tbuckley/cabot-search huggingface dataset:
Factors Associated With Avoidance of Severe Complications After 25 Yr of IDDM: Pittsburgh Epidemiology of Diabetes Complications Study I
Authors: Trevor J Orchard, Janice S Dorman, Raelene E Maser, Dorothy J Becker, Demetrius Ellis, Ronald E LaPorte, Lewis H Kuller, Sidney K Wolfson, Allan L Drash
Journal: Diabetes Care (1990)

To identify characteristics associated with long-term avoidance of insulin-dependent diabetes mellitus (IDDM) complications, subjects taking part in an epidemiologic natural history study of childhood-onset IDDM, with a duration of disease ≥25 yr, were studied. Nineteen percent of 175 subjects had avoided overt nephropathy, definite cardiovascular and peripheral vascular disease, clinical neuropathy, and proliferative retinopathy. Approximately half of the nonrenal complications occurred in the absence of renal disease. Subjects free of these advanced complications were characterized by a longer duration of disease (P &amp;lt; 0.05), better lipid profile and blood pressure (P &amp;lt; 0.01), and considerably lower glycosylated hemoglobin levels (P &amp;lt; 0.001). Health-related behaviors, including recent medical contact, regular glucose monitoring, physical activity in youth, and avoidance of cigarette smoking, did not relate to complication status, although regular (at least weekly) alcohol consumption was more prevalent (P &amp;lt; 0.05) in those without complications. We conclude that a lower mean glycosylated hemoglobin level is strongly related to the avoidance of all IDDM complications.
Epidermodysplasia Verruciformis and Epidermoid Carcinoma
Authors: Charles M. Aaronson
Journal: JAMA (1967)

The finding of papilloma virus in verruca plana-like lesions from a patient with epidermodysplasia verruciformis (EV) by means of electron microscopy has been confirmed in our patient. It has been suggested that EV is a genodermatosis characterized by reduced resistance to infection by the wart virus. Because of the frequent occurrence of skin cancer in patients with EV, it is possible that the common wart virus may be a carcinogenic agent in genetically predisposed patients.
Fibroid Tumors of the Uterus.
Authors: Byron Robinson
Journal: JAMA (1895)

Chicago, Aug. 16,1895. <h3>To the Editor:</h3> —In his address before the Gynecologic Section of theAmerican Medical Association(Journalissue Aug. 10, 1895), Dr. Franklin Martin has grossly misrepresented my work and I beg a short space in ourJournalto reply. Dr. Martin stated that I "still open the abdomen with the deliberate intention of removing the appendages for fibroids." On the contrary, it is my invariable custom to do hysterectomy for fibroid tumors of the uterus, and I only resort to the removal of the appendages when the condition of the patient makes it unsafe to subject her to the added risk of complete removal. It is true that when I do perform the "makeshift operation of removal of the appendages," I also tie the uterine arteries as they course through the broad ligaments. Dr. Martin's claim that this procedure is simply his operation applied "from above," is,
Complacency over sexually transmitted infections leads to rise in cases
Authors: Andrew Cole
Journal: BMJ (2006)

Sexually transmitted infections in the United Kingdom are continuing to rise, according to latest figures from the Health Protection Agency, the infectious diseases watchdog. The figures show particularly big increases in new cases of chlamydia and syphilis.

Almost 110 000 cases of chlamydia were diagnosed in genitourinary medicine clinics in 2005, an increase of 5% over the previous year and a 223% increase in the past 10 years. Almost three quarters of last year's cases were in the 16-24 age group.

It is vital to “shatter the complacency” that still exists in young people about sexual diseases, said Peter …
Aggregate Cost of Mammography Screening in the United States: Comparison of Current Practice and Advocated Guidelines
Authors: Cristina O'Donoghue, Martin Eklund, Elissa M. Ozanne, Laura J. Esserman
Journal: Annals of Internal Medicine (2014)

Background: Controversy exists over how often and at what age mammography screening should be implemented. Given that evidence supports less frequent screening, the cost differences among advocated screening policies should be better understood. Objective: To estimate the aggregate cost of mammography screening in the United States in 2010 and compare the costs of policy recommendations by professional organizations. Design: A model was developed to estimate the cost of mammography screening in 2010 and 3 screening strategies: annual (ages 40 to 84 years), biennial (ages 50 to 69 years), and U.S. Preventive Services Task Force (USPSTF) guidelines (biennial for those aged 50 to 74 years and personalized based on risk for those younger than 50 years and based on comorbid conditions for those 75 years and older). Setting: United States. Patients: Women aged 40 to 85 years. Intervention: Mammography annually, biennially, or following USPSTF guidelines. Measurements: Cost of screening per year, using Medicare reimbursements. Results: The estimated cost of mammography screening in the United States in 2010 was $7.8 billion, with approximately 70% of women screened. The simulated cost of screening 85% of women was $10.1 billion, $2.6 billion, and $3.5 billion for annual, biennial, and USPSTF guidelines, respectively. The largest drivers of cost (in order) were screening frequency, percentage of women screened, cost of mammography, percentage of women screened with digital mammography, and percentage of mammography recalls. Limitation: Cost estimates and assumptions used in the model were conservative. Conclusion: The cost of mammography varies by at least $8 billion per year on the basis of screening strategy. The USPSTF guidelines are based on the scientific evidence to date to maximize patient benefit and minimize harm but also result in far more effective use of resources. Primary Funding Source: University of California and the Safeway Foundation.
Cytotoxic T‐cell non‐Hodgkin's lymphoma of the thyroid gland
Authors: Akio Okamoto, Kyoko Namura, Hitoji Uchiyama, Yoshihiro Kajita, Tohru Inaba, Shigeo Nakamura, Chihiro Shimazaki
Journal: American Journal of Hematology (2005)

An 86-year-old female was diagnosed with peripheral T-cell lymphoma, unspecified, which affected only her thyroid gland. Lymphoma cells were TIA-1(+), suggesting cytotoxic T-cell origin. She had not suffered from autoimmune thyroiditis and showed normal thyroid function. Without any specific therapies, the lymphomatous lesion showed the partial spontaneous regression before diagnostic hemithyroidectomy, and she had been well for 2 years without relapse. This is the first case of primary thyroid lymphoma of cytotoxic T-cell origin that showed spontaneous regression.
Glycemic Control and Health Disparities in Older Ethnically Diverse Underserved Adults With Diabetes
Authors: Ruth S. Weinstock, Jeanne A. Teresi, Robin Goland, Roberto Izquierdo, Walter Palmas, Joseph P. Eimicke, Susana Ebner, Steven Shea
Journal: Diabetes Care (2011)

OBJECTIVE The Informatics for Diabetes Education and Telemedicine (IDEATel) project randomized ethnically diverse underserved older adults with diabetes to a telemedicine intervention or usual care. Intervention participants had lower A1C levels over 5 years. New analyses were performed to help better understand this difference. RESEARCH DESIGN AND METHODS IDEATel randomized Medicare beneficiaries with diabetes (n = 1,665) to receive home video visits with a diabetes educator and upload glucose levels every 4–6 weeks or usual care (2000–2007). Annual measurements included BMI, A1C (primary outcome), and completion of questionnaires. Mixed-model analyses were performed using random effects to adjust for clustering within primary care physicians. RESULTS At baseline, A1C levels (mean ± SD) were 7.02 ± 1.25% in non-Hispanic whites (n = 821), 7.58 ± 1.78% in non-Hispanic blacks (n = 248), and 7.79 ± 1.68% in Hispanics (n = 585). Over time, lower A1C levels were associated with more glucose uploads (P = 0.02) and female sex (P = 0.002). Blacks, Hispanics, and insulin-users had higher A1C levels than non-Hispanic whites (P &amp;lt; 0.0001). BMI was not associated with A1C levels. Blacks and Hispanics had significantly fewer uploads than non-Hispanic whites over time. Hispanics had the highest baseline A1C levels and showed the greatest improvement in the intervention, but, unlike non-Hispanic whites, Hispanics did not achieve A1C levels &amp;lt;7.0% at 5 years. CONCLUSIONS Racial/ethnic disparities were observed in this cohort of underserved older adults with diabetes. The IDEATel telemedicine intervention was associated with improvement in glycemic control, particularly in Hispanics, who had the highest baseline A1C levels, suggesting that telemedicine has the potential to help reduce disparities in diabetes management.
Outcomes of Kidney Transplantation in HIV-Infected Recipients
Authors: Peter G. Stock, Burc Barin, Barbara Murphy, Douglas Hanto, Jorge M. Diego, Jimmy Light, Charles Davis, Emily Blumberg, David Simon, Aruna Subramanian, J. Michael Millis, G. Marshall Lyon, Kenneth Brayman, Doug Slakey, Ron Shapiro, Joseph Melancon, Jeffrey M. Jacobson, Valentina Stosor, Jean L. Olson, Donald M. Stablein, Michelle E. Roland
Journal: New England Journal of Medicine (2010)

The outcomes of kidney transplantation and immunosuppression in people infected with human immunodeficiency virus (HIV) are incompletely understood.We undertook a prospective, nonrandomized trial of kidney transplantation in HIV-infected candidates who had CD4+ T-cell counts of at least 200 per cubic millimeter and undetectable plasma HIV type 1 (HIV-1) RNA levels while being treated with a stable antiretroviral regimen. Post-transplantation management was provided in accordance with study protocols that defined prophylaxis against opportunistic infection, indications for biopsy, and acceptable approaches to immunosuppression, management of rejection, and antiretroviral therapy.Between November 2003 and June 2009, a total of 150 patients underwent kidney transplantation; survivors were followed for a median period of 1.7 years. Patient survival rates (±SD) at 1 year and 3 years were 94.6±2.0% and 88.2±3.8%, respectively, and the corresponding mean graft-survival rates were 90.4% and 73.7%. In general, these rates fall somewhere between those reported in the national database for older kidney-transplant recipients (≥65 years) and those reported for all kidney-transplant recipients. A multivariate proportional-hazards analysis showed that the risk of graft loss was increased among patients treated for rejection (hazard ratio, 2.8; 95% confidence interval [CI], 1.2 to 6.6; P=0.02) and those receiving antithymocyte globulin induction therapy (hazard ratio, 2.5; 95% CI, 1.1 to 5.6; P=0.03); living-donor transplants were protective (hazard ratio, 0.2; 95% CI, 0.04 to 0.8; P=0.02). A higher-than-expected rejection rate was observed, with 1-year and 3-year estimates of 31% (95% CI, 24 to 40) and 41% (95% CI, 32 to 52), respectively. HIV infection remained well controlled, with stable CD4+ T-cell counts and few HIV-associated complications.In this cohort of carefully selected HIV-infected patients, both patient- and graft-survival rates were high at 1 and 3 years, with no increases in complications associated with HIV infection. The unexpectedly high rejection rates are of serious concern and indicate the need for better immunotherapy. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00074386.).
THRESHOLDS FOR DRUG-INDUCED AKATHISIA
Authors: DANIEL X. FREEDMAN, JACOB DE JONG
Journal: American Journal of Psychiatry (1961)

The findings indicate that low-dose akathisia results from an individual's specific sensitivity to a specific molecular configuration. There is a population with a low threshold for the disorder. Thresholds are determined by the spectrum of individual sensitivities for specific molecular configurations, administered in a specified dosage schedule. The incidence and intensity of low-dose akathisia depend on at least 2 factors: the population tested, and specific molecular structure. [SEE TABLE 1 IN SOURCE PDF]
Goiter in Gandhara
Authors: H. Leslie Frewing
Journal: JAMA (1965)

<h3>To the Editor:—</h3> Your issue for Sept 28, 1964, arrived yesterday [Dec 1, 1964]. I always enjoy the contact with stateside medicine, even if same is delayed. The communication by Dr. Blumberg on "Goiter in Gandhara" ( 189: 1008) attracted my attention because for the past years we have lived in and near this ancient territory. It is a fascinating region and offers great opportunity for study. Our experience does not confirm the observations made on page 1011 relative to the prevalence of goiter in this area. Currently, we have more than 12,000 Pakistani nationals employed. Further, through the past 2 1/2 years we have had for short-term employment another 20,000 men. All of these have had preemployment examinations at which time the neck is palpated for goiter. These employees are drawn largely from northern West Pakistan or Azad Kashmir. Hazara, Kagan Valley, Swat, Peshawar, Muzafarabad, and Kashmir are principal areas
Pulmonary Langerhans Cell Histiocytosis
Authors: Neil J. Hansen, Jordan H. Hankins
Journal: Clinical Nuclear Medicine (2014)

A 40-year-old man underwent pan-endoscopy owing to abdominal pain. Biopsies of the gastrointestinal tract demonstrated diffuse Langerhans cell histiocytosis. PET/CT was done, with CT demonstrating classic pulmonary manifestations of Langerhans cell histiocytosis that had association with intense FDG uptake on PET. Bowel appeared normal. Treatment was initiated with smoking cessation and 6 cycles of cytarabine. Follow-up PET/CT after initial treatment demonstrated improvement of parenchymal abnormalities seen on CT, with resolution of hypermetabolic activity. Maintenance chemotherapy was initiated. PET/CT is increasingly being used for initial staging and treatment response assessment in this rare disorder.
The neglect of trauma surgery
Authors: Nigel R M Tai, James M Ryan, Adam J Brooks
Journal: BMJ (2006)

are much easier to deliver than universal vaccine programmes run separately for different infections.One barrier to combined universal immunisation in infancy would be the unfounded anxiety some people feel about giving multiple antigens to babies.Furthermore, immune responses and clinical protection against Haemophilus influenzae type b is reduced in some combination vaccines, and British authorities want to ensure that any combined vaccine would not jeopardise control of other infections. 9A two dose (rather than three dose) schedule of hepatitis B vaccine could be given in adolescence instead.This schedule has been shown to be acceptable and effective in a deprived area of Glasgow and in the United States. 10 11 Would universal vaccination against hepatitis B in the United Kingdom be too costly?This topic was discussed recently at a meeting of the Viral Hepatitis Prevention Board in Edinburgh. 12 Health economics evaluations in countries with low endemicity have produced variable results, but most were done before vaccine prices were influenced by global markets.Vaccine costs, together with the burden of infection, are the most influential national measures in such economic evaluations. 13 But the full economic burden of hepatitis B still needs to be established, including the direct costs of providing current and anticipated antiviral treatments for infection and of managing chronic liver disease and hepatocellular carcinoma, as well as the economic and personal costs of early deaths among carriers.If direct costs can be reduced by negotiated tendering, there can no longer be a financial argument against adopting a universal immunisation strategy against hepatitis B in the United Kingdom.
ENDOSCOPIC THERAPY FOR BARRETT'S OESOPHAGUS
Authors: H Barr
Journal: Gut (2005)

Barrett’s oesophagus or columnar lined oesophagus is among the most intriguing of gastroenterological conditions. This is because of its pathogenesis, prevalence, association with reflux disease, male sex and, in particular, the potential for neoplastic degeneration to adenocarcinoma. The current and dramatic rise in the incidence of oesophageal adenocarcinoma is centred on the UK (5–8.7/100 000), over double that of the USA (3.7/100 0000). This epidemic is fairly localised and is not evident in Asia, where squamous cell cancer remains the predominant oesophageal malignancy. Large rises in incidence, up to 30% per year, have been seen in West European White men, a rise not mirrored in Eastern Europe.1,2

At present the incidence remains paralleled by mortality. The prognosis of oesophageal cancer remains universally poor; median survival has hardly changed from 0.75 years between 1973 and 1977 to 0.9 years between 1993 and 1999. This almost trivial change has led some to suggest that the change could be accounted for by improved reporting and detection bias rather than any important therapeutic advance.3

Gradual malignant degeneration within a segment of Barrett’s oesophagus occurs in a probabilistic rather than in a deterministic manner. Barrett’s appears to be a necessary intermediary step. The relatively long time sequence to cancer may allow early intervention with endoscopic ablation, thus offering the possibility of preventing the lethal development of symptomatic oesophageal adenocarcinoma. Stark choices face patient and clinician in the presence of a degenerating “possibly” premalignant Barrett’s mucosa. Radical therapy offers an overaggressive, “possibly” flawed approach if the diagnosis and prognosis remain uncertain. It cannot be considered a triumph to have a millimetre of worrying but superficial disease and remove a whole oesophagus. The alternative of surveillance presents other concerns. It offers intermittent endoscopic inspection at proscribed, economically viable, and societal designated intervals, and awaits …
Women in Medicine-Reply
Authors: Marilyn Heins
Journal: JAMA (1983)

<h3>In Reply.—</h3> Medicine is not new, nor is motherhood. What is new and healthy is a willingness to reexamine traditional sex roles. Dialogue between men and women physicians such as Dr Dimond and myself carried out in the pages of<i>JAMA</i>is also healthy and should continue.
Stimulated hepatic tissue repair underlies heteroprotection by thioacetamide against acetaminophen-induced lethality
Authors: Sanjay Chanda, Raja S. Mangipudy, Alan Warbritton, Thomas J. Bucci, Harihara M. Mehendale
Journal: Hepatology (1995)

Acetaminophen (APAP) is a widely used analgesic and antipyretic drug that causes massive centrilobular hepatic necrosis at high doses, leading to death. The objectives of this study were to test our working hypothesis that preplaced cell division and hepatic tissue repair by prior thioacetamide (TA) administration provides protection against APAP-induced lethality and to investigate the underlying mechanism. Male Sprague-Dawley rats were treated with a low dose of TA (50 mg/kg, intraperitoneally [i.p.]) before challenge with a 90% lethal dose (1,800 mg/kg, i.p.) of APAP. This protocol resulted in a 100% protection against the lethal effect of APAP. Because TA caused a 23% decrease of hepatic microsomal cytochromes P-450, the possibility that TA protection may be caused by decreased bioactivation of APAP was examined. A 30% decrease in cytochromes P-450 induced by cobalt chloride failed to provide protection against APAP lethality. Time course of serum enzyme elevations (alanine aminotransferase, aspartate aminotransferase, and sorbitol dehydrogenase) indicated that actual infliction of liver injury by APAP peaked between 12 to 24 hours after the administration of APAP, whereas the ultimate outcome of that injury depended on the biological events thereafter. Although liver injury progressed in rats receiving only APAP, it regressed in rats pretreated with TA. Acetaminophen t1/2 was not altered in TA-treated rats, indicating that significant changes in APAP disposition and bioactivation are unlikely. Moreover, hepatic glutathione was decreased to a similar extent regardless of TA pretreatment, suggesting that decreased bioactivation of APAP is unlikely to be the mechanism underlying TA protection. [3H]Thymidine incorporation studies confirmed the expected stimulation of S-phase synthesis, and proliferating cell nuclear antigen studies showed a corresponding stimulation of cell division through accelerated cell cycle progression. Intervention with TA-induced cell division by colchicine antimitosis ended the TA protection in the absence of significant changes in the time course of serum enzyme elevations during the inflictive phase of APAP hepatotoxicity. These studies suggest that hepatocyte division and tissue repair induced by TA facilitate sustained hepatic tissue repair after subsequent APAP-induced liver injury, producing recovery from liver injury and protection against APAP lethality.
Hair Nicotine and Cotinine in Women and Newborn Infants
Authors: Joseph C. Avakoff
Journal: JAMA (1994)

To the Editor.  —I read with interest the article by Dr Eliopoulos and colleagues. 1 This article was widely publicized by the news media as showing  the first time measurable levels of nicotine in infants from passive smoking. I would like to ask the authors two questions.  First, the article indicates that infants from mothers who were nonsmokers had 0.4 ng/mg of nicotine. Where did this nicotine come from?  Second, the article indicates that infants from mothers with passive smoke exposure had 0.28 ng/mg of nicotine. I may not be a cognitive physician, but to me it looks as if the infants whose mothers were nonsmokers had a higher amount of nicotine than those from mothers exposed to passive smoke. Could the authors please explain this for me?  While I await a reply to this question I shall fire up a fine cigar and enjoy life a little bit
Sheer delight in doing evil
Authors: Theodore Dalrymple
Journal: BMJ (2007)

In Sir Arthur Conan Doyle's The Resident Patient , a doctor called Trevelyan comes to see Sherlock Holmes about a little problem. Dr Watson recognises him as the author of “a monograph on obscure nervous lesions.” Dr Trevelyan is delighted, naturally enough: “I so seldom hear of the work that I thought it was quite dead. My publishers give me a most discouraging account of its sale.”

This, the common lot of all authors, or at least the lot of all the authors known to me in person (though this, I admit, may be a reflection merely on the nature of my literary acquaintance and therefore indirectly on me), is not the problem …