tbuckley/cabot-search huggingface dataset:
Case 18-1963
Authors: Warren Point, Walter Putschar
Journal: New England Journal of Medicine (1963)

Presentation of Case First admission. A sixty-five-year-old woman entered the hospital because of pain in the abdomen and vomiting.Five days before entry she had the sudden onset of severe, diffuse, crampy abdominal pain, followed by intermittent nausea and projectile vomiting. The pain was less severe after episodes of vomiting. There was no hematemesis, melena or jaundice. No stool was passed over a four-day period; the urinary output was scant, but there was no hematuria or dysuria.One year before admission the blood pressure was elevated to 190 systolic, 110 diastolic, dropping to 170 systolic, 88 diastolic, after rest; at . . .
Sarcoidosis and Hyperparathyroidism with Hypercalcemia
Authors: Janice M. Burr, John J. Farrell, A. Gorman Hills
Journal: New England Journal of Medicine (1959)

TT has recently been discovered that certain conditions giving rise to hypercalcemia and hypercalciuria exhibit in common excessive proportional absorption of dietary calcium and elevated renal calcium clearance, and that in these conditions cortisone regularly and promptly restores normocalcemia and normocalciuria. No such effect upon hypercalcemia and hypercalciuria due to hyperparathyroidism is apparent. These observations not only are of theoretical interest and therapeutic importance but also have furnished the rationale for a diagnostic aid in cases of hypercalcemia in which, as not infrequently happens, the cause proves difficult to establish.A less common but at least equally puzzling problem arises . . .
Estrogens and Endometrial Cancer in a Retirement Community
Authors: Thomas M. Mack, Malcolm C. Pike, Brian E. Henderson, Robert I. Pfeffer, Vibeke R. Gerkins, Mary Arthur, Sandra E. Brown
Journal: New England Journal of Medicine (1976)

All cases of endometrial cancer occurring among the residents of an affluent retirement community were compared with controls chosen from a roster of all women in the same community. Evidence of estrogen and other drug use and of selected medical conditions was obtained from three sources: medical records of the principal care facility, interviews, and the records of the local pharmacy. The risk ratio for any estrogen use was estimated from all available evidence to be 8.0 (95 per cent confidence interval, 3.5 to 18.1). and the for conjugated estrogen use to be 5.6 (95 per cent confidence interval, 2.8 to 11.1). Increased risk from estrogens was shown for invasive as well as noninvasive cancer, and a dose-response effect was demonstrated. For an estrogen user, the risk from endometrial cancer appeared to exceed by far the base-line risk from any other single cancer.
Biology and Management of Bladder Cancer
Authors: Derek Raghavan, William U. Shipley, Marc B. Garnick, Pamela J. Russell, Jerome P. Richie
Journal: New England Journal of Medicine (1990)

IN recent years, there have been important advances in our understanding of the biology of bladder cancer. They have been achieved with the use of new experimental models, the study of oncogenes in bladder cancer, and the demonstration of a wide range of functional heterogeneity in populations of morphologically identical bladder cancer cells. The development of new techniques of management — including diagnosis and staging, the use of intravesical chemotherapy and preemptive (neoadjuvant) intravenous chemotherapy, and the application of new monoclonal antibodies — appears to be yielding higher rates of response, prolonged disease-free survival, and perhaps even improved rates of . . .
Penicillin Allergy and Desensitization in Serious Infections during Pregnancy
Authors: George D. Wendel, Barbara J. Stark, Richard B. Jamison, Richard D. Molina, Timothy J. Sullivan
Journal: New England Journal of Medicine (1985)

Penicillin allergy presents a major obstacle to the successful management of some antepartum infections. We studied 15 pregnant women with histories of penicillin allergy confirmed by positive immediate wheal-and-flare skin tests. Thirteen had syphilis, one listeria sepsis, and one Streptococcus viridans endocarditis. Each patient was desensitized over four to six hours by oral administration of increasing doses of penicillin V. At the completion of the procedure, full-dose parenteral therapy with penicillin G or ampicillin was instituted. No extracutaneous reactions were detected. Five of the subjects (33 per cent) experienced pruritus (three) or urticaria (two), but no interruption of desensitization or therapy was necessary. All clinically apparent maternal infections were cured. The pregnancy complicated by listeriosis aborted in the first trimester. The 11 neonates delivered to date are normal. These results indicate that oral desensitization is an acceptably safe approach to therapy in pregnant women who are allergic to penicillin and have infections that require beta-lactam drugs.
A mindful and unemotional revolution
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2016)

What are you thinking about as you read this? It’s a serious question. How often is your mind on what you are doing? You drive a couple of miles on a motorway and can’t remember how you did it. Or you relax at home with family, except you have no idea what anybody said or did since you were mesmerised by your mobile device. What’s really on your mind when you are taking a history or examining a patient? You are present in body, but your concentration is elsewhere.
Treatment of Colonic and Rectal Adenomas with Sulindac in Familial Adenomatous Polyposis
Authors: Francis M. Giardiello, Stanley R. Hamilton, Anne J. Krush, Steven Piantadosi, Linda M. Hylind, Paul Celano, Susan V. Booker, C. Rahj Robinson, G. Johan A. Offerhaus
Journal: New England Journal of Medicine (1993)

Familial adenomatous polyposis is an autosomal dominant disorder characterized by the formation of hundreds of colorectal adenomas and eventual colorectal cancer. Administration of the nonsteroidal antiinflammatory drug sulindac has been followed by regression of polyps in patients with this disorder, but no controlled trial of this drug in patients who have not had surgery has been reported.
Case 15-2010
Authors: Hyman B. Muss, Helen Anne D'Alessandro, Elena F. Brachtel
Journal: New England Journal of Medicine (2010)

An 85-year-old woman had poorly differentiated invasive ductal cancer (positive for estrogen and progesterone receptors and HER2) with no clinical evidence of lymph-node or distant metastases. She had hypercholesterolemia, hypertension, chronic obstructive pulmonary disease, hypothyroidism, arthritis, and a history of pleural and pericardial effusions of unknown cause. She lived with a daughter and performed all activities of daily living. A management decision was made.
Idiopathic Hirsutism — An Ovarian Abnormality
Authors: Marvin A. Kirschner, I. Richard Zucker, Diana Jespersen
Journal: New England Journal of Medicine (1976)

We investigated increased production of testosterone and androstenedione in 44 women with unexplained adult-onset hirsutism, 41 of whom had normal-sized ovaries. Twenty women in this group had at least 50 per cent suppression of plasma testosterone and androstenedione after four to five days of dexamethasone. Testosterone and androstenedione values in ovarian-vein effluents were higher than those of their adrenal veins. We calculated adrenal secretion rates of both androgens in each patient by relating the adrenal gradients to those of cortisol. In 42 of the hirsute women, including those whose androgens were suppressed after dexamethasone, the ovaries were the predominant source of androgen production. The women with dexamethasone suppression had milder degrees of virilism and lower production rates of testosterone and androstenedione. We conclude that the ovaries are the source of excessive androgens in most women with unexplained hirsutism, and that corticoid-suppressible patients have milder forms of ovarian hyperandrogenism.
Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF)
Authors: Erkan Demirkaya, Cengizhan Acikel, Philip Hashkes, Marco Gattorno, Ahmet Gul, Huri Ozdogan, Turker Turker, Omer Karadag, Avi Livneh, Eldad Ben-Chetrit, Seza Ozen
Journal: Annals of the Rheumatic Diseases (2016)

Objective To develop widely accepted international severity score for children and adult patients with familial Mediterranean fever (FMF) that can be easily applied, in research and clinical practice. Methods Candidate severity criteria were suggested by several FMF expert physicians. After three rounds of Delphi survey, the candidate criteria, defined by the survey, were discussed by experts in a consensus meeting. Each expert brought data of clinical manifestations, laboratory findings and physician's global assessments (PGAs) of minimum 20 patients from their centres. We used the PGAs for disease severity as a gold standard. Logistic regression analysis was used to evaluate the predicting value of each item, and receiver operating characteristic curve analysis was performed to demonstrate the success of the criteria set. Results A total of 281 patients consist of 162 children and 119 adults with FMF were enrolled and available for validity analysis: Nine domains were included in the final core set of variables for the evaluation of disease severity in FMF. The International Severity Score for FMF (ISSF) may reach a maximum of 10 if all items are maximally scored. The threshold values to determine: severe disease ≥6, intermediate disease 3–5, mild disease ≤2. Area under the curve was calculated as 0.825 for this set in the whole group. Conclusions The initial validity of ISSF both in children and adult with FMF was demonstrated. We anticipate that it will provide a robust tool to objectively define disease severity for clinical trials, future research as well as for therapeutic decisions in managing patients with FMF.
Infantile Hypersensitivity Pneumonitis as a Reaction to Organic Antigens
Authors: Roger M. Katz, William T. Kniker
Journal: New England Journal of Medicine (1973)

A child with allergic bronchopulmonary aspergillosis had immunofluorescent demonstration of antibody, complement, and Aspergillus fumigatus antigen in sites of Arthus vasculitis in resected lung. This case, demonstrating features of both extrinsic allergic alveolitis and allergic bronchopulmonary aspergillosis, suggests that hypersensitivity pneumonitis is a disease spectrum, and that its manifestations depend on variations in the host response and site of reaction with antigens.
Oral Combination Therapies for Hepatitis C Virus Infection: Successes, Challenges, and Unmet Needs
Authors: Susanna Naggie, Andrew J. Muir
Journal: Annual Review of Medicine (2016)

The current standard of care for the treatment of hepatitis C virus (HCV) consists of interferon-free direct-acting antiviral (DAA) regimens, including combinations of DAAs and fixed-dose combination pills. DAAs for HCV are likely to be heralded as one of medicine's greatest advancements. Viral eradication rates are pushing 100% for many HCV-infected populations, including patients with HIV/HCV coinfection, decompensated cirrhosis, liver and kidney transplants, and end-stage liver disease. We highlight the greatest successes of combination DAA therapies, discuss the ongoing challenges, and identify the remaining patient subgroups with unmet medical needs.
Malignant Thyroid Tumors after Iodine-131 Therapy
Authors: Lars-Erik Holm, Ingemar Dahlqvist, Anders Israelsson, Göran Lundell
Journal: New England Journal of Medicine (1980)

We studied the incidence of malignant thyroid tumors after 131I therapy in 2727 patients with hyperthyroidism and in 273 euthyroid patients with cardiac disease. The patients were all adults, with a mean age of 57 years. The 131I therapy was given between 1951 and 1965. The mean follow-up period was 13 years for the hyperthyroid patients (15 years for the 85 per cent surviving for more than five years) and six years for the cardiac patients (12 years for the 41 per cent surviving for more than five years). The incidence of malignant thyroid tumors was based on a search of the Swedish Cancer Registry for the occurrence of such tumors in any of the 3000 patients. At present there is no increased incidence of malignant thyroid tumors after 131I therapy (four cases observed versus 3.2 cases expected).
Hodgkin's Disease: Evidence for a Tumor-Associated Antigen
Authors: Stanley E. Order, Marilyn Porter, Samuel Hellman
Journal: New England Journal of Medicine (1971)

Perisplenic nodes and splenic tumor nodules were obtained from two patients with Hodgkin's disease and used to immunize individually assigned rabbits. After immunization, the antiserums were absorbed with the normal splenic tissue from the same patient. The absorbed antiserums were used to identify a tumor-associated antigen by indirect immunofluorescence in cryostat sections. Tumor nodules fluoresced, whereas adjacent normal splenic tissue, serving as concomitant control, did not. Common antigenicity between patients was also demonstrated by fluorescence of absorbed antiserums cross-reactive with cryostat sections of other patients' tumors.
Interleukin-2-induced fever in relation to objective tumor response and survival in patients with metastatic melanoma.
Authors: M. Ellegaard, L. Bastholt, A. Jakobsen, F. Donskov, H. Schmidt
Journal: Journal of Clinical Oncology (2010)

8569 Background: Recent data has suggested fever as a beneficial side effect to immunotherapy. In 2007 we decided to abandon the routine use of antipyretics in patients receiving immunotherapy with interleukin 2 (IL-2) and interferon- a (IFN). The aim of this retrospective study was to examine the role of treatment-related fever during IL-2 treatment in metastatic melanoma. Patients were allowed temperatures up to 41 °C before intervention was instituted. Methods: 133 consecutive patients with metastatic melanoma treated with IL-2 and IFN from January 2006 to April 2009 were included. Temperature was measured every 8 hours during IL-2 treatment. We analyzed the highest temperature as a predictive factor for objective response and overall survival, using logistic regression and Cox proportional hazard analyses. 37 patients treated before 2007 received paracetamol and 96 patients after 2007 were treated without. Results: A maximum temperature of 39.0 °C or higher was shown to be an independent predictive factor for objective response/stable disease versus progression. The same result was obtained analyzing the maximum temperature as a continuous variable. In the survival analysis a maximum temperature of 39.5 °C or higher was associated with longer survival independent of performance status, lactate dehydrogenase, number of metastatic sites and neutrophils. No statistically significant differences in treatment-related side-effects were observed in the 2 cohorts. Patients who didn't receive paracetamol had a median maximum temperature of 39.8 °C compared to 38.9 °C in the paracetamol group. There was a trend towards a better response in the non-paracetamol group (p = 0.05). Conclusions: Temperatures of 39.5 °C and above during treatment with IL-2 appear to be an independent favourable factor for objective response and longer survival. Avoidance of paracetamol resulted in higher max temperatures. These data suggests that the use of paracetamol may have a negative impact on treatment results with immunotherapy. No significant financial relationships to disclose.
Cardiovascular Manifestations in Acute Poliomyelitis
Authors: Louis Weinstein, Alexis Shelokov
Journal: New England Journal of Medicine (1951)

CARDIOVASCULAR disturbances in poliomyelitis were first described in 1910 by Robertson and Chesley,1 who commented on the presence of interstitial edema and swelling of the fibers in the myocardium of patients dying of the infection. The earliest clinical report of heart involvement was published in 1912 by Hertz, Johnson and Depree2; they observed a patient who recovered from an attack of infantile paralysis in which myocarditis was present. Although the presence of cyanosis, rapid pulse, and cardiac arrhythmias in severe cases had been noted in passing by many students of this disease, it remained for Saphir and Wile3 in . . .
The Women’s Health Initiative randomized trial of calcium plus vitamin D: Effects on breast cancer and arthralgias
Authors: R. T. Chlebowski, K. C. Johnson, C. Kooperberg, A. Hubbell, D. Lane, M. O’Sullivan, S. Cummings, T. Rohan, S. Yasmeen, J. Khandekar
Journal: Journal of Clinical Oncology (2006)

LBA6 Background: Calcium (Ca) and vitamin D (D) have been associated with reduced breast cancer and breast density in observational studies. Randomized trials have not evaluated Ca/D supplementation for breast cancer prevention. Methods: We randomized 36,282 postmenopausal women without prior breast cancer from 40 WHI centers to 1000 mg of elemental calcium as calcium carbonate and 400 IU of vitamin D 3 (N = 18,176) daily or matching placebo (N = 18,106); 54% were also randomized one year previously to hormone therapy (HT) or placebo; conjugated equine estrogen (CEE) plus medroxyprogesterone acetate or CEE alone (the latter for those with prior hysterectomy). Ca/D effects on hip fracture and colorectal cancer have been reported (NEJM 2006). We report here pathologically confirmed invasive breast cancer as a secondary outcome of the Ca/D trial. Baseline serum 25(OH) D levels (in 1787 women) and serial joint symptoms (pain/stiffness and hand/feet swelling 0–3 scale, in a 6% sample) were also assessed. Results: Breast cancer incidence did not differ between Ca/D and placebo randomization groups (528 and 546 cases in Ca/D and placebo; hazard ratio 0.96; 95 percent confidence interval (CI), 0.85, 1.09). While SEER stage and abnormal mammogram frequency were similar between groups, breast cancers were smaller in the Ca/D group (1.54 cm (1.23), mean (SD) versus 1.71 (1.29), P = 0.05). Total vitamin D baseline intake was associated with lower breast cancer risk in the placebo group. Baseline vitamin D (nmol per liter) deficiency was common (≥30, sufficient (n = 266), 16 ≤ 30, insufficient (277), &lt; 16, deficient (743)) but was not related to joint pain (seen in 72.2%, 74.0%, 74.6%, of sufficiency and deficiency groups, respectively). Joint symptoms were lower in women randomized to CEE alone (P &lt; 0.01) but did not significantly differ by Ca/D group assignment and no significant interactions were seen between HT and Ca/D. Conclusion: Among healthy postmenopausal women, Ca/D supplementation did not reduce breast cancer risk but the cancers in those randomized to Ca/D were somewhat smaller. Exogenous estrogen use but not Ca/D supplementation influences arthralgias. [Table: see text]
Expression of P Antigen in Parvovirus B19–Infected Bone Marrow
Authors: Jonathan R. Kerr, Stephen McQuaid, Peter V. Coyle
Journal: New England Journal of Medicine (1995)

To the Editor: Parvovirus B19 causes erythema infectiosum,1 transient aplastic crisis,2 hydrops fetalis,3 and persistent infection in immunocompromised patients.4,5 Replication of parvovirus B19 has been demonstrated only in human erythroid progenitor cells, a tropism explained by the recent discovery of the cellular receptor of B19.6 The virus binds to P antigen of the P system blood group, as demonstrated by in vitro hemagglutination. Parvovirus B19 does not agglutinate erythrocytes from persons with the P1k or p phenotypes,6 and bone marrow from persons lacking P antigen is naturally resistant to parvovirus B19 infection, as Brown et al. have shown . . .
US panel recommends low dose aspirin to prevent cardiovascular disease and colorectal cancer
Authors: Michael McCarthy
Journal: BMJ (2016)

The US Preventive Services Task Force has recommended low dose aspirin for the primary prevention of cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who are at high risk of cardiovascular disease.

The recommendations apply to adults who have a 10% or greater 10 year risk of a cardiovascular event, are not at risk of gastrointestinal bleeding, have a life expectancy of at least 10 years, and are willing to take low dose aspirin daily for at least 10 years. The recommendations and accompanying evidence reviews appeared in Annals of Internal Medicine on 12 April.1 2 3 4

Cardiovascular disease is responsible for more than half of …
Treatment for Refractory Myasthenia Gravis—New Lymphs for Old
Authors: Daniel B. Drachman
Journal: JAMA Neurology (2016)

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Flocks of Chicken Free From Antibody to Rous Virus<xref ref-type="fn" rid="fn1">2</xref>
Authors: F.B. Bang, M. Foard
Journal: JNCI Journal of the National Cancer Institute (1963)

A flock of chickens entirely free from antibodies to Rous virus was maintained for 2 years through 3 generations. The initiating eggs were from an open flock that had been isolated for 6 months. These eggs were hatched and the chicks were raised in isolation. Such chickens were readily infected with Rous virus and developed antibodies to it. After inoculation with the Harris (British) strain of Rous virus, they did not delelop antibodies to the Bryan (American) strain. When these birds were placed in close contact with chickens having experimentally induced tumors, a few of their antibody-free progeny developed antibodies. None of the progeny developed antibodies when kept in rooms with open-flock chickens or when raised from the age of 3 days with open-flock age mates. The same proportion of embryos was resistant to Rous virus in the antibody-free flock as in the open commercial flock. These embryos were completely resistant to virus after infectious doses varying from 10 to 200. Analysis of the embryo resistance derived from individual antibody-free and open-flock hens is compatible with the interpretation of resistance as a single recessive character and excludes a single dominant but not multifactorial characters.