tbuckley/cabot-search huggingface dataset:
A randomised comparison of single agent carboplatin with radiotherapy in the adjuvant treatment of stage I seminoma of the testis, following orchidectomy: MRC TE19/EORTC 30982
Authors: R. T. Oliver, M. Mason, H. Von der Masse, S. P. Stenning, S. Kirk, G. J. Rustin, G. M. Mead, P. J. Ell
Journal: Journal of Clinical Oncology (2004)

4517 Background: Adjuvant radiotherapy is effective treatment for stage I seminoma, but is associated with a late risk of 2nd cancers. The MRC has undertaken two trials to reduce adjuvant radiation dose (TE18: 30Gy vs 20Gy) and volume (TE10: PA strip vs dog-leg field) without loss of effectiveness. Following reports that 1 course of carboplatin (C) may be equivalent to radiation (R) this large randomised trial was undertaken to compare these approaches; we present the initial results of this study. Methods: The primary randomisation was between R and 1 course of C AUCx7; R dose was optionally decided by randomisation between 20 Gy/10f and 30 Gy/15f prior to results of TE18, or centre choice of schedule. The trial was powered to exclude absolute differences in the 2 year relapse rates of >3%. Results: From June 96 to March 01 1447 patients (pts) were randomised (ratio 3:5) between C and R. Pt characteristics were well balanced: mean age 38 years, 14% had elevated HCG and 10% had previous ipsilateral inguinal operations. Of pts randomised to R 13% had dogleg field and 87% PA strip. Median follow up (FU) is now 3 years and over 90% of patients have at least 2 years FU. Relapse-free survival rates for R vs C (95%CI) are 97.2% (95.9, 98.1) v 98.1% (96.6, 98.9) at 2 years and 96.6% (95.2, 97.6) v 95.4% (93.3, 96.9) at 3 years; HR 1.39 (90% CI: 0.92, 2.11) p=0.195; the 90% CI excludes an increase in relapse rates in the C arm of more than 3% at 2 years and of more than 4% at 3 years. Pattern of relapse varied, sites being the PA nodes only in 70% (C) v 7% (R), and pelvis relapse in 4% (C) vs 28%(R). Second germ cell tumours (GCTs) have been reported in 1 pt allocated C and 7 allocated R, non-GCTs 2 C vs 4 R. No disease or treatment related deaths have been reported after C and only 1 after R; non-cancer deaths 1 (C) vs 2 (R). Conclusions: With a median FU of 3 years, an absolute increase in relapse rate in the C arm of more than 3% at 2 years can be excluded reliably, early data on 2nd malignancies favours the C group and to date there have been no disease or treatment related deaths. Further FU is needed to confirm that these results are maintained beyond 3 years. No significant financial relationships to disclose.
E-cigarettes—beware of the rocket in your pocket
Authors: Aidan M Rose, Kenneth J Nicoll, Omar Quaba, Alastair G Lowrie
Journal: BMJ (2016)

The recent Royal College of Physicians report on e-cigarettes and tobacco harm reduction missed an important point.1 2 We recently published the first case series of burn injuries from exploding rechargeable lithium ion batteries in e-cigarettes—thigh burns that required hospital admission and surgical debridement.3 Both patients described …
Local Immunotherapy of Superficial Bladder Cancer by Intravesical Instillation of Recombinant lnterleukin-2
Authors: A Tubaro, A Stoppacciaro, F Velotti, P C Bossola, G Cusumano, C Vicentini, P De Carli, L Ruco, A Santoni, A Cancrini
Journal: European Urology (1995)
RICKETS IN INDIA
Authors: H S Hutchison, S J Murphy
Journal: JAMA (1922)

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
Awareness during Anaesthesia
Authors: J. Wilson, D. J. Turner
Journal: BMJ (1969)

MMICAJOUNALfour thugs, and having had a chair broken over his head at three o'clock in the morning, is back at work functioning efficiently by about 9 a.m.?The only logical explanation is that being beaten unconscious really does very little harm to anyone.Let us have less violence and a more realistic presentation of the after-effects of trauma -I am, etc.,
Abstract 12538: Pulmonary Arterial Capacitance after Left Ventricular Assist Device Implantation
Authors: S. Carolina Masri, Rebecca Cogswell, Richard C Madlon-Kay, Monica M Colvin-Adams
Journal: Circulation (2013)

Background: Left ventricular assist device (LVAD) improves pulmonary vascular resistance (PVR), which reflects the resistive load. However, the response of the pulmonary arterial capacitance (PAC),...
Prevalence of and Factors Related to Discordance About Prognosis Between Physicians and Surrogate Decision Makers of Critically Ill Patients
Authors: Douglas B. White, Natalie Ernecoff, Praewpannarai Buddadhumaruk, Seoyeon Hong, Lisa Weissfeld, J. Randall Curtis, John M. Luce, Bernard Lo
Journal: JAMA (2016)

<h3>Importance</h3> Misperceptions about prognosis by individuals making decisions for incapacitated critically ill patients (surrogates) are common and often attributed to poor comprehension of medical information. <h3>Objective</h3> To determine the prevalence of and factors related to physician-surrogate discordance about prognosis in intensive care units (ICUs). <h3>Design, Setting, and Participants</h3> Mixed-methods study comprising quantitative surveys and qualitative interviews conducted in 4 ICUs at a major US medical center involving surrogate decision makers and physicians caring for patients at high risk of death from January 4, 2005, to July 10, 2009. <h3>Main Outcomes and Measures</h3> Discordance about prognosis, defined as a difference between a physician's and a surrogate's prognostic estimates of at least 20%; misunderstandings by surrogates (defined as any difference between a physician's prognostic estimate and a surrogate's best guess of that estimate); differences in belief (any difference between a surrogate's actual estimate and their best guess of the physician's estimate). <h3>Results</h3> Two hundred twenty-nine surrogate decision makers (median age, 47 [interquartile range {IQR}, 35-56] years; 68% women) and 99 physicians were involved in the care of 174 critically ill patients (median age, 60 [IQR, 47-74] years; 44% women). Physician-surrogate discordance about prognosis occurred in 122 of 229 instances (53%; 95% CI, 46.8%-59.7%). In 65 instances (28%), discordance was related to both misunderstandings by surrogates and differences in belief about the patient's prognosis; 38 (17%) were related to misunderstandings by surrogates only; 7 (3%) were related to differences in belief only; and data were missing for 12. Seventy-five patients (43%) died. Surrogates' prognostic estimates were much more accurate than chance alone, but physicians' prognostic estimates were statistically significantly more accurate than surrogates' (C statistic, 0.83 vs 0.74; absolute difference, 0.094; 95% CI, 0.024-0.163;<i>P</i> = .008). Among 71 surrogates interviewed who had beliefs about the prognosis that were more optimistic than that of the physician, the most common reasons for optimism were a need to maintain hope to benefit the patient (n = 34), a belief that the patient had unique strengths unknown to the physician (n = 24), and religious belief (n = 19). <h3>Conclusions and Relevance</h3> Among critically ill patients, discordant expectations about prognosis were common between patients' physicians and surrogate decision makers and were related to misunderstandings by surrogates about physicians' assessments of patients' prognoses and differences in beliefs about patients' prognoses.
Abstract P6-10-17: Rates of prophylactic surgeries among BRCA 1 or 2 mutation carriers: A single institution experience
Authors: J Raphael, P Hewitt, T Graham, K Ott, T Mancuso, J Lorentz, M Emmerson, A Eisen
Journal: Cancer Research (2016)

Abstract Background Women with identified BRCA1/2 mutation have a substantially increased risk of developing several types of cancer, mainly breast and ovarian, during their lifetime. Management options included close surveillance, chemoprevention and prophylactic surgeries. The aim of this study is to assess the rate of prophylactic surgeries among BRCA1/2 carriers counseled and screened at a single institution in the last 2 decades. Methods We retrospectively captured all women with a BRCA1/2 mutation that were identified in our genetic clinic between 2000 and 2015. The incidence of breast and ovarian cancer among all BRCA carriers was reported. The rates of prophylactic surgeries were calculated and analyzed in all identified carriers. Results Six hundred and eighty four women were identified to carry a deleterious BRCA mutation, among them 364 BRCA1 (53%) and 320 BRCA2 (47%). Three hundred and twenty seven (48%) were diagnosed with breast cancer and 80 (12%) had either ovarian or fallopian tumor. Forty percent (N=271) of the women assessed were healthy carriers. Prophylactic bilateral salpingo-oophorectomies (BSO) were performed in 342 women (50%) and prophylactic mastectomies (PM) (bilateral or unilateral) in 190 (28%). Furthermore, 154 women (23%) had both BSO and PM. Of note, 79 women (12%) were less than 35 years old and 122 were less than 40 years old (18%), the majority of those were waiting to have BSO later on. If we remove the young women from the analysis, 57 and 61% of the women would have had BSO (less than 35 and 40 years excluded respectively). If we only analyze the women who had a recent follow up in our clinic (2014-2015), 422 women would be eligible. Among those, 58 and 84 were less than 35 and 40 years old (y) respectively. For this cohort, the rates of BSO would be 61% (257/422)(whole cohort), 71% (excluding women less than 35y) and 76% (excluding women less than 40y). Conclusion A promising rate of BSO was reported in our cohort of BRCA carriers as compared to the literature. This rate was even higher (from 50 to over 70%) when we only analyzed patients with recent follow up in clinic and when we excluded young women waiting to have BSO. More efforts are needed to determine why the rates of PM are lower, for example limited breast reconstruction resources, in order to reduce the incidence of subsequent invasive breast cancer in this high-risk population. Citation Format: Raphael J, Hewitt P, Graham T, Ott K, Mancuso T, Lorentz J, Emmerson M, Eisen A. Rates of prophylactic surgeries among BRCA 1 or 2 mutation carriers: A single institution experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-17.
Comparative phenomenology of early-onset versus late-onset panic attacks: a pilot survey
Authors: J I Sheikh, R J King, C B Taylor
Journal: American Journal of Psychiatry (1991)

Studies of panic attacks in older adults are virtually nonexistent. The authors surveyed 520 adults with panic attacks; 445 were younger than age 55, 57 were 55 years old or older but had their first panic attack before age 55, and 18 were 55 years old or older and had their first panic attack at age 55 or later. The respondents with late-onset panic attacks reported fewer symptoms during their attacks and were less avoidant than both groups of respondents with early-onset panic attacks.
Relationship of Bone Scan Index and Progression-Free Survival Data for Metastatic Crpc Patients Who Received Odm-201
Authors: R. Jones, M. Reza, C. Massard, J. Aspegren, L. Mattila, L. Edenbrandt, A. Bjartell, M. Mustonen, K. Fizazi
Journal: Annals of Oncology (2014)
Acetaminophen
Authors: Jan Koch-Weser
Journal: New England Journal of Medicine (1976)

Acetaminophen (N-acetyl-para-aminophenol) (Fig. 1) has been used as an analgesic and antipyretic for about 80 years. The drug has become increasingly popular during the past 25 years since the recognition that the effects of another widely used para-aminophenol analgesic, phenacetin (acetophenetinin, ethoxyacetanilid), are due primarily to its rapid biotransformation to acetaminophen.1 Today, acetaminophen is marketed in the United States under approximately 50 brand names and in almost 200 proprietary combinations with other drugs.2 Acetaminophen is available without prescription and is being intensively promoted both to the medical profession and to the public as a superior alternative to aspirin. In Great Britain, . . .
Abstract P4-03-09: Malignant hyperechoic lesions in breast ultrasound - Frequency and characteristics
Authors: J Camacho, E Horvath, MF Pizzolon, MA Pinochet, M Gallegos, C Galleguillos, M Uchida, F Cadiz, C Silva
Journal: Cancer Research (2016)

Abstract PURPOSE Challenge current axiom regarding hyperechogenic lesions in breast US categorized as mainly benign lesions. 2) Present frequency of malignant hyperechoic lesions, describe their sonographic and histological characteristics. METHOD AND MATERIALS IRB approved retrospective review of 2369 consecutive US-guided Core biopsies between 2006 and 2014. Lesions were considered hyperechogenic when more than 90% of its volume had higher echogenicity than surrounding subcutaneous tissue. Variables assessed were: age, size, histology, mass or non-mass, margins, echogenicity, acoustic effect, orientation, location, presence of a hypoechoic center, vascularization and BI-RADS category. Qualitative variables were described by percentage distribution, mean and SD. RESULTS Thirty one (1,3%) lesions biopsied were hyperechoic: only 17 (54.8%) were benign. We found 14 patients (range, 39-81 years, mean 57,5 years) with hyperechoic cancers, accounting for 1,77% of all cancers. 12 (85,7%) were ductal and 2 (14,3%) lobular histology (mean 17,5 mm range 8-40mm). All of them exhibited a small central hypoechoic area and were partially or completely surrounded by fatty tissue. Shape, margins, orientation and vascular architecture were highly suggestive of malignancy at US, mammography and in MRI (BI-RADS 4B and 5). On histology, all lesions were surrounded by fatty tissue, with a low–cell count collagenous center with a higher peripheral cellularity, mixing and interweaving with adipose tissue. CONCLUSION Hyperechogenic breast cancers are rare (1.77%), and we challenge the current concept of high rate of benignity with a 45,2% of chances for malignancy. We propose that hyperechogenicity is given by interweaving bundles with adipose tissue, which provide higher amount of acoustic reflective surfaces, thus explaining its sonographic pattern. CLINICAL RELEVANCE/APPLICATION Hyperechogenic breast lesions should not be considered as always benign. Malignancy thresholds should not be influenced by this sonographic characteristic. We propose histopathological explanation of this sonographic pattern. Citation Format: Camacho J, Horvath E, Pizzolon MF, Pinochet MA, Gallegos M, Galleguillos C, Uchida M, Cadiz F, Silva C. Malignant hyperechoic lesions in breast ultrasound - Frequency and characteristics. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-03-09.
Abstract P6-09-03: Time-dependent nomogram for risk of locoregional recurrence in early breast cancer patients: 10 year extension
Authors: A Witteveen, IMH Vliegen, GS Sonke, JM Klaase, MJ IJzerman, S Siesling
Journal: Cancer Research (2016)

Abstract Background The objective of this study was to extent the recently developed and validated time-dependent logistic regression model and web-based nomogram. This nomogram is suitable for the annual long term risk prediction of locoregional recurrence (LRR) in individual breast cancer patients and clinical decision support with regard to the follow-up. Methods Women first diagnosed with early breast cancer between 2003-2006 in all Dutch hospitals were selected from the Netherlands Cancer Registry with five year of recurrence follow-up (n=37,230). Of the year 2003 follow-up was retrieved for ten years. In the first five years following primary breast cancer treatment 3.7% of the selected patients developed a LRR as a first event, in ten years 6.2%. Risk factors were determined using logistic regression and the risks were calculated per year, conditional on not being diagnosed with recurrence in the previous year. Discrimination and calibration were assessed. Bootstrapping was used for internal validation. Data on primary tumors diagnosed between 2007-2008 in 43 Dutch hospitals was used for external validation of the performance of the nomogram (n=12,308). Results The final model included the variables grade, size, multifocality, and nodal involvement of the primary tumor, and whether patients were treated with radio-, chemo- or hormone therapy. Model predictions were well calibrated. Estimates in the validation cohort did not differ significantly from the index cohort. The results were incorporated in a web-based nomogram. In 0.7% of the patients, the risk of LRR between year 5-10 was higher than the average risk of all patients in the first five years. All of these patients were aged below 50, had a tumour size larger than 2 cm, non-negative hormone status, received radiotherapy, but no hormone therapy and 19% developed a recurrence during ten years. Conclusion/discussion This validated and time-dependent nomogram for the prediction of annual LRR risks over ten years is simple to use and shows a good predictive ability in the Dutch population. It can be used as an instrument to identify patients with a low or high risk of LRR who might benefit from a less or more intensive and longer follow-up after breast cancer and to aid clinical decision-making for personalized follow-up. Citation Format: Witteveen A, Vliegen IMH, Sonke GS, Klaase JM, IJzerman MJ, Siesling S. Time-dependent nomogram for risk of locoregional recurrence in early breast cancer patients: 10 year extension. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-09-03.
Uniquely disadvantaged
Authors: Anthony E Livesey
Journal: BMJ (2007)

Klitzman's article on interviewing doctors as patients highlighted interesting and important perspectives on the patient's position, role, and motivations, as well as the unique position of doctors as patients.1 Sometimes seen as a perk of the job by others, I suggest that doctors may occupy a uniquely disadvantaged position when ill.

We may struggle with taking time off work, taking up the time of an already busy colleague, and the impossibility of remaining objective about our own condition (usually underplaying symptoms). This position is further exaggerated by guilt at not having been able to manage our condition without recourse to a fellow doctor. The complicated set of dynamics can be further exaggerated if we present with a depressive illness or other psychiatric condition. Any objectivity and insight is long gone, and feelings of guilt, worthlessness, and inadequacy compound a difficult presentation but also affect the ongoing relationship needed for treatment. We may also harbour anxieties around having to maintain a professional relationship with our physician when we return to work.

As a profession I am not sure that we are sufficiently aware of (or comfortable with) the position of the sick doctor. Fearing a possible charge of nepotism should not deter us from looking closer.
Hyperinsulinemic Hypoglycemia with Nesidioblastosis after Gastric-Bypass Surgery
Authors: Andreas M Kaiser
Journal: New England Journal of Medicine (2005)

n engl j med 353;20 www.nejm.org november 17, 2005 2192 to the editor: The causal links between bariatric surgery and pancreatic nesidioblastosis are unclear. Service et al. (July 21 issue)1 suggest a link between nesidioblastosis and glucagon-like peptide 1 (GLP-1), since GLP-1 causes beta-cell expansion in animal models of diabetes. GLP-1 and the incretin mimetic exenatide enhance insulin secretion in a glucose-dependent manner.2,3 Similarly, incretin-induced beta-cell expansion appears to be glucose-dependent. It is relevant that studies of two years’ duration in normal mice and rats of exenatide at doses of more than 100 times those given to humans showed no pathological changes in the islets (data on file, Amylin Pharmaceuticals); a study of nine months’ duration in healthy cynomolgus monkeys at doses of more than 400 times those used in humans showed minimal-to-mild islet hypercellularity with no increase in islet size (data on file, Amylin Pharmaceuticals). There have been no reports of recurrent, severe hypoglycemia or of nesidioblastosis in patients with type 2 diabetes mellitus during more than 2670 patient-years of exposure to exenatide. Given that neither experimental nor clinical evidence suggests that GLP-1 or exenatide induces nesidioblastosis, and given the multiple hormonal and metabolic changes that occur after bariatric surgery,4-6 we would suggest that the link between bariatric surgery and nesidioblastosis is multifactorial. Further study may lead to insights concerning the regulation of beta-cell function and growth. Thomas Carpenter, Ph.D.
Leadless Pacemaker Approved
Authors: Rebecca Voelker
Journal: JAMA (2016)

A first-of-its-kind pacemaker that regulates heart rate without lead wires has received FDA approval. The Micra Transcatheter Pacing System is a self-contained, 1-inch-long device that is implanted directly into the heart’s right ventricle (http://1.usa.gov/23iwftQ).
The trial use of clozapine for abnormal involuntary movement disorders
Authors: E D Caine, R J Polinsky, R Kartzinel, M H Ebert
Journal: American Journal of Psychiatry (1979)

Twelve patients with abnormal involuntary movement disorders were treated with clozapine in a double-blind, placebo-controlled trial. The cohort consisted of individuals with Gilles de la Tourette's syndrome, Huntington's disease, and atypical persistent dyskinesia that was drug induced. Two subjects were dropped from the protocol due to complications. Two patients with Huntington's disease showed a marked decrease in movements; other individuals obtained no significant therapeutic benefits. Seven of the 10 patients completing the trial experienced moderate or marked side effects.
Azithromycin therapy during respiratory syncytial virus bronchiolitis: Upper airway microbiome alterations and subsequent recurrent wheeze
Authors: Yanjiao Zhou, Leonard B. Bacharier, Megan Isaacson-Schmid, Jack Baty, Kenneth B. Schechtman, Geneline Sajol, Kristine Wylie, Gregory A. Storch, Mario Castro, Avraham Beigelman
Journal: Journal of Allergy and Clinical Immunology (2016)