tbuckley/cabot-search huggingface dataset:
Therapy for mild hypertension. Toward a more balanced view
Authors: N. M. Kaplan
Journal: JAMA (1983)

PUBLICATION in this journal of the results of the Multiple Risk Factor Intervention Trial (MRFIT)<sup>1</sup>should bring about a reassessment of the current widespread and routine use of drug treatment for most people with mild hypertension, defined as a diastolic BP between 90 and 104 mm Hg. Such patients make up about 75% of the hypertensive population, a total of at least 30 million Americans. Most American practitioners are now responding to the admonishments of hypertension experts and pharmaceutical advertisements that the "HDFP (Hypertension Detection and Follow-up Program) findings justify early and aggressive management of mild hypertension." Even before the HDFP<sup>2</sup>or any other data in support of the value of such therapy for mild hypertension were available, 92% of the physicians in New York State who responded to a questionnaire indicated they routinely gave antihypertensive drug therapy to patients with diastolic BPs between 90 and 104 mm
Characteristics associated with common reasons to pursue genomic profiling among patients with metastatic genitourinary cancers.
Authors: Jasnoor Malhotra, Errol James Philip, Ameish Govindarajan, Sabrina Salgia, Luis A Meza, Zeynep Busra Zengin, Ramya Muddasani, Neal Shiv Chawla, Daniela Castro, Alex Chehrazi-Raffle, Nazli Dizman, Paulo Gustavo Bergerot, Joann Hsu, Tanya B. Dorff, Sumanta K. Pal, Cristiane Decat Bergerot
Journal: Journal of Clinical Oncology (2022)

327 Background: Patients with cancer may possess limited knowledge of emerging modalities in oncology, including genomic profiling (GP) tests, which can create barriers to shared decision making. Effective provider communication can address such barriers but little is understood regarding patients’ perceptions of GP. Methods: In this cross-sectional study, patients who were diagnosed with advanced genitourinary cancers (bladder, renal, and prostate cancers), and were referred for GP responded to a survey to assess reasons to pursue such testing. Clinicopathologic characteristics were collected via chart review. Kolmogorov-Smirnov tests were used to assess associations between reasons to pursue GP and patient characteristics. Results: Data was obtained from a sample of 126 patients (gender: 75% M, 25% F; average age: 67; marital status: 78% married; education: 76% some college; histology: 67% renal cell carcinoma, 19% urothelial, and 14% prostate). The most common reasons to pursue GP by patient response were: to guide treatment (73%), to improve treatment response (32%), to follow physician’s indication (27%), to predict treatment response (23%), to learn about their disease (19%), and to contribute to the science (12%). Notably, older age was significantly associated with three reasons (guide treatment, P = 0.001; physician’s indication, P = 0.03; contribute to the science, P = 0.001). No association was found among younger patients. A higher level of education was associated with the desire to guide treatment (P = 0.001). In contrast, a lower level of education was associated with physician’s indication (P = 0.002). Conclusions: This study highlights important associations between reasons to pursue GP and age and level of education. Differing strategies for information delivery could be considered when communicating GP benefits to older patients and to patients with lower levels of education.
On Haemoptysis
Authors: A. Foxwell
Journal: BMJ (1894)

JA1.1,)10'1 \ ,SIS [ Ta Ba-nau 849 APUL21, 894j ILMOPysis'.IMKIDIC&L JOLNAL ca.used by tIIe itlttiieiza Wve had( to (lefer for the presvellt -is hiis business rIequirS lhis personall tittendalice.Nowv (Febluary t;th), aifter the 1.pse of two,l-) illoluthis, Ie, (c.anI sce thle stecoind pointer of at watch, reads 2) Snellei at 31 feet distanee and 20 Jateter.lie has beenalttendillng to h-is bliisinetss live lhoulrs aI-day, wIhere hle can see Iiis clients and diaift lhis letters, anid does lhis work satisfactorily.
Portable cholesterol analyzers
Authors: Jeffrey L. Furst
Journal: JAMA (1990)

<h3>To the Editor.—</h3> Kaufman et al<sup>1</sup>reported the coefficient of variation of cholesterol on the Reflotron analyzers as being 13.3%. These results differ from those reported in the literature, including references cited by the authors of the<i>JAMA</i>study. The tabulation below presents the results of eight other studies compared with the study of Kaufman et al. The coefficients of variation varied between 1.1% and 5.7% in these studies vs 13.3% in that by Kaufman et al. We do not know why the results of Kaufman et al differ so dramatically from those in the other reports. It is possible that their study protocol may have differed from that recommended by the manufacturers. We have requested a copy of the protocol so that we can validate the results internally. We encourage workers to continue to evaluate our system. We are confident that the analytical performance of the Reflotron
JAMA 75 YEARS AGO
Journal: JAMA (1980)

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Subarachnoid haemorrhage.
Authors: A Richardson
Journal: BMJ (1969)

In cases of proved subarachnoid haemorrhage how should one proceed ?Clearly the answer will depend on the nature of the lesion, the risk involved if it remains untreated, the possibilities of treatment in relation to the lesion itself, and, finally, the clinical features of the individual patient.An analysis of the cases admitted to Atkinson Morley's Hospital with a diagnosis of subarachnoid haemorrhage in the last 10 years shows the incidence of the various responsible lesions (Table I).TABLE I.-Incidence of Lesions Causing Subarachnoid Haemorrhage Aneurysm ... .
Management of convulsions with fever.
Journal: BMJ (1991)

obese subjects than in controls of normal weight (p<O0-OOl), and there was a correlation between Lp(a) and fibrinogen concentrations (r=0 523), Lp(a) and cholesterol concentrations (r=0 273), and Lp(a) concentration and body mass index (r= 0-210).We conclude that the increased values among obese patients and a significant correlation with other important risk factors for atherosclerosis show that Lp(a) concentration can be considered to be a "trouble marker" of coronary heart disease.
Association Between Short-term Exposure to Environmental Air Pollution and Psoriasis Flare
Authors: Francesco Bellinato, Giovanni Adami, Silvia Vaienti, Camilla Benini, Davide Gatti, Luca Idolazzi, Angelo Fassio, Maurizio Rossini, Giampiero Girolomoni, Paolo Gisondi
Journal: JAMA Dermatology (2022)

Psoriasis is a chronic inflammatory disease with a relapsing-remitting course. Selected environmental factors such as infections, stressful life events, or drugs may trigger disease flares. Whether air pollution could trigger psoriasis flares is still unknown.To investigate whether short-term exposure to environmental air pollution is associated with psoriasis flares.This observational study with both case-crossover and cross-sectional design retrospectively analyzed longitudinal data from September 2013 to January 2020 from patients with chronic plaque psoriasis consecutively attending the outpatient dermatologic clinic of the University Hospital of Verona. For the case-crossover analysis, patients were included who had at least 1 disease flare, defined as Psoriasis Area and Severity Index (PASI) increase of 5 or greater between 2 consecutive assessments in a time frame of 3 to 4 months. For the cross-sectional analysis, patients were included who received any systemic treatment for 6 or more months, with grade 2 or higher consecutive PASI assessment.We compared the mean and cumulative (area under the curve) concentrations of several air pollutants (carbon monoxide, nitrogen dioxide, other nitrogen oxides, benzene, coarse particulate matter [PM; 2.5-10.0 μm in diameter, PM10] and fine PM [<2.5 μm in diameter, PM2.5]) in the 60 days preceding the psoriasis flare and the control visits.A total of 957 patients with plaque psoriasis with 4398 follow-up visits were included in the study. Patients had a mean (SD) age of 61 (15) years and 602 (62.9%) were men. More than 15 000 measurements of air pollutant concentration from the official, open-source bulletin of the Italian Institute for Environmental Protection and Research (ISPRA) were retrieved. Among the overall cohort, 369 (38.6%) patients with psoriasis flare were included in the case-crossover study. We found that concentrations of all pollutants were significantly higher in the 60 days before psoriasis flare (median PASI at the flare 12; IQR, 9-18) compared with the control visit (median PASI 1; IQR, 1-3, P < .001). In the cross-sectional analysis, exposure to mean PM10 over 20 μg/m3 and mean PM2.5 over 15 μg/m3 in the 60 days before assessment were associated with a higher risk of PASI 5 or greater point worsening (adjusted odds ratio [aOR], 1.55; 95% CI, 1.21-1.99; and aOR, 1.25; 95% CI, 1.0-1.57, respectively). Sensitivity analyses that stratified for trimester of evaluation, with various lag of exposure and adjusting for type of treatment, yielded similar results.The findings of this case-crossover and cross-sectional study suggest that air pollution may be a trigger factor for psoriasis flare.
Hiatus hernia.
Authors: M Atkinson
Journal: BMJ (1967)

Gastro-oesophageal reflux is one of the commonest causes of dyspepsia in this country and is usually due to hiatus hernia.Yet many clinicians still in the prime of their careers were trained before the syndrome of gastro-oesophageal reflux or the significance of hiatus hernia was generally appreciated, and 20 years ago these received little attention in the medical curriculum.It is hardly surprising that today hiatus hernia is often overlooked, and it is worth restating the ways in which it may present. Types of HerniaOn anatomical grounds hiatus hernia is commonly divided into three types.The sliding type is most frequently encountered, and here the oesophago-gastric junction moves up through the hiatus into the chest producing a bell-or funnel-shaped configuration.These hernias present with symptoms of gastro-oesophageal reflux, and though they are often quite small and reducible the severity of symptoms bears no relation to their size or mobility.Only when oesophagitis has caused much fibrosis is the oeso- phagus shortened, and hence " short oesophagus " is virtually always the consequence and not the cause of the hernia.The para-oesophageal variety is characterized by herniation of the fundus of the stomach and gastro-colic omentum through the hiatus alongside the cardia, which retains its normal position.This is the least common variety and often produces few symptoms.It may be impossible to distinguish from hernia- tion through a diaphragmatic defect separate from but close to the oesophageal hiatus-which is not of course a true hiatus hernia yet is believed by many to be the usual origin of this type of hernia.The mixed variety is far commoner than a true para- oesophageal hiatus hernia, with which it is often confused because of difficulty in determining the positions of the cardia relative to the hiatus.Here the symptoms are usually those of gastro-oesophageal reflux, though many remain silent.Symp- toms of obstruction may occur, since the cardia lies above the diaphragmatic hiatus-the herniated portion of the stomach may become distended with food if the hiatus is small. Causation of Hiatus HerniaHiatus hernia is usually an acquired condition, the causes of which are still incompletely understood.Unlike other abdo- minal hernias it is seldom clearly related to trauma or to sudden muscular straining increasing intra-abdominal pressure.Very occasionally a patient does feel a sharp tearing retrosternal pain on straining shortly before symptoms of gastro-oesophageal reflux commence, but it seems probable that this is a separate entity from the common type of hiatus hernia, and it usually occurs in younger subjects.
Otitis Externa
Authors: J. F. Birrell
Journal: BMJ (1945)

DiscussionThe nine survivors were among the most appreciative and grateful patients I had in Iraq.They were able to return to their husbands and homes and begin a normal life again.It can be realized what that meant when one remembers that their average age was between 18 and 25 years.Nevertheless a far more efficient follow-up system than is possible in Iraq is neces- sary to compute the end-results of the operation.In Grey Turner's series some patients survived for 20 and 30 years.The mortality of 2 deaths in 11 cases makes the operation one of considerable hazard, certainly not to be undertaken lightly.But the lot of a patient with an incurable vesico-vaginal fistula is such a miserable one that I believe it to be justified.In more skilled hands the mortality is likely to be considerably lower. SummaryEleven cases of ureterocolostomy for incurable vesico-vaginal fistula are described.The operative modification whereby incision of the bowel is avoided is described.There were two deaths in the series, both from peritonitis; the remaining nine patients returned to active life.It is a pleasure to acknowledge the great help and advice given by Brig.C. Naunton Morgan in this series, the stimulation and practical assistance of the writings of my teacher and chief, Prof.
Smallpox vaccination.
Authors: L M Hambraeus
Journal: BMJ (1972)

The men concerned had received multiple injections of analgesics and antihistamines with consequent haematoma formation in the gluteal and lateral thigh musculature.With the exception of small volume injections during immunization, intramuscular therapy is usually unnecessary and always dangerous in patients with coagulation de- fects.The consequent haemorrhage not only causes pain and pressure on surrounding tissues, but may result in muscle fibrosis and permanent crippling.-I am, etc.,
Address in Surgery
Authors: A. Ogston
Journal: BMJ (1899)

NAVY.IN presence of an assemblage of so many representatives of the medical science of the British Empire, I have much pleasure in gratefully acknowledging the honour of being called upon to deliver the Address in Surgery.It is a task I enter upon with a sense of responsibility, and a fear lest I should fail to do justice to the duty entrusted to me by the Council of the British Medical Association.But I take courage from the be- lief that you will be disposed to form a lenient judgment of any endeavour to contribute to the usefulness of the annual meeting of our Association, and because I think that the theme I have chosen for the Address in Surgery on this occa- sion is one in harmony with the high aims of our science, since it has for its design to promote the great objects for which our profession exists, those, namely, of saving the lives and diminishing the sufferings of our fellow-men.
Septic shock.
Authors: C J Wright
Journal: BMJ (1970)

MErBcAJ.OUNAL ventilated varied from 2 hours to 264 hours.The total ventilation time for the 18 patients was 2,088 hours.At the peak period of the epidemic 8 ventilators were used at one time.Out of 18 patients 5 survived.Of the 13 patients who died 10 died with fulminating pneumonia.Two diabetic patients, with blood sugar up to 1,300 mg./100 ml.despite peritoneal dialysis, gradually deteriorated and died.One died after an acute episode of status asthmaticusIn surveying these cases the following findings were of interest: Cerebral vascular episodes were found in three patients during acute viraemia.One patient had epileptiform fits during severe hypoxaemia and viraemia.Hyperkalaemia and a high blood urea were found in severe acidotic patients on admis- sion, while hypokalaemia was the common finding after prolonged treatment of this group of patients.In weaning the patients off the ventilators, the call for reinstitution of intermit- tent positive pressure ventilation was indi- cated when Pao2 fell below 70 mm.Hg and physical exhaustion was observed.-Iam, etc., K. T. TCHEN.St. Mary's General Hospital, Portsmouth.***The reference level for which 10-12 cm.water could
Immune characterization of urothelial bladder carcinoma integrating transurethral resection of bladder tumor (TURBT) samples and serum: A feasibility study.
Authors: Carmen Alvarez-Dominguez, Ainara Azueta, Nerea Muñoz Unceta, Jose Luis Gutierrez-Baños, Hector Teran, Javier Ocejo-Viñals, Elena Gonzalez-Lopez, Belen Caramelo, Sara Marcos-Gonzalez, David Salcines-Cuevas, Mario Dominguez, Rebeca Madureira-Rivero, Felix Campos-Juanatey, Marta Sotelo, Andrea Zeoli, Laura Revuelta, Ignacio Duran
Journal: Journal of Clinical Oncology (2022)

538 Background: Urothelial bladder cancer (UBC) is characterized by high immunogenicity. Multiple immunotherapies both in the perioperative and advanced setting are being developed. However, we lack good predictive biomarkers of response to immunotherapy in UBC. We aimed to characterize the immune profile of UBC patients using TURBT and serum samples. Methods: 13 UBC biopsies from TURBT samples were analyzed along with sera of these patients. Biopsy samples were divided in two equal parts. One part was formalin-fixed paraffin embedded and stained for immune histochemistry [IHC] for the following markers (CD3, CD4, CD8, CD20, CD68 and PD-L1 using SP142 antibody) and results expressed in percentages. The other part was homogenized and processed for immune cell isolation (human tumor isolation Miltenyi Kit). Tumor cells were stained with PHK and double positive CD8 and PHK were isolated using a MACSTM procedure. Different immune cell populations were analyzed by flow cytometry for the following markers (CD3, CD4, CD8, CD20 and CD68) and results expressed in percentages. Cytokines were examined in sera using the Luminex multiparametric procedure and results were expressed as pg/mL. Results: IHC and flow cytometry data were comparable and identified three groups according to the immune cells associated with the tumors (Table). Groups 1 and 2 showed high and moderate levels of tumor activated CD8 + T cells (1-4%) along with a higher expression of PD-L1 (40-20%). Group 3 lacked tumor activated CD8 + T cells and show lower expression of PD-L1 (15%). All groups showed significant levels of Th2 cytokines (IL-4, IL-6 or IL-10) while very low or lack of Th1 cytokines (IFN or IL-2) was observed except in group 2. Conclusions: TURBT biopsies and serum analysis of cytokines could represent a valid approach to further evaluate potential predictive biomarkers of response to immunotherapy in UBC. Different immune populations subgroups were identified in our series and could potentially predict for diverse responses to treatment. Further prospective validation in larger series is ongoing to confirm these results.[Table: see text]
On Massage
Authors: A. Colles
Journal: BMJ (1888)

general knowledge as possible, as he miht thereby often be able to engender confidence in his patient.He should also endeavour to " see himself as others see him," so as to be better able to deal with them.Much help in this direction might be obtained from a study of works of fiction, in which medical men are portrayed from the outside.The profes8ion was often misunderstood and misjudged by the public, but this should never be allowed to dis- courage its members from the prosecution of their task.Nor should they be disheartened by the inexactitude of the science on which their art was founded, and the large proportion of suess- work which there necessarily was in their methods."If,' con- cluded the President, " our work, like that of the stuident in every branch of science, is largely a work of conjecture, it is no fault of ours that our strivings have such a limitation.We have only to see to it that our conjectures are framed aright; that we toil after the attainment of what is noble, enduring, and true, recognising in our quest that there must be always things beyond knowledge, and moved by a faith in the sublimity of natural law, which we may not express in finite terms, but which may inspire us with resolution to go forward and with a saving humility as we gaze meanwhile tupon the Temples that, crowd the crumbled brink O'er hanginig Triuth'eternal flow.Their tablets hold with what we thlinik," Their echoes dumb to " what we kniow."ON MASSAGE.
Sacroiliac strain.
Authors: J Bourne
Journal: BMJ (1979)

antigenic concentrations of plasma anti- proteases, as protease-antiprotease complexes with no functional activity are still detected immunochemically.Of particular relevance to the above mentioned article were the observa- tions of Teger-Nilsson,7 who found that functional antiplasmin activities in patients with acute venous thrombosis were normal on the day of diagnosis and that elevated activities were found three and four days after the diagnosis.Another point to be considered is the possible role of platelet antiproteases released during thrombus formation.Platelets contain inhibitors of fibrinolysis,8 which would certainly hinder thrombus resolution.We would like to suggest that chromogenic substrate assays for the estimation of functional antiprotease activities should be included in any protocol for studies on the various plasma protease systems.These assays, which are simple and rapid to perform, give a better indication of the inhibitor status than immunochemical determinations.