bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary lymphoma mimicking metastases: a case report
Authors: Hadda Vijay , Khilnani Gopi C , Bhalla Ashu Seith , Gupta Ruchika , Gupta Siddhartha D , Goel Ashish 
Published: November 2009

Abstract

Introduction
Lung mass is a common radiological finding among elderly. Bronchogenic carcinoma with metastases is the commonest cause of lung mass with multiple nodules in same or other lung seen in this age group. However, sometimes other uncommon malignancies with better prognosis can also present similarly. Primary pulmonary lymphoma is one of the rare malignancies, which have similar radiological presentation but different treatment and prognosis.

Case presentation
We present a non-smoking, elderly, diabetic man who presented with nonspecific symptoms of generalized weakness without any symptom pertaining to respiratory system. Examination of chest revealed findings suggestive of right lower lobe mass. On evaluation, he was found to have a well circumscribed lung mass on chest radiograph. Computerized tomography of chest with contrast showed a large mass involving right lung and multiple nodules in both lungs. For diagnosis, biopsy from right lung mass was done under image guidance. Histopathology revealed diffuse large B-cell non-Hodgkins lymphoma. Evaluation for primary malignancy leading to lung metastases was inconclusive. Patient was advised chemotherapy.

Conclusion
Primary pulmonary lymphoma is a rare disease and can present with non specific symptoms. Radiologically, it can easily be confused with commoner malignancies like, bronchogenic carcinoma with or without metastases. Primary pulmonary lymphoma carries different therapeutic and prognostic implications. Therefore, physicians should make every effort to achieve histopathological diagnosis before prognosticating patient presenting with lung mass.
Virilizing ovarian steroid cell tumor in a 40 year old South Indian female: a case report
Authors: Salim Shihas , Shantha Ghanshyam Palamaner Subash , Patel Amish Dilip , Kumar Anita A , Ganeshram Prasanthi , Mehra Nikita , Rajan Anish George , Joseph Tarun , Sudhakar Lavangi 
Published: November 2009

Abstract
Virilism is the masculinization and enhancement of male secondary sexual characteristics in females. The etiology is usually of adrenal or ovarian origin. Here we report a case of virilizing Leydig cell type, steroid cell tumor of the left ovary, in a 40 year old female who presented with clinical signs and symptoms of virilization: deepening of voice, hirsutism (Ferriman-Gallwey score 26), clitoromegaly, and androgenic alopecia. On further evaluation, laboratory investigations revealed hyperandrogenism in the male range. Basal testosterone values were elevated. Folicle Stimulating Hormone and Luteinising Hormone levels were within normal limits. Dexamethasone suppression test did not alter cortisol or testosterone levels. An ovarian mass was confirmed radiologically. Following a total abdominal hysterectomy with bilateral salpingoophorectomy, histopathological studies confirmed a left sided steroid-cell ovarian tumor, Leydig cell type (stage T1N0M0), which proved to the etiology of virilization in this patient. Post-operatively her serum testosterone levels declined with near-complete reversal of symptoms over time.
Streptococcus constellatus bacteremia causing septic shock following tooth extraction: a case report
Authors: Ng Kay Wei Ping , Mukhopadhyay Amartya 
Published: November 2009

Abstract

Introduction
Organisms of the Streptococcus milleri group consists of Streptococcus
intermedius, Streptococcus constellatus, and Streptococcus anginosus. Though they are commonly associated with abscesses, bacteremia with subsequent septic shock and mortality is infrequent.

Case presentation
We report a case of a 27-year-old Chinese man who presented with Streptococcus constellatus bacteremia following an incomplete tooth extraction resulting in septic shock.

Conclusion
Bacteremia from the Streptococcus milleri group is infrequent but must trigger the search for an underlying abscess. Knowledge of each member's predilection for different clinical presentations can aid in determining the location of the underlying source of infection.
An interdisciplinary, family-centered approach to treating pediatric obesity in an 11-year-old female: a case report
Authors: Keaschuk Rachel A , Newton Amanda S , Kaczmarek Tesia G , Ball Geoff DC 
Published: November 2009

Abstract
Pediatric obesity has become increasingly prevalent over the past 2-3 decades. Recently-published clinical practice guidelines and expert recommendations provide guidance for obesity treatment, but therapy is often complicated by a host of medical, behavioural, psychosocial, and interpersonal issues. We report the case of an 11-year-old obese girl and her family referred for weight management. Our case underscores the need for an interdisciplinary, family-centered approach to the assessment and treatment of pediatric obesity, and highlights the value of understanding familial complexities that often accompany this health issue. The importance of utilizing multiple health indicators to assess weight management 'success' is discussed.
Irreducible distal radial fracture due to extensor pollicis longus tendon interposition: a case report
Authors: Mohanlal Paraskumar , Jain Sunil 
Published: November 2009

Abstract
Various causes have been reported for irreducible fractures of the distal radius. Most of them have been reported in children.
We report a case of irreducible distal radial fracture in an 18-year-old Caucasian male patient. The fracture was not reducible by closed methods and extensor pollicis tendon was found to be interposed during surgical intervention. At one year follow-up, the patient had good radiological evidence of fracture healing and a good functional outcome.
This case report highlights the need for a high index of suspicion to rule out soft tissue interposition in cases of irreducible distal radial fractures and a low threshold for open reduction.
Inadvertent insertion of a nasogastric tube into both main bronchi of an awake patient: a case report
Authors: Takwoingi Yohanna M 
Published: November 2009

Abstract
The use of nasogastric tube is desirable for the short-term administration of calories when oral feeding is not possible. Although the insertion of nasogastric tubes has been described as being easy this is not without risks. An unusual case of malpositioning of a fine bore nasogastric tube into both main bronchi in a patient that was awake is reported. Respiratory complications of misplaced nasogastric tubes and the importance of a check chest x-ray following tube placement are discussed.
Malposition of subclavian vein catheter inserted through indirect technique in a pediatric liver transplantation: a case report
Authors: Coskun Demet , Mahli Ahmet , Oncul Sema , Ilvan Gizem , Dalgic Aydin 
Published: November 2009

AbstractIntroductionClinicians use either direct or indirect (Seldinger) techniques for internal juguler or subclavian vein catheterization. This report aims to point out that the success rate of the direct technique where the catheter is inserted directly through the cannula may be higher particularly in catheterization of pediatric cases.Case presentationA 7.5-month-old female infant weighing 7200 gm was operated on for liver transplantation. The patient suffered jaundice at one month of age and was diagnosed with neonatal colestatic hepatitis. After routine monitoring, via indirect technique, central catheterization was attempted through internal jugular vein. However, the attempt failed. Therefore, again via indirect technique, catheterization was achieved through the right subclavian vein and fixed at 8 cm. After the operation started, fluid replacement and central venous pressure monitoring were performed with this catheter. Immediately after the operation, a control postero-anterior chest radiograph of the patient was obtained. This graph revealed that the tip of the catheter was fixed in the right internal jugular vein. Since the vital symptoms of the patient were not stable, the catheter was not removed and fluid replacement was performed via this technique. The catheter was removed on the postoperative 2ndday.ConclusionThe J wire advanced via the indirect technique advances anatomically following the upper wall of subclavian vein. Because of the smaller vessel dimensions and sharper, more angulated routes the subclavian and internal jugular veins make in infants, the rigid J wire may advance in the cephalic direction. However, in the technique where the catheter (Cavafix®catheter) is inserted directly through the cannula, this probability is less since J wire is not used and the catheter employed is flexible. We concluded that especially in pediatric cases, employment of the technique where the catheter is inserted directly through the cannula would be more convenient in order to decrease the catheter malpositioning probability.
CTLA4-Ig interacts with cultured synovial macrophages from rheumatoid arthritis patients and downregulates cytokine production
Authors: Cutolo Maurizio , Soldano Stefano , Montagna Paola , Sulli Alberto , Seriolo Bruno , Villaggio Barbara , Triolo Pierfranco , Clerico Paolo , Felli Lamberto , Brizzolara Renata 
Published: November 2009

Abstract
Introduction
Co-stimulatory signal B7(CD80/CD86):CD28 is needed in order to activate T cells in immune response. Cytotoxic T lymphocyte-associated antigen-4-immunoglobulin (CTLA4-Ig) binding to the B7 molecules on antigen-presenting cells downregulates this activation and represents a recent biological treatment in rheumatoid arthritis (RA). Objectives of the study were to investigate the presence of the B7.2 (CD86) molecule and its masking by CTLA4-Ig on cultures of both RA synovial macrophages (RA SM), and of macrophages differentiated from THP-1 cells (M). In addition, the anti-inflammatory effects of CTLA4-Ig on co-cultures of RA SM and M with activated T cells were tested.

Methods
All macrophages were co-cultured for 24 hours with activated T cells, without or with CTLA4-Ig (10, 100, 500 μg/ml for 1 hour, 3 hours and overnight, respectively). Immunofluorescence (IF) staining for B7.2, and an analysis of inflammatory cytokine expression (interleukin (IL) -6, tumor necrosis factor (TNF) α, IL-1β, transforming growth factor (TGF) β) by immunocytochemistry (ICC), western blot (WB) and reverse transcriptase-polymerase chain reaction (RT-PCR) were performed.

Results
Macrophages showed intense B7.2 expression. CTLA4-Ig/B7.2 masking was evident for all macrophages, even after only 1 hour of cell culture (range from 10 to 100 μg/ml). ICC of co-cultures showed a dose-dependent decrease in inflammatory cytokines (P < 0.001 for IL-6, TNFα, IL-1β and TGFβ). Data were confirmed by WB and RT-PCR analysis.

Conclusions
Optimal concentrations of CTLA4-Ig for the CTLA4-Ig/B7.2 masking on activated macrophages were identified and were found to induce significant downregulation in the cell production of IL-6, TNFα, IL1-β and TGFβ. In conclusion, macrophages would appear to be a sensitive target for CTLA4-Ig treatment in RA.
Effect of fluid resuscitation on mortality and organ function in experimental sepsis models
Authors: Brandt Sebastian , Regueira Tomas , Bracht Hendrik , Porta Francesca , Djafarzadeh Siamak , Takala Jukka , Gorrasi José , Borotto Erika , Krejci Vladimir , Hiltebrand Luzius B , Bruegger Lukas E , Beldi Guido , Wilkens Ludwig , Lepper Philipp M , Kessler Ulf , Jakob Stephan M 
Published: November 2009

Abstract
Introduction
Several recent studies have shown that a positive fluid balance in critical illness is associated with worse outcome. We tested the effects of moderate vs. high-volume resuscitation strategies on mortality, systemic and regional blood flows, mitochondrial respiration, and organ function in two experimental sepsis models.

Methods
48 pigs were randomized to continuous endotoxin infusion, fecal peritonitis, and a control group (n = 16 each), and each group further to two different basal rates of volume supply for 24 hours [moderate-volume (10 ml/kg/h, Ringer's lactate, n = 8); high-volume (15 + 5 ml/kg/h, Ringer's lactate and hydroxyethyl starch (HES), n = 8)], both supplemented by additional volume boli, as guided by urinary output, filling pressures, and responses in stroke volume. Systemic and regional hemodynamics were measured and tissue specimens taken for mitochondrial function assessment and histological analysis.

Results
Mortality in high-volume groups was 87% (peritonitis), 75% (endotoxemia), and 13% (controls). In moderate-volume groups mortality was 50% (peritonitis), 13% (endotoxemia) and 0% (controls). Both septic groups became hyperdynamic. While neither sepsis nor volume resuscitation strategy was associated with altered hepatic or muscle mitochondrial complex I- and II-dependent respiration, non-survivors had lower hepatic complex II-dependent respiratory control ratios (2.6 +/- 0.7, vs. 3.3 +/- 0.9 in survivors; P = 0.01). Histology revealed moderate damage in all organs, colloid plaques in lung tissue of high-volume groups, and severe kidney damage in endotoxin high-volume animals.

Conclusions
High-volume resuscitation including HES in experimental peritonitis and endotoxemia increased mortality despite better initial hemodynamic stability. This suggests that the strategy of early fluid management influences outcome in sepsis. The high mortality was not associated with reduced mitochondrial complex I- or II-dependent muscle and hepatic respiration.
COMIT: identification of noncoding motifs under selection in coding sequences
Authors: Kural Deniz , Ding Yang , Wu Jiantao , Korpi Alicia M , Chuang Jeffrey H 
Published: November 2009

AbstractCoding nucleotide sequences contain myriad functions independent of their encoded protein sequences. We present the COMIT algorithm to detect functional noncoding motifs in coding regions using sequence conservation, explicitly separating nucleotide from amino acid effects. COMIT concurs with diverse experimental datasets, including splicing enhancers, silencers, replication motifs, and microRNA targets, and predicts many novel functional motifs. Intriguingly, COMIT scores are well-correlated to scores uncalibrated for amino acids, suggesting that nucleotide motifs often override peptide-level constraints.
Expansion of the human mitochondrial proteome by intra- and inter-compartmental protein duplication
Authors: Szklarczyk Radek , Huynen Martijn A 
Published: November 2009

Abstract
Background
Mitochondria are highly complex, membrane-enclosed organelles that are essential to the eukaryotic cell. The experimental elucidation of organellar proteomes combined with the sequencing of complete genomes allows us to trace the evolution of the mitochondrial proteome.

Results
We present a systematic analysis of the evolution of mitochondria via gene duplication in the human lineage. The most common duplications are intra-mitochondrial, in which the ancestral gene and the daughter genes encode mitochondrial proteins. These duplications significantly expanded carbohydrate metabolism, the protein import machinery and the calcium regulation of mitochondrial activity. The second most prevalent duplication, inter-compartmental, extended the catalytic as well as the RNA processing repertoire by the novel mitochondrial localization of the protein encoded by one of the daughter genes. Evaluation of the phylogenetic distribution of N-terminal targeting signals suggests a prompt gain of the novel localization after inter-compartmental duplication. Relocalized duplicates are more often expressed in a tissue-specific manner relative to intra-mitochondrial duplicates and mitochondrial proteins in general. In a number of cases, inter-compartmental duplications can be observed in parallel in yeast and human lineages leading to the convergent evolution of subcellular compartments.

Conclusions
One-to-one human-yeast orthologs are typically restricted to their ancestral subcellular localization. Gene duplication relaxes this constraint on the cellular location, allowing nascent proteins to be relocalized to other compartments. We estimate that the mitochondrial proteome expanded at least 50% since the common ancestor of human and yeast.
Predictors of Competing Mortality in Advanced Head and Neck Cancer
Authors: Mell Loren K. , Dignam James J. , Salama Joseph K. , Cohen Ezra E.W. , Polite Blase N. , Dandekar Virag , Bhate Amit D. , Witt Mary Ellyn , Haraf Daniel J. , Mittal Bharat B. , Vokes Everett E. , Weichselbaum Ralph R. 
Published: November 2009

Purpose Death from noncancer causes (competing mortality) is an important event in head and neck cancer, but studies identifying predictors of this event are lacking. We sought to identify predictors of competing mortality and develop a risk stratification model for competing events. Patients and Methods Cohort study of 479 patients with stage III to IV carcinoma of the head and neck diagnosed between August 1993 and November 2004. Patients were treated on consecutive prospective clinical trials involving organ-preserving chemoradiotherapy and surgery. We used multivariable competing risks regression models to analyze factors associated with the cumulative incidence of competing mortality, locoregional and distant failure, and second malignancies as first events. Results Median follow-up was 52 months median for survivors. The 5-year cumulative incidence of competing mortality was 19.6% (95% CI, 15.8 to 23.4). On multivariable analysis, competing mortality was associated with female sex (hazard ratio [HR], 1.72; 95% CI, 1.13 to 2.63), increasing age (HR, 1.30; 95% CI, 1.04 to 1.62), increasing Charlson Comorbidity Index (HR, 1.24; 95% CI, 1.05 to 1.47), decreasing body mass index (HR, 0.33; 95% CI, 0.13 to 0.84), and decreasing distance traveled to the treating center (HR, 0.65; 95% CI, 0.44 to 0.98). Patients with zero, one, two, and ≥ three risk factors had 5-year competing mortality of 8.9% (95% CI, 3.0% to 14.8%), 12.4% (95% CI, 7.0% to 17.8%), 22.1% (95% CI, 14.5% to 29.7%), and 39.3% (95% CI, 28.6% to 50.1%), respectively. Conclusion Competing mortality in advanced head and neck cancer is associated with several demographic and health status characteristics. Analyses of risk factors for competing mortality may be useful in outcomes reporting and designing clinical trials.
Evaluating Overall Survival and Competing Risks of Death in Patients With Localized Renal Cell Carcinoma Using a Comprehensive Nomogram
Authors: Kutikov Alexander , Egleston Brian L. , Wong Yu-Ning , Uzzo Robert G. 
Published: November 2009

Purpose Many patients with localized node-negative renal cell carcinoma (RCC) are elderly with competing comorbidities. Their overall survival benefit after surgical treatment is unknown. We reviewed cases in the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the impact of kidney cancer versus competing causes of death in patients with localized RCC and develop a comprehensive nomogram to quantitate survival differences. Methods We identified individuals with localized, surgically treated clear-cell, papillary, or chromophobe RCC in SEER (1988 through 2003). We used Fine and Gray competing risks proportional hazards regressions to predict 5-year probabilities of three competing mortality outcomes: kidney cancer death, other cancer death, and noncancer death. Results We identified 30,801 cases of localized RCC (median age, 62 years; median tumor size, 4.5 cm). Five-year probabilities of kidney cancer death, other cancer death, and noncancer death were 4%, 7%, and 11%, respectively. Age was strongly predictive of mortality and most predictive of nonkidney cancer deaths (P < .001). Increasing tumor size was related to death from RCC and inversely related to noncancer deaths (P < .001). Racial differences in outcomes were most pronounced for nonkidney cancer deaths (P < .001). Men were more likely to die than women from all causes (P < .002). This nomogram integrates commonly available factors into a useful tool for comparing competing risks of death. Conclusion Management of localized RCC must consider competing causes of mortality, particularly in elderly populations. Effective decision making requires treatment trade-off calculations. We present a tool to quantitate competing causes of mortality in patients with localized RCC.
Early-Stage, Lymphocyte-Predominant Hodgkin's Lymphoma: Patient Outcomes From a Large, Single-Institution Series With Long Follow-Up
Authors: Chen Ronald C. , Chin Michael S. , Ng Andrea K. , Feng Yang , Neuberg Donna , Silver Barbara , Pinkus Geraldine S. , Stevenson Mary Ann , Mauch Peter M. 
Published: November 2009

Purpose The optimal treatment for early-stage, lymphocyte-predominant Hodgkin's lymphoma (LPHL) is not well defined. Treatment has become less aggressive over time in an attempt to reduce iatrogenic complications, such as cardiac mortality and second cancers, but long-term efficacy is unclear. We present the long-term outcome of patients treated at a single institution. Patients and Methods The study population includes 113 patients with stage I or II LPHL treated between 1970 and 2005. Pathologic diagnosis for all patients was confirmed using standard criteria. Ninety-three patients received radiation therapy (RT) alone, 13 received RT with chemotherapy, and seven received chemotherapy alone. Among patients treated with RT, 25 received limited-field, 35 received regional-field, and 46 received extended-field RT. Results Median follow-up was 136 months. Ten-year progression-free survival (PFS) rates were 85% (stage I) and 61% (stage II); overall survival (OS) rates were 94% and 97% for stages I and II, respectively. PFS and OS did not differ among patients who received limited-field, regional-field, or extended-field RT. In contrast, six of seven patients who received chemotherapy alone without RT developed early disease progression and required salvage treatment. Multivariable analysis adjusting for extent of RT, clinical stage, sex, and use of chemotherapy confirmed that the extent of RT was not significantly associated with PFS (P = .67) or OS (P = .99). The addition of chemotherapy to RT did not improve PFS or OS compared with RT alone. Conclusion RT alone leads to sustained disease control and high long-term survival rates in patients with early-stage LPHL. This study supports the use of limited-field RT alone to treat this disease.