tbuckley/cabot-search huggingface dataset:
Soundings: Glue, spark, or string?
Authors: Colin Douglas
Journal: BMJ (2003)

Or is it more like just oiling the wheels? Money, it seems, comes into it, with more than a suspicion that it might be funny money: the now-you-see-it-now-you-don't kind that appeared when fundholding began, then vanished, mirage-like, as later applicants were punished for their tardiness.

So, glue, spark, string (all analogies were on offer), or just money? Even after a three hour session with an enthusiastic team from Edinburgh, few of us here in Auchendreich were much the wiser about the Scottish Executive's latest nostrum for the transformation of our NHS: the managed clinical consortium (MCC).

Certainly the MCC presentation was impressive, not just for its virtuoso PowerPoint. Drawing on all the latest management theory, MCCs will, we were told, offer low friction, high gain, information rich, user friendly virtual networks that cross boundaries, transcend distance, and maximise added value over entire clinical journeys through complex healthcare systems.

“Eh, does that mean we're all going to be told what to do?” a urologist asked. The lead presenter smiled. “That's a question that comes up quite often. No, not at all. Clinically led, fully automated quality control systems are fundamentally supportive, with compliance and significant aberrance handled alike in strict confidence, through anonymised datasets, coded feedback, and lockdown password control.”

The urologist nodded thoughtfully. There was no stopping the lead presenter: “If anything, most clinicians feel liberated by what MCCs can do. And while they're not a panacea... ” To our surprise she went on to cite more than a dozen problems they might address, including waiting lists, consultant understaffing, and—intriguingly—the European working time directive.

Any worries? Well, the pilot consortium had met difficulties arising from the 59 different IT systems in use; and burnout was a significant issue for both IT people and clinical leadership. But such minor matters were essentially front loaded and transitional, with no real bearing on the national rollout of a brand new initiative of limitless potential.

As evening sunlight flooded the chairman's hospitality suite in our otherwise cramped new PFI, the meeting drew to its close. Evangelical fervour had won no converts. Discussion had elicited the kind of scepticism to be expected in Auchendreich. So, as with all NHS fads, Auchendreich will simply wait and see.
PTU-134 An audit of ercp in a dgh hospital in which ptc is not practiced
Authors: V Manda, V Blackhall, S Gibson, C Sharp, K Robertson
Journal: Gut (2015)

<h3>Introduction</h3> The audit was undertaken to provide accurate success and complication rates to patients undergoing ERCP. Although PTC is available within the Health Board it is not practiced in the endoscopist’s base hospital. Laparoscopic bile duct exploration is normally reserved for cases of failed endoscopic stone clearance. <h3>Method</h3> Consecutive procedures from a single endoscopist’s practice were included. Data on indications, results and early complications were collected prospectively. <h3>Results</h3> 162 procedures from an 8 months period were studied. In 119 (73%) the ampulla was intact (no earlier sphincterotomy). The majority of cases, 112 (69%), were undertaken for gallstone disease, 36 (22%) for cancers and 9 (6%) for post surgical biliary leaks. One each was performed for sphincterotomy stenosis, stent within the CBD and blood clot. In 2 cases cholangiography showed no pathology but in each there had been concern of choledocholithiasis and MRI was contraindicated by cardiac pacemaker. In 10 cases biliary cannulation failed; 6.2% of all cases and 8.4% of intact ampullae. Only four were repeated, each with success. Of the remaining 6, 3 had massive duodenal distortion from cancers and required PTC. For one the treating surgeon elected surgery in the form of cholecystectomy and choledocho-duodenostomy. One was during stent removal after treatment of cystic duct stump leak and was not pursued when the patient became restless. The last died of unrelated causes awaiting repeat procedure. There were no deaths during the immediate post-operative period. Complications occurred in 19 (12%) of procedures. The commonest complication was acute pancreatitis. It occurred in 13 (8.0%) cases of which 12 were mild and quickly self-limiting. In the other, respiratory failure responded to conservative measures. No surgical or radiological intervention was required. In 3 (1.9%) cases bleeding occurred requiring laparotomy, endostasis and transfusion in one case each. Two (1.2%) cases had post-operative sepsis requiring intravenous antibiotics. There was one iatrogenic perforation of a hiatus hernia that was successfully managed conservatively. Complications occurred in 7.0% (3 complications) of procedures with earlier sphincterotomy compared to 13.4% (16 complications) of procedures where the ampulla was intact. Bleeding, perforation and severe pancreatitis only complicated those cases where the ampulla was intact. <h3>Conclusion</h3> ERCP can be practiced successfully in a DGH setting but complication rates are not insignificant. Complications are twice as common in those having an intact ampulla and may be more severe in this group. <h3>Disclosure of interest</h3> None Declared.
Effects of the cholecystokinin agonist pentagastrin in patients with generalized anxiety disorder
Authors: O Brawman-Mintzer, R B Lydiard, J Bradwejn, G Villarreal, R Knapp, N Emmanuel, M R Ware, Q He, J C Ballenger
Journal: American Journal of Psychiatry (1997)

The anxiogenic and panicogenic effects of peripheral administration of the cholecystokinin-B receptor agonist pentagastrin and placebo were evaluated in patients with generalized anxiety disorder and normal comparison subjects.Seven patients with generalized anxiety disorder and seven age- and sex-matched normal subjects received an intravenous bolus of placebo and pentagastrin.Panic attacks occurred in five patients with generalized anxiety disorder (71%) and in one normal subject (14%). Patients with generalized anxiety disorder were more likely to report more nonpanic anxiety than were normal subjects.Patients with generalized anxiety disorder appear to exhibit greater subjective sensitivity to pentagastrin than do normal subjects.
The effect of living alone on bereavement symptoms
Authors: P J Clayton
Journal: American Journal of Psychiatry (1975)

The author reports on a study of widows and widowers who were followed for one year after the deaths of their spouses. The study shows that bereavement itself rather than the effects of living alone influences the occurrence of depressive symptoms in widows and widowers at one month. The data gathered also support the idea that younger people who have lost a spouse tend to show more physical depressive symptoms and to require hospitalization more often than either matched married controls or older widows and widowers at one year.
Induction of Tumors in Syrian Hamsters by a Cytopathogenic Virus Derived From a C3H Mouse Mammary Tumor&lt;xref ref-type="fn" rid="FN1"&gt;2&lt;/xref&gt;
Authors: A. A. Axelrad, E. A. McCulloch, A. F. Howatson, A. W. Ham, L. Siminovitch
Journal: JNCI Journal of the National Cancer Institute (1960)

Tumors of the kidney and heart have been induced, by a cytopathogenic virus, in Syrian hamsters. The virus, which had been recovered in tissue culture from an extract of a C3H/Jax mouse mammary tumor and serially cultivated in vitro on normal mouse cells, was injected subcutaneously into the hamsters on their 1st day of life. In 3 experiments with both random-bred and partly inbred hamsters, over 90 percent of animals died with tumors. Mortality was highest around the 12th day after the animals received the virus, and at autopsy, in most of the animals, both kidneys were massively enlarged and diffusely infiltrated with tumor. A second, lower peak incidence of death occurred around the 19th day; in these animals, nodular tumors of the kidney and heart were found. The tumors were spindle-cell sarcomas which were locally invasive and many metastasized to the lungs. A number of these tumors grew progressively after transplantation into adult hamsters and killed their new hosts. Hemorrhage into the peritoneal and pleural cavities was common in animals that died with extensive tumors after receiving the virus. Localized vascular dilatations were also commonly found in the liver, lungs, intestine, and reproductive organs of these animals. At the surface of the liver and lungs, the dilatations formed blood-filled blebs, and rupture of these blebs probably led to the hemorrhages that were observed. Newborn hamster controls that received supernatant fluid from cultures of normal mouse kidney cells, normal monkey kidney cells, or fresh culture medium developed no tumors during the first 10 weeks thereafter. A number of animals that received fluid from normal mouse kidney cultures were retained for 5½ months and they remained free of tumors. However subcutaneous tumors developed in a number of animals that received fluid from monkey kidney cultures and in one that had received fresh medium only, after a long latent period, which indicated that these animals had somehow received a small dose of virus. The results demonstrate an extraordinarily rapid and regular induction of malignancy by a mammalian tumor virus.
A rare cause of biliary colic
Authors: Ahmed Altonbary, Monir Bahgat
Journal: Endoscopy (2015)

A 29-year-old woman presented to our center for the evaluation of recurrent biliary colic. Abdominal ultrasound revealed mild dilatation of the common bile duct (CBD) apparently with a small stone at its distal end ([Fig. 1]). The patient underwent endoscopic retrograde cholangiopancreatography (ERCP), which showed mild dilatation of the CBD but no stones. A horizontal filling defect was observed at the distal end of the CBD ([Fig. 2]). Lateral fluoroscopic examination showed a small biliary web ([Fig. 3]). During a sweep of the CBD with the extraction balloon, mild resistance was encountered at the site of the web, which was then dilated with the balloon ([Fig. 4]).
Fluconazole Under Review
Authors: Rebecca Voelker
Journal: JAMA (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
­­­­­­N-Me, a Long Range T-Cell Specific Oncogenic Enhancer in T-ALL
Authors: Daniel Herranz, Alberto Ambesi-Impiombato, Teresa Palomero, Stephanie A. Schnell, Laura Belver, Agnieszka A. Wendorff, Luyao Xu, Mireia Castillo-Martin, David Llobet-Navas, Carlos Cordon-Cardo, Emmanuelle Clappier, Jean Soulier, Adolfo A. Ferrando
Journal: Blood (2014)
PWE-166 CT response to neo-adjuvant chemotherapy as a predictor of survival following resection of oesophageal adenocarcinoma
Authors: M Pringle, S Sheridan, S Ballantyne, P Glen
Journal: Gut (2015)

<h3>Introduction</h3> Consensus management for oesophageal adenocarcinoma is currently neo-adjuvant chemotherapy (NAC) followed by resection. The importance of staging following NAC has become more apparent, and currently staging which occurs post NAC is by CT imaging. We aimed to determine if CT response to NAC predicted survival in patients with oesophageal adenocarcinoma. <h3>Method</h3> A retrospective analysis of consecutive patients who underwent oesophageal resection. Clinico-radiological data was identified and pre and post NAC MDT reports were reviewed to assess response to NAC. Patients were grouped into improved, static or deterioration. Survival was calculated for each group and Kaplan-Meier analysis performed. <h3>Results</h3> One hundred and sisty nine patients underwent NAC and resection between June 2008 and Jan 2014, with radiological data being available for 150. 65 (43%) patients showed improved CT response, 75 (50%) had static disease and 5 (3%) deterioration. 5 (3%) patients scans were inaccessible. Median survival for the group that showed response was 35 months compared to 30 months for static disease (deterioration group: incalculable). This difference was not statistically significant (p = 0.638). Kaplain-Meier analysis showed a non-significant trend towards increased survival in the response group. <h3>Conclusion</h3> In our cohort, CT response to NAC did noes not significantly predict survival in patients with oesophageal carcinoma although a trend is demonstrated. This may be due to oedema round the tumour at time of post NAC scan or tumour replacement with fibrosis which may look similar. With an increasing emphasis on staging post neo-adjuvant chemotherapy, the predictive value of post-NAC functional imaging such as PET needs to be explored. <h3>Disclosure of interest</h3> None Declared.
Oseltamivir-resistant influenza viruses circulating during the first year of the influenza A(H1N1)2009 pandemic in the Asia-Pacific region, March 2009 to March 2010
Authors: A C Hurt, Y M Deng, J Ernest, N Caldwell, L Leang, P Iannello, N Komadina, R Shaw, D Smith, D E Dwyer, A R Tramontana, R T Lin, K Freeman, A Kelso, I G Barr
Journal: Eurosurveillance (2011)

During the first year of the influenza A(H1N1) 2009 pandemic, unprecedented amounts of the neuraminidase inhibitors, predominantly oseltamivir, were used in economically developed countries for the treatment and prophylaxis of patients prior to the availability of a pandemic vaccine. Due to concerns about the development of resistance, over 1,400 influenza A(H1N1) 2009 viruses isolated from the Asia-Pacific region during the first year of the pandemic (March 2009 to March 2010) were analysed by phenotypic and genotypic assays to determine their susceptibility to the neuraminidase inhibitors. Amongst viruses submitted to the World Health Organization Collaborating Centre for Reference and Research in Melbourne, Australia,oseltamivir resistance was detected in 1.3% of influenza A(H1N1) 2009 strains from Australia and 3.1% of strains from Singapore, but none was detected in specimens received from other countries in Oceania or south-east Asia, or in east Asia. The overall frequency of oseltamivir resistance in the Asia-Pacific region was 16 of 1,488 (1.1%). No zanamivir-resistant viruses were detected. Of the 16 oseltamivir-resistant isolates detected, nine were from immunocompromised individuals undergoing oseltamivir treatment and three were from immunocompetent individuals undergoing oseltamivir treatment. Importantly, four oseltamivir-resistant strains were from immunocompetent individuals who had not been treated with oseltamivir, demonstrating limited low-level community transmission of oseltamivir-resistant strains. Even with increased use of oseltamivir during the pandemic, the frequency of resistance has been low, with little evidence of community-wide spread of the resistant strains. Nevertheless, prudent use of the neuraminidase inhibitors remains necessary, as does continued monitoring for drug-resistant influenza viruses.
Preoperative biliary drainage in perihilar cholangiocarcinoma: identifying patients who require percutaneous drainage after failed endoscopic drainage
Authors: Jimme Wiggers, Bas Koerkamp, Robert Coelen, Erik Rauws, Mark Schattner, C. Nio, Karen Brown, Mithat Gonen, Susan van Dieren, Krijn van Lienden, Peter Allen, Marc Besselink, Olivier Busch, Michael D’Angelica, Robert DeMatteo, Dirk Gouma, T. Kingham, William Jarnagin, Thomas van Gulik
Journal: Endoscopy (2015)

Preoperative biliary drainage is often initiated with endoscopic retrograde cholangiopancreatography (ERCP) in patients with potentially resectable perihilar cholangiocarcinoma (PHC), but additional percutaneous transhepatic catheter (PTC) drainage is frequently required. This study aimed to develop and validate a prediction model to identify patients with a high risk of inadequate ERCP drainage.Patients with potentially resectable PHC and (attempted) preoperative ERCP drainage were included from two specialty center cohorts between 2001 and 2013. Indications for additional PTC drainage were failure to place an endoscopic stent, failure to relieve jaundice, cholangitis, or insufficient drainage of the future liver remnant. A prediction model was derived from the European cohort and externally validated in the USA cohort.Of the 288 patients, 108 (38%) required additional preoperative PTC drainage after inadequate ERCP drainage. Independent risk factors for additional PTC drainage were proximal biliary obstruction on preoperative imaging (Bismuth 3 or 4) and predrainage total bilirubin level. The prediction model identified three subgroups: patients with low risk (7%), moderate risk (40%), and high risk (62%). The high-risk group consisted of patients with a total bilirubin level above 150 µmol/L and Bismuth 3a or 4 tumors, who typically require preoperative drainage of the angulated left bile ducts. The prediction model had good discrimination (area under the curve 0.74) and adequate calibration in the external validation cohort.Selected patients with potentially resectable PHC have a high risk (62%) of inadequate preoperative ERCP drainage requiring additional PTC drainage. These patients might do better with initial PTC drainage instead of ERCP.
Lithogenic Bile after Conjugated Estrogen
Authors: R Tritapepe, C Di Padova, M Zuin, M Bellomi, M Podda
Journal: New England Journal of Medicine (1976)

Reference is made to a previous paper by Bennion et al. describing t he effects of contraceptive steroids on the lipid composition of gall bladder bile. A similar rise in cholesterol saturation of hepatic bile was observed after giving conjugated equine estrogens (.5 mg/kg) to 7 fa sting patients with indwelling T-tubes. Liver function tests were norma l and bile culture was negative. 1 ml of hepatic bile was collected aft er 6, 12, and 24 hours for lipid determinations. The administration of estrogens promptly produced lithogenic hepatic bile. The effect was tra nsient with the lithogenic index returning to normal at 24 hours. 3 day s previous to this investigation hepatic bile had been normal. In a pre vious study a reduced biliary concentration of bile acids had been found in rats exposed to estradiol.
Imaging More Wisely—Already At Work—Reply
Authors: Rebecca Smith-Bindman, Andrew B. Bindman
Journal: JAMA Internal Medicine (2016)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Does Urinary Oxalate Interfere with the Inhibitory Role of Glycosaminoglycans and Semisynthetic Sulfated Polysaccharides in Calcium Oxalate Crystallization?
Authors: L C Cao, G Deng, E R Boevé, J C Romijn, W C de Bruijn, C F Verkoelen, F H Schröder
Journal: European Urology (1997)
Endoscopic removal of bands in Roux-en-Y gastric bypass: ask your friendly surgeon what he did!
Authors: Daniel Blero, Jacques Deviere
Journal: Endoscopy (2016)

The use of bands or rings is common in bariatric surgery, namely in silastic ring vertical gastroplasty and in laparoscopic adjustable gastric banding (LAGB). Band slippage, gastric pouch outlet stenosis, and band or ring erosion with intragastric migration are the classical late complications that often lead to pain, nausea, vomiting, and possible infection. The frequency of these complications has led to the development of endoscopic procedures that allow the removal of gastroplasty rings or partially migrated Lap-Bands (Apollo Endosurgery, Inc., Austin, Texas, USA) [1] [2]. The treatment may be simple and involve only a section of the ring, such as in cases of almost complete intraluminal migration.
Bichat guidelines for the clinical management of smallpox and bioterrorism-related smallpox
Authors: P Bossi, A Tegnell, A Baka, F van Loock, A Werner, J Hendriks, H Maidhof, G Gouvras
Journal: Eurosurveillance (2004)

Smallpox is a viral infection caused by the variola virus. It was declared eradicated worldwide by the Word Health Organization in 1980 following a smallpox eradication campaign. Smallpox is seen as one of the viruses most likely to be used as a biological weapon. The variola virus exists legitimately in only two laboratories in the world. Any new case of smallpox would have to be the result of human accidental or deliberate release. The aerosol infectivity, high mortality, and stability of the variola virus make it a potential and dangerous threat in biological warfare. Early detection and diagnosis are important to limit the spread of the disease. Patients with smallpox must be isolated and managed, if possible, in a negative-pressure room until death or until all scabs have been shed. There is no established antiviral treatment for smallpox. The most effective prevention is vaccination before exposure.
Surveillance of tuberculosis in Europe
Authors: V Schwoebel, H. L. Rieder, J M Watson, M. C. Raviglione
Journal: Eurosurveillance (1996)

This paper summarises recommendations for uniform reporting on tuberculosis cases made by a working group set up in 1994 following a meeting on tuberculosis control in low prevalence countries. The meeting had been organised jointly by the World Health Or
The dose dilemma.
Authors: G P Canellos
Journal: Journal of Clinical Oncology (1988)

Article Tools Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1988.6.9.1363 Journal of Clinical Oncology - published online before print September 22, 2016 PMID: 3047330 The dose dilemma. G P CanellosxG P CanellosSearch for articles by this author https://doi.org/10.1200/JCO.1988.6.9.1363 PDF "The dose dilemma.." Journal of Clinical Oncology, 6(9), pp. 1363–1364© 1988 by American Society of Clinical Oncology