tbuckley/cabot-search huggingface dataset:
Survival in patients with synchronous versus metachronous lymph node (LN) involvement in stage III melanoma: Is there a difference?
Authors: K. F. Fournier, Y. Xing, M. I. Ross, J. E. Lee, J. E. Gershenwald, P. F. Mansfield, A. Lucci, J. N. Cormier
Journal: Journal of Clinical Oncology (2008)

9034 Background: The presence of regional LN metastasis in melanoma patients is a major determinant of outcome. The objective of this analysis was to compare the outcomes of patients with synchronous vs. metachronous LN metastasis. Methods: Medical records for all patients who underwent therapeutic LN dissection (LND) at our institution (1975–2000) were reviewed. Only patients with macroscopic LN metastasis (N1b, N2b, and N3) were included; those with LN metastasis within 12 months of primary tumor diagnosis were defined as synchronous disease (SD) while those with LN metastasis after this period were defined as metachronous disease (MD). Kaplan-Meier survival analyses were performed to compare disease specific survival (DSS) from the time of LN dissection for both groups. Multivariate analyses were performed to identify prognostic factors for DSS. Results: The cohort was comprised of 491 patients: 250 (51%) had SD and 241 (49%) had MD. Median time to LN involvement was 1.7 months in the SD group vs. 2.8 years in the MD group. While the groups were similar with respect to nodal stage and nodal clinical/pathologic features, significant differences with respect to primary tumor and patient characteristics included a higher incidence of younger patients (p=0.03), thick primary tumors (p< 0.001), and tumor ulceration (p=0.002) in the SD group. With a median follow-up of 8.9 years, DSS for the entire cohort was 3.2 years. Median DSS was 2.4 years and 3.7 years for SD vs. MD respectively (p=0.04). Multivariate analyses confirmed that adverse prognostic factors for DSS included SD, male gender, advanced age, extracapsular nodal extension, and higher nodal stage (N2b or N3 versus N1b). Conclusions: Metachronous LN metastasis occurs in a significant number of patients more than 2 years following treatment of their primary tumor. MD is associated with better DSS compared to those who present with SD possibly indicating differences in tumor biology which is not completely explained by primary tumor factors and should be considered in clinical decision making. No significant financial relationships to disclose.
Periorbital Edema in Kaposi's Sarcoma
Authors: B L Zidar
Journal: New England Journal of Medicine (1995)

Figure 1. A 27-year-old man who was seropositive for the human immunodeficiency virus presented with severe periorbital and facial edema (Panel A) and generalized cutaneous Kaposi's sarcoma. Note the lesion (arrows) on the nose. Computed tomography (CT) of the head demonstrated thickening of the eyelids and the skin of the nose and face. The patient had neither superior vena cava syndrome nor nephrotic syndrome. Doxorubicin, vincristine, and bleomycin were administered intravenously every two weeks for four months. Facial and periorbital edema resolved rapidly (Panel B), as did the Kaposi's sarcoma. The CT findings also returned to normal. This type of . . .
Metaplastic breast cancer: Clinical traits and outcomes
Authors: G. R. Gibson, L. Lai
Journal: Journal of Clinical Oncology (2004)

844 Background: Metaplastic carcinoma of the breast is a rare neoplasm with both epithelial and mesenchymal elements and represents less than 5% of all breast cancer. Because little data exist regarding progression, treatment, and overall outcome in patients with this subtype of breast cancer, we sought to review our institutional experience.Methods: We retrospectively reviewed the records of all patients who were diagnosed with metaplastic breast cancer from 1991 to 2003. All patients who presented with metastatic disease were excluded. Results: We identified 21 patients. Mean primary tumor size was 4.62 cm (range, 1.4–12.0 cm). Eight patients (38%) had axillary node involvement at presentation. Of the 21 patients, 2 (9.5%) were stage I; 12 (57%) were stage II; 7 (33%) were stage III. All the tumors were described as high grade. Nineteen (90%) of the tumors were estrogen and progesterone receptor negative. HER2/neu receptor expression was negative in all eight specimens tested. Seventeen (81%) of the patients received adjuvant chemotherapy. Of the 11 recurrences in 10 patients, 4 were local only, 4 were distant only, and 3 were local, regional and distant synchronously. No patient developed isolated axillary node recurrence. With a median follow up of 33 months (range, 4–106 mos.), the 4-year disease-specific survival and overall survival were 80% (95% CI: 54–100%) and 70% (95% CI: 44–96%) respectively. By multivariate analysis, nodal status had a significant impact on overall survival (p<0.05) whereas size and age did not. Conclusion: Metaplastic carcinoma is a unique and uncommon neoplasm of the breast. These lesions tend to be high-grade and large at presentation, although this does not appear to impact survival. Because recurrences tend to be local and metastatic, aggressive local control as well as adjuvant chemotherapy could impact outcome. Despite the apparent aggressiveness of the histology, the lack of hormone receptors, and the overwhelming number of patients who present at later stages, the survival data of this cohort of patients suggest a favorable prognosis. No significant financial relationships to disclose.
115PD: Brain metastases (BM) development after chemoradiation (CRT) for stage III non-small cell lung cancer (NSCLC): Does the type of chemotherapy matter?
Authors: L. Hendriks, A. Brouns, M. Amini, W. Uyterlinde, R. Wijsman, B. Biesma, J. Stigt, D. De Ruysscher, M. van den Heuvel, A.-M. Dingemans
Journal: Journal of Thoracic Oncology (2016)
Aflibercept + Folfiri for Treatment of Metastatic Colorectal Cancer After Oxaliplatin Failure: 4Th Interim Safety Data from the Global Aflibercept Safety and Quality-Of-Life Program (Asqop/Afeqt Studies)
Authors: L. Frassineti, M. Di Bartolomeo, V. Heinemann, A.L. Thomas, J. Taieb, G. Lledo, Y. Moore, C. Zilocchi, S. Brette, A. Sobrero, R. Bordonaro
Journal: Annals of Oncology (2014)
Systemic Lupus Erythematosus Simulating Acute Surgical Condition of the Abdomen
Authors: Victor E. Pollak, William J. Grove, Robert M. Kark, Robert C. Muehrgke, Conrad L. Pirani, Irving E. Steck
Journal: New England Journal of Medicine (1958)

SYSTEMIC lupus erythematosus affects small blood vessels throughout the body; as a consequence any or all organs may be involved by the disease. Although the occurrence of abdominal symptoms is well known,1 , 2 we can find few reports that indicate clearly that they may be so acute and severe as to simulate an "acute surgical condition of the abdomen."We have observed 14 patients with systemic lupus erythematosus in whom abdominal symptoms severe enough to warrant consultation with a surgeon developed. In 4 the predominant clinical picture was that of pancreatitis. Ten had lupus peritonitis, and an abdominal operation was done . . .
Case 12-2007
Authors: Nelson B. Goes, Robert B. Colvin
Journal: New England Journal of Medicine (2007)

A 56-year-old woman was admitted to the hospital because of renal failure. Ten years earlier, heart–lung transplantation had been performed because of primary pulmonary hypertension; her immunosuppressive regimen consisted of cyclosporine, prednisone, and azathioprine. Her medical history included glomerulonephritis at the age of 19 years, which resolved, and recurrent urinary tract infections. Renal function had been deteriorating slowly since the transplantation, and proteinuria had developed. A diagnostic procedure was performed.
Psychiatric Aspects of Cerebral Arteriosclerosis
Authors: Edward B. Allen
Journal: New England Journal of Medicine (1951)

THAT physicians with varied disciplines of observation, training and therapy should be invited to discuss cerebral arteriosclerosis before this society is of timely significance. The Federal Security Agency1 , 2 reports that chronic diseases are the leading causes of death in the older age groups. In 1900 they were also the leading killers of persons sixty-five years and over. Then, as now, heart disease headed the list. Intracranial lesions of vascular origin were the second leading cause of death in 1900 and the third in 1948, with cancer and other malignant tumors now assuming second place. But the percentage distribution of deaths . . .
Specific Language Disability
Authors: J. Roswell Gallagher
Journal: New England Journal of Medicine (1950)

PARENTS who take a child to a physician because of failure in school usually ask if the child "needs thyroid," is "below par" or has poor vision or hearing or diseased tonsils; some physical cause is sought as the explanation of the trouble. In rare cases the cause may be organic, but failure in school is more likely to be related to emotional adjustment, interest or intelligence. In addition to those causes a significant number of children, perhaps as many as 10 per cent, fail because they are handicapped by what has come to be known as a specific language . . .
PWE-075 Day-1 post-operative alt does not predict morbidity following liver resection – analysis of a contemporary cohort of 110 patients
Authors: A Nair, D Papis, RH Bhogal, A Prasad, A Kaur, S Khan, FT Lam, G Marangoni
Journal: Gut (2015)

<h3>Introduction</h3> Predicting the risk of post-operative complications following liver resection is an integral part of liver surgery planning. Post-operative liver function tests have been used for prediction of liver failure. We sought to clarify whether post-operative day 1 (POD-1) Alanine aminotransferase (ALT) was predictive of complications in a contemporary cohort of liver resections. <h3>Method</h3> Interrogation of a prospectively maintained database from January 2013 to December 2014 was performed. POD-1 ALT was analysed against the occurrence of post-operative complications which were graded as per the Clavien-Dindo classification. <h3>Results</h3> There were 114 liver resections; 4 patients were excluded as they underwent synchronous pancreas/liver surgery. There were 61 males (56%) and median patient age was 65 years. Sixty-nine (63%) resections were performed for colorectal liver metastases. Forty-two patients (38%) received neoadjuvant chemotherapy. There were 58 (52%) non-anatomical resections and 29 (26%) major hepatectomies. Forty-three (39%) patients had &gt; 3 segments resected. The Pringle manoeuvre was used in 55 patients (50%) for a median (IQR) time of 18 (10–25) minutes. Intra-operative radiofrequency ablation (RFA) was employed as an adjunct to resection in 17 (16%) patients. Overall morbidity was 28% (n = 31) whereas mortality was 0.9% (n = 1). There were 16 Grade 2 (15%), 14 Grade 3 (13%) and no Grade 4 complications. Mean POD-1 ALT (IU/L) was significantly higher in the group of patients who underwent RFA (674 vs 330; p &lt; 0.0001). POD-1 ALT was not statistically higher in the Pringle group (411 vs 353; p = 0.189). No significant increase in mean POD-1 ALT was seen in patients who had &gt;grade 2 Clavien-Dindo complications (450 vs 357; p = 0.585). <h3>Conclusion</h3> Our data shows that POD-1 ALT does not reliably predict the occurrence of post-operative complications after liver resection. <h3>Disclosure of interest</h3> None Declared.
<i>COMT</i>,<i>BDNF</i>, and<i>DTNBP1</i>polymorphisms and cognitive functions in patients with brain tumors
Authors: Denise D. Correa, Jaya Satagopan, Kenneth Cheung, Arshi K. Arora, Maria Kryza-Lacombe, Youming Xu, Sasan Karimi, John Lyo, Lisa M. DeAngelis, Irene Orlow
Journal: Neuro-Oncology (2016)

Cognitive dysfunction is common among patients with brain tumors and can be associated with the disease and treatment with radiotherapy and chemotherapy. However, little is known about genetic risk factors that may moderate the vulnerability for developing cognitive dysfunction. In this study, we examined the association of single nucleotide polymorphisms (SNPs) in the catechol-O-methyl transferase (COMT), brain-derived neurotrophic factor (BDNF), and dystrobrevin-binding protein 1 (DTNBP1) genes with cognitive functions and neuroimaging outcomes in patients with brain tumors. One hundred and fifty patients with brain tumors completed neuropsychological tests of attention, executive functions, and memory and were genotyped for polymorphisms in the COMT, BDNF, and DTNBP1 genes. Ratings of white matter (WM) abnormalities on magnetic resonance imaging scans were performed. Multivariate regression shrinkage analyses, adjusted for age, education, treatment type, time since treatment completion, and tumor location, indicated a significant association between the COMT SNP rs4680 (Val158Met) and memory with lower scores in delayed recall (P < .01) among homozygotes (valine/valine). Additional COMT, BDNF and DTNBP1 SNPs were significantly associated with attention, executive functions, and memory scores. This is the first study to suggest that known and newly described polymorphisms in genes associated with executive and memory functions in healthy individuals and other clinical populations may modulate cognitive outcome in patients with brain tumors.
The Crescendo Presystolic Murmur of Mitral Stenosis with Atrial Fibrillation
Authors: J. Michael Criley, Alan J. Hermer
Journal: New England Journal of Medicine (1971)

A crescendo presystolic murmur was recorded in four patients with mitral stenosis and atrial fibrillation. Hemodynamic and cineangiographic data support the contention that this crescendo murmur is caused by the closing of the mitral valve in the presence of a persistent end-diastolic pressure gradient between the left atrium and ventricle. We postulate that the progressive narrowing of the mitral orifice in the face of continued atrioventricular flow causes an increase in velocity of flow across the valve leaflets.
Antenatal Thyrotropin-Releasing Hormone to Prevent Lung Disease in Preterm Infants
Authors: Roberta A. Ballard, Philip L. Ballard, Avital Cnaan, Jennifer Pinto-Martin, Deborah J. Davis, James F. Padbury, Roderic H. Phibbs, Julian T. Parer, Montgomery C. Hart, Frank L. Mannino, Shirley K. Sawai
Journal: New England Journal of Medicine (1998)

Pulmonary disease is common in preterm infants, despite antenatal glucocorticoid therapy. The addition of antenatal thyrotropin-releasing hormone therapy has been reported to decrease pulmonary morbidity in these infants.
Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents
Authors: Emanuele Di Angelantonio, Shilpa N Bhupathiraju, David Wormser, Pei Gao, Stephen Kaptoge, Amy Berrington de Gonzalez, Benjamin J Cairns, Rachel Huxley, Chandra L Jackson, Grace Joshy, Sarah Lewington, JoAnn E Manson, Neil Murphy, Alpa V Patel, Jonathan M Samet, Mark Woodward, Wei Zheng, Maigen Zhou, Narinder Bansal, Aurelio Barricarte, Brian Carter, James R Cerhan, Rory Collins, George Davey Smith, Xianghua Fang, Oscar H Franco, Jane Green, Jim Halsey, Janet S Hildebrand, Keum Ji Jung, Rosemary J Korda, Dale F McLerran, Steven C Moore, Linda M O'Keeffe, Ellie Paige, Anna Ramond, Gillian K Reeves, Betsy Rolland, Carlotta Sacerdote, Naveed Sattar, Eleni Sofianopoulou, June Stevens, Michael Thun, Hirotsugu Ueshima, Ling Yang, Young Duk Yun, Peter Willeit, Emily Banks, Valerie Beral, Zhengming Chen, Susan M Gapstur, Marc J Gunter, Patricia Hartge, Sun Ha Jee, Tai-Hing Lam, Richard Peto, John D Potter, Walter C Willett, Simon G Thompson, John Danesh, Frank B Hu
Journal: The Lancet (2016)

Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up.
Case 24-1998
Authors: John B. Wong, Carolyn C. Compton
Journal: New England Journal of Medicine (1998)

Presentation of CaseA 76-year-old woman was admitted to the hospital because of gastrointestinal blood loss and worsening anemia.The patient had a long history of hypertension with mild azotemia and asymptomatic idiopathic thrombocytopenia. Eight weeks before the current admission, she was admitted to the hospital because of worsening congestive heart failure, which improved with diuretic medication. Laboratory examination showed a hematocrit of 32.3 percent and a platelet count of 79,000 per cubic millimeter. The urea nitrogen level was 31 mg per deciliter (11 mmol per liter), and the creatinine level was 3.7 mg per deciliter (330 μmol per liter). . . .
Treating allergic bronchopulmonary aspergillosis: the way forward
Authors: Richard B. Moss
Journal: European Respiratory Journal (2016)

Allergic bronchopulmonary mycoses are an endotype of allergic lung disease, similar to but more severe than uncomplicated asthma, caused by a Th2-dominated immune response and a bronchocentric granulocytic inflammation provoked by endobronchial growth of filamentous fungi in individuals with innate host defence defects (primarily people with severe allergic asthma or cystic fibrosis); untreated, it leads to progressive structural damage [1–3]. The scope of this problem, however, has only been recognised recently [4, 5]. ABPA remains a difficult disease to control and entails troubling steroid toxicity <http://ow.ly/V4mrR>
The Use of Transcranial Ultrasonography to Predict Stroke in Sickle Cell Disease
Authors: Robert Adams, Virgil McKie, Fenwick Nichols, Elizabeth Carl, Dao-Long Zhang, Kathy McKie, Ramon Figueroa, Mark Litaker, William Thompson, David Hess
Journal: New England Journal of Medicine (1992)

Stroke, especially cerebral infarction, is a major cause of morbidity and mortality in children with sickle cell disease. Primary prevention of stroke by transfusion therapy may be feasible if there is a way to identify the patients at greatest risk. Transcranial Doppler ultrasonography can measure flow velocity in the large intracranial arteries. The narrowing of these arteries, which leads to cerebral infarction, is characterized by an increased velocity of flow.Using transcranial Doppler ultrasonography, we prospectively measured the velocity of cerebral blood flow in children and young adults being followed because of sickle cell disease. The results were classified as either normal or abnormal on the basis of the highest velocity of flow in the middle cerebral artery. Abnormal velocity was defined as a flow greater than or equal to 170 cm per second, a definition determined by post hoc analysis to maximize the predictive success of the test. The end point was a clinically apparent first cerebral infarction.Two hundred eighty-three transcranial ultrasound examinations were performed in 190 patients with sickle cell disease (age at entry, 3 to 18 years). After an average follow-up of 29 months, cerebral infarction was diagnosed in seven patients. In 23 patients the results of the ultrasound examinations were abnormal, and in 167 patients they were normal. The clinical and hematologic characteristics of the two groups were similar, but six of the seven strokes occurred among the 23 patients with abnormal ultrasound results (P less than 0.00001 by Fisher's exact test). In this group, the relative risk of stroke was 44 (95 percent confidence interval, 5.5 to 346).Transcranial ultrasonography can identify the children with sickle cell disease who are at highest risk for cerebral infarction. Periodic ultrasound examinations and the selective use of transfusion therapy could make the primary prevention of stroke an achievable goal.
Late-onset cutaneous porphyria in a patient heterozygous for a uroporphyrinogen III synthase gene mutation
Authors: P. Aguilera, C. Badenas, S.D. Whatley, J. To-Figueras
Journal: British Journal of Dermatology (2016)

Deficiency of uroporphyrinogen III synthase (UROS) causes congenital erythropoietic porphyria (CEP). The disease, originating from the inheritance of mutations within the UROS gene, presents a recessive form of transmission. In a few patients, a late-onset CEP-like phenotype without UROS mutations appears to be associated with a myelodysplastic syndrome. We report a 60-year-old man with late-onset signs of cutaneous porphyria and accumulation in urine, plasma and faeces of type I porphyrin isomers characteristic of CEP. Analysis of DNA from peripheral leucocytes, skin and bone marrow aspirate showed that he was a heterozygous carrier of a Cys73Arg (c.217 T>C) mutation within UROS. Sequencing of cDNA from peripheral blood confirmed heterozygosity and expression of the normal allele. Measurement of UROS enzymatic activity in erythrocytes showed values ~70% of normal, indirectly indicating expression of the normal allele. Differently from other cases of late-onset uroporphyria, the patient did not present thrombocytopenia or any evidence of a myelodysplastic syndrome. Five years of clinical follow-up showed persistence of skin signs and increased excretion of porphyrins, independently of lifestyle factors or changes in medication regimes. We hypothesize acquired mosaicism (in the bone marrow) affecting the UROS gene. Thus, unstable cellular clones initiated overproduction of isomer I porphyrins leading to a CEP phenotype. This could be explained either by a clonal expansion of the porphyric (Cys73Arg) allele or by loss of function of the normal allele. Cellular turnover would facilitate release of uroporphyrins into circulation and subsequent skin lesions. This is the first case of a CEP heterozygous carrier presenting clinical manifestations.
Hematuria in a Patient with an Ileal Conduit and Hepatic Cirrhosis
Authors: David M. Felig, David P. Bleeker, John S. DeMeritt
Journal: New England Journal of Medicine (2001)

To the Editor: Hernández-Díaz and colleagues (Nov.30 issue) 1 suggest that the use of folic acid antagonists in pregnant women increases the risk of oral clefts and cardiovascular and urinary tract defects in their infants.The possible role of trimethoprim in increasing the risk of malformations of the cardiovascular and urinary systems has practical implications.Trimethoprim is one of the most commonly prescribed drugs in the United States.Furthermore, it is commonly given in the early stages of pregnancy, often before women are aware that they are pregnant.In their report, Hernández-Díaz and colleagues group together data on trimethoprim, triamterene, and sulfasalazine.We wonder why the data on trimethoprim were not highlighted and reported separately, considering the widespread use of this drug.
A Screening Test for Aminoaciduria
Authors: H. Ghadimi, H. Shwachman
Journal: New England Journal of Medicine (1959)

THERE is a growing interest in the detection of aminoaciduria as more and more conditions are found associated with an abnormal excretion of amino acids in urine. The Chromatographic technic1 , 2 stimulated investigation in this area and has been widely applied. However, in two-dimensional paper chromatography, desalting of the urine and the Chromatographic procedure take at least two days to complete. Proper performance and interpretation requires technical skill and experience. In addition, determinations of alpha amino nitrogen and total nitrogen are often required for proper evaluation. In view of the normal findings in the majority of specimens submitted for this type . . .
Variable attenuation of amphetamine effects by lithium
Authors: B Angrist, S Gershon
Journal: American Journal of Psychiatry (1979)

In an open study of 8 subjects, approximately half showed some attenuation of CNS stimulant effects of amphetamine after pretreatment with lithium. Two showed specific blockade of euphoria, with persistence of some CNS stimulant effects. In 3 subjects lithium did not appear to affect the response to amphetamine. Lithium caused significant attenuation of the amphetamine-induced increase in systolic blood pressure for the group as a whole.