tbuckley/cabot-search huggingface dataset:
Endoscopic Laser Third Ventriculostomy
Authors: F A Wood
Journal: New England Journal of Medicine (1993)

Figure 1. Endoscopic Laser Third Ventriculostomy. A 37-year-old woman was admitted to the hospital because she had had headaches for two years. A neurologic examination was remarkable for the absence of retinal venous pulsations. Magnetic resonance imaging of the brain (Panel A) showed noncommunicating hydrocephalus due to stenosis of the caudal aqueduct of Sylvius (open arrow), with enlargement of the third ventricle and attenuation of its floor (solid arrow). Endoscopic laser third ventriculostomy (Panel B) was performed in an effort to control hydrocephalus without the use of a ventricular shunt. The right lateral ventricle was cannulated through a coronal burr . . .
Phase II trial of sorafenib in patients with advanced thyroid cancer.
Authors: S. M. Keefe, A. B. Troxel, S. Rhee, K. Puttaswamy, P. J. O'Dwyer, L. A. Loevner, S. J. Mandel, M. S. Brose
Journal: Journal of Clinical Oncology (2011)

5562 Background: Sorafenib is a multikinase inhibitor that targets VEGFR, PDGFR, and Raf. We report the results of UPCC 03305, our completed phase II trial of sorafenib for advanced thyroid carcinoma. Median progression-free and overall survival, response rates and genotyping data are included. Methods: 55 Patients with progressing advanced, iodine-refractory differentiated or poorly differentiated thyroid cancer (DTC/PD), and medullary and anaplastic thyroid carcinoma (MTC and ATC) were eligible. Patients were treated with sorafenib 400 mg BID and evaluated with imaging every two to three months per protocol. The primary outcome was progression-free survival (PFS) per RECIST. Secondary endpoints included overall survival (OS), response rate (RR), toxicity, and tumor cell genotype. Mutations in cancer cells were identified using a customized Sequenom panel containing 197 mutations known to occur in thyroid cancer including BRAF, RAS, MET, RET, and PIK3CA. Results: The study completed enrollment in 8/2009, and was closed in 2/2011. 47 (85%) patients had DTC/PD, 5 (9%) patients had ATC, and 3 (6%) patients had MTC. Overall median PFS was 93.6 wks (95% CI, 62.9-101.9), and median OS was 140.6 wks (95% CI, 79.3-204.7). For the 47 DTC/PD patients, PFS was 96 wks (95% CI, 75.1-135.4), and OS was 140.9 wks (95% CI, 93.9-). 18 (38%) DTC/PD patients achieved a partial response (PR), and 22 (47%) had stable disease (SD) for a clinical benefit rate (PR + SD) of 85%. Tissues from 31 (66%) DTC/PD patients were found to contain at least 1 mutation, including BRAF - 21 pts (45%), RAS - 9 (19%), RET - 5 (11%), and PIK3CA - 4 (9%). Tissue from 8 (17%) DTC/PD and 3 (60%) ATC patients harbored multiple mutations. Conclusions: Our data demonstrate that sorafenib has significant anti-tumor activity in patients with advanced differentiated thyroid cancer. DTC/PD patients treated with sorafenib experience a long progression-free survival, and overall survival compares favorably to historic controls. Mutations were common in thyroid tumor specimens. Our study is the first to report overall survival for patients treated with sorafenib and to fully document the results of a comprehensive mutational analysis of patients enrolled in a thyroid cancer clinical trial.
Sarcoidosis and breast carcinoma: Three case reports and a review
Authors: W. Chen, R. A. Miller, K. A. Hebbe, G. K. Guron
Journal: Journal of Clinical Oncology (2004)

867 Background: Sarcoidosis and breast carcinoma are two distinct diseases that affect women. Both diseases can present with pulmonary nodules that are clinically indistinguishable. Coexistence of sarcoidosis and breast carcinoma has been described in few case reports after carefully ruling out sarcoid-like granulomatous reacton which is well-recognized in association with malignant tumors. The sarcoidosis patients develop breast cancer at the expected frequency, although literature suggests an increased incidence of testucular cancers and lymphomas in patients of systemic sarcoidosis. Results: We report three cases of breast cancers with pulmonary nodules. One had systemic sarcoidosis preceding the diagnosis of breast cancer, one had coexisting breast cancer and sarcoidosis, and the third patient had a sarcoid-like granulomatous reaction. The histology of pulmonary nodules in all three cases was confirmed to be non-malignant. Conclusions: In order to establish an accurate staging in patients with breast cancer and sarcoidosis, it is crucial to obtain tissue biopsy of suspicious pulmonary lesions. No significant financial relationships to disclose.
QOL-03OVERALL SURVIVAL AND HEALTH-RELATED QUALITY OF LIFE IN RECURRENT GLIOBLASTOMA PATIENTS RECEIVING INTRA-ARTERIAL CARBOPLATIN AFTER STANDARD CARE
Authors: Nilanjana Banerji, Meghan Hultman, Anna Kistner, Patricia Bruns, Katheryn Gilliland, Amy Schrecengost, John Trusheim
Journal: Neuro-Oncology (2015)

INTRODUCTION: Prognosis for glioblastoma (GBM) remains dire with a reported median survival of 14.6 months. Various aggressive treatment regimens have been pursued, in certain instances with a negative impact on Heath-Related Quality of Life (HR-QOL), with modest survival benefits. In this prospective study, we describe our experience in patient reported HR-QOL and survival benefit of an intra-arterial (IA) carboplatin-based treatment for recurrent GBM in combination with other cytotoxic agents. METHODS: Adult patients with recurrent GBM treated with 400 mg/m2 IA carboplatin every 4 weeks were enrolled in this study. Additionally, patients received (a)10 mg/kg bevacizumab every 2 weeks or (b) 660 mg/m2 cyclophosphamide and 400 mg/m2 etoposide every 4 weeks. HR-QOL was measured specific time-points with EORTC QLQ-30 & BN-20 questionnaires. HR-QOL scores of 7 selected domains expected to be most affected in GBM patients were studied. Patients were followed for treatment-related adverse events and overall survival. RESULTS: The study cohort comprised of 24 patients with a median age of 49.5 years. The most prevalent neurological complications reported were headaches (n = 10) and focal seizures (n = 5). A majority of the patients (n = 14) reported nausea and fatigue. Groin hematoma at catheter insertion site was noted in 4 patients and visual deficit in 5 patients. Grade 4 thrombocytopenia was observed in 4 patients and 3 patients had strokes. Longitudinal global-QOL scores were maintained or improved in a majority of patients, prior to disease progression. For this cohort, median overall survival was 25 months (range, 16-30) with 6 surviving patients at the end of the follow-up period. CONCLUSION: IA chemotherapy with carboplatin is a relatively safe and well tolerated treatment in recurrent GBM demonstrating encouraging outcomes in terms of overall survival in a selected group of patients. In addition, there were no significant unfavorable effects on HRQOL scores noted in the 7 preselected domains.
Cultivation of the Bacillus of Whipple's Disease
Authors: Didier Raoult, Marie L. Birg, Bernard La Scola, Pierre E. Fournier, Maryse Enea, Hubert Lepidi, Veronique Roux, Jean-Charles Piette, François Vandenesch, Denis Vital-Durand, Tom J. Marrie
Journal: New England Journal of Medicine (2000)

Whipple's disease is a systemic bacterial infection, but to date no isolate of the bacterium has been established in subculture, and no strain of this bacterium has been available for study.Using specimens from the aortic [corrected] valve of a patient with endocarditis due to Whipple's disease, we isolated and propagated a bacterium by inoculation in a human fibroblast cell line (HEL) with the use of a shell-vial assay. We tested serum samples from our patient, other patients with Whipple's disease, and control subjects for the presence of antibodies to this bacterium.The bacterium of Whipple's disease was grown successfully in HEL cells, and we established subcultures of the isolate. Indirect immunofluorescence assays showed that the patient's serum reacted specifically against the bacterium. Seven of 9 serum samples from patients with Whipple's disease had IgM antibody titers of 1:50 or more, as compared with 3 of 40 samples from the control subjects (P<0.001). Polyclonal antibodies against the bacterium were generated by inoculation of the microorganism into mice and were used to detect bacteria in the excised cardiac tissue from our patient on immunohistochemical analysis. The 16S ribosomal RNA gene of the cultured bacterium was identical to the sequence for Tropheryma whippelii identified previously in tissue samples from patients with Whipple's disease. The strain we have grown is available in the French National Collection.We cultivated the bacterium of Whipple's disease, detected specific antibodies in tissue from the source patient, and generated specific antibodies in mice to be used in the immunodetection of the microorganism in tissues. The development of a serologic test for Whipple's disease may now be possible.
Cervical-Disk Herniation
Authors: A Ansari, G Rockswold
Journal: New England Journal of Medicine (1998)

Figure 1. A 46-year-old woman with an unsteady gait, muscle weakness, and tingling and numbness in both hands was found to have brisk deep-tendon jerks and an extensor plantar response on the left. T2-weighted magnetic resonance imaging of the cervical spine (Panel A) showed multiple disk herniations from C3 to C7 (open arrows) that were most prominent at the junction of C4 and C5 (solid arrow). In contrast, no herniations were visible below C7. A cervical myelogram with the patient's head in extension (Panel B) showed a complete block of the flow of contrast medium at C4–C5 because . . .
Bevacizumab beyond disease progression after first-line treatment with bevacizumab plus chemotherapy inadvanced nonsquamous non–small cell lung cancer (WJOG 5910L): An open-label, randomized, phase II trial.
Authors: Masayuki Takeda, Takashi Seto, Hidetoshi Hayashi, Morihito Okada, Koichi Azuma, Shunichi Sugawara, Haruko Daga, Tomonori Hirashima, Kimio Yonesaka, Yoshiko Urata, Haruyasu Murakami, Haruhiro Saito, Akihito Kubo, Toshiyuki Sawa, Eiji Miyahara, Naoyuki Nogami, Takeharu Yamanaka, Yoichi Nakanishi, Kazuhiko Nakagawa, Isamu Okamoto
Journal: Journal of Clinical Oncology (2015)

8056 Background: Bevacizumab combined with platinum-based chemotherapy has been established as a standard treatment option in the first-line setting for advanced nonsquamous non–small cell lung cancer (NSCLC). However, there have been no evidence-based studies to support the use of bevacizumab beyond disease progression in NSCLC patients receiving such treatment. Methods: WJOG 5910L was designed as a multicenter, open-label, randomized, phase II trial of docetaxel (60 mg/m2) versus docetaxel (60 mg/m2) plus bevacizumab (15 mg/kg) every 3 weeks in patients with recurrent or metastatic nonsquamous NSCLC whose disease has progressed after first-line treatment with bevacizumab plus a platinum-based doublet. The primary end point was progression-free survival (PFS). Results: One hundred patients were randomly assigned to receive docetaxel (Doc, n = 50) or docetaxel plus bevacizumab (Doc+Bev n = 50). The median PFS was 4.4 months for the Doc+Bev group and 3.4 months for the Doc group, with a hazard ratio (HR) of 0.71 (95% confidence interval [CI], 0.47–1.09) and stratified log-rank P value of 0.058, which met the predefined value for statistical significance (P < 0.2). The median overall survival also tended to be longer in the Doc+Bev group (13.1 months; 95% CI, 10.6–21.4) than in the Doc group (11.0 months; 95% CI, 7.6–16.1), with a HR of 0.74 (95% CI, 0.46–1.19; stratified log-rank P = 0.11). Frequent adverse events of grade ≥ 3 included neutropenia (90% in the Doc+Bev group vs. 82% in the Doc group), leukopenia (64% vs. 52%, respectively), and febrile neutropenia (26% in both groups). There were two treatment-related deaths (one in each group). Conclusions: The addition of bevacizumab to docetaxel in the second-line setting shows promising efficacy with regard to PFS for patients with nonsquamous NSCLC whose disease has progressed while receiving bevacizumab plus a platinum-based doublet. The addition of bevacizumab was associated with a slight increase in toxicity, although the combination regimen was tolerable. Phase III studies of this combination are warranted. Clinical trial information: 000004715.
Case 13-1995
Authors: J. Van Dam, F.M. Graeme-Cook
Journal: New England Journal of Medicine (1995)

Presentation of CaseA 35-year-old woman was admitted to the hospital because of recurrent melena after treatment for a gastric ulcer with positive tests for Helicobacter pylori. The patient had been well until 21 months earlier, when abdominal pain developed. Two months later melena appeared, and she was admitted to another hospital, where endoscopic examination showed a bleeding gastric ulcer. Four transfusions of packed red cells were given, and she was treated with several histamine H2-receptor antagonists. At the time of discharge she was receiving ranitidine therapy. The following month a repeated endoscopic examination revealed a healed gastric . . .
OC-096 The delivery of high-risk emergency general surgery across the dr foster global comparators network: an examination of international outcomes
Authors: P Chana, N Casey, D Chang, M Joy, E Burns, S Arora, A Darzi, C Peden, O Faiz
Journal: Gut (2015)

<h3>Introduction</h3> The Dr Foster Global Comparators Network (GC) aims to improve quality in healthcare by promoting inter-hospital collaboration through sharing of outcome data and benchmarking standards. This study aims to utilise the GC database to establish whether geographical differences in outcomes exist following high-risk emergency general surgery (EGS) admissions, whilst determining if structural differences between healthcare systems can be linked to high-quality care. <h3>Method</h3> Discharge data for a cohort of EGS patients were collated using a pre-determined protocol. Hierarchical logistic regression analysis was performed to examine geographical and structural differences between GC hospitals. <h3>Results</h3> 69,490 patients, admitted to 23 centres across Australia, England and the USA with high-risk EGS diagnoses from 2007–2012 were identified. Outcomes including: seven/thirty-day mortality, readmission and length of stay were all superior in the USA. 19,082 patients (27%) underwent emergency abdominal surgery. No geographical differences in mortality were seen at seven-days in this subgroup. Thirty-day mortality (OR = 1.47) readmission (OR = 1.42) and length of stay (OR = 1.98) were all worse in the UK. Across this cohort, patient factors, (age, pathology and co-morbidity) were significantly associated with worse outcome as were structural factors including: low ITU bed ratios, high unit volume and inter-hospital transfers. Having dedicated EGS teams cleared of elective commitments with formalised handover of patients was associated with shorter length of stay. <h3>Conclusion</h3> Post-operative outcomes were similar at seven but not at thirty-days. This may be attributable to better infrastructure and resource allocation towards EGS in the US. The costs associated with this healthcare gain were not measured. <h3>Disclosure of interest</h3> None Declared.
Who comes to a voluntary depression screening program?
Authors: K M Magruder, G S Norquist, M B Feil, B Kopans, D Jacobs
Journal: American Journal of Psychiatry (1995)

The purpose of this study was to describe who comes to a voluntary depression screening program by analyzing findings from the 1992 National Depression Screening Day.Survey results from 5,367 adult volunteers at 345 facilities were analyzed. The authors examined the prevalence of depression detected at the screening test and sociodemographic characteristics and treatment history of the respondents. They also estimated the percentage of these individuals who would actually have a diagnosis of major depression (positive predictive value). The main assessment measure was the Zung Self-Rating Depression Scale.Of all participants, 76.6% (N = 4,109) had at least minimal depressive symptoms (score of at least 50 on the Zung depression scale), 53.3% (N = 2,859) had at least moderate symptoms (score of at least 60), and 22.6% (N = 1,214) had severe symptoms (score of at least 70). Few of the depressed respondents were currently in treatment for a mental health problem. The positive predictive value of a screening test diagnosis of depression was between 92.5% and 95.5% when a cutoff score of 60 was used to indicate depression and between 88.7% and 92.3% when a cutoff score of 50 was used.Voluntary screening tests, as exemplified by results from the National Depression Screening Day, provide a good opportunity for identifying previously unidentified and untreated individuals with depression.
Pediatric salivary gland neoplasms: The M. D. Anderson Cancer Center experience
Authors: W. W. Huh, C. Bosworth, A. C. Hessel, A. Mahajan, D. P. Hughes, C. E. Herzog
Journal: Journal of Clinical Oncology (2007)

20006 Background: Epithelial salivary gland neoplasms (ESGN) are uncommon tumors that mainly occur in adults, only 5 percent of ESGNs occur in children. Data regarding differences in clinical presentation and biologic behavior of these tumors between adult and pediatric patients remain unclear. There is less data concerning the role of radiation therapy in the treatment of ESGNs in pediatric patients. Methods: Retrospective review of medical records of patients presenting under age 18 years from January 1988 to August 2006. Results: 45 patients were evaluable. 26 patients were female. Median age at diagnosis was 14.7 years. Mucoepidermoid carcinoma (MEC) was seen in 22 cases (49%), acinic cell carcinoma 10 cases (22%), adenocystic carcinoma (ACC) 8 cases, and pleomorphic adenoma (PA) 5 cases. The parotid area was the most common involved site (25/45; 56%) with MEC and acinic cell noted in 80% of parotid cases. 76% of MEC cases (16/21) were grade 2 or 3 tumors. Initial complete resection was achieved in 20 ESGN cases, while the remaining cases required re-excision or adjuvant therapy. Thirteen patients received postoperative radiation. Median age was 15.8 years. Radiation therapy was used in 6 ACC cases, 4 MEC and 3 adenoid cystic. Primary site and first echelon nodes dose range was 54–64 Gy, and supraclavicular dose was 50 Gy in those in whom regional nodes were treated. Positive margin status and local invasion (perineural, lymphatic, or nodal) were the most common indications. Mean follow-up for 35 patients was 60.3 months (2–175 months). Nine patients were lost to follow- up, and one patient received therapy at another institution. Two patients died from progressive disease, and both had received radiation therapy. Conclusions: MEC is the most common ESGN in pediatrics, and the parotid is the most common involved site. Complete surgical resection remains the treatment of choice. Radiation therapy may be used as adjuvant therapy, but more study is required. No significant financial relationships to disclose.
Annals Graphic Medicine - Please Don't Use Patient Names
Authors: Nathan Gray
Journal: Annals of Internal Medicine (2016)

Web Exclusives5 April 2016Annals Graphic Medicine - Please Don't Use Patient NamesFREENathan Gray, MDNathan Gray, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/G15-0020 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Download figure Download PowerPoint Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Disclosures: The author has disclosed no conflicts of interest. Form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=G15-0020.Author Information: Dr. Gray is a staff physician in palliative care with Duke University Health System and a clinical instructor in palliative care for Duke University School of Medicine. He is interested in access to palliative care for vulnerable patient populations, and he cartoons as a creative outlet.Corresponding Author: Nathan Gray, MD, Duke University Hospital, DUMC Box 2706, Durham, NC 27710; e-mail, [email protected].Author Contributions: Conception and design: N. Gray.Drafting of the article: N. Gray.Final approval of the article: N. Gray. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 5 April 2016Volume 164, Issue 7Page: W12KeywordsConflicts of interestDisclosureHealth careHealth information technologyPalliative carePatientsPopulation statistics ePublished: 5 April 2016 Issue Published: 5 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
IMPS-45IDH MUTANT GLIOMAS ESCAPE NATURAL KILLER CELL IMMUNE SURVEILLANCE THROUGH DOWNREGULATION OF NKG2D LIGANDS
Authors: Xiaoran Zhang, Aparna Rao, Christopher Deibert, Paola Sette, Jason Kim, Michael Lotze, Paola Grandi, Nduka Amankulor
Journal: Neuro-Oncology (2015)

Mutations in isocitrate dehydrogenase 1 and 2 are common in gliomas. 50-80% of WHO II/III gliomas possess IDH1/IDH2 mutation. Methylation-related transcriptional repression is a feature of IDH mutant (IDHmut) tumors. Epigenetic repression of natural killer (NK) cell ligands is a common mechanism of immune escape in cancer, but it is unknown if this occurs in gliomas. We compared IDHmut and IDHwt tumor expression (z-score) and methylation (mean methylation score) data from the TCGA low-grade glioma database, and found two NKG2D ligands (ULBP1, ULBP3) that were downregulated (-0.47, p = 0.02; -1.28, p < 0.01) and hypermethylated (-0.31, p < 0.01; -0.15, p < 0.01) in IDHmut tumors. We validated this finding by measuring ULBP1 and ULBP3 gene expression in cells derived from IDHwt and IDHmut patients and found both genes were repressed in IDHmut cells (-0.85 fold expression, p = 0.01; -0.57 fold expression, p = 0.01). To determine whether repression of NKG2D ligand expression resulted in escape from NK recognition and specific lysis, we these cells with NK cells. We observed significantly (p = 0.03) reduced specific lysis of IDHmut cell (3.62%) as compared to IDHwt cells (24.13%). To determine NK activation, we measured inflammatory cytokine release in co-cultures, no basal release were detected in either tumor or NK monocultures. IDHmut co-cultures has significantly reduced IFN-g (82.08 pg/mL vs 250.1 pg/mL, p = 0.02) and TNF-a (151.2 pg/mL vs 650.2 pg/mL, p < 0.01) release compared to IDHwt co-cultures. To validate that IDHmut immune escape is NKG2D dependent, we blocked NKG2D binding using an antibody. Addition of isotype antibody did not significantly reduce specific lysis in IDHwt co-culture (10.40% vs 10.20%, p = 0.94). Addition of NKG2D blocking antibody to IDHwt significantly reduced specific lysis below isotype (3.34% vs 10.40%, p < 0.01). In conclusion, we were able to demonstrate that IDH mutant gliomas are able to escape from NK immune surveillance through repression of NKG2D ligand expression.
Case 3-1993
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Mark S. Pasternack, Eugene J. Mark
Journal: New England Journal of Medicine (1993)

Presentation of CaseA 51-year-old woman was admitted to the hospital with diffuse aches and mediastinal lymphadenopathy.The patient was well until 15 months earlier, when she began to experience pain in the shoulders, right arm, and legs with the onset of cold weather. She was seen in a hospital in her native Ethiopia, where injections were administered and oral medications were prescribed, without improvement. Six months before admission sweats developed and continued; the patient was uncertain about the presence of fever. One month later she found that her myalgias and arthralgias interfered with her sleep and were accompanied by . . .