tbuckley/cabot-search huggingface dataset:
Malignant Carcinoid Syndrome Associated with Noncarcinoid Tumors
Authors: Charles G. Moertel, Oliver H. Beahrs, Lewis B. Woolner, Gertrude M. Tyce
Journal: New England Journal of Medicine (1965)

DURING the past decade the "malignant carcinid syndrome" has been a favored subject in the medical literature because of the dramatic nature of its acute and chronic clinical manifestations and of its as yet unresolved challenges to the physiologist and therapist. Still more fascinating are recent reports that the syndrome has been produced by noncarcinoid tumors. To date, 7 such unusual cases have been adequately documented and recorded1 2 3 4 5 6 7: in 3, the primary carcinoma had its origin in the pancreas1 2 3; in 3, the primary lesion was an oat-cell carcinoma of the lung; and in 1, it was a highly . . .
Bacitracin in Dermatology: Its Effectiveness in Topical Therapy
Authors: Edmund F. Finnerty
Journal: New England Journal of Medicine (1951)

THIS REPORT, covering a period of eight successive months, presents significant clinical data obtained after the application of bacitracin topical therapy in 83 cases, 75 of which represent a wide variety of the accessible pyodermas.A large percentage of these cases had been unresponsive to numerous other therapeutic routines and agents previously administered. Response, however, to either an ointment consisting of 500 units of bacitracin per gm. of petrolatum or to compresses with an optional concentration of 500 units of bacitracin per cc. was rapid and effective and led to no recurrence in an astonishing number of cases. Cures were . . .
Comparative genomics of Neisseria meningitidis strains: new targets for molecular diagnostics
Authors: S.M. Diene, C. Bertelli, T. Pillonel, N. Jacquier, A. Croxatto, K. Jaton, G. Greub
Journal: Clinical Microbiology and Infection (2016)

In 2010, Jaton et al. (False-negative PCR result due to gene polymorphism: the example of Neisseria meningitidis. J Clin Microbiol 2010;48:4590–2) reported an isolate of Neisseria meningitidis serogroup B that was not detected by the ctrA quantitative real-time PCR (qRT-PCR) used in our diagnostic laboratory. Sequence analysis of ctrA revealed several single nucleotide polymorphisms responsible for the negative qRT-PCR. Therefore, we sequenced the genome of this isolate and performed comparative genomics to propose new gene targets for the specific detection of N. meningitidis from clinical specimens. We identified 11 genes as specific to N. meningitidis genomes and common to at least 177 (97%) of the 183 genomes available. Among them, three genes (metA, tauE and shlA) were selected to develop new qRT-PCRs for the detection of N. meningitidis DNA. The three qRT-PCRs were highly sensitive and specific, and they exhibited a good reproducibility when tested on plasmidic positive controls and genomic DNA extracted from strains of N. meningitidis and other relevant bacterial species. The clinical sensitivity and specificity of metA and tauE qRT-PCRs were both 100% based on a testing of cerebrospinal fluid samples positive for N. meningitidis or other clinically relevant bacteria. Despite a 100% specificity, the sensitivity of the shlA qRT-PCR was only 70%. We thus recommend using the metA and/or tauE qRT-PCRs developed here. To prevent PCR failure in the presence of new polymorphic strains, the detection of dual targets by duplex qRT-PCR would be more accurate and suitable for the diagnosis of N. meningitidis from clinical specimens.
M27 Wheezes, coughs and splutters: how do paediatric trainees manage them?
Authors: M Ramphul, LJ Thanikkel, R Ross Russell
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> Wheezy pre-school children frequently present to paediatric departments. There is a wide variation in how paediatric trainees investigate and manage these children, which can be associated with unnecessary costs to the NHS. Our aim was to assess this diversity in management options initiated by paediatric trainees. <h3>Methods</h3> Web-based survey on how paediatric trainees approach scenarios of wheezy pre-school children. Trainees across the UK were asked to fill in a questionnaire consisting of four case scenarios involving wheezy children under the age of 5. <h3>Results</h3> 194 trainees responded to the survey. There was a good representation amongst different training grades across UK deaneries. In the bronchiolitis scenario, 13% requested blood tests or a chest x-ray, whilst 27% of trainees stated they would not investigate further. Treatment options included oxygen, salbutamol, ipratropium, 0.9% saline drops or nebulisers, 3% saline nebulisers or not doing anything at all. It appears that trainees are less confident at differentiating episodic viral wheeze from multi-trigger wheeze. 49% of trainees stated they would be give prednisolone to children with a first episode of viral wheeze. Trainees used different cut-off levels of oxygen saturations to initiate oxygen therapy. 69% of trainees felt that recurrent episodes of multi-trigger wheeze warranted regular inhaled beclomethasone, whilst 15% felt that montelukast was more appropriate. The need for an asthma action plan and asthma clinic follow up was raised by 85% and 76% of trainees respectively. We sought to assess the knowledge of trainees on predisposing factors for early-onset multi-trigger wheeze. The two most predictive risk factors are a personal history of eczema, and a family history of asthma in mum or dad, which were identified by 78% and 59% of trainees respectively. <h3>Conclusions</h3> There is a marked variation in how paediatric trainees deal with childhood wheeze. Rationalising investigations and therapeutic measures in bronchiolitis is associated with cost savings. Commonly used steroids are well known to have side-effects and should only be used where indicated. Local and national guidelines on childhood wheeze should aim to standardise practice across the UK for paediatric trainees, and reduce the financial burden on the NHS.
Intra-amniotic lipopolysaccharide leads to fetal cardiac dysfunction A mouse model for fetal inflammatory response
Authors: S Rounioja
Journal: Cardiovascular Research (2003)

Intrauterine infection is associated with increased lipopolysaccharide (LPS) and proinflammatory cytokines in amniotic fluid. We hypothesized that intra-amniotic LPS launches a fetal inflammatory response leading to cardiac dysfunction.A mouse model was established. At 15-16 days of gestation, 52 fetuses of nine dams received LPS and 46 fetuses of nine dams vehicle intra-amniotically. Five dams underwent a sham operation. Echocardiography was performed before and 6 h after the injection to obtain inflow and outflow blood velocity waveforms. Outflow mean velocity (V(mean)) and the proportions of isovolumetric relaxation (IRT%) and contraction (ICT%) times of the cardiac cycle were calculated. Pulsatility indices (PI) were calculated from the umbilical and intracranial arteries and the descending aorta. Pulsatility indices for veins (PIV) were obtained from ductus venosus. Toll-like receptor-4 (TLR4) and several other inflammatory mediators were determined using ELISA, immunohistochemistry, or ribonuclease protection assay.In the LPS group, outflow V(mean) was significantly lower, and ICT% and IRT% longer than in the other groups. LPS increased PIs, except in the intracranial arteries, which showed a decrease in PIs. In ductus venosus, PIVs were increased after LPS. LPS increased interleukin (IL)-6 in amniotic fluid and induced the expression of proinflammatory cytokines in placenta and fetal membranes, but not in lung. In fetal myocardium, TLR4 was constitutional. LPS induced the expression of IL-1beta and tumor necrosis factor (TNF)-alpha mRNA in myocardium, whereas inducible nitric oxide synthase (NOS2) protein and nitrotyrosine remained undetectable.As a response to endotoxin in amniotic fluid, fetal myocardium acutely generates cytokines and severe fetal cardiovascular compromise develops. These two may be linked through a mechanism that does not include NO.
Infectious Gastroenteritis in Bone-Marrow-Transplant Recipients
Authors: Robert H. Yolken, Catherine A. Bishop, Timothy R. Townsend, Elizabeth A. Bolyard, John Bartlett, George W. Santos, Rein Saral
Journal: New England Journal of Medicine (1982)

We prospectively evaluated infections with several gastrointestinal pathogens in patients undergoing bone-marrow transplantation, in an attempt to correlate infection with morbidity and mortality. Thirty-one of 78 patients (40 per cent) were infected with one or more of the following enteric pathogens during the study: adenovirus (12 infections), rotavirus (nine), coxsackievirus (four), or Clostridium difficile (12). Several patients were infected with more than one pathogen. Infection correlated with the occurrence of diarrhea and abdominal cramps. The mortality rate among the infected patients was 55 per cent--significantly higher than the rate (13 per cent) among the noninfected patients (P less than 0.001). This study indicates that enteric pathogens that often cause mild diarrhea in normal populations can cause serious infections in marrow-transplant recipients. Measures aimed at preventing or treating such infections might reduce the morbidity and mortality associated with marrow transplantation.
Impact of neoadjuvant chemoradiotherapy on functional outcomes for patients with uT3 rectal cancer undergoing restorative resection
Authors: L. Lian, R. Kiran, I. Lavery
Journal: Journal of Clinical Oncology (2008)

4098 Background: Our aim is to determine whether neoadjuvant chemoradiation adversely affects functional outcomes for patients with ultrasound stage T3 (uT3) middle and lower third rectal cancer undergoing surgery. Methods: All patients with uT3 middle and lower third rectal cancers who underwent surgery from 1986–2007 were identified from a prospectively maintained cancer database. Prospectively accrued functional outcomes for patients who had neoadjuvant therapy (Group A) were compared with those for patients who did not (Group B). Quality of life (QOL) was measured using SF 36. Results: There were 297 patients in Group A and 153 in group B. Complete response rate was 16.6%. Group A had more males(76 vs 65%, p=0.02) and were younger (59±11.9 vs 66.5 ±12.2 yrs, p<0.001). Group A also had lower tumor distance from anal verge(5.5±2.4 vs 6.2±2.3 cm, p=0.004), greater use of hand-sewn anastomoses (29.9% versus 12.0%, p=0.002) and proximal diversion(38.2% vs19.2%, p<0.001). Tumor differentiation was similar in both groups. Group B had larger tumors (4.5±1.8 vs 2.6±1.7, p=<0.001) with more involved lymph nodes (1, 0–52; 0, 0–22, p=<0.001). Anastomotic leak rate was similar(Grp A: 4 vs 6.8%, p=0.27). Group A had lower local recurrence (12.6% vs. 24.4%, p<0.001) and greater disease free survival rate(75.7% vs. 51.9%, p<0.001). Long term functional outcome were measured by number of day and night time bowel movements, control of solid, liquid and gas and pad use. After adjusting for age, gender, complication and reservoir use, at the time of their most recent evaluation, functional outcomes for patients undergoing restorative resection (Grp A 67.8%, Grp B53.5%) were comparable between groups. Despite the greater proportion of patients with a permanent stoma in Group B, QOL was similar between groups. Conclusion: For uT3 cancer of the mid and lower rectum, neoadjuvant therapy is associated with better oncologic outcomes. With careful surgical technique and judicious use of a reservoir, chemoradiation prior to surgery does not appear to adversely influence functional outcomes. The presence of a permanent stoma does not seem to influence QOL. No significant financial relationships to disclose.
Nature and Etiology of the Poland Anomaly
Authors: Timothy J. David
Journal: New England Journal of Medicine (1972)

The Poland anomaly consists of congenital unilateral absence of the sternocostal part of the pectoralis major muscle, with ipsilateral syndactyly. Dermatoglyphic evidence confirms the unilaterality of the Poland anomaly. Of 10 patients with this anomaly five were adopted. The mothers of the other five had probably tried to obtain an abortion in early pregnancy, with four of these five living in the same city suburb. Thus, at least in these cases, there is a prevalence of potentially noxious social and physical ante-natal influence.
Long-Term Pathological Follow-up of Cerebral Arteriovenous Malformations Treated by Embolization with Bucrylate
Authors: Harry V. Vinters, Mark J. Lundie, John C.E. Kaufmann
Journal: New England Journal of Medicine (1986)

We examined 17 intracranial arteriovenous malformations that were resected after treatment by embolization using bucrylate (isobutyl-2-cyanoacrylate). In nine specimens removed 5 days to 16 months after embolization therapy, a series of pathologic changes was seen, including patchy mural angionecrosis (adjacent to bucrylate fragments) up to six weeks after embolization, the presence of bucrylate in vessel walls and fibromuscular intimal cushions, and the occurrence (after several months) of entirely extravascular bucrylate. Occasional parts of recanalized vascular malformations were identified. Bucrylate was present within arteriovenous malformations as late as 16 months after embolization, although the amount appeared to be diminished. These findings suggest a specific sequence of events in the interaction between bucrylate and mural components within the malformations and may explain some important complications of embolization therapy (e.g., delayed hemorrhage after embolization). (N Engl J Med 1986; 314:477–83.)
Case 11-2006
Authors: Carolyn N. Krasner, Maria Roche, Neil S. Horowitz, Jeffrey G. Supko, Susanna I. Lee, Esther Oliva
Journal: New England Journal of Medicine (2006)

A 54-year-old woman was seen in the gynecologic oncology clinic because of a pelvic mass that was associated with urinary frequency and urgency, pelvic pain, fever, and weight loss. A large, central pelvic mass was noted on examination, and imaging studies showed a complex solid and cystic mass with ascites. The evaluation and management of malignant tumors of the ovaries and fallopian tubes are discussed by a multidisciplinary team.
Peptic Ulcer among Soldiers in the Mediterranean Theater of Operations
Authors: James A. Halsted, Henry Weinberg
Journal: New England Journal of Medicine (1946)

AT THE beginning of the war, it was thought that peptic ulcer would present a serious military medical problem. This has evidently been the case in Army hospitals and induction centers in the United States. Owing to rejections at induction and discharge from the service of patients in Army hospitals in the Zone of the Interior, the disease was not seen in the Mediterranean theater of operations with the frequency expected, particularly after the first year. At the Sixth General Hospital in North Africa, however, to which a considerable proportion of patients were sent for evacuation to the United States, . . .
Prognostic value of three microRNA expression profiles in early-stage squamous cell lung cancer (SqCLC).
Authors: M. T. Skrzypski, A. Szymanowska, E. Jassem, P. Czapiewski, R. Rzepko, W. Biernat, R. Pawowski, W. Rzyman, J. Jassem
Journal: Journal of Clinical Oncology (2010)

7028 Background: About 50% of NSCLC patients (pts) will develop distant metastases following pulmonary resection. Currently, apart from clinical stage at diagnosis, there are no reliable clinical factors to select high risk pts for adjuvant chemotherapy. We previously demonstrated high prognostic value of selected microRNAs in frozen tissues of early stage SqCLC (Skrzypski et al, J Clin Oncol 27; 15s: 2009). In the present study we evaluated the feasibility and prognostic relevance of this assay in formalin fixed paraffin embedded (FFPE) samples. Methods: FFPE tumor tissue was obtained from 72 stage I-II SqCLC pts. Of those, 30 pts developed distant metastases and 42 had no relapse after a median follow-up of 5.6 years (range, 3.8-7.1 years). MicroRNA was isolated from paraffin blocks after macrodissection of tumor tissue, and extracted with RecoverAll kit (Ambion). Expression of 5 microRNAs was analyzed by RT-PCR assays (Appliedbiosystems). Raw expression data were normalized vs. the expression of U6 RNA and calibrated by ΔΔCt method. After z-score transformation, the risk score was constructed based on the expression of 3 MiRs. Results: MicroRNA yield from tumor tissue was successful in 92% of cases. Expression of MiR 192* and MiR 10b was significantly related to the time to distant metastases (log-rank; p=0.001 and p=0.003, respectively), whereas MiR 532-3p was of borderline significance (p=0.08). The risk score based on the expression of MiRs 192*, 10b and 532-3p was significantly related to the time to distant metastases (log-rank; p=0.00006). With the risk score median as a cut-off value, the test sensitivity for distant relapse prediction was 80% at the specificity level of 72%. Conclusions: Prognostic test based on microRNA assessment in FFPE is feasible and robust. Three-miRNA expression profile: 192*, 10b and 532-3p is strongly related to the risk of distant metastases in operable SqCLC. The results are being validated. No significant financial relationships to disclose.
Pooled Analysis of the Prognostic and Predictive Value of Kras Mutation Status and Mutation Subtype in Patients with Non-Small Cell Lung Cancer (Nsclc) Treated with Egfr Tkis (E-Tki)
Authors: A. Zer, K. Ding, S. Lee, G. Goss, L. Seymour, P.M. Ellis, P.A. Bradbury, C. O'Callaghan, M. Tsao, F.A. Shepherd
Journal: Annals of Oncology (2014)
Loss of The Normal NF1 Allele from the Bone Marrow of Children with Type 1 Neurofibromatosis and Malignant Myeloid Disorders
Authors: Kevin M. Shannon, Peter O'Connell, George A. Martin, Dorothy Paderanga, Kristin Olson, Patricia Dinndorf, Frank McCormick
Journal: New England Journal of Medicine (1994)

Children with type 1 neurofibromatosis (NF-1) are at increased risk for malignant myeloid disorders. Analysis of the NF-1 gene (NF1) suggests that the function of its product, neurofibromin, is reduced in affected persons and that NF1 belongs to the tumor-suppressor class of recessive cancer genes. This model is consistent with evidence that neurofibromin accelerates the intrinsic guanosine triphosphate-hydrolyzing activity of the Ras family of regulatory proteins. Loss of constitutional heterozygosity has not been reported in the benign tumors associated with NF-1, however, and has only been detected in a few malignant neural-crest tumors and in some tumor-derived cell lines.
Changes in T-Lymphocyte Subpopulations after Antigenic Bronchial Provocation in Asthmatics
Authors: Adi A. Gerblich, Ann E. Campbell, Mark R. Schuyler
Journal: New England Journal of Medicine (1984)

To determine whether inhaled agents can alter T-cell subsets in the peripheral blood of patients with bronchial asthma, we tested six asymptomatic asthmatics who were sensitive to mixed grass (positive skin test) with mixed grass extract, methacholine, and an antigen to which they were not sensitized (negative skin test). Levels of OKT4 cells (helper T lymphocytes) were reduced in the peripheral blood immediately after the challenge with mixed grass extract, and remained low for at least 72 hours. Levels of la-positive (activated) T cells were increased 48 hours after the challenge. No changes were observed in any of these T-cell subpopulations after challenge with methacholine or after the inhalation of an equal amount of an antigen to which the subjects were not sensitized. These results suggest that the selective loss of circulating helper T cells and an increase in activated T cells after an asthmatic attack induced by antigenic inhalation may serve as an indicator of immune-mediated bronchoconstriction. (N Engl J Med 1984; 310:1349–52.)
Quinacrine in the Treatment of Refractory Petit-Mal Epilepsy
Authors: William A. Sibley, Howard J. Tucker, Clark T. Randt
Journal: New England Journal of Medicine (1962)

IN 1952 Méndez and Hartley1 reported the disappearance of petit-mal seizures in a seven-year-old boy receiving quinacrine (Atabrine) for a Giardia lamblia intestinal infestation; the petit-mal seizures unexpectedly ceased on the second day after institution of therapy. Since then, several reports from abroad have indicated that quinacrine was effective therapy in a number of children with petit-mal seizures.2 3 4 5 6 7 The appearance of a yellow discoloration of the skin and sclerae after several days of therapy has undoubtedly discouraged more widespread trial of quinacrine in this country. However, it should be emphasized that this cutaneous discoloration is reversible and constitutes an objection . . .
Harm reduction
Authors: Ann McNeill
Journal: BMJ (2004)

<h3>Objective</h3> To report outcomes on patients with multiple sclerosis (MS) and related disorders with coronavirus disease 2019 (COVID-19) illness. <h3>Methods</h3> From March 16 to April 30, 2020, patients with MS or related disorders at NYU Langone MS Comprehensive Care Center were identified with laboratory-confirmed or suspected COVID-19. The diagnosis was established using a standardized questionnaire or by review of in-patient hospital records. <h3>Results</h3> We identified 76 patients (55 with relapsing MS, of which 9 had pediatric onset; 17 with progressive MS; and 4 with related disorders). Thirty-seven underwent PCR testing and were confirmed positive. Of the entire group, 64 (84%) patients were on disease-modifying therapy (DMT) including anti-CD20 therapies (n = 34, 44.7%) and sphingosine-1-phosphate receptor modulators (n = 10, 13.5%). The most common COVID-19 symptoms were fever and cough, but 21.1% of patients had neurologic symptom recrudescence preceding or coinciding with the infection. A total of 18 (23.7%) were hospitalized; 8 (10.5%) had COVID-19 critical illness or related death. Features more common among those hospitalized or with critical illness or death were older age, presence of comorbidities, progressive disease, and a nonambulatory status. No DMT class was associated with an increased risk of hospitalization or fatal outcome. <h3>Conclusions</h3> Most patients with MS with COVID-19 do not require hospitalization despite being on DMTs. Factors associated with critical illness were similar to the general at-risk patient population. DMT use did not emerge as a predictor of poor COVID-19 outcome in this preliminary sample.
Case 18-1993
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Joop M. Grevelink, Andrew E. Rosenberg
Journal: New England Journal of Medicine (1993)

Presentation of CaseA 57-year-old man was admitted to the hospital because of reddish-purple lesions on the right lower extremity.The patient had been well until the age of 38 years, when he felt a mass in the right inguinal region. Two years later the mass increased slightly in size, and warmth and erythema developed about it, with a rise in the temperature to 39.9 °C. The patient was admitted to the hospital, where physical examination showed a mass, 12.7 by 10 cm, in the right inguinal region. Cephalexin was administered by vein, with prompt resolution of the fever, local . . .