tbuckley/cabot-search huggingface dataset:
Pulmonary Embolism: Where the Problem Is Not
Authors: Kenneth M. Moser
Journal: JAMA (1976)

There is always danger that sharply focused medical information will lead to unwarranted generalization. When examining a biopsy specimen under the microscope, we know that  tissue in one field of view proves nothing. Cancer or other pathologic findings may be noted in the immediately adjacent field of view. Even one normal section does not imply that other slices are normal, and if all sections are normal, rebiopsy may yield a different result.  Alpert and his colleagues (p 1477) have provided us with data focused sharply on one aspect of the panorama of venous thromboembolism. The temptation to generalize from their data must be resisted. Quoted or recalled fuzzily out of the discrete context in which they were generated, the authors' quite valid conclusions can be distorted so as to place patients in jeopardy of death due to pulmonary embolism.  For example, the authors' conclusion that overall mortality caused by
Management of sulfadiazine allergy in patients with acquired immunodeficiency syndrome
Authors: B. de la Hoz Caballer, M. Fernandez-Rivas, J.Fraj Lazaro, S.Quirce Gancedo, I.Davila Ruiz, J.Puyana Ruiz, J.Cuesta Herranz, E.Alvarez Cuesta, M. Cuevas, M.J.Perez Elias
Journal: Journal of Allergy and Clinical Immunology (1991)
Coronary Artery Surgery in New York State
Authors: Herman C. B. Denber
Journal: JAMA (1991)

To the Editor. —  Hannan et al 1 concluded from their study that significant risk factors for in-hospital death were age, gender, ejection fraction, previous myocardial infarction, previous  heart surgery, diabetes requiring medication (oral or insulin?), dialysis dependence, and others.  Hannan et al confuse open heart surgery—an incision into the myocardial cavity exposing the chambers—with coronary artery bypass graft surgery, in which the epicardial surface is not penetrated. Combining coronary artery bypass graft surgery and valvular surgery obviously means longer operative, cardiopulmonary bypass, and aortic cross-clamp times with greater probability of perioperative and postoperative complications.  In this era of extreme cost consciousness and with New York's serious fiscal problems, how could this research proposal requiring extensive data collection and computer time clear an institutional review board, whose reply certainly would have been, These data have already been collected and reported in the world literature. What is original about your
Psychiatric Disorders Among Cancer Patients
Authors: Richard M. Glass
Journal: JAMA (1983)

There is a time-honored distinction in psychiatry between the misery caused by mental disorders and "common unhappiness."1 Recent developments in psychiatric diagnosis and epidemiology have extended this notion to stress the importance of distinguishing among (1) variations of normal feelings and experiences, (2) symptoms that may occur in a number of disparate conditions, and (3) syndromes that constitute mental disorders. A concern to maintain these distinctions, and as a consequence improve the reliability of psychiatric diagnosis, was central in the development of the current "official" psychiatric diagnostic system, the third edition of the American Psychiatric Association's<i>Diagnostic and Statistical Manual of Mental Disorders (DSM-III)</i>.<sup>2</sup>In this context, the article by Derogatis et al in this issue ofThe Journal(p 751) should be of interest to all physicians. This study of the prevalence of psychiatric disorders among cancer patients was performed by the Psychosocial Collaborative Oncology Group (PSYCOG) and
Influenza 1981 to 1982
Authors: William R. Barclay
Journal: JAMA (1981)

Physicians, like farmers, find their responsibilities and work load seasonal in nature. As the fall and winter seasons approach, they bring with them outbreaks of influenza caused by one of the well-recognized virus strains and possibly by a new variant, against which previous vaccination or illness will have no protective effect. Patients commonly ask about the value of influenza vaccine and its complications and about their physician's personal biases on the subject. The Immunizations Practices Advisory Committee of the Public Health Service has issued a timely and informative statement about the influenza vaccine that is available for the 1981 to 1982 season.<sup>1</sup> The committee recommends that chronically ill children and adults older than 65 years be vaccinated, for they are at high risk of serious complications and even death from influenza infection. In the 1980 to 1981 season, no outbreaks of influenza B were recorded; the predominant strain was
Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units
Authors: Jan N. M. Schieveld, Judith A. van der Valk, Inge Smeets, Eline Berghmans, Renske Wassenberg, Piet L. M. N. Leroy, Gijs D. Vos, Jim van Os
Journal: Intensive Care Medicine (2009)

If delirium is not diagnosed, it is unlikely that any effort will be made to reverse it. Given evidence for under-diagnosis, tools that aid recognition are required.Relating three presentations of pediatric delirium (PD) to standard criteria and developing a diagnostic algorithm.Delirium-inducing factors, disturbance of consciousness and inattention are common in PICU patients: a pre-delirious state is present in most. An algorithm is introduced, containing (1) evaluation of the sedation-agitation level, (2) psychometric assessment of behavior and (3) opinion of the caregivers.It may be argued that the behavioral focus of the algorithm would benefit from the inclusion of neurocognitive measures.No sufficiently validated diagnostic instrument covering the entire algorithm is available yet.This is the first proposal for a PD diagnostic algorithm. Given the high prevalence of predelirious states at the PICU, daily evaluation is mandatory. Future algorithmic refinement is urgently required.
A Grave Menace to the Public Health; A Correction.
Authors: Albert L. Gihon
Journal: JAMA (1898)

New York, Sept. 24, 1898. <h3>To the Editor:</h3> —In your issue of September 17, p. 666, the statement is made in a letter signed by "T. S. Dabney, M.D.": "Eight hundred marines were camped for many weeks at Guantanamo and their health remained excellent, and why? Because the surgeons of the Marine-Hospital Service not only understand preventive medicine, but they<i>practice</i>it." I beg to correct the inference that the United States Marine Corps is under the medical supervision of the Marine-Hospital Service. The latter organization was established for the care of sick and disabled sailors of the merchant service, a "mercantile marine," as it is sometimes termed, thus, doubtless occasioning the misunderstanding. The United States Marine Corps is part of the United States Navy, and is cared for exclusively by the officers of the medical department of the United States Navy. The writer would have been strictly within bounds
Abnormal vitamin D metabolism, intestinal calcium transport, and bone calcium status in the spontaneously hypertensive rat compared with its genetic control.
Authors: P A Lucas, R C Brown, T Drüeke, B Lacour, J A Metz, D A McCarron
Journal: Journal of Clinical Investigation (1986)

Abnormalities of intestinal calcium absorption and the vitamin D axis in the spontaneously hypertensive rat (SHR) are controversial. The present report documents a reduction in circulating 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in the 12-14-wk-old male SHR with evidence of its functional significance. Both plasma 1,25(OH)2D3 and mucosa-to-serosa duodenal calcium flux (Jm-s), measured by the Ussing chamber, were significantly lower (approximately 60% of value in Wistar-Kyoto rats [WKY]) in SHR on both normal (1%) and low (0.1%) calcium diets than in corresponding control WKY. Low dietary calcium increased both 1,25(OH)2D3 and Jm-s by approximately 80% in SHR and WKY, with levels of both parameters rising in the SHR to levels found in the WKY under baseline conditions. The latter fact suggests the improbability of intestinal resistance to the action of 1,25(OH)2D3 in the SHR. Plasma 25-hydroxyvitamin D3 (25(OH)D3) was not significantly different between the strains. Intraperitoneal 1,25(OH)2D3 increased Jm-s in 12-14-wk-old SHR to levels observed in equivalent WKY. In 20-24-wk-old SHR, calcium deprivation was associated with significantly reduced Jm-s compared with equivalent WKY. Bone density and bone calcium content in 20-30-wk-old SHR were significantly reduced. In summary, we provide evidence that the SHR was unable to sustain appropriate circulating levels of 1,25(OH)2D3, an impairment which resulted in reduced duodenal calcium absorption.
Tl-201 and Tc-99m HMPAO SPECT in a Patient With Recurrent Thymoma
Authors: HITOYA OHTA, TETSUO TANIGUCHI, HIROYOSHI WATANABE, TOMOO KOMIBUCHI, MASAHARU NAKADE, KEIJIRO KOHNO
Journal: Clinical Nuclear Medicine (1996)

Tl-201 scintigraphy has been used for the evaluation of various tumors and Tc-99m HMPAO has been used for the assessment of tumor perfusion. The authors present Tl-201 and Tc-99m HMPAO imaging in recurrent thymoma.
In memoriam Romain Pauwels
Authors: J. Bousquet, L. Fabbri, P. O'Byrne, P. Van Cauwenberge
Journal: European Respiratory Journal (2005)

Romain Pauwels passed away peacefully on January 3, 2005, at his home in Sint-Denijs-Westrem (Ghent, Belgium), after a long fight against his own disease and after having devoted his entire life to fighting the diseases of others.

In particular, we would like to remember his efforts in the fight against asthma and chronic obstructive pulmonary disease (COPD). In addition to performing pivotal basic and clinical research in the fields of asthma and COPD, Professor Pauwels played a fundamental role as Chairman of both the Global Initiative for Asthma (GINA) and the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). These international initiatives were sponsored by the National Heart, Lung and Blood Institute US and the World Health Organization, both of which have had an important impact in attracting attention to these two devastating diseases around the world.

Born on June 13, 1943, Professor Pauwels obtained …
Anemia After Orchiectomy
Authors: Rafael Fonseca, S. Vincent Rajkumar, William L. White, Ayalew Tefferi, H. Clark Hoagland
Journal: American Journal of Hematology (1998)

The decrease in testosterone production associated with bilateral orchiectomy may result in normocytic anemia in men. We sought to determine the effect of orchiectomy on hemoglobin concentration. Patients were evaluated at the Mayo Clinic in 1993 and 1994 and underwent bilateral orchiectomy for prostate carcinoma. All patients were seen by one of the staff urologists. Patients were included if they had a normal preoperative complete blood cell count and serum levels of creatinine, if they remained without disease progression (suppressed prostate-specific antigen level and no evidence of clinical progression on review), and if they had normal serum levels of creatinine and mean corpuscular volume during the follow-up period. The patients could have no other cause of anemia. The complete blood cell count, prostate-specific antigen level, and serum level of creatinine were determined preoperatively and at least once (>90 days) after orchiectomy. Sixty-four patients were included in the analysis (median age, 68 years). The median decrease in hemoglobin concentration was 1.2 g/dL after orchiectomy. There was a statistically significant difference in the hemoglobin concentration before orchiectomy compared with postoperative values at all the intervals studied, both by the paired group t-test and the Kruskal-Wallis test. There is a clinically and statistically significant decrease in hemoglobin concentration after orchiectomy. Knowledge of this phenomenon may prevent unnecessary diagnostic work-up in men with normocytic anemia after bilateral orchiectomy. Am. J. Hematol. 59:230–233, 1998. © 1998 Wiley-Liss, Inc.
Significance of cardiac defects in the developing fetus: a study of spontaneous abortuses.
Authors: P C Ursell, J M Byrne, B A Strobino
Journal: Circulation (1985)

We investigated the impact of heart defects on the developing human fetus by examining 412 hearts from consecutive spontaneous abortuses. In each case, the cardiac morphology was correlated with the autopsy findings and the karyotype (unavailable in 115 hearts not successfully cultured). Of the 412 hearts, 10 (2.4%) contained structural defects (six ventricular septal defects, one atrial septal defect with ventricular septal defect, and one each coarctation, atrioventricular septal defect, and tetralogy of Fallot). Only one of 10 had major extracardiac malformations. Of the 277 fetuses with normal karyotype, three (1.1%) had heart defects. Of the 20 fetuses with abnormal karyotype, four (20%) had heart defects. In the remaining three fetuses with heart defects, the karyotype was not obtained. Thus (1) 57% of spontaneous abortuses with congenital heart defects contained major chromosomal abnormalities, (2) the spectrum of heart defects among spontaneous abortuses was similar to that among liveborns, and (3) since the prevalence of heart defects among fetuses without other major abnormalities was similar to that among liveborns, heart defects alone may not jeopardize the survival of a developing fetus.
IMPORTANCE OF DIAGNOSIS IN OPHTHALMOLOGY.
Authors: E. WILLIAMS
Journal: JAMA (1884)

In this case there was no bad odor from the dis¬ charges, as in the former cases, and the effect of the injections in arresting the poison of the septic matter was prompt and striking.Should antiseptics be used in every puerperal case?I believe so, especially as antisepsis has come to be considered as the use of every means of cleanliness, and the prevention of infectious or contagious mat¬ ters.And just here let me record it «as my fixed belief, that thousands of women have come to their deaths, from the dirt and other matters under the finger nails of their attendants.That dirt, the nest of infectious particles scraped from the body of himself, or possibly bathed in the infectious fluids of another person, is conveyed by means of the touch to the abraded surfaces in the puerperal patient, and she becomes inoculated with the virus that causes her death.I believe that any one suffering from a chronic skin disease, or who is afflicted with a chronic ulcer of any kind, should not attend upon puerperal patients, no more than he who is attending patients with scarlatina or erysipelas.In fact it is my deliberate judgment, that puerperal women should not be attended by the general practitioner at all, and for one I will gladly welcome the day, when I can turn over all such patients to well educated and thoroughly trained lady physicians who will make that their special calling.Begging pardon for this digression I would say in conclusion that within twenty-four hours after con¬ finement, the use of vaginal injections of carbolized water, affords the greatest comfort to the patient, bathing and soothing the neck of the uterus where there may be abrasions or lacerations, and cleansing and purifying the parts.If the discharges become foul in odor, and there is a marked rise in the tem¬ perature, then the injections should be intra-uterine.One precaution should be borne in mind, in pre¬ scribing vaginal injections, and that is to have the hole in the end of the pipe or syringe closed.I have in several cases seen a severe and dangerous uterine colic, caused by the injection passing into the uterus through the patulous and open os.In the
THE MILITARY, INDUSTRIAL AND PUBLIC HEALTH FEATURES OF NARCOTIC ADDICTION
Authors: CHARLES F. STOKES
Journal: JAMA (1918)

It behooves us at this time carefully to consider, from every angle, all possible sources of man-power in order that we may claim for service many who believe themselves incapacitated for work, and force to purposeful effort others, who have sought exemption by reason of acquired or assumed physical deficiencies.  Distributed over the country are hordes of drug users in the age of conscription who, if drafted, must either claim exemption by reason of addiction, or, if accepted, must later be discharged as undesirable, or unable to serve, unless steps are taken to conserve this loss.  In some sections of the country heroin claims 90 per cent. of the narcotic victims. Nearly all of these persons are in the period of adolescence. It is difficult to say just how many addicts there are in the United States. The number may be surmised, however, when we consider the figures of a
Disseminated Penicillium marneffei infection with cutaneous lesions in an HIV-positive patient
Authors: M.-T. LIU, C.-K. WONG, C.-P. FUNG
Journal: British Journal of Dermatology (2006)

We report the occurrence of disseminated Penicillium marneffei infection with typical skin lesions, in an HIV-positive man. His symptoms resolved, and the skin lesions healed completely, after 2 weeks' oral therapy with fluconazole.
Functional Abdominal Pain in Children and Adolescents
Authors: Megan A. Moreno, Fred Furtner, Frederick P. Rivara
Journal: JAMA Pediatrics (2013)

Functional Abdominal Pain in Children and AdolescentsA bdominal pain is very common among children and adolescents.It can be challenging for parents to figure out what is causing the pain and whether it is serious.When a parent takes the child to the pediatrician to evaluate the abdominal pain, the doctor will ask questions about the pain and do a physical examination.Sometimes other tests such as blood tests, urine tests, or radiology tests are needed to investigate the abdominal pain.There are many causes of chronic recurrent abdominal pain in children, but parents may find it surprising that it is very common for there to be no clear cause identified for childhood abdominal pain even though examinations and tests have been done.Functional abdominal pain is a diagnosis that may be made if a child has a particular pattern of symptoms and no other tests for other abdominal diseases have been positive.The symptoms of recurrent functional abdominal pain include pain often located in the middle of the child's abdomen.The pain may happen once in a while or all the time.Typically there is no nausea, vomiting, or fever with this kind of pain.The pain is not usually worse with eating, but it may be worse if the child is under stress or worried about something.Children diagnosed as having functional abdominal pain may have potential negative consequences of this illness.These children are at risk for increased psychological problems such as depression, missing out on activities and school because of the pain, and decreased quality of life.Functional abdominal pain can be difficult for parents to cope with, as they see their child in pain but no medical tests can prove the diagnosis.Fortunately, there are treatments for functional abdominal pain.One treatment for functional abdominal pain that has had good success is cognitive behavioral therapy.This treatment often includes several sessions with a trained therapist in which the child and parents learn ways to think about and cope with pain.These may include learning to relax during times of pain and approaches for the child to stay involved in school and regular activities.A study in this month's issue showed that 1 year after the treatment, children in this type of treatment had improved pain and better ways to cope with the pain when it happened.
Fibronectin Expression Modulates Mammary Epithelial Cell Proliferation during Acinar Differentiation
Authors: Courtney M. Williams, Adam J. Engler, R. Daniel Slone, Leontine L. Galante, Jean E. Schwarzbauer
Journal: Cancer Research (2008)

Abstract The mammary gland consists of a polarized epithelium surrounded by a basement membrane matrix that forms a series of branching ducts ending in hollow, sphere-like acini. Essential roles for the epithelial basement membrane during acinar differentiation, in particular laminin and its integrin receptors, have been identified using mammary epithelial cells cultured on a reconstituted basement membrane. Contributions from fibronectin, which is abundant in the mammary gland during development and tumorigenesis, have not been fully examined. Here, we show that fibronectin expression by mammary epithelial cells is dynamically regulated during the morphogenic process. Experiments with synthetic polyacrylamide gel substrates implicate both specific extracellular matrix components, including fibronectin itself, and matrix rigidity in this regulation. Alterations in fibronectin levels perturbed acinar organization. During acinar development, increased fibronectin levels resulted in overproliferation of mammary epithelial cells and increased acinar size. Addition of fibronectin to differentiated acini stimulated proliferation and reversed growth arrest of mammary epithelial cells negatively affecting maintenance of proper acinar morphology. These results show that expression of fibronectin creates a permissive environment for cell growth that antagonizes the differentiation signals from the basement membrane. These effects suggest a link between fibronectin expression and epithelial cell growth during development and oncogenesis in the mammary gland. [Cancer Res 2008;68(9):3185–92]
Bran yesterday... bran tomorrow?
Authors: K W Heaton
Journal: BMJ (1984)

but it can be seen from table I that preterm infants delivered from 35 weeks onwards did not have a significantly increased incidence of asphyxia.The complications of pregnancy listed in table II were associated with a significant increase in the inci- dence of asphyxia, but the medical complications listed in table III were not.TABLE I-Influence of gestational age on incidence oj birth asphyxia No of Gestational No of babies with age (weeks) babies asphyxia p (%,0) 26-32 30 15 (50) <0-002 33-34 40 13 (33) <0-
Seven lessons from Africa
Authors: Robin Stott
Journal: BMJ (2004)

Use of language— I was born in Kenya but left, aged 12, for an English public school. When I returned 30 years later my colleagues gave me an eloquent personal lesson in the assumptions held by colonialists. My Swahili, though rusty, was passable, but my conversations provoked incredulity. Do you realise, my colleagues said, that you still speak the “come here,” “do this” instructive Swahili of the colonial era? Whereas I believe I learnt my lesson, the language widely used by powerful nations when speaking of Africa is equally patronising and dismissive.

The truth about primary care— Several colleagues formed an association to offer practical health related help to anticolonial revolutionaries. We worked particularly closely with Frelimo (the Mozambique Liberation Front), who graciously accepted the basic health kits we sent. However, we all realised that what was important to health was mobilising people to till fields, dig wells, teach children, emancipate women, and help distribute vaccines. Seeds and agricultural equipment are better for health than bandages. The fruits of this …