tbuckley/cabot-search huggingface dataset:
Neonatal Thrombocytopenia Associated with Ante-Partum Administration of Thiazide Drugs
Authors: Salud U. Rodriguez, Sanford L. Leikin, Marilyn C. Hiller
Journal: New England Journal of Medicine (1964)

WITHIN the last several years there have been scattered reports of purpura occurring in patients receiving chlorothiazide and hydrochlorothiazide.1 2 3 4 5 6 7 Since the conditions for which these drugs are used occur chiefly in the older age groups, purpura in association with the administration of the drugs mentioned above has not been reported in the pediatric literature.Recently, we observed a group of newborn infants with thrombocytopenia whose mothers had neither a platelet deficiency nor detectable anti-platelet antibody in the serum. However, these mothers had received either chlorothiazide, hydrochlorothiazide or methyclothiazide during pregnancy, and the thrombocytopenia in their infants was possibly due to . . .
Skin Barrier Disrupted By Enzymatic Activity of House Dust Mite Extracts
Authors: Lukas Einhorn, Kumiko Oida, Ina Herrmann, Susanne Vrtala, Yvonne Resch, Lucia Panakova, Gerlinde Hofstetter, Hiroshi Matsuda, Akane Tanaka, Erika Jensen-Jarolim
Journal: Journal of Allergy and Clinical Immunology (2016)
Case 36-1992
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, P.F. Kamitsuka, J.F. Southern
Journal: New England Journal of Medicine (1992)

Presentation of CaseA 31-year-old man was admitted to the hospital because of the acquired immunodeficiency syndrome (AIDS) and a recent onset of intermittent fever, diarrhea, and progressive weakness.The patient was well until 20 months earlier, when he was treated at another hospital for Pneumocystis carinii pneumonia and Kaposi's sarcoma; a serologic test for human immunodeficiency virus (HIV) antibodies was positive. When a rash developed after trimethoprim–sulfamethoxazole was administered, pentamidine was substituted, with improvement. Radiation therapy was given for Kaposi's sarcoma. Sixteen months before admission zidovudine was begun. Acyclovir was initiated later because of recurrent herpes simplex lesions in . . .
Anticonvulsant-Associated Megaloblastic Anemia
Authors: Malcolm S. Druskin, Marven H. Wallen, Lucas Bonagura
Journal: New England Journal of Medicine (1962)

IN 1954 Badenoch1 reported "a hitherto undescribed form of megaloblastic anemia" in 2 patients who were receiving phenytoin (diphenylhydantoin) and phenobarbitone (phenobarbital). This association was subsequently confirmed by others.2 3 4 5 6 7 8 Megaloblastic anemia has followed diphenylhydantoin therapy alone9 , 10 and phenobarbital alone.11 , 12 In addition, the use of related drugs has been implicated in the production of megaloblastosis. These include primidone,13 14 15 methophenobarbital,16 secobarbital combined with amobarbital17 and other combinations of anticonvulsants.18 , 19 An excellent hematologic response to large doses of folic acid has occurred in most cases.2 , 3 , 5 , 6 , 10 11 12 13 , 17 18 19 However, as little as 500 microgm. daily has produced remission.20 The present case is reported for the following . . .
The Value of a Histamine H<sub>2</sub>-Receptor Antagonist in the Management of Patients with the Zollinger-Ellison Syndrome
Authors: Charles T. Richardson, John H. Walsh
Journal: New England Journal of Medicine (1976)

Inhibition of acid secretion by an H2-receptor antagonist (metiamide) was assessed in three patients with the Zollinger-Ellison syndrome. Metiamide (200 or 300 mg) inhibited acid secretion transiently (2 1/2 hours) by 85 to 100 per cent in all patients. Although anticholinergic drugs alone inhibited acid secretion by only 0 to 35 per cent in these patients, the combination of metiamide and anticholinergic markedly prolonged the inhibitory effect of metiamide. Total gastrectomy was refused by one patient, and was impossible in another; both were treated with metiamide and anticholinergic for five and 10 months. A third patient was treated with metiamide and anticholinergic for three weeks in preparation for total gastrectomy. Ulcer pain and diarrhea disappeared, and each gained weight. H2-receptor antagonists may be useful in the treatment of some patients with the Zollinger-Ellison syndrome.
A case report of successful treatment of dysmorphophobia with tranylcypromine
Authors: M A Jenike
Journal: American Journal of Psychiatry (1984)

The author describes a 21-year-old woman with persistent disabling dysmorphophobia (atypical somatoform disorder) that failed to respond to neuroleptics and heterocyclic antidepressants but resolved completely with the monamine oxidase inhibitor tranylcypromine.
Mifepristone (RU 486) -- A Modulator of Progestin and Glucocorticoid Action
Authors: Alastair J.J. Wood, Irving M. Spitz, C.W. Bardin
Journal: New England Journal of Medicine (1993)

Antiprogestins, agents that inhibit the action of progesterone, are among the most controversial and yet the more interesting therapeutic compounds developed in the past 20 years. These agents provide the most effective and safest means of medical abortion, and in addition they may be used for the treatment of patients with cancer, Cushing's syndrome, and gynecologic disorders and for contraception. The first effective antiprogestin was mifepristone (also known as RU 486),1 a derivative of the progestin norethindrone (Figure 1). By analogy with the antiestrogens, it is likely that the substitution at the 11 beta position is responsible for the antiprogestin . . .
P260 Potential Impact of the 2015 NICE Consultation Guideline for Tuberculosis on the number of children assessed and treated for TB infection and disease in the UK: Abstract P260 Table 1
Authors: L Turnbull, C Bell, F Child
Journal: Thorax (2015)

<h3>Background</h3> NICE Tuberculosis (TB) guideline 2015 recommends all children, regardless of BCG status, with Mantoux ≥5 mm induration receive treatment for latent TB once active TB has been excluded. The 2011 version defines a positive Mantoux as ≥6 mm (no prior BCG) and ≥15 mm (prior BCG). NICE 2011 recommends screening of household contacts of all cases of TB compared with the 2015 guideline which recommends screening of contacts of pulmonary TB only. <h3>Objectives</h3> To establish the impact of the change in NICE recommendations on the number of children assessed and treated for latent TB infection (LTBI) or TB disease in our department. <h3>Methods</h3> We performed a retrospective analysis of all children. <h3>Results</h3> 445 patients were referred, 75 with symptoms, 138 new entrants, 63 non-pulmonary contacts and 169 pulmonary contacts. Of those with symptoms, 5 had positive Mantoux (NICE 2011) compared with 18 (NICE 2015). In this group 0/75 were treated for LTBI and 7/75 for TB disease. Results of patients referred for contact tracing/new entrant screening are shown in Table 1. Two contacts with LTBI and 1 with TB disease (all IGRA positive) would have been missed by the 2011 guideline but identified in 2015. Following NICE 2015 63 non-pulmonary contacts would not have been seen. None of these had LTBI or TB disease. Of the remaining 307 contacts/new entrants 47(15%) had a positive Mantoux of whom 11(4%) had LTBI and 4(1%) TB disease. <h3>Conclusion</h3> 37% more children will be investigated and treated for TB infection/disease under the new NICE TB guideline. In a 12 month period in our clinic this represents 33 additional children with 1 extra case of TB disease and 2 cases of LTBI identified.
A pooled analysis to estimate the prevalence of sleep complaints among cancer patients
Authors: D. E. McMillan, P. L. Schaefer, J. A. Sloan, T. I. Morgenthaler, P. J. Novotny, P. Yang, J. L. Huntington, J. D. Beardon, J. A. Mailliard, C. L. Loprinzi
Journal: Journal of Clinical Oncology (2005)

8053 Background: The ardors of cancer and its related treatments can deeply impact patient quality of life. Little attention has been given to the maintenance of normal sleep patterns or the recording of sleep complaints among cancer patients. Sleep disruption can have a profound impact on patient well-being and perhaps in the cancer process itself. We undertook an analysis to obtain an estimate of the prevalence of sleep complaints among cancer patients participating in oncology treatment and cancer control clinical trials. Methods: Data from 27 studies conducted either at the Mayo Clinic or through the North Central Cancer Treatment Group, involving 4027 patients were included in this pooled analysis. The trials included 15 cancer control studies (1421 patients), 11 treatment studies (2365 patients), and one survey (241 patients). In 17 studies (3364 patients) the insomnia question from the Symptom Distress Scale was used. For these studies, a sleeping complaint was defined as having frequent trouble sleeping. In 5 studies (91 patients), scores from visual analogue questions regarding sleep problems were used where scores of 50 or lower out of 100 were considered evidence of sleep complaints. In 4 studies (331 patients) yes/no questions were asked about sleeping complaints. In the survey (241 patients), patients who rated their current sleep as worse compared to before their cancer diagnosis were to considered to have sleep complaints. Results: The overall prevalence of patients with sleep complaints was 31%. The rates varied from a low of 15% to a high of 65% for individual studies. The type of cancers included were 52% GI (27% with sleep complaints), 8% lung (33% with sleep complaints), 5% neuro (23% with sleep complaints), and 35% of various cancer control studies (34% with sleep complaints). Patients on lung and cancer control studies had the most complaints with sleep (p<0.0001). Conclusions: This study indicates that cancer patients experience sleep complaints with considerable frequency regardless of tumor type, age, gender, or race. These data are justification for targeted interventions for improved sleep among cancer patients. No significant financial relationships to disclose.
An Outbreak of Multidrug-Resistant Pneumococcal Pneumonia and Bacteremia among Unvaccinated Nursing Home Residents
Authors: J. Pekka Nuorti, Jay C. Butler, James M. Crutcher, Ramon Guevara, David Welch, Patricia Holder, John A. Elliott
Journal: New England Journal of Medicine (1998)

Outbreaks of pneumococcal disease are uncommon and have occurred mainly in institutional settings. Epidemic, invasive, drug-resistant pneumococcal disease has not been seen among adults in the United States. In February 1996, there was an outbreak of multidrug-resistant pneumococcal pneumonia among the residents of a nursing home in rural Oklahoma.We obtained nasopharyngeal swabs for culture from residents and employees. Streptococcus pneumoniae isolates were serotyped and compared by pulsed-field gel electrophoresis. A retrospective cohort study was conducted to identify factors associated with colonization and disease.Pneumonia developed in 11 of 84 residents (13 percent), 3 of whom died. Multidrug-resistant S. pneumoniae, serotype 23F, was isolated from blood and sputum from 7 of the 11 residents with pneumonia (64 percent) and from nasopharygeal specimens from 17 of the 74 residents tested (23 percent) and 2 of the 69 employees tested (3 percent). All the serotype 23F isolates were identical according to pulsed-field gel electrophoresis. Recent use of antibiotics was associated with both colonization (relative risk, 2.3; 95 percent confidence interval, 1.3 to 4.2) and disease (relative risk, 3.6; 95 percent confidence interval, 1.2 to 10.8). Only three residents (4 percent) had undergone pneumococcal vaccination. After residents received pneumococcal vaccine and prophylactic antibiotics, there were no additional cases of pneumonia, and the rates of carriage decreased substantially.In this outbreak a single pneumococcal strain was disseminated among the residents and employees of a nursing home. The high prevalence of colonization with a virulent organism in an unvaccinated population contributed to the high attack rate. Clusters of pneumococcal disease may be underrecognized in nursing homes, and wider use of pneumococcal vaccine is important to prevent institutional outbreaks of drug-resistant S. pneumoniae infection.
The benefits of integration
Authors: A. Ciuffi
Journal: Clinical Microbiology and Infection (2016)

Retroviruses, including the human immunodeficiency virus (HIV), are notorious for two essential steps of their viral replication: reverse transcription and integration. This latter property is considered to be essential for productive replication and ensures the stable long-term insertion of the viral genome sequence in the host chromatin, thereby leading to the life-long association of the virus with the infected cell. Using HIV as a prototypic example, the present review aims to provide an overview of how and where integration occurs, as well as presenting general consequences for both the virus and the infected host.
The Surgical Treatment of Peptic Ulcer
Authors: Frank H. Lahey, Samuel F. Marshall
Journal: New England Journal of Medicine (1952)

SO MUCH has been said and written on the subject of peptic ulcer that one could not unreasonably ask why we are presenting a discussion of the subject to this audience. Our reasons for doing so are based on the fact that the clinic, because of its interest in this subject, has had to deal with such a large number (16,000) of cases of peptic ulcer, in which some 1600 partial gastrectomies have been performed (Table 1). In discussing numbers we are aware that the mention of numbers of cases may be construed as vanity. Such is not the case . . .
Comparative genomics of Crohn's disease-associated adherent-invasive<i>Escherichia coli</i>
Authors: Claire L. O'Brien, Marie Agnès Bringer, Kathryn E. Holt, David M. Gordon, Anaëlle L. Dubois, Nicolas Barnich, Arlette Darfeuille-Michaud, Paul Pavli
Journal: Gut (2016)

Adherent-invasive Escherichia coli (AIEC) are a leading candidate bacterial trigger for Crohn's disease (CD). The AIEC pathovar is defined by in vitro cell-line assays examining specific bacteria/cell interactions. No molecular marker exists for their identification. Our aim was to identify a molecular property common to the AIEC phenotype.41 B2 phylogroup E. coli strains were isolated from 36 Australian subjects: 19 patients with IBD and 17 without. Adherence/invasion assays were conducted using the I-407 epithelial cell line and survival/replication assays using the THP-1 macrophage cell line. Cytokine secretion tumour necrosis factor ((TNF)-α, interleukin (IL) 6, IL-8 and IL-10) was measured using ELISA. The genomes were assembled and annotated, and cluster analysis performed using CD-HIT. The resulting matrices were analysed to identify genes unique/more frequent in AIEC strains compared with non-AIEC strains. Base composition differences and clustered regularly interspaced palindromic repeat (CRISPR) analyses were conducted.Of all B2 phylogroup strains assessed, 79% could survive and replicate in macrophages. Among them, 11/41 strains (5 CD, 2 UCs, 5 non-IBD) also adhere to and invade epithelial cells, a phenotype assigning them to the AIEC pathovar. The AIEC strains were phylogenetically heterogeneous. We did not identify a gene (or nucleic acid base composition differences) common to all, or the majority of, AIEC. Cytokine secretion and CRISPRs were not associated with the AIEC phenotype.Comparative genomic analysis of AIEC and non-AIEC strains did not identify a molecular property exclusive to the AIEC phenotype. We recommend a broader approach to the identification of the bacteria-host interactions that are important in the pathogenesis of Crohn's disease.
Preoperative Pulmonary Evaluation
Authors: Gerald W. Smetana
Journal: New England Journal of Medicine (1999)

Postoperative pulmonary complications are an important part of the risk of surgery and prolong the hospital stay by an average of one to two weeks.1 Much of the literature on the assessment of perioperative risk has focused on identifying the now well-defined cardiac risk factors. However, clinically significant postoperative pulmonary complications are as common as postoperative cardiac complications. According to one review, pulmonary complications were at least as common as or more common than cardiac complications in 17 of 25 studies of postoperative complications.2 This article reviews patient- and procedure-related risk factors, clinical evaluation, pulmonary-function testing, and risk-reduction strategies. The . . .
Effect of Ultraviolet Radiation on Cataract Formation
Authors: Hugh R. Taylor, Sheila K. West, Frank S. Rosenthal, Beatriz Muñoz, Henry S. Newland, Helen Abbey, Edward A. Emmett
Journal: New England Journal of Medicine (1988)

To investigate the relation of ultraviolet radiation and cataract formation, we undertook an epidemiologc survey of 838 watermen (mean age, 53 years) who worked on Chesapeake Bay. The annual ocular exposure was calculated from the age of 16 for each waterman by combining a detailed occupational history with laboratory and field measurements of sun exposure. Cataracts were graded by ophthalmologic examination for both type and severity. Some degree of cortical cataract was found in 111 of the watermen (13 percent), and some degree of nuclear cataract in 229 (27 percent). Logistic regression analysis showed that high cumulative levels of ultraviolet B exposure significantly increased the risk of cortical cataract (regression coefficient, 0.70; P = 0.04). A doubling of cumulative exposure increased the risk of cortical cataract by a factor of 1.60 (95 percent confidence interval, 1.01 to 2.64). Those whose annual average exposure was in the upper quartile had a risk increased by 3.30 (confidence interval, 0.90 to 9.97) as compared with those in the lowest quartile. Analysis using a serially additive expected-dose model showed that watermen with cortical lens opacities had a 21 percent higher average annual exposure to ultraviolet B (t-test, 2.23; P = 0.03). No association was found between nuclear cataracts and ultraviolet B exposure or between cataracts and ultraviolet A exposure. We conclude that there is an association between exposure to ultraviolet B radiation and cataract formation, which supports the need for ocular protection from ultraviolet B. (N Engl J Med 1988; 319:1429–33.)
Potential markers predicting bevacizumab efficacy for metastatic colorectal cancer patients.
Authors: M. Suenaga, S. Matsusaka, K. Takagi, Y. Kuboki, T. Watanabe, E. Shinozaki, K. Chin, N. Mizunuma, K. Hatake
Journal: Journal of Clinical Oncology (2010)

e14107 Background: Fluoropyrimidine-based chemotherapy plus bevacizumab (BV) is standard first-line treatment for metastatic colorectal cancer (mCRC). However, useful markers predicting BV efficacy have not been cleared. The aim of this study was to investigate potential markers of efficacy of BV combined with FOLFOX in mCRC retrospectively. Methods: Eighty-five consecutive patients with previously untreated mCRC were included in this study. All patients received FOLFOX4 plus BV 5mg/kg until progression or unmanageable toxicity occurred. Biomarkers including testing the KRAS gene by DNA direct sequencing as well as clinical factors were evaluated as predictors of outcome. Hazard ratios (HR) and 95% confidence intervals (CI) for survival were estimated using the Cox proportional hazards analysis. Results: The overall response and disease control rate was 61.2% and 95.3% respectively. The median progression-free survival (PFS) and time to treatment failure (TTF) were 18.4 and 13.1 months respectively. Two-year survival rate was 65.9%. In univariate analysis, small number of metastatic site (N-meta), good tumor response (TR), temporary interruption of oxaliplatin (L-OHP) and continuance of BV as clinical factors and normal CA125, ALP and LDH levels as biomarkers were associated with better PFS and overall survival (OS). Normal D-dimer level significantly prolonged PFS and TTF. KRAS gene status (72.7% wild-type, 27.3% mutant) did not impact on TR, PFS, TTF or OS. According to multivariate analysis results, TR (HR 0.24; 95%CI 0.12-0.48, p < 0.001) and normal LDH level (HR 0.13; 95%CI 0.06-0.29, p < 0.001) were associated with better PFS. TR (HR 0.11; 95%CI 0.03-0.43, p = 0.002), N-meta (HR 0.38; 95%CI 0.12-0.74, p = 0.004) and dose reduction of 20% for L-OHP (HR 0.07; 95%CI 0.02-0.29, p < 0.001) were significantly associated with better OS. Conclusions: This study suggests that continuing L-OHP and BV accepting appropriate interruption due to adverse events were considered to improve survival for mCRC patients receiving L-OHP-based chemotherapy plus BV. Moreover, CA125, ALP, LDH and D-dimer may have the possibility to be predictive biomarkers of outcome, but KRAS gene status could not be a predictor. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Chugai Pharma, Yakult Honsha Co.
Results following resection for stage IV gastric cancer: Are better outcomes observed in selected patient subgroups?
Authors: S. H. Lim, B. E. Muhs, S. G. Marcus, E. Newman, R. S. Berman, S. P. Hiotis
Journal: Journal of Clinical Oncology (2004)

4207 Background: Patients who present with stage IV gastric cancer are not commonly managed with surgical resection, as effective palliation can usually be accomplished with systemic chemotherapy, endoscopic stenting, or surgical bypass. . The purpose of this study is to review outcomes following resection for stage IV gastric cancer and to identify patient or tumor variables predictive of improved outcomes following gastrectomy in this setting. Methods: A retrospective analysis of a prospective gastrointestinal oncology database was conducted. Sixty-three patients with stage IV gastric cancer managed with surgical resection between 1989 and 2001 were identified. Variables including demographic data, patterns of distant spread (e.g.: peritoneal, lymphatic, hematogenous), location of tumor, and type of gastrectomy were utilized to conduct survival analyses. Results: Actuarial survival for all patients at 1 and 3-years was 52% and 12%, respectively. Improved survival was observed for patients of East Asian race (median survival 20 vs. 12 months, p<0.05, students t test) and age <60 years (median survival 15 vs. 12 months, p<0.05). This trend was also illustrated by Kaplan-Meier analysis. Other variables including pattern of distant spread, location of tumor, and type of gastrectomy were not associated with any observed difference in survival. Both East Asian race and age <60 years were statistically significant predictors of improved survival when assessed by univariate regression analysis. Conclusions: Long term survival for patients with stage IV gastric cancer who are managed with surgical resection is achievable. Certain patient specific variables, including East Asian race and age <60 years, appear to be associated with prolonged survival when assessed by comparison of means, Kaplan-Meier analysis, and univariate regression analysis. Surgical resection should be considered a treatment option for a select group of patients with stage IV gastric cancer. No significant financial relationships to disclose.
Hemodynamic Alterations in Congestive Heart Failure
Authors: A. B. Shaffer, L. N. Katz
Journal: New England Journal of Medicine (1967)

THE cardinal underlying features of congestive heart failure – namely, chamber enlargement (large systolic residue), low cardiac output and venous congestion – are well documented. Nonetheless, precise definition of heart failure is difficult. This is probably because the fundamental defect (or defects) within the myocardium that initiates the complex train of events leading to overt congestive heart failure remains unknown. Since the prime function of the heart is maintenance of appropriate cardiac output, it appears reasonable to define heart failure as existing when cardiac output is limited by inadequacy of cardiac performance in relation to systemic metabolic demands, rather than . . .