tbuckley/cabot-search huggingface dataset:
Case 32-2001
Authors: Helen M. Hollingsworth, Eugene J. Mark
Journal: New England Journal of Medicine (2001)

Presentation of CaseA 77-year-old man was transferred to this hospital because of worsening bilateral air-space disease and acute renal failure.He had stopped smoking 30 years before admission. He had mild chronic obstructive pulmonary disease; hypertension, for which he was taking lisinopril; and rheumatoid arthritis, which had begun one and a half years before admission and was being treated with indomethacin and hydroxychloroquine.Six days before admission, the patient entered another hospital because of an acute onset of dyspnea, without fever. Bilateral rales and rhonchi were audible. A thoracic radiograph showed numerous diffuse pulmonary opacities and a minimal right-sided . . .
Male Hypogonadism with Gynecomastia Caused by Late-Onset Deficiency of Testicular 17-Ketosteroid Reductase
Authors: M Castro-Magana, M Angulo, J Uy
Journal: New England Journal of Medicine (1993)

17-Ketosteroid reductase deficiency results in male pseudohermaphroditism because conversion of the weak androgen androstenedione to the more potent androgen testosterone is impaired. If a late-onset form exists, hypogonadism and gynecomastia caused by decreased testosterone production and increased estrogen production, respectively, would be expected as the major clinical manifestations in men.
Case 33-1994
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, Kim A. Eagle, John T. Fallon
Journal: New England Journal of Medicine (1994)

Presentation of CaseA 41-year-old woman was transferred to this hospital because of thrombocytopenia, anemia, and changed mental status.There was a history of treated hypothyroidism, well-controlled hypertension, and mild anemia of several years' duration accompanied by slight leukopenia. Hematologic studies were performed seven months before admission (Table 1). A test for antinuclear antibodies, performed 11 months before admission, was negative. The patient was otherwise well until five days before admission, when she was admitted to another hospital because of one week of substernal pain that radiated to the left hand, tingling in the right leg, intermittent headaches, and light . . .
OP0108 Risk Factors for Progression of Knee Joint Osteoarthrosis (5-Year Prospective Study)
Authors: N. Kashevarova, E. Zaitseva, O. Pushkova, A. Smirnov, N. Demin, L. Alekseeva, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Objectives</h3> To identify risk factors for progression of knee joint osteoarthrosis (OA). <h3>Methods</h3> Prospective 5-year study included 110 female-patients with primary knee OA (ACR criteria), mean age – 59,11±8,95 y., average disease duration – 12,2±10,4 y. All relevant patients9 data, including anthropometric parameters, case history, clinical examination findings, evaluation of pain intensity by VAS, knee joint status and therapeutic modalities used during the follow up period were recorded in individual patient9s file. Instrumental diagnostic methods used in each patient included plain radiography of knee joints (gonarthrosis stage was classified by Kellgren J.- Lawrence J. scale), dual energy X-ray absorptiometry (DEXA) of lumbar spine, femoral neck and of subchondral bone of the hip and tibia, ultrasound (US) and MRI examination of knee joints. <h3>Results</h3> After 5 year follow up radiographic progression was stated in 40 patients (Group 1), while in 70 patients Kellgren J.- Lawrence J. stage remained unchanged (Group 2). Patients from both groups were similar in terms of age and disease duration. Although, patients with OA progression had more intense knee pain when walking: 66,2±17,9 vs 55,1±18,24 (<i>p</i>=0,003) (mm); higher BMI: 33,2±6,05 vs 30,5±5,63 (<i>p</i>=0,021) (kg/m<sup>2</sup>); higher incidence of synovitis: 50,0% vs 18,6%, <i>p</i>=0,001, and bone marrow edema in medial tibia aspect: 72,5% vs 27,1%, <i>p</i>=0,001, higher rate of serious medial meniscus damage: 52,5% vs 24,3%, <i>p</i>=0,003 as compared to patients from Group 2 without OA progression. Patients9 re-examination in 5 years revealed similar statistically significant difference between the groups in all evaluated parameters. Discriminate analysis identified the following major risk factors, responsible for gonarthrosis progression: obesity, synovitis and bone marrow edema. Based on identified factors and their coefficients a predictive model was suggested (with area under the curve – AUC- equal to 0,87), allowing to prognosticate the future course of the disease in a particular patient with high precision, i.e. 75% sensitivity and 78% specificity. <h3>Conclusions</h3> Obesity, synovitis, bone marrow edema- are major risk factors responsible for progression of knee OA. <h3>Disclosure of Interest</h3> None declared
The Antibiotic Therapy of Tuberculous Meningitis
Authors: Louis Ravreby, Gerald H. Caron, Vasilios A. Georgantas
Journal: New England Journal of Medicine (1952)

DURING the five-year period 1947–1951, 40 cases of tuberculous meningitis in children were treated with antibiotics at the North Reading State Sanatorium. This institution has been designated as a treatment center for children with active lung tuberculosis. The majority of the meningitis patients came from hospitals throughout the state after diagnosis was made and treatment started in those hospitals.The observation periods have been long enough, in a considerable number of the cases, to enable the writers to formulate some concepts concerning the management of the most serious form of tuberculosis. A variety of the therapeutic regimens employing para-aminosalicylic acid . . .
Transfusion Treatment of Shock Due to Myocardial Infarction
Authors: Franklin H. Epstein, Arnold S. Relman
Journal: New England Journal of Medicine (1949)

THE pathogenesis and treatment of the vascular collapse often attending myocardial infarction have perplexed investigators for many years. Particularly vigorous in recent years has been the debate over the safety and efficacy of treatment with transfusions of blood or plasma. Although a few case reports of such treatment have appeared in the literature1 , 2 and many opinions have been given pro3 4 5 and con,6 7 8 no series of cases has yet been published.At the New Haven Hospital transfusion of patients in shock after myocardial infarction has both advocates and opponents. During the past six years some of these patients have been given . . .
A Preliminary Study of Aerosolized Recombinant Human Deoxyribonuclease I in the Treatment of Cystic Fibrosis
Authors: Richard C. Hubbard, Noel G. McElvaney, Peter Birrer, Steven Shak, Woodrow W. Robinson, Clara Jolley, Margaret Wu, Milica S. Chernick, Ronald G. Crystal
Journal: New England Journal of Medicine (1992)

CYSTIC fibrosis is a lethal recessive genetic disorder caused by mutations of the cystic fibrosis transmembrane conductance regulator, a gene comprising 27 exons and 250 kilobases that resides on chromosome 7.1 2 3 4 5 The most important clinical manifestation of cystic fibrosis is chronic progressive lung disease, which despite aggressive antibiotic therapy and chest physiotherapy, remains the principal cause of disability and death.1 Airway secretions play a major part in the respiratory dysfunction in cystic fibrosis. The secretions are thick, viscous, and difficult to expectorate, and they obstruct airways and contribute to reduced lung volumes and expiratory flow rates.1 , 2 , 6 The presence of high . . .
Treatment of Severe Chloroquine Poisoning
Authors: B Riou, P Barriot, A Rimailho, F J Baud
Journal: New England Journal of Medicine (1988)

No therapy has been proved to be effective for patients with severe chloroquine poisoning, which is usually fatal. In a retrospective study of 51 cases, we found that ingestion of more than 5 g of chloroquine was an accurate predictor of a fatal outcome, and therefore chose this dose as the criterion for severe chloroquine poisoning. We selected as a control group 11 consecutive patients who had ingested more than 5 g of chloroquine between July 1983 and December 1985. We then undertook a prospective study to determine whether a better outcome could be obtained with immediate mechanical ventilation and the administration of diazepam and epinephrine. Eleven consecutive patients who ingested more than 5 g of chloroquine in 1986 received this combination therapy. Ten of these patients survived, whereas only one control had survived (P = 0.0003). There was no significant difference between the combination-therapy and control groups in age (29 +/- 3 vs. 27 +/- 2 years), amount of chloroquine ingested (7.5 +/- 0.5 vs. 8.5 +/- 0.8 g), systolic arterial pressure (74 +/- 2 vs. 74 +/- 3 mm Hg), or QRS duration (0.14 +/- 0.01 vs. 0.14 +/- 0.01 second). In our combination-therapy group, blood chloroquine levels ranged from 40 to 80 mumol per liter, whereas a literature search showed that no patient in whom blood levels were more than 25 mumol per liter had survived. These preliminary data suggest that combining early mechanical ventilation with the administration of diazepam and epinephrine may be effective in the treatment of severe chloroquine poisoning.
Randomized Comparison of Surveillance Intervals after Colonoscopic Removal of Newly Diagnosed Adenomatous Polyps
Authors: Sidney J. Winawer, Ann G. Zauber, Michael J. O'Brien, May Nah Ho, Leonard Gottlieb, Stephen S. Sternberg, Jerome D. Waye, John Bond, Melvin Schapiro, Edward T. Stewart, Joel Panish, Fred Ackroyd, Robert C. Kurtz, Moshe Shike
Journal: New England Journal of Medicine (1993)

The identification and removal of adenomatous polyps and post-polypectomy surveillance are considered to be important for the control of colorectal cancer. In current practice, the intervals between colonoscopies after polypectomy are variable, often a year long, and not based on data from randomized clinical trials. We sought to determine whether follow-up colonoscopy at three years would detect important colonic lesions as well as follow-up colonoscopy at both one and three years.
Effect of the Ownership of Dialysis Facilities on Patients' Survival and Referral for Transplantation
Authors: Pushkal P. Garg, Kevin D. Frick, Marie Diener-West, Neil R. Powe
Journal: New England Journal of Medicine (1999)

More than 200,000 patients with end-stage renal disease undergo dialysis in the United States each year, about two thirds in for-profit centers. Economic pressures, such as the decline in inflation-adjusted Medicare payments for dialysis, may compromise the quality of care. Facilities may also be reluctant to refer patients to be evaluated for transplantation because of the loss of revenues from dialysis after patients receive transplants. It is unknown whether for-profit facilities respond more aggressively than not-for-profit facilities to these financial pressures. Therefore, we examined the effect of for-profit ownership of dialysis facilities on patients' survival and referral for possible transplantation.We used data from the U.S. Renal Data System to assemble a nationally representative cohort of patients with end-stage renal disease of recent onset. We followed patients for a minimum of three years and a maximum of six years, until death, placement on the waiting list for a renal transplant, or loss to follow-up, or until May 31, 1996. We used proportional-hazards models to assess the effect of the profit status of the dialysis facility on patients' outcomes and adjusted for differences in sociodemographic, clinical, and facility-level characteristics.Of the 3681 patients who were eligible for inclusion, we included 3569 in the analysis of mortality and 3441 in the analysis of the waiting list. The crude mortality rate per 100 person-years of end-stage renal disease was 21.2 for patients treated in for-profit facilities and 17.1 for patients treated in not-for-profit centers (adjusted relative hazard, 1.20; 95 percent confidence interval, 1.02 to 1.42). The likelihood of being placed on the waiting list for a renal transplant was lower for patients treated at for-profit centers (adjusted relative hazard, 0.74; 95 percent confidence interval, 0.56 to 0.98).In the United States, for-profit ownership of dialysis facilities, as compared with not-for-profit ownership, is associated with increased mortality and decreased rates of placement on the waiting list for a renal transplant.
A Novel MIF Signaling Pathway Drives the Malignant Character of Pancreatic Cancer by Targeting NR3C2
Authors: Shouhui Yang, Peijun He, Jian Wang, Aaron Schetter, Wei Tang, Naotake Funamizu, Katsuhiko Yanaga, Tadashi Uwagawa, Abhay R. Satoskar, Jochen Gaedcke, Markus Bernhardt, B. Michael Ghadimi, Matthias M. Gaida, Frank Bergmann, Jens Werner, Thomas Ried, Nader Hanna, H. Richard Alexander, S. Perwez Hussain
Journal: Cancer Research (2016)

Abstract Pancreatic cancers with aberrant expression of macrophage migration inhibitory factor (MIF) are particularly aggressive. To identify key signaling pathways that drive disease aggressiveness in tumors with high MIF expression, we analyzed the expression of coding and noncoding genes in high and low MIF-expressing tumors in multiple cohorts of pancreatic ductal adenocarcinoma (PDAC) patients. The key genes and pathways identified were linked to patient survival and were mechanistically, functionally, and clinically characterized using cell lines, a genetically engineered mouse model, and PDAC patient cohorts. Here, we report evidence of a novel MIF-driven signaling pathway that inhibits the orphan nuclear receptor NR3C2, a previously undescribed tumor suppressor that impacts aggressiveness and survival in PDAC. Mechanistically, MIF upregulated miR-301b that targeted NR3C2 and suppressed its expression. PDAC tumors expressing high levels of MIF displayed elevated levels of miR-301b and reduced levels of NR3C2. In addition, reduced levels of NR3C2 expression correlated with poorer survival in multiple independent cohorts of PDAC patients. Functional analysis showed that NR3C2 inhibited epithelial-to-mesenchymal transition and enhanced sensitivity to the gemcitabine, a chemotherapeutic drug used in PDAC standard of care. Furthermore, genetic deletion of MIF disrupted a MIF–mir-301b–NR3C2 signaling axis, reducing metastasis and prolonging survival in a genetically engineered mouse model of PDAC. Taken together, our results offer a preclinical proof of principle for candidate therapies to target a newly described MIF–miR-301b–NR3C2 signaling axis for PDAC management. Cancer Res; 76(13); 3838–50. ©2016 AACR.
Prospective randomized phase II study of FOLFIRI versus FOLFOX7 in advanced gastric adenocarcinoma: A Chinese Western Cooperative Gastrointestinal Oncology Group study.
Authors: Feng Bi, Qiu Li, Feng Wen, Chengya Zhou, Meng Qiu, Jiyan Liu, Jing Chen, Cheng Yi, Zhiping Li, Deyun Luo, Feng Xu, Xiaohong Cai
Journal: Journal of Clinical Oncology (2016)

1 Background: The purpose was to compare mFOLFIRI (arm A) with mFOLFOX7 (arm B) as first-line treatments in patients (pts) with locally advanced gastric adenocarcinoma in an open, randomized, phase II study. Methods: Previously untreated metastatic or recurrent gastric adenocarcinoma pts with measurable disease received mFOLFIRI (arm A) or mFOLFOX7 (arm B) every 2 weeks. The second-line treatment was mFOLFOX7 for arm A and mFOLFIRI for arm B. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were overall survival (OS), disease control rate (DCR) and toxicity. Results: In total, 200 pts were included. The evaluable population consisted of 128 pts (54 in arm A; 74 in arm B). The median PFS of arm A was 2.9 months (m) (1.9 to 4.1 m) versus 4.1 m (3.2 to 4.8 m) for arm B(p0.109). The median OS was 9.9 months (6.0 to 13.5 m) for arm A versus 12.0 m for arm B (10.3 to 13.7m; p= 0.431). The DCRs for arm A and arm B were 59.3% and 66.3%, respectively (p = 0.850). In subgroup analysis of the pts who completed both treatment lines per protocol, the median OS was 11.0 m (5.1 to 16.9 m) for the mFOLFIRI/mFOLFOX7 group and 20.2 m (13.4 to 26.6 m) for the mFOLFOX7/mFOLFIRI group ( p= 0.030). Both regimens were well-tolerated with acceptable and manageable toxicities. Grade ¾ adverse events were 53.2% and 55.4% in arm A and arm B, respectively. Conclusions: There was no significant difference in the PFS or DCR. However, mFOLFOX7 followed by mFOLFIRI might have a better OS. Clinical trial information: ChiCTR-TRC-08000167. [Table: see text]
Changes in Simian Virus 40 Susceptibility and Chromosome Numbers During Long-Term Cultivation of BS-C-1 Cells
Authors: G. A. Tomkins, D. Pye
Journal: JNCI Journal of the National Cancer Institute (1968)

Cytogenetic studies were performed on cultures of an established Cercopithecus monkey kidney cell line, BS-C-1. The susceptibility of each culture to simian virus (SV40) was determined during long-term cultivation by the production of a cytopathic effect in the culture. The chromosome number of BS-C-1 cells cultured for more than 60 subcultures often increased from the diploid to the near-tetraploid region. In some instances, this change was accompanied by a loss of susceptibility of the cells to SV40 infection. Sublines of BS-C-1 cells were isolated and compared to their parent cultures. These sublines retained their diploid chromosome numbers, while the chromosome number of the parent cultures increased from the diploid to the near-tetraploid region. In one culture the parent line, but not the sublines, showed a loss of susceptibility to SV40 infection. In the second culture, both the parent line and the sublines were less susceptible to SV40. Possible reasons for this variability are discussed.
Cesarean Section at the Boston City Hospital, 1936–1946
Authors: Daniel J. McSweeney, Arthur J. Hassett
Journal: New England Journal of Medicine (1948)

AT THE Boston City Hospital in the ten-year period from 1936 to 1946 there were 961 cesarean sections — 3.3 per cent of 28,341 deliveries, or 1 cesarean section in every 29 cases. This incidence is about the same as that reported by Duncan and Doyle1 for the previous ten years, in which there were 703 sections in 22,880 deliveries, an incidence of 3.07 per cent. The Boston Lying-in Hospital2 reported an incidence of 3.4 per cent on its ward service, and the State of Massachusetts 3.3 per cent.3 These figures suggest a general attitude of conservatism throughout Massachusetts in . . .
Transient Hyperammonemia of the Preterm Infant
Authors: Roberta A. Ballard, Barry Vinocur, John W. Reynolds, Richard P. Wennberg, Allen Merritt, Lawrence Sweetman, William L. Nyhan
Journal: New England Journal of Medicine (1978)

We report on five preterm infants (34 to 36 weeks' gestation) in whom an overwhelming illness developed within the first 48 hours of life. Each had mild respiratory distress that progressed within 48 hours to deep coma requiring ventilatory assistance. Ammonia concentrations in the plasma ranged from 844 to 7640 microgram per deciliter. Four received exchange transfusion and peritoneal dialysis; ammonia values returned to the normal range (less than 150 mug per deciliter) within 72 hours and remained there even after protein challenge. These four subsequently fed and developed normally. The fifth infant died without an attempt to lower plasma ammonia. In this infant (and two of the others) urea-cycle enzymes measured in liver tissue were in the normal range. Transient hyperammonemia of unknown cause may be a relatively common variety of neonatal hyperammonemia; it responds well to prompt diagnosis and aggressive therapy.
Whipworm Infections
Authors: A. G. Hucker, F. D. Schofield
Journal: BMJ (1956)

The mass treatment with piperazine adipate of all the children aged 1 to 14 years on one of the Shetland Isles is described.The object was to rid them of thread- worms.A total of 194 children were treated.A sample group of 50 children were examined by anal swabs, and their mothers questioned about their symptoms, before and after treatment.Before treatment 32 were found to be infested with threadworms.Two weeks after treatment all 30 who completed the course were free of infestation.Six months later 20 had become reinfested, but one month after a second course of treatment all were again free.There was also amelioration in symptoms, generally ascribed to threadworm infestation, with the notable exception of enuresis.Side-effects of treatment were few and unimportant.It is concluded that mass treatment with piperazine adipate is effective in eradicating threadworm infestation in a community of children, but to prevent relapse parents, especially the mothers, must be treated at the same time.My thanks are due to Dr. S. A. B. Black, medical officer ot Health for Zetland, for his advice and encouragement; to Nurse Cowie, who helped to distribute the piperazine adipate; to the headmasters of Livister Primary School and Brough Secondary School for their willing co-operation; and to British Drug Houses Ltd., who generously supplied, free, the large amount of piper- azine adipate required in the form of " entacyl " tablets.My
Still Hazy after All These Years
Authors: Eldad Ben-Chetrit, Chaim Putterman
Journal: New England Journal of Medicine (1994)

A 23-year-old woman of Moroccan Jewish origin was admitted to the hospital with abdominal pain. She had had recurrent attacks of abdominal pain, sometimes with fever, for the previous three months. There were no other gastrointestinal or urinary tract symptoms. Her medical history was unremarkable, and her parents were not related.Acute abdominal pain may occur in a number of medical conditions. Common causes include gastroenteritis, urinary tract infection, salpingitis, intestinal obstruction, intestinal ischemia, and irritable bowel syndrome. However, a history of recurrent attacks of abdominal pain with fever in a patient of Mediterranean origin immediately suggests a . . .
Massive Cardiac Tamponade in Uremic Pericarditis with Complete Recovery
Authors: George Merikas, Miltiades Samartzis, Spyros Marketos
Journal: New England Journal of Medicine (1962)

IT has been known for many years that uremic pericarditis has the most unfavorable prognosis of all the various clinical manifestations of chronic renal disease.1 That pericardial effusion may result in cardiac tamponade as a terminal event in the course of uremic pericarditis was pointed out recently by Goodner and Brown.2 However, these authors, on the basis of autopsy findings, suggested that this complication is a potentially reversible one, and that its prompt recognition and treatment may be lifesaving.This point was demonstrated by Guild, Bray and Merrill,3 who reported 2 cases of cardiac tamponade from hemopericardium in patients with . . .