tbuckley/cabot-search huggingface dataset:
P251 Tuberculosis in older versus younger adult patients: a retrospective comparison of patient characteristics and treatment outcomes at a major UK referral centre
Authors: A Abbara, KG Buell, JAL Sullivan, SM Collin, OM Kon, T Hansel, L John, RN Davidson
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> Tuberculosis (TB) in older persons presents challenges related to diagnosis, management, comorbidities and polypharmacy potentially contributing to increased morbidity and mortality. This retrospective cohort review compares the baseline characteristics, diagnosis, management and outcome between older patients (OPs) (over 65 years) and younger patients (YPs) (25–35 years.) <h3>Method</h3> All patients ≥65 years treated at Northwick Park Hospital during 2002–2014 were identified from London TB register; a comparison group of patients aged 25–35 years were randomly selected. Clinical, microbiological, radiological and biochemical parameters together with management and outcomes were obtained from electronic records. Characteristics of patients were compared between the two groups using Chi-squared and Kruskal-Wallis tests; analyses were performed using Stata (Stata Corp. 2013). <h3>Results</h3> The comparison groups comprised 313 patients aged ≥65 years and 339 patients aged 25–35. Demographics, site of disease, TB culture, treatment regimens and outcomes are recorded in Table 1. 35.6% of OPs and 29.6% of YPs were symptomatic for &gt;2 months at review in secondary care. Median duration to starting treatment from review was 17 days (IQR: 4–57) in OPs compared to 2 (IQR: 1–19) in YPs (p = 0.001). 44.8% of OPs experienced drug toxicity compared to 27.3% of YPs (p = &lt;0.001.) Gastrointestinal symptoms affected 24.8% and 9.6% of OPs and YPs respectively (p &lt; 0.001). There was no difference in prevalence of rash (4.8% in OPs,) arthralgia (2.4% of OPs,) or drug induced liver injury (6.4% of OPs, p = 0.32.) Comorbidities were higher in OPs, with diabetes present in 34.5%, hypertension in 52.6% and renal failure in 17.9% compared to 1.5%, 1.2% and 1.8% in YPs (all p = 0.001). 58.8% of ≥65 and 37.9% of YPs had inpatient admissions, with 30% of OPs admitted for &gt;10 days (p = &lt;0.001). Completion was 78.7% and mortality 16.0% amongst OPs, versus 91.2% with no deaths amongst YPs (both p = &lt;0.001). <h3>Conclusion</h3> These data characterise the delays in presentation and treatment initiation in older patients who also experience a more complicated treatment course with an increased side effect profile, more variation from standard quadruple therapy, lower completion rates and poorer outcomes. This, together with longer inpatient stays impacts patients, but also has financial implications for services.
Carcinogenesis From Polymer Implants: New Mpects From Chromosomal and Transplantation Studies During Premalignancy<xref ref-type="fn" rid="FN1">2</xref>
Authors: K. Gerhard Brand, Lance C. Buoen, Inge Brand
Journal: JNCI Journal of the National Cancer Institute (1967)

Inbred CBA/H and CBA/H-T6 mice received implants of 15 X 22 mm plastic films. Plastic inserts and tissue capsules were cut in thirds at half monthly and monthly intervals. The first portion of the inserts and capsules was left in the original animal. The second portion was separated and individually transplanted into recipients that differed from the original animals with respect to the T6 marker chromosome. The third portion and all tumors which developed in original and recipient animals were examined by karyological, histological, and cultural methods. Film pieces caused tumors in recipient animals up to 9 months after transfer, capsule tissue only up to about 1 month after transfer. Tumors in original and corresponding recipient animals were identical in their chromosomal stemlines and pace of premalignant maturation. The karyotype of the stemline was never discovered among the film-attached cell population because there seemed to be no cell division. This points to the existence of a single, specific premalignant cell clone residing on the film surface in a dormant state of nondivision many months before tumor appearance. At the end, the (pre)malignant cells detached from the film, invaded the capsule tissue, and propagated to produce the tumor within about 4 weeks. The existence of a specific inhibition phenomenon during the premalignant phase is suggested.
Recurrent Intussusception Associated with Hypertrophy of Peyer's Patches
Authors: Ernest L. Sarason, John T. Prior, Ralph L. Prowda
Journal: New England Journal of Medicine (1955)

INTUSSUSCEPTION is considered by most clinicians to be one of the most important acute abdominal conditions occurring in infancy and childhood. This is attested to by the voluminous literature that has appeared on the subject in recent years. Numerous reports citing series of hundreds of cases are in general agreement that the etiology of intussusception in the younger age groups is for the most part not understood. The mechanism whereby the terminal ileum telescopes into the colon and becomes incarcerated remains an enigma. What is equally puzzling is why this condition, having been relieved by one form of therapy or . . .
Dermatologic Ailments in the White House
Authors: Stephanie Mlacker, Adam S. Aldahan, Vidhi V. Shah, Keyvan Nouri
Journal: JAMA Dermatology (2016)

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 Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Dermatology journal
Sixty seconds on . . . Mind the Rota Gap
Authors: Anne Gulland
Journal: BMJ (2016)

With the dispute over their new contract, who could blame them? But no, Mind the Rota Gap [#mindtherotagap] is a campaign highlighting how few junior doctors are available to work shifts in specialties such as emergency medicine and paediatrics.

Not really. In February the Royal College of Physicians warned of risks to the …
Risk-adapted treatment in clinical stage 1 (CS1), non-seminomatous germ cell testicular cancer (NSGCT)
Authors: T. Tandstad, D. Olav, G. Cohn-Cedermark, E. Cavallin-Stahl, U. K. Stierner, A. Solberg, R. M. Bremnes, C. W. Langberg, O. H. Klepp
Journal: Journal of Clinical Oncology (2008)

5034 Background: From 1995–2005, 874 Norwegian and Swedish CS1 NSGCT patients were included into a prospective, community-based multicenter SWENOTECA study. Methods: Patients were restaged 6 weeks after orchiectomy (orch.). Based on vascular invasion (VASC ±) in the primary tumour, and patient’s preference, close surveillance or treatment with brief adjuvant chemotherapy (ACT) with bleomycin, etoposide and cisplatin (BEP) was chosen. Results: Median follow-up is now 5.2 years. Ten patients have died during follow-up. None died from progressive cancer or from evident side effects of ACT. One patient died of a complication to salvage CT after relapse following surveillance. The toxicity of adjuvant BEP was acceptable. Only 5% of patients receiving adjuvant BEP required hospitalisation due to toxicity. Of the seven patients relapsing after ACT, six received chemotherapy as part of salvage treatment. One patient was resistant to salvage BEP, but was cured by a combination of other chemotherapy, surgery and radiation therapy. Only four relapses occurred more than three years after orch, one of these had received ACT (BEP x 1). Relapse rates according to risk group and adjuvant CT are as follows: Conclusions: Relapse rates in this cohort of patients are low. Surveillance is an excellent option for VASC - CS1 NSGCT. One course of adjuvant BEP x 1 reduces the risk of relapse by about 90% in both VASC ± CS1 NSGCT. A second course of BEP will virtually eliminate relapses in VASC + patients, however thereby increasing the total burden of chemotherapy for these young patients. There is no evidence of clinically significant chemoresistance induction or increased risk of late relapses by ACT. Preliminary and limited data of these results were published as posters at ASCO annual meeting 2003, and as a poster at ECCO 2007. Risk Group Adjuvant chemotherapy No patients No relapses Relapse rate (K-M) Median time to relapse (y) Median obs. time (y) All pts 874 69 (7.9%) 8.7% 1.0 (0.2–6.4) 5.1 VASC+ None 17 8 (47.1%) 47.1% 0.5 (0.2- 1.3) 6.5 VASC+ BEP x 1 157 5 (3.2%) 3.5% 1.1 (0.9–3.3) 4.8 VASC+ BEP x 2 70 0 0% 5.0 VASC- None 461 54 (11.7%) 12.6% 0.7 (0.2–6.4) 5.8 VASC- BEP x 1 155 2 (1.3%) 1.4% 1.2 (1.0–1,2) 4.1 VASC- BEP x 2 2 0 0% 2.9 Other 12 0 0% No significant financial relationships to disclose.
Catheter Shunts for Fetal Hydronephrosis and Hydrocephalus
Authors: Frank A. Manning, Michael R. Harrison, Charles Rodeck
Journal: New England Journal of Medicine (1986)

In the period 1982 to 1985, 73 placements of catheter shunts for fetal obstructive uropathy and 44 drainage procedures for obstructive hydrocephalus were reported to a voluntary international registry. The attempts to decompress the obstructed fetal urinary tracts resulted in the survival of 30 fetuses (41 percent), with a procedure-related death rate of 4.6 percent. Pulmonary hypoplasia was the major cause of death in both untreated and treated fetuses. Although the natural history of fetal obstructive uropathy has not been well studied, the outcome of intervention for selected fetuses with posterior urethral valve syndrome was encouraging. The results of shunt procedures for obstructive hydrocephalus were less encouraging. Although 34 of 44 fetuses (83 percent) survived, the procedure-related death rate was 10.25 percent, 18 of the 34 survivors (52.9 percent) have serious neurologic handicaps, 4 (11.8 percent) have less severe handicaps, and only 12 (35.3 percent) are developing normally. Analysis of data from this registry has guided the early development of fetal surgery, but it cannot establish the efficacy of the procedures because of selection bias. A controlled trial is needed.
The Hemodynamic Mechanism of Pounding in the Neck in Atrioventricular Nodal Reentrant Tachycardia
Authors: Sinan Gürsoy, Günter Steurer, Josep Brugada, Erik Andries, Pedro Brugada
Journal: New England Journal of Medicine (1992)

ALTHOUGH the diagnosis of atrioventricular nodal reentrant tachycardia is made on the basis of electrophysiologic criteria, the symptoms and results of physical examination in patients with this arrhythmia may differ from those in patients with other forms of supraventricular tachycardia.1 2 3 4 The present study suggests that among patients with supraventricular tachycardia, only those with atrioventricular nodal reentrant tachycardia feel pounding in the neck during the arrhythmia. They also have higher right atrial pressures and more pronounced reversal of flow in the superior and inferior vena cava during atrial systole than patients with other forms of supraventricular tachycardia. The feeling of regular, . . .
Mechanism of Pyrimethamine-Induced Megaloblastosis in Human Bone Marrow
Authors: Samuel Waxman, Victor Herbert
Journal: New England Journal of Medicine (1969)

Megaloblastosis appeared in a patient receiving pyrimethamine. Pyrimethamine seemed to act as does the folate antagonist methotrexate in short-term in vitro culture of the patient's bone marrow. It produced defective deoxyuridine conversion to thymidylate, a defect that was corrected poorly by oxidized and well by reduced folate. Increased deoxyuridine did not correct the defect induced by pyrimethamine or methotrexate but did correct that produced by 5-fluorouracil. As has been suggested, pyrimethamine acts biochemically in man as an antifolate.
Clinical phase II evaluation of paclitaxel in combination with cisplatin in metastatic or recurrent squamous cell carcinoma of the head and neck
Authors: F Thödtmann, F Theiss, M Kemmerich, B Heinrich, C Laubenbacher, S Quasthoff, R Kau, M Herzog, K Diergarten, A R Hanauske
Journal: Annals of Oncology (1998)
PWE-261 Elderly, ethnic minorities and socially deprived patients at high risk of requiring emergency surgery for colorectal cancer
Authors: A Askari, S Nachiappan, A Currie, A Bottle, T Athanasiou, J Abercrombie, O Faiz
Journal: Gut (2015)

<h3>Introduction</h3> Emergency surgery for colorectal cancer (CRC) conveys high postoperative morbidity and mortality. The aim of this study is to identify patient groups at high risk of emergency presentation and quantify their overall survival. <h3>Method</h3> All patients diagnosed with colorectal cancer between the year 1997–2011 were identified from the Hospital Episode Statistics (HES) database. Logistic regression analyses were undertaken to identify patient groups at risk of undergoing emergency surgery for colorectal cancer at first presentation. Survival plots using multivariable cox proportional hazard analyses were generated. <h3>Results</h3> Over this time period, 286,591 patients underwent resection for CRC, 69,718 (24.3%) of which were as emergencies. While, the overall rate of emergency CRC resection has significantly decreased from 29.5% in 1997 to 16.5% in 17.2% in 2011 (p &lt; 0.001), certain patient groups continue to be at risk of undergoing colorectal cancer resection as an emergency. Elderly patients (&gt;79 yrs old) are 55% more likely to require emergency surgery (OR 1.55, CI: 1.50–1.60, p &lt; 0.001) compared to &lt;55 year olds. Similarly patients from a socially deprived background are 64% more likely to undergo emergency surgery than affluent patients (OR 1.64, CI: 1.50–1.80, p &lt; 0.001). Patients from the Black Afro-Caribbean community were also at increased risk compared to White British patients (OR 1.36, CI: 1.21–1.66, p &lt; 0.001). Long-term survival (5-year) remains poor in patients who have emergency surgery even when adjusting for immediate (90-day) post operative mortality (emergency patients HR 1.64, CI 1.63–1.67, p &lt; 0.001). In the screening age population (60–69 years old), there was a significant drop in emergency presentation (23.4% to 14.9%, p &lt; 0.001) before and after the implementation in screening in 2006. <h3>Conclusion</h3> Whilst the overall rate of emergency colorectal cancer surgery is reducing, elderly patients, those from a socioeconomically deprived background and Black Afro-Caribbean patients remain at high risk of emergency attendance. Post-operative morbidity and mortality remains high in emergency presenters and 5-year survival in this patient group remains poor. Targeting screening of these high-risk patient groups is essential to reduce the number of patients attending as an emergency further. <h3>Disclosure of interest</h3> None Declared.
1320_PR: Subgroup analyses of patients with epidermal growth factor receptor (EGFR)-expressing tumors in SQUIRE: A randomized, multicenter, open-label, phase III study of gemcitabine–cisplatin (GC) plus necitumumab (N) versus GC alone in the first-line treatment of patients (pts) with stage IV squamous non-small cell lung cancer (sq-NSCLC)
Authors: L. Paz-Ares, M.A. Socinski, J. Shahidi, R.R. Hozak, V. Soldatenkova, N. Thatcher, F. Hirsch
Journal: Journal of Thoracic Oncology (2016)
Recurrence risk of node-negative and ER-positive early-stage breast cancer patients by combining recurrence score, pathologic, and clinical information: A meta-analysis approach.
Authors: G. Tang, J. Cuzick, C. Wale, J. P. Costantino, M. Crager, S. Shak, N. Wolmark, M. Dowsett, J. F. Forbes
Journal: Journal of Clinical Oncology (2010)

509 Background: The 21-gene Oncotype DX Recurrence Score (RS) is widely used for assessment of recurrence risk and prediction of chemotherapy benefit in patients with early stage ER-positive breast cancer. Pathologic and clinical factors such as tumor size and grade, and patient age also provide independent prognostic utility and might be combined with the RS to achieve more prognostic power. Methods: All patients in the NSABP trial B-14 and the ATAC study who had ER-positive tumor specimens with successful Oncotype DX RS assay were included. B-14 patients were node-negative and were treated with tamoxifen. ATAC patients were node-positive or node-negative, and were treated with tamoxifen or anastrozole. Meta-analysis methods were used to assess the risk of distant recurrence by combining the individual study multivariate risk assessments using RS-pathologic-clinical (RSPC) information. A RSPC risk index was defined a priori as the predicted risk of distant recurrence at 10 years with predetermined cut-offs at 12% and 20% risk. Results: The meta- analysis included 647 B-14 patients and 1088 ATAC patients. RSPC prognosis combining clinical and pathology information with RS is more powerful than using RS alone (likelihood ratio test p-value < 0.001). The RSPC risk index was shown superior to RS in risk discrimination among node-negative, ER+, tamoxifen-treated patients. Compared with RS risk stratification, fewer patients were classified as intermediate risk by the RSPC index (18% vs 26%; p-value 0.001), and 72% of pts with intermediate RS 18-30 were either up-staged or down-staged. Average risk in the low, intermediate- and high-risk classes were similar between the RSPC and RS classifications. Conclusions: The RSPC index combining RS with pathology and clinical information with RS supplied more powerful prognosis for early stage breast cancer patients than RS alone. It was estimated that its application would reduce patients with intermediate risk by 30% and enhance personalized treatment decisions in oncology practice. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Genomic Health AstraZeneca, Novartis Genomic Health AstraZeneca AstraZeneca, Genomic Health, Novartis
Misconduct in Medical Research
Authors: John D. Dingell
Journal: New England Journal of Medicine (1993)

One of the distinguishing characteristics of American society, noted long ago by Alexis de Tocqueville, has been optimism and a belief, bordering on faith, in progress. That characteristic is evident in our popular culture and in our politics. We recall -- nostalgically -- the 1939 New York World's Fair, the General Motors Parade of Progress, the can-do spirit of the New Frontier, and the hopes of the Great Society. Our sometimes misplaced sense of optimism is at its core an expression of confidence in science and the scientific method. We believe that honest intellectual inquiry can lead us to theories . . .
Isolated Gonadotrope Failure in the Polyglandular Autoimmune Syndrome
Authors: Ariel L. Barran, Robert P. Kelch, John C. Marshall
Journal: New England Journal of Medicine (1985)

Hypogonadism is a component of the polyglandular autoimmune syndromes and usually results from primary gonadal failure. Isolated gonadotropin deficiency is a disorder of prepubertal onset that usually results from a failure of hypothalamic secretion of gonadotropin-releasing hormone (GnRH). We describe here two men with polyglandular autoimmune syndrome and isolated gonadotropin deficiency acquired after puberty. Plasma levels of luteinizing hormone and follicle-stimulating hormone in response to bolus doses of GnRH and to pulsatile GnRH injections (25 ng per kilogram of body weight intravenously every two hours) over a four-day period were subnormal. Pituitary secretion of thyroid-stimulating hormone, prolactin, growth hormone, and ACTH was not impaired. These data indicate that isolated gonadotropin deficiency may result from a selective pituitary gonadotrope failure. In addition, they suggest that autoimmune hypophysitis may be an integral part of the polyglandular autoimmune syndrome and can be selective, involving only one type of pituitary cells.
S44 Prognostic scoring systems for Idiopathic Pulmonary Fibrosis: Comparison of the composite physiologic index (CPI) and the GAP score
Authors: K Relf, K Sylvester, M Toshner, H Parfrey
Journal: Thorax (2015)

<h3></h3> Idiopathic Pulmonary Fibrosis (IPF) is a progressive, scarring lung disease with a poor prognosis and median survival of 3 years. It is a heterogeneous disorder with varying rates of progression, which presents a challenge for accurate prognostic prediction. The CPI<sup>1</sup> and the GAP<sup>2</sup> score are validated scoring systems for prognostic determination in IPF. However, it remains unclear which is the optimal method for accurate prediction of mortality in IPF. Therefore, a comparison of the predictive ability of the GAP score and CPI was undertaken in a cohort of IPF patients. <h3>Methods</h3> Baseline data were collected retrospectively from 213 IPF patients (in accordance with ATS/ERS criteria and MDT consensus) from a single centre in the UK between 19<sup>th</sup> April 2007 and 14<sup>th</sup> July 2014. Thirty-eight patients were excluded, either because pulmonary function test results could not be obtained or the patient received a lung transplant during follow-up. Gender, age, FVC and DLCO were used to calculate the GAP score whilst FVC, FEV1 and DLCO were used for the CPI. Spearman’s correlation was used to analyse the relationship between GAP score or CPI and survival time. The ability of the scoring systems to predict survival at 1 and 3 years was assessed using ROC curve analysis. <h3>Results</h3> Of the 175 patients, 131 (75%) were male with a mean age of 71 ± 8 years (mean ± SD) at presentation. Overall 3-year mortality was 50%. The CPI demonstrated a better correlation with survival (r<sup>2</sup> = 0.37, p &lt; 0.01) compared to the GAP score (r<sup>2</sup> = 0.24, p &lt; 0.01). ROC curve analysis for 1-year mortality found that area under curve (AUC) was 0.726 for the GAP score and 0.783 for the CPI. For 3-year mortality AUC was 0.749 for the GAP score and 0.805 for the CPI. <h3>Conclusion</h3> These data show that the CPI more accurately predicts survival at presentation and 3-years than the GAP score in a UK IPF cohort. <h3>References</h3> 1 Wells AU, <i>et al</i>.<i> Am J Resp Crit Care Med</i>. 2003;<b>167</b>:962 2 Ley B, <i>et al</i>.<i> Ann Intern Med</i>. 2012;<b>156</b>:684
<i>Plasmodium malariae</i>Infection in an Asymptomatic 74-Year-Old Greek Woman with Splenomegaly
Authors: Joseph M. Vinetz, Jun Li, Thomas F. McCutchan, David C. Kaslow
Journal: New England Journal of Medicine (1998)

Malaria most commonly presents as an acute systemic, febrile illness but may manifest more indolently as chronic anemia, glomerulonephritis, or tropical splenomegaly syndrome (or hyperreactive malarial splenomegaly) due to Plasmodium falciparum, P. vivax, or P. malariae. 1 Although all the major malaria parasites of humans cause acute illness that may be accompanied by splenomegaly, P. malariae is the only one recognized to cause asymptomatic infections that can last decades.1 Asymptomatic P. malariae infections are typically associated with very low levels of parasitemia and normal physical examinations,2,3 and they generally come to medical attention when malaria is transmitted by transfusion2, . . .