tbuckley/cabot-search huggingface dataset:
Case 54-1964
Authors: John A. Mills, Jonas Hallgrimsson
Journal: New England Journal of Medicine (1964)

Presentation of CaseA fifty-three-year-old woman was admitted to the hospital because of weakness of the leg.She had had severe rheumatoid arthritis for seventeen years and for the past eight years had been treated with prednisone, 0.9 gm. daily, in addition to aspirin. A myocardial infarction had occurred two years before admission. Ten months before entry she was involved in an automobile accident, sustaining fracture and dislocation of the fifth cervical vertebra, and was placed in cervical traction and a collar. Four months later, while arising suddenly from a chair, she experienced severe pain over the low dorsal region. . . .
SAT0341 Polymyalgia Rheumatica and its Association with Cancer
Authors: E. Pfeifer, C. Crowson, B. Major, E. Matteson
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Polymyalgia rheumatica (PMR) is a common rheumatologic disease in the elderly population. Several other rheumatologic conditions, including rheumatoid arthritis and systemic lupus erythematosus have been associated with certain forms of cancer. Studies on the relationship between PMR and cancer have yielded mixed results, with one finding up to a 69% increase in the risk of cancer in the first 6 months after diagnosis with PMR while other studies have found no association. These studies have been limited by small sample sizes, limited follow up time and cohort source. <h3>Objectives</h3> The purpose of this study is to further investigate if, based on data obtained through the Rochester Epidemiology Project, there is an association between PMR and development of cancer. <h3>Methods</h3> A population-based cohort of PMR patients diagnosed between 1/1/1970 and 12/31/1999 was assembled. A comparison cohort of subjects with similar age and sex was also established. Records of the PMR and comparator subjects were reviewed for details concerning diagnosis of cancer. For each malignancy the date of diagnosis, site and type of malignancy were collected. Descriptive statistics were used to summarize the data comparing the PMR and non-PMR cohorts. The cumulative incidence of malignancy in patients with and without PMR, adjusted for the competing risk of death, was estimated and compared using methods by Gray. Cox proportional hazards models were used to assess the trends in malignancy over time. <h3>Results</h3> This study included 359 patients diagnosed with PMR and 357 non-PMR subjects. The individuals in these two comparison groups were similar in age (mean age in years ± SD: PMR 73.5±8.5, non-PMR 73.3±8.5), sex (PMR 66.6% female, non-PMR 66.9% female) and follow up time (mean follow up time in years ± SD: PMR 11.8±6.7, non-PMR 10.7±7.4). There was no significant difference in the prevalence of malignancy prior to PMR incidence date/index date between the two groups, with prior malignancies in 41 (11%) of PMR patients and 50 (14%) of non-PMR subjects (p-value 0.31). Analysis of individual solid and hematologic malignancies also revealed no difference between the two groups. Following PMR incidence, evaluation of the cumulative incidence of malignancy at 10 years for PMR patients and non-PMR subjects also showed no difference between the two groups (cumulative incidence at 10 years ± SE: PMR 13.8±2.0, control 13.1±2.0; p-value 0.89). <h3>Conclusions</h3> There is no increased risk of malignancy in patients who are diagnosed with PMR when compared to subjects without PMR in this population-based cohort study. <h3>Disclosure of Interest</h3> None declared
Cancer patients with ECOG-PS higher than 1: Who are those who benefit of palliative chemotherapy?
Authors: Rafael Caires-Lima, Bruno Mendonça Protásio, Inacelli Queiroz de Souza Caires, Lucila Soares Da Silva Rocha, Julia Andrade De Oliveira, Raquel Bezerra Guerra, Milena Perez Mak, Paulo M. Hoff, Gilberto Castro
Journal: Journal of Clinical Oncology (2013)

9561 Background: Palliative chemotherapy (PC) is a treatment option in pts with metastatic cancer. Although pts with ECOG-PS &gt; 1 are underrepresented in clinical trials, they are often treated with PC in daily practice. We aimed to identify factors associated with poorer survival and lack of benefit of PC in this subset of pts. Methods: We conducted a case-control retrospective analysis of 301 consecutive pts with solid tumors and ECOG-PS &gt; 1 when initiated PC, selected from 2514 pts who died between Aug/2011 and Jul/2012 in a tertiary cancer care institution or its hospice. Cases were defined as those pts who survived &lt; 90d after the first cycle of first line PC, and controls were those who had a longer survival. Frequencies were compared by chi-square test or Fisher exact test. Risks were estimated by odds ratios (OR) and logistic regression analysis. Overall survival (OS) was calculated by Kaplan-Meier method and curves was compared using log-rank test. Results: 142 cases/159 controls were included: median age 58/63 y.o. (p=0.09; t-test) and 49%/50% female (p=0.941; chi-square). Gastrointestinal and lung cancers were the most frequent primaries (31 and 17%, respectively). Factors associated with poorer OS were age &gt; 60 y.o. (OR 1.7; 95%CI 1.0–2.6), ECOG-PS &gt; 2 (1.9; 1.2–3.1), weight loss &gt; 10% (1.8; 1.1-2.8), hemoglobin &lt; 10 g/dL (2.6; 1.6-4.2), albumin &lt; 3 g/dL (2.7; 1.5-5.1), serum creatinine (sCr) &gt; 1 mg/dL (2.8; 1.6-5.0), C-reactive protein ≥ 5 mg/L (8.6; 1.0-72.9), altered mental status (4.2; 1.4-13.2) and in-hospital PC (3.2; 1.9-5.2). Cases were more likely to experience grade ≥ 3 toxicity (43 vs. 28%; p=0.005), die of toxicity (16 vs. 6%; p = 0.0007) and not be offered palliative care only (47 vs. 71%; p&lt;0.0001). mOS was 204 and 34d among controls and cases, respectively (HR 0.177; 95%CI 0.015-0.033, p&lt;0.0001). Median time to death was 39.5d (0-1103). Logistic regression analysis identified ECOG-PS &gt; 2 (OR 2.3, p=0.044) and sCr &gt; 1 mg/dL (OR 11.2, p=0.0002) as independent predictors of 3-mo fatality. Conclusions: ECOG-PS &gt; 2 and elevated sCr were identified as independent predictors of poor OS in these pts. PC needs to be prescribed with caution in ECOG-PS &gt; 1 pts, since it seems to offer no benefit in OS and could lead to abbreviation of life.
Reply
Authors: Søren Torp‐Pedersen, Robin Christensen, Karen Ellegaard, Arendse Torp‐Pedersen, Marcin Szkudlarek, Maria Antonietta D'Agostino, Annamaria Iagnocco, Esperanza Naredo, Peter Balint, Richard J. Wakefield, Lene Terslev, Jørgen Arendt Jensen
Journal: Arthritis & Rheumatology (2015)
P1008 : Value of controlled attenuation parameter (CAP) in the clinical practice: preliminary results
Authors: G. Ferraioli, R. Lissandrin, C. Tinelli, E. Above, C. Dellafiore, M. Di Gregorio, G. Poma, M. Zicchetti, R. Maserati, C. Filice
Journal: Journal of Hepatology (2015)
Hepatic arterial infusion chemotherapy using low-dose cisplatin and 5-fluorouracil (5-FU) in the treatment of patients with advanced hepatocellular carcinoma with portal vein tumor thrombus or refractory to transarterial chemoembolization: A single institute outcome analysis
Authors: T. Nishimura, S. Matsumoto, M. Kanai, H. Ishiguro, T. Kitano, K. Yanagihara, M. Fukushima
Journal: Journal of Clinical Oncology (2009)

e15563 Background: Although sorafenib has been reported to prolong survival of patients with advanced hepatocellular carcinoma (HCC), the prognosis of those who did not respond to or are not candidate to transarterial chemoembolization (TACE) remains poor. The aim of this outcome analysis is to evaluate the safety and efficacy of hepatic arterial infusion chemotherapy (HAIC) via a subcutaneously implanted injection port in the treatment of such patients. Methods: From the prospective cohot database of Outpatient Oncology Unit, Kyoto University Hospital, patients with HCC who had been treated with HAIC using low dose cisplatin and 5-FU (cisplatin 10mg and 5-FU 250mg for day 1–5, repeated serially for three or four weeks, then repeated once weekly) between October 2003 and December 2008 were searched for. All adverse events were assessed according to Common Terminology Criteria for Adverse Events v3.0. Survival analysis was performed by using Kaplan-Meier method. Prognostic factors were assessed using Log-rank test. Results: Forty-one patients were identified. The indications of HAIC were: (1) the presence of portal vein tumor thrombus (20/41 cases, 49%), (2) failure to TAE (19/41, 46%) or (3) not candidate for TAE due to the presence of extrahepatic disease (2/41 case, 5%). One complete response and 7 partial responses were observed, overall response rate being 19.5% (95%CI, 7.4–31.6%). Median overall survival was 26.1 month (95%CI: 9.6–45.6). Commonly observed grade 3/4 adverse events were thrombocytopenia (10 cases, 16.3%) and neutropenia (10 cases, 16.3%). There was a trend that fewer death occur in patients who responded to HAIC (1/8 cases, 12.5%) as compared to patients who did not (11/33, 33.3%), but log-rank test failed to detect a statistical significance (P=.145). Conclusions: HAIC for patients with advanced HCC who are not candidate for TACE warrants randomized controlled trial. No significant financial relationships to disclose.
Breaking Good
Authors: Benjamin W. Corn
Journal: JAMA (2014)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Drug Allergy
Authors: Charles W. Parker
Journal: New England Journal of Medicine (1975)

Drug Reactions Suspected of Being AllergicThe role of allergy in drug-induced inflammation of the liver, kidney, lungs and small blood vessels is not well defined. Very frequently, some form of direct toxicity appears to be involved, as suggested by its high rate, the rapid induction of symptoms in the absence of known previous exposure and an inability to demonstrate marked fluctuations in sensitivity in serial studies of the same patient. On the other hand, examples can be cited in which the available evidence favors an immune mechanism. For example, in hepatitis induced by aminosalicylates, sulfonamides . . .
Lung Recruitment Assessed by Respiratory Mechanics and Computed Tomography in Patients with Acute Respiratory Distress Syndrome. What Is the Relationship?
Authors: Davide Chiumello, Antonella Marino, Matteo Brioni, Irene Cigada, Federica Menga, Andrea Colombo, Francesco Crimella, Ilaria Algieri, Massimo Cressoni, Eleonora Carlesso, Luciano Gattinoni
Journal: American Journal of Respiratory and Critical Care Medicine (2015)

The assessment of lung recruitability in patients with acute respiratory distress syndrome (ARDS) may be important for planning recruitment maneuvers and setting positive end-expiratory pressure (PEEP).To determine whether lung recruitment measured by respiratory mechanics is comparable with lung recruitment measured by computed tomography (CT).In 22 patients with ARDS, lung recruitment was assessed at 5 and 15 cm H2O PEEP by using respiratory mechanics-based methods: (1) increase in gas volume between two pressure-volume curves (P-Vrs curve); (2) increase in gas volume measured and predicted on the basis of expected end-expiratory lung volume and static compliance of the respiratory system (EELV-Cst,rs); as well as by CT scan: (3) decrease in noninflated lung tissue (CT [not inflated]); and (4) decrease in noninflated and poorly inflated tissue (CT [not + poorly inflated]).The P-Vrs curve recruitment was significantly higher than EELV-Cst,rs recruitment (423 ± 223 ml vs. 315 ± 201 ml; P < 0.001), but these measures were significantly related to each other (R(2) = 0.93; P < 0.001). CT (not inflated) recruitment was 77 ± 86 g and CT (not + poorly inflated) was 80 ± 67 g (P = 0.856), and these measures were also significantly related to each other (R(2) = 0.20; P = 0.04). Recruitment measured by respiratory mechanics was 54 ± 28% (P-Vrs curve) and 39 ± 25% (EELV-Cst,rs) of the gas volume at 5 cm H2O PEEP. Recruitment measured by CT scan was 5 ± 5% (CT [not inflated]) and 6 ± 6% (CT [not + poorly inflated]) of lung tissue.Respiratory mechanics and CT measure-under the same term, "recruitment"-two different entities. The respiratory mechanics-based methods include gas entering in already open pulmonary units that improve their mechanical properties at higher PEEP. Consequently, they can be used to assess the overall improvement of inflation. The CT scan measures the amount of collapsed tissue that regains inflation. Clinical trial registered with www.clinicaltrials.gov (NCT00759590).
The impact of the psychiatric intensive care unit on patients and staff
Authors: H Rosen
Journal: American Journal of Psychiatry (1975)

Inpatient crisis intervention units have many of the characteristics of medical/surgical intensive care units. The author believes that the environment of these psychiatric intensive care units serves as an important source of stress and may increase the patient's symptomatology and impair the therapeutic effectiveness of the staff. He suggests some modifications in the environment that may ameliorate these effects.
AB0952 Neuropathic Pain Component Under Musculoskeletal Diseases
Authors: V. Povoroznyuk, T. Shinkarenko, U. Pryimych
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Neuropathic pain caused by the musculoskeletal diseases has recently been the focus of numerous studies. <h3>Objectives</h3> The aim of this study was to estimate the structure of pain syndrome and reveal the presence of neuropathic pain component in patients suffering from the musculoskeletal diseases. <h3>Methods</h3> We9ve examined 68 patients aged 45-85 years (average age 67,6±1,3years). Patients were divided into 3 groups: A – patients with osteoporosis and vertebral fractures (N=29), B – patients with low back pain (N=22), C – patients with osteoarthritis of knee joints (N=17). To assess the NP component we used painDETECT, LANSS, DN4 questionnaires. <h3>Results</h3> Regression analysis shows correlation between the questionnaires: LANSS and painDETECT (r=0.73, p=0.000001), DN4 and painDETECT (r=0.73, p=0.000001). 63,6% of patients with osteoporosis examined by painDETECT were unlikely to have the NP component, 17,2% might possibly, 17,2% – probably. LANSS scale: 24,1% were probably to have NP. DN4 scale: 37,9% probably had NP. 63,7% of patients with low back pain examined by painDETECT were unlikely to have NP, 22,7% might possibly, 13,6% – probably. LANSS scale: 22,7% were probably to have NP. DN4 scale: 36,4% had probably NP. 64,7% of patients with osteoarthritis of knee joints examined by painDETECT were unlikely to have the NP component, 29,4% might possibly, 5,9% - probably. LANSS scale: 23,5% probably had NP. DN4 scale: 41,2% had probably NP. <h3>Conclusions</h3> Thus, in patients with musculoskeletal diseases the pain syndrome may include NP features. Identification of these would promote a treatment strategy targeted at the NP. <h3>Disclosure of Interest</h3> None declared
Commentary: Is evidence based patient choice feasible?
Authors: Peter Cantillon
Journal: BMJ (2004)

What could be more ordinary and humdrum (for a clinician) than a case of a woman with osteoarthritis of the knee? Yet a doctor's potential responses to her uncertainty about whether to take a non-steroidal anti-inflammatory drug (NSAID) or paracetomol has stimulated an interesting debate. Tugwell and colleagues have used this case to demonstrate the use of a decision aid as a tool in helping a patient to make an informed choice. The decision aid is clearly very patient centred. It asks the patient to consider exactly what needs to be decided and the pros and cons of different options using visual representations of risk and benefit. It also encourages the patient to decide who should have what role in making the decision. It is clear that such a tool could be of enormous benefit in helping patients make decisions where the balance of the relative benefits and risks of competing options is not obvious.1

There are, however, clear sources of potential bias in the construction of decision aids. Are all the potential risks considered (in this case gastrointestinal bleeding was the only risk assessed for NSAIDs)? Were all the relevant sources of evidence appraised, and is the representation of the synthesised findings appropriate? Should decision aids aim to be more comprehensive? For example, should Mrs Patell be told about alternative therapies and about the other risks associated with taking NSAIDs? If a decision aid becomes more comprehensive will it be too complicated for patients to interpret? Does a partial consideration of the benefits and risks constitute informed choice? Is there not an element of “framing” involved in selecting what to put into a decision aid and what to leave out?

I can see a clear value in using decision aids as tools for teaching students about the concepts of contextual complexity, shared decision making, informed choice, and the explanation of risk. They represent an excellent vehicle for explaining the relevance of numbers needed to treat, numbers needed to harm, etc. If doctors are to use such tools in practice, decision aids need to be readily available (internet or desktop reference), sufficiently flexible to meet different idiosyncratic patient values, and appropriately comprehensive to cover the main risks and benefits that a patient needs to consider. To interpret and explain a decision aid, doctors need to be statistically numerate,2 and other visual means of communicating risk should be considered.3 Above all, doctors need to value the time required to help patients to make informed choices.
AB0399 Rheumatoid Arthritis Impact of Disease: A Global Disease Assessment Index that Correlates with Activity and Function in RA Patients
Authors: T. Meirinhos, R. Aguiar, C. Ambrόsio, A. Barcelos
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Pain is a major feature in rheumatoid arthritis (RA), often occurring with other symptoms and functional impairment, which are difficult to assess. An increasing interest has been dedicated to the patient perspective in the assessment of RA, by using indexes that approach other health domains such as fatigue, well-being and sleep disturbance. <i>Rheumatoid Arthritis Impact of Disease</i> (RAID) includes seven domains (pain, function, fatigue, sleep disturbance, physical and psychological wellbeing, sleep disturbance and coping), which enable the assessment of the global impact of the disease, through the patient perspective. <h3>Objectives</h3> To compare, in a cohort of patients with rheumatoid arthritis, the impact of the disease assessed with RAID questionnaire and <i>Health Assessment Questionnaire</i> (HAQ), and to identify possible association with disease activity (as assessed by DAS28-3v). <h3>Methods</h3> Cross-sectional study, enrolling outpatients attending a Rheumatology Department, diagnosed with RA. All patients answered both HAQ and RAID at the same visit; DAS28-3v was determined. Statistical analysis with SPSS, version 18; a <i>p</i> value &lt;0.05 with a 95% confidence interval was assumed. <h3>Results</h3> Among the 68 patients enrolled, 45 were male; age was 61.15±13.6 years. Mean RAID value was 3.59±2.24; in 21 patients, RAID was ≥5. As expected, the question with higher mean value was that referring to pain (3.93±2.64). Mean HAQ value was 0.3±0.47 and mean DAS28-3v was 2.74±1.06 (corresponding to low disease activity). In our cohort, the increase in RAID value is significantly correlated with an increase in HAQ value – particularly when RAID≥4 (<i>p</i>=0.01). All items assessed by RAID are significantly associated with HAQ value – being the highest correlation identified for functional impairment (<i>p</i>=0.009). RAID value was also associated with DAS28-3v (<i>p</i>=0.02). No correlation was found between RAID and age and no significant difference between genders was identified. <h3>Conclusions</h3> This work demonstrates the usefulness of RAID in the assessment of RA, presenting a good correlation with HAQ, that assesses functional impairment - being this correlation stronger for higher RAID values. In our cohort, there was also a correlation between RAID and disease activity, as assessed using DAS28-3v. The evaluation of RA patients should include autofill indexes that assess global impact of the disease; RAID gathers the features to be included among those indexes. <h3>References</h3> Dougados M, Brault Y, Logeart I, van der Heijde D, Gossec L, Kvien T. Defining cut-off values for disease activity states and improvement scores for patient-reported outcomes: the exemple of the Rheumatoid Arthritis Impact of Disease (RAID). Arthritis Res Ther. 2012 May 30;14(3). <h3>Disclosure of Interest</h3> None declared
Reply to Kim
Authors: Emo van Halsema, Jeanin van Hooft, Cesare Hassan
Journal: Endoscopy (2016)

We thank our colleague Dr. Min Ki Kim for his interest in the European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline “Self-expandable metal stents [SEMSs] for obstructing colonic and extracolonic cancer” [1]. We completely agree that the results in the literature on the oncological outcomes of the use of SEMS as a bridge to surgery are still inconclusive. Nevertheless, the guideline development group felt that, based on the available evidence, a conservative recommendation was justified and we still think that one should be reticent about the use of SEMS as a bridge to surgery in young and fit patients with a potentially curable, left-sided, malignant, colonic obstruction.
DSM-III: the major achievements and an overview
Authors: R L Spitzer, J B Williams, A E Skodol
Journal: American Journal of Psychiatry (1980)

DSM-III will be published early this year. In the first part of this article the authors describe some of the major achievements of DSM-III: the process of its development, reaching consensus on many controversial diagnostic categories and a definition of mental disorder, the provision of diagnostic criteria and a multiaxial evaluation system, and the demonstration of improved diagnostic reliability. In the second part of the article the authors present an overview of DSM-III in which they describe its departures from DSM-II and the reasons for these changes. They conclude that in the next few years there should be systematic study of DSM-III in use, so that information about its strengths and limitations can be made available to those responsible for developing DSM-IV.