Massachusetts Memorial Hospitals Research Articles

An Homage to Two Explorers of Uncharted Cancer Waters

An Homage to Two Explorers of Uncharted Cancer Waters

Julia Gordon Arrowood (1900 – 1984): A Brilliant Anesthesiologist and a Woman of Many Firsts in Medicine

After a brief “golden age” in the late 1800s, the patriarchal establishment fought back and women faced increasing restrictions in practicing medicine. In 1900, 18.2% of all physicians in the city of Boston were women, but this number decreased to 8.7% by 1930. The relatively young field of anesthesiology was one of the more welcoming specialties for women during this time. History has been unkind to these early female trailblazers who have often been overlooked in favor of the men in their fields. Julia Gordon Arrowood (1900–1984) was a forerunner for women in medicine and a prominent anesthesiologist in Boston from the 1930s until the 1950s. Her work included not only clinical medicine, but also research and teaching. She attended Boston University School of Medicine, graduating as valedictorian in the class of 1933. She interned at Belmont Hospital in Worcester, MA where she decided on a career in anesthesiology. She was accepted as a resident at Massachusetts General Hospital (MGH) by chief-anesthetist Henry Beecher in 1935, thereby becoming the first woman anesthesiology resident in Massachusetts. She remained at MGH and was named Acting Chief of Anesthesia in 1943. In 1944, she became president of the New England Society of Anesthesiologists, another first for a woman. In 1946, she joined Reginald Smithwick's team as Chief of Anesthesia at Massachusetts Memorial Hospital, Boston, and concurrently held the position of Professor of Anesthesiology at Boston University School of Medicine. Arrowood led many of the earliest studies on spinal anesthesia, muscle relaxants, and spinal headaches. In 1957, she moved to Kentucky and joined the United Mine Workers hospital system where she worked until her retirement in 1970. Women such as Julia Arrowood remain underrepresented in the annals of the history of medicine. Much work is needed to recognize the many contributions made by women physicians and to provide equal opportunities, pay, and status.

Overview of the First Natural Language Processing Challenge for Extracting Medication, Indication, and Adverse Drug Events from Electronic Health Record Notes (MADE 1.0).

This work describes the Medication and Adverse Drug Events from Electronic Health Records (MADE 1.0) corpus and provides an overview of the MADE 1.0 2018 challenge for extracting medication, indication, and adverse drug events (ADEs) from electronic health record (EHR) notes. The goal of MADE is to provide a set of common evaluation tasks to assess the state of the art for natural language processing (NLP) systems applied to EHRs supporting drug safety surveillance and pharmacovigilance. We also provide benchmarks on the MADE dataset using the system submissions received in the MADE 2018 challenge. The MADE 1.0 challenge has released an expert-annotated cohort of medication and ADE information comprising 1089 fully de-identified longitudinal EHR notes from 21 randomly selected patients with cancer at the University of Massachusetts Memorial Hospital. Using this cohort as a benchmark, the MADE 1.0 challenge designed three shared NLP tasks. The named entity recognition (NER) task identifies medications and their attributes (dosage, route, duration, and frequency), indications, ADEs, and severity. The relation identification (RI) task identifies relations between the named entities: medication-indication, medication-ADE, and attribute relations. The third shared task (NER-RI) evaluates NLP models that perform the NER and RI tasks jointly. In total, 11 teams from four countries participated in at least one of the three shared tasks, and 41 system submissions were received in total. The best systems F1 scores for NER, RI, and NER-RI were 0.82, 0.86, and 0.61, respectively. Ensemble classifiers using the team submissions improved the performance further, with an F1 score of 0.85, 0.87, and 0.66 for the three tasks, respectively. MADE results show that recent progress in NLP has led to remarkable improvements in NER and RI tasks for the clinical domain. However, some room for improvement remains, particularly in the NER-RI task.

Lysia K.S. Forno, MD February 14, 1918-May 8, 2015.

Lysia K.S. Forno, MD Lysia K. Saxe was born on Valentine's Day in Hallund, Denmark, and died at home in Redwood City, California, on the 70th anniversary of the Victory in Europe Day. During her childhood, she enjoyed bicycling through the countryside (and occasionally smoking cigars) with her brother Skjold. Because both of her parents were teachers, it was not surprising that she would pursue higher education. She attended the University of Copenhagen and received her MD in 1943, at the time of the Nazi occupation. After a rotating internship, she trained in internal medicine, psychiatry, neurosurgery, and neurology at various Danish hospitals (1944–1947). She then served as a clinical assistant in Neurology at the Aarhus Municipal Hospital and Aarhus University Neurology Clinic (1947–1950). Her interest in the field of neuropathology was inspired by Dr. Erna Christensen, the first diagnostic neuropathologist in Denmark. An American Association of University Women Fellowship provided her with the opportunity to come to the United States to study neuropathology with Drs. Raymond D. Adams and E. P. Richardson, Jr, at the Massachusetts General Hospital (MGH) in Boston where she subsequently was a resident and fellow in Neuropathology. She then trained in General Pathology at the Massachusetts Memorial Hospital, Boston (now Boston University Hospital). She returned to Denmark where she continued to practice pathology and neurology from 1953 to 1954. On the boat from the United States to Denmark, she met Bert H. Forno whom she married in 1954. Bert died in 1978. In 1957, Dr. Forno began her association with the Stanford University School of Medicine (then located in San Francisco), where she worked with Dr. Knox Finley. She was a research associate in Neuropathology, Department of Pathology, and worked one-half to two-thirds time while balancing neuropathology with domestic chores and the care of her …

Bill Paul: The heart of immunology

Sadly, on September 19, 2015, a giant in the field of immunology, William “Bill” Paul, died of lymphoma. The passing of this outstanding scientist, with his warm avuncular personality and intense excitement about immunology, is a great loss to the field. His self-effacing manner and erudition were instrumental in advancing modern immunology as a discipline, an influence that continues through the many immunologists he has trained and influenced. Bill was born in Brooklyn in 1936 to parents who were European emigres. He attended local schools, including Brooklyn College and the State University of New York College of Medicine, Downstate, followed by internal medicine training at Massachusetts Memorial Hospital, now Boston Medical Center. To fulfill his military obligation, Bill joined the Public Health Service and engaged in clinical and laboratory research in the Endocrinology Branch of the National Cancer Institute in Bethesda, Maryland. There, in the research group of Roy Hertz, Bill participated in the first curative chemotherapy for choriocarcinoma. His laboratory work in developing a radioimmunoassay for thyroid-stimulating hormone stimulated his nascent interest in fundamental aspects of immune responses.

Abstract P4-11-17: Validation of a multi-marker test that predicts recurrence in patients diagnosed with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS)

Abstract Background: DCIS is diagnosed in ∼54,000 women/year in the US. Identifying patients who are most likely to recur has been deemed one of the most important unmet needs in breast cancer treatment. The goal of this study was to develop and blindly validate a multi-marker risk stratification test in DCIS patients treated with BCS. Material and Methods: A variety of clinical, pathological, immunohistochemical, and in situ hybridization data were derived from a set of patients diagnosed with DCIS (without evidence of invasive breast cancer) between 1986 and 2004 in Uppland and Västmanland, Sweden–the Uppsala University Hospital (UUH) patient set. Separate models to predict DCIS and invasive event risk were developed using statistical pattern recognition and modeling methods on UUH patients treated with BCS in the absence of adjuvant therapy (n=200). In addition, an "overall" risk model was created by combining the DCIS and invasive models. The risk models consist of algorithms that combine data on p16/INK4A, Ki-67, COX2, PR, HER2, FOXA1, SIAH2, CD31, patient age, necrosis, tumor size, palpability, and/or margin status, along with predefined thresholds that create low, intermediate, and high risk groups ("elevated" risk groups combine the intermediate and high risk groups). The models were then tested blindly on a set of patients diagnosed with DCIS and treated with BCS from 1999 through July 2008 at the University of Massachusetts Memorial Hospital, Worcester, MA (UMass patient set). Molecular marker data was collected with CLIA-validated assays and Board-certified pathologists, and other data was collected from medical records. Testing was done according to a predefined statistical analysis plan in the UMass patients equivalent to those in the UUH patient training set--those with complete marker data and treated with BCS, and were either PR-negative or not treated with hormone therapy (n=155). Event rates were assessed for up to 10-year outcome using Kaplan-Meier survival analysis. Hazard ratios (HRs) were determined using Cox proportional hazards analysis. Results: The 10-year overall event rate in the full population was 10% (5% invasive plus 5% DCIS). For the invasive risk model, the low (n=53) and elevated (n=102) risk groups had 0% and 8% 10-year invasive event rates, respectively. For the DCIS risk model, the low (n=97) and elevated (n=58) risk groups had 1% and 13% 10-year DCIS event rates, respectively. For the overall risk model (combined risk of DCIS or invasive events), the low (n=34), intermediate (n=51), and high (n=70) risk groups had 0%, 12%, and 15% overall 10-year event rates, respectively (HR=4.1/bin, p=0.0088). The overall risk model maintained significance when adjusted for nuclear grade, tumor size, patient age, necrosis, and margin status, while none of these clinicopathologic factors demonstrated significance in the presence of the model. Discussion: This study indicates that the present approach to risk stratification modeling can accurately identify patients at risk for DCIS or invasive events after a primary DCIS diagnosis. The models presented here are the basis of a comprehensive multi-marker panel undergoing formal validation. Citation Format: Steven P Linke, Troy M Bremer, Pat Whitworth, Alfred Lui, Jess Savala, Yelina Noskina, Todd Barry, Stephen Lyle, Stephanie C Walters, Cherie Taglienti, Karl Simin, Wenjing Zhou, Karin Jirström, Rose-Marie Amini, Fredrik Wärnberg. Validation of a multi-marker test that predicts recurrence in patients diagnosed with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-11-17.

Abstract P4-11-18: FOXA1 and PR predict ipsilateral event risk and identify a group with strong radiation response in ductal carcinoma in situ (DCIS)

Abstract Background: Identification of biomarkers in DCIS is critical to help guide treatment decisions, particularly for patients receiving breast-conserving surgery (BCS). The goal of this study was to assess FOXA1 levels in the context of PR status in primary DCIS to predict ipsilateral invasive and DCIS events, given the established roles of these endocrine signaling factors in breast cancer. Material and Methods: Patients included in this study (n=518) were women diagnosed with DCIS without evidence of invasive cancer treated with BCS, and for whom tumor tissue was evaluable for both PR and FOXA1. An Uppsala University Hospital (UUH) set was diagnosed in 1986-2004 (117 treated and 122 not treated with adjuvant radiation therapy [RT]); and a University of Massachusetts Memorial Hospital (UMass) set was diagnosed in 1999-2008 (195 treated and 84 not treated with RT). Tumors were immunohistochemically stained for PR and FOXA1 and scored by pathologists for percentage (0-100) and intensity (0-3), with the product being calculated for FOXA1 immunoscore (0-300). Patients were considered PR+ when ≥10% of cells stained positively, and immunoscore thresholds of 100 and 270 were used to separate patients into FOXA1 low, intermediate, and high groups. Event rates were assessed for 10-year outcome using Kaplan-Meier survival analysis. Hazard ratios (HR) were determined using Cox proportional hazards analysis. Results: Neither FOXA1 nor PR were prognostic as independent factors for either invasive or DCIS event risk. However, in PR- patients, the invasive event rate decreased with increasing FOXA1 (24%, 4%, and 0%, respectively, in the FOXA1 low, intermediate, and high groups, HR=6.7/bin, p=0.0034), and, in PR+ patients, the invasive event rate increased with increasing FOXA1 (0%, 10%, and 13%, respectively, HR=2.95/bin, p=0.041). In contrast, the DCIS event rate increased in PR- patients with increasing FOXA1 (3%, 12%, and 26%, respectively, HR=2.7/bin, p=0.020), and the DCIS event rate was lower in PR+ patients with elevated FOXA1 levels (28% in FOXA1 low vs. 8% in FOXA1 intermediate plus high, HR=4.0, p=0.011). In the full population, RT-treated patients (n=312) fared better than the unirradiated (n=206) with invasive event rates of 6% and 10%, respectively (HR=0.41, p=0.021). By comparison, the patients with high marker-based invasive event risk (PR-/FOXA1 low and PR+/FOXA1 high, n=191) had a remarkable response to RT–event rate reduced from 19% to 4% (HR=0.13, p<0.001). In contrast, the remainder of patients (n=327) showed no evident RT response--event rate increased from 5% to 6%. In an interactional Cox analysis, the high-risk group (HR=5.0, p=0.0045) and RT response within that group (HR=0.10, p=0.020) were significant, but baseline RT response was not (p=0.72). Discussion: These results indicate a complex interaction between PR and FOXA1, in which the prognosis for invasive and DCIS events flips both within and between the event types. Thus, the biology that drives these events differs and, in order to predict both event types, risk models must include biomarkers in context. In addition, PR/FOXA1 identify a risk group with remarkably strong RT response with the remaining patients exhibiting no measurable response. Citation Format: Steven P Linke, Troy M Bremer, Pat Whitworth, Aflred Lui, Jess Savala, Yelina Noskina, Todd Barry, Stephen Lyle, Stephanie C Walters, Cherie Taglienti, Karl Simin, Wenjing Zhou, Karin Jirström, Rose-Marie Amini, Fredrik Wärnberg. FOXA1 and PR predict ipsilateral event risk and identify a group with strong radiation response in ductal carcinoma in situ (DCIS) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-11-18.

William Leslie Jack Edwards, MD: A Conversation with the Editor

Jack Edwards (Figure ​(Figure11) was born on September 21, 1926, in Dallas, Texas, where he grew up and has lived most of his life. After attending public schools in Dallas, he went to Harvard College in Boston, Massachusetts, finishing 3 years in 2 years. He then went to the University of Texas (UT) Southwestern Medical College in Dallas, where he received his medical degree in 1948. He completed two internships: one in pathology at the Peter Bent Brigham Hospital in Boston (July 1948–June 1949) and one in medicine at the Massachusetts Memorial Hospital (July 1949–June 1950). He returned to Dallas and soon thereafter was called to active duty, serving in the Navy. In 1952, discharged from the service, he went to Birmingham, Alabama, and the University of Alabama Hospitals where he was assistant resident and chief resident and then a National Heart Institute trainee in cardiology under Dr. Tinsley Harrison. He then returned to Dallas, settling in private practice and using primarily Baylor University Medical Center at Dallas (BUMC). From 1971 until 1993, he also was clinical professor of medicine at UT Southwestern Medical College. Jack was a past president of the Southwestern Alumni Association and the Dallas Heart Association. He is a longstanding member of the Little Brothers Journal Club. He was a major player in the BUMC community from 1955 until he retired from active practice in 1993. Jack was married March 15, 1947, to the late Patsy Hayes. They have three outstanding offspring. Jack and his late wife Patsy were very active in the Highland Park Presbyterian Church for many years. Jack Edwards is a great guy, and it was a pleasure to visit with him for this interview.

Management of Rheumatoid Arthritis 2012: A Canadian State of the Art

> Our thesis is that there is no specific therapy for rheumatoid arthritis. With early diagnosis, simple conservative measures plus salicylates can be so effective that there is little need to utilize more potent pharmacologic therapy with the attendant increase in danger. These words were one man’s opinion of the state of the art of the treatment of rheumatoid arthritis (RA) in 19661. Whether one agreed completely with that opinion or not in 19662, it needs to be acknowledged that the opinion was well argued and informed by a thorough, albeit not systematic, review of the literature of the time. The author found the published evidence on salicylates and personal experiences with bed rest convincing, decried the lack of well-done randomized clinical trials evaluating gold, noted that any longterm benefits of gold were not sustained, and concluded that the lack of sustained effect coupled with the well-known toxicities of gold could not justify its use. This opinion (level II/III evidence) led to a course of action (strength of recommendation C, D). > In the past 3 years, patients have been adequately managed with bed rest, salicylates, and physiotherapy at the Massachusetts Memorial Hospitals and Boston City Hospital. Indeed, gold salt therapy has not been used by any of a large group of Arthritis Clinic Staff Physicians in these clinics, and no patient has been started on this form of treatment. Revisiting the issue of care of RA in 1974, the editors opined that no developments had occurred to alter the conclusions of 19663. Since 1974, the … Address correspondence to Dr. Karsh; E-mail: jkarsh{at}ottawahospital.on.ca

The First Closure of the Persistent Ductus Arteriosus

Congenital heart disease began to be a treatable condition when, in 1938, Robert Edward Gross first successfully ligated a persistent ductus arteriosus. This overview traces the historical development from Munro's first idea of how to close a patent ductus, presented in 1907, to the clinical ligation or division of the ductus. Surgical treatment of the infected ductus began with an unsuccessful attempt by Strieder, but it was not until Tubbs' and Touroff's successful operations that it was actually accomplished.

Machine learning of clinical performance in a pancreatic cancer database

We consider predictive models for clinical performance of pancreatic cancer patients based on machine learning techniques. The predictive performance of machine learning is compared with that of the linear and logistic regression techniques that dominate the medical oncology literature. We construct predictive models over a clinical database that we have developed for the University of Massachusetts Memorial Hospital in Worcester, Massachusetts, USA. The database contains retrospective records of 91 patient treatments for pancreatic tumors. Classification and regression targets include patient survival time, Eastern Cooperative Oncology Group (ECOG) quality of life scores, surgical outcomes, and tumor characteristics. The predictive performance of several techniques is described, and specific models are presented. We show that machine learning techniques attain a predictive performance that is as good as, or better than, that of linear and logistic regression, for target attributes that include tumor N and T stage, survival time, and ECOG quality of life scores. Bayesian techniques are found to provide the best performance overall. For tumor size as the target attribute, however, logistic regression (respectively linear regression in the case of a numerical as opposed to discrete target) performs best. Preprocessing in the form of attribute selection and supervised attribute discretization improves predictive performance for most of the predictive techniques and target attributes considered. Machine learning provides techniques for improved prediction of clinical performance. These techniques therefore merit consideration as valuable alternatives to traditional multivariate regression techniques in clinical medical studies.

Madness: A Bipolar Life

Back to table of contents Previous article Next article Book ReviewFull AccessMadness: A Bipolar LifePaul Plasky M.D., Ph.D.Paul Plasky M.D., Ph.D.Search for more papers by this authorPublished Online:13 Jan 2015https://doi.org/10.1176/ps.2008.59.11.1354AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Madness, Marya Hornbacker has written a first-person account of her struggle with bipolar disorder from her childhood through her late twenties. Using the for>m of a streaming monologue, all in the present tense, she has produced a chaotic and titillating portrait of rapid cycling, self-harm, and alcohol abuse. The tone of her book is set in her introductory chapter, a graphic description of a cutting episode with blood spurting around the room, with italics and exclamation marks going on for pages. She experiences it all here: mania and isolation, sadness and delusions, fighting and sex. There is lots of intense drinking, impulsive travel, and grandiose start-overs, all related with a sense of urgency and immediacy. However, it seems at times that nothing is learned and little is gained. Episodes blend into each other; people come and go. It makes for wild reading, but it is uncertain whether it contributes to our knowledge about a terrible, life-threatening illness. Describing a fire is not the same as understanding it. Underneath all this, of course, there is a keen mind that knows how to write a compelling sentence. Hornbacker makes good use of her book by offering several helpful informational appendices and an excellent bibliography citing the more readable guides to bipolar disorder. Also to her credit, she is positive about treatment and medication, and she tries to normalize the experience of electroconvulsive therapy, a task that cannot be done too often. Oddly enough, she has written about some of this same material before in her previous best-selling memoir, Wasted, which describes her earlier struggle with an eating disorder. She demonstrates that like many patients with bipolar disorder, she was misdiagnosed and improperly treated. Who is the likely audience for this book? Given the age of the author during these events, the older adolescent may readily relate to it. However, it is not a book to give to your patients who are trying to come to terms with a new diagnosis of bipolar disorder; it simply has too much drama. Medical students may find it useful as an introduction to the field because it is fast reading and leaves a strong impression. Of course, the benchmark book in this area is Kay Jamison's An Unquiet Mind, a masterwork of balance, insight, and information, and this should be any reader's first choice for a first-hand account of bipolar disorder. Dr. Plasky is medical director at the University of Massachusetts Memorial Hospital, Worcester. FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 11 November, 2008Pages 1354-1354PSYCHIATRIC SERVICES November 2008 Volume 59 Number 11 Metrics PDF download History Published online 13 January 2015 Published in print 1 November 2008

Jay D. Coffman, MD 1928–2006

Jay D. Coffman, Professor of Medicine and Chief of the Peripheral Vascular Section at Boston University School of Medicine, died on December 12, 2006, of adenocarcinoma of the colon at the age of 78 years. His research accomplishments focused on the physiology and pathophysiology of peripheral blood flow, and his career exemplified the ideal of translating research findings directly to the care of patients. He fostered understanding atherosclerosis as a systemic disease and nurtured the discipline of vascular medicine as a clinical subspecialty.⇓ Born in Quincy, Mass, as the youngest of 4 siblings, he was educated at Harvard College and at the Boston University School of Medicine, earning his doctoral degree in 1954. After internship and residency training in internal medicine at Massachusetts Memorial Hospital, he trained in cardiovascular research in the Department of Cardiorespiratory Diseases at the Walter Reed Army Institutes of Research in Washington, DC. In 1960, he joined the faculty at Boston University School of Medicine. He remained there until his retirement from patient care in 2001, although he continued as a research consultant, scientific author, and editor until a few months before his death. He was elected chairman of the Council on Circulation of the American Heart Association in 1975 and was a founder of the Society for Vascular Medicine and Biology, serving as president from 1992 to 1994. Dr Coffman was an influential medical investigator, an outstanding clinician, and a treasured educator and mentor. A pioneer in the emerging field of peripheral vascular medicine, he conducted seminal studies of limb circulation, investigating blood flow during reactive hyperemia in normal subjects and in patients with intermittent …

Professorial achievement: Robert W. Wilkins.

AT Boston University School of Medicine (BUSM), a dynasty bound not by blood but by intellect and attitude is entering a new era. The beginnings of the dynasty were described by R.W.W. in a recent moving account of how Chester Keefer came to BUSM and what he did there.1 R.W.W. is Robert W. Wilkins, who joined Keefer in 1940 and who, 20 years later, succeeded Keefer as director of the Evans Memorial, physician-in-chief of the Massachusetts Memorial Hospitals (now University Hospital), and chairman of the Department of Medicine at BUSM. With the beginning of the new academic year, this triple . . .

The Chemotherapy of Hypertension

It was by chance that I became involved in 1946 in the clinical evaluation of antihypertensive agents. After World War II, I had returned to Boston to complete my residency training in internal medicine and to work in hemodynamics research with Robert Wilkins at the Massachusetts Memorial Hospital. Surgical sympathectomy was then the popular method for treating hypertension and Dr. Wilkins was involved with Reginald Smithwick in assessing the cardiovascular and circulatory changes associated with this operative procedure. However, Dr. Wilkins and Chester Keefer had been asked by James Shannon, who was then director of the Squibb Institute for Medical Research, to work with the Institute in exploring the possibility of developing a successful chemotherapy for hypertension. The clinical evaluation of any drugs that might emerge in this project was assigned to me working under the direction of Dr. Wilkins. The first drug tested was an outgrowth of the World

The participation of cells in disturbances of acid-base balance.

Annals of the New York Academy of SciencesVolume 133, Issue 1 p. 160-170 THE PARTICIPATION OF CELLS IN DISTURBANCES OF ACID-BASE BALANCE* Arnold S. Relman, Arnold S. Relman Department of Medicine, Boston University School of Medicine, and the Evans Memorial Department of the Massachusetts Memorial Hospitals, Boston University Medical Center, Boston, Mass. Recipient of a Research Career Award of the National Institute of Arthritis and Metabolic Diseases, US. Public Health Service (AM-K6-1589).Search for more papers by this author Arnold S. Relman, Arnold S. Relman Department of Medicine, Boston University School of Medicine, and the Evans Memorial Department of the Massachusetts Memorial Hospitals, Boston University Medical Center, Boston, Mass. Recipient of a Research Career Award of the National Institute of Arthritis and Metabolic Diseases, US. Public Health Service (AM-K6-1589).Search for more papers by this author First published: April 1966 https://doi.org/10.1111/j.1749-6632.1966.tb50721.xCitations: 14 * Recent studies described in this paper have been supported by grants from the National Institute of Arthritis and Metabolic Diseases (AM-06728), National Heart Institute (H-6395), and the American Heart Association. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume133, Issue1Current Concepts of Acid‐Base MewsurementApril 1966Pages 160-170 RelatedInformation

Boston University–Massachusetts Memorial Hospitals Medical Center

Boston University–Massachusetts Memorial Hospitals Medical Center

A CRITIQUE OF THE PARAMETERS USED IN THE EVALUATION OF ACID-BASE DISORDERS ???WHOLE-BLOOD BUFFER BASE??? AND ???STANDARD BICARBONATE??? COMPARED WITH BLOOD pH AND PLASMA BICARBONATE CONCENTRATION

Departments of Medicine, Tufts University School of Medicine and Boston University School of Medicine, and the Pratt Clinic-New England Center Hospital and the Evans Memorial, Massachusetts Memorial Hospitals, Boston University Medical Center, Boston, Massachusetts

INTRAMUSCULAR SUCCINYLCHOLINE IN ADULTS. A CONTROLLED STUDY.

Received from the Department of Anesthesiology, Massachusetts Memorial Hospitals, and the Department of Anesthesiology, Boston University School of Medicine, Boston University Medical Center, Boston, Massachusetts. Accepted for publication June. 7, 1963. Dr. Yanderveen is Assistant Professor of Anesthesiology, Boston University School of Medicine; Dr. Sneddon, Associate Professor of Anesthesiology, Boston University School of Medicine; and Dr. Schmidt, Instructor in Anesthesiology, Boston University School of Medicine.

A MESIO-PYRAMIDAL BUTTRESS OF THE TYMPANUM AND ITS CLINICAL SIGNIFICANCE.

The LaryngoscopeVolume 73, Issue 10 p. 1284-1287 Article A mesio-pyramidal buttress of the tympanum and its clinical significance M. Stuart Strong M.D., M. Stuart Strong M.D. Boston, Mass. Professor of Otolaryngology, Boston University School of Medicine, and Chief of Service, Massachusetts Memorial Hospitals, Boston, Mass.Search for more papers by this authorVennelaganti Sambamurthy M.B., M.S., Vennelaganti Sambamurthy M.B., M.S. Boston, Mass. Assistant Professor of Otolaryngology, Andra Medical College, India.Search for more papers by this authorCharles W. Vaughan M.D., Charles W. Vaughan M.D. Boston, Mass. Assistant in Otolaryngology, Boston University School of Medicine, and Assistant in Otolaryngology, Massachusetts Memorial Hospitals.Search for more papers by this author M. Stuart Strong M.D., M. Stuart Strong M.D. Boston, Mass. Professor of Otolaryngology, Boston University School of Medicine, and Chief of Service, Massachusetts Memorial Hospitals, Boston, Mass.Search for more papers by this authorVennelaganti Sambamurthy M.B., M.S., Vennelaganti Sambamurthy M.B., M.S. Boston, Mass. Assistant Professor of Otolaryngology, Andra Medical College, India.Search for more papers by this authorCharles W. Vaughan M.D., Charles W. Vaughan M.D. Boston, Mass. Assistant in Otolaryngology, Boston University School of Medicine, and Assistant in Otolaryngology, Massachusetts Memorial Hospitals.Search for more papers by this author First published: October 1963 https://doi.org/10.1288/00005537-196310000-00004Citations: 1 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume73, Issue10October 1963Pages 1284-1287 RelatedInformation