tbuckley/cabot-search huggingface dataset:
The heart of medicine: growing up with pioneering treatment
Authors: Liza Morton
Journal: BMJ (2015)

In our patient authored series, Liza Morton describes what it feels like to be a child with a serious condition, and what clinicians can do to make that experience easier.For more information about the series, contact Rosamund Snow, patient editor, rsnow@bmj.com.At a few days old, I was transferred to hospital, where, already in congestive heart failure, I was attached to an external cardiac pacemaker.When this restored life-in a world first for an 11 day old baby-I was diagnosed as having complete heart block and fitted with an implantable pacemaker.Now an adult and mother of one, I am tremendously grateful to the NHS, advances in medicine, and those pioneers for my life.Congenital heart disease is a success story of modern medicine-90% of babies born with this condition now survive into adulthood, compared with just 20% in the 1940s. 1 Yet, medical advances raise questions about the psychological and emotional impact of being dependent on lifelong medical care.
Nonoperative therapy for squamous-cell cancer of the esophagus.
Authors: L Leichman, A Herskovic, C G Leichman, P B Lattin, Z Steiger, E Tapazoglou, J C Rosenberg, A Arbulu, I Asfaw, J Kinzie
Journal: Journal of Clinical Oncology (1987)

Based on the surgical pathology and survival for patients in previous trials using a neoadjuvant program of chemotherapy (5-fluorouracil [5-FU]-cisplatin) and radiation (3,000 cGy) before surgery for squamous-cell cancer (SCC) of the esophagus, a nonoperative pilot trial was designed to test if survival and recurrence would differ from our historical controls if routine esophagectomy was eliminated. Twenty patients were treated. The protocol called for the delivery of 5-FU infusion (1,000 mg/m2/d X 4 d) days 1 to 4 and 29 to 32 with cisplatin (100 mg/m2) day 1 and 29 sandwiched around external beam radiation (3,000 cGy over 3 weeks). Mitomycin C (10 mg/m2) day 57 was administered with bleomycin infusion (20 U/d X 4 d) days 57 to 60 and 78 to 81. A radiation boost of 2,000 cGy was administered 200 cGy/d days 99 to 103 and 106 to 110. Clinical pulmonary toxicity forced withdrawal of bleomycin and mitomycin C in the last four patients treated; two further courses of 5-FU-cisplatin were administered instead. The median measurement of the 20 esophageal lesions by barium swallow was 7 cm. Four patients underwent salvage surgery to prevent life-threatening aspiration pneumonia. The median survival for the 20 patients is 22 months, with a range from 6 to 39+ months. The six patients clinically without cancer are alive 22+ to 39+ months (median, 35+ months). Three patients died manifesting only local (infield) recurrence; five died manifesting only distant recurrence; and five developed local and distant recurrence. While the toxicity of the four drug regimen as administered was prohibitive, the survival and quality of survival is superior to the regimen previously used, which routinely used surgery after preoperative chemotherapy and radiation.
Recurrence of Atrial Fibrillation Correlates With the Extent of Post-Procedural Late Gadolinium Enhancement
Authors: Dana C. Peters, John V. Wylie, Thomas H. Hauser, Reza Nezafat, Yuchi Han, Jeong Joo Woo, Jason Taclas, Kraig V. Kissinger, Beth Goddu, Mark E. Josephson, Warren J. Manning
Journal: JACC. Cardiovascular imaging (2009)
Neuropsychologic effects of cranial irradiation, intrathecal methotrexate, and systemic methotrexate in childhood cancer.
Authors: R W Butler, J M Hill, P G Steinherz, P A Meyers, J L Finlay
Journal: Journal of Clinical Oncology (1994)

PURPOSE To investigate the neuropsychologic effects of cranial irradiation (CRT), intrathecal methotrexate (IT-MTX), and systemic methotrexate (SYS-MTX) in a cohort of pediatric patients with cancer who had either received no, moderate, or high doses of these treatments alone or in various combinations. PATIENT AND METHODS Data were collected on 120 pediatric cancer patients from a large variety of diagnostic groups. Patients completed a comprehensive neuropsychologic test battery designed to assess most areas of cognitive functioning. In analyzing cancer treatment effects, the following variables were statistically controlled: (1) age, (2) socioeconomic status (SES), (3) age at diagnosis, (4) months since both onset and cessation of CNS treatments, (5) time missed from schooling, and (6) presence/type of CNS cancer. RESULTS CRT, largely in combination with IT-MTX, was significantly associated with deficits in several, primarily nondominant, hemispheric neuropsychologic functions, even after control and other treatment variables were addressed. This relationship was somewhat, but not highly, dose-dependent at CRT doses greater than approximately 18 Gy, at least over the first several years posttreatment. While there was statistically significant evidence for cognitive impairment, absence from school during treatment and age at diagnosis were more predictive of reading and spelling academic achievement than having received CRT. IT-MTX and SYS-MTX alone were not associated with significant degrees of neuropsychologic involvement. CONCLUSION CRT, especially when administered with IT-MTX, at currently used dosages was associated with significant neuropsychologic impairment in children. These impairments are most likely to be reflected in nonverbal intelligence, perceptual abilities, and susceptibility to distraction. IT-MTX and SYS-MTX did not result in a consistent pattern of cognitive deficit.
Positron emission tomography-computed tomography can be useful in the early detection of metastases in primary mucinous carcinoma of the skin on the head and neck
Authors: S. Kitamura, H. Hata, Y. Inamura, K. Imafuku, T. Sakashita, K. Hirata, H. Shimizu
Journal: British Journal of Dermatology (2015)

Primary mucinous carcinoma of the skin (PMCS) is a rare cutaneous malignant neoplasm; its regional node metastasis is also rare. Currently, positron emission tomography-computed tomography (PET-CT) is known to be a useful tool to search for early metastatic lesions in various carcinomas. However, PET-CT is not always specific for head and neck lesions because of physiological uptake in the brain, palatine tonsil, salivary gland, thyroid etc. Herein we present two cases of head and neck PMCS in which metastasis was diagnosed accurately by PET-CT. In these cases, nodal uptake of fluorodeoxy-d-glucose (FDG) histopathologically proved PMCS metastasis, verifying the utility of PET-CT in detail. A surgeon was involved in the verification to compare the histopathological manifestations with the imaging results. Histopathologically, two of 13 nodes were positive in case 1, and one of 41 nodes was positive in case 2. These positive nodes were completely in accordance with the FDG uptake findings with no false negative findings. In treating PMCS on head and neck lesions, PET-CT may be useful in the preoperative assessment when planning the extent of resection.
Effects of corticosteroid and montelukast treatment in inflammation in guinea pigs with chronic allergic inflammation
Authors: Nathalia Gobbato, Flavia Souza, Carla Prado, Milton Martins, Iolanda Tiberio, Edna Leick
Journal: European Respiratory Journal (2012)

The effects of montelukast or dexamethasone in asthma pathophysiology are barely understood. We evaluated the inflammation and the eosinophilic recruitment in distal lung parenchyma and airway walls in guinea pigs (GP) with chronic allergic inflammation. GP were inhaled with ovalbumin (OVA group-2x/week/4weeks). After 4th inhalation, GP were treated with montelukast (M group-10mg/Kg/PO/day) or dexamethasone (D group-5mg/Kg/IP/day). After 72 hrs of 7th inhalation, GP were anesthetised, lung strips were submitted to histopathological evaluation.On distal parenchyma both montelukast and dexamethasone were effective in reducing the number of eosinophils, RANTES and NF-kB positive cells compared to OVA group (p
Implications of self-reported cognitive and motor dysfunction in HIV- positive patients
Authors: J W Wilkins, K R Robertson, C R Snyder, W K Robertson, C van der Horst, C D Hall
Journal: American Journal of Psychiatry (1991)

The authors examined HIV-positive subjects to determine the relationship of patient complaints of cognitive and motor dysfunction to psychiatric status and performance on established cognitive and motor function tests.HIV-positive volunteers (N = 77) were evaluated at entry into a longitudinal neurological study. Forty were asymptomatic, 29 had AIDS-related complex, and eight had AIDS. The subjects were not selected for the presence or absence of cognitive or motor complaints. Complaints of cognitive and motor dysfunction were assessed with items from the AIDS Clinical Trials Group Macro Neurologic Exam. Current depression and anxiety were assessed with the Profile of Mood States. Psychiatric status was assessed with the NIMH Diagnostic Interview Schedule, a structured interview that provides DSM-III psychiatric diagnoses. Actual cognitive and motor performance was measured with standard neuropsychological tests known to be sensitive to the effects of HIV.Cognitive complaints were found in 38 (49%) of the subjects. These complaints were associated with psychiatric symptoms but not with cognitive performance. Motor complaints, found in 12 (16%) of the subjects, were associated with poorer motor performance but not with psychiatric symptoms. The overall frequency of psychiatric diagnosis was high.Self-reports of cognitive and motor dysfunction were common in this unselected group and are of concern to health care providers. Potentially treatable psychiatric conditions were also common, particularly in subjects with cognitive complaints, and appropriate treatment referrals are indicated. Patients who report motor dysfunction should be neurologically evaluated for treatable causes.
Effect of proteinase inhibitor from crataeva tapia (cratabl) in distal lung mechanical, inflammatory and remodeling alterations induced by elastase in mice
Authors: Leandro V. Oliva, Rafael Almeida-Reis, Osmar Theodoro, Bruno Tadeu Martins-Oliveira, Clarice R. Olivo, Tales V. Lopes, Alessandra C. Toledo, Rodrigo S. Ferreira, Marlon V. Brito, Milton A. Martins, Maria L.V. Oliva, Iolanda F.L.C. Tiberio
Journal: European Respiratory Journal (2011)

Aims: The leading role of elastase in the emphysema physiopathology has been recognized. The present study aimed to evaluate if a plant proteinase inhibitor CratabL contributes to inactivation of elastase-induced mechanical, inflammatory and extracellular matrix remodelling alterations.

Methods: C57Bl6 mice received elastase intranasally (50ml/animal E group). Control group received saline (Ve group). Afterwards, mice were treated with CratabL (2mg/kg) at days 1, 15, 21, 28, 35 after elastase instillation (I-E group). At day 40, mice were anesthetized and mechanically ventilated and we analyzed respiratory system resistance and elastance, tissue elastance, tissue damping and airway resistance. Afterwards, BAL was performed and lungs were removed. By morphometry, we quantified the mean linear intercept (Lm) and the collagen and elastic fibers in distal lung parenchyma.

Results: We did not observe any differences in pulmonary mechanics comparing all groups. In E group, there was an increase in BAL-total cells, BAL-lymphocytes, BAL-neutrophils, collagen and elastic fibers and Lm compared to Ve group (p<0.05). The CratabL treatment in elastase treated animals decreased Lm (105.9±10.0μm) compared to E group (p<0.05). BAL-neutrophils (7.2±1.4×104cells/mL), and collagen content (0.59±0.02%) were decreased in I-E group compared to E animals (p<0.05).

Conclusions: This plant proteinase inhibitor ( CratabL ) reduced elastase-induced pulmonary inflammatory and remodeling alterations which may be considered as a new and potential therapeutic strategy for COPD treatment.

Financial support: FAPESP, CNPq, LIM- HCFMUSP.
Abstract 3044: Transcatheter Aortic Valve Implantation in 168 High-Risk Patients with Symptomatic Severe Aortic Stenosis - Single Centre Experience
Authors: Robert H Boone, Lukas A Altwegg, Jean-Bernard Masson, Abullah Al Ali, Saad Al Bugami, Sanjeevan Pasupati, Lee May, Ronald G Carere, Robert R Moss, Brad Munt, Cheung Anson, Jian Ye, Christopher R Thompson, Samuel V Lichtenstein, John G Webb
Journal: Circulation (2008)

Objectives: We describe the outcome of 168 patients with severe symptomatic aortic stenosis treated with transcatheter aortic valve implantation (TAVI). This cohort includes the first in man transarterial and off-pump transapical patients. Methods: The balloon-expandable aortic prosthesis was implanted via the femoral artery or left ventricular apex in 113 and 58 patients respectively. Data are described as 1–57, 58 –114 femoral and 1–58 apical procedures, respectively. Clinical and echocardiographic follow-up occurred at 1, 6, 12, and 24 months. Unsuccessful cases were censored at 30 days. Results: Mean age was 82.5 years (range 50 –97) with 57% males. Procedural success was 94.2% [88%, 96%, &amp; 98%] with no unsuccessful procedures in the last 46 cases. One patient had a successful transfemoral procedure after a prior failure, and 3 patients had successful transapical procedures following failed transfemoral attempts. Logistic EuroSCORE and STS predicted 30-day surgical mortality was 31% [28.4%, 29.1% &amp; 36%], and 10.4% [8.9%, 9.6% &amp; 12.6%] respectively. Observed 30-day mortality was 10.5% [10.5%, 3.5%, &amp; 17.2%], and 0% in the last 39 trans-femoral cases. Intra-procedural mortality was 1.1% [1.8%, 0% &amp; 1.7%]. Peri-procedural stroke occurred in 4% [3.5%, 7%, &amp; 1.7%]. Median hospital stay was 5 days [4, 5, &amp; 7]. Survival at 1, 6, 12 and 24 months was 88%, 80%, 74% [73.9%, 84%, &amp; 65.6%] and 61%. AVA, MG, LVEF and MR significantly improved post TAVI (Table 1 ), and MR, EF, and NYHA class significantly improved during follow-up. MG did not increase during follow-up, but AVA decreased slightly at 1 year (mean difference: 0.2±0.54cm 2 , p=0.04). Mild paravalvular AR was common but severe AR was not observed post-implant or at follow-up. Conclusion: TAVI provides sustained clinical benefit for up to 2 years in patients with symptomatic severe AS and high operative risk. Procedural outcome continues to improve with experience and device development. Table 1: Echocardiographic follow-up
Guidelines for Combining Neoplasms for Evaluation of Rodent Carcinogenesis Studies
Authors: Ernest E. McConnell, Hendricus A. Solleveld, James A. Swenberg, Gary A. Boorman
Journal: JNCI Journal of the National Cancer Institute (1986)

In a continuing review of long-term toxicology and carcinogenesis studies in rats and mice, the National Toxicology Program (NTP) is confronted with many problems concerning the interpretation of tumor data. A frequently raised question is: “Should certain neoplasms be combined for overall assessment of rodent carcinogenesis data?” NTP policy is that certain neoplasms may be combined for statistical assessment of tumor data and that hyperplastic responses may be used as supportive evidence. The primary reason for combining neoplastic lesions is to gain more insight into the evidence of the carcinogenicity of a given chemical in that species of animal. This report gives the rationale, criteria, and guidelines used by the NTP for combining neoplasms for the evaluation of long-term rodent toxicology and carcinogenesis studies. The guidelines are based mainly on lesions occurring in the F344/N inbred rat and (C57BL/6 × C3H)F1 mouse and may or may not be appropriate for other strains or species. The concepts of combining neoplasms and sites should be viewed in terms of the study as a whole, since tumor formation is only one of many responses caused by chemicals in mammals. The resulting information becomes part of the “weight of the evidence” for estimating the potential hazard of a given chemical.
Cancer by another name: a randomized trial of the effects of euphemism and uncertainty in communicating with cancer patients.
Authors: S M Dunn, P U Patterson, P N Butow, H H Smartt, W H McCarthy, M H Tattersall
Journal: Journal of Clinical Oncology (1993)

PURPOSE In this study we tested some assumptions about the use of euphemism in communicating with cancer patients. Does an explicit statement about the diagnosis of cancer cause patients to respond with greater anxiety than when uncertainty or ambiguity is allowed to persist? Do patients believe they cope better with cancer when the diagnosis is explicit? METHODS A heterogeneous sample of 165 cancer patients completed a new measure of emotional adjustment to cancer using random assignment among four testing variables: agent (self-report v interview), terminology (the words cancer v illness), identification (patient identified v anonymous), and supervision (clinic v home). Internal consistency (Cronbach's alpha) for the 39-item set was 0.74 and face and content validity were determined using the focus-group technique and preliminary factor analysis. After answering the adjustment measures, subjects completed the Spielberger State-Trait Anxiety Inventory (STAI). RESULTS Overall anxiety levels were significantly lower in the sample than published norms for general medical and surgical patients. Exposure to the word cancer as distinct from illness increased anxiety, but did not alter adjustment scores. Supervision and agent conditions did not affect anxiety, but reported adjustment was poorer in the interview condition compared with the self-report condition. Ambiguous instructions, such as asking patients to complete the questionnaire anonymously but return it in person to staff in the clinic, resulted in poorer adjustment, which was reversed by the consistent instruction to complete the questionnaire anonymously at home and return it by mail. CONCLUSION Use of the word cancer generated anxiety to levels similar to those reported in general medical and surgical patients, but did not produce any distortion in reported adjustment. However, any ambiguity associated with the conditions under which adjustment is assessed may lead to distortion and an increase in the patient's reported psychologic distress.
Complications after treatment with external-beam irradiation in early-stage prostate cancer patients: a prospective multiinstitutional outcomes study.
Authors: C J Beard, K J Propert, P P Rieker, J A Clark, I Kaplan, P W Kantoff, J A Talcott
Journal: Journal of Clinical Oncology (1997)

PURPOSE To use data from a prospective quality-of-life study to assess differences in disease-specific and general health-related quality-of-life changes after treatment with different external-beam irradiation techniques for prostate cancer. PATIENTS AND METHODS Patients were divided into three groups based on their pretreatment field size and planning technique: whole pelvis, small field, or conformal. Measures of bowel, urinary, and sexual function and of global health-related quality-of-life parameters (from the Health Survey Short Form [SF-36] and the Profile of Mood States [POMS]) were obtained from self-report questionnaires completed before initiation of therapy and at 3 and 12 months after therapy. RESULTS Irritative gastrointestinal and genitourinary side effects were frequent 3 months after treatment, but were substantially improved at 12 months. Sexual dysfunction increased steadily over the study period. The POMS and the SF-36 did not demonstrate significant changes over time. Despite small patient numbers, we found trends in favor of conformal therapy across several symptom measures, including sexual function. In the fatigue, energy, and vigor subscales, patients who received whole-pelvis treatment fared significantly worse than those in the other two groups. CONCLUSION Prospective, detailed data from a feasibility study allowed us to assess the effect of technique on quality of life following external-beam irradiation. Although limited by the small planned sample size, these results suggest that smaller radiation fields limit treatment-related complications, including, unexpectedly, sexual dysfunction. However, confirmation in a larger study is necessary.
Evaluation of the apnea-hypopnea index determined by adaptive-servo ventilation devices in heart failure patients with sleep disordered breathing
Authors: Yasuhiro Tomita, Takatoshi Kasai, Satomi Kasuga, Kanako Morimoto, Hisashi Takaya, Ken-ichi Maeno, Satoshi Kasagi, Taro Adachi, Fusae Kawana, Yuka Kimura, Sugao Ishiwata, Koji Narui
Journal: European Respiratory Journal (2014)

Introduction: Adaptive-servo ventilation (ASV) is helpful in treating for sleep disordered breathing (SDB) in patients with heart failure (HF). ASV devices provide information on residual respiratory events while patients using them. However, it has not been fully evaluated whether the apnea-hypopnea index (AHI) determined by the AutoSet CS (ACS), an ASV device is in good accordance with the AHI detected by polysomnography in HF patients with SDB.  Methods: Consecutive patients with SDB who were titrated on ASC were included. We assessed the correlation between the AHI determined by manual scoring on polysomnography (AHI-P) and by ASC (AHI-ASC) during an overnight polysomnography on ASV.  Results: Thirty HF patients with SDB (age, 68.8±2.8 years; 2 women; LVEF, 53.8±3.4%) were enrolled. The mean AHI on the diagnostic study was 34.2±3.6 events/hour including both obstructive and central respiratory events. During the titration, ASV devices markedly suppressed the respiratory events (AHI-P, 4.1±0.8 events/hour), while the mean AHI-ASC was 11.6±1.3 events/hour. We found a modest correlation between the AHI-P and the AHI-ASC (r=0.36, p=0.04). Brand-Altman plot indicated that ASC generally overestimated AHI but agreement was not too poor.  Discussion: We found only a modest correlation between the AHI-P and the AHI-ASC. Such discrepancy may be explained by the central respiratory events during wakefulness or sleep-awake transition. Clinicians should take such discrepancy into account when they interpret residual respiratory events determined by ASV devices.
Characteristics of the uncontrolled asthmatic patients on GINA step 4 treatment in Korea
Authors: Kwang Ha Yoo, Ki Suck Jung, Yong Il Hwang, Yong Bum Park, San Yeub Lee, Seung Hun Jang, Joo Hee Kim, Dong Gyu Kim, Yang Deok Lee
Journal: European Respiratory Journal (2012)

Although the majority of asthma patients can obtain the targeted level of control, some patients will not do so even with the best therapy. The aim of this study was to explore the clinical characteristics of the bronchial asthma patients who do not achieve the well-controlled status despite the step 4 treatment of the GINA guideline in Korea.  This study was a part of the clinical phenotype of asthma investigation in Korea which was performed using structure questionnaire during February 2011 ∼ June 2011. Of the overall study subjects, we enrolled 112 patients from 5 teaching hospitals in Korea who were on GINA step 4 treatment at least 1 year. We defined the difficult-to-treat asthma as uncontrolled asthma status or at least 1 unscheduled visit during the prior year of the enrollment despite GINA step 4 treatment. We compared the demographic, clinical, and laboratory data between difficult-to-treat asthma patients and well controlled patients.  The difficult-to-asthma patients had lower the ratio of FEV1/FVC than well controlled asthma patients(66.8% vs. 69.0%, p=0.008) The proportion of patients with experiencing the symptom aggravation in work-place was higher in difficult-to treat group than well controlled group (33.3% vs. 14.5%, p=0.03). However, the age, FEV1, smoking status and body-mass index were not different between the groups. The presence of co-morbidities such as COPD, reflux espophagitis and cardiovascular was not also different. In conclusion, a total 24.1 % of asthma patients are not in well controlled status despite GINA step 4 treatment. Occupational history should be considered in these patients an addition to the known risk factors.