tbuckley/cabot-search huggingface dataset:
An adequate margin of excision in ductal carcinoma in situ
Authors: Malcolm R Kell, Monica Morrow
Journal: BMJ (2005)

2 mm plus radiotherapy is as good as a bigger margin 

T he widespread use of mammography screening has led to a change in the perceived pathology of breast cancer. The increased detection of asymptomatic disease has resulted in an increased incidence of ductal carcinoma in situ (DCIS), which now accounts for about 20% of all cases of breast cancer. In addition, the past decade has seen a change in the management of primary breast cancer, from mastectomy to breast conservation where possible.1 Clearly surgical management of DCIS poses several challenges, none more so than what should be the width of an adequate margin of resection. What is at issue is the size of the margin that ensures no residual tumour cells while minimising the deformity of the breast.

The National Surgical Adjuvant Breast and Bowel Project (NSABP) regards “no tumour cells on the ink”—that is, a minimal margin free of disease—as a negative margin. Yet in a recent survey of 1137 radiation oncologists only 45.9% of North American respondents and 27.6% of Europeans agreed with this definition.2 When this margin was extended to 2 mm over 75% of North American respondents agreed that this could be regarded as negative, …
Oral <scp>l</scp> -Arginine in Patients With Coronary Artery Disease on Medical Management
Authors: Arnon Blum, Londa Hathaway, Rita Mincemoyer, William H. Schenke, Martha Kirby, Gyorgy Csako, Myron A. Waclawiw, Julio A. Panza, Richard O. Cannon
Journal: Circulation (2000)

Background —Vascular nitric oxide (NO) bioavailability is reduced in patients with coronary artery disease (CAD). We investigated whether oral l -arginine, the substrate for NO synthesis, improves homeostatic functions of the vascular endothelium in patients maintained on appropriate medical therapy and thus might be useful as adjunctive therapy. Methods and Results —Thirty CAD patients (29 men; age, 67±8 years) on appropriate medical management were randomly assigned to l -arginine (9 g) or placebo daily for 1 month, with crossover to the alternate therapy after 1 month off therapy, in a double-blind study. Nitrogen oxides in serum (as an index of endothelial NO release), flow-mediated brachial artery dilation (as an index of vascular NO bioactivity), and serum cell adhesion molecules (as an index of NO-regulated markers of inflammation) were measured at the end of each treatment period. l -Arginine significantly increased arginine levels in plasma (130±53 versus 70±17 μmol/L, P &lt;0.001) compared with placebo. However, there was no effect of l -arginine on nitrogen oxides (19.3±7.9 versus 18.6±6.7 μmol/L, P =0.546), on flow-mediated dilation of the brachial artery (11.9±6.3% versus 11.4±7.9%, P =0.742), or on the cell adhesion molecules E-selectin (47.8±15.2 versus 47.2±14.4 ng/mL, P =0.601), intercellular adhesion molecule-1 (250±57 versus 249±57 ng/mL, P =0.862), and vascular cell adhesion molecule-1 (567±124 versus 574±135 ng/mL, P =0.473). Conclusions —Oral l -arginine therapy does not improve NO bioavailability in CAD patients on appropriate medical management and thus may not benefit this group of patients.
Does left heart disease cause most systemic sclerosis associated pulmonary hypertension?
Authors: Gerry Coghlan
Journal: European Respiratory Journal (2013)

In systemic sclerosis we should ask what, in this individual patient, is the driver for elevated pulmonary pressures?http://ow.ly/nwLNMIn this issue of the European Respiratory Journal, FOX et al. [1] present data that suggest most pulmonary hypertension (PH) in systemic sclerosis is post-capillary and that many patients are receiving pulmonary vasodilator therapy inappropriately.Of 53 patients identified as having PH, nearly half (24) had elevated wedge pressures, a further five had elevated left ventricular end-diastolic pressure and another six were ''exposed'' as having occult post-capillary abnormalities in response to a 500-mL fluid challenge administered over 5-10 min.Thus, in total, 35 (67%) out of 53 PH patients did not have pulmonary arterial hypertension (PAH).The number of patients with elevated pulmonary artery occlusion pressures (PAOP) is high when compared with other studies [2, 3] and there is no ''threshold'' wedge pressure that differentiates normality from cardiac disease during fluid challenge [4,5], but this misses the bigger point.Their work illustrates the flaws in the accepted diagnostic benchmark.
Hepatitis B virus DNA in children's liver diseases: detection by blot hybridisation in liver and serum.
Authors: J Scotto, M Hadchouel, C Hery, F Alvarez, J Yvart, P Tiollais, O Bernard, C Brechot
Journal: Gut (1983)

Molecular hybridisation using cloned hepatitis B virus DNA (HBV DNA) was applied to liver and serum samples from 46 children (39 with liver diseases and seven controls) for detection of HBV DNA sequences, free and integrated into the liver cell genome. HBV DNA integration was observed in 10 children. The young age of some of these cases indicates that such integration can occur early in liver disease and is not related to the duration of viral infection. Thirteen children exhibited serological evidence of active viral multiplication. All but one had free HBV DNA in liver tissue and integrated HBV DNA sequences were found in four cases. Integrated HBV DNA sequences alone were also detected in three children with neither HBV-antigens nor HBV DNA in serum. One had inactive cirrhosis, and the two others, chronic active hepatitis. Consequently DNA hybridisation may be useful for diagnosis, in the absence of serological signs of HBV infection; its specificity was enhanced in the present investigation by negative results in six children with autoimmune chronic active hepatitis. Taken together, the above results imply that HBV-DNA integration can occur in both active and inactive liver disease. Integrated HBV DNA was also observed in the liver of three children with fatal hepatic failure who presented with antibodies to HBsAg and/or to hepatitis B core antigen in the serum. This finding raises the question of the relationship between the host immune factors and the state of HBV DNA.
Paraspinal Extramedullary Hematopoiesis Diagnosed Using Tc-99m Sulfur Colloid
Authors: Sukhdev Singh, Ishan Gunatunga, Lee Bartley, Philip Facey, John Rees, Patrick Fielding
Journal: Clinical Nuclear Medicine (2008)

A 73-year-old man with thalassemia intermedia presented acutely with abdominal pain and distension. He had previously undergone a splenectomy. A diagnostic computed tomography (CT) scan through the abdomen and pelvis was performed with oral and intravenous contrast. This showed bilateral paravertebral and retrocrural soft tissue masses. It was believed that this was unlikely to be the cause of the patient's acute presentation. Nevertheless, the possibility of lymphoma or extramedullary hematopoiesis was raised. To avoid an invasive diagnostic biopsy, a Tc-99m sulfur colloid scan was performed. Initially, planar images were obtained; however, no clear corresponding colloid uptake was demonstrated. Therefore, a single-photon computed emission tomography (SPECT)/CT examination was performed. This demonstrated uptake of Tc-99m sulfur colloid in the paravertebral masses, confirming that these are likely to represent extramedullary hematopoiesis rather than lymphoma.
Distalgesic poisoning--cause for concern.
Authors: P S Dwyer, I F Jones
Journal: BMJ (1980)

gists stated that "the appearances are those of idiopathic retroperitoneal fibrosis.The histological appearances of practolol peritonitis are different...." This is not the appropriate comparison.The patient obviously had fibrosis in the retroperitoneal space and not the peritoneal cavity.The point is that idopathic and drug-related (for example, methysergide) retroperitoneal fibrosis present the same histological picture.'Oxprenolol is also listed in reports of the Committee on Safety of Medicines as being ingested by patients developing sclerosing
A randomized, blinded, placebo-controlled trial of recombinant human tissue-type plasminogen activator in patients with unstable angina pectoris.
Authors: H K Gold, J A Johns, R C Leinbach, T Yasuda, E Grossbard, R Zusman, D Collen
Journal: Circulation (1987)

Twenty-four patients with unstable angina pectoris, defined as chest pain at rest with transient ST segment deviation of at least 1 mm, were randomly assigned to blinded treatment with either placebo or intravenous recombinant human tissue-type plasminogen activator (rt-PA). Before randomization, all patients were treated with oral beta-blockers, calcium antagonists, nitrates, and continuous intravenous heparin for a monitoring period of 12 to 28 hr. After this monitoring period the 24 patients were randomly assigned to receive either placebo or 1.75 mg/kg intravenous rt-PA given over 12 hr at a rate of 0.75 mg/kg over 1 hr, 0.5 mg/kg over 4 hr, and 0.5 mg/kg over 7 hr. One patient, assigned to receive placebo, developed acute myocardial infarction after randomization but before receiving the study drug. Ischemic events were recorded during a hospital follow-up period of at least 4 days unless a further intervention was indicated or the coronary angiogram was normal. The follow-up period was 7 +/- 5 days (mean +/- SD) after the placebo infusion and 8 +/- 4 days after the infusion of rt-PA. Unstable angina pectoris persisted after the completion of the infusion in six of 11 patients receiving placebo and only one of 12 patients receiving rt-PA (p less than .03). Coronary angiography, performed 38 +/- 19 hr after the infusion, demonstrated subocclusive thrombus in eight of 11 patients receiving placebo but in none of 11 patients treated with rt-PA (p less than .002). One patient on rt-PA refused coronary angiography.(ABSTRACT TRUNCATED AT 250 WORDS)
Moving beyond journals: the future arrives with a crash
Authors: T. Delamothe, R. Smith
Journal: BMJ (1999)

“It's easy to say what would be the ideal online resource for scholars and scientists: all papers in all fields, systematically interconnected, effortlessly accessible and rationally navigable,from any researcher's desk, worldwide for free.”—Stevan Harnad

Three hundred years of print journals have bequeathed us almost the exact opposite of the idealproposed by Harnad, one of the leading thinkers on how the internet will change science. In biomedicine thousands of journals fragment information into largely arbitrary groupings and charge usersfor access. The burgeoning of the world wide web (almost all researchers and three quarters of doctors in the developed world now have access) makes it inevitable that new systems of disseminatingresearch will replace or at least supplement traditional journals. Concrete proposals for new systems are now appearing, with an ambitious one from the National Institutes of Health leading the way. 1 2 We are about toenter a period of what the Austrian-American economist Joseph Schumpeter called “creative destruction,” and only some of us will still be in business at the end. And those of us who still exist will not be doing exactly what we are doing now.

The present system of disseminating research through journals has many failings (see BMJ 's website for a summary of defects in journals), but there are two main drivers of change. One, as almost always, is money. The academic community, particularly in the United States, has come to resent the money sucked out of the research system by publishers.3 Most research is funded with public money, yet the US Association of Research Libraries spends $432m (£270m) ($12 000 (£7500) for each scientist) buying research journals.4 In the face of declining subscriptions publishers have long been putting up their prices each year by considerably more than inflation. Something had to give.

Many researchers think …
Beer and Wine for Geriatric Patients
Authors: Thomas B. Turner
Journal: JAMA (1973)

Moderate amounts of alcoholic beverages have been recognized as useful therapeutic agents in geriatric patients for many years.<sup>1</sup>Recently, several groups of investigators have attempted to conduct controlled studies of the use of beer or wine among institutionalized patients. Among the reported studies have been those by Kastenbaum and associates,<sup>2,3</sup>Black,<sup>4</sup>and Chien et al.<sup>5,6</sup> Kastenbaum and Slater<sup>2</sup>make the point that among institutionalized geriatric patients, there is a dearth of peer interaction and often social impoverishment, which the authors regard as neither desirable nor necessary. Two groups of 20 patients each were studied for a base line period of one month. Members of one group were then given one or two glasses of wine daily, and the others grape juice. After three weeks the groups were switched for a similar period that was followed by an extended free choice period. Appropriate psychological tests were
Sex, Drugs, and Rock ‘n’ Roll: Caring for Adolescents and Young Adults With Cancer
Authors: Sue Morgan, Simon Davies, Susan Palmer, Meg Plaster
Journal: Journal of Clinical Oncology (2010)

Adolescents and young adults (AYAs) with cancer are a distinct group whose needs have been poorly addressed within health care systems. This imbalance is being addressed in some countries, and this growing specialty is now receiving the recognition it requires in order to develop further. This article discusses some of the psychosocial issues of AYAs and, with reference to the phrase of sex, drugs, and rock and roll, highlights the various rites of passage that young people experience. It also discusses how services and professionals can work alongside AYAs, enabling them to feel a part of the process by providing age-appropriate environment and expertise.
Microbial flora on doctors' white coats.
Authors: D Wong, K Nye, P Hollis
Journal: BMJ (1991)

To determine the level and type of microbial contamination present on the white coats of doctors in order to assess the risk of transmission of pathogenic micro-organisms by this route in a hospital setting.Cross sectional survey of the bacterial contamination of white coats in a general hospital.East Birmingham Hospital, an urban general hospital with 800 beds.100 doctors of different grades and specialties.The cuffs and pockets of the coats were the most highly contaminated areas. The level of bacterial contamination did not vary with the length of time a coat had been in use, but it increased with the degree of usage by the individual doctor. Staphylococcus aureus was isolated from a quarter of the coats examined, more commonly from those belonging to doctors in surgical specialties than medical specialties. Pathogenic Gram negative bacilli and other pathogenic bacteria were not isolated.White coats are a potential source of cross infection, especially in surgical areas. Scrupulous hand washing should be observed before and after attending patients and it may be advisable to remove the white coat and put on a plastic apron before examining wounds. There is little microbiological reason for recommending a more frequent change of white coat than once a week, nor for excluding the wearing of white coats in non-clinical areas.
Congenital colonic stenosis diagnosed in adulthood
Authors: J. Baudet, I. Redondo, X. Arguiñarena, V. Castro, M. Alonso
Journal: Endoscopy (2010)

A 32-year-old immigrant woman presented with abdominal pains, nausea, and vomiting. She had not been able to expel gas or feces for 5 days. She had had constipation since birth and had experienced many episodes similar to the current bout. The patient had been hospitalized during infancy in her country, but the cause for her complaint had not been identified. She regularly took laxatives as required. On examination, her abdomen was bloated and tympanic with diffuse tenderness. The rest of the examination and laboratory tests were normal. An abdominal radiograph ([Fig. 1]) and computed tomography scan ([Fig. 2]) showed a dilated ascending and transverse colon, and oval lesions with a radiopaque peripheral ring in the upper left quadrant. Colonoscopy ([Fig. 3]) revealed stenosis of the splenic flexure, which was covered by normal mucosa. The patient underwent surgical resection. Histological studies revealed a normal colon with a 2-cm concentric stenosis of the wall and hypertrophy of the muscular layer. There were no inflammatory, ischemic, or neoplastic changes, or changes in the nerve plexuses, but calcified fecalomas were seen proximally. At 12 months of follow-up, the patient remains asymptomatic with daily bowel movements that do not require taking laxatives.
PNEUMONIA FROM INHALATION OF ZINC STEARATE TALCUM POWDER
Authors: William Edmonds
Journal: JAMA (1923)

A child, aged 8 months old, who was given a can of zinc stearate talcum to play with, was heard to cough, drawing the mother's attention. Talcum was found on the child's face and in its mouth. The mother washed out what she could, and then called me. I arrived in a few minutes, Nov. 18, 1922, and gave an emetic, which brought up some powder. The child seemed limp, with shallow respirations, and the pulse ranging about 90. At midnight the condition became rapidly worse. The lungs became congested, breathing was difficult, and the child moaned. The temperature rose to 104.6 and remained there in spite of treatment. High enemas brought gray and whitish discharges. The baby nursed until eighteen hours before the end, which came, November 20. The lungs were congested and filled with liquid. The temperature was 105, the respiration 97 and the pulse 105, according to
Loss of visual imagery: Neuropsychological evidence in search for a theory
Authors: Georg Goldenberg
Journal: Behavioral and Brain Sciences (2002)

Observations on patients who lost visual imagery after brain damage call into question the notion that the knowledge subserving visual imagery is “tacit.” Dissociations between deficient imagery and preserved recognition of objects suggest that imagery is exclusively based on explicit knowledge, whereas retrieval of “tacit” visual knowledge is bound to the presence of the object and the task of recognizing it.
Comparison of in vitro hydrolysis, subcutaneous and intramedullary implantation to evaluate the strength retention of absorbable osteosynthesis implants
Authors: Jarkko Vasenius, Seppo Vainionpää, Kimmo Vihtonen, Antero Mäkelä, Pentti Rokkanen, Matti Mero, Pertti Törmälä
Journal: Biomaterials (1990)
Reversible Ischemic Colitis After Intravenous Vasopressin Therapy
Authors: Michel Lambert
Journal: JAMA (1982)

VASOPRESSIN reduces splanchnic blood flow, decreases portal pressure, and has been used in the treatment of bleeding esophageal varices.<sup>1</sup>Severe complications may arise from its use, in particular, myocardial and small-bowel ischemia.<sup>2</sup>We recently observed reversible ischemic colitis in a patient who received intravenous (IV) vasopressin for variceal hemorrhage. <h3>Report of a Case</h3> A 54-year-old man with alcoholic cirrhosis was admitted to the Hôpital Cantonal of Geneva because of hematemesis. There was no history of angina, claudication, or hypertension. The patient was conscious and oriented, with a pulse rate of 80 beats per minute and a blood pressure of 120/70 mm Hg. Hepatosplenomegaly was present without ascites. Bowel sounds were normal. Initial laboratory values included the following: hematocrit, 35%; leukocytes, 7,200/cu mm; platelets, 59,000/cu mm; prothrombin time, 14.2 s (control, 12 s); BUN, 18 mg/dL; sodium, 138 mEq/L; potassium, 4.3 mEq/L; chloride, 104 mEq/L; total serum bilirubin, 2.9
SERIAL ANGIOGRAPHIC FOLLOW-UP AFTER SUCCESSFUL IMPLANTATION OF SIROLIMUS-ELUTING STENT AND PACLITAXEL-ELUTING STENT FOR CHRONIC TOTAL OCCLUSIONS: MULTICENTER REGISTRY IN ASIA
Authors: Sunao Nakamura, Hisao Ogawa, Jang-Ho Bae, Yeo Hans Cahyadi, Wasan Udayachalerm, Damras Tresukosol, Sudaratana Tansuphaswadikul
Journal: Journal of the American College of Cardiology (2010)
Teaching Touch at Medical School
Authors: Jules Older
Journal: JAMA (1984)

The association between touch and healing is ancient and worldwide. Skilled hands are among the physician's most important diagnostic and therapeutic tools. Yet a survey of medical schools in the English-speaking world revealed that most offer no touch training in their curricula. Of 169 medical schools, only 12 give any formal instruction in the uses and meaning of therapeutic touch in medicine. The teaching modes of these 12 schools are discussed, and the program of the most touch-conscious school, the University of Otago, is described.
CHROMATOGRAPHIC PATTERNS OF INDIVIDUAL GASTRIC JUICE SPECIMENS FROM NORMAL HUMAN SUBJECTS*
Authors: Jack D. Welsh, Lois Russell, Stewart Wolf
Journal: Journal of Clinical Investigation (1962)

Separation of the large molecular components of pooled human gastric juice into fractions of different biological activity by means of the Am- berlite IRC-50 resin column has been reported earlier (1-6).In the present study a modification of this technic has been adapted to the fractionation of individual specimens of gastric juice.These modifications have improved and further standardized the older method. METHODGastric juice was obtained from fasting healthy sub- jects through a nasogastric tube by means of constant hand suction (7).The subjects were encouraged to avoid swallowing saliva.The overnight residual and the material aspirated during the first 10 to 15 minutes were discarded.Basal secretion was then collected for 0.5 hour, after which collections were continued for an additional 75 minutes with or without stimulation by either histamine sulfate (0.01 mg per kg, s.c.) or regular insulin (10 U, iv.).The samples were kept cold and filtered through Pyrex wool.The volume of each speci- men was recorded in milliliters.The titratable acidity was determined against Topfer's reagent and phe- nolphthalein.The specimens obtained from a single in- dividual prior to and after stimulation were then sepa- rately pooled, dialyzed at 40 C against five changes of distilled water for 48 hours, and lyophilized (2).The content of hexose (8) and total proteolytic activity (9) of the lyophilized material was determined.The hexoses were expressed in milligrams per 100 mg of nondialyz- able lyophilized gastric solids.The proteolytic activity (proteolytic units, PU) was recorded in PUHb X 10' per mg of nondialyzable lyophilized gastric solids.Fifty mg of the dialyzed and lyophilized material was dis- solved in 1 ml of a pH 3.0 buffer and kept for 24 hours at 40 C. The material was warmed to room temperature and loaded on an Amberlite IRC-50 resin column, 1 X 11
Mechanisms of anemia.
Authors: Louis R. Limarzi
Journal: JAMA (1963)

This volume contains a series of ten lectures given in a seminar at the University of California, Los Angeles, in December, 1959. The material has been expanded and updated and aimed at clinicians, house officers, and medical students who wish to gain further insight into the basic mechanisms of anemia. The subjects covered deal with the morphologic, physiologic, biochemical, and immunologic aspects of normal and abnormal red blood cells. There is an excellent chapter, "Autoimmune Hemolytic Disease," with a discussion of the uses and limitations of the Coombs test. There are well-selected chapters, such as "Iron Metabolism and Iron Deficiency Anemia" and "Anemia and the Spleen," with a discussion of clinical syndromes associated with disturbed splenic function. The authors, each an expert in his field, are permitted to expand fully on a topic of their own special interest and inject their personal evaluation and experience. Based on the most recent