tbuckley/cabot-search huggingface dataset:
Flexor forces and rheumatoid metacarpophalangeal deformity. Clinical implications
Authors: E. M. Smith
Journal: JAMA (1966)

A new theory concerning dynamics of deformity formation in the rheumatoid metacarpophalangeal (MCP) joint has been advanced which is pertinent to the management of the rheumatoid hand. The theory implicates the large forces normally present in the flexor tendons during pinch or grasp. Because of the bends at the MCP joints in these tendons, there is a strong tendency for them to "bowstring" volarly in all fingers, and also ulnad in digits 2, 3, and 4. If diseased joint structures can no longer restrain this tendency, the deformity of volar subluxation and ulnar deviation may follow. In the fifth digit, however, ulnar deviation appears to be the result of the incompletely opposed pull of the hypothenar muscles. The implications of the theory are significant for the prevention, conservative management, and surgical treatment of rheumatoid MCP-joint deformity.
The unsettling UGDP controversy
Authors: A. M. Sackler
Journal: JAMA (1980)

IN 1970 when diabetics and diabetologists had only press releases available, patients and practicing physicians had a right to expect national medical organizations to protect their interests properly. Unfortunately, the American Diabetes Association (ADA) and the American Medical Association accepted, and their journals published, the University Group Diabetes Program (UGDP) report. The Food and Drug Administration not only accepted, but tried to act on the basis of that study. <h3>Editorial Statement</h3> Among the UGDP reports was an editorial by Thomas Chalmers, MD (231:624-625, 1975), titled "Settling the UGDP Controversy." This communication was characterized by a number of misleading implications. In his editorial, Dr Chalmers stated: "age-specific death rates were decreasing steadily from the time insulin was discovered until the late 1950s, in the older age groups there has been only an abrupt and continuing increase that started with the widespread use of oral agents.<sup>5,6</sup>" Reference 5 was from Reid and
Acute, Chronic Poisoning, Residential Exposures to Elemental Mercury—Michigan, 1989-1990
Journal: JAMA (1991)

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
THE EVIL OF EPONYMS.
Journal: JAMA (2003)

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
MANAGEMENT OF PAIN IN MALIGNANCIES
Journal: JAMA (1961)

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
On Rounds
Authors: Jerald Winakur
Journal: Annals of Internal Medicine (2004)

Ad Libitum2 November 2004On RoundsJerald Winakur, MDJerald Winakur, MDFrom Comfort, TX 78013.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-9-200411020-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail When will my eyesbe as vacant as hismy pulse as weakmy joints as stiffwhen will I needmy first walkerfirst wheelchairhas the cellthat is parentto my canceralready mutatedare there now twofour, eight, sixty-fourhave they brokenten thousandwhen will my heartbeat in that peculiarway, require a jump-startwhen will it—onceand for all—stopwhen will my skin takeon that waxen lookin certain lightit looks that way nowwhen will I forgetyour namemy own? Author, Article, and Disclosure InformationAffiliations: From Comfort, TX 78013.Current Author Address: Jerald Winakur, MD, PO Box 128, Comfort, TX 78013. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEstimating Development Cost for a Tailored Interactive Computer Program to Enhance Colorectal Cancer Screening Compliance 2 November 2004Volume 141, Issue 9Page: 692KeywordsHeartHeart rateWheelchairs ePublished: 2 November 2004 Issue Published: 2 November 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Infographic. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases
Authors: Francesco Della Villa, Matthew Buckthorpe, Alberto Grassi, Alberto Nabiuzzi, Filippo Tosarelli, Stefano Zaffagnini, Adam Virgile, Stefano Della Villa
Journal: British Journal of Sports Medicine (2020)
<i>Erratum:</i> Vol. 67, No. 40
Authors: Maria Morales-Betoulle, Sara Zufan, Shannon Whitmer
Journal: MMWR Morbidity and Mortality Weekly Report (2018)

In addition, in the first paragraph, the seventh sentence should have read "A blood specimen collected on November 9 tested positive for SNV, with an immunoglobulin M titer of ≥1:6400 and an immunoglobulin G titer of ≥1:6400; nested reverse transcription-polymerase chain reaction (RT-PCR) followed by nucleic acid sequencing confirmed the SNV diagnosis."
Simvastatin Induces Regression of Cardiac Hypertrophy and Fibrosis and Improves Cardiac Function in a Transgenic Rabbit Model of Human Hypertrophic Cardiomyopathy
Authors: Rajnikant Patel, Sherif F. Nagueh, Natalie Tsybouleva, Maha Abdellatif, Silvia Lutucuta, Helen A. Kopelen, Miguel A. Quinones, William A. Zoghbi, Mark L. Entman, Robert Roberts, A.J. Marian
Journal: Circulation (2001)

Background Hypertrophic cardiomyopathy is a genetic disease characterized by cardiac hypertrophy, myocyte disarray, interstitial fibrosis, and left ventricular (LV) dysfunction. We have proposed that hypertrophy and fibrosis, the major determinants of mortality and morbidity, are potentially reversible. We tested this hypothesis in β-myosin heavy chain–Q 403 transgenic rabbits. Methods and Results We randomized 24 β-myosin heavy chain–Q 403 rabbits to treatment with either a placebo or simvastatin (5 mg · kg −1 · d −1 ) for 12 weeks and included 12 nontransgenic controls. We performed 2D and Doppler echocardiography and tissue Doppler imaging before and after treatment. Demographic data were similar among the groups. Baseline mean LV mass and interventricular septal thickness in nontransgenic, placebo, and simvastatin groups were 3.9±0.7, 6.2±2.0, and 7.5±2.1 g ( P &lt;0.001) and 2.2±0.2, 3.1±0.5, and 3.3±0.5 mm ( P =0.002), respectively. Simvastatin reduced LV mass by 37%, interventricular septal thickness by 21%, and posterior wall thickness by 13%. Doppler indices of LV filling pressure were improved. Collagen volume fraction was reduced by 44% ( P &lt;0.001). Disarray was unchanged. Levels of activated extracellular signal-regulated kinase (ERK) 1/2 were increased in the placebo group and were less than normal in the simvastatin group. Levels of activated and total p38, Jun N-terminal kinase, p70S6 kinase, Ras, Rac, and RhoA and the membrane association of Ras, RhoA, and Rac1 were unchanged. Conclusions Simvastatin induced the regression of hypertrophy and fibrosis, improved cardiac function, and reduced ERK1/2 activity in the β-myosin heavy chain–Q 403 rabbits. These findings highlight the need for clinical trials to determine the effects of simvastatin on cardiac hypertrophy, fibrosis, and dysfunction in humans with hypertrophic cardiomyopathy and heart failure.
Inflammation and platelet-activating factor production during hepatic ischemia/reperfusion
Authors: W Zhou
Journal: Hepatology (1992)

The role of platelet-activating factor as a potential mediator of hepatic inflammatory injury associated with liver ischemia/reperfusion was investigated using a partial no-flow model in rats in vivo. Plateletactivating factor levels of livers from sham-operated rats and from animals experiencing hepatic reperfusion for less than 6 hr were very low. They were observed to increase significantly after 12 hr of reperfusion and reached peak levels after a 24-hr reperfusion period, a time when maximal hepatic injury and inflammation occurred. Treatment of experimental rats with WEB2170, a platelet-activating factor receptor antagonist, attenuated the hepatic injury and inflammation, as evidenced by decreases in plasma ALT and in hepatocyte necrosis and neutrophil infiltration. Both inactivation of Kupffer cells with gadolinium chloride and inhibition of the formation of reactive oxygen species with allopurinol reduced platelet-activating factor production in the liver, whereas induction of neutropenia had no effect, suggesting that interaction of Kupffer cells with oxygenderived free radicals may be a plausible mechanism for hepatic platelet-activating factor accumulation. It is concluded that platelet-activating factor contributes to the inflammatory consequences of ischemia/reperfusion underlying late-phase hepatic injury. (HEPATOLOGY 1992;16:1236–1240.)
L'ostéo-synthèse métallique dans les fractures diaphysaires: Étude expérimentale et anatomo-pathologique; applications pratiques à la chirurgie humaine.
Journal: JAMA (1930)

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
Fruit and Vegetable Intake and Coronary Heart Disease
Authors: Kaumudi J. Joshipura, Frank B. Hu, Walter C. Willett
Journal: Annals of Internal Medicine (2002)

Letters16 July 2002Fruit and Vegetable Intake and Coronary Heart DiseaseKaumudi J. Joshipura, ScD, Frank B. Hu, MD, and Walter C. Willett, MDKaumudi J. Joshipura, ScDHarvard School of Public Health Boston, MA 02115 (Joshipura, Hu, Willett)Search for more papers by this author, Frank B. Hu, MDHarvard School of Public Health Boston, MA 02115 (Joshipura, Hu, Willett)Search for more papers by this author, and Walter C. Willett, MDHarvard School of Public Health Boston, MA 02115 (Joshipura, Hu, Willett)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-137-2-200207160-00021 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The suggestion by Drs. Alves-Rodrigues and Thomas that the cardioprotective effect of green leafy vegetables may be related to high lutein levels is based on an animal study of lutein and arteriosclerosis (1) and a study among humans examining the relation between lutein and other antioxidants and coronary disease (2). In our study, we mentioned that antioxidant vitamins, folate, fiber, and such minerals as potassium may contribute to the apparent beneficial effects of fruits and vegetables, and we agree that lutein may also partly explain this benefit.Dr. Lindenauer and colleagues propose a new term, NNEB, as a ...References1. Dwyer JH, Navab M, Dwyer KM, Hassan K, Sun P, Shircore A, et al . Oxygenated carotenoid lutein and progression of early atherosclerosis: the Los Angeles atherosclerosis study. Circulation. 2001;103:2922-7. [PMID: 11413081] CrossrefMedlineGoogle Scholar2. Howard AN, Williams NR, Palmer CR, Cambou JP, Evans AE, Foote JW, et al . Do hydroxy-carotenoids prevent coronary heart disease? A comparison between Belfast and Toulouse. Int J Vitam Nutr Res. 1996;66:113-8. [PMID: 8843985] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Harvard School of Public Health Boston, MA 02115 (Joshipura, Hu, Willett) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease Kaumudi J. Joshipura , Frank B. Hu , JoAnn E. Manson , Meir J. Stampfer , Eric B. Rimm , Frank E. Speizer , Graham Colditz , Alberto Ascherio , Bernard Rosner , Donna Spiegelman , and Walter C. Willett Fruit and Vegetable Intake and Coronary Heart Disease Alexandra Alves-Rodrigues and Boban Thomas Fruit and Vegetable Intake and Coronary Heart Disease Peter Lindenauer , Darius A. Rastegar , and Dorothea von Goeler Metrics 16 July 2002Volume 137, Issue 2Page: 144KeywordsAdverse reactionsAge distributionAntioxidantsCoronary heart diseaseFolic acidPotassiumRelative riskStable coronary artery diseaseVitamins ePublished: 16 July 2002 Issue Published: 16 July 2002 CopyrightCopyright © 2002 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...
Orals
Authors: J Clevers, S Gourtsoyianni, S Yarmenitis, N Papanikolaou, P Taflampas, M Christodoulakis, M Tzardi, D Tsiftsis, N Gourtsoyiannis, F Oort, J Terhaar Sive Droste, M Craanen, R Van Wanrooy, L De Baay, E Mutsaers, S Van De Reijt, C Mulder, R Van Der Hulst, H Van Heukelem, R Loffeld, I Wesdorp, G Meijer, R Siegel, S Dresel, S Koswig, B Gebauer, M Hu ¨nerbein, W Schneider, P Schlag, G Beets, M Lahaye, S Engelen, A Kessels, K Keymeulen, A De Bruı ¨ne, A Willig, J Van Engelshoven, C Van De Velde, R Beets-Tan, I Nagtegaal, T Tot, D Jayne, H Thorpe, A Nihlberg, L Pahlman, J Brown, L Holmberg, P Guillou, P Quirke, A Ensari, B Savas, A Hirschmann, A Jung, T Kirchner
Journal: Annals of Oncology (2008)
Die biogenen Amine und ihre Bedeutung für die Physiologie und Pathologie des pflanzlichen und tierischen Stoffwechsels. Monographien aus dem Gesamtgebiet der Physiologie der Pflanzen und der Tiere.
Journal: JAMA (1924)

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
The Placebo Effect in Psychotherapy
Journal: JAMA (2017)

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
Air embolism from exposure of posterior cranial fossa in prone position
Authors: H. N. Shenkin
Journal: JAMA (1969)

<h3>To the Editor:—</h3> Air embolism as a complication of exploration of the posterior fossa or cervical portion of the spine is usually associated with these procedures when carried out with the patient in the upright position. Michenfelder et al reported 39 instances of air embolism in 751 patients operated upon for lesions in the posterior cranial fossa.<sup>1</sup> The case reported below points out that precautions against air embolism are indicated even if the patient is in the prone position, especially in view of the recent widespread adoption of hyperventilation using a negative pressure phase in the respiratory cycle. Should the structures involved at operation include large venous channels, the possibilities for air embolism are obviously enhanced. <h3>Report of a Case:—</h3> A 47-year-old right-handed man was admitted to the neurosurgical service at the Episcopal Hospital in Philadelphia on March 30, 1968, with a six-week history of vertigo and syncopal episodes,
Diagnosis of Meckel diverticulum by sodium pertechnetate Tc 99m scan
Authors: M. Cooper
Journal: JAMA (1976)

Meckel diverticulum was diagnosed preoperatively as the cause of recurrent rectal bleeding in a 2-year-old child by means of a sodium pertechnetate Tc 99m scan. Although false-negative scans have been reported to occur in approximately 50% of all cases of Meckel diverticulum, the procedure should be considered in any case of unexplained, painless rectal bleeding, especially in pediatric patients. (<i>JAMA</i>235:1471-1472, 1976)
Massachusetts Medical Society
Authors: John Figgis Jewett
Journal: New England Journal of Medicine (1965)

COMMITTEE ON MATERNAL WELFAREFibroid with Pulmonary EmboliA thirty-six-year-old gravida 1 was first seen at thirteen weeks with an acute abdominal emergency, which after thirty-six hours' observation was found due to infarction of a large leiomyoma. A 15-cm. tumor was resected from the anterior uterine wall, and the large defect was carefully closed. No further complaints were evoked until thirty weeks, when an episode of precordial pressure and dyspnea required readmission. On the next day the pressure had disappeared, but tachypnea persisted. These symptoms could not be explained by physical examination, and the patient was treated with sedatives. In . . .
The medical treatment of Cushing's syndrome
Authors: J. W. Miller
Journal: Endocrine Reviews (1993)

WITH the advent of synthetic glucocorticoids in the late 1940s, adrenalectomy ushered in the modern era of treatment for Cushing's syndrome. Nearly two decades later, the development of transsphenoidal microsurgical techniques allowed the treatment of Cushing's disease with preservation of anterior pituitary function. Medical treatment for hypercortisolism has also progressed during this time. In the 1950s and 1960s, steroidogenic blocking agents, metyrapone and aminoglutethimide, and the adrenolytic agent, mitotane, first achieved use, later to be joined by the imidazole derivative, ketoconazole. As understanding of ACTH neuroregulation advanced in subsequent decades, agents such as bromocriptine, cyproheptadine, and valproate achieved some clinical use. Most recently, a different class of agent, the steroid receptor antagonist RU-486, has been added to the list of potential therapeutic agents. Although medical therapies for Cushing's syndrome have proliferated, no single agent has yet achieved widespread clinical use compared to surgical therapy. The purpose of this paper is to review clinical studies of the pharmacotherapy of Cushing's syndrome, and to consider the indications for medical therapy in light of accumulated experience with medical, surgical, and radiation therapy.