient's problems in terms of "shadows" on the roentgenogram, relating these shadows with pathology. Dr. Lucy Frank Squire has produced a book which is not a reference work, but a manual for teaching young physicians how to look at roentgenograms. In a field that has become increasingly more useful and more complex, it is the best work available for medical students as well as interns and residents. The book is eminently successful in conveying an understanding of radiographs and in developing skill in their interpretation. The text, beautifully illustrated, provides a basic system for dealing with x-ray films and the problems of radiology. In 16 chapters it covers the basic concepts in the diagnostic applications of
Anti-flu drug may not reduce death rate
Authors: G. Yamey
Journal: BMJ (1999)

GlaxoWellcome has admitted that its drug to treat influenza, zanamivir (Relenza), may not reduce mortality from flu. Dr Robert Pearson, GlaxoWellcome's respiratory associate medical director, commented at a press launch that there is “no evidence that Relenza will reduce mortality—we can't make any claims for its use in high risk groups.”

Mortality was not an end point in one of the largest trials to date, based in Australia, New Zealand, and South Africa; only 17% of patients were considered at high risk—because of asthma—and most had only mild asthma (Lancet 1998;352:1877-81). Nor …
Nasal hyper-reactivity is a common feature in both allergic and nonallergic rhinitis
Authors: C. L. Segboer, C. T. Holland, S. M. Reinartz, I. Terreehorst, A. Gevorgyan, P. W. Hellings, C. M. van Drunen, W. J. Fokkens
Journal: Allergy (2013)

Background Nasal hyper-reactivity is an increased sensitivity of the nasal mucosa to various nonspecific stimuli. Both allergic rhinitis (AR) and nonallergic rhinitis (NAR) patients can elicit nasal hyper-reactivity symptoms. Differences in the prevalence or type of nasal hyper-reactivity in AR and NAR patients are largely unknown. In this study, we quantitatively and qualitatively assessed nasal hyper-reactivity in AR and NAR. Methods In the first part, an analysis of a prospectively collected database was performed to reveal patient-reported symptoms of hyper-reactivity. In the second part, cold dry air provocation (CDA) was performed as a hyper-reactivity measure in AR and NAR patients and healthy controls, and symptoms scores, nasal secretions and peak nasal inspiratory flow were measured. Comparisons were made between AR and NAR patients in both studies. Results The database analysis revealed high hyper-reactivity prevalence in AR (63.4%) and NAR (66.9%). There were no differences between AR and NAR in terms of the number or type of hyper-reactivity stimuli. Hyper-reactivity to physical stimuli did not exclude a response to chemical stimuli, or vice versa. CDA provocation resulted in a significant increase in rhinitis symptoms and the amount of nasal secretions in AR and NAR patients, but not in controls. Conclusions We found no quantitative or qualitative differences in nasal hyper-reactivity between AR and NAR patients. It is not possible to differentiate NAR subpopulations based on physical or chemical stimuli.
The Importance of the Psychologic Factor in Gynecology
Authors: Doris Menzer
Journal: New England Journal of Medicine (1953)

KNOWLEDGE of the sexual and reproductive functions of women has been built into the specialty of gynecology with contributions not only from obstetricians and surgeons, from endocrinologists and physiologists, but also from the field of psychiatry, in which one may learn the psychologic meaning of sex to a person and her reactions and attitudes to her role as a woman and mother.1 2 3 4 5 6 7 8 9 10 11 Every general practitioner no doubt encounters almost daily examples of the emotional element that often accompanies the normal changes in a woman's reproductive physiology. There is the general emotional upheaval at the menarche, the premenstrual depressions and tensions, . . .
Scintigraphic Demonstration of Mesenteric Metastasis Invading Small Bowel
Authors: M R HABIBIAN, A A HINTON
Journal: Clinical Nuclear Medicine (1986)

A 58-year-old man with a poorly differentiated lung carcinoma established by bronchial biopsy, was admitted for gastrointestinal bleeding. An abdominal image was obtained at 4 and at 6 hours following the intravenous injection of Tc-99m labeled RBCs. At autopsy, the following were noted: total replacement of the left adrenal by a necrotic mass, infrarenal aortic aneurysm, and mesenteric metastases with invasion of the small bowel.
Health in Colleges and Universities
Authors: Dana L. Farnsworth, Curtis Prout, Preston K. Munter
Journal: New England Journal of Medicine (1962)

THE factor mainly responsible for increasing the standards of performance of college health services since the last progress report was published in 1956 has been the revitalization of the American College Health Association. This organization, now more than forty years old, had become somewhat routine and perfunctory in the pursuit of its goals of improving college health services, and it was seriously handicapped by lack of funds. During the latter part of the last decade it changed its format from that of institutional membership alone to a combination of institutional and individual membership. It developed its own quarterly journal, the . . .
Defaulting from tuberculosis treatment in the Netherlands: rates, risk factors and trend in the period 1993–1997
Authors: M.W. Borgdorff, J. Veen, N.A Kalisvaart, J.F Broekmans, N.J.D Nagelkerke
Journal: European Respiratory Journal (2000)

The aim of this study was to assess the rate of defaulting from treatment among tuberculosis patients diagnosed in the Netherlands in the period 1993-1997, whether risk groups for defaulting can be identified at the start of treatment and the trend of defaulting over time. The Netherlands Tuberculosis Register provided data on all patients diagnosed in the Netherlands during the period 1993-1997. Defaulting probabilities were determined using Kaplan-Meier survival analysis and risk factors were identified with Cox's proportional hazard analysis. Of 7,529 patients with reported treatment outcome, 718 (10%) defaulted or left the country within 1 yr after starting treatment. Defaulting probabilities were 9% (95% confidence interval (CI) 8-10%) among 5,256 patients in low-risk groups, 17% (95% CI 14-19%) among 1,437 asylum seekers and 29% (95% CI 24-34%) among 836 patients in other high-risk groups (other recent immigrants, illegal immigrants, the homeless, prisoners and nationals from Eastern Europe). Defaulting probabilities decreased over time from 12% in 1993 to 7% in 1997. Risk groups for defaulting can be recognized at the start of treatment. The decreasing defaulting probabilities were probably due in part to shortening treatment from 9 to 6 months and improved follow-up of asylum seekers. However, additional measures are needed to reduce defaulting among the homeless, recent immigrants, illegal immigrants and prisoners.
Necropsy Findings in a Case of Q Fever in Britain
Authors: J. W. Whittick
Journal: BMJ (1950)

Q fever, first described by Derrick (1937) in Australia, was recognized clinically in Great Britain by Harman in 1949 and confirmed serologically by MacCallum et al. (1949), who also isolated rickettsiae from one of his cases.Three of Harman's patients had become infected, presumably by inhalation, at the necropsy they performed on a man who died from pneumonia.That Rickettsia burneti was the cause of this pneumonia was not suspected until later.Histological examination has since shown the presence of Rickettsia bodies not only in the consolidated lungs, as mentioned in Harman's paper, but also in other lesions.In earlier reported fatal.cases of Q fever-and these are very few-rickettsiae have not been demonstrated in the tissues.As the disease is now known to occur in this country, a fuller description of the pathological findings seems necessary. Clinical HistoryA tailor aged 78 was admitted for investigation of dysphagia of five weeks' duration.After nearly three weeks in hospital he suddenly became febrile and later developed signs of pneumonia and auricular fibrillation.Despite treatment with sulphonamides and penicillin he became comatose and died 11 days after the onset.No cutaneous rash appeared during
Comparison of mortality of patients with heart attacks admitted to a coronary care unit and an ordinary medical ward.
Authors: J D Hill, G Holdstock, J R Hampton
Journal: BMJ (1977)

During a 32-month period 2047 patients suspected of having heart attacks were admitted to hospital and were followed up prospectively. Out of 1480 eventually found to have definite or probable myocardial infarction, 483 had initially been admitted to an ordinary medical ward because of the shortage of coronary care unit (CCU) beds. More patients aged over 65 had been admitted to a ward than to a CCU, and more patients aged 65 or less had been admitted initially to a CCU. Within each age group, however, patients admitted initially to a CCU were clinically similar to those admitted initially to a ward. There was a higher proportion of successful resuscitations among patients admitted to a CCU, but there was no significant difference in mortality in either age group between patients admitted to a CCU and a ward.
Expression of endothelial-leukocyte adhesion molecule-1 in elicited late phase allergic reactions.
Authors: D Y Leung, J S Pober, R S Cotran
Journal: Journal of Clinical Investigation (1991)

To better understand the events involved in the local migration of inflammatory cells into sites of allergic reactions, we studied expression of the cytokine inducible endothelial cell (EC) neutrophil adhesion molecule, endothelial-leukocyte adhesion molecule (ELAM-1), in sequential skin biopsies from patients with respiratory allergy during the late phase reaction (LPR) between 20 min and until 24 h after intradermal allergen (ragweed or dust mites) injection. In 7 of 7 atopic patients but in only 1 of 4 apparently normal controls, allergen induced appearance of ELAM-1 on EC. ELAM-1 expression occurred concurrently with the development of inflammatory cell infiltrates by 3-4 h after intradermal injection. Saline injected sites in all subjects were negative. Skin organ cultures demonstrated that allergen could produce the same EC changes in vitro whether allergen was injected in vivo 20 min before culture or added during skin culture. These EC changes in organ culture were inhibited by the presence of combined anti-sera to both TNF-alpha and IL-1, but not by antisera to either cytokine alone. We conclude that EC activation occurs in elicited LPR and suggest that cytokine-induced EC activation may play a role in the migration of inflammatory cells into allergic skin reactions. Furthermore, resident cells in the skin rather than infiltrating leukocytes appear to be the source of the cytokines that mediate endothelial activation.
Adipose tissue cellularity and lipolysis. Response to exercise and cortisol treatment.
Authors: E W Askew, R L Huston, C G Plopper, A L Hecker
Journal: Journal of Clinical Investigation (1975)

Male rats a 5 wk of age were subjected to 13 wk of intensive treadmill running to study the effect of exercise on adipose tissue cellularity and lipolysis. Untrained controls of the same age remained sedentary in their cages for the duration of the experiment. Adipocyte numbers were similar in eqidiymal fat pads from trained and untrained rats (12.7 plus or minus 1.3 X 10(6) vs. 15.3 plus or minus 1.3 X 10(6) cells/pad), however trained rats had smaller fat pads containing smaller cells (0.09 plus of minus 0.01 vs. 0.20 plus or minus 0.04 mug triglyceride/cell). Adipocytes from trained rats possessed greater epinephrine-sensitive lipase activity than sedentary rats on a per cell, per milligram protein, per gram adipose tissue, or per fat pad basis. Although the smaller cells of the trained rats had greater epinephrine-sensitive lipase activity than the larger cells of the untrained rats, lipolysis was positively correlated with cell size within both treatment groups. Cortisol treatment of intact animals did not significantly affect in vitro adipose tissue lipolysis. The results of this study indicate that exercise training increased the potential of adipose tissue cells to release free fatty acids in response to epinephrine stimulation. Exercise training initiated at 5 wk of age had only a small effect on adipose tissue cell numbers but significantly decreased cell size.
Management of coarctation of the aorta in the first six weeks of life
Authors: G. Meredith, R. Sawyer, M. V. Braimbridge
Journal: Thorax (1970)

The position of surgery in the management of coarctation of the aorta in infants under 6 weeks of age is still not established, primarily because of the high mortality associated with resection of the coarctation. Five patients with coarctation in this age group who have undergone resection at St. Thomas9 Hospital are described. One patient died at operation and one other has required a second operation to relieve restenosis of the anastomosis. The advisability of banding the pulmonary artery at the time of resection of coarctation complicated by other left-to-right shunts is suggested.
Fatal Compulsive Water Drinking
Authors: Marc Rendell, Daniel McGrane, Manuel Cuesta
Journal: JAMA (1978)

In two cases of psychogenic polydipsia, water intoxication developed and contributed to the patient's death. The treatment of the patient with psychogenic polydipsia has been based on the presumed reversibility of the condition. Treatment of such patients must be reconsidered in light of these deaths. (<i>JAMA</i>240:2557-2559, 1978)
Why running is not for people
Authors: P. Arnold
Journal: BMJ (2003)

Ahhh! The exhilaration of a fast run—the feeling of flying and the rush of wind in the face and hair! Many would say that there's nothing to beat it. Certainly not a sedate walk!

But cast your mind back a few thousand years. Go back to the aeons when man was a hunter-gatherer. Slow of foot, but agile of mind, how did he catch the speedy antelope and other game which provided him with his protein? Not by chasing, but by stealth. That stealth required careful, slow, steady pacing, downwind of the animal, without rustling dry leaves or cracking twigs underfoot. One foot before the other, carefully avoiding uneven earth or stones, until our “Stone Age stalker”1 was …
Age and Asian Influenza, 1957
Authors: J. Woodall, K. E. K. Rowson, J. C. McDonald
Journal: BMJ (1958)

<h3>Background</h3> Recent upsurge of new HIV infections among men who have sex with men (MSM) is a major concern in China. Paucity of national-level information regarding the burden and predictors of this progressive epidemic of new infections called for a multi-centric, timely and comprehensive investigation. <h3>Methods</h3> Mixed methods were used to recruit MSM (MSM) from seven cities in China between 2012 and 2013. Early and established HIV infections were estimated by Western Blot and BED HIV-1 capture enzyme immunoassay. Syphilis and herpes simplex virus-2 (HSV-2) were also tested. <h3>Results</h3> A total of 4496 eligible MSM were recruited. The majority was aged ≤35 years (77·5%), migrants (60·3%), never married (69·8%), and played receptive role in anal sex (70·5%). The HIV prevalence was 9·9%, and 41·9% were recently infected, with HIV incidence of 8·9/100 Person-Years (95% CI: 7·6–10·2). The prevalence of history HSV-2 and syphilis were 12·5% and 8·5%, respectively. Early HIV infection was associated with having multiple male partners (aOR = 1·4, 95% CI 1·1–1·9), recreational drug use (aOR = 2·2, 95% CI 1·6–3·0), anal bleeding (aOR = 2·1, 95% CI 1·4–3·0), circumcision experience (aOR = 2·0, 95% CI 1·3–3·1), syphilis infection (aOR = 2·8, 95% CI 1·9–4·3) and history HSV-2 infection (aOR = 2·3, 95% CI 1·5–3·3). <h3>Conclusion</h3> High rate of early HIV infection is potentially resulting in progressive deterioration of the overall HIV epidemic among MSM in China. Targeted interventions to address high-risk MSM including those having multiple partners, history of recreational drug use and syphilis or HSV-2 infection seemed to be the need of the hour.