tbuckley/cabot-search huggingface dataset:
Role of epoetins in beta-thalassemia minor patients with solid tumors undergoing chemotherapy: Results of a retrospective analysis
Authors: H. J. Soto Parra, E. Medula, F. Latteri, G. Lavenia, P. Amadio, S. Cordio, C. Magnano
Journal: Journal of Clinical Oncology (2007)

19600 Background: β-Thalassemia minor (β-Tm) is the most common hereditary disorder in the Mediterranean region with a prevalence of 6% in Sicily. β-Tm is characterised by mild anemia (A). Therefore, we performed a retrospective analysis to evaluate the course of A in β-Tm pts with solid tumors (ST) undergoing chemotherapy (CT). Methods: β-Tm pts with ST were identified from our clinical record database [history and/or hemoglobin (Hb) A2 level &gt; 3.3%]. Inclusion criteria were first-line or second-line CT after a CT-free interval of 6 mos. Exclusion criteria:concomitant radiotherapy (RT) , or previous RT to pelvic region, or active bleeding. Results: From July 2004 until the present day, 26 β-Tm pts with ST have been observed, and 23 fulfil the criteria of this analysis. The pt demography was as follows: median age, 56 years (range, 38–76 years); Males: 9 pts; PS 0/1: 19/4; stage IV: 10; types of cancers: breast 7, gastrointestinal 7, others 9; platinum containing regimen: 7. A was evaluated during first and second-line treatments in 19 and 4 pts, respectively. The mean values of Hb and the incidence of pts (%) with mild (from ≥10 and &lt;12 gr/dl) or moderate (&lt;10 gr/dl) A during CT, were as follows. No paradoxical effect of CT on the Hb level was observed. One pt received transfusions (Hb level, 7.8 gr/dl). Nine pts were treated with epoetin (darbepoetin alfa, 7 pts) and iron supplements due to worsening A (mean Hb value = 9 gr/dl ± 0.6): five pts experienced a ≥2 gr/dl increase in the Hb level at 8 weeks, one had &gt;1 gr/dl, one had stable values = 9 gr/dl, and two pts had decreased values, i.e. &lt; 8 gr/dl, and required transfusions. Conclusion: This analysis demonstrates that 70% of β-Tm pts with ST have mild or moderate A prior to CT. The A of β-Tm patients is worsened by CT and results in moderate A in 55% of the pts. Epoetins, particularly effectively ameliorate A when administered to pts with Hb levels of &lt;10 gr/dl. This data suggests that epoetin treatment during CT may benefit β-Tm pts; however, prospective trials are required. No significant financial relationships to disclose. [Table: see text]
Renal-Pressor Hypertension Secondary to Unilateral Hydronephrosis
Authors: A. Barry Belman, Kenneth A. Kropp, Norman M. Simon
Journal: New England Journal of Medicine (1968)

In a patient with hypertension temporally related to unilateral hydronephrosis the kidney disorder appeared to be a complication of abdominal pregnancy. Renal arterial disease and urinary-tract infection were excluded as contributing causes for the hypertension. Renal-vein catheterization demonstrated greatly increased activity of the renin-angiotensin system in the kidney affected by hydronephrosis. Corrective ureteral surgery resulted in cure of hypertension, with restoration of normal renal pressor activity. Early diagnosis and treatment are common factors shared by this case with the few reported cases in which hypertension associated with hydronephrosis has been alleviated by surgery.
The Variation Phenomenon in 1994
Authors: David Blumenthal
Journal: New England Journal of Medicine (1994)

Fifty years of scholarship have established the existence and importance of the variation phenomenon in modern medicine -- the observation of differences in the way apparently similar patients are treated from one health care setting to another. Recent experience also suggests that the response to this phenomenon has the potential for both great good and great harm as health care reform continues to unfold.The contribution by Fisher and his colleagues in this issue of the Journal1 is only the latest of many studies from the groups at Dartmouth, the Rand Corporation, and elsewhere that have confirmed beyond any reasonable . . .
Case 43-1975
Authors: Richard C. Cabot, Robert E. Scully, James J. Galdabini, Betty U. McNeely, Joel F. Habener, Alan L. Schiller
Journal: New England Journal of Medicine (1975)

Presentation of CaseA 23-year-old man was admitted to the hospital because of pain in the feet.He was in excellent health until one year previously, when he began to travel in Europe and reduced his customary heavy intake of milk. Several months later he began to experience pain in the soles of both feet. X-ray examination yvas reported to be negative, and the local injection of adrenocorticosteroid gave no relief. During the succeeding months the pain gradually worsened, and low-back pain developed, accompanied by tightness and aching in the chest and shoulders that was aggravated by coughing, deep breathing . . .
EPID-04PREVALENCE OF MALIGNANT PRIMARY BRAIN TUMORS IN THE UNITED STATES COMPARED TO OTHER COMMON CANCERS, 2010
Authors: Adah Zhang, Quinn Ostrom, Carol Kruchko, Lisa Rogers, David Peereboom, Jill Barnholtz-Sloan
Journal: Neuro-Oncology (2015)

BACKGROUND: Prevalence rates reflect the complex relationship between incidence, survival, and population demographics and illustrate the total burden of disease in a population. This study estimates the 2010 prevalence of malignant primary brain tumors overall and by Central Brain Tumor Registry of the United States (CBTRUS) histology groups, and compares them to the prevalence of other common cancers by age at diagnosis: children (0-14 years), adolescent and young adult (AYA) (15-39 years), and adult (40+ years). METHODS: The prevalence of common cancers was estimated using 2010 incidence data from the United States Cancer Statistics (USCS) with 10-year survival data from Surveillance, Epidemiology, and End Results program (SEER). Malignant primary brain tumor prevalence was estimated using incidence data from CBTRUS with 10-year survival data from SEER. RESULTS: The overall prevalence rate for malignant primary brain tumors in 2010 was 29.65 per 100,000 population (∼92,000 prevalent tumors). The most prevalent cancer in children was childhood leukemia (48.48), the most prevalent in AYA was lymphoma (77.49), and the most prevalent in adults was prostate (1,477.94). The most prevalent brain tumor histology was pilocytic astrocytoma (3.47) among children, diffuse astrocytoma (1.03) among AYA, and glioblastoma (7.16) among adults. CONCLUSIONS: The relative impact of malignant primary brain tumors is higher among children than any other age group. For AYA, malignant primary brain tumors are the third most prevalent cancer. While less common in adults, malignant primary brain tumors contribute disproportionately to mortality and morbidity in adults in the United States. Prevalence estimates can provide critical information towards public health and healthcare planning, including treatment, decision-making, funding, and advocacy programs.
Intravenous Urography in the Patient with Renal Insufficiency
Authors: William B. Schwartz, Albert Hurwit, Alice Ettinger
Journal: New England Journal of Medicine (1963)

IN the evaluation of patients with impairment of renal function it is often important to delineate the anatomic status of the urinary tract. For this purpose retrograde pyelography is customarily employed since it is generally believed that intravenous urography will not provide adequate visualization in the presence of renal insufficiency.1 2 3 4 5 6 7 8 Some authors state that in the presence of "azotemia," the procedure is useless; others indicate a specific level of blood nitrogen concentration above which visualization cannot be expected. There are no published data, however, defining the degree of renal insufficiency incompatible with satisfactory urographic examination. Only an occasional observer has . . .
Emergency departments in England report worst waiting times ever
Authors: Anne Gulland
Journal: BMJ (2016)

Hospital trusts in England have reported their worst waiting times in accident and emergency departments since monthly data began to be collected.

Figures published by NHS England on Thursday 14 April showed that 87.8% of patients were seen within four hours in all emergency departments in February: the worst performance since monthly data became available in August 2010. 1 The figure was below the target of 95% and lower than the 92% reached in the same month last year. This was the second month in a row that the proportion has been the lowest ever, with 88.7% …
Disturbances of Eye Movements as a Neurologic Problem
Authors: Carl F. List
Journal: New England Journal of Medicine (1956)

DISTURBANCES of eye movements frequently confront the physician with puzzling diagnostic problems. First of all, the examiner must determine whether the abnormal function of eye muscles is the result of mechanical factors or caused by a disorder of innervation. Since purely mechanical impairment of ocular motility depends on local factors, such cases belong exclusively to the domain of ophthalmology and, therefore, are not discussed here. On the other hand neuroarenic disorders of eve movements rarely originate in the eye itself but are due to a lesion (or lesions) in the nervous system; consequently, a detailed neurologic examination becomes mandatory.It . . .
Acute Postoperative Pancreatitis
Authors: J. Englebert Dunphy, John R. Brooks, Frederick Achroyd
Journal: New England Journal of Medicine (1953)

ACUTE pancreatitis as a complication of surgical operations on organs adjacent to the pancreas has been recognized for many years. Because it has been regarded generally as a rare occurrence attributable to direct injury to the pancreas or, in operations on the biliary tract, to reflux of bile into the pancreatic duct, the subject has not received adequate attention in the literature. Our attention was drawn to this problem by an experience with 8 cases over a two-year period and by the excellent studies of Millbourn1 and Warren.2 The latter author's data are of particular interest because they demonstrate that . . .
Smoking and Cancer of the Lower Urinary Tract
Authors: Philip Cole, Richard R. Monson, Hedda Haning, Gilbert H. Friedell
Journal: New England Journal of Medicine (1971)

Interviews were conducted with 470 patients with transitional or squamous-cell carcinoma of the lower urinary tract, more than 90 per cent of whom had a bladder tumor. An age-stratified and sex-stratified but otherwise random sample of 500 persons drawn from the population of the entire study area was also interviewed as a control. Among men, cigarette smokers have a relative risk of bladder cancer of 1.89 as compared with nonsmokers, and about 39 per cent of the cases are related to smoking. This amounts to 16.4 cases per year per 100,000 men 20 years of age and over. Among women 20 years of age and over, the comparable figures are 2.00, 29 per cent and 3.9 cases per year per 100,000. For both sexes risk is increased among those who smoked heavily and those who inhaled. None of the excess risk of bladder cancer associated with cigarette smoking is explained by any indirect association with occupational experience. No significant risk is associated with pipe or cigar smoking. The data also suggest that incidence rates will increase during the next decade or so, especially among women.
EPID-31ATRX AND TERT ASSAYS PROVIDE NON-REDUNDANT INFORMATION IN ADULT GLIOMA PATIENTS: INCORPORATING TELOMERE MARKERS INTO NEUROPATHOLOGY PRACTICE
Authors: Kyle Walsh, Melike Pekmezci, Paul Decker, Helen Hansen, Hugues Sicotte, Terri Rice, Tom Kollmeyer, Lucie McCoy, Gobinda Sarkar, Arie Perry, Caterina Giannini, Tarik Tihan, Mitchel Berger, Annette Molinaro, Joe Wiemels, Jeanette Eckel-Passow, Dan Lachance, John Wiencke, Robert Jenkins, Margaret Wrensch
Journal: Neuro-Oncology (2015)

BACKGROUND: Recent work indicates that molecularly-defined glioma subgroups have similar clinical presentation and patient prognoses. These molecularly-defined subgroups often incorporate a measure of the tumor's telomere maintenance strategy, defined by mutations in either TERT or ATRX. Somatic mutations in these genes are typically mutually exclusive and there is ongoing debate over which telomere marker should be adopted into neuropathology practice. METHODS: We assessed both TERT promoter mutation status and ATRX mutation status in 1174 infiltrative adult gliomas (Grades II-IV) from the UCSF Adult Glioma Study, The Mayo Clinic, and TCGA using a combination of sequencing and immunohistochemistry. RESULTS: 653 gliomas were TERTmt only (56%), 337 were ATRXmt only (29%), 164 were TERTwt/ATRXwt (14%), and 20 were TERTmt/ATRXmt (2%). Among IDHwt patients, those with TERTwt/ATRXwt tumors had similar overall survival to patients with TERTmt tumors (HR = 0.91, 95%CI = 0.70-1.18, P = 0.47) but significantly worse survival than patients with ATRXmt tumors (HR = 1.88, 95%CI = 1.01-3.51, P = 0.047) after adjusting for age and grade. Among IDHmt patients, those with TERTwt/ATRXwt tumors had significantly worse overall survival than patients with TERTmt tumors (HR = 2.97; 95%CI = 1.43-6.17, P = 0.0035) and moderately worse survival than patients with ATRXmt tumors (HR = 1.61, 95%CI = 0.98-2.67, P = 0.063) after adjusting for age, grade and 1p/19q status. CONCLUSIONS: These data suggest that among patients with IDHwt glioma, ATRX status may be adequate for prognostication, as both TERTmt and TERTwt/ATRXwt patients differed from ATRXmt patients but did not differ from each other. Among IDHmt patients, those with TERTmt tumors, ATRXmt tumors, and TERTwt/ATRXwt tumors all had different survival experiences. This suggests that knowing both ATRX status and TERT status may be important for patients with IDHmt glioma in order to identify the TERTwt/ATRXwt patients.
Case 38-2008
Authors: Walter H. Dzik, Michael Laposata, Martin Hertl, Warren S. Sandberg, Manjil Chatterji, Joseph Misdraji
Journal: New England Journal of Medicine (2008)

A 58-year-old man was admitted to this hospital because of hepatitis C infection, hepatocellular carcinoma, and recurrent bleeding. Hemophilia had caused multiple hemarthroses, for which he had received blood products since infancy. Hepatocellular carcinoma was detected 8 months before admission; attempts at radiofrequency ablation had been complicated by hemorrhage and the failure to correct coagulation-test results with factor VIII. A surgical procedure was performed.
Characterization of NSCLC patients responding to anti-IGF-IR therapy
Authors: A. Gualberto, C. L. Melvin, A. Dean, A. L. Ang, J. M. Reynolds, A. V. Lee, L. W. Terstappen, P. Haluska, A. Lipton, D. D. Karp
Journal: Journal of Clinical Oncology (2008)

8000 Background: CP-751,871, a fully human IgG2 subtype monoclonal antibody, is a potent and specific inhibitor of the insulin-like growth factor type I receptor (IGF-IR). Methods: A comprehensive evaluation of blood and tissue markers of the IGF-IR pathway was undertaken during the conduct of phase I/II studies to evaluate the safety and efficacy of the combination of paclitaxel (T), carboplatin (C) and CP-751,871 (I) as first line treatment of advanced non-small cell lung cancer (NSCLC) patients (pts). Expression of IGF- IR and its ligands was investigated further in archival samples using tissue arrays and AQUA technology. IGF1R gene scanning was also performed. Circulating Tumor Cells (CTCs) expressing the IGF-IR were enumerated using CellTracks. Serum markers investigated included cleaved circulating IGF-IR, total and free IGF-I, IGFBP-3 and ALS. Glycemia was evaluated using fasting glucose. hGH and insulin levels were determined in a cohort of pts treated with single agent CP-751,871. Results: Blood and/or tissue samples were obtained from 190 NSCLC pts. Tissue markers were further investigated in 178 archival NSCLC specimens. Tumor IGF-IR expression was most pronounced in squamous cell carcinoma in concert with a high objective response rate to TCI in that histology (72% response rate). Two somatic mutations were identified in the beta subunit of the IGF-IR tyrosine kinase domain. One of them translated into blockade of ligand-induced receptor autophosphorylation in functional studies. CTCs expressing the IGF-IR were cleared from blood upon TCI treatment and reappeared in some patients upon disease progression. Circulating IGF-IR decreased, and IGF-1, IGFBP3 and ALS levels accumulated in serum in response to I treatment in a dose dependent manner. Importantly, sustained IGF-1 levels were observed at higher I doses, consistent with systemic IGF-IR downregulation. Hyperglycemia (glucose >250 mg/dL) was seen in 11% of NSCLC pts receiving combination TCI. It was manageable, reversible and independent of glucose levels at enrollment. hGH and glucose oscillated in parallel suggesting that hGH may play a role in the pathogenesis of I induced hyperglycemia. Conclusions: Biomarkers of the IGF-IR pathway are key elements in the development and monitoring of anti-IGF-IR therapy. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration HistoRx Inc, Immunicon, Pfizer Oncology Immunicon, Pfizer Inc, Pfizer Oncology Pfizer Oncology
Surgery for Severe Ischemic Mitral Regurgitation
Authors: Daniel H Drake, Karen G Zimmerman, Cynthia D Nichols
Journal: New England Journal of Medicine (2014)

To the Editor: In 2009, Magne et al. 1 summarized numerous studies showing that simple ring repair of severe ischemic regurgitation associated with moderate or severe tethering would prematurely fail.They concluded that comprehensive imaging was necessary to tailor the intervention to the individual patient.Subsequently, a multi-institutional laboratory trial showed that more complex annular and subvalvular repair was required to optimize remodeling and prevent recurrent regurgitation. 2 Complex repair is also supported clinically. 3,4 Nonetheless, Acker et al. (Jan. 2 issue) 5 used a simple ring for all repairs, even though tethering was required for enrollment.Mitral intervention was guided solely by regurgitant grade.Conducting a blind, randomized trial in which all patients with ischemic regurgitation were assigned to simple ring repair or replacement is akin to randomly assigning all patients with lung cancer to lobectomy or pneumonectomy, regardless of the stage of disease.The trial does not support the authors' conclusion that replacement is superior to repair.They simply reaffirm that simple ring repairs fail when moderate or severe tethering is present.Axial echocardiography greatly facilitates the stratification of disease severity and the identification of the individualized techniques required to optimize remodeling, provide freedom from recurrence, and increase the likelihood of survival (Fig. 1). 4 Detailed image guidance is essential to achieve the best possible results.
Transient High Levels of Viremia in Patients with Primary Human Immunodeficiency Virus Type 1 Infection
Authors: Eric S. Daar, Tarsem Moudgil, Richard D. Meyer, David D. Ho
Journal: New England Journal of Medicine (1991)

The rapidly evolving clinical picture of primary infection with the human immunodeficiency virus type 1 (HIV-1) suggests that a better understanding of the kinetics of viral replication in vivo during the short period before seroconversion may provide insight into the pathogenesis of the acquired immunodeficiency syndrome (AIDS).
Implications of Third Heart Sounds in Patients with Valvular Heart Disease
Authors: Edward D. Folland, Bruce J. Kriegel, William G. Henderson, Karl E. Hammermeister, Gulshan K. Sethi
Journal: New England Journal of Medicine (1992)

The presence of third heart sounds in patients with valvular heart disease is often regarded as a sign of heart failure, but it may also depend on the type of valvular disease.
Clinical research techniques in tardive dyskinesia
Authors: W E Fann, J R Stafford, R L Malone, J D Frost, B W Richman
Journal: American Journal of Psychiatry (1977)

The authors have developed standardized assessment and control techniques designed to provide objective measures of tardive dyskinesia in patients progressing through an experimental treatment program. Standardized videotaping is carried out and blind ratings on the Abnormal Involuntary Movement Scale are made by a team of psychiatrists and neurologists. Other assessments include several measurements of vocal function and a quantitative acceleration profile standardized on normal subjects. Such measures allow quantifiable determination of response to drug treatment and may provide clues to the etiology and definition of the dyskinetic syndrome.
Targeted Therapy in Relapsed Classical Hodgkin Lymphoma
Authors: Shira Dinner, Ranjana Advani
Journal: Journal of the National Comprehensive Cancer Network (2013)

Although frontline treatment of advanced Hodgkin lymphoma (HL) produces high cure rates, disease either will not respond to or will relapse after initial therapy in approximately a quarter of patients. Many patients with disease relapse can be successfully salvaged with second-line chemotherapy followed by autologous stem cell transplantation (ASCT). Patients whose disease relapses after ASCT are rarely cured. A unique pathophysiologic feature of HL is that the malignant Reed-Sternberg (HRS) cell is rare and resides within a microenvironment of inflammatory and immune-related cells. The recent FDA approval of the anti-CD30 antibody-drug conjugate brentuximab vedotin (BV) for patients with either primary refractory HL or those whose disease relapses after ASCT represents a major advance in therapy. This article focuses on BV and other novel agents that target the HRS cell surface, intracellular signaling pathways, and tumor microenvironment.
Case 35-1996
Authors: Walter E. Donat, Elena Savilo
Journal: New England Journal of Medicine (1996)

Presentation of CaseA 57-year-old woman was admitted to the hospital because of fever, sweats, neuropathy, and multiple pulmonary nodules.The patient had been well until nine months earlier, when weakness developed in the left ankle. During the following month, she had fevers, night sweats, and fatigue. Electrophysiologic testing performed elsewhere revealed a posterior tibial neuropathy of mixed demyelinative type. The fevers and night sweats waxed and waned, and the fatigue persisted. Three months before admission, the fevers and night sweats increased, with a rise in the temperature to 38.3°C and rigors. She lost 4.5 kg in weight.Five weeks . . .
Management of Dermatologic Toxicities
Authors: Mario E Lacouture
Journal: Journal of the National Comprehensive Cancer Network (2015)

Dermatologic toxicities related to cancer therapies have become even more common with the use of targeted treatments. A proactive approach is necessary to reduce the pain and suffering these patients experience. The oncologist should become comfortable in preventing and managing these complications to keep patients on optimal drugs and doses. At the NCCN 20th Annual Conference, Dr. Mario E. Lacouture advised clinicians on appropriate strategies to manage rash, paronychia, alopecia, and other dermatologic conditions frequently seen in patients with cancer.
A Balancing Act
Authors: Somnath Saha, Sanjay Saint, Lawrence M. Tierney
Journal: New England Journal of Medicine (1999)

A 50-year-old man with alcoholism was brought to the emergency department by his wife because of altered mental status. According to her, the patient had been drinking his usual case of beer (approximately 9 liters) each night until 36 hours earlier, when he reported a frontal headache, which gradually increased in intensity and spread to the occipital area. A day later, the patient felt feverish and took aspirin at bedtime. On the morning of admission, he was difficult to arouse and, on awakening, was combative and confused. The patient's wife denied knowledge of recent head trauma, upper respiratory tract . . .