tbuckley/cabot-search huggingface dataset:
PTH-306 R1 rectal cancer: an analysis of survival
Authors: HM Joshi, N Ormsby, M Chadwick, M Scott, A Samad, R Rajaganeshan
Journal: Gut (2015)

<h3>Introduction</h3> Evidence has shown that a positive resection margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes of patients with R1 resection of rectal cancer. <h3>Method</h3> Retrospective study of all patients operatively managed within our institution between April 2008–April 2013 for rectal cancer. Baseline demographics and multiple outcome measures recorded. Overall survival (OS), disease free survival (DFS) and recurrence were the primary outcome measures. <h3>Results</h3> Overall there were 306 primary rectal cancers. 76% were grade T3/4 tumours. OS of 30 months. R1 rate was 16% (48 patients). 31 patients underwent APR, and 17 AR. 32 patients underwent neo-adjuvant treatment. In responders, overall survival was 55 months, with no EMV. In non-responders OS was 29 months, with EMV in 48%. In patients who did not receive NAC, OS was 23 months, with EMV in 74%. EMV is the strongest predictor for poor survival following R1 (p = 0.001). We found a correlation between number of positive nodes, and OS/DFS(p = 0.004). <h3>Conclusion</h3> R1 rectal cancer is not an automatic death sentence. We have demonstrated relatively positive OS in this cohort. In particular, those who respond to NAC have the potential for very good OS and DFS, with the potential for remission. We have shown EMV to be the strongest predictor for poor survival. Perhaps these patients could benefit from intraoperative frozen section histo-pathological analysis and intraoperative radiotherapy to improve survival and reduce recurrence rate. <h3>Disclosure of interest</h3> None Declared.
Psychiatry in crisis
Authors: J S Eaton, L S Goldstein
Journal: American Journal of Psychiatry (1977)

Psychiatry today faces sociopolitical, economic, and philosophical pressures that threaten its existence as a valued medical specialty. Recent legislation that decreases the numbers of foreign medical graduates eligible to practice in the United States, increases the numbers of community mental health centers and types of services they offer, and limits federal support of psychiatric education will affect the future of psychiatry as a profession and discipline. Forthcoming legislation and federal health policies will be related to the ability of the profession to demonstrate its unique role in the provision of mental health and health services. The authors offer suggestions for the education of the American public regarding the important role of psychiatry in America's health and mental health care system.
PTH-004 Is emr for large colonic polyps clinically and histologically safe?
Authors: S Dixon, S Parker, P O’Loughlin
Journal: Gut (2015)

<h3>Introduction</h3> Endoscopic mucosal resection (EMR) can successfully treat large polyps endoscopically, however adequate information regarding margins of excision, or in the malignant cases, submucosal invasion are crucial for deciding future management. En bloc resection with clear margins allows confident further management but compromised margins or unexpected malignancy in excised polyps creates prognostic and management uncertainty. Therefore it is crucial to accurately assess for malignancy and feasibility of en-bloc excision prior to commencing EMR. <h3>Method</h3> A retrospective case note review of all large (≥20 mm) colonic polyps identified on colonoscopy between the study period August 2013 to August 2014. We collected data on lesion characteristics, procedural, clinical and histological outcomes. <h3>Results</h3> 92 Patients were identified as having a large colonic polyp, mean age 64.5 years (range 19–90). Mean polyp size was 29.0 mm (range 20–100). During the study period there was one adverse event of EMR which was a caecal perforation treated with an emergency right hemi-colectomy. 18 cases of invasive adenocarcinoma were identified (19.5%). 12 were correctly recognised and had biopsy only at endoscopic procedure (EMR not attempted). Malignancy was found in 38% (13/31) of rectal polyps, 11.7% (4/34) and 75% (3/4) of polyps identified as Pit Pattern IV and V respectively. 6 patients had piecemeal EMR of malignancies resulting in inadequate histology to predict prognosis. 3 of these patients underwent subsequent surgical resection, no residual malignancy was found in these 3 cases suggesting en bloc resection may have prevented major surgery. <h3>Conclusion</h3> EMR can lead to inadequate tissue sampling for diagnosis and treatment of invasive carcinoma. We propose that EMR should not be attempted in rectal polyps ≥20 mm without specialist assessment. <h3>Disclosure of interest</h3> None Declared.
Propranolol and depression
Authors: W M Petrie, R J Maffucci, R L Woosley
Journal: American Journal of Psychiatry (1982)

The authors report the cases of 3 patients who had depressive episodes after administration of propranolol for medical illnesses. The depressive episodes were severe, occurred in a dose-dependent manner, and promptly remitted when propranolol was discontinued. Physicians' awareness of this complication, especially in cases of patients with a history of depression, may reduce the occurrence of this drug reaction.
Specialists attack drug agency’s fast track approval scheme
Authors: Nigel Hawkes
Journal: BMJ (2016)

A plan to fast track the approval of new medicines in Europe has been criticised by a group of leading specialists in pharmacology and public health.

They argued in a letter to top officials at the European Medicines Agency (EMA) that the “adaptive pathways” pilot, which aims to speed the adoption of new drugs and reduce their cost, is based on flawed assumptions that lack a proper evidence base.

Among the signatories were Martin McKee, of the London School of Hygiene and Tropical Medicine; Peter Gotzsche, of the Nordic Cochrane Centre in Copenhagen, Denmark; Tom Jefferson, honorary fellow at the Centre for Evidence-Based Medicine at Oxford; and Richard Thompson, past president of the Royal College of Physicians.

The EMA’s plan was also attacked by the European Public Health Alliance, a European non-governmental organisation, in …
Hemodynamic Responses to Energy Drink Consumption
Authors: Erik Konrad Grasser, Jennifer Lynn Miles-Chan, Jean-Pierre Montani
Journal: JAMA (2016)

EnglishDr Svatikova and colleagues1 investigated acute cardiovascular responses in healthy adults 30 minutes after ingestion of an energy drink (containing 62 g of sugar, caffeine, and taurine) compared with a placebo drink (containing approximately 62 g of sugar but no caffeine or other stimulants). In addition, the authors investigated the cardiovascular response of energy drink consumption during mental and physical stress tests. EnglishDr Grasser and colleagues discuss the importance of longer postdrink blood pressure and heart rate observation periods and suggest that water would have been a more appropriate placebo drink. First, with regard to duration of observation, our protocol was designed to follow closely the metabolism and bioavailability of caffeine. Oral absorption of caffeine from the intestinal tract is rapid and caffeine becomes completely bioavailable, reaching a peak plasma concentration 30 minutes after ingestion, whereas plasma half-life ranges from 3 to 10 hours.1
Myocardial free-radical injury after cardioplegia.
Authors: Weisel Rd, Mickle Da, Finkle Cd, Tumiati Lc, Madonik Mm, Ivanov J, Burton Gw, Ingold Ku
Journal: Circulation (1989)

Although cold blood cardioplegia provides excellent myocardial protection for elective coronary bypass surgery, myocardial metabolic recovery is delayed postoperatively, perhaps because of free-radical injury during reperfusion. To assess free-radical reperfusion injury, we measured the products of lipid peroxidation and the cardiac concentrations of alpha tocopherol in 10 patients undergoing elective surgical revascularization. Arterial and coronary sinus blood measurements revealed a delayed recovery of myocardial oxygen consumption and lactate utilization and the myocardial release of conjugated dienes (chemical signatures of free-radical injury) at 3 and 60 minutes after reperfusion. In addition, myocardial concentrations of alpha tocopherol decreased after reperfusion, suggesting consumption of the major membrane antioxidant. These results support the hypothesis that oxygen-derived free radicals contribute to myocardial injury after cardioplegic arrest and that antioxidant therapy should improve myocardial protection.
Efficacy of intraportal infusion for colon cancer: a fair assessment?
Authors: S Marsoni, V Torri, A Taiana, A Liberati, R Labianca, G Pancera, R Gray, M Clarke
Journal: Journal of Clinical Oncology (1991)

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.1991.9.5.888 Journal of Clinical Oncology - published online before print September 22, 2016 PMID: 1958247 Efficacy of intraportal infusion for colon cancer: a fair assessment? S MarsonixS MarsoniSearch for articles by this author , V TorrixV TorriSearch for articles by this author , A TaianaxA TaianaSearch for articles by this author , A LiberatixA LiberatiSearch for articles by this author , R LabiancaxR LabiancaSearch for articles by this author , G PanceraxG PanceraSearch for articles by this author , R GrayxR GraySearch for articles by this author , M ClarkexM ClarkeSearch for articles by this author Show More https://doi.org/10.1200/JCO.1991.9.5.888 PDF "Efficacy of intraportal infusion for colon cancer: a fair assessment?." Journal of Clinical Oncology, 9(5), pp. 888–889© 1991 by American Society of Clinical Oncology
The apprenticeship of Philippe Pinel: a new document, "observations of Citizen Pussin on the insane"
Authors: D B Weiner
Journal: American Journal of Psychiatry (1979)

Philippe Pinel is usually pictured in histories of psychiatry and of medicine as the man who first liberated the insane from their chains. The document presented here, discovered in 1978 in the Archives nationales in Paris, reveals the crucial role of Jean-Baptiste Pussin, the "governor" of mental patients at Bicêtre. It was Pussin who initiated Pinel to psychological methods (the famous traitement moral) in dealing with hospitalized mental patients. Further, in 1797, Pussin first replaced chains with straitjackets. Pinel later obtained Pussin's transfer to the Salpêtrière to help him reorganize that huge hospital.
Management of esophageal cancer in an elderly UK population
Authors: N. Dorey, R. Powell, R. Berrisford, T. Daneshmend, E. Toy
Journal: Journal of Clinical Oncology (2008)

20582 Background: Recent randomised trials have established bi/tri modality therapy as the standard of care for localised esophageal cancer. However evidence for the optimal care of the elderly patient with either radical or palliative intent remains scanty. We report a retrospective review of practice and outcome relating to an elderly population presenting to a UK District General Hospital with esophageal malignancy over a four year period. Methods: Patients ≥ 75 years at diagnosis of an esophageal or junctional cancer were identified. Histology, stage, comorbidity, performance status (PS), and management were studied. Kaplan-Meier analysis of outcome was performed. Results: 142 patients with a median age of 78.1 years (75 - 84.6) in those treated radically and 81.3 years (75 - 98.3) in those treated palliatively. PS, stage and patient choice dictated the management plan. 35 patients (25%) presented with distant metastatic disease. 28 patients (20%) received more than one line of active therapy. Median follow-up was 38.6 months. 21 patients (15%) were treated radically. 3 patients did not complete intended radical treatment. Peri-operative mortality was 6% (1/16). Overall median survival is 8.3 months (95% CI: 5.6 to 10.9) with mean survival for those treated radically 47.2 months (95% CI: 34.6–59.7) and median survival for palliative treatment 7.3 months (95% CI: 5.6–10.9). Conclusions: Our results compare favorably with published outcomes in younger patients of equivalent stage and PS. Although the elderly patient requires careful consideration as to the most appropriate treatment, radical management or active palliation with oncological intervention should be considered where the prognosis is estimated to be more than 3 months. Survival according to 1st line treatment intent (in months). Number Median survival (95% CI) Mean survival (95% CI) Surgery 9 NR 56 (38.8- 73.2) Surgery + Chemotherapy 9 NR 44 (29.2–58.8) Chemoradiation 3 6.4 (0.1–12.7) External Beam Radiation (EBRT) 23 7.7 (3.5–11.9) Brachytherapy (HDR) 15 14.9 (6.9–23.1) EBRT + HDR boost 24 12.5 (10.6–14.4) Systemic chemotherapy 12 11.1 (6.3–15.9) Stent 27 3.2 (1.6- 4.6) BSC alone 20 0.9 (0.3–1.5) No significant financial relationships to disclose.
Prenatal Antidepressant Use and Risk of Autism Spectrum Disorders in Children
Authors: Nicholas A. Link, Mary E. Temple-Cooper
Journal: JAMA Pediatrics (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 Pediatrics 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 Pediatrics journal
OP0293 Long Term Outcome and Clinical Characteristics in Childhood- Onset Mixed Connective Tissue Disease – A Norwegian Nationwide Study:
Authors: S.O. Hetlevik, B. Flatø, E. Nordal, M. Rygg, V. Lilleby
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> In approximately 25% (1) of all cases of mixed connective tissue disease (MCTD) the disease presents during childhood and adolescence. Only few, small studies have examined disease outcome in patients with juvenile MCTD. <h3>Objectives</h3> The aim of this study is to describe long-term outcome and clinical characteristics in a nationwide representative Norwegian juvenile MCTD population. <h3>Methods</h3> Inclusion criteria in this cross-sectional study were fulfillment of the Kasukawa or Alarcon-Segovia criteria and symptom-onset before 18 years. All patients underwent a thorough clinical examination and charts were reviewed. As there are no criteria for remission in MCTD, this was defined as fulfillment of the Wallace criteria for remission in juvenile idiopathic arthritis, plus the absence of myositis, progressive lung- or esophageal manifestations- or progressive sclerodactyly (with or without Raynaud phenomena). <h3>Results</h3> 54 patients with juvenile MCTD were identified. 2 patients had deceased, and 48 patients (92%) accepted to participate (88% females). Mean age was 14,0±4,8 years at diagnosis and 28.5±10.0 years at inclusion. Mean disease duration was 16.8±9.7 years. 2 of the patients had developed SLE, none had developed other connective tissue diseases. Of the 46 patients with continuous MCTD, only one patient developed pulmonal arterial hypertension. At 16.8 year follow-up remission off medication was found in 8 patients (17%), remission on medication in 9 patients (20%), whereas 29 patients (63%) had active disease. 35 (70%) were currently on immunosuppressive treatment. Mean Physician9s Global Disease Activity score was 18.7±15.7 (100 mm Visual Analogue Scale). <h3>Conclusions</h3> In this Norwegian childhood-onset MCTD study we found that a majority of 63% still had active disease after mean 16.8 years disease duration. Only 17% were in remission off medication, and very few patients had evolved into another connective tissue disease. SLE-like disease was the most common disease pattern. <h3>References</h3> Burdt MA et al; Long-term outcome in mixed connective tissue disease: longitudinal, clinical and serologic findings. Arthritis Rheum, 1999. 42(5) <h3>Disclosure of Interest</h3> None declared
PWE-162 Lap band unclipping and reclipping, should the patient keep the band?
Authors: J Houghton, K Keogh, L Merker, D Wilson-Evans, J Hewes
Journal: Gut (2015)

<h3>Introduction</h3> After initial enthusiasm it has become apparent that laparoscopic gastric bands are prone to complications including formation of fibrous capsules leading to dysphagia and vomiting. Gastric bands are often unclipped and then reclipped after division of the fibrous capsule. We analyse the outcomes of these patients to assess whether keeping the band is beneficial or if removing the band at first revision is advisable. <h3>Method</h3> Patients having revisional surgery to their gastric band were identified through an online patient management system in a high volume bariatric centre. Prospectively recorded electronic patient records were examined to identify patient demographics and key events in the patient pathway. The primary outcome measure was removal of the band. <h3>Results</h3> The period of assessment was from March 2009 to March 2014. Over that period 772 laparoscopic bands were inserted in this trust and 101 (13%) were removed. During the assessment period 48 patients had gastric bands unclipped or changed with division of fibrous capsule (including patients whose bands were inserted in other centres). The median age of these patients was 43 at insertion of band. The median duration from gastric band insertion to revision was 26 months. The median duration to reclipping was 6 months. 15 (31%) patients went on to have further surgery to have their band removed. <h3>Conclusion</h3> Gastric bands are a useful tool for treating obesity. While the majority of patients tolerate their band well a significant proportion are associated with fibrous band formation. If patients undergo surgery to unclip the band and divide the capsule this is associated with significant weight gain and a large proportion of patients (31%) will ultimately have their band removed due to intolerance. Patients should be counselled as such before first revision to enable informed choice. <h3>Disclosure of interest</h3> None Declared.
Bulimia Nervosa
Authors: Philip S Mehler
Journal: New England Journal of Medicine (2003)

A 20-year-old woman presents with fatigue; laboratory tests reveal a serum potassium level of 2.3 mmol per liter and a serum bicarbonate level of 36 mmol per liter. She is 163 cm (64 in.) tall and weighs 54 kg (119 lb). The findings on physical examination are normal. On questioning, she admits to binge eating and vomiting as frequently as five times per day. How should she be treated?
PWE-158 Magnetic sphincter augmentation broadens the appeal of surgical intervention in chronic reflux sufferers
Authors: JO Brewer, AM Reece-Smith, P Mackenzie, T Royles, T Daneshmend, S Wajed
Journal: Gut (2015)

<h3>Introduction</h3> Magnetic bead oesophageal sphincter augmentation device (MSAD) offers an alternative to tissue fundoplication (TF) in the management of gastro oesophageal reflux disease (GORD). This study evaluates patient decision pathways in selecting one of these surgical options and quality of life based outcomes. <h3>Method</h3> Consecutive patients with chronic GORD who underwent surgical intervention for definitive treatment were enrolled in the study. The selection criteria for MSAD procedure included objective evidence of GORD, good oesophageal motility, absence of a large hiatus hernia and long segment Barrett’s oesophagus. Pre-operative symptoms, oesophageal physiology, pre-operative and one year post-operative reflux related quality of life scores (HRQL) and the reason for selection of a surgical technique were obtained from a prospective database. Comparative analysis between the MSAD and the TF group was performed. <h3>Results</h3> A total of 80 patients were included in the study. Forty six patients were suitable for MSAD, of which 44 (96%) elected to undergo the procedure. Thirty four patients failed to meet the inclusion criteria for MSAD and underwent TF, along with 2 patients who preferred to be treated with TF despite suitability for MSAD. Distal oesophageal acid exposure was significantly higher in the TF group (DeMeester score median 52.6 [22–74]) than in the MSAD group (DeMeester score median 34.4 [16–55] (p = 0.011). The HRQL score however were similar for both groups (TF 23.9; MSAD 25.8; p = 0.55). MSAD patients felt the main reason for choosing the procedure was becasue it was less invasive,(30/44, 71%) and secondarily because they perceived it to be associated with less side effects (5/44, 11%). In the TF group 24 patients (64%) felt that the surgeon had influenced their choice of procedure, of which 22 (94%) would have chosen MSAD had they been suitable. Four patients however (11%) chose TF because it was an established procedure with extensive experience. <h3>Conclusion</h3> Suitability for MSAD was found in 57.5% of patients with objective evidence of GORD. The perception that it represents a less invasive, less problematic but definitive procedure, is an attractive option for patients who may not otherwise have considered more radical surgery. There was no clear correlation with the extent of distal oesophageal acid exposure and the impact of this on patient health related quality of life, suggesting that debilitating symptoms can still occur with relatively modest degrees of reflux. The option of MSAD as a sphincter augmentation rather than a gastric reconstruction procedure may broaden the spectrum of patients willing to undergo surgical rather than medical therapy. <h3>Disclosure of interest</h3> None Declared.
Cerebral Microbleeds, Cognition, and Therapeutic Implications
Authors: Philip B. Gorelick, Muhammad U. Farooq
Journal: JAMA Neurology (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 Neurology 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 Neurology journal