tbuckley/cabot-search huggingface dataset:
Pubic apophysitis: 6 questions that need answers before I'm convinced it's a new clinical condition
Authors: J F W Garvey
Journal: British Journal of Sports Medicine (2016)

The description of pubic apophysitis in response to chronic stress in a consecutive retrospective series of 26 male adolescent football players1 is a welcome addition to the literature of a previously under-recognised entity that until now has probably been regarded as ‘osteitis pubis’. However several questions arise.

All 26 players had plain pelvic radiographs and approximately one-third each had either ultrasound, CT scan or MRI scan in addition to the plain radiograph. The radiologists involved in this publication are described as being involved with the comparison group of 31 individuals free from groin injury, all had CT scans and were performed at two different hospitals in France and Australia (not at the hospital at which the diagnostic survey was performed). But did …
Blood Carbonic Anhydrase Activity and Zinc Concentration in Infants with Respiratory-Distress Syndrome
Authors: Leonard I. Kleinman, Harold G. Petering, James M. Sutherland
Journal: New England Journal of Medicine (1967)

CARBONIC anhydrase is a zinc metalloenzyme that reversibly catalyzes the hydration of carbon dioxide to bicarbonate and hydrogen ions according to the following equation1: The enzyme is found in red blood cells, kidney, gastric mucosa and, to a lesser extent, the central nervous system, lungs, pancreas and salivary glands.2 Roughton3 and, more recently, Enns4 have discussed the importance of this enzyme for the physiologic transport of carbon dioxide.Earlier investigators found less carbonic anhydrase activity in the blood obtained from newborn infants than from adults, and an even lower enzyme activity in blood obtained from premature infants5 6 7 8 and fetuses. . . .
Outcome for metastatic (M+) medulloblastoma (MB) treated with carboplatin during craniospinal radiotherapy (CSRT) followed by cyclophosphamide (CPM) and vincristine (VCR): Preliminary results of COG 99701
Authors: R. Jakacki, P. Burger, T. Zhou, E. Holmes, R. Packer, J. Goldwein, M. Mehta, I. Pollack
Journal: Journal of Clinical Oncology (2007)

2017 Background: The outcome for patients with metastatic medulloblastoma has historically been poor. Carboplatin is both a potent radiosensitizer and has activity against medulloblastoma. In this study, we evaluated the feasibility of administering carboplatin during CSRT and the impact of anaplasia as an independent predictor of outcome. Methods: All patients underwent surgical debulking followed by 36 Gy CSRT with boosts to the posterior fossa and sites of bulk disease. During CSRT, patients received weekly VCR as well as carboplatin doses ranging from 30 mg/m 2 /dose x 15 to 45 mg/m 2 /dose x 30 given 1–4 hours prior to each RT fraction, using a Phase I design. G-CSF was given for neutropenia during CSRT. Six weeks after completing chemoradiotherapy, patients received six courses of monthly CPM (2 gm/m 2 ) and VCR. Central pathology review was performed to confirm the diagnosis and assess for anaplasia. Results: 57 patients (median age 7.3 yrs, range 3.1–18.1 years, M/F ratio of 2.6:1) with centrally reviewed M+ MB were enrolled. Thrombocytopenia was dose limiting and 35 mg/m 2 /dose x 30 was selected as the maximum tolerated carboplatin dose. 20 patients (35%) had severe anaplasia. There was no difference in age, M/F ratio or distribution of M-stage between those with or without anaplasia. Median follow-up for surviving patients is 4.5 yrs. Four-year overall survival (OS) and event-free survival (EFS) for the entire group is 81 ± 5% and 66 ± 6%. Four-year OS is 89 ± 5% for patients without anaplasia vs. 65 ± 11% for those with anaplasia (log-rank p=0.002). Four-year EFS is 76 ± 7% for patients without anaplasia vs. 48 ± 12% for those with anaplasia (log-rank p=0.02). There was no difference in survival based on M-stage. Conclusions: The use of daily carboplatin as a radiosensitizer appears to be a promising strategy for patients with metastatic MB. The presence of anaplasia is a significant negative predictor of outcome. No significant financial relationships to disclose.
Electrophysiologic Testing to Identify Patients with Coronary Artery Disease Who Are at Risk for Sudden Death
Authors: Alfred E. Buxton, Kerry L. Lee, Lorenzo DiCarlo, Michael R. Gold, G. Stephen Greer, Eric N. Prystowsky, Michael F. O'Toole, Anthony Tang, John D. Fisher, James Coromilas, Mario Talajic, Gail Hafley
Journal: New England Journal of Medicine (2000)

The mortality rate among patients with coronary artery disease, abnormal ventricular function, and unsustained ventricular tachycardia is high. The usefulness of electrophysiologic testing for risk stratification in these patients is unclear.
Interview at “The Brigham”
Authors: Richard Bronson
Journal: Annals of Internal Medicine (2016)

Ad Libitum19 April 2016Interview at “The Brigham”Richard Bronson, MDRichard Bronson, MDFrom Stony Brook University Medical Center, Stony Brook, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-3068 Audio Reading - “Interview at “The Brigham”” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Interview at 'The Brigham,'" by R. Bronson. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I sat at a table in a darkened room,the chairman opposite me,committee members silent on either side,while Harvard men in academic robeslooked down from portraits on the wall.I'd passed the written exam,answered the riddle of the ice fishposed by the first committee,now sat before the second,hoping to be chosen for internship.“Tell us of your work at Fort Sam Houston,and why the Army was interested in whales.”What did I do with whales in Texas?I had entered a dark woodsof the Brothers Grimm, where the right wordswould grant me happiness, the wrongturn me into a raven or toad.“I'm ... Author, Article, and Disclosure InformationAffiliations: From Stony Brook University Medical Center, Stony Brook, New York.Current Author Address: Richard Bronson, MD, Department of Obstetrics & Gynecology, Stony Brook University Medical Center, HSC T9-080, Stony Brook, NY 11794-8091; e-mail, Richard.[email protected]edu. PreviousarticleNextarticle Advertisement Audio Reading - “Interview at “The Brigham”” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Interview at 'The Brigham,'" by R. Bronson. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 19 April 2016Volume 164, Issue 8Page: 569KeywordsBurnsHappinessMemoryMuscular dystrophies ePublished: 19 April 2016 Issue Published: 19 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Effects of Tissue Plasminogen Activator for Acute Ischemic Stroke at One Year
Authors: Thomas G. Kwiatkowski, Richard B. Libman, Michael Frankel, Barbara C. Tilley, Lewis B. Morgenstern, Mei Lu, Joseph P. Broderick, Christopher A. Lewandowski, John R. Marler, Steven R. Levine, Thomas Brott
Journal: New England Journal of Medicine (1999)

In 1995, the two-part National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator Stroke Study found that patients who were treated with tissue plasminogen activator (t-PA) within three hours after the onset of symptoms of acute ischemic stroke were at least 30 percent more likely than patients given placebo to have minimal or no disability three months after the stroke. It was unknown, however, whether the benefit would be sustained for longer periods.
Multicenter retrospective analysis for elderly patients with advanced gastric cancer (AGC) received first-line chemotherapy in clinical practice.
Authors: Kenji Kunieda, Akitaka Makiyama, Masaaki Noguchi, Takeshi Kajiwara, Takao Tamura, Koji Takeda, Yasushi Tsuji, Keiko Minashi, Toshikazu Moriwaki, Naotoshi Sugimoto, Michitaka Nagase, Yuji Negoro, Takashi Tsuda, Hideki Shimodaira, Naohiro Okano, Daisuke Sakai, Kazuhiro Yanagihara, Narikazu Boku, Ichinosuke Hyodo, Taito Esaki
Journal: Journal of Clinical Oncology (2015)

4046 Background: Indication of elderly patients (pts) to intensive chemotherapy has not been established. We hypothesized that a survival benefit of doublet chemotherapy with fluoropyrimidine plus platinum, standard treatment might be attenuated in elderly AGC pts with decreased physiological function due to their low tolerability. Methods: We retrospectively investigated clinical outcomes of the elderly AGC pts, 70 years or older, who were treated with S-1 or S-1 + CDDP (SP) as the first-line chemotherapy between 2009 and 2011 at 29 medical centers participating West Japan Oncology Group. Among these pts we selected the pts considered to be fit for SP, and the efficacy and toxicity of S-1 with SP therapy was compared, calculating the propensity scores for receiving each treatment and conducted survival analyses by inverse probability of treatment weighting. Results: Among 464 pts enrolled this study, 446 pts were eligible for the criteria. Patient characteristics were: median age 75 years old (range 70-86); PS 0/1/2 38%/54%/8%; male/female 71%/29%; some co-morbidity +/- 68%/32%; CCr < 50 ml/min/ > = 50 ml/min 21%/79%; received S-1/SP 47%/53%. Between the S-1 and SP groups, there was a large imbalance in PS, better in the SP group (p < 0.001). Limited to the 170 pts with PS 0, 56 pts (33%) and 114 pts (67%) received S-1 and SP, respectively. Between the two groups in this subset of PS 0 showed no significant differences in gender and co-morbidity rate, but SP group showed better background such as age, (p < 0.001), CCr (p < 0.05). The median PFS in the S-1 and SP group, were 8.0 months and 7.9 months (HR = 0.999, 95 % CI 0.698-1.429, p = 0.999), and median OS were 15.0 months and 17.2 months (HR=1.116, 95 % CI 0.760-1.640, p = 0.574). The results were consistent after background factors were statistically adjusted by propensity score. Hematologic toxicities (p < 0.001), G3/4 adverse event (p < 0.001) and hospitalization due to AE (p < 0.001) were more frequent in the SP group. Conclusions: It is suggested optimal treatment strategy for elderly AGC patients should be established separately from younger patients, we are now planning the clinical trial for elderly AGC patients.
18F-DOPA PET/CT in Orbital Metastasis From Medullary Thyroid Carcinoma
Authors: Jean-Baptiste Ruiz, Mathieu Orré, Anne-Laure Cazeau, Bénédicte Henriques de Figueiredo, Yann Godbert
Journal: Clinical Nuclear Medicine (2016)

A 53-year-old-woman is being followed up for a sporadic medullary thyroid carcinoma that was initially treated surgically. Nine years later, a progressive increase in calcitonin levels along with headaches was observed. An orbital metastasis from medullary thyroid carcinoma was diagnosed by performing an F-DOPA PET/CT. The orbital lesion was treated by an external beam radiation. Four months later, an MRI revealed a global morphological stability and a reduction in calcitonin levels.
Case 26-2009
Authors: Steven D. Freedman, Raul N. Uppot, Mari Mino-Kenudson
Journal: New England Journal of Medicine (2009)

A 34-year-old man with cystic fibrosis was admitted to this hospital because of cough, increased dyspnea, and sputum production. Broad-spectrum antimicrobial therapy was initiated. On the fifth hospital day, fever developed, and on the eighth day, nausea, vomiting, leukocytosis, and acidosis developed. The next day, a diagnostic procedure was performed.
Accelerated partial breast irradiation: Preliminary experience with the IntraBeam System
Authors: R. L. Elliott, M. M. DeLand, J. F. Head, M. C. Elliott
Journal: Journal of Clinical Oncology (2008)

11581 Local failure after breast conserving surgery (BCS) and breast radiation usually occurs at the tumor site. This has increased interest in accelerated partial breast irradiation (APBI), because better local control should be achieved if radiation is delivered directly to the tumor bed. The interstitial catheter and Mammosite balloon brachytherapy procedures require multiple visits to the radiation center and another procedure to remove the devices. Veronesi’s intraoperative radiotherapy technique (IORT) and the Mobetron require a special operating room (OR), expensive equipment, and are not very mobile. The IntraBeam IORT system is ideal for APBI. It is inexpensive, safe, easy to use, mobile and can be used in any standard OR. The system also can be used at multiple sites. The photon radiation unit, control console, and applicators all fit easily in cases, requiring only a stand at another site. This makes the system versatile and cost effective. It is convenient for the patient because it requires no further surgery or visits to the radiation center. The procedure is very practical for the community setting. We have performed the procedure to compliment BCS in 54 patients, 49 as part of the original surgery, while 5 had re-exploration of the previous segmental mastectomy site. Because of the final pathology, 3 patients had total mastectomies and 8 went on to have total breast irradiation. When total breast radiation is required, the IntraBeam IORT serves as the radiation boost. There have been no serious surgical or radiation complications, however, most patients developed seromas, managed by aspiration. There were no wound infections. One patient had re-excision of the segmental mastectomy site after 22 months because of severe induration. The pathology report was only radiation fibrosis and fat necrosis. Patient satisfaction has been great and there have been no local recurrences. However, our follow-up is not long enough to determine the true efficacy of preventing local recurrence. No significant financial relationships to disclose.
Degenerative Mitral Stenosis
Authors: Karan Sud, Shikhar Agarwal, Akhil Parashar, Mohammad Q. Raza, Kunal Patel, David Min, Leonardo L. Rodriguez, Amar Krishnaswamy, Stephanie L. Mick, A. Marc Gillinov, E. Murat Tuzcu, Samir R. Kapadia
Journal: Circulation (2016)

Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients.
Folate-conjugated polyspermine for lung cancer–targeted gene therapy
Authors: Mei Zhang, You-Kyoung Kim, Pengfei Cui, Jialiang Zhang, Jianbin Qiao, Yujing He, Jinyuan Lyu, Chengqiong Luo, Lei Xing, Hulin Jiang
Journal: Acta Pharmaceutica Sinica B (2016)

Biodegradable polyamines have long been studied as potential recombinant viral gene vectors. Spermine (SPE) is an endogenous tetra-amine with excellent biocompatibility yet poor gene condensation capacity. We have previously synthesized a polyspermine based on SPE and poly(ethylene glycol) (PEG) diacrylate (SPE-alt-PEG) for enhanced transfection performance, but the synthesized SPE-alt-PEG still lacked specificity towards cancer cells. In this study, folic acid (FA) was incorporated into SPE-alt-PEG to fabricate a targeted gene delivery vector (FA-SPE-PEG) via an acylation reaction. FA-SPE-PEG exhibited mild cytotoxicity in both cancer cells and normal cells. FA-SPE-PEG possessed higher transfection efficiency than PEI 25 K and Lipofectamine(®) 2000 in two tested cancer cell lines at functional weight ratios, and its superiority over untargeted SPE-alt-PEG was prominent in cells with overexpressed folate receptors (FRs). Moreover, in vivo delivery of green fluorescent protein (GFP) with FA-SPE-PEG resulted in highest fluorescent signal intensity of all investigated groups. FA-SPE-PEG showed remarkably enhanced specificity towards cancer cells both in vivo and in vitro due to the interaction between FA and FRs. Taken together, FA-SPE-PEG was demonstrated to be a prospective targeted gene delivery vector with high transfection capacity and excellent biocompatibility.
Hypothyroidism Caused by Chronic Autoimmune Thyroiditis in Very Young Infants
Authors: Thomas P. Foley, Val Abbassi, Kenneth C. Copeland, Martin B. Draznin
Journal: New England Journal of Medicine (1994)

Hypothyroidism in neonates and very young infants is usually caused by thyroid dysgenesis associated with an absent, ectopic, or hypoplastic gland1. It can be detected by neonatal screening, even if it is not clinically evident at that time. Although this condition is usually permanent, it can be transient, as it is, for example, in infants of mothers with chronic autoimmune thyroiditis2,3. In these infants transplacental passage of maternal thyrotropin-receptor antibodies inhibits the action of thyrotropin on the infant's thyroid gland until the antibodies are metabolized by the infant during the first several weeks of life2–4. . . .
Do Older Patients With Moderate-Severe Chronic Graft-Versus-Host Disease Differ From Younger Patients?
Authors: Areej El-Jawahri, Joseph Pidala, Xiaoyu Chai, William A. Wood, Nandita Khera, Mukta Arora, Samantha M. Jaglowski, Stephanie J. Lee, Yi-Bin Chen
Journal: Blood (2013)
Conflicts between Patients' Wishes to Forgo Treatment and the Policies of Health Care Facilities
Authors: Steven H. Miles, Peter A. Singer, Mark Siegler
Journal: New England Journal of Medicine (1989)

The right of patients to forgo life-sustaining treatment has been well established in health law and medical ethics. But do patients also have a right to compel health care facilities or their staffs to participate in carrying out such a decision? What happens when an institution has enunciated a treatment philosophy that is incompatible with a patient's or family's request to discontinue life support? If institutions and their staffs refuse to execute a patient's request, how can that patient's right to forgo life-sustaining treatment be effectuated? In recent cases involving decisions to forgo artificial feeding, courts have held that the . . .
Case 11-1995
Authors: S.A. Abraham, K.K. Hansen
Journal: New England Journal of Medicine (1995)

Presentation of CaseA 39-year-old man was admitted to the hospital because of calcifications around the aortic root, a recent myocardial infarction, and subsequent congestive heart failure, with increasing aortic regurgitation.The patient had been well until six years earlier, when progressive renal insufficiency with hypertension was found. A low-protein diet and enalapril were begun. He was subsequently well until four months before admission, when chest pain developed and he entered another hospital. The urea nitrogen concentration was 143 mg per deciliter (51.1 mmol per liter), and the creatinine concentration was 9.4 mg per deciliter (830 μmol per liter). An . . .
Relationship Between Calcium Channel Antagonists and Nocturnal Hypotension and Autonomic Imbalance in Patients With a Previous Myocardial Infarction
Authors: Hirofumi Tomiyama, Goki Watanabe, Koichiro Siojima, Eisuke Nishikawa, Tuyoshi Nakayama, Akira Yamamoto, Yasuro Ishikawa, Hideo Yoshida, Nobutaka Doba
Journal: Circulation (1998)

The present study was conducted to evaluate the effect of calcium channel antagonists on diurnal changes in blood pressure and on autonomic function in 71 patients who were receiving a calcium channel antagonist because they had previously suffered a myocardial infarction. Ambulatory blood pressures and Holter ECGs were recorded simultaneously for 24 h. Autonomic function was assessed by heart rate variability, Nocturnal systolic pressure was ≥ 90 mmHg in 63 patients (group I) and <90 mmHg in 8 patients (group II). Significant day to night changes in high-frequency power (from 4.3±1.2 to 4.5±1.0/m 2) as well as in the ratio of low-frequency power to high-frequency power (from 1.3±0.1 to 1.1±0.2) were observed in group I, whereas such changes were blunted in group II. When the calcium antagonist was discontinued or the dose was reduced in group II, the autonomic imbalance improved along with elevation of nocturnal systolic blood pressure. Thus, nocturnal blood pressure should be monitored when such drugs are administered for the treatment of ischemic heart disease to a patient with a previous myocardial infarction. If nocturnal hypotension occurs, the dose should be reduced or the drug should be discontinued. (Jpn Circ J 1998; 62: 21-28)
Fusion for Lumbar Spinal Stenosis — Safeguard or Superfluous Surgical Implant?
Authors: Wilco C. Peul, Wouter A. Moojen
Journal: New England Journal of Medicine (2016)

Lumbar spinal stenosis is typically caused by degenerative facet-joint arthrosis and leads to compression of the nerves, resulting in walking disability and leg pain in the elderly. The use of surgical decompression alone to treat lumbar spinal stenosis declined slightly in the United States between 2002 and 2007, whereas the use of a combined procedure of decompression and fusion increased by a factor of 15 during this period.1 Evidence showing a benefit of adding fusion to decompression surgery is lacking, even in the subgroup of patients who have degenerative spondylolisthesis (a slip of adjacent vertebrae caused by facet-joint arthrosis).2, . . .
The diagnostic interview for borderline patients
Authors: J G Gunderson, J E Kolb, V Austin
Journal: American Journal of Psychiatry (1981)

The authors describe the content, administration, reliability, construct validity, and training requirements for a semistructured diagnostic interview for borderline patients. The interview is composed of operationally defined and scored variables that assess five areas of functioning considered most characteristic of borderline patients--social adaptation, impulse/action patterns, affects, psychosis, and interpersonal relations. Their results show that the interview provides a reasonably constructed and reliable method for researchers and clinicians interested in identifying the syndrome of borderline personality disorders. Although existing research supports the clinical utility of defining borderline patients with the diagnostic interview for borderline patients, both the diagnosis and the content of the interview may require revisions.