tbuckley/cabot-search huggingface dataset:
Clinical and Laboratory Studies of 207 Consecutive Patients in a Kidney-Stone Clinic
Authors: Roger A. Melick, Philip H. Henneman
Journal: New England Journal of Medicine (1958)

THIS paper summarizes the data obtained in a review of the records of all patients attending the Stone Clinic of the Massachusetts General Hospital between November, 1949, and December, 1954, to determine the current frequency of the various types of stones and stone syndromes and to evaluate the medical care of such patients. A small number of records were discarded since they represented patients who had never had stones or who had not been investigated. The final number considered was 207.MaterialThe patients in this survey have been classified according to the chemical composition of their stones and further . . .
Racial Differences in Aldosterone Excretion and Plasma Aldosterone Concentrations in Children
Authors: J. Howard Pratt, Jerrlyn J. Jones, Judy Z. Miller, Mary Anne Wagner, Naomi S. Fineberg
Journal: New England Journal of Medicine (1989)

Blacks are more likely to have hypertension, have lower levels of plasma renin activity, and typically consume less potassium than whites. Whether blacks and whites secrete different amounts of aldosterone is less clear. We estimated aldosterone secretion indirectly in 715 children, 249 of whom were black, by measuring their nocturnal rates of urinary excretion of aldosterone. Dietary sodium and potassium intakes were estimated from their excretion rates. The mean (±SE) aldosterone-excretion rate was lower in the black children than in the white children (0.045±0.003 vs. 0.078±0.004 nmol per micromole of creatinine per kilogram of body weight; P<0.001). The potassium-excretion rate was also lower in the black children than in the white children (0.13+0.01 vs. 0.18±0.01 mmol per micromole of creatinine per kilogram; P<0.001). Aldosterone excretion was highly correlated with potassium excretion (P<0.001), but the lower aldosterone-excretion rate in blacks was explained only in part by their lower dietary intake of potassium. Systolic blood pressure was higher in black children (P<0.001), as was diastolic pressure (P = 0.037). In a second study of 99 children, the plasma aldosterone level was found to be significantly lower in black children than in white children (230±30 vs. 400±30 pmol per liter; P<0.001). Plasma renin activity and plasma cortisol levels were the same in both groups. In summary, we found that black children secrete about 40 percent less aldosterone than white children. The role of the lower aldosterone-secretion rate in the genesis of the higher blood pressures observed in black children is not known. (N Engl J Med 1989; 321:1152–7.)
Mutations in the Nonstructural Protein 5a Gene and Response to Interferon in Patients with Chronic Hepatitis C Virus 1b Infection
Authors: Nobuyuki Enomoto, Ikuo Sakuma, Yasuhiro Asahina, Masayuki Kurosaki, Takeshi Murakami, Chikara Yamamoto, Yuki Ogura, Namiki Izumi, Fumiaki Marumo, Chifumi Sato
Journal: New England Journal of Medicine (1996)

A region associated with sensitivity to interferon has been identified in the nonstructural protein 5A (NS5A) of hepatitis C virus (HCV) genotype 1b. The region spans amino acid residues 2209 to 2248 (NS5A2209–2248) of HCV-J, a strain of HCV-1b whose complete genomic sequence has been identified. We examined whether the NS5A2209–2248 sequence present before therapy could be used as a predictor of the response to interferon therapy in patients with chronic HCV-1b infection.
Website of the Week: Lesbian health
Authors: Jocalyn Clark
Journal: BMJ (2003)

An editorial in this week's BMJ appeals for greater recognition of the special needs of women who have sex with women (p 939). Online health information for lesbians is burgeoning, but often it is to be found within broader gay health sites.

However, there are sites specific to women who have sex with women. www.lesbianhealth.org.uk highlights sexual and mental health risks and the topics of breast cancer, diet, smoking, and exercise. http://lesbianhealthinfo.org claims to be  virtual potluck of information about lesbian health, but mostly describes the work of the University of California Lesbian Research Center. Commercial endeavour masquerades as health information at Lesbian Health Net, which markets natural nutritional products specially formulated to meet the unique needs of lesbians (http://lesbianhealth.net/).

The relevant sections of the American (www.4woman.gov/faq/Lesbian.htm) and Canadian (www.hc-sc.gc.ca/english/women/facts_issues/lesbian_health.htm) government women's health pages offer some guidance about the frequency with which lesbian women should have pap smears, screening for sexually transmitted infections, and mammograms. And an excellent review available full text at the Medical Journal of Australia emphasises the role of discrimination in creating health inequalities for lesbian women (www.mja.com.au/public/issues/178_12_160603/mcn10852_fm.html).

The outstanding health resource at McMaster University in Ontario, Canada, includes an extensive list of links (http://hsl.mcmaster.ca/tomflem/gay.html).

The pharmaceutical company funded website of the influential US Gay and Lesbian Medical Association is a comprehensive resource for both providers and patients (www.glma.org). Emphasising the association's advocacy work to end homophobia in health care, the site is a wide ranging and extremely well organised collection of news, research, working papers, and clinical information. It includes an online searchable database to help find a gay friendly doctor (in north America) and recommendations for the top ten things lesbians should ask their doctors. The website of its UK contemporary, the Gay and Lesbian Association of Doctors and Dentists, is far less extensive (www.gladd.org.uk).
Case 14-1994
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Glenn M. LaMuraglia, Eugene J. Mark
Journal: New England Journal of Medicine (1994)

Presentation of CaseA 54-year-old woman was admitted to the hospital because of intermittent hemoptysis, dyspnea, and a left mediastinal mass.The patient had been well until seven months earlier, when a cough, fatigue, and hemoptysis developed. She was seen at another hospital, where radiographs of the chest showed patchy and linear opacities in the left lower lobe. Another radiograph of the chest (Figure 1), obtained eight days later, revealed progressive air-space disease in the lingula and left lower lobe and an ill-defined focal opacity in the left upper lobe. Penicillin was prescribed, but the patient was unimproved and began . . .
A Comparison of Blood-Sugar and Urine-Sugar Determinations for the Detection of Diabetes
Authors: Donald Harting, Barbara Glenn, Hugh L. C. Wilkerson
Journal: New England Journal of Medicine (1951)

General Method of StudyDIABETES case-finding activities have been carried on since June, 1947, as part of a community diabetes control program in the town of Brookline, Massachusetts. This town has a population of approximately 58,000. For 3186 persons over 25 years of age, both blood-sugar and urine-sugar determinations were done as initial screening procedures. A screening procedure is a simple test used to divide people into two groups, — one large group of negatives and a smaller group of positives considered to have a high enough index of suspicion to warrant more detailed examination for the disease in question. . . .
Case 22-1999
Authors: Maura A. Kelley, Chin-Lee Wu
Journal: New England Journal of Medicine (1999)

Presentation of CaseA 68-year-old woman with refractory multiple myeloma was admitted to the hospital because of pancytopenia with bleeding.Multiple myeloma had been diagnosed 10 years earlier but had not been treated until 7 years after the diagnosis, when the IgG level rose to 9270 mg per deciliter. Treatment with pulsed doses of dexamethasone resulted in a partial response. Seventeen months before admission, skeletal radiographs showed only osteopenia in the left hip. Radiographs of the lumbar spine, obtained eight months before admission because of low back pain, showed compression fractures of four vertebral bodies. Pneumonia developed in the same . . .
Sirolimus reduced tumor-related morbidity and resulted in biochemical and radiographic response in patients with progressive sarcoma
Authors: S. M. Schuetze, L. H. Baker, R. G. Maki
Journal: Journal of Clinical Oncology (2006)

9503 Background: Chemotherapy options for palliative treatment of advanced sarcomas are limited and studies are underway to identify new classes of active agents. Second generation inhibitors of the mammalian target of rapamycin (mTOR) are being tested in phase II trials. Objective responses of sarcomas to the mTOR inhibitor AP23573 have been reported. Sirolimus (rapamycin) is a macrocyclic triene antibiotic that inhibits activation of S6 kinase, the cdk2/cyclinE complex and phosphorylation of retinoblastoma protein and causes cell cycle arrest in G1-S phase. Methods: We report the cases of four (out of 20) patients (pts) with progressive, metastatic sarcoma failing 2–6 chemotherapies treated with sirolimus and followed for clinical benefit. Sirolimus was self-administered daily with (n=2) or without (n=2) daily oral cyclophosphamide 200 mg every other week. Patients were followed in clinic for disease and toxicity assessments every 2 weeks. Molecular analysis of mTOR targets will be performed. Results: Patients with MFH, leiomyosarcoma, angiosarcoma and osteosarcoma were treated using 4–8 mg sirolimus daily for a median of 16 weeks (range 8–28 wks). Three pts were symptomatic from disease and had reduced performance status prior to treatment. All 3 pts had subjective improvement in tumor-related symptoms and 2 had improvement in performance status. LDH and bilirubin fell from 1,712 u/L and 5.6 mg/dl to 388 u/L and 1.1 mg/dl, respectively, in the pt with angiosarcoma during 3 months of sirolimus and cyclophosphamide. Alkaline phosphatase fell from 791 u/L to 120 u/L in the pt with osteosarcoma over 6 weeks of simolimus and cyclophosphamide. Three pts had minor radiographic improvement in tumor and remain on treatment. One pt has died of disease progression. Treatment was well tolerated. Conclusions: Sirolimus treatment was associated with improvement in tumor-related symptoms, performance status and biochemical markers of disease activity and inhibited tumor growth in pts with advanced sarcoma failing multiple prior therapies. Phase I studies of sirolimus in advanced cancer are underway at the University of Chicago. Formal study of sirolimus in advanced sarcoma is contemplated. No significant financial relationships to disclose.
Case 12-2011
Authors: Marsha Kay Fearing, Esther J. Israel, Inderneel Sahai, Otto Rapalino, Mikhail Lisovsky
Journal: New England Journal of Medicine (2011)

A 9-month-old boy was admitted to the hospital because of fever, diarrhea, and acute liver failure. He had been well, and the results of routine newborn metabolic screening were normal. Examination showed an enlarged liver that was fatty on imaging studies.
Alpha-Adrenergic Hyper-Responsiveness in Asthma
Authors: William R. Henderson, James H. Shelhamer, Douglas B. Reingold, Laurie J. Smith, Richard Evans, Michael Kaliner
Journal: New England Journal of Medicine (1979)

Because alpha-adrenergic stimulation causes bronchoconstriction, the alpha-adrenergic responsiveness of 21 subjects with allergic asthma was compared with that of 16 subjects with allergic rhinitis and 38 normal control subjects. None of the patients had taken medications for at least 30 days before study. Alpha-adrenergic responsiveness was measured by the capacity of phenylephrine to constrict the cutaneous vascular bed and to dilate the pupillary sphincter muscle. Asthmatic subjects required 4.0 +/- 0.6 ng to reduce their cutaneous blood flow by 50 per cent, whereas normal controls required 32.0 +/- 7.5 ng (P less than 0.005) and subjects with allergic rhinitis required 23.7 +/- 9.4 ng (P less than 0.02). The pupils of asthmatic subjects dilated by greater than 0.5 mm in response to 1.8 +/- 0.14 per cent phenylephrine, patients with allergic rhinitis required 2.4 +/- 0.16 (P less than 0.01), and normal controls needed 2.7 +/- 0.07 (P less than 0.00001). Therefore, the patients with allergic asthma had significantly enhanced alpha-adrenergic responses when compared both to normal subjects and patients with allergic rhinitis; the possibility that increased alpha-adrenergic activity contributes to the asthmatic diathesis warrants further exploration.
Atheromatous Emboli to the Kidneys after Aortic Surgery
Authors: William M. Thurlbeck, Benjamin Castleman
Journal: New England Journal of Medicine (1957)

SURGICAL treatment for aneurysm of the abdominal aorta and for aortic atherosclerosis with thrombotic occlusion is relatively new, and the results have been good.1 2 3 Because excision of the diseased aorta and replacement with a graft is a major procedure and because the renal arteries are close to the operative field, renal complications can be expected; 14 of the 22 patients dying at the Massachusetts General Hospital after aortic surgery had anuria or oliguria.The first case of anuria to be studied was caused by multiple emboli of atheromatous material from the aorta to the kidneys, with multiple renal infarcts and . . .
PTU-059 “i can cope right now, because i know where i have come from”; a qualitative exploration of the lived experience of young adults with inflammatory bowel disease
Authors: AJ Brooks, G Rowse, A Ryder, P Narula, BM Corfe, P Norman, AJ Lobo
Journal: Gut (2015)

<h3>Introduction</h3> Young people (YP) living with inflammatory bowel disease (IBD) are at risk of increased psychological morbidity, with increased rates of anxiety and depression at a life stage characterised by change, exploration, risk-taking and identity development whilst learning to manage and adjust to living with IBD as an adult. This is in the context of a globally rising incidence in paediatric Crohn’s disease (CD) with a peak onset in adolescence. However, despite this there remains little research exploring YPs perceptions and experiences of living with IBD. The aim of this first qualitative study was to explore the lived experiences of YP with IBD. <h3>Method</h3> YP aged 19–21 years with a diagnosis of ulcerative colitis (UC) or CD at a single large teaching centre were recruited for a qualitative face-to-face interview with a single investigator. Interviews were conducted following a semi-structured interview schedule regarding; receiving a diagnosis, impact on relationships, ways of coping, identity and the future. Interviews were audio-recorded, transcribed and subject to in-depth interpretative phenomenological analysis (IPA) used in clinical and health psychology. <h3>Results</h3> Seven patients were interviewed (4 CD, 3 UC), median age 20 years (range 19–21) with 43% (3/7) male. Through IPA the YPs accounts clustered around 4 super-ordinate themes with <i>contradiction</i>as an overarching theme, with several sub-themes illustrating experiences of living with IBD; 1) <i>coping with uncertainty and unpredictability</i>; included misdiagnosis, mislabelling, “everyone is different” and “takes years to make sense of it” 2) <i>living with invisibility and visibility</i>; included “losing myself”, embarrassment, disgust and use of humour. 3) <i>Lack of compassion for self</i>; included a contradiction of control and lack of control, being limited by yet not held back, stoic and hiding emotions. 4) <i>Resilience</i>; included positive impact on relationships and a positive outlook. <h3>Conclusion</h3> The findings of this first qualitative study to investigate the lived experience of YP with IBD highlights key areas for enabling other YP to make sense of a diagnosis of IBD. Furthermore, improving health care professionals (HCPs) understanding of the experiences of YP may improve relationships and encourage positive changes in psychological health, social interactions and capacity for self-management. This in turn may inform development of high quality, young-person friendly healthcare services, described as the ‘Cinderella’ of the NHS. <h3>Disclosure of interest</h3> None Declared.
Case 18-1990
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Karim A. Fawaz, Carolyn C. Compton
Journal: New England Journal of Medicine (1990)

Presentation of CaseA 58-year-old man was admitted to the hospital because of hematochezia.The patient was in a stable state of health until the early morning of the day of entry, when he awoke with the urge to defecate and passed a dark-red liquid stool. After the passage of several additional stools of similar nature he was persuaded by his wife to come to the Emergency Ward.The patient was a personnel manager. There was a 20-year history of insulin-dependent diabetes mellitus, which was currently regulated on 30 units of NPH insulin in the morning and 18 units before . . .
Uracil Mustard, a New Alkylating Agent for Oral Administration in the Management of Patients with Leukemia and Lymphoma
Authors: B. J. Kennedy, Athanasios Theologides
Journal: New England Journal of Medicine (1961)

SINCE the introduction of nitrogen mustard, methyl-bis-β-(chloroethyl)-amine, or HN2 (Fig. 1), as a therapeutic agent in human cancer a number of analogues and related alkylating agents have been synthesized and evaluated as potential antitumor drugs. The goal has been to obtain compounds exhibiting greater antitumor effect and less general toxicity to the host.Lyttle and Petering1 , 2 synthesized 5-bis-(2-chloroethyl)-aminouracil, uracil mustard, or NSC-34462 or U-8344 (Fig. 2), replacing the methyl group of nitrogen mustard with a physiologically active group, uracil. This agent, which does not appear to be a uracil antagonist, has been found to be a particularly active carcinostatic . . .
Soundings: Friday the 13th
Authors: James Owen Drife
Journal: BMJ (1998)

The breathing trouble had begun on Monday with an unusually poor showing in the Railtrack sprint. Then came difficulty going upstairs. Just a virus, said I, but on Friday the 13th I had unilateral calf pain and breathlessness going downstairs too.

Words like “barndoor” spring to mind but I had just proof read the latest maternal mortality report, with its sharp increase in pulmonary embolism and its comments on doctors who ignore the signs. When I developed a full house myself I naturally thought it was my imagination.

Finally in theatre, dyspnoea on scrubbing made me call a physician. He seemed impressed. So were the staff when the professor, still in surgeon’s pyjamas but now with an oxygen mask, was wheeled out on a trolley. Surely the operation had not been that difficult? My first emotion was relief that this was not hypochondria. The next was gratitude—to the porter who knew where in the reorganised hospital the computed tomography scanner was, to the nurse who stayed with me until my wife arrived, and to the radiographer who warned me that contrast medium produces strange feelings in the perineum.

In an emergency, carers communicate by body language. You can feel the team working together and you want to play your part, albeit horizontally. All my questions were put on hold except the big one: who would give tonight’s after dinner speech?

After years in obstetrics, I feared I would be given a choice of treatment options. Thank goodness, these were proper doctors. A young consultant told me that I would get streptokinase. OK? Yup. Later the cardiothoracic surgeon dropped by, watchful and impressive, neither fazed nor wistful about the chance of operating on a member of the General Medical Council.

Wired up on the ward, I had time to reflect. I should not have worn those new long socks during a week of non-stop travel. Is that pump really working? The link to my arm seemed so fragile. Something steam driven with brass tubes would inspire more confidence. What would I like to be called, asked the nurse. In Tony Blair’s new Britain it had to be Jim.

I watched the clock. The annual dinner would be nearly over. On balance, it had been a lucky day, but I would feel happier when Saturday the 14th arrived.
Antimicrobial Treatment for Viral and Related Infections
Authors: Maxwell Finland
Journal: New England Journal of Medicine (1952)

BEFORE the introduction of aureomycin it was generally conceded that the so-called primary atypical or "viral" pneumonias were not benefited by the available antimicrobial agents.1 Indeed, the failure of a patient with an acute pulmonary infection to respond favorably to treatment with sulfonamides and penicillin was often accepted as one of the major criteria for the diagnosis of primary atypical pneumonia, provided that evidence for the presence of a definite inciting cause or agent could not be demonstrated. With the establishment of effectiveness of aureomycin and chloramphenicol against rickettsial infections and against infections with organisms of the psittacosis-lymphogranuloma-venereum-trachoma group,2 , 3 it . . .
Cardiovascular and Metabolic Responses to Exercise in a Patient with McArdle's Syndrome
Authors: Daniel Porte, Daniel W. Crawford, Donald B. Jennings, Clive Aber, Malcolm B. McIlroy
Journal: New England Journal of Medicine (1966)

IN 1951 McArdle1 described a patient who was unable to exercise for more than five or ten minutes without becoming fatigued and who noted that his exercised muscles became stiff and swollen. A defect in the breakdown of muscle glycogen was postulated but not demonstrated. Several years later Schmid and Mahler2 and Pearson, Rimer and Mommaerts3 reported similar cases and demonstrated a lack of muscle phosphorylase "b". Subjects with this syndrome can exercise for a longer time during intravenous infusion of a variety of substrates including glucose,1 2 3 fructose, lactate and emulsified fat.3 In addition, Pearson et al.3 noted that exercise . . .
Impaired Orthostatic Tolerance after Bed Rest in Patients with Myocardial Infarction
Authors: Khaja Fareeduddin, Walter H. Abelmann
Journal: New England Journal of Medicine (1969)

In the presence of coronary atherosclerosis, systemic hypotension may result in acute ischemic damage to the myocardium. In 22 patients convalescing from acute myocardial infarction, orthostatic tolerance was studied by means of measurements of heart rate and blood pressure after bed rest. Tests were repeated after full mobilization in 16 patients. In five of 10 patients treated with strict bed rest for nine to 24 days, systemic blood pressure transiently fell by more than 38 mm of mercury during 15 minutes of passive, upright tilt to 70°, a response abolished after full ambulation. This response was also seen in three of eight patients assuming a passive, sitting posture after strict bed rest. It was usually asymptomatic. The response was not observed in eight patients treated with modified bed rest. Strict bed rest in the treatment of acute myocardial infarction may result in cardiovascular deconditioning. Initial mobilization of such patients should be gradual and under careful supervision.