tbuckley/cabot-search huggingface dataset:
Case 9-1997
Authors: Lee M. Kaplan, Fiona M. Graeme-Cook
Journal: New England Journal of Medicine (1997)

Presentation of CaseA 39-year-old woman was admitted to the hospital because of a gastric mass and pernicious anemia.She had had sporadic abdominal pain and chronic anxiety for many years. Two years before admission, the results of an upper gastrointestinal series were reported to be normal. The patient subsequently began to have more frequent episodes of pain, which were confined to the right upper quadrant. Ranitidine was added to her base-line medications of clonazepam and trazodone, without improvement.Eight and a half months before admission, a cholecystographic examination performed after the oral administration of contrast material was normal. An . . .
P162 CT follow up after surgery for lung cancer – should the availability of radio-surgery prompt a change in screening protocol to detect early intracerebral recurrence?
Authors: S Roberts, L Jones, C Exley
Journal: Thorax (2015)

<h3></h3> Although routinely performed, the optimal screening regimen for recurrent disease after curative surgery for lung cancer has yet to be agreed. Radio-surgery has improved prognosis for patients with limited intra-cerebral metastases,<sup>1</sup> however screening for intracerebral recurrence has little evidence base. Local protocol is to perform CT head/chest/abdomen pre surgery and CT chest/abdomen at 3, 12 and 24 months after surgery. We proposed that the addition of CT head to the post-surgical protocol would enable earlier detection of intra-cerebral recurrence, facilitating timely treatment. CT head was added to standard post surgical surveillance programme in February 2015. CT reports were reviewed prospectively and we report data to June 2015. For comparison, retrospective data for all patients currently enrolled in screening was also reviewed. All 222 CT scans for the 115 patients undergoing post-surgical surveillance were reviewed. 28 of these have been performed since our protocol changed to include CT head. In total, 22 patients (19%) had recurrent disease. 2 patients had isolated intracerebral recurrence. This represents 9% of all patients with recurrent disease and these patients would not be identified on previous screening protocol. This is in line with findings from previous work.<sup>2</sup> Four cases of symptomatic intra-cerebral recurrence were identified prior to protocol change. Only one of these patients was eligible for radio-surgery. Since protocol change, one case of asymptomatic isolated intra-cerebral recurrence has been detected through screening; this patient was thereafter treated with radio-surgery. Our results show that isolated intra-cerebral recurrence would be missed on the previous screening protocol. These preliminary results suggest that the addition of CT head in post operative surveillance enables earlier identification of these patients. The earlier detection of intracerebral recurrence as a result of screening may increase referrals for radio-surgery, with potential for improved survival. <h3>References</h3> 1 Andrews, <i>et al</i>. <i>Lancet</i> 2004;<b>363</b>:1665 2 Yokoi, <i>et al</i>. <i>Ann Thorac Surg</i>. 1996;<b>61</b>:546
Sildenafil in Primary Pulmonary Hypertension
Authors: Sanjay Prasad, James Wilkinson, Michael A. Gatzoulis
Journal: New England Journal of Medicine (2000)

To the Editor: A 21-year-old man presented with a three-year history of worsening dyspnea and a four-month history of being unable to walk more than 100 yards (90 m) without resting. Physical exami...
Management of the Circulatory, Inflammatory and Metabolic Complications of Mitral Valvulotomy
Authors: A. V. N. Goodyer, W. W. L. Glenn
Journal: New England Journal of Medicine (1957)

THE management of rheumatic heart disease in adult patients has been greatly advanced in recent years by the development of surgical methods for partial relief of the valvular stenoses that contribute so greatly to the symptoms of this disease. Mitral valvulotomy has won particularly wide acceptance and, in selected, uncomplicated cases, has attained a favorably low operative mortality (5 per cent). Nevertheless, various problems that may arise after this operation are of particular concern not only to those responsible for the immediate postoperative care of the patient but also to those who must continue to meet the problems of a . . .
Oral Candidiasis in High-Risk Patients as the Initial Manifestation of the Acquired Immunodeficiency Syndrome
Authors: Robert S. Klein, Carol A. Harris, Catherine Butkus Small, Bernice Moll, Martin Lesser, Gerald H. Friedland
Journal: New England Journal of Medicine (1984)

We studied the frequency with which unexplained oral candidiasis led to unequivocal acquired immunodeficiency syndrome (AIDS) in patients at risk. Twenty-two previously healthy adults with unexplained oral candidiasis, of whom the 19 tested had a reversed T4/T8 ratio and 20 had generalized lymphadenopathy, were compared with 20 similar patients with a reversed T4/T8 ratio and generalized lymphadenopathy who did not have oral candidiasis. All were intravenous-drug abusers, homosexual or bisexual men, or both. Thirteen of the 22 patients with oral candidiasis (59 per cent) acquired a major opportunistic infection or Kaposi's sarcoma at a median of three months (range, 1 to 23) as compared with none of 20 patients with generalized lymphadenopathy and immunodeficiency but without candidiasis who were followed for a median of 12 months (range, 5 to 21) (P less than 0.001). AIDS developed in 12 of 15 patients with candidiasis and T4/T8 ratios less than or equal to 0.51, as compared with none of four with ratios equal to or greater than 0.60 (P less than 0.01). We conclude that in patients at high risk for AIDS, the presence of unexplained oral candidiasis predicts the development of serious opportunistic infections more than 50 per cent of the time. Whether the remainder will have AIDS is not yet known.
Treatment of Pernicious Anemia by Oral Administration of Vitamin B<sub>12</sub>without Added Intrinsic Factor
Authors: Eugene A. Brody, Solomon Estren, Louis R. Wasserman, Mrs. Hazel Weill
Journal: New England Journal of Medicine (1959)

PERNICIOUS anemia is generally considered to be a heredofamilial disease in which a lack of intrinsic factor is associated with atrophy of the gastric mucosa. As the disease develops, intrinsicfactor production decreases and then ends; vitamin B12 in physiologic amounts then cannot be transported across the intestinal mucosa, and the tissue stores of the vitamin are gradually depleted and eventually exhausted. Serum and urinary B12 levels approach zero and may be interpreted as an indication of the markedly depleted tissue stores. Nucleoprotein synthesis, especially that in the hematopoietic and nervous systems, is altered, and the clinical picture of . . .
Case 38-1970
Authors: Richard C. Cabot, Benjamin Castleman, Betty U. McNeely, Irving P. Ackerman, Benjamin Castleman
Journal: New England Journal of Medicine (1970)

Presentation of CaseA 68-year-old woman was admitted to the hospital because of renal failure.For more than 40 years she had had hypertension, and in recent years she had taken chlorthalidone, digitoxin and furosemide. One year before admission pruritus vulvae occurred. Six months later there was the onset of chronic fatigue. During the six weeks before entry she was increasingly less active and experienced pain in the left foot, which was ascribed to long standing arthritis; propoxyphene was prescribed. Three weeks before admission she remained in bed all day, feeling vaguely unwell. During the next few days she complained . . .
23P Prolonged pemetrexed pretreatment increases efficiency of ionizing radiation combination therapy and correlates with the persistence of treatment-induced DNA damage in lung cancer cells
Authors: T.M. Marti, P. Dorn, C.C. Tièche, R.-W. Peng, L. Froment, R.A. Schmid
Journal: Journal of Thoracic Oncology (2016)
Case 34-1999
Authors: John R. Saltzman, Carolyn C. Compton
Journal: New England Journal of Medicine (1999)

Presentation of CaseA 37-year-old woman was referred to the gastrointestinal unit because of abnormal results of liver-function tests.Eleven months before referral and one month after an uneventful pregnancy during which she took no medications, the patient underwent an examination to qualify for life insurance. The results of several laboratory tests were abnormal (Table 1 and Table 2). A urinalysis and a test for antibodies to the human immunodeficiency virus (HIV) were negative. At about the same time, abdominal cramps and diarrhea developed. Stool tests for ova and parasites and for occult blood were negative. A test for Clostridium difficile toxin . . .
Comparing CT colonography and flexible sigmoidoscopy: a randomised trial within a population-based screening programme
Authors: Daniele Regge, Gabriella Iussich, Nereo Segnan, Loredana Correale, Cesare Hassan, Arrigo Arrigoni, Roberto Asnaghi, Piero Bestagini, Gianmarco Bulighin, Maria Carla Cassinis, Andrea Ederle, Andrea Ferraris, Giovanni Galatola, Teresa Gallo, Giovanni Gandini, Licia Garretti, Maria Cristina Martina, Daniela Molinar, Stefania Montemezzi, Lia Morra, Massimiliano Motton, Pietro Occhipinti, Lucia Pinali, Gian Alberto Soardi, Carlo Senore
Journal: Gut (2016)

<h3>Importance and aims</h3> The role of CT colonography (CTC) as a colorectal cancer (CRC) screening test is uncertain. The aim of our trial was to compare participation and detection rate (DR) with sigmoidoscopy (flexible sigmoidoscopy (FS)) and CTC in a screening setting. <h3>Design setting and participants</h3> We conducted two randomised clinical trials (RCTs). (1) Participation RCT: individuals, aged 58 years, living in Turin (Italy), were randomly assigned to be invited to FS or CTC screening; (2) detection RCT: residents in northern Italy, aged 58–60, giving their consent to recruitment, were randomly allocated to CTC or FS. Polyps ≥6 mm at CTC, or 'high-risk' distal lesions at FS, were referred for colonoscopy (TC). <h3>Main outcome measures</h3> Participation rate (proportion of invitees examined); DR of advanced adenomas or CRC (advanced neoplasia (AN)). <h3>Results</h3> Participation was 30.4% (298/980) for CTC and 27.4% (267/976) for FS (relative risk (RR) 1.1; 95% CI 0.98 to 1.29). Among men, participation was higher with CTC than with FS (34.1% vs 26.5%, p=0.011). In the detection RCT, 2673 subjects had FS and 2595 had CTC: the AN DR was 4.8% (127/2673, including 9 CRCs) with FS and 5.1% (133/2595, including 10 CRCs) with CTC (RR 1.08; 95% CI 0.85 to 1.37). Distal AN DR was 3.9% (109/2673) with FS and 2.9% (76/2595) with CTC (RR 0.72; 95% CI 0.54 to 0.96); proximal AN DR was 1.2% (34/2595) for FS vs 2.7% (69/2595) for CTC (RR 2.06; 95% CI 1.37 to 3.10). <h3>Conclusions and relevance</h3> Participation and DR for FS and CTC were comparable. AN DR was twice as high in the proximal colon and lower in the distal colon with CTC than with FS. Men were more likely to participate in CTC screening. <h3>Trial registration number</h3> NCT01739608; Pre-results.
Phonocardiographic Studies in Mitral Stenosis
Authors: Ernest Craige
Journal: New England Journal of Medicine (1957)

THE widespread employment of surgery for the relief of mitral stenosis has made it desirable to have some objective measure of the success of the operation. At times the patient's subjective observations after surgery have been more enthusiastic than the data obtained by precise methods appear to justify.1 Some of the most valuable information regarding changes in circulatory dynamics before and after fracture of the valve has been afforded by catheterization,2 as well as by direct puncture of the chambers of the left side of the heart at the time of surgery.3 These methods, however, are cumbersome. It would be . . .
Platelets and Thrombolytic Therapy
Authors: Barry S. Coller
Journal: New England Journal of Medicine (1990)

FIBRINOLYTIC therapy is a major advance in the treatment of occlusive vascular disease. Problems remain, however, including resistance to fibrinolytic therapy, delays in reperfusion, reocclusion after successful thrombolysis, and serious hemorrhage.1 2 3 Increasing evidence indicates that platelets have an important role in both delaying reperfusion and mediating reocclusion. In addition, preliminary data suggest that some thrombi resist lysis because they are rich in platelets and that platelet dysfunction contributes to the hemorrhagic diathesis associated with thrombolytic therapy. It is worthwhile, therefore, to review the complex interrelations between platelets and fibrinolysis, with emphasis on the therapeutic potential (and risks) of combining thrombolytic . . .
Case 86-1962
Authors: Daniel D. Federman, Winfield S. Morgan
Journal: New England Journal of Medicine (1962)

Presentation of CaseA thirty-one-year-old woman entered the hospital because of fever and malaise.Two years before admission enlargement of the left parotid gland was observed and diagnosed as possibly mumps. The swelling did not subside for several months, and the size of the gland never returned to normal, although the patient felt well. Sialograms (Fig. 1) showed moderate saccular ectasia of the peripheral ducts on the left side. Two months before admission the left parotid gland again became swollen, with associated malaise, fever and enlarged "glands" in the neck, and the patient complained of a dry mouth. At that . . .
Bronchodilator Reversibility Testing Selection Criteria and Interpretation in Allergy Office Settings
Authors: Rithik Binoy, Shruti Anant, Sudhir Sekhsaria, Naba A. Sharif
Journal: Journal of Allergy and Clinical Immunology (2016)

Bronchodilator reversibility testing can be useful as a diagnostic aid for asthma. ATS guidelines for reversibility are defined as FEV1 of 12% and 200 mL above baseline values. However, use of these criteria in allergy practices has not been studied. This study seeks to gather information about selection criteria and interpretation of bronchodilator reversibility tests in allergy practices. An electronic survey was sent to North American allergists belonging to the American Academy of Allergy, Asthma, and Immunology (AAAAI). After a three week period, collected responses were analyzed. 496 members of the AAAAI participated in the survey. Of allergists that use bronchodilator reversibility testing, most (95.7%) administered the test to a majority of new patients with asthma symptoms (99.36%). One-fourth of allergists (25.61%) administered the test to a majority of new patients without asthma symptoms (90.38%). 374 allergists (76.64%) administered the test to a majority of new patients with a history of asthma (95.51%). Over half of allergists (55.74%) administered the test to a majority of follow-up patients with asthma (92.31%). 13.9% of allergists' use cut-off points other ATS guidelines for interpreting positive bronchodilator reversibility tests. After a negative test, most allergists' treat empirically, generally with inhaled corticosteroids (42.56%) or order a provocation test (27.67%). Bronchodilator reversibility tests are most commonly administered for diagnosing new patients with asthma. A significant number of allergists do not follow ATS guidelines for interpreting results. This emphasizes a need for improved education on the selection criteria and interpretation of bronchodilator reversibility tests among allergists.
Increased Chloride Reabsorption as an Inherited Renal Tubular Defect in Familial Type II Pseudohypoaldosteronism
Authors: Chiharu Take, Kyoji Ikeda, Tadahiro Kurasawa, Kiyoshi Kurokawa
Journal: New England Journal of Medicine (1991)

HYPERKALEMIA is a common electrolyte disorder. Among its common causes are renal insufficiency; adrenal insufficiency; hyporeninemic hypoaldosteronism, usually associated with diabetes mellitus, mi...
Randomised Placebo-Controlled Trial of Grass Pollen Allergen Tablet Immunotherapy for Seasonal Rhinitis: Clinical and Surrogate Outcomes and Early Time Course of Immunologic Changes
Authors: Esther H. Steveling, Mongkol Lao-Araya, Christopher Koulias, Merajur Chowdhury, Guy Scadding, Aarif Eifan, Alina Dumitru, Martin J. Penagos Paniagua, Mohamed H. Shamji, Stephen R. Durham
Journal: Journal of Allergy and Clinical Immunology (2016)
Determinants of Atrial (S<sub>4</sub>) and Ventricular (S<sub>3</sub>) Gallop Sounds in Primary Myocardial Disease
Authors: Pravin M. Shah, Raymond Gramiak, David H. Kramer, Paul N. Yu
Journal: New England Journal of Medicine (1968)

Clinical, hemodynamic and angiographic correlates in 23 patients with primary myocardial disease and either atrial (S4) or ventricular (S3) gallop sounds differentiated the two groups. Those with S4 gallop had normal mean left atrial pressures, low amplitude "v" waves, small drop from "v" to "y", usually reduced v/y slope, prominent "a" kick, abnormal echocardiogram of mitral valve, nearly normal cardiac output and marked left ventricular hypertrophy. In contrast the S3 group had elevated mean left atrial pressures, tall "v" waves and large drop from "v" to "y", with increased v/y slope, no prominent "a" kick, rapid filling on the echocardiogram, reduced cardiac output and left ventricular cavitary dilatation. Atrial gallop sound can thus be explained by ventricular hypertrophy, causing reduced compliance and increased resistance to filling, with augmented atrial boost and gallop, whereas considerable ventricular dilatation, with reduced cardiac output, elevated filling pressure and augmented early filling may produce ventricular gallop.
Influential Factors for Post-Fellowship Career Decision-Making: An NCCN Survey
Authors: Jennifer L Lyle, Jonathan L Vandergrift, Jennifer M Hinkel, Eva M Lepisto, Kristie A Cortazzo, Stephen Sherman, F Marc Stewart
Journal: Journal of the National Comprehensive Cancer Network (2012)

Insight into factors important to fellows' decision-making about their career paths is critical to successfully developing program curricula, making capacity projections, and recruiting oncology physicians. This study was performed to determine the factors associated with post-fellowship career decision-making. Program evaluation surveys were administered to oncology fellows who attended the Fellows Recognition Program at the 2009 NCCN Annual Conference. A total of 125 (75%) fellows completed the initial survey. Overall, 73% of fellows reported participating in clinical research and 58% received formal training as part of their fellowship program. Receipt of formal training was correlated with greater program satisfaction (rs = 0.20; P = .03), feeling more prepared for a post-fellowship career (rs = 0.30; P < .001), and greater interest in clinical research post fellowship (rs = 0.32; P < .001). Interest in post-fellowship clinical research (rs = 0.49; P < .001) and importance of protected academic time (rs = 0.57; P < .001) were strongly correlated with interest in practicing in an academic environment, whereas institutional reputation (rs = 0.18; P = .04) and a multidisciplinary practice environment (rs = 0.22; P = .02) were moderately associated with interest. Location, salary, multidisciplinary environment, and flexible scheduling were the most important controllable lifestyle (CL) factors. These results suggest that fellowship programs may be able to foster a desire to participate in research and subsequent interest in practicing in an academic institution through providing opportunities for formal training in clinical research skills. However, even in an academic setting, CL factors are important to attracting and retaining faculty.
Abstract P3-07-63: Ki67 cut-off point to predict the benefit of adjuvant chemotherapy in ER+ HER2- breast cancer patients
Authors: R Rouzier, L Rossi, F Lerebours, A Savignoni, M-C Falcou, C Bonneau, J-Y Pierga, J-M Guinebretière
Journal: Cancer Research (2016)

Abstract BACKGROUND: The benefit of chemotherapy for patients with estrogen receptor(ER)+ HER2- breast cancers is an ongoing question. The evaluation of the tumor's proliferation by Ki67 may guide the indication but no consensual predictive cut-off has been set yet. MATERIALS AND METHODS: This study included women with a first ER+HER2- invasive breast cancer treated by primary surgery between 2003 and 2008. Data was collected prospectively. Ki67 cut-off was sequentially set each 1% from 5% to 30%. For each threshold, the interaction between Ki67 and adjuvant chemotherapy was integrated in a multivariate Cox model to determine when it became statistically significant in predicting distant-disease free survival (DDFS). Using different Ki67 cut-offs, we also compared DDFS of patients who had or not an indication of chemotherapy, depending on whether they actually received it or not. RESULTS: Among the 3221 breast cancers, median Ki67 was 10%, with a mean of 15% (S.D = 14). Ki67 was an independent prognosis factor whether the cut-off was set to 14% or to 20% (p&amp;lt;0.001). The interaction between Ki67 and chemotherapy became significant only for a threshold of Ki67 above 20% (p&amp;lt;0.05). When adjuvant chemotherapy was not indicated according to St Gallen guidelines 2013 with a Ki67 cut-off set to 20%, DDFS was not significantly improved if patients did receive chemotherapy. CONCLUSION: In ER+ HER2- breast cancers, a Ki67 level of expression &amp;gt;= 20% was predictive of benefit from adjuvant chemotherapy. A threshold at 14% was not as discriminant. Based on this large cohort study, we recommend the use of a cut-off at 20% to decide whether patientes with ER positive tumors should receive chemotherapy or not/. Citation Format: Rouzier R, Rossi L, Lerebours F, Savignoni A, Falcou M-C, Bonneau C, Pierga J-Y, Guinebretière J-M. Ki67 cut-off point to predict the benefit of adjuvant chemotherapy in ER+ HER2- breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-63.
TMIC-17LOSS OF SOCS3 IN MYELOID CELLS PROMOTES A DECREASED M2 MACROPHAGE PHENOTYPE AND AN INCREASED CYTOTOXIC T-CELL RESPONSE IN A SYNGENEIC MODEL OF GLIOMA
Authors: Braden C. McFarland, Margaret P. Marks, Amber L. Rowse, Magda Gerigk, Hongwei Qin, Etty N. Benveniste
Journal: Neuro-Oncology (2015)

TMIC-17. LOSS OF SOCS3 IN MYELOID CELLS PROMOTES A DECREASED M2 MACROPHAGE PHENOTYPE AND AN INCREASED CYTOTOXIC T-CELL RESPONSE IN A SYNGENEIC
Margaret McCartney: The great QOF experiment
Authors: Margaret McCartney
Journal: BMJ (2016)

It’s April, and Scotland is abandoning the quality and outcomes framework (QOF) general practitioner contract—unlike in England and Wales, where it will remain, allegedly in lighter form. Currently, all GPs are paid basic rates for each patient registered (no matter how many times the patient attends), for points on the QOF, and for additional services on top (from contraceptive implants to prescribing reviews).

The framework creates perverse incentives. Administration is mainly by computer: unless we code, we don’t get paid. There are quality points for encouraging people to stop smoking. But the GP loses money even if a patient had never smoked …