tbuckley/cabot-search huggingface dataset:
Case 6-1995
Authors: B.R. Benacerraf, J.H. Eichhorn
Journal: New England Journal of Medicine (1995)

Presentation of CaseA one-month-old girl was admitted to the hospital because of an intraabdominal mass.After a 42-week gestation, the infant had been delivered by cesarean section because of cephalopelvic disproportion. There were no complications during the pregnancy or delivery. A routine ultrasonographic examination (Figure 1), performed during the 28th week of pregnancy, showed a multiseptated cystic mass in the midabdomen. An ultrasonographic study during the 29th week of pregnancy showed the same mass slightly to the left of the midline. Another prenatal ultrasonographic examination at 30 weeks also showed the cystic abdominal mass near the midline. The infant . . .
A Randomized Comparison of Transcervical and Transabdominal Chorionic-Villus Sampling
Authors: Laird G. Jackson, Julia M. Zachary, Sarah E. Fowler, Robert J. Desnick, Mitchell S. Golbus, David H. Ledbetter, Maurice J. Mahoney, Eugene Pergament, Joe Leigh Simpson, Susan Black, Ronald J. Wapner
Journal: New England Journal of Medicine (1992)

Chorionic-villus sampling is done in early pregnancy to obtain fetal cells for the prenatal diagnosis of genetic and chromosomal defects. Transcervical chorionic-villus sampling has been shown to be safe and effective in national trials. Recently, an alternative transabdominal technique has been suggested as potentially easier and safer.From April 1987 through September 1989, we prospectively compared transcervical and transabdominal chorionic-villus sampling in 3999 women with singleton pregnancies in whom the risk of a genetically abnormal fetus was increased. Women between 7 and 12 weeks of gestation underwent ultrasonographic evaluation of placental and uterine position. Those with active vaginal infections, active bleeding, or cervical polyps were excluded. If the obstetrician thought either sampling procedure was acceptable, the woman was asked to consent to random assignment to one of the two procedures. Both groups were followed to determine the outcome of pregnancy and the rate of spontaneous fetal loss after chorionic-villus sampling.Among the 3999 women who entered the study, sampling was attempted in 3873 (97 percent), 1944 of whom had been assigned to undergo transcervical sampling and 1929 to undergo transabdominal sampling. Of these 3873 women, sampling was eventually successful in 3863. Sampling was successful after a single insertion of the sampling instrument in 94 percent of the transabdominal procedures and 90 percent of the transcervical procedures. Among the women with cytogenetically normal pregnancies who had sampling because of maternal age, the rate of spontaneous fetal loss through 28 weeks of pregnancy was 2.5 percent in the transcervical-sampling group and 2.3 percent in the transabdominal-sampling group (difference, 0.26 percent; 95 percent confidence interval, -0.5 to 1.0 percent).Transabdominal and transcervical chorionic-villus sampling appear to be equally safe procedures for first-trimester diagnosis of fetal abnormalities.
Case 24-1993
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Christopher Longcope, John H. Eichhorn
Journal: New England Journal of Medicine (1993)

Presentation of CaseA 56-year-old woman was referred to the hospital because of male-pattern baldness and hirsutism.The patient's menarche had occurred at the age of 13 years, and her menses were regular in the absence of premenstrual molimina or dysmenorrhea. Her gynecologist, since deceased, told her that she would never have children, although she did not recall his explanation. She was sexually active during much of her married life. She used no contraceptive measures but never conceived. Seven years before entry her menses became less frequent and ceased; she did not have hot flashes.A year and a half . . .
Tularemia Epidemic: Vermont, 1968
Authors: Lowell S. Young, Donald S. Bicknell, Benedict G. Archer, James M. Clinton, Linus J. Leavens, James C. Feeley
Journal: New England Journal of Medicine (1969)

North America's largest outbreak of tularemia linked to human contact with aquatic mammals occurred in the spring of 1968 in Vermont, a state with no previous reports of tularemia. Forty-seven cases were diagnosed in persons who had trapped or handled muskrats within a four-week period. Investigation revealed a wide spectrum of disease ranging from severe prostrating illness to inapparent infection. Almost all the symptomatic patients had fever and constitutional symptoms. Skin lesions and axillary adenopathy, although present in most symptomatic patients, were variable features. In the 46 patients who had agglutination titers of 1:160 or greater against Francisella tularensis, there was no correlation between titer and presence or absence of symptoms, severity of symptoms, duration of illness or effect of treatment. F. tularensis was identified in the exudate from the skin lesion of one patient. It was also cultured from water, mud, and 5 per cent of the muskrats in the area of most intensive trapping.
The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database
Authors: S T Ward, A Hancox, M A Mohammed, T Ismail, E A Griffiths, R Valori, P Dunckley
Journal: Gut (2016)

<h3>Objective</h3> The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. <h3>Design</h3> OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of &gt;20 procedures or had submitted data for &lt;20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. <h3>Results</h3> Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, &gt;90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. <h3>Conclusions</h3> There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate.
Renin-Angiotensin System in Anephric Patients
Authors: Leonard B. Berman, Victor Vertes, Sumanta Mitra, Anne B. Gould
Journal: New England Journal of Medicine (1972)

Plasma renin activity in anephric human beings has been reported by some investigators. We studied 10 anephric subjects under several conditions, including upright posture and dehydration. Preliminary recovery experiments revealed no renin inhibitors in the serum and a minimum detectability of 0.06 Goldblatt U X 10–4 per milliliter (0.20 ng of angiotensin per milliliter per hour). There was no renin in 61 serum specimens from 10 subjects, nor was there any measurable generation of angiotensin I in 19 of 20 specimens. Renin substrate concentration was moderately elevated in nine of the 10 subjects. Our results demonstrate that anephric males and females have no circulating renin, and suggest that physiologic systems such as aldosterone secretion are controlled by factors other than the renin-angiotensin system in anephric patients.
Atovaquone Compared with Dapsone for the Prevention of<i>Pneumocystis carinii</i>Pneumonia in Patients with HIV Infection Who Cannot Tolerate Trimethoprim, Sulfonamides, or Both
Authors: Wafaa M. El-Sadr, Robert L. Murphy, Teresa McCabe Yurik, Roberta Luskin-Hawk, Tony W. Cheung, Henry H. Balfour, Robert Eng, Thomas M. Hooton, Thomas M. Kerkering, Malte Schutz, Charles van der Horst, Richard Hafner
Journal: New England Journal of Medicine (1998)

Although trimethoprim–sulfamethoxazole is the drug of choice for the prevention of Pneumocystis carinii pneumonia, many patients cannot tolerate it and must switch to an alternative agent.
Principles and Techniques of Radiation Therapy for Esophageal and Gastroesophageal Junction Cancers
Authors: Lisa Hazard, Gary Yang, Mary Frances McAleer, James Hayman, Christopher Willett
Journal: Journal of the National Comprehensive Cancer Network (2008)

Radiation therapy serves an integral role in the primary and adjuvant treatment of esophagus cancer. Radiation techniques continue to improve, providing more accurate localization of the tumor while limiting dose to normal structures. This article reviews current practices and recommendations for radiation therapy technique for esophageal and gastroesophageal malignancies.
Ductal Carcinoma in Situ (Dcis) Treated By Mastectomy, or Local Excision with or Without Radiotherapy: a Retrospective Study About 608 Women
Authors: S. Frank, A. Dupont, R. Porcher, A. De Roquancourt, L. Teixeira, M. Espié, C. Cuvier
Journal: Annals of Oncology (2014)
Responses to Hydrochlorothiazide and Acetazolamide in Patients with Calcium Stones
Authors: Roger A. L. Sutton, Valerie R. Walker
Journal: New England Journal of Medicine (1980)

Urinary excretion of sodium, calcium, and magnesium has been measured after single oral doses of hydrochlorothiazide (100 mg) and acetazolamide (500 mg) in unselected patients with calcareous renal stone formation and in normal control subjects. With hydrochlorothiazide, 36 stone formers had significantly greater increments in sodium (P less than 0.01), calcium (P less than 0.05), and magnesium (P less than 0.05) excretion than 20 normal subjects. With acetazolamide, 13 stone formers had a smaller increment in sodium excretion (P less than 0.05) than 10 normal subjects. The abnormal responses to both diuretics were most marked in the patients with hypercalciuria during fasting. These data suggest that the tubular handling of sodium, magnesium, and calcium may be abnormal in patients with calcareous renal stones and are consistent with the presence of a defect in proximal-tubular reabsorption of fluid and electrolytes that may be partly offset by increased reabsorption in the distal nephron.
MPTH-28STUDY OF THE ROLE OF IFI-16 EXPRESSION IN GLIOMAS
Authors: Bianca Pollo, Monica Patanè, Chiara Calatozzolo, Francesca Sciacca, Vita Girgenti, Valentina Dell'Oste, Santo Landolfo, Gaetano Finocchiaro, Jasenka Mazibrada
Journal: Neuro-Oncology (2015)

Interferon inducible protein 16 (IFI-16) is a member of the p200 human family proteins, having two domains: C-terminus binding dsDNA and N-terminus as a typical protein-protein interaction domain. IFI-16 gene is located at 1q23.1 chromosome, its functions ranging from transcriptional regulation, apoptosis, proliferation and differentiation. IFI-16 is mostly expressed in epithelial, endothelial and hematopoietic tissues, with nuclear localization signal: in the nucleolus it is able to activate and fine-tune the transcription, when in the nucleoplasm probably it is inactivated. In the nucleoli a physical and functional link of IFI-16 to p53 has been reported, as negative regulator of the cell cycle. We have studied IFI-16 expression in 40 low grade and 40 anaplastic gliomas (half of them analysed with their relapse) and 40 glioblastomas using immunohistochemical and molecular techniques, using two antibodies against the C- and N-terminus of IFI-16. Nuclear accumulation of p53, IDH1(R132H), MGMT methylation status and LOH of chromosomes 1p, 19q, 9p, 17p and 10q were also evaluated. We mainly found a nucleolar expression of IFI-16 in astrocytic lower grade gliomas, related to p53: this physical and functional binding was also demonstrated by co-immunoprecipitation and Protein Ligation Assay analysis. In anaplastic gliomas and glioblastomas, IFI-16 is largely expressed in the nucleoplasm, unrelated to p53 expression. This shift of localization suggests a possible loss of its role as protective factor in lower grade astrocytic gliomas. In oligodendrogliomas IFI-16 expression was completely absent and it is strictly related to 1p/19q co-deletion. Our results, related to clinical data, identify IFI-16 as a possible prognostic marker in glioma patients and of interest to define new molecular profiles for their therapy. This is the first study of IFI-16 in gliomas, suggesting an early role of this molecule in proliferation and malignant progression of these tumours.
Children and Food — Order Amid Chaos
Authors: Gilbert B. Forbes
Journal: New England Journal of Medicine (1991)

IN everyday life, and especially at mealtime, the behavior of young children can seem chaotic. Great variability in the incensity of activity and a capricious appetite are the norm, as are vigorous likes and dislikes, dawdling over food, spillage, refusal of nutritious foods (even those low in cholesterol), and variations in intake. This may be difficult for the parents to bear, particularly if they have taken courses in nutrition and are supremely aware of what is a good and proper diet, one designed to preclude (so it is claimed) the arterial incompetencies of later years, while at the same time . . .
Helper and Suppressor T-Lymphocyte Leukemia in Ataxia Telangiectasia
Authors: Andrew Saxon, Ronald H. Stevens, David W. Golde
Journal: New England Journal of Medicine (1979)

We investigated the nature of the lymphoid leukemia that developed in one of two siblings with ataxia telangiectasia. The leukemic cells were shown to be T lymphocytes. Furthermore, the neoplastic cells carried a characteristic 14q+ chromosome tandem translocation. This chromosome abnormality had been identified 11 years earlier among the patient's "normal" lymphocytes. The patient's neoplastic T lymphocytes in vitro provided helper and suppressor T-lymphocyte activity equivalent to that of normal T lymphocytes. Some neoplastic T lymphocytes bore a receptor for the Fc portion of IgM (45 per cent Tmu) whereas other carried receptors for the Fc portion of IgG (10 per cent Tgamma). All the Tmu and Tgamma lymphocytes possessed the chromosome 14 abnormality. These data suggest that neoplastic transformation occurred in an uncommitted T lymphocyte that was capable of further differentiation into the distinct pathways for help and suppression, in a lymphoid analogy of chronic myelogenous leukemia.
NOTCH Signaling Regulates Asymmetric Cell Fate of Fast- and Slow-Cycling Colon Cancer–Initiating Cells
Authors: Tara Srinivasan, Jewell Walters, Pengcheng Bu, Elaine Bich Than, Kuei-Ling Tung, Kai-Yuan Chen, Nicole Panarelli, Jeff Milsom, Leonard Augenlicht, Steven M. Lipkin, Xiling Shen
Journal: Cancer Research (2016)

Colorectal cancer cells with stem-like properties, referred to as colon cancer-initiating cells (CCIC), have high tumorigenic potential. While CCIC can differentiate to promote cellular heterogeneity, it remains unclear whether CCIC within a tumor contain distinct subpopulations. Here, we describe the co-existence of fast- and slow-cycling CCIC, which can undergo asymmetric division to generate each other, highlighting CCIC plasticity and interconvertibility. Fast-cycling CCIC express markers, such as LGR5 and CD133, rely on MYC for their proliferation, whereas slow-cycling CCIC express markers, such as BMI1 and hTERT, are independent of MYC. NOTCH signaling promotes asymmetric cell fate, regulating the balance between these two populations. Overall, our results illuminate the basis for CCIC heterogeneity and plasticity by defining a direct interconversion mechanism between slow- and fast-cycling CCIC. Cancer Res; 76(11); 3411-21. ©2016 AACR.
Boyle's Law and Breast Implants
Authors: James J. Bachman
Journal: New England Journal of Medicine (1994)

To the Editor: A 51-year-old woman who had recently come from sea level presented with cough and congestion at our emergency room in Frisco, Colorado (altitude, 9300 ft [3200 m]). She described a “swishing sound” in her breasts. She had had saline breast implants for 20 years and had noted this unusual sound on previous travel to high altitudes. She said that the sound in her breasts would disappear on her return to sea level or resolve slowly during a prolonged stay at high altitude. A chest film revealed crescent-shaped air-fluid levels in both implants (Figure 1). Trapped air in . . .
Glucose Counterregulation and Waning of Insulin in the Somogyi Phenomenon (Posthypoglycemic Hyperglycemia)
Authors: Geremia B. Bolli, Irving S. Gottesman, Peter J. Campbell, Morey W. Haymond, Philip E. Cryer, John E. Gerich
Journal: New England Journal of Medicine (1984)

To determine the roles of glucose counterregulation and the waning of insulin action in the development of posthypoglycemic hyperglycemia (the Somogyi phenomenon), we studied changes in plasma glucose and glucose turnover in five patients with insulin-dependent diabetes mellitus (IDDM) after subcutaneous injection of insulin under conditions in which hypoglycemic glucose counterregulation and the waning of insulin action were allowed to occur or were prevented. In control experiments, in which both glucose counterregulation and insulin waning were allowed to occur, plasma glucose levels decreased from 94 +/- 3 to 47 +/- 7 mg per deciliter and then increased to 289 +/- 20 mg per deciliter at 12 hours because of a marked increase in glucose production. When the waning of insulin action was prevented by insulin infusion, glucose production increased less (P less than 0.01), but marked rebound hyperglycemia still occurred (188 +/- 26 mg per deciliter at 12 hours). When both insulin waning and glucose counterregulation were prevented by infusion of both glucose and insulin, glucose production did not increase, and rebound hyperglycemia did not occur. We conclude that hypoglycemia can cause rebound hyperglycemia in the absence of insulin waning in patients with IDDM, and that this results primarily from an excessive increase in glucose production due to activation of glucose counterregulatory systems.
Viremia in Infection Due to Echo Virus Type 9
Authors: I. Yoshioka, D. M. Horstmann
Journal: New England Journal of Medicine (1960)

VIREMIA during the course of infections with ECHO viruses has been reported in only a few cases. Neva and Zuffante1 demonstrated virus in 1 of 10 blood specimens collected two to five days after onset of Boston exanthem disease (ECHO virus Type 16), and Sabin and Wigand2 have reported isolation of ECHO virus Type 9 from the blood of 2 patients, 1 thirty-six hours before, and the other within twenty-four hours after the appearance of the first sign of illness. The latter authors failed to find ECHO virus Type 9 in 22 blood specimens collected two to five days after . . .
Influence of Corticosteroids on the Results of Surgical Treatment for Ulcerative Colitis
Authors: K. N. Jalan, R. J. Prescott, A. N. Smith, W. Sircus, J. P. A. McManus, W. P. Small, C. W. A. Falconer
Journal: New England Journal of Medicine (1970)

The influence of treatment with corticosteroids on the mortality and morbidity of 140 patients undergoing surgical treatment for ulcerative colitis was examined in a retrospective study. After separation of these patients according to the severity of their disease, no difference in operative result, complications, duration of postoperative hospital stay, healing of the perineal wound and status of health could be found between patients treated and those not treated with steroids. Poorer results in these respects were found with the greater severity of colitis.
Prevalence of Parkinsonian Signs and Associated Mortality in a Community Population of Older People
Authors: David A. Bennett, Laurel A. Beckett, Anne M. Murray, Kathleen M. Shannon, Christopher G. Goetz, David M. Pilgrim, Denis A. Evans
Journal: New England Journal of Medicine (1996)

Older people frequently have signs of parkinsonism, but information about the prevalence of parkinsonism and mortality among those with the condition in the community is limited.
Shock and Low-Tension Glaucoma
Authors: Bernard Schwartz
Journal: New England Journal of Medicine (1973)

IN this issue of the Journal, Drance, Morgan and Sweeney call attention to the fact that shock is a feature of the past medical history in an appreciable number of patients with low-tension glaucoma. Furthermore, they have noted that few of these patients with a history of shock show progression of loss of visual field.It has long been recognized that loss of visual field and cupping and pallor of the optic disk can occur without increased ocular pressure. To explain the phenomenon of low-tension glaucoma, it has been postulated that development of optic-nerve atrophy is dependent on the . . .
Review: In older persons at vascular risk, statins do not prevent dementia or cognitive decline at 3.5 to 5 years
Authors: Eric B. Larson
Journal: Annals of Internal Medicine (2016)

ACP Journal Club19 April 2016Review: In older persons at vascular risk, statins do not prevent dementia or cognitive decline at 3.5 to 5 yearsEric B. Larson, MD, MPHEric B. Larson, MD, MPHGroup Health Research Institute, Seattle, Washington, USA (E.B.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2016-164-8-042 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationMcGuinness B, Craig D, Bullock R, Passmore P. Statins for the prevention of dementia. Cochrane Database Syst Rev. 2016;1:CD003160. https://pubmed.ncbi.nlm.nih.gov/26727124Clinical Impact RatingsGIM/FP/GP: Endocrinology: Neurology: References1 Li G, Larson EB, Sonnen JA, et al. Statin therapy is associated with reduced neuropathologic changes of Alzheimer disease. Neurology. 2007;69:878-85. [PMID: 17724290] Google Scholar2 Li G, Shofer JB, Rhew IC, et al. Age-varying association between statin use and incident Alzheimer's disease. J Am Geriatr Soc. 2010;58:1311-7. [PMID: 20533968] Google Scholar3 Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385:2255-63. [PMID: 25771249] Google Scholar Author, Article, and Disclosure InformationAffiliations: Group Health Research Institute, Seattle, Washington, USA (E.B.L.)This article was published at Annals.org on 5 April 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 19 April 2016Volume 164, Issue 8Page: JC42KeywordsAdverse eventsAlzheimer diseaseBrainCognitionDementiaPopulation statisticsRelative riskStatinsVascular diseases ePublished: 19 April 2016 Issue Published: 19 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...