tbuckley/cabot-search huggingface dataset:
Reviews and Notes: Legal Medicine: The Girl Who Died Twice. Every Patient's Nightmare: The Libby Zion Case and the Hidden Hazards of Hospitals
Authors: R. Scott Wright
Journal: Annals of Internal Medicine (1996)

Literature of Medicine15 December 1996Reviews and Notes: Legal Medicine: The Girl Who Died Twice. Every Patient's Nightmare: The Libby Zion Case and the Hidden Hazards of HospitalsR. Scott Wright, MDR. Scott Wright, MDMayo Clinic, Rochester, MN 55905.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-12-199612150-00038 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail N Robins. 352 pages. New York: Delacorte Pr; 1995. $22.95. ISBN 0-385-30809-4. Order phone 800-323-9872.Future generations will attribute changes in graduate medical education to the Libby Zion case, just as the Flexner Report has been credited with altering the curriculum of undergraduate medical education. We do not question the rationale for, the need for, the effects on public safety caused by, and the educational merits of the changes produced by the Flexner Report, but I do not find much evidence that similar credit has been extended to the Zion Case. Little available work summarizes the facts, feelings, and events ... Author, Article, and Disclosure InformationAffiliations: Mayo Clinic, Rochester, MN 55905. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLiability of the Sleep-Deprived Resident 15 December 1996Volume 125, Issue 12Page: 1023-1024KeywordsGraduate medical educationHealth careHealth care qualityMedical educationMotivationNursing administrationPatientsPrevention, policy, and public healthSafetySleep deprivation ePublished: 15 August 2000 Issue Published: 15 December 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
US panel recommends young children receive hepatitis A vaccination
Authors: Fred Charatan
Journal: BMJ (2005)

The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention has recommended that all children in the United States between the ages of 1 and 2 years receive a two dose vaccination against the hepatitis A virus.

Hepatitis A vaccines were first licensed in 1995. Since 1999 the government has recommended hepatitis A vaccinations for children in 17 states where rates of the disease were highest. But the success of these campaigns seems to have levelled off, and health officials fear rates might rebound.

About …
Extensive Peritoneal Uptake of Technetium-99m-Labelled Hydroxy Diphosphonate in a Patient Undergoing Hemodialysis
Authors: Maria Mesquita, Christelle Fosso, Francesco Moretti, Dimitri Calembert, Nasroolla Damry, Pierre Bergmann
Journal: Clinical Nuclear Medicine (2011)

A 48-year-old African lady started peritoneal dialysis in 1994 after transplant failure. After several episodes of peritonitis and hemorrhagic ascites, hemodialysis was resumed in 2003 because of small bowel subocclusion. In 2006, an abdominal CT showed calcifications and dilatation of intestinal loops. Sclerosing peritonitis was diagnosed and she underwent enterolysis and resection of the peritoneal capsule. She remained asymptomatic until 2009 when she presented again with subocclusion. Because of generalized skeletal pain, a bone scan was performed, which showed Tc-99m hydroxy diphosphonate uptake on the peritoneum. The patient is currently on hemodialysis with parenteral nutrition.
EXPOSURE OF THE BRACHIAL PLEXUS WITH NERVE-TRANSPLANTATION
Authors: HOWARD K. TUTTLE
Journal: JAMA (1913)

<h3>Patient.</h3> —John P., white, single, aged 30, Polish laborer, was examined Oct. 30, 1912; family and past history were negative. He got into a brawl, Sept. 21, 1912, and received a stab-wound at the base of the neck, above the left clavicle. He was taken to a near-by hospital, and the wound, together with another slight stab-wound of the back, was closed with sutures. Immediately following the injury he had complete motor and partial sensory paralysis of the left arm. He was kept at the hospital for one month, was told that he might require further operation, and then transferred to the city farm, whence he was admitted to the state infirmary. According to patient's statement there was still an area of anesthesia over the arm and shoulder, the strength of his hand was coming back, but he had complete paralysis of the left arm. <h3>Physical Examination.</h3> —At the posterior
Re: Consolidation Therapy With Autologous Bone Marrow Transplantation in Adults With Acute Myeloid Leukemia: A Meta-analysis
Authors: I. Levi, I. Grotto, R. Yerushalmi, I. Ben-Bassat, O. Shpilberg
Journal: JNCI Journal of the National Cancer Institute (2004)

The comprehensive meta-analysis reported by Nathan et al. (1) used comparable methods and produced results similar to those in our recent meta-analysis (2), which dealt with the same group of patients and clinical trials.Despite these similarities, the authors of the two studies reached different conclusions.Nathan et al. concluded that the data did not support the routine use of autologous bone marrow transplantation (ABMT) in adult
Alcohol intake and risk of oesophageal adenocarcinoma: a pooled analysis from the BEACON Consortium
Authors: N. D. Freedman, L. J. Murray, F. Kamangar, C. C. Abnet, M. B. Cook, O. Nyren, W. Ye, A. H. Wu, L. Bernstein, L. M. Brown, M. H. Ward, N. Pandeya, A. C. Green, A. G. Casson, C. Giffen, H. A. Risch, M. D. Gammon, W.-H. Chow, T. L. Vaughan, D. A. Corley, D. C. Whiteman
Journal: Gut (2011)

<h3>Background and aims</h3> Alcohol intake is a strong and well established risk factor for oesophageal squamous cell carcinoma (OSCC), but the association with oesophageal adenocarcinoma (OA) or adjacent tumours of the oesophagogastric junction (OGJA), remains unclear. Therefore, the association of alcohol intake with OSCC, OA, and OGJA was determined in nine case–control studies and two cohort studies of the Barrett9s Esophagus and Esophageal Adenocarcinoma Consortium (BEACON). <h3>Materials and methods</h3> Information was collected on alcohol intake, age, sex, education, body mass index, gastro-oesophageal reflux, and tobacco smoking from each study. Along with 10 854 controls, 1821 OA, and 1837 OGJA, seven studies also collected OSCC cases (n=1016). Study specific ORs and 95% CIs were calculated from multivariate adjusted logistic regression models for alcohol intake in categories compared to non-drinkers. Summary risk estimates were obtained by random effects models. <h3>Results</h3> No increase was observed in the risk of OA or OGJA for increasing levels of any of the alcohol intake measures examined. ORs for the highest frequency category (≥7 drinks per day) were 0.97 (95% CI 0.68 to 1.36) for OA and 0.77 (95% CI = 0.54 to 1.10) for OGJA. Suggestive findings linked moderate intake (eg, 0.5 to &lt;1 drink per day) to decreased risk of OA (OR 0.63, 95% CI 0.41 to 0.99) and OGJA (OR 0.78, 95% CI 0.62 to 0.99). In contrast, alcohol intake was strongly associated with increased risk of OSCC (OR for ≥7 drinks per day 9.62, 95% CI 4.26 to 21.71). <h3>Conclusions</h3> In contrast to OSCC, higher alcohol consumption was not associated with increased risk of either OA or OGJA. The apparent inverse association observed with moderate alcohol intake should be evaluated in future prospective studies.
PTU-255 Is the service provision of direct access upper GI endoscopy being used effectively beyond 2010?
Authors: S Mahmood, S Singh, M Naseer, S Sarkar
Journal: Gut (2012)

<h3>Introduction</h3> Upper GI Endoscopy can generate significant income through payment by results (PBR) in the UK. Primary care physicians have a direct access for endoscopy via open access (GPOA) or 2-week rule (2WR) systems and appropriateness of these lists have been long-debated. With the current financial cut backs within the NHS, it is worthwhile to re-evaluate their effectiveness. <h3>Aim</h3> To assess the effectiveness of GPOA/2WR upper GI Endoscopy service. <h3>Methods</h3> Retrospective audit of GPOA and 2WR lists between April and October 2011 was performed. 483 referrals were audited (n=400 2WR, n=83 GPOA) for patient demographics, indications, significant diagnosis, additional tests and patient outcomes. <h3>Results</h3> <b>2WR—Patients</b>: Audit capture rate 86%. Median age of the patient was 65 years (range 18–96), 58% were Females, with median ASA 2. NICE criteria for referrals was not met in 12% and a further 14% had a gastroscopy within 3 years. Outcomes: Significant diagnoses (cancer, oesophagitis, Barretts, PUD, Coeliac Disease, Stricture, <i>Helicobacter pylori</i> gastritis) were present in 44% (cancer diagnosis 3.4%). An endoscopy urease test was performed in 48%, with a 30% positivity rate. Biopsies were taken in 64%. 86% were discharged back to the GP, 4% were referred to clinic, 6% booked for a repeat endoscopy and 4% referred to cancer MDT. <b>GPOA Patients</b>: Audit capture rate was 96% referrals. Patients were younger than the 2WR with median age 52 years (range 17–86) (p=0.0001), and healthier with median ASA 1 (p=0.0001). 53% were females. 31% of patients did not meet NICE guidelines and 4% had a gastroscopy within 3 years. <b>Outcomes</b>: Significant diagnoses were made in 29.9% (cancer diagnosis 1.2%). While the cancer diagnoses with 2WR was comparable (p=0.2), there were less benign diagnoses (p=0.01). Additional tests included urease test in 19%, positivity rate 20% and biopsies 14%. Patient outcomes were similar to 2WR with 88% of patients discharged directly back to GP, 6% booked for a repeat endoscopy, 4% referred to Gastroenterology Clinic and 2% to a cancer MDT. Overall, 51 patients (12%) had a previous endoscopy within 3 years, none of which had cancer and 83 patients (19%) did not meet NICE guidelines that is, 31% were inappropriate. <h3>Conclusion</h3> With 31% of patients being inappropriate and low cancer pick up rate, the value of these lists may be questionable. However, benign pathology was significant in both lists and therefore process mapping the patient to see if the endoscopy changed the patient9s management would be useful given the very high discharge rate to the GP. There still remains significant room for improving the effective use of these services. <h3>Competing interests</h3> None declared.
Bilateral Testicular Tumors in Untreated Congenital Adrenocortical Hyperplasia
Authors: Jerry M. Earll
Journal: JAMA (1969)

Congenital adrenal hyperplasia in a 40-year-old man was undiagnosed until bilateral interstitial cell tumors of the testicles developed. Adrenal insufficiency developed following excision of the testicular tumors. Studies led to diagnosis of congenital adrenal hyperplasia. Surgical exploration for a hemorrhagic adrenal cyst allowed comparison of adrenal and testicular tissue. Testicular tumor histological findings were not similar to those of the adrenal gland. The association of testicular interstitial cell tumors with chronic excess adrenocorticotropic hormone (ACTH) stimulation is rare but has been reported.
Advanced glycation end products in the skin are enhanced in COPD
Authors: Susan J.M. Hoonhorst, Adèle T. Lo Tam Loi, Jorine E. Hartman, Eef D. Telenga, Maarten van den Berge, Leo Koenderman, Jan Willem J. Lammers, H. Marike Boezen, Dirkje S. Postma, Nick H.T. ten Hacken
Journal: Metabolism (2014)
Evidence for damage control resuscitation is lacking
Authors: M. D. Wiles
Journal: BMJ (2012)

The authors of this clinical review advocate damage control resuscitation (DCR) and permissive hypotension in multiply injured patients,1 but good evidence is lacking.

Much of the evidence for permissive hypotension has been extrapolated from animal studies. Although the largest human study cited by the authors suggested some benefit from a DCR strategy, there were …
Women and halfe witted men
Authors: Jeremy Hugh Baron
Journal: BMJ (2004)

DiscussionThe exact pathophysiology of pituitary swelling in apoplexy is uncertain, but, histologically, ischaemic necrosis or haemorrhage is usually present or sometimes both. 4 General anaesthesia and surgery, especially cardiac surgery, expose patients to risk factors for apoplexy of a pituitary tumour.These include embolisation, mechanical ventilation, labile blood pressure, coughing, anticoagulation, and crystalloid haemodilution. 8-11 The cases presented are therefore representative of a population at risk of pituitary apoplexy.Signs and symptoms of pituitary apoplexy result from acute compression of perisellar structures, endocrinopathy, and meningeal irritation.Four in five patients present with a visual field defect, but, contrary to popular teaching, only half have a bitemporal hemianopia. 4Our first patient was not unusual in having one eye more profoundly affected than the other.This was due to asymmetrical compression of the chiasm and optic nerves.We could not formally quantify the visual field defects because the patients were too unstable to leave their beds and too unwell to give reliable results in such investigations.This problem is likely to be seen often in patients who have recently had major surgery.Simple bedside examination of visual acuity, pupil reactions, and visual fields can be enough to identify the underlying pathology.Ophthalmoplegia is a useful sign in conjunction with a sellar mass because it indicates apoplexy rather than a simple adenoma.This is caused by the mass having extended laterally into the cavernous sinus.Three quarters of apoplexy cases present with an eye movement abnormality, 2 but this was absent in our cases.Recognising that acutely expansile pituitary lesions may not cause papilloedema or optic atrophy is important.The discs were normal in both of our cases.A pituitary mass may compromise hypothalamic function leading to impaired regulation of blood pressure, temperature, cardiac rhythm, and level of consciousness.These changes may be falsely attributed to the iatrogenic effects of surgery and general anaesthesia.In patients with reduced consciousness it may not be possible to get a history of endocrine dysfunction.Amenorrhoea, gynaecomastia, impotence, and weight gain should specifically be asked about.Symptoms of endocrinopathy have been found in over a third of cases of pituitary apoplexy. 2 5We discovered a history of endocrine dysfunction in case 2 only when the patient had recovered from the acute illness.In case 1 we found hyponatraemia-an important biochemical clue of endocrinopathy-present in 75% of patients at presentation. 6This probably reflects an established adrenocorticotrophic hormone deficiency and hypoaldosteronism.Meningeal irritation caused by extravasated blood in the subarachnoid space can lead to diagnostic confusion.The commonest misdiagnosis is an intracranial aneurysm with subarachnoid haemorrhage. 4The differential diagnosis includes meningitis, cerebrovascular accident, cerebral metastatic disease, cavernous sinus thrombosis, and transtentorial herniation.The
Predictive value of ALT levels for histologic findings in chronic hepatitis C: A European collaborative study
Authors: Pierre Pradat, Alfredo Alberti, Thierry Poynard, Juan-Ignacio Esteban, Ola Weiland, Patrick Marcellin, Salvatore Badalamenti, Christian Trépo
Journal: Hepatology (2002)

The aim of this retrospective study was to determine the predictive value of alanine aminotransferase (ALT) levels for histologic findings in patients with chronic hepatitis C virus (HCV) infection. Data on 864 HCV RNA-positive patients were collected. ALT values were obtained at the time of biopsy (before treatment), and normal ALT values were defined as normal values obtained at serial evaluations during a 6-month period. Histologic results were scored using the METAVIR system. Among all patients, 99% of those with elevated ALT levels had a score of at least F1 (positive predictive value [PPV], 99%) and 88% had a score greater than A1F1. Among patients with persistently normal ALT values, 65% had a score of at least F1 (negative predictive value [NPV], 35%) and 26% had a score greater than A1F1. The receiver operating characteristics analysis indicates that the ALT threshold for the best compromise sensitivity-specificity was about 2.25 times the upper limit of normal (ULN). In conclusion, almost all HCV RNA-positive patients with elevated ALT levels have some degree of fibrosis. However, an important proportion of patients with persistently normal ALT levels also show some histologic signs of fibrosis; the degree of fibrosis is usually mild but is sometimes more marked, and in rare cases cirrhosis may be present. In this subset of patients, the indication of liver biopsy and the potential benefit of therapy need to be further evaluated. These results suggest the need to revisit the algorithm for liver biopsy practice.
1002-85 Utility of Unique Projections in Dynamic Transthoracic Three-Dimensional Echocardiography in the Pre- and Post-Operative Delineation of Lesions Associated with Tetralogy of Fallot in Neonates and Infants
Authors: Gerald Marx, Michael Vogel, Achi Ludomirski, Lissa Sugeng, Oi-Ling Cao, Alain Delabays, Barbara Romero, David Fulton, Natesa Pandian
Journal: Journal of the American College of Cardiology (1995)
A prospective cohort study of vertical pressure on hands of sitting volleyball players using tekscan pressure mat
Authors: JM Zhang, D Bader, R Twycross-Lewis, N Padhiar
Journal: British Journal of Sports Medicine (2011)

Introduction Current sports medicine knowledge of sitting volleyball injuries in the UK is poor. This prospective pilot study looks at vertical pressures exerted on the hands of sitting volleyball players in controlled movements and compares them to a prospective survey of blister incidences. Method The pilot study was conducted in Mile End Hospital, London. Using Tekscan F-mat 3150, the researcher recorded peak vertical pressure on volunteer sitting volleyball players. 12 months prospective survey collected demographic data and blister incidences on player volunteers. Results Data from pressure readings generated a geographical model of typical peak pressures on the hand. The data from the prospective survey generated a geographical map of blister hotspots. The locations of peak vertical pressure correlated with blister hotspots on the hands. Pressure readings from the small volunteer group showed highest peak pressure reading over the proximal aspect of the palm-hypothenar eminence. Real time trajectory of the centre of force was between pisiform and scaphoid of the thenar hypothenar eminences in large portion of the real time trajectory path before transferring to the 2nd and 3rd fingers via the metacarpalphalangeal joints. The lack of recruitment numbers for the pressure readings reduced the accuracy of the data such that the results were more descriptive in nature. Conclusion Indication from this pilot study suggests that sitting volleyball hand movements can be assessed using gait analysis techniques with a pressure sensitive mat. Further research is recommended.
Neonatal screening for cystic fibrosis in Brittany, France: assessment of 10 years' experience and impact on prenatal diagnosis
Authors: Virginie Scotet, Marc de Braekeleer, Michel Roussey, Gilles Rault, Philippe Parent, Michel Dagorne, Hubert Journel, Auguste Lemoigne, Jean-Pierre Codet, Michel Catheline, Véronique David, André Chaventré, Ingrid Duguépéroux, Claudine Verlingue, Isabelle Quéré, Bernard Mercier, Marie-Pierre Audrézet, Claude Férec
Journal: The Lancet (2000)
377 GENOMIC CHANGES IN HEPATITIS B VIRUS ASSOCIATED WITH THE DEVELOPMENT OF HEPATOCELLULAR CARCINOMA: A COHORT STUDY IN PATIENTS WITH CHRONIC HEPATITIS B OF GENOTYPE C2
Authors: H. Lyu, Y.-H. Chung, J.A. Kim, D. Lee, J.-H. Lee, P. Mathews, Y.-J. Jin, W. Park, E. Jaffee, L. Zheng, E. Yu, Y.J. Lee
Journal: Journal of Hepatology (2011)
Rheumatoid arthritis synovial membrane contains a 62,000-molecular-weight protein that shares an antigenic epitope with the Epstein-Barr virus-encoded associated nuclear antigen.
Authors: R Fox, R Sportsman, G Rhodes, J Luka, G Pearson, J Vaughan
Journal: Journal of Clinical Investigation (1986)

A monoclonal antibody, selected for reactivity with the Epstein-Barr virus (EBV)-encoded antigen EBNA-1, exhibited strong reactivity with the synovial lining cells in joint biopsies from 10 of 12 patients with rheumatoid arthritis (RA) and adherent cells eluted from these tissues. No staining of RA synovial membrane frozen tissue sections or eluted synovial-lining cells was obtained with monoclonal antibodies directed against other EBV-encoded antigens (anti-p160, anti-gp200/350) or with monoclonal antibodies directed against antigens encoded by cytomegalovirus, herpes simplex viruses, or human T cell leukemia virus type I. Among 12 osteoarthritis and normal synovial biopsies only rare reactive cells were noted. Characterization of the antigen(s) in RA synovium by the Western immunoblotting technique revealed a 62,000-molecular-weight (mol-wt) protein, in contrast to the 70,000-85,000-mol-wt EBNA-1 antigen found in EBV-transformed cells. The structural basis for the cross-reactivity of the RA synovial membrane 62,000-mol-wt protein and the EBNA-1 antigen appears to reside in the glycine-alanine rich region of these molecules. A rabbit antibody directed against a synthetic peptide (IR3-VI-2) derived from the glycine-alanine-rich region of EBNA-1 reacted with the 70,000-85,000-mol-wt EBNA-1 antigen in EBV-infected cells and with the 62,000-mol-wt molecule in RA synovial membrane extracts. Since strong antibody responses to EBNA-1 are known to exist in RA patients, these results suggest that immune responses to a cross-reactive antigen may play a role in the pathogenesis of RA.
Repeat prescribing of non-steroidal anti-inflammatory drugs excluding aspirin: how careful are we?
Authors: K Steele, K A Mills, A E Gilliland, W G Irwin, A Taggart
Journal: BMJ (1987)

About 5% of all National Health Service prescriptions in Britain and a quarter of reports of suspected adverse reactions are accounted for by non-steroidal anti-inflammatory drugs. Their prescription was investigated in two computerised group practices serving 11850 patients. Altogether 198 patients receiving repeat prescriptions of non-steroidal anti-inflammatory drugs were identified and relevant clinical details extracted from their notes. Of these patients, 119 were over 65 years old; 172 were receiving one of six different non-steroidal anti-inflammatory drugs; and 76 were taking drugs that can interact with non-steroidal anti-inflammatory drugs. Ninety one patients had one or more medical conditions that may be aggravated by non-steroidal anti-inflammatory drugs, and 36 had experienced side effects important enough for their treatment to be changed. A questionnaire to assess opinions and knowledge of non-steroidal anti-inflammatory drugs was given to 42 general practitioners and 26 rheumatologists. Although the two groups showed a comparable knowledge of the properties and costs of non-steroidal anti-inflammatory drugs, they differed significantly in their views on the circumstances under which these drugs should be used. Clear guidelines on the prescription of these drugs would indicate when careful monitoring is essential for patients to benefit from them safely.