tbuckley/cabot-search huggingface dataset:
P171 A Local Cancer Network Root Cause Audit of 62-day Lung Cancer Pathway Breaches
Authors: O Eneje, N Kumar, D Powrie, B Yung, M Lawson
Journal: Thorax (2015)

<h3>Introduction</h3> Over several years there has been an ongoing rise in 62-day Lung Cancer pathway referrals initiated by GPs as two-week wait referrals (2WW). This was particularly marked in 2014 and breach rates increased across the East of England SCN. Within the Essex Lung Cancer Network an audit of these breaches was undertaken by three Trusts to look for common themes and to share best practice. <h3>Methods</h3> Data were collected for all pathways that failed to meet the 62-day target across three NHS Trusts in Essex to identify any predictive factors for breaching the pathway. A standard proforma was used for abstraction. Results were analysed using GraphPad Prism 6 (La Jolla, CA). <h3>Results</h3> In 2014 a total of 1,419 2WW referrals were received by the three Trusts of which 13–23% were diagnosed with lung cancer. Between 19% and 54% breached the 62-day target (89 of 246 pathways). The median length of the breached pathways varied from 86–88 days by Trust. Trusts did not appear to differ significantly by end treatment after pathway breach. There were generic common themes within the breached pathways of each Trust but for the two worst performing Trusts specific pathway issues were identified. In one Trust it was clear that time delays to perform CT guided lung biopsies with a 2.75 relative risk of breaching if a pathway involved a CT biopsy (95% CI 1.6–4.6, p &lt; 0.0001). At another Trust a high proportion of breached pathways had a bronchoscopy as the first test but went on to have further diagnostic biopsies by other methods. <h3>Conclusion</h3> Many of the diagnostic delays were due to complex patient pathways needing multiple diagnostic tests. However for two Trusts significant problems were highlighted for targeted quality improvement plans. Selecting the best test to give diagnostic and staging information is vital particularly when services are stretched and capacity is reached.
Application of biological markers in depression secondary to thyrotoxicosis
Authors: Z Kronfol, J F Greden, M Condon, M Feinberg, B J Carroll
Journal: American Journal of Psychiatry (1982)

Biological markers of affective disorders have not been studied intensively in patients with secondary depression. An elderly woman with severe delusional depression secondary to thyrotoxicosis was monitored with weekly dexamethasone suppression tests (DSTs) and three sleep electroencephalography (EEG) evaluations. She received treatment only for her thyrotoxicosis, but her depression resolved completely. The serial DSTs were normal throughout her depression, consistent with the specificity of this test for primary endogenous depression. The sleep EEG erroneously suggested a diagnosis of primary depression but effectively monitored clinical improvement. Biological markers may have applicability in evaluating and monitoring patients with secondary depression.
Real-life assessment of the multidimensional nature of dyspnoea in COPD outpatients
Authors: Capucine Morélot-Panzini, Hélène Gilet, Bernard Aguilaniu, Philippe Devillier, Alain Didier, Thierry Perez, Christophe Pignier, Benoit Arnould, Thomas Similowski
Journal: European Respiratory Journal (2016)

Dyspnoea is a prominent symptom of chronic obstructive pulmonary disease (COPD). Recent multidimensional dyspnoea questionnaires like the Multidimensional Dyspnea Profile (MDP) individualise the sensory and affective dimensions of dyspnoea. We tested the MDP in COPD outpatients based on the hypothesis that the importance of the affective dimension of dyspnoea would vary according to clinical characteristics. A multicentre, prospective, observational, real-life study was conducted in 276 patients. MDP data were compared across various categories of patients (modified Medical Research Council (mMRC) dyspnoea score, COPD Assessment Test (CAT) score, Global Initiative for Chronic Obstructive Lung Disease (GOLD) airflow obstruction categories, GOLD “ABCD” categories, and Hospital Anxiety and Depression Scale (HADS)). Univariate and multivariate regressions were conducted to explore factors influencing the affective dimension of dyspnoea. Cluster analysis was conducted to create homogeneous patient profiles. The MDP identified a more marked affective dimension of dyspnoea with more severe mMRC, CAT, 12-item Short-Form Health Survey mental component, airflow obstruction and HADS. Multivariate analysis identified airflow obstruction, depressive symptoms and physical activity as determinants of the affective dimension of dyspnoea. Patients clustered into an “elderly, ex-smoker, severe disease, no rehabilitation” group exhibited the most marked affective dimension of dyspnoea. An affective/emotional dimension of dyspnoea can be identified in routine clinical practice. It can contribute to the phenotypic description of patients. Studies are needed to determine whether targeted therapeutic interventions can be designed and whether they are useful.
Fatal Toxic Nephrosis Following the Administration of Mercurial Diuretics
Authors: Michael S. Bruno
Journal: New England Journal of Medicine (1948)

FATAL toxic nephrosis resulting from the administration of mercurial diuretics is undoubtedly a rare condition. When one considers the extent to which these drugs are used, as well as the failure to find lesions at autopsy that suggest that they have caused ill effects, it becomes evident that morbidity and mortality resulting from their use is infinitesimal.Friedenson1 has reported a case in which a total of 1250 cc. of mercupurin (mercuzanthin) was administered over a period of several years to a young rheumatic patient. Autopsy failed to reveal demonstrable abnormalities in the kidneys after careful microscopical study. Gold et . . .
Integrating Perioperative Chemotherapy into the Treatment of Muscle-Invasive Bladder Cancer: Strategy Versus Reality
Authors: S. Machele Donat
Journal: Journal of the National Comprehensive Cancer Network (2009)

Since the initial report in 2003 of the Intergroup-0080 trial confirming benefit of combined neoadjuvant M-VAC (methotrexate, vinblastine, adriablastine, and cisplatin) chemotherapy and cystectomy in the treatment of muscle-invasive bladder cancer, debate has continued in the literature as to the relative risk/benefits of integrating perioperative chemotherapy into the care of patients, especially in those with organ-confined, muscle-invasive, node-negative disease in whom the benefit may be less. Because of the inaccuracies of clinical staging, the potential morbidity related to M-VAC chemotherapy, a 70% cure rate in pT2No disease with surgery alone, and only a modest (5%) improvement in absolute overall survival with combined therapy, many favor limiting chemotherapy to patients with a pathologic stage of pT3 or greater or node-positive disease. This philosophy was also reflected in the 2008 National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Bladder Cancer, in which neoadjuvant chemotherapy for clinical T2 disease versus adjuvant therapy based on pathologic risks is only “considered.” Additionally, a recent study looking at the perioperative integration of chemotherapy for stage III bladder cancer in the United States using the National Cancer Data Base showed that only 11.6% of patients underwent any perioperative chemotherapy, with most in the adjuvant setting. These findings indicate that despite randomized trial data showing survival benefit for perioperative chemotherapy, and the current guidelines for therapy supporting those findings, chemotherapy is not being integrated well into the care of patients with muscle-invasive bladder cancer, even in those who, experts agree, have the most potential for benefit.
Soundings: Guest faculty
Authors: James Owen Drife
Journal: BMJ (1999)

Southern California is often portrayed as being on another planet, so it came as a surprise, at a meeting there recently, to find that the doctors did not arrive on roller blades, wearing fluorescent shades.

Lecturing abroad is straightforward if you have invented a new technique like transspecies fertilisation or minimal access caesarean section. If, however, the purpose of the meeting is local postgraduate education the guest faculty becomes uneasy and asks itself thoughtful questions.

Just how international is medicine? Global journals and research networks would have us believe it is universal and that the results of trials conducted in South America or Africa are applicable in London or Yorkshire. I am unconvinced, but I find it hard to explain why. It is not just my concerns about informed consent given by people who cannot read but more a feeling that there may be confounding factors which I cannot discern from a distance.

Colleagues overseas could apply the latter reservation to research here, so is British experience useful to doctors abroad? Are results in our hospital system of trainee based medicine relevant to places where senior obstetricians sleep near the delivery suite? American speakers on the faculty seemed to think so. They cited United Kingdom studies with gratifying frequency, though with a bit more emphasis on our mavericks than on our mainstream opinions. The “gee whizz” attitude is hard to avoid, whichever direction you look across the Atlantic.

I thought that my postgraduate education was benefiting more than my hosts’ was. I had not known that obstetricians on the east coast of the United States use forceps while those on the west coast dare not for fear of litigation. Nor had I realised how much pressure they all feel to reduce caesarean section rates, sometimes against their clinical judgment. Or that many American women use their gynaecologist as their primary care doctor.

Some of the differences between Leeds and Los Angeles were more spectacular. Our menopause clinic does not as yet offer complementary therapy by a robed and turbaned doctor with a waist length beard. Experience in Beverly Hills suggests that this would be hugely successful and that the practitioner could be caucasian. Whether or not therapeutic efficacy would be altered by a Scottish accent remains to be tested.
Vasopressin-Resistant Hyposthenuria in Advanced Chronic Renal Disease
Authors: Richard L. Tannen, Edward M. Regal, Michael J. Dunn, Robert W. Schrier
Journal: New England Journal of Medicine (1969)

Eleven of 13 patients with far advanced chronic renal disease of diverse etiologies were found to have urine that remained hypotonic to plasma in spite of the administration of a supramaximal dose of vasopressin. The vasopressin-resistant hyposthenuria seemed to be related more to the advanced nature of the disease than to the particular type of renal involvement. This defect has not previously been recognized as a common feature of end-stage renal disease, since before the present investigation, only a few patients with severe renal impairment had been studied. Possible pathophysiologic mechanisms resulting in this abnormality include anatomic derangement of the renal tubule or peritubular vasculature, an inhibitor of antidiuretic hormone, disordered calcium metabolism and osmotic diuresis per nephron. Although the urinary osmolality was always hypotonic it was not "fixed," every patient tested responding to a water load with further dilution.
Use of Pentothal Sodium in the Prevention of Musculoskeletal Injuries during Electroconvulsive Therapy
Authors: Samuel M. Tarnower, Robert W. Gladstone
Journal: New England Journal of Medicine (1950)

A VARIETY of musculoskeletal injuries are known to occur as a complication of electroconvulsive therapy. Such injuries vary from muscular strains to fractures of long and flat bones. Lingley and Robbins1 studied a group of 230 patients who had received no premedication at the time of treatment. Their studies, which included x-ray films before and after treatment, revealed that 23 per cent of the patients sustained fractures of one or more bones. Such statistical reports usually appear more serious than need be, since the most common bony injury is a compression fracture of the body of one of the middorsal . . .
Neurologic Outcome in Children with Inborn Errors of Urea Synthesis
Authors: Michael Msall, Mark L. Batshaw, Richard Suss, Saul W. Brusilow, E. David Mellits
Journal: New England Journal of Medicine (1984)

We studied 26 children with inborn errors of urea synthesis who survived neonatal hyperammonemic coma. There was a 92 per cent one-year survival rate associated with nitrogen-restriction therapy and stimulation of alternative pathways of waste nitrogen excretion. Seventy-nine per cent of the children had one or more developmental disabilities at 12 to 74 months of age; the mean IQ was 43 +/- 6. There was a significant negative linear correlation between duration of Stage III or IV neonatal hyperammonemic coma and IQ at 12 months (r = -0.72, P less than 0.001) but not between the peak ammonium level (351 to 1800 microM) and IQ. There was also a significant correlation between CT abnormalities and duration of hyperammonemic coma (r = 0.85, P less than 0.01) and between CT abnormalities and concurrent IQ (r = -0.75, P less than 0.02). These results suggest that prolonged neonatal hyperammonemic coma is associated with brain damage and impairment of intellectual function. This outcome may be prevented by early diagnosis and therapy.
Multiple Cell Origin of Hereditary Neurofibromas
Authors: Philip J. Fialkow, Richard W. Sagebiel, Stanley M. Gartler, David L. Rimoin
Journal: New England Journal of Medicine (1971)

In a female heterozygous for the A and B genes at the X-linked glucose-6-phosphate dehydrogenase (G-6-PD) locus, single cells express the activity of only one or the other gene. Thus, this system can be used to trace the cellular origin of tumors. Neoplasms arising from a single cell should exhibit only Type A or B enzyme, whereas those with multiple cell origin can show both enzyme types. Each of 14 neurofibromas studied from two G-6-PD heterozygotes with hereditary neurofibromatosis exhibited both Type A and Type B enzyme, strongly suggesting that hereditary neurofibromas have a multiple cell origin. A minimal estimate of the starting number of cells for a neurofibroma is 150, but the number may be as high as several thousand. This suggests that the initial tumorigenic event affects a relatively large number of cells simultaneously or that it affects one or a few cells, subsequently altering the pattern of growth in adjacent cells.
Autoantibodies to Gastrin-Producing Cells in Antral (Type B) Chronic Gastritis
Authors: Carmen Vandelli, Gian Franco Bottazzo, Deborah Doniach, Fabio Franceschi
Journal: New England Journal of Medicine (1979)

Autoantibodies that react exclusively with the gastrin-secreting cell of human antrum have been detected by immunofluorescence in eight of 106 patients with histologic evidence of chronic atrophic gastritis, Type B, involving mainly the antrum. These antibodies were of the IgG class and of low titer. However, follow-up studies one to two years later showed persistently positive reactions, despite symptomatic treatment. These data support the concept of an autoimmune variant of chronic "antral" gastritis, Type B.
PTU-035 Endoscopic treatment of biliary anastomotic strictures in patients with liver transplant. a terciary centre experience
Authors: C Padilla, K Klimova, Ó Nogales Rincón, A Ahumada, J García Lledó, L Perez Carazo, B Merino, C González Asanza, D Rincón, MM Salcedo, P Menchen
Journal: Gut (2015)

<h3>Introduction</h3> Biliary anastomotic strictures are a frequent complication of liver transplantation (LT), that is associated with important morbidity and high costs. ERCP is considered the treatment of choice, however, the optimal management of these patients has not yet been shown. <h3>Objective</h3> To evaluate the efficacy and complicaitons of endoscopic treatment with ERCP of patients with LT and stricture of biliary anastomosis, and to identify predictors of good response to endoscopic treatment. <h3>Method</h3> Retrospective study, which included all patients with previous history of LT and subsequent diagnosis of biliary anastomotic stenosis and underwent ERCP between January 2002 and December 2013. Good response was defined as total resolution of the stricture with no need of further interventions. <h3>Results</h3> 103 patients were included in the study, 79 (77%) were men, mean age of 53 years (range 35 to 70 years). The most frequent indications for LT were hepatocellular carcinoma (33%), alcoholic cirrosis (20.4%) and hepatitis C (18%). 44% of the patients presented early anastomotic stricture, that developed after a mean time of 79 weeks after LT. Furthermore, 4% of the patients associated a biliary fistula. The mean number of ERCP sessions was 3,4 (range 1–10), with mean success rate of 80%. As for the endoscopic technique, endoscopic dilatation was performed in 77% of cases (mean number of dilatations of 1,9); plastic stent was placed in 73% (average 3,9 stents per patient), and in 16% of the patients, plastic stents were initially placed and changed for metalic stents in subsequent ERCPs (1,5 stents per patient). The complication rate was of 9,1%: migration of stent was observed in 11 cases (10 plastic stents and 1 metal stent); colangitis/bacteriaemia in 3,1%, pancreatitis in 3,1%, bleeding in 1,1% and perforation in 0,3%. Two patients died as a direct complication of ERCP, both due to pancreatitis. 57 patients (55%) presented complete response to endoscopic treatment, with posterior reappearance of stricture in 11 (11%) cases, and 31 patients did not respond, 17 of those underwent surgery. <h3>Conclusion</h3> In our experience, ERCP is a reasonably safe technique of treatment of biliary strictures in LT patients, that can avoid surgical procedures in a high proportion of them. <h3>Disclosure of interest</h3> None Declared.
Sulfated hyaluronan improves bone regeneration of diabetic rats by binding sclerostin and enhancing osteoblast function
Authors: Ann-Kristin Picke, Juliane Salbach-Hirsch, Vera Hintze, Sandra Rother, Martina Rauner, Christian Kascholke, Stephanie Möller, Ricardo Bernhardt, Stefan Rammelt, M. Teresa Pisabarro, Gloria Ruiz-Gómez, Matthias Schnabelrauch, Michaela Schulz-Siegmund, Michael C. Hacker, Dieter Scharnweber, Christine Hofbauer, Lorenz C. Hofbauer
Journal: Biomaterials (2016)
Control of Chemotherapy-Induced Emesis
Authors: Alastair J.J. Wood, Steven M. Grunberg, Paul J. Hesketh
Journal: New England Journal of Medicine (1993)

The development of antiemetic drugs has been one of the most rewarding areas of oncologic research, since therapeutic advances in this area can result in immediate improvement in the quality of life for patients undergoing chemotherapy. Antiemetic therapy has progressed dramatically during the past decade and a half. Fifteen years ago, patients receiving cisplatin for the first time had a median of 12 vomiting episodes within the first 24 hours, whereas now more than 50 percent of such patients have no vomiting episodes at all. Theoretical and clinical challenges remain, however, in the effort to control chemotherapy-induced emesis. The mechanisms of anticipatory vomiting and delayed vomiting are still not understood, and consistently effective therapeutic approaches to these problems have yet to be developed.
Medical Complications of Operative Bile-Duct Injuries
Authors: John W. Norcross, John L. Dadey
Journal: New England Journal of Medicine (1957)

AS a result of Dr. Frank H. Lahey's1 2 3 early and continued interest in the repair of bile-duct strictures, this clinic has had a large experience with the management of patients referred here with this unfortunate complication of biliary surgery. This paper reviews 400 cases of bile-duct injuries taken at random from a larger series treated here between 1935 and 1955. Of a total of 1008 repair operations performed on these patients, 626 were done at this clinic.In the consideration of the complications of bile-duct injuries, two phases are discussed: the immediate result of partial or complete biliary obstruction from . . .
Effects of Leg Exercise on Insulin Absorption in Diabetic Patients
Authors: Veikko A. Koivisto, Philip Felig
Journal: New England Journal of Medicine (1978)

To examine the effects of leg exercise on insulin absorption from various injection sites, 125I-labelled rapid actin insulin (9 units) was injected subcutaneously into the leg, arm or abdomen of patients with insulin-dependent diabetes before one hour of intermittent leg (bicycle) exercise and on a resting, control day. Insulin disappearance from the leg increased by 135 per cent during the first 10 minutes of leg exercise (P less than 0.05) and remained 50 per cent above resting levels after 60 minutes (P less than 0.02). Leg exercise had no effect on insulin disappearance from the arm, but insulin disappearance from the abdomen was reduced during the post-exercise recovery period (P less than 0.02). As compared to leg injection, arm or abdominal injection reduced the hypoglycemic effect of exercise by 57 per cent (P less than 0.02) and 89 per cent (P less than 0.005), respectively. Leg exercise accelerates insulin absorption from the leg. Arm or abdominal injection avoids this acceleration during leg exercise and reduces exercise-induced hypoglycemia.
AB0999 Kawasaki Disease Shock Syndrome (KDSS). Presentation of 5 Cases: Table 1
Authors: M. Camacho-Lovillo, M. Melόn-Pardo, M.D. Moreno-Mejías, J.D. Carmona-Ponce, A.V. Ardanuy-Pizarro, I. Obando-Santaella
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Kawasaki disease (KD) is an acute, self-limited vasculitis commonly affecting children &lt;5 years. Over the last years several cases of KD associated with hemodynamic instability or Kawasaki disease shock syndrome (KDSS) have been described <h3>Methods</h3> Retrospective descriptive study of patients diagnosed with KDSS in our hospital (January 2009 - December 2014). KDSS was defined as those patients with KD who showed clinical signs of hypoperfusion (cold extremities, oliguria, reduced pulse amplitude, prolonged capillary refill time &gt;2 second, tachycardia and/or hypotension for age (&lt;2 SD of the mean) and need for ICU admission. <h3>Results</h3> During a six-year period a total of 5 patients met the criteria for KDSS. 4/5 of the children presented at an atypical age (&lt;6 months or &gt;5 years). 3/5 of the children presented with incomplete KD. 3/5 did not respond to the first dose of IVIG and 4/5 received high dose steroids. All children achieved full remission of symptoms. Only one patient has cardiac sequelae <h3>Conclusions</h3> KDSS is an unusual but severe form of KD presentation. In children with suspected toxic shock, negative cultures and/or poor response to antibiotics, KDSS should be considered as possible differential diagnosis, even when the classical criteria of KD are not met. Early diagnosis is essential in order to initiate appropriate and aggressive therapy thereby reducing the risk of coronary arteries aneurysm, more frequently occurring in children with KDSS. <h3>References</h3> Dominguez et al. Pediatrics 2008; 122; e786e790. Kanegaye et al. Pediatrics 2009; 123;e783-e789. <h3>Disclosure of Interest</h3> None declared
181P: Anti-PD-1 antibodies in non-small cell lung cancer (NSCLC): The real-life setting experience
Authors: E. Dudnik, M. Moskovitz, M. Wollner, A. Zer, J. Bar, A. Agbarya, T. Idan, Y. Shechtman, M. Abu Amna, N. Peled
Journal: Journal of Thoracic Oncology (2016)