tbuckley/cabot-search huggingface dataset:
PTU-236 Endoscopic retrograde cholangiopancreatography (ERCP) metal biliary stent insertions: outcome and complications
Authors: M Z Cader, M W James
Journal: Gut (2012)

<h3>Introduction</h3> Endoscopic retrograde cholangiopancreatography (ERCP) is an established technique for palliative stenting and symptomatic relief of obstruction of the biliary tree. Although mortality following ERCP is high in patients with advanced age and a malignant diagnosis, a Cochrane review has shown that endoscopic stents have reduced complications and mortality compared with surgical bypass in inoperable pancreatic cancer. Furthermore metal stents have improved patency in biliary obstruction than plastic stents. Our aim was to evaluate patient outcomes following endoscopic metallic stenting at a specialist tertiary referral centre, including the need for re-intervention and mortality rates. <h3>Methods</h3> We performed a retrospective audit and service evaluation for all endoscopic metallic biliary stent procedures at Queen9s Medical Centre, Nottingham University Hospitals Trust over a 1-year period during 2010 with patients receiving at least 1-year follow-up. Demographic data, the need for repeat intervention (either endoscopic or radiological), procedure-related complications and mortality were determined. <h3>Results</h3> During 2010, 40/776 (5.2%) patients undergoing ERCP had metallic biliary stents inserted; uncovered Zilver® stents (Wilson Cook, USA) n=38 (95%), covered Niti-S® stents (Taewoong Medical, S. Korea) n=2 (5%). Of these 22 (55%) were male and mean (±SD) age was 73.1±12.3 years. Final diagnosis was pancreatic cancer; n=22 (55%), cholangiocarcinomas; n=13 (33%), other malignancy; n=3 (7%) and benign stricture; n=2 (5%). Strictures were located either distally n=25 (63%), mid-duct strictures n=4 (10%) or proximal/hilar strictures n=11 (27%). All patients underwent radiological imaging prior to ERCP. 22 patients (55%) had undergone prior ERCP with the majority, 21/22 (95%) patients, having confirmed cytological diagnosis of malignancy and 20/22 (91%) patients having previous biliary stents in situ. These were predominantly plastic stents which had blocked or required stent exchange. All cause 1-year mortality was 80%, with median (range) survival 120 (6–361) days. 7-day and 30-day mortality was 5% and 13% respectively. There were no immediate reported complications at time of endoscopy. 9/40 (22.5%) patients required further ERCP or percutaneous transhepatic cholangiography stenting procedures. All re-interventions were in patients with uncovered stents; 6 due to tumour in growth or stent occlusion and one due to stent misplacement. <h3>Conclusion</h3> Although technical success and immediate complications were satisfactory, need for re-intervention was required in 22.5%. Median survival and stent patency in this study is comparable to data from the Cochrane review, however further work is required to compare different metallic stent construction or other manoeuvres to reduce the need for re-intervention. <h3>Competing interests</h3> None declared.
Hydrops Fetalis with Alpha Thalassemia
Authors: Yuet Wai Kan, Alex Allen, Louis Lowenstein
Journal: New England Journal of Medicine (1967)

HYDROPS fetalis associated with hemoglobin Barts is believed to represent the homozygous state of α thalassemia. Ten cases occurring in Chinese families in Indonesia, Malaya and Hong Kong, 1 in a Greek Cypriot family and 1 in a Filipino family, have been described.1 2 3 4 5 6 7 Recently, several more cases have been seen among Chinese in Hong Kong.8 We have encountered an additional case of this disease in a Chinese family in Montreal. In addition, a detailed study of the available members of the family has revealed some very unusual findings. While the mother of the baby presented a picture compatible with the . . .
Vitamin D<sub>3</sub>and Calcium to Prevent Hip Fractures in Elderly Women
Authors: M C Chapuy, M E Arlot, F Duboeuf, J Brun, B Crouzet, S Arnaud, P D Delmas, P J Meunier
Journal: New England Journal of Medicine (1992)

Hypovitaminosis D and a low calcium intake contribute to increased parathyroid function in elderly persons. Calcium and vitamin D supplements reduce this secondary hyperparathyroidism, but whether such supplements reduce the risk of hip fractures among elderly people is not known.We studied the effects of supplementation with vitamin D3 (cholecalciferol) and calcium on the frequency of hip fractures and other nonvertebral fractures, identified radiologically, in 3270 healthy ambulatory women (mean [+/- SD] age, 84 +/- 6 years). Each day for 18 months, 1634 women received tricalcium phosphate (containing 1.2 g of elemental calcium) and 20 micrograms (800 IU) of vitamin D3, and 1636 women received a double placebo. We measured serial serum parathyroid hormone and 25-hydroxyvitamin D (25(OH)D) concentrations in 142 women and determined the femoral bone mineral density at base line and after 18 months in 56 women.Among the women who completed the 18-month study, the number of hip fractures was 43 percent lower (P = 0.043) and the total number of nonvertebral fractures was 32 percent lower (P = 0.015) among the women treated with vitamin D3 and calcium than among those who received placebo. The results of analyses according to active treatment and according to intention to treat were similar. In the vitamin D3-calcium group, the mean serum parathyroid hormone concentration had decreased by 44 percent from the base-line value at 18 months (P < 0.001) and the serum 25(OH)D concentration had increased by 162 percent over the base-line value (P < 0.001). The bone density of the proximal femur increased 2.7 percent in the vitamin D3-calcium group and decreased 4.6 percent in the placebo group (P < 0.001).Supplementation with vitamin D3 and calcium reduces the risk of hip fractures and other nonvertebral fractures among elderly women.
Correction of Severe Combined Immunodeficiency by Fetal Liver Cells
Authors: Rebecca H. Buckley, John K. Whisnant, Richard I. Schiff, Richard B. Gilbertsen, Andrew T. Huang, Marvin S. Platt
Journal: New England Journal of Medicine (1976)

As an alternative to bone-marrow transplantation, two infants with severe combined immunodeficiency who had no histocompatible donors were given intraperitoneal infusions of fresh liver cells from fetuses of eight and nine to 10 weeks. Transient graft-versus-host disease began at 42 and 52 days, respectively. Both infants had rises in T cells and declines in B cells by three months. No functional immunologic improvement occurred in the first infant, who died of pulmonary disease 10 months later. Clinical and functional immunologic improvement occurred in the other, who is now 19 months after transplantation. Lymphocyte responses to phytohemagglutinin and pokeweed mitogen were noted by three months, to concanavalin A by five months, and to allogeneic cells by eight months. Delayed cutaneous responsiveness to candida developed and IgM became norma. IgA and IgG remained low. Chimerism was demonstrated by a donor marker chromosome in metaphases from recipient lymphocytes. Fetal liver cells therefore reversed the immunodeficiency.
Scientists Told Colon Cancer Is Preventable
Authors: E. Blume
Journal: JNCI Journal of the National Cancer Institute (1988)

Journal Article Scientists Told Colon Cancer Is Preventable Get access Elaine Blume Elaine Blume Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 80, Issue 13, 7 September 1988, Pages 992–993, https://doi.org/10.1093/jnci/80.13.992 Published: 07 September 1988
A Twenty-Year Survey of Thromboembolism at the Massachusetts General Hospital, 1939–1959
Authors: Gordon A. Donaldson, Robert R. Linton, Grant V. Rodkey
Journal: New England Journal of Medicine (1961)

APPROXIMATELY twenty years ago the treatment of venous thrombosis and pulmonary embolism underwent radical clinical change. Previously, prolonged bed rest and the occasional use of typhoid vaccine given intravenously, thyroid medication or local leeches were accepted measures. Under such therapy patients exhibiting thrombotic disease might expect a mortality from massive pulmonary embolism of 5 per cent.1 Although McLean had discovered heparin in 1916, Murray and Best, in 1938, were the first to give this expensive drug an extensive clinical trial. Three years later Link isolated and synthesized bishydroxycoumarin, the first of several coumarin derivatives. At the same time Ochsner and . . .
NI-57 * DYNAMIC CONTRAST-ENHANCED MAGNETIC RESONANCE PERFUSION WEIGHTED IMAGING (DCE-MRI) AND DIFFUSION WEIGHTED IMAGING (DWI) FOR PHARMACODYNAMIC EVALUATION OF CARBOXYAMIDOTRIAZOLE OROTATE (CTO) AND TEMOZOLOMIDE IN MALIGNANT GLIOMA
Authors: R. Magge, J. A. Perez, R. Young, T. Kaley, E. Pentsova, L. DeAngelis, E. Diamond, I. Mellinghoff, K. Peck, B. Anderson, G. Gorman, S. Mclean, R. Karmali, A. Omuro
Journal: Neuro-Oncology (2014)

BACKGROUND: Advanced imaging techniques have been proposed as potentially useful tools for evaluation of biological effects of new targeted agents. CTO is an oral inhibitor of non-voltage-dependent calcium signaling that modulates several pathways, including EGFR, MEK, RAS, HDAC, HSP90, WNT/B-catenin, Akt, ERK, VEGF and Bcr-Abl. We prospectively evaluated advanced MRI parameters in a phase I trial of combined CTO and adjuvant temozolomide for temozolomide-refractory recurrent/progressive malignant glioma, aiming at characterizing early pharmacodynamic effects after drug exposure. METHODS: Within an exploratory imaging correlative study, a subset of patients enrolled in this trial underwent DCE-MRI and DWI at baseline and after two 28-day cycles. Changes in imaging parameters were evaluated utilizing volumetric histogram analysis of the entire tumor (NordicICE v2.3; NordicNeuroLab, Bergen, Norway), including blood perfusion (relative plasma volume [Vp]), vascular permeability (Ktrans) and diffusion (apparent diffusion coefficient [ADC]). Normalized results were analyzed with Mann-Whitney u tests. RESULTS: Among 17 enrolled patients, 7 were included in the imaging component (glioblastoma: 5; grade III: 2; MGMT methylated: 3, unmethylated: 2, unknown: 2; bevacizumab failures: 3), with CTO dose range of 219-625mg/m2/day. All patients displayed a reduction in blood perfusion, with mean Vp = 10.65 at baseline vs 3.82 after 2 cycles, p = 0.001. There were no statistically significant differences in vascular permeability parameters, such as Ktrans (mean 11.07 vs 5.14, p = 0.38) or ADC (mean 1.54 vs 1.54, p = 0.81). CONCLUSIONS: DCE-MRI depicted decreases in blood perfusion, demonstrating biological effects of CTO in all evaluated patients after two cycles. Interestingly, such changes were not accompanied by significant decreases in vascular permeability, suggesting an effect distinct from that observed with bevacizumab and VEGF blockade, and likely reflecting modulation of other signaling pathways. This study provides insight into the mechanism of action of CTO, and highlights the usefulness of advanced neuroimaging in early drug development in brain tumors.
Impact of Progression during Neoadjuvant Chemotherapy on Operative Management of Breast Cancer.
Authors: A. Caudle, A. Gonzalez-Angulo, K. Hunt, H. Kuerer, L. Pusztai, S. Kau, E. Mittendorf, G. Hortobagyi, F. Meric-Bernstam
Journal: Cancer Research (2009)

Abstract Background: Neoadjuvant chemotherapy (NCT) is the standard of care for locally advanced breast cancer, but remains controversial in early stage disease. Some have raised concerns that disease progression may make breast-conserving therapy (BCT) or even mastectomy impossible. The goal of this study was to determine the impact of disease progression during NCT on operative management. Methods: We reviewed clinicopathologic data on patients receiving NCT for Stage I-III breast cancer at a cancer center between 1994 and 2007. Chemotherapy regimens were anthracycline and/or taxane-based as determined by the medical oncologist. Results: 1928 patients received NCT, of which 1762 (91%) had a response (minor, partial, or complete), 107 (6%) had stable disease (SD), and 59 (3%) progressed (PD) on at least one regimen. Of the 59 patients with progression, 13 (22%) had tumor response and 7 (12%) had SD with their first regimen, but progressed on their second regimen. Thirty-nine (66%) had progression on their first regimen of which 4 (10%) proceeded to surgery, 1 (3%) developed metastasis, and 1 (3%) refused further therapy. Thirty-three (85%) received a second chemotherapy regimen after progression on the first regimen; 18 (55%) had response to the second regimen, 5 (15%) had SD, and 10 (30%) had further progression. Eight (14%) had XRT to control local progression. In the 59 patients with progression at any point during NCT, 40 (68%) underwent mastectomy, 12 BCT (20%), and 7 (12%) had no surgery. In patients who had mastectomies, 3 (8%) were BCT candidates before progression, one (3%) was converted to mastectomy for technical reasons, and 2 (5%) were not evaluable from available data. Overall, disease progression changed the operative plan in 11 (0.5%): 2 developed distant metastasis, 2 developed clinical lymphadenopathy, 3 required mastectomy instead of BCT, 3 became inoperable, and 1 required flap closure. Conclusion: Patients treated with NCT should be evaluated by multi-disciplinary team members for response to therapy. Progression on NCT is infrequent (3%), but the optimal management in these patients needs further study. Overall, progression on NCT changes the operative management in only a small proportion of patients. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1090.
SHOULD WE DISCOURAGE THE USE OF MULTI-VESSEL ANGIOPLASTY DURING STEMI OR THE USE OF REGISTRY DATA IN COMPARATIVE EFFICACY RESEARCH? AN ANALYSIS OF 35,008 PATIENTS
Authors: Sayan Sen, Darrel Francis, Ricardo Petraco, Christopher Broyd, Sukhjinder Nijjer, Nicholas Foin, Iqbal Malik, Ghada Mikhail, Rodney Foale, Alun Hughes, Jamil Mayet, Justin Davies
Journal: Journal of the American College of Cardiology (2012)
Current Issues in Cancer: Multiple myeloma
Authors: I C M MacLennan, M Drayson, J Dunn
Journal: BMJ (1994)

Multiple myeloma occurs in over 2000 new patients in England and Wales each year.It presents most frequently as bone pain and patients tend to become dehydrated and may develop renal failure.No avail- able treatment is curative, but about two thirds of patients achieve a stable response with low dose combination chemotherapy.Combination chemo- therapy including doxorubicin and carmustine with the alkylating agents cyclophosphamide and melphalan achieve a higher stable response rate than conventional treatment with melphalan and prednisone without additional haematological toxicity.These responses are associated with loss of bone pain and patients remain symptom free for months without further treatment.Relapse occurs on average in a little under two years and, though second responses are frequently obtained, the disease eventually becomes refractory.This paper looks at who should be treated and the benefits that may be expected from the treatments available.Multiple myeloma is a diffuse neoplasm of bone marrow plasma cells in which the malignant cells mingle with the haemopoietic cells throughout the red bone marrow.In many patients microplasmacytomas are present within the marrow and occasionally neoplastic cells grow as a tumour from bone.Overt spread of multiple myeloma outside the red bone marrow is seen in only a proportion of patients and then at a late stage of their disease.In most patients the neoplastic clone induces excess osteoclastic activity that results in osteoporosis, osteolytic lesions, and pathological fractures.About a quarter of patients, however, have no clinical or x ray signs of skeletal disease at presentation.Some patients never develop This is the sixth in a series of artcles examining recent developments in cancer and updating what we know about the disease
Pancreatic Fluid Secretion and Protein Hyperconcentration in Cystic Fibrosis
Authors: Hinda Kopelman, Peter Durie, Kevin Gaskin, Zvi Weizman, Gordon Forstner
Journal: New England Journal of Medicine (1985)

To study pancreatic protein and water secretion in 28 patients with cystic fibrosis and 21 controls matched for pancreatic acinar function as defined by trypsin secretion, we used a quantitative-marker perfusion technique and continuous intravenous secretin-pancreozymin stimulation. Regardless of the level of pancreatic acinar function, secretions from the patients contained significantly higher concentrations of protein than those from the controls. Total protein output and albumin:protein ratios were not increased in secretions from the patients, but their fluid secretion was significantly decreased at any level of pancreatic function. A significant linear correlation was found between protein and volume secretion in the patients (r = 0.86, P less than 0.001), most of whom had a fluid output of less than 4.2 ml per kilogram of body weight per hour. No such relation was found in the control subjects, whose flow was always above 4.2 ml per kilogram per hour. We conclude that fluid secretion in patients with cystic fibrosis may be a rate-limiting factor in protein output and that a limited flow of hyperconcentrated protein secretions may predispose to protein precipitation and ductal obstruction in the pancreas.
AB1158-HPR The Avoidance Model in Knee and Hip Osteoarthritis: A Systematic Review of the Evidence
Authors: J.F. Holla, D.C. Sanchez-Ramirez, M. van der Leeden, J.C. Ket, L.D. Roorda, W.F. Lems, M.P. Steultjens, J. Dekker
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> The avoidance model explains how behavioral mechanisms may lead to activity limitations in patients with osteoarthritis (OA) of the knee or hip. According to this model, the patient with OA experiences pain during activities. This leads to the expectation that renewed activity will cause greater pain, resulting in avoidance of activities. Avoidance of activities results in physical decline, most notably muscle weakness. Muscle weakness leads to an increase in activity limitations. In addition, it is hypothesized that psychological distress enhances the tendency to avoid activities, leading to muscle weakness and activity limitations. <h3>Objectives</h3> To review the scientific evidence for the validity of the avoidance model in patients with knee and hip OA. <h3>Methods</h3> A literature search was conducted in four electronic databases. Selection criteria included: knee or hip OA or pain; examination of consecutive components of the avoidance model; observational study; original research report. The methodological quality of the selected articles was assessed, and qualitative data synthesis identified levels of evidence. <h3>Results</h3> Sixty studies were included. In patients with knee OA, strong evidence was found that avoidance of activities is associated with activity limitations via muscle weakness (mediation by muscle weakness); strong evidence was found for an association between muscle weakness and activity limitations; and weak evidence was found that pain and psychological distress are associated with muscle weakness via avoidance (mediation by avoidance). In patients with hip OA, weak evidence was found for mediation by muscle weakness; and strong evidence was found for an association between muscle weakness and activity limitations. <h3>Conclusions</h3> In patients with knee OA, the association between avoidance of activities and activity limitations is for a substantial part explained by muscle weakness. In both patients with knee OA and patients with hip OA, muscle weakness is associated with activity limitations. These results emphasize the importance of muscle strength in maintenance of activities. More research is needed on the consecutive associations between pain or psychological distress, avoidance of activities and muscle weakness, and to confirm causal relationships. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.1191
Multiple Palpable Cysts
Authors: Nguyen De, Thanh Hoa Le
Journal: New England Journal of Medicine (2013)

A 42-year-old man presented with seizures and approximately 300 palpable intramuscular cysts on his head, face, neck, chest, back, arms, and legs. During the 3 years preceding presentation, he reported having a chronic headache and witnessing the development of the cysts.
Natural History of Symptomatic Partial Ornithine Transcarbamylase Deficiency
Authors: Peter C. Rowe, Stephen L. Newman, Saul. W. Brusilow
Journal: New England Journal of Medicine (1986)

We reviewed the natural history and differential diagnosis of ornithine transcarbamylase deficiency (an X-linked inborn error of urea synthesis) in 13 symptomatic female heterozygotes. The patients presented as early as the first week of life or as late as the sixth year. The most common symptoms before diagnosis were nonspecific: episodic extreme irritability (100 percent), episodic vomiting and lethargy (100 percent), protein avoidance (92 percent), ataxia (77 percent), Stage II coma (46 percent), delayed physical growth (38 percent), developmental delay (38 percent), and seizures (23 percent). Including the proband, 42 percent of the female members of the 13 families studied had symptoms. The median interval between the onset of major symptoms (vomiting and lethargy, seizures, and coma) and diagnosis was 16 months (range, 1 to 142). Five patients had IQ scores below 70 at the time of diagnosis. We suggest that careful evaluation of the family history, the dietary history, the episodic nature of the nonspecific symptoms, the response of these symptoms to the withdrawal of protein, and their frequent onset at the time of weaning from breast milk will permit early diagnosis and might thereby reduce the risk of death or neurologic impairment in female patients with partial ornithine transcarbamylase deficiency.