tbuckley/cabot-search huggingface dataset:
Evaluation of a ring enhancing lesion
Authors: Christopher B Scoma, Ashish H Shah, Amade Bregy, Ricardo J Komotar
Journal: BMJ (2015)

A 49 year old previously healthy woman presented to her general practitioner with a two week history of progressive headaches, forgetfulness, and decreased visual acuity. She had no other symptoms or findings of note. On examination, she was oriented to person, location, and time. Her heart rate was 78 beats/min, respiratory rate was 18 breaths/min, and blood pressure was 116/78 mm Hg. She was afebrile and had no meningeal signs. Physical examination identified a right homonymous hemianopsia but no other neurological or cognitive deficits. There was no evidence of papilloedema. Her electrolytes, complete blood count, and C reactive protein concentration were normal. Magnetic resonance imaging (MRI) showed a single ring enhancing lesion with irregular borders.



### 1. On the basis of the clinical picture, where is the lesion and what is it likely to be?

#### Short answer

The lesion is probably in the left temporal lobe of the brain. The clinical picture suggests a primary central nervous system (CNS) tumor or brain abscess.

#### Discussion

Given that the physical examination found no relevant findings except for a right homonymous hemianopsia, it is reasonable to suspect a lesion in the left optic tract. The two week history of forgetfulness and headaches, although not specific, suggests that the lesion affects the temporal lobe of the brain and not the eye itself. The lesion is probably small because the patient has no symptoms of raised intracranial pressure (such as Cushing’s triad of hypertension, bradycardia, and bradypnea) and she is alert and oriented to person, location, and time. The symptoms suggest that the lesion is rapidly growing, but ischemic or hemorrhagic small vessel …
Plasminogen Activator Content of Human Colon Tumors and Normal Mucosae: Separation of Enzymes and Partial Purification&lt;xref ref-type="fn" rid="fn2"&gt;2&lt;/xref&gt;&lt;xref ref-type="fn" rid="fn3"&gt;3&lt;/xref&gt;
Authors: J G Corasanti, C Celik, S M Camiolo, A Mittelman, J L Evers, A Barbasch, G H Hobika, G Markus
Journal: JNCI Journal of the National Cancer Institute (1980)

Plasminogen activator content was determined quantitatively in extracts of 23 pairs of surgically removed colon tumors and adjacent normal mucosa specimens. The activator content averaged 4.4 times higher in the tumor samples than in the corresponding normal tissue. Polyps removed with the adenocarcinomas gave values intermediate between those for tumors and those for the normal mucosae. The enzyme content of the group of tumors that showed invasive propagation or metastatic spread was significantly higher (P<0.05) than was the enzyme content of the group not manifesting these conditions. Activator activity of the tumor extracts was completely inhibited by rabbit antibody formed against human urokinase. The activity of the normal mucosae was variably inhibited, suggesting the presence of several kinds of activator in normal tissues. The activator from the normal tissues could be separated into a completely refractory fraction and a completely inhibitable fraction by means of an affinity column made of Sepharose-linked, rabbit antiurokinase antibody. The activator, eluted from this column with 1 M acetic acid in 0.5 M NaCI (pH 2.2), was highly purified and had an isoelectric point of 8.6, as does authentic urokinase. The details of the isoelectric profile of the two, however, differed. The data are discussed in relation to earlier studies on the fibrinolytic system in colon cancer.
Clinical correlates of distinct immunophenotypic and histologic subcategories of lymphocyte-predominance Hodgkin's disease.
Authors: A Tefferi, R A Zellers, P M Banks, T M Therneau, J P Colgan
Journal: Journal of Clinical Oncology (1990)

Histologic and paraffin immunohistologic studies were carried out on 32 patients with lymphocyte-predominance Hodgkin's disease (LPHD) seen from 1970 through 1982. While nodular histology was accurately predictive of B-cell phenotype (Leu M1 -/L26+), diffuse histology corresponded to either B-cell or Hodgkin's (Leu M1 +/L26-) phenotype, not invariably predictable even when attention was paid to subtle paragranuloma cytology. Clinical characteristics were compared between histologic (diffuse v nodular) and immunophenotypic (Leu M1 +/L26-, Hodgkin's phenotype, v Leu M1 -/L26+, B-cell phenotype) subgroups. Ten patients have since died, and the median follow-up of the living patients was 14 years (range, 6 to 31). Of the several clinical parameters compared, only axillary nodal presentation was strongly associated with both B-cell phenotype and nodular histology, while male predominance related more to B-cell phenotype than nodular histology. No significant difference in overall survival or relapse rate was apparent among either the histologic or the immunophenotypic subgroups. However, very late but salvageable relapses were associated with nodular histology. The incidences of secondary malignancies and death from Hodgkin's disease (HD) were also comparable between the subgroups. Although difference in clinical presentation may exist, neither the histologic nor the immunophenotypic subcategories of LPHD could be demonstrated to correlate with differences in clinical outcome.
Problems with IUCD tails. (Letter)
Authors: Chamberlain G
Journal: BMJ (1978)

R.A. Sparks November 19 p. 1351 draws attention to some of the problems associated with the tail of the IUD.  Another difficulty is that while most practitioners who fit an IUD place emphasis on teaching the woman to check that it has not been expelled a large number of patients are unable to detect the IUD tail.  We recently published an analysis of 172 women bearing IUDs with tails fitted for at least 6 months who were seen consecutively by 1 family planning doctor.  Of these 17 were unable or unwilling to examine themselves while 1/3 of the remainder (57/155) were persistently unable to find the tail.  Of the factors possibly concerned there was a weak positive association between frequency of detection and increased parity and higher social class but no correlation with length of tail.  A lower detection rate for the Copper-7 (59.3%) than for the Lippes Loop (73.8%) may only reflect small-number variation.  However the Lippes Loop has 2 tails of thicker nylon while the tail of the Copper-7 is a single thread.  The numbers of other types of IUD used were too small for any comparison to be attempted.  The motivation of the woman is probably the most important single factor in successful vaginal self-examination.  If she is made anxious by vaginal manipulation a woman will either not examine herself or do so less thoroughly.  In the past such patients have been recognized as being unsuitable for vaginal diaphragm or cervical cap contraception and perhaps such inhibitions should be appraised when considering fitting an IUD.  Without self-exmination no IUD wearer can be sure that she still carries an effective contraceptive method.(FULL TEXT)
Pathogenesis of Rauscher Leukemia&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: Michel Boiron, Jean-Paul Levy, Jacqueline Lasneret, Stella Oppenheim, Jean Bernard
Journal: JNCI Journal of the National Cancer Institute (1965)

A systematic histologic and cytologic study of Rauscher disease was undertaken. After inoculation with Rauscher virus, 184 BALB/c and 93 C57BL/6 mice were randomly killed at uniform intervals. Additional lots of inoculated mice were subjected to repeated hematologic examinations until death. Also, 32 Wistar rats were inoculated and observed until death. The disease in BALB/c mice began with a proliferation of young cells of the erythroid series and of primitive reticulum cells in the spleen and liver. In a second phase, a leukemia of myeloblastic type, beginning in the marrow, was observed in most of the animals surviving the first phase. The initial leukemic lesions before generalization were revealed only by systematic cytologic studies and differential counts of the marrow. No lymphatic leukemia was observed and the thymus was generally normal, except for its occasional, secondary invasion by myeloblastic cells. In C57BL/6 mice, splenic and hepatic erythroblastosis was absent, but there was regularly a myeloblastic leukemia of medullary origin (occasionally chloroleukemia). Only in Wistar CF rats was a lymphatic leukemia of thymic origin observed. The first phase of Rauscher disease in BALB/c mice is identical with the first phase of Friend disease. Rauscher disease and Friend disease seem to make up a particular group among the murine leukemias.
Comparing smokers and non-smokers attending a rapid access lung cancer clinic
Authors: Rachel Roberts, Keir Lewis
Journal: European Respiratory Journal (2014)

Tobacco smoking is the biggest cause of lung cancer (LC) but continued smoking probably independently worsens outcomes.

Aims:

1. To assess the prevalence of smoking in people attending a rapid access clinic for suspected LC, given the changing demographics of UK smokers and introduction public smoking bans.

2. To see if smoking status is associated with traditional adverse prognostic indicators for LC.

As part of a larger trial we report on the first 415 attenders who were subsequently diagnosed with LC. Anyone who admitted to smoking within 7 days or who had an exhaled carbon monoxide >10 parts per million were deemed smokers. Patients also completed a baseline quality of life questionnaire (EQ5D) and WHO performance status.

41% of attenders with LC were smoking at the time of their LC diagnosis.

View this table:

Table to compare smokers and non-smokers (ex or never)





At the time of LC diagnosis current smokers were significantly younger yet had larger tumours and worse performance status. The larger tunour size may reflect delays in presentation or that nicotine accelerates tumour growth.1

The lower performance status probably also reflects more co-morbidity (e.g. COPD/ cardiac dysfunction etc) as there was no significant difference in TNM cancer stage.

Data collection continues to compare clinical outcomes and responses to treatment in smokers and non-smokers.

1. Hecht, S.S. (1999). Tobacco smoke carcinogens and lung cancer. JNCI J Natl Cancer Inst, 91 (14), 1194-1210.
Phase II study of cetuximab plus weekly cisplatin and 24-hour infusion of high-dose 5-fluorouracil and leucovorin for the first-line treatment of advanced gastric cancer
Authors: K. Yeh, C. Hsu, C. Hsu, C. Lin, Y. Shen, S. Wu, T. Chiou, Y. Chao, A. Cheng
Journal: Journal of Clinical Oncology (2009)

4567 Background: Cisplatin-HDFL regimen, using weekly 24-hour infusions of cisplatin and high-dose 5-fluorouracil (5-FU) and leucovorin, is commonly used in Taiwan for patients with advanced gastric cancer (GC), showing an overall response rate of approximately 60% (95% CI: 45%-76%) [J Clin Oncol (Suppl) 2006; 24(18S): A14063 ]. We have demonstrated that cetuximab is cytotoxic to human GC cells, and has a chemosensitizing effect for cisplatin and 5-FU in GC cells [Proc AACR 2006; 47: A1233]. Methods: All patients had pathologically confirmed metastatic/ recurrent chemonaive GC, at least 1 measurable lesion, a fasting serum triglyceride level &gt; 70 mg/dl, WHO PS 0/1/2, adequate hepatic, renal, and bone marrow functions. Cetuximab 400 mg/m 2 was given as 2h infusion, initially (i.e., D1 of cycle 1); and followed by weekly 1h infusion of 250 mg/m 2 (i.e., D8, D15, D22 of cycle 1, and D1, D8, D15, D22 of cycle 2). Cisplatin 35 mg/m 2 was given as a 24h infusion, admixing with 5-FU 2,000 mg/m 2 and leucovorin 300 mg/m 2 (HDFL), D1, D8. A 24h infusion of HDFL was given on D15. Cycles were repeated every 28 days, and response evaluation was performed every 2 cycles &amp; at the end of protocol treatment. The primary end-point was confirmed objective response rate (RR) by RECIST. Results: Between Dec. 2005 and Nov. 2008, 35 patients (M:19, F:16) with a median age of 56 (40–74) were enrolled and evaluable for response assessment. The overall RR was 68.6% (51–83%, 95% C.I.) with 1 CR and 23 PRs. Among a total of 269 cycles (median: 7, range: 2 to 22+ cycles) given, Gr3/4 neutropenia, infection, and hepatic toxicity developed in 6.0%, 4.8%, and 0.74% of 269 cycles, respectively. Two patients have developed acute hepatitis B flare-up among seven HBsAg (+) carriers, and were well controlled by lamivudine. Gr1, Gr2, and Gr3 acne- like rashes have developed in 57.1%, 31.4%, 5.7%; and Gr1, Gr2, Gr3 paronychia have developed in 40.0%, 8.6%, and 2.9% of 35 patients, respectively. Median PFS (range: 3 to 22+ months) and median OS (range: 3 to 35+ months) was11.0 and 14.5 months, respectively. Conclusions: Cetuximab plus infusional cisplatin-HDFL is a highly effective regimen with low toxicity and favourable survival in the first-line treatment of advanced GC. No significant financial relationships to disclose.
Acute hemodynamic effects of a therapy with adaptive servoventilation in patients with heart failure compared to healthy volunteers
Authors: Jens Spießhöfer, Jessica Heinrich, Roman Lehmann, Christina Efken, Britta Körber, Thomas Bitter, Henrik Fox, Dieter Horstkotte, Olaf Oldenburg
Journal: European Respiratory Journal (2013)

Purpose: Adaptive Servoventilation (ASV) allows for effective treatment of nocturnal Cheyne-Stokes respiration in heart failure (HF) patients, but acute hemodynamic effects of such therapy remain unknown.  Methods: HF patients (EF ≤ 50%, NYHA ≥ II) and CSR (apnea-hypopnea-index, AHI ≥ 15/h) were ventilated using ASV (PaceWace™, ResMed) for 1h at their individual therapeutic pressure level (mean expiratory pressure: 8 ± 2 cmH2O; mean inspiratory pressure support: 15 ± 2 cmH 2 O). Hemodynamic effects were analyzed non-invasively (Task Force Monitor, CNSystems) and compared to those 30 minutes before and after ventilation and with results obtained in 15 healthy volunteers. Echocardiography was performed to assess mitral and tricuspid annular plane systolic excursion (MAPSE, TAPSE).  Results: A total of 27 patients (26 male, 70 ± 11 years, EF 37 ± 8%) and 15 healthy volunteers were included. The table summarizes hemodynamic response and demonstrates a decrease in HF in all, a trend towards an increase in stroke volume (SV) in HF patients and a decrease in healthy volunteers. In addition diastolic BP increased in both groups. Further analysis revealed that response in SV was dependent on right and left ventricular function.  Conclusion: Acute hemodynamic effects of ASV seem to be different in HF patients and healthy volunteers and might be dependent on ventricular filling pressures.
Abstract 14139: Prehospital High-Sensitivity Troponin T Analysis in Patients with Suspected Acute Myocardial Infarction
Authors: Carsten Stengaard, Jacob Thorsted Sorensen, Soren A Ladefoged, Erika F Christensen, Jens F Lassen, Hans Erik Botker, Christian J Terkelsen, Kristian Thygesen
Journal: Circulation (2012)

Prehospital analysis of cardiac troponins (cTn) may accelerate the diagnostic process and improve the triage of patients with suspected of AMI. The aim of the study was to: 1) Evaluate the feasibil...
Intensive combination chemotherapy (ROAP 10) and splenectomy in the management of chronic myelogenous leukemia.
Authors: H M Kantarjian, L Vellekoop, K B McCredie, M J Keating, J Hester, T Smith, B Barlogie, J Trujillo, E J Freireich
Journal: Journal of Clinical Oncology (1985)

To investigate the role of intensive chemotherapy in chronic myelogenous leukemia (CML), we treated 37 patients who had Philadelphia-positive benign-phase disease with rubidazone 300 mg/m2/d 1 (or daunorubicin 30 mg/m2/d X 4), cytosine arabinoside 80 mg/m2/d X 10, vincristine 2 mg/d 1, and prednisone 100 mg/d X 5 (ROAP 10), every four weeks for a median of three cycles. This treatment was followed by splenectomy and by subsequent maintenance therapy with 1 to 5 g hydroxyurea daily in intermittent courses. After a median follow-up of 42 months (range, 24 to 54 months), 20 patients (54%) remain in benign phase. The projected median survival is 52 months, and the three-year survival rate is 67%. Six patients (16%) developed blastic crisis, and eight died in the benign phase. A significant cytogenetic response, defined as a fall in the percentage of Philadelphia-positive cells to less than or equal to 30%, occurred in 18 (53%) of 34 patients who had serial cytogenetic studies. Six patients (18%) had reductions to 35% to 90%, whereas ten remained 100% positive. Cytogenetic response lasted for a median of six months from the time of maximal response (range, 1 to 18 months). Blastic crisis or accelerated disease developed in seven (44%) of the 16 patients who manifested minimal or no cytogenetic response, compared to only two of the 18 patients (11%) who achieved a significant cytogenetic response. Toxicity, which resulted in one death, was due to myelosuppression and consisted of febrile episodes during neutropenia (24% of courses), documented infections (8% of courses), and bleeding (8% of courses). ROAP 10 intensive therapy produces moderate survival improvement for CML patients compared to a matched historical control group of patients treated at our institution, but it has considerable myelosuppressive toxicity. The Philadelphia chromosome response is an important treatment-related prognostic factor.
Phase II trial of the irreversible oral pan-HER inhibitor PF-00299804 (PF) as first-line treatment in recurrent and/or metastatic (RM) squamous cell carcinoma of the head and neck (SCCHN).
Authors: C. Le Tourneau, E. Winquist, S. J. Hotte, S. A. Laurie, D. Soulieres, S. K. Chia, S. Singh, T. Wang, C. Mormont, L. L. Siu
Journal: Journal of Clinical Oncology (2010)

5531 Background: PF is an irreversible and potent small molecule pan-HER tyrosine kinase inhibitor. In preclinical studies, PF has much lower IC50 values than gefitinib in cell lines engineered to express EGFRvIII mutations (1.2 nM versus 2,700 nM) and produces tumor growth inhibition in gefitinib-resistant xenografts. Methods: Eligibility criteria included: RM SCCHN with measurable disease, no prior systemic therapy for RM disease, and no prior anti-EGFR therapy. PF is administered at 45 mg p.o. daily and continuously, in 21-day cycles. Primary endpoint is overall response rate (ORR), assessed every 6 weeks by RECIST. Statistical parameters are Ho: ORR ≤ 5%, Ha: ORR ≥ 15%, if ≥ 2/23 responses in stage I, then stage II will accrue an additional 33 pts, with ≥ 6/56 responses being the threshold for further evaluation. Biomarkers including EGFRvIII mutations will be analyzed on archived tumor specimens. Results: Thirty-five pts have been enrolled: median age 62.5 years (range: 40–78); M:F = 31:4, ECOG 0:1:2 = 10:24:1; prior radiation = 34, prior chemotherapy = 21. Thirty pts have been treated so far, all are evaluable for toxicity and 28 evaluable for response. A median of 2.7 cycles have been administered (range 0.3-10.2). Adverse events (AEs) led to drug discontinuation, reduction and interruption in 3, 6 and 13 pts, respectively. The most frequent grade 3 AEs were fatigue in 5 (17%), diarrhea in 4 (13%), hyponatremia in 3 (10%), and rash in 3 (10%) pts. The most common grade 1/2 AEs included rash (90%), diarrhea (67%), hypophosphatemia (43%), stomatitis (40%), hyponatremia (37%), hypomagnesemia (33%), hand and foot reaction (27%), and fatigue (20%). No significant hematological AEs and no toxic deaths have occurred. To date, 2 pts (7%) had a partial response, and 18 pts (64%) had stable disease; 5 pts (18%) have had clinical benefit lasting more than 6 months. Median progression-free survival was 3.1 months (95% CI: 1.7-NR) and 6-month progression-free rate was 24% (95% C.I. 5-51%). Conclusions: PF is well tolerated and displays interesting antitumor activity in SCCHN. Conditions to proceed to stage II of the trial were met and accrual is ongoing. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Pfizer Merck, Millennium Pfizer Bayer, Bristol-Myers Squibb, Cyclacel Pharmaceuticals, GlaxoSmithKline, Merck, Novartis, Pfizer, Regeneron, Roche
Critical analysis of the ability of the endorectal coil magnetic resonance imaging scan to predict pathologic stage, margin status, and postoperative prostate-specific antigen failure in patients with clinically organ-confined prostate cancer.
Authors: A V D'Amico, R Whittington, S B Malkowicz, D Schultz, M Schnall, J E Tomaszewski, A Wein
Journal: Journal of Clinical Oncology (1996)

To determine whether there is a role for endorectal coil magnetic resonance imaging (erMRI) in the prediction of pathologic stage, margin status, and/or postoperative prostate-specific antigen (PSA) failure in patients with clinically organ-confined prostate cancer.Using erMRI, the radiologic-pathologic correlation of extracapsular extension (ECE) and seminal vesicle invasion (SVI) was evaluated in 445 surgically managed patients. Logistic regression multivariable analysis was applied to the clinical stage, PSA, biopsy Gleason grade, and erMRI findings to assess the outcomes of ECE, SVI, positive surgical margins (PSM), and postoperative PSA failure.The accuracy of erMRI to predict for ECE and SVI numerically decreased with both increasing PSA and biopsy Gleason score because of the increasing false-negative scans in cases of microscopic transcapsular or seminal vesicle disease. Of patients who could not be categorized into low or high risk for postoperative PSA failure on the basis of clinical stage, preoperative PSA, and biopsy Gleason score, a negative or positive erMRI for ECE or SVI stratified these patients into groups with a 78% versus 21% (P < .0001) 3-year rate of actuarial freedom from PSA failure. In this subgroup, the overall accuracy of the erMRI was 70% +/- 6% and 94% +/- 2% for ECE and SVI, respectively. The most significant predictor on multivariable analysis of PSM was the erMRI finding of ECE (P = .0001).This initial report suggests that a preoperative erMRI can identify clinically organ-confined prostate cancer patients at high risk for having ECE, SVI, and PSM that otherwise would be missed on the basis of the clinical stage, preoperative PSA, and biopsy Gleason score. Confirmatory studies are needed.