tbuckley/cabot-search huggingface dataset:
Cultural and Antigenic Properties of Newly Established Cell Strains Derived From Adenocarcinomas of the Human Colon and Rectum
Authors: W. A. F. Tompkins, A. M. Watrach, J. D. Schmale, R. M. Schultz, J. A. Harris
Journal: JNCI Journal of the National Cancer Institute (1974)

Two strains of neoplastic cells were established from adenocarcinomas of the human lower gastrointestinal tract. Both strains, human colon tumor-8 (HCT-8) and human rectal tumor-18 (HRT-18), grew as discrete and tightly packed colonies of epithelial cells, each with a large nucleus and scanty cytoplasm. Fairly uniform microvilli, disposed over the entire free surface of the cells, were frequently parallel, closely resembling the brush border of the intestinal epithelial cells. The strains were characterized by a short generation time and high plating efficiency. The cells formed colonies when plated on human fibroblasts but did not form colonies on fibroblasts from other species. Cytogenetic analysis of HCT-8 revealed a mode of 48 chromosomes at both low and high in vitro passage levels, with extra A and D chromosomes in approximately 90%. HRT-18 also had a mode of 48 chromosomes. However, the additional chromosomes were more random, appearing for the most part in groups D and F. Both HCT-8 and HRT-18 yielded high levels of carcinoembryonic antigen (CEA) in vitro, with most CEA in the culture supernatant and not cell associated.
Treatment of Alcohol Withdrawal
Authors: B MacDougall
Journal: New England Journal of Medicine (1976)

Abrupt cessation of regular use of alcohol in a dependent person causes a withdrawal syndrome that may range from mild to extremely severe.Most patients require pharmacologic intervention, especially.those with severe symptoms.Historically, the pharmacotherapy of alcohol withldrawal has involved a wide variety of agents.Benzodiazepines are currently preferred due to their consistently high degree of efficacy and laudable record of safety.In addition, I3 blockers and clonidine are useful, as both effectively combat the hypertension and tachycardia commonly associated with withdrawal.They are ineffective as anticonvulsants; however.Opinions differ concerning the best treatment for withdrawal seizures.Prophylaxis with benzodiazepines may be all that is required, although some authors advocate the use of phenytoin for 5 days, especially in persons with a history of prior seizures during alcohol withdrawal.Once established, delirium tremens are difficult to treat.Benzodiazepines are most commonly used to provide sedation, and extremely large doses may be required.Careful clinical assessment is essential to the proper treatment of patients undergoing alcohol withdrawal since the coexistence of medical problems may complicate the condition.
Case 42-1970
Authors: Richard C. Cabot, Benjamin Castleman, Betty U. McNeely, Raymond D. Adams, Edward P. Richardson, Benjamin Castleman
Journal: New England Journal of Medicine (1970)

Presentation of CaseA 56-year-old woman was admitted to the hospital because of weakness of the shoulders, arms and neck.She had been well until three years previously, when she began to experience difficulty in swallowing solids. During the next two years the dysphagia progressed, and she lost 18 kg in weight. One year before entry she was admitted to another hospital, where a stricture was found in the lower portion of the esophagus; a thoracotomy was performed, with repair of the stricture and symptomatic improvement. Eight months before admission, while talking on the telephone, she became aware of loss . . .
SP0040 Transitional Care – Recommendations for Best Practice
Authors: H.E. Foster
Journal: Annals of the Rheumatic Diseases (2015)

Transitional care is an integral component of best practice for young people with paediatric onset rheumatic disease. 9Getting it right9 is increasingly regarded as a priority for all health care providers working in paediatric, adolescent and adult rheumatology. This lecture will describe the importance of transitional care and provide an update on the recent multinational, multidisciplinary and multiprofessional initiative from EULAR and PRES to define recommendations for best practice for transitional care for young people with Juvenile Idiopathic Arthritis. These recommendations encompass clinical care, health care service provision, training and research. <h3>Disclosure of Interest</h3> None declared
Case 72-1963
Authors: Earle W. Wilkins, Benjamin Castleman
Journal: New England Journal of Medicine (1963)

Presentation of CaseA sixty-year-old woman entered the hospital because of abdominal pain.Ten years previously the patient was referred to the hospital because of hyperthyroidism and was given radioiodine, with a satisfactory response. Six months later she was readmitted to the hospital because of extensive herpes zoster involving the neck and shoulder; an x-ray film of, the chest was normal. Four years before admission she returned to the clinic because of recurrence of excessive perspiration and nervousness. The blood pressure was 200 systolic, 110 diastolic. Physical examination did not suggest recrudescence of hyperthyroidism, and the protein-bound iodine was 7.2 . . .
Characteristics and Survival of Anti–U1 RNP Antibody–Positive Patients With Connective Tissue Disease–Associated Pulmonary Arterial Hypertension
Authors: Vincent Sobanski, Jonathan Giovannelli, Bernadette M. Lynch, Benjamin E. Schreiber, Svetlana I. Nihtyanova, Jennifer Harvey, Clive E. Handler, Christopher P. Denton, John G. Coghlan
Journal: Arthritis & Rheumatology (2015)

Objective Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue diseases (CTDs). This study aimed to investigate the clinical and hemodynamic characteristics and survival of anti–U1 RNP–positive patients with CTD‐associated PAH, with a focus on systemic sclerosis (SSc)–associated PAH. Methods We implemented a prospective database that included patients with CTD‐associated PAH for whom there were clinical, autoantibody, and mortality data. We compared clinical and hemodynamic characteristics to anti–U1 RNP antibody status. We then assessed whether anti–U1 RNP antibodies could be a prognostic factor in CTD‐associated PAH with a focus on SSc‐associated PAH. Results We studied a total of 342 patients with CTD‐associated PAH, of whom 36 (11%) were anti–U1 RNP antibody positive. Anti–U1 RNP–positive patients were younger and less functionally impaired than were anti–U1 RNP–negative patients in CTD‐ and SSc‐associated PAH. Hemodynamic parameters were similar in anti–U1 RNP–positive and anti–U1 RNP–negative patients. In CTD‐associated PAH, anti–U1 RNP positivity was associated with decreased mortality in univariable analysis (hazard ratio 0.34 [95% confidence interval 0.18–0.65], P &lt; 0.001). In multivariable analysis, anti–U1 RNP positivity was also associated with decreased mortality (hazard ratio 0.44 [95% confidence interval 0.20–0.97], P = 0.043) independently of age, sex, functional parameters, lung involvement, and hemodynamic parameters. Results were similar in SSc‐associated PAH, although the association between anti–U1 RNP positivity and survival did not reach significance in univariable (hazard ratio 0.47 [95% confidence interval 0.22–1.02], P = 0.055) and multivariable (hazard ratio 0.47 [95% confidence interval 0.20–1.11], P = 0.085) analyses. Conclusion Anti–U1 RNP positivity was associated with distinct clinical characteristics and survival in CTD‐ and SSc‐associated PAH. While hemodynamic parameters were similar in anti–U1 RNP–positive and anti–U1 RNP–negative patients, our results suggest that anti–U1 RNP positivity could be a factor protecting against mortality in CTD‐ and SSc‐associated PAH.
Soundings: Medicine is not a club
Authors: Liam Farrell
Journal: BMJ (2006)

There is a small hospital in Drogheda in Ireland, where, between 1974 and 1998, 188 peripartum hysterectomies were performed, most of them caesarean hysterectomies, and most by the same doctor; most obstetricians would carry out less than 10 in their whole career.

That a doctor should deviate from normal practice is not exceptional; we can all get set in our ways, and nowadays change occurs so rapidly that it is easy to fall behind. But in this case the practice adopted at the hospital was so unusual that surely it should have been noticed. The other obstetricians, the midwives, the anaesthetists, the paediatricians, the registrars, the physicians, the surgeons, the local general practitioners, surely one of them should have noticed that something was going on. And yet the Royal College of Obstetricians and Gynaecologists inspected the unit as recently as 1992 and found it suitable for training.

A complaint was eventually made (courageously, it must be said) by a newly appointed midwife, who obviously didn't understand that rocking the boat was not what the doctor ordered. This complaint was then investigated by three Irish obstetricians, who found that there was no case to answer.

A later and highly critical government report dismissed this finding as motivated by “compassion and collegiality,” and this is what I find most disturbing. Who most deserved the compassion, the obstetricians' colleague, or the women who had this unnecessary procedure, with all its implications?

And what does “collegiality” mean? It implies a “them and us,” that doctors and patients are mutually exclusive groups. But they aren't; every one of us will be a patient sooner or later.

We are slow to criticise each other because we understand that humans are frail, that mistakes are easily made, and that we could be the next to make one; we don't want to cast the first stone. We also know that often bad things happen and it's nobody's fault, that we manage uncertainty every day and sometimes the gamble comes unstuck, that medicine has its limitations and that patient expectations are often unrealistic.

But none of these should translate into a misplaced loyalty to our profession when we can see that something is clearly going wrong.

When I became a doctor, I didn't join a club.
PTH-267 Direct to test pathways in two week wait referrals for colorectal cancer may improve time to diagnosis and cost-efficiency
Authors: J Voll, N Waraich, S Thomson, S Asgari Mowahad, H Edis, T Hossain, A Ahmed, R Briggs, D Humes, A Banerjea
Journal: Gut (2015)

<h3>Introduction</h3> There is immense pressure on NHS organisations to achieve early diagnosis and rapid treatment of cancer. Nottingham Colorectal Cancer Service introduced a Direct to test (DTT) initiative to shorten the time to diagnosis and improve 62 day target compliance. <h3>Method</h3> We amended our 2WW referral form to incorporate ECOG performance status and a Charlson co-morbidity checklist. GPs were asked to provide an up to date eGFR and FBC/Ferritin. All 2WW referrals received between 1/8/14 and 30/11/14 were vetted by a Colorectal Consultant and selected for DTT according to a pre-defined protocol. DTT patients were telephoned by a Nurse Specialist (NS) to confirm suitability and explain the process. Those not deemed suitable for DTT were offered outpatient assessment (OPA). A tariff of £24 was agreed for telephone assessments in place of OPA. All referrals were logged in a database and outcomes of investigation and treatment were analysed. Statistical comparisons were performed on GraphPad Prism software. <h3>Results</h3> 553,2WW referrals were vetted and 355 patients (64.1%) were deemed suitable for DTT. 64 (11.6%) failed telephone assessment and underwent OPA. 11 patients (2.0%) failed to complete the pathway. 280 patients successfully completed a DTT pathway (50.6%) and 233 (42.1%) completed OPA/investigation. 40 patients (7.2%) were excluded due to inappropriate referral, patient choice/DNA, or OPA that investigation was not appropriate. The DTT group (mean age 64.9y) was significantly younger (p &lt; 0.0001) than the OPA group (71.0y). No adverse events were reported. The median time to first test was significantly shorter in the DTT group 12 days vs. 23 days in OPA (Mann Whitney P &lt; 0.0001). Median time to final diagnosis 16 days (DTT) was also significantly lower (Mann Whitney P &lt; 0.0001) than 26 days (OPA). 15 colorectal cancers (CRC) were detected in the DTT group (5.4%) and 22 CRC in the OPA group (9.4%). 11 DTT cancers underwent elective surgery all within 62 days whereas 3 patients in the OPA group (13.6%) required emergency surgery. 5 patients in the OPA group (22.7%) received palliative care only compared to 1 in the DTT group (6.7%). The DTT pathway obviated the need for outpatient clinic (tariff £193) prior to testing in 280 patients, saving a total of £47320 in 4 months. <h3>Conclusion</h3> The DTT initiative in our service has improved time to diagnosis and compliance with 62 day targets. It also saved the cost of 280 outpatients assessments, assuming that all of these patients would have been investigated in the same manner after OPA. However, DTT selects out a younger and fitter group that is less likely to have Colorectal Cancer but may detect CRC at an earlier stage. <h3>Disclosure of interest</h3> None Declared.
Capsule Endoscopy in Chronic Gastrointestinal Bleeding
Authors: S.  Sauerland, M.  Korenkov
Journal: Endoscopy (2004)

The study by Ell et al. [1] is certainly of major importance in the evaluation of wireless capsule endoscopy, as it was conducted with a prospective, comparative and blinded design. However, there are two points that require correction and explanation.
Home treatment for acute psychiatric illness.
Journal: BMJ (1991)

Objective-To determine the factors influencing the successful outcome of community treatment for severe acute psychiatric illnesses that are tradition- ally treated in hospital.Design-All patients from a single electoral ward who were either admitted to hospital or treated at home over a two year period (1 October 1987 to 30 September 1989) were included in the study and their case notes audited.The second year of the study is reported.Setting-Electoral ward of Sparkbrook, Birming- ham.Subjects-99 Patients aged 16-65 with severe acute psychiatric illness.Results-65 Patients were managed by home treatment alone; 34 required admission to hospital.The location of treatment was significantly (all p<005) influenced by social characteristics of the patients (marital state, age (in men), ethnicity, and living alone) and by characteristics of the referral (occurring out of hours; assessment taking place at hospital or police station).DSM-III-R diagnosis was more weakly associated with outcome.Violence during the episode was significantly related to admission, although deliberate self harm was not.Conclusions-Home treatment is feasible for most patients with acute psychiatric illness.A 24 hour on call assessment service increases the likelihood of success because admission is determined more strongly by social characteristics of the patient and the referral than by illness factors.Admission will still be required for some patients.A locally based mental health resource centre, a 24 hour on call service, an open referral system, and an active follow up policy increase the effectiveness of a home treatment service.
Soundings: Giving up on getting better
Authors: James Owen Drife
Journal: BMJ (2006)

The stillbirth rate in the United Kingdom has fallen steadily during my lifetime. This was not a by-product of prosperity: cars and foreign holidays do not save babies' lives. Things got better because we wanted them to. There was a consensus among professionals, politicians, and the public that we should work together to make pregnancy safer.

In 1998, however, the graph levelled off, and in 2002 the stillbirth rate increased for the first time in 50 years. Recent figures show the rise has been maintained. What is interesting is that we are pretending not to notice this historic change, let alone trying to understand what lies behind it.

Official statistics still say most stillbirths are “unexplained,” but this is an old fashioned fudge. We know that over 50% of the deaths are associated with intrauterine growth restriction. The small babies who are at risk may be identified by ultrasound scans and timely intervention can deliver them alive.

We could try to save some of them but we choose not to. The reasons are not economic but political. Lay campaigners have managed to persuade us that pregnancy should be demedicalised. The NHS, intent on keeping people out of hospital, has been happy to agree. My antenatal clinic today is almost empty.

Pregnant women are now classified on arbitrary criteria as high risk or low risk. The former are carefully monitored. For the latter, the abdomen is checked by palpation, a technique unsupported by evidence. As a result, corrected singleton perinatal mortality is now higher among “low risk” than “high risk” women.

We do not mention this when women choose their antenatal care. Although we know that a hospital's stillbirth rate is inversely proportional to intervention and consultant availability, NHS patients are not allowed to book directly with an obstetrician. Instead, community midwifery is being overstretched.

Is it just that when figures are good, people give up on making them better? Not necessarily. When the risk of cot death was 1 in 500 a media campaign reduced it to 1 in 2000. Our current stillbirth rate of 1 in 200 could be tackled and the first step would be to give women the facts. But that would mean disturbing the new politically convenient consensus. Easier to keep quiet and let some babies die.
Drug-drug interactions in patients with castration-resistant prostate cancer undergoing abiraterone therapy: Characterizing the scale of the problem.
Authors: Rehana Jamani, Esther K. Lee, Scott R. Berry, Carlo DeAngelis, Angie Giotis, Urban Emmenegger
Journal: Journal of Clinical Oncology (2015)

269 Background: Abiraterone acetate (AA), used to treat CRPC, inhibits androgen biosynthesis by blocking cytochrome P450 (CYP) 17. It also inhibits other cytochromes involved in the metabolism of various widely-used medications (strong inhibition of CYP1A2, CYP2D6, and CYP2C8; moderate inhibition of CYP2C9, CYP2C19 and CYP3A4/5). Hence, there is presumably a high potential for drug-drug interactions (DDI) that can either diminish the efficacy of AA or concurrent medications, or increase the risk of DDI-related adverse events (AE); however, the scale of AA-associated DDI is currently unknown. Methods: We conducted a retrospective review of pharmacy records and electronic pt charts to retrieve individual drug histories, comorbidities, and AE of CRPC pts beginning AA treatment between Jan 2010 and Apr 2014. Individual drug histories were analyzed for DDI using two commercial databases, Lexicomp and Micromedex. Results: 91 informative pts were identified. Using Lexicomp, the most common drugs flagged for potential DDI of high clinical significance (i.e., “avoid combination”, or “consider therapy modification”) with AA were dexamethasone, metoprolol, clopidogrel, oxycodone, and citalopram. They were administered to 12 (13%), 10 (11%), 6 (7%), 4 (4%), and 4 (4%) pts respectively. Micromedex assigned a major risk of DDI to oxycodone and a moderate risk to metoprolol. At least 1 potentially significant DDI was found in 38/91 pts (42%) with Lexicomp, and in 42/91 pts (46%) with Micromedex. Most common AE were fluid retention seen in 19 pts (21%), fatigue in 15 (16%), liver-function test abnormalities in 13 (14%), hypertension in 13 (14%), and pain in 11 (12%), all corresponding to AE typically associated with the use of AA. We did not find unequivocal evidence for DDI-related AE. Conclusions: The use of commercial DDI databases reveals a substantial risk of potentially consequential DDI in CRPC pts undergoing AA therapy, although some of the flagged DDI (e.g., between AA and dexamethasone) may be of theoretical rather than practical concern. Further investigation with larger patient populations is required to better establish the clinical relevance of these DDI.
Molecular Analysis of Single B Cells From T-Cell–Rich B-Cell Lymphoma Shows the Derivation of the Tumor Cells From Mutating Germinal Center B Cells and Exemplifies Means by Which Immunoglobulin Genes Are Modified in Germinal Center B Cells
Authors: Andreas Bräuninger, Ralf Küppers, Tilmann Spieker, Reiner Siebert, John G. Strickler, Brigitte Schlegelberger, Klaus Rajewsky, Martin-Leo Hansmann
Journal: Blood (1999)
Dexamethasone plus Ondansetron versus Dexamethasone plus Alizapride in the Prevention of Emesis Induced by Cisplatin- Containing Chemotherapies for Urological Cancers
Authors: Nicola Nicolai, Barbara Mangiarotti, Roberto Salvioni, Luigi Piva, Marco Faustini, Giorgio Pizzocaro
Journal: European Urology (1993)
THE STUDY OF ANEMIA
Authors: A E RAPPOPORT
Journal: JAMA (1930)

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Behavior therapy in a community mental health center
Authors: R P Liberman, E Bryan
Journal: American Journal of Psychiatry (1977)

Behavioral principles offer an operational model for the services of a community mental health center. A demonstration and clinical research project adapted behavior analysis and therapy to the problems, patients, staff, and setting a typical comprehensive community mental health center. Innovations in the day hospital included a credit incentive system, educational workshops for community adaptation, and a goal-attainment method of planning and evaluating individual treatment. Behavior therapy was introduced for outpatients with anxiety and depression, marital conflict, and deficits in social skills. Consultation and education programs were established for parents, schools, and other community agencies. Experimental and evaluative research has documented the effectiveness of these programs.