tbuckley/cabot-search huggingface dataset:
PWE-191 17 years of oesophageal stent insertion: experience from a tertiary centre
Authors: K Axe, G Thomas
Journal: Gut (2015)

<h3>Introduction</h3> Dysphagia occurs in 70% oesophageal cancers,<sup>1</sup>self-expanding metal stents (EMS) are an established palliative treatment for dysphagia, fistula and perforation.<sup>2</sup> <h3>Method</h3> We review our Centre’s experience of EMS placement since 1997. Over 17 years all EMS were placed by a single operator (GT) using a standard dual Endoscopy and Radiology assisted technique. A Database was maintained and analysed for this review. <h3>Results</h3> 397 EMS were placed in 373 patients (25–35/year). Average age 74 years, 59% were men. 97% placed for malignant disease; 83% for dysphagia palliation, 14% for fistulae and 3% for benign perforation. 3/4 of tumours were lower oesophageal. Adenocarcinoma was the commonest tumour type (46%), the majority of these were male (75%). Squamous made up 24%, with 63% being female; the rest were poorly differentiated (10%), and miscellaneous (20%) including breast, lung, mesothelioma and melanoma. Most tumours were 2–10cm long, 68% had moderately tight stricturing but only 18% of all tumours required dilatation (average 11mm). Tumour clearance was successful in 99% where an EMS was deployed. 1/3 procedures were considered technically challenging, reasons included; difficult tumour anatomy e.g. angulation (15%) and inability to cross the tumour after dilatation resulting in ‘blind’ distal placement (5%). EMS placement was unsuccessful in 1% and failed to expand adequately or slipped from the ideal position in 5%. Bleeding occurred in 4%, all minor, and resuscitation due to respiratory arrest occurred in 1 case. 30 day mortality was 10%; 1 patient died within 24 h of EMS placement. Stent choice changed over time; Ultraflex (Boston Scientific) was used between 1998–2006 and partially covered Ni-Ti stents (various manufacturers) thereafter. <h3>Conclusion</h3> Our patient demographics reflect national trends in age, sex and tumour type<sup>3</sup>. 99% achieved successful EMS placement, 18% required dilatation for placement. Our complication rate is similar to published work but the rate of severe bleeding and 30 day mortality were lower than published figures of 1% and 24% respectively.<sup>4</sup> In our 17 year experience, EMS are a useful palliative treatment for oesophageal cancer with high success rates of placement and relatively low incidence of complications. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Brierley JD, Oza AM. Radiation and chemotherapy in the management of malignant esophageal strictures. Gastint Endo Clin N Am. 1998;8(2):451–463 Hindy P, Hong J, Lam-Tsai Y, Gress F. A comprehensive review of esophageal stents. Gastroenterol Hepatol. 2012;8(8):526–534 Office for National Statistics. Cancer survival rates, cancer survival in England, patients diagnosed 2005-2009, followed up to 2010. Nov 2011 [Online] www.ons.gov.uk Martinez J, Puc M, Quiros R. Esophageal stenting in the setting of malignancy. ISRN Gastroenterol<i>. </i>2011; 2011:719575. [Published online]
Problems Arising in the Treatment of Syphilis with Penicillin
Authors: William R. Hill
Journal: New England Journal of Medicine (1946)

THIS report deals with the therapeutic pitfalls encountered in 125 patients with various types of syphilis who were treated with penicillin at the Massachusetts General Hospital subsequent to November, 1944. All these patients were hospitalized and treated for periods ranging from eight to fifteen days. Penicillin in aqueous solution was administered intramuscularly in doses of 20,000 to 40,000 Oxford units every three hours, day and night. The total dose was from a minimum of 1,200,000 to 2,400,000 Oxford units. Arsenicals and bismuth were not used concomitantly with penicillin, but in most patients with interstitial keratitis or neurosyphilis, fever therapy supplemented . . .
<i>PD-L1</i> and <i>PD-L2</i> Genetic Alterations Define Classical Hodgkin Lymphoma and Predict Outcome
Authors: Margaretha G.M. Roemer, Ranjana H. Advani, Azra H. Ligon, Yasodha Natkunam, Robert A. Redd, Heather Homer, Courtney F. Connelly, Heather H. Sun, Sarah E. Daadi, Gordon J. Freeman, Philippe Armand, Bjoern Chapuy, Daphne de Jong, Richard T. Hoppe, Donna S. Neuberg, Scott J. Rodig, Margaret A. Shipp
Journal: Journal of Clinical Oncology (2016)

Classical Hodgkin lymphomas (cHLs) include small numbers of malignant Reed-Sternberg cells within an extensive but ineffective inflammatory/immune cell infiltrate. In cHL, chromosome 9p24.1/PD-L1/PD-L2 alterations increase the abundance of the PD-1 ligands, PD-L1 and PD-L2, and their further induction through Janus kinase 2-signal transducers and activators of transcription signaling. The unique composition of cHL limits its analysis with high-throughput genomic assays. Therefore, the precise incidence, nature, and prognostic significance of PD-L1/PD-L2 alterations in cHL remain undefined.We used a fluorescent in situ hybridization assay to evaluate CD274/PD-L1 and PDCD1LG2/PD-L2 alterations in 108 biopsy specimens from patients with newly diagnosed cHL who were treated with the Stanford V regimen and had long-term follow-up. In each case, the frequency and magnitude of 9p24.1 alterations-polysomy, copy gain, and amplification-were determined, and the expression of PD-L1 and PD-L2 was evaluated by immunohistochemistry. We also assessed the association of 9p24.1 alterations with clinical parameters, which included stage (early stage I/II favorable risk, early stage unfavorable risk, advanced stage [AS] III/IV) and progression-free survival (PFS).Ninety-seven percent of all evaluated cHLs had concordant alterations of the PD-L1 and PD-L2 loci (polysomy, 5% [five of 108]; copy gain, 56% [61 of 108]; amplification, 36% [39 of 108]). There was an association between PD-L1 protein expression and relative genetic alterations in this series. PFS was significantly shorter for patients with 9p24.1 amplification, and the incidence of 9p24.1 amplification was increased in patients with AS cHL.PD-L1/PD-L2 alterations are a defining feature of cHL. Amplification of 9p24.1 is more common in patients with AS disease and associated with shorter PFS in this series. Further analyses of 9p24.1 alterations in patients treated with standard cHL induction regimens or checkpoint blockade are warranted.
A pediatric phase I trial and pharmacokinetic (PK) study of sunitinib: A Children’s Oncology Group Phase I Consortium study
Authors: S. G. DuBois, S. Shusterman, A. M. Ingle, S. Baruchel, D. Stempak, J. Sun, S. P. Ivy, J. Glade-Bender, S. M. Blaney, P. C. Adamson
Journal: Journal of Clinical Oncology (2008)

3561 Background: Sunitinib is an oral multitargeted tyrosine kinase inhibitor of VEGF, PDGF, c-KIT, and flt-3 receptors. This study was conducted to define the dose limiting toxicities (DLT) and to determine the maximum tolerated dose (MTD) of sunitinib in children with relapsed or refractory solid tumors. Methods: Sunitinib was administered orally once daily in 6 week cycles (4 weeks on / 2 weeks off). Cohorts of 3–6 pts (≥ 2 to ≤ 21 yr) were enrolled at a starting dose level of 20 mg/m2/d, based on the adult recommended dose of 50 mg/d. Weekly 24-hour trough plasma concentrations of sunitinib and the active metabolite, SU12662, were determined. Results: 12 pts (8 male), median age 14.6 (range 10.6–20.6) yrs, were enrolled. 3/6 pts at the initial dose level of 20 mg/m2/d had DLT: grade 2 systolic dysfunction, grade 3 anorexia, and grade 4 neutropenia. Two pts developed grade 2 hypothyroidism. 2/6 pts at dose level -1 (15 mg/m2/d) had DLTs: grade 3 systolic dysfunction and grade 3 ALT. Of the 2 pts with cardiotoxicity, one required treatment with digoxin and lisinopril for symptom control; both improved several weeks following sunitinib discontinuation. No objective responses were observed. The median d21 steady-state trough sunitinib plasma concentrations were 24.6 (range 6.0–37.7) and 37.4 (24.2–62.9) ng/mL at the 15 and 20 mg/m2 dose levels, respectively. Conclusions: Sunitinib at a dose of 20 mg/m2/d exceeded the MTD in pediatric patients included in this study. The steady-state PK profile of sunitinib in children appears comparable to that observed in adults. Due to the observed and emerging concerns of cardiotoxicity, further pediatric evaluation of sunitinib is being undertaken in pts not previously treated with anthracyclines or radiation fields involving the heart. No significant financial relationships to disclose.
Effect of Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor on Hematopoietic Reconstitution after High-Dose Chemotherapy and Autologous Bone Marrow Transplantation
Authors: S J Brandt, W P Peters, S K Atwater, J Kurtzberg, M J Borowitz, R B Jones, E J Shpall, R C Bast, C J Gilbert, D H Oette
Journal: New England Journal of Medicine (1988)

Original Article from The New England Journal of Medicine — Effect of Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor on Hematopoietic Reconstitution after High-Dose Chemotherapy and Autologous Bone Marrow Transplantation
Chromosome Analyses in Mongolism (Langdon–Down Syndrome) Associated with Leukemia
Authors: Josef Warkany, William K. Schubert, Jerry N. Thompson
Journal: New England Journal of Medicine (1963)

IN 1930 Brewster and Cannon1 reported a case of mongolism associated with acute lymphatic leukemia, and seventeen years later Ingalls2 mentioned as a curiosity that 2 of 50 children with mongolism autopsied at Boston Children's Hospital died of leukemia. These isolated observations were followed between 1950 and 1960 by numerous publications3 4 5 6 7 8 9 10 11 showing that the occurrence of the combined disorders was many times higher than that which might be expected to result from chance associations. By 1961 Stewart12 had found in England and Wales 50 cases of leukemia associated with mongolism, and Wald et al.,13 examining death certificates of all who . . .
A boy with a sac-like protrusion at the occipital region
Authors: Yong-Hai Zhou, Ming-Hua Zheng
Journal: BMJ (2016)

A 1 year old boy presented to the neurosurgery clinic with a sac-like protrusion at the occipital region that had been present since birth. He was born at full term by caesarean section. He had no neurological symptoms and the swelling had not enlarged since birth. On examination, his head circumference was normal for age. The protrusion was 2.5×2.5 cm and his cry impulse was positive. A systemic examination …
Skin dose effects of postmastectomy chest wall radiation therapy using brass mesh as an alternative to a bolus.
Authors: Erin Healy, Shawnee Anderson, Jing Cui, Laurel Beckett, Allen M. Chen, Julian Perks, Robin Stern, Jyoti Mayadev
Journal: Journal of Clinical Oncology (2012)

157 Background: The use of brass mesh as an alternative to a bolus is relatively uncommon in post-mastectomy chest wall radiation therapy (PMRT). This study aimed to characterize the skin dose effects of using 2mm fine brass mesh as an alternative to the traditional tissue-equivalent bolus during chest wall PMRT. Methods: Data was collected from patients who received PMRT using brass mesh at UC Davis Medical Center’s Department of Radiation Oncology between January 2008 and June 2011. Several patient characteristics including age, body habitus, and ethnicity were analyzed along with several disease and treatment characteristics to determine whether or not they had an impact on the skin reaction observed during radiation treatment. In addition to assessing skin toxicity visually using standardized National Cancer Institute scores (NCIS), surface doses were measured for 16 of the 48 patients (33%) to quantify radiation exposure to the chest wall. Results: 48 female patients aged 28-83 received PMRT using brass mesh. As expected, the severity of skin toxicity increased with subsequent doses of radiation with all patients beginning treatment with no skin reaction (NCIS = 0) and the majority of patients completing treatment with either faint to moderate erythema (N = 19, 40%, NCIS = 1) or moderate to brisk erythema (N = 23, 48%, NCIS = 2). In vivo dosimetry analysis revealed surface doses between 81% and 110% of the prescribed dose, with an average of 99% of the prescribed radiation dose being delivered and a standard deviation of 10%. Conclusions: For post-mastectomy chest wall radiation therapy, brass mesh is an effective alternative to the tissue-equivalent bolus. The brass mesh achieved moderate erythema in the majority of patients at the end of treatment and the surface dose was validated using in vivo dosimetry.
Evidence of Aluminum Loading in Infants Receiving Intravenous Therapy
Authors: Aileen B. Sedman, Gordon L. Klein, Russell J. Merritt, Nancy L. Miller, Kim O. Weber, William L. Gill, Harish Anand, Allen C. Alfrey
Journal: New England Journal of Medicine (1985)

To investigate the possibility that premature infants may be vulnerable to aluminum toxicity acquired through intravenous feeding, we prospectively studied plasma and urinary aluminum concentrations in 18 premature infants receiving intravenous therapy and in 8 term infants receiving no intravenous therapy. We also measured bone aluminum concentrations in autopsy specimens from 23 infants, including 6 who had received at least three weeks of intravenous therapy. Premature infants who received intravenous therapy had high plasma and urinary aluminum concentrations, as compared with normal controls: plasma aluminum, 36.78±45.30 vs. 5.17±3.1 μg per liter (mean ±S.D., P<0.0001); urinary aluminum:creatinine ratio, 5.4±4.6 vs. 0.64±0.75 (P<0.01). The bone aluminum concentration was 10 times higher in infants who had received at least three weeks of intravenous therapy than in those who had received limited intravenous therapy: 20.16±13.4 vs. 1.98±1.44 mg per kilogram of dry weight (P<0.0001). Creatinine clearances corrected for weight did not reach expected adult values until 34 weeks of gestation. Many commonly used intravenous solutions are found to be highly contaminated with aluminum. We conclude that infants receiving intravenous therapy have aluminum loading, which is reflected in increased urinary excretion and elevated concentrations in plasma and bone. Such infants may be at high risk for aluminum intoxication secondary to increased parenteral exposure and poor renal clearance. (N Engl J Med 1985; 312: 1337–43.)
The Infant Seat as Treatment for Gastroesophageal Reflux
Authors: Susan R. Orenstein, Peter F. Whitington, David M. Orenstein
Journal: New England Journal of Medicine (1983)

Positioning in the infant seat ("chalasia chair") for treatment of infants with gastroesophageal reflux is presumed to have a beneficial effect. We undertook a controlled, prospective study of such positioning to evaluate this purported benefit. Nine infants with documented gastroesophageal reflux participated in 18 paired two-hour postprandial trials in an infant seat and in the horizontal prone position. Distal esophageal pH monitoring demonstrated longer exposure to gastroesophageal reflux while infants were in the seat than when they were prone (28.2±6.4 per cent vs. 12.8±3.7 per cent of total time with pH <4.0, P = 0.023), a difference due largely to more episodes (16.0±2.4 vs. 10.1±2.3 per two-hour postprandial period, P = 0.002). We conclude that the infant seat, rather than being therapeutic in gastroesophageal reflux in children under six months of age, is actually detrimental, when compared with simply placing an infant prone. (N Engl J Med 1983; 309:760–3.)
Emotional Problems of Burned Children
Authors: Robert T. Long, Oliver Cope
Journal: New England Journal of Medicine (1961)

THE severely burned patient is a notoriously difficult problem for the doctor and nurse. The medical care is arduous because of the unrelenting, meticulous physical work involved but also in larger part because of the antagonistic behavioral patterns frequently assumed by the patient. On entry to the hospital immediately after injury the patient is usually reasonable, Cooperative and grateful. Soon, however, the pattern changes. The patient tends to become irritable, whining and unCooperative, and often shows aggressive and even assaultive behavior. The illness is often prolonged by open wounds as well as infection, and the staff becomes fatigued, morale tends . . .
Rapid opiate detoxification: clinical evidence of antidepressant and antipanic effects of opiates
Authors: M S Gold, A L Pottash, D R Sweeney, H D Kleber, D E Redmond
Journal: American Journal of Psychiatry (1979)

I. Prange A, Wilson I, Breese G. et al: Hormonal alteration of imipramine response: a review. in Hormones, Behavior and Psychopathology. Edited by Sachar E. New York. Raven Press. 1976 2. Gram L: Plasma level monitoring of tricyclic antidepressant therapy. Clin Pharmacokinet 2:237-251. 1977 3. Brunswick DI, Needelman B. Mendels J: Radioimmunoassay of imipramine and desmethylimipramine. Life Sci 22:137-146, 1978 4. Burckhardt C, Raeder E. Muller V. et al: Cardiovascular effects of tricyclic and tetracyclic antidepressants. JAMA 239:213-216, 1978 5. Hoffman I. Lowery R: The electrocardiogram in thyrotoxicosis. Am I Caldiob 6:893-904, 1960 6. Prange A: Paroxysmal auricular tachycardia apparently resulting from combined thyroid-imipramine treatment. Am I Psychiatry I 19:994-995, 1963 7. Zung WW: A self-rating depression scale. Arch Gen Psychiatry 12:63. 1965 8. Breese G, Traylor T. Prange A: The effect of triiodothyronine on the disposition and actions of imipramine. Psychopharmacologia 25:101-111. 1972 9. Prange A. Bakewell W: Effects of imipramine and reserpine on body size and organ size in euthyroid and hyperthyroid growing rats. I Pharmacol Exp Ther 15 1:409-412, 1966 10. Brodie B, Davies I, Hynie S. et al: Interrelationships of catecholamines with other endocrine systems. Pharm Rev 18:273289, 1966
A Comparison of Beclomethasone, Salmeterol, and Placebo in Children with Asthma
Authors: F. Estelle R. Simons
Journal: New England Journal of Medicine (1997)

An inhaled glucocorticoid is currently the medication of choice for long-term control of persistent asthma in children. The role of long-acting β2-adrenergic–receptor agonists, such as salmeterol, needs to be defined.
The Hypothermia of Hypoglycemia
Authors: Norbert Freinkel, Boyd E. Metzger, Ethan Harris, Sumner Robinson, Milton Mager
Journal: New England Journal of Medicine (1972)

Abstract An inhibitor of glucose utilization, 2-deoxy-D-glucose (2-DG) was employed to study the hypothermia of hypoglycemia. After 2-DG infusions, rectal temperatures in normal human subjects fell to nadir levels averaging 1.1°C below base-line values in two to 2.5 hours coincident with maximal increases of plasma growth hormone. Temperatures remained below basal values for six hours in the face of increases in plasma glucose and insulin, and urinary catecholamines. The findings indicate that the hypothermia is conditioned by intracellular glucopenia rather than the availability of circulating glucose or glucoregulatory hormones. To assess the role of central thermoregulatory mechanisms, 2-DG was injected into tail veins or cerebral ventricles of conscious mice. Although rectal temperatures fell with either route, hypothermic potencies were approximately fivefold greater with intracerebral administration. Thus, exclusion of glucose from central rather than peripheral sites plays the major part in the hyp...
Tumor-Infiltrating Lymphocytes (Tils) and Pd-L1 Expression in Non- Small Cell Lung Cancer Brain Metastases (Bm) and Matched Primary Tumors (Pt)
Authors: A.S. Berghoff, C. Inan, G. Ricken, G. Widhalm, K. Dieckmann, P. Birner, F. Oberndorfer, B. Dome, R. Bartsch, C. Zielinski, M. Preusser
Journal: Annals of Oncology (2014)
Coping with pain: a developmental approach to treatment of burned children
Authors: F J Stoddard
Journal: American Journal of Psychiatry (1982)

The treatment of children aged 1-18 who experienced physical pain from an acute burn and the emotional pain of disfigurement offers a prototype for treatment of pain and understanding its impact on the child's emotional life. The author presents an initial report on differential response to and treatment of burn pain in infancy, the preschool years, latency, preadolescence, and adolescence. He describes the basic therapeutic interventions for such children, including psychological preparation, consistent "holding" relationships, selective reinforcement of denial, tolerance of regression, medications, and hypnosis or relaxation techniques.
Letter to the editor: Responding to a call for action - where are we now?
Authors: Flavia Riccardo, Paolo Giorgi Rossi, Antonino Chiarenza, Teymur Noori, Silvia Declich
Journal: Eurosurveillance (2015)

Preview this article: Letter to the editor: Responding to a call for action - where are we now?, Page 1 of 1 < Previous page | Next page > /docserver/preview/fulltext/eurosurveillance/20/50/eurosurv-20-50-4-1.gif
Crystalline and Macrocrystalline Nitrofurantoin in the Treatment of Urinary-Tract Infection
Authors: Steven Kalowski, N. Radford, Priscilla Kincaid-Smith
Journal: New England Journal of Medicine (1974)

SINCE the first reports1 of the successful use of nitrofurantoin in the treatment of urinary infection, this drug has been widely accepted as a reliable and effective antimicrobial in the treatment2 and prophylaxis3 , 4 of urinary-tract infections in patients with normal renal function.A major advantage of the drug for prophylaxis is that, because the blood levels are negligible, the intestinal and normal introital flora are not altered.3 Moreover, most bacteria do not become resistant.5 The reported rate of adverse reactions2 , 6 7 8 varies between 3.5 and 40 per cent, and these reports2 , 6 , 7 may represent only a small fraction of the adverse reactions . . .
Psychologic Factors in Low-Back Pain
Authors: Thornton Brown, John C. Nemiah, Joseph S. Barr, Herbert Barry
Journal: New England Journal of Medicine (1954)

IT is well known that the diagnosis of back pain is difficult and that the results of treatment, particularly in industrial practice, are not entirely satisfactory. Among the reasons commonly given for these diagnostic and therapeutic failures is the presence of psychogenic factors. The phrases "functional overlay" and "neurotic symptoms" are frequently and loosely used, on the basis of clinical impressions rather than carefully evaluated observations.A few psychiatric studies of such patients have been presented,1 2 3 4 5 and some of the clinical characteristics have been described. The present study was undertaken in the hope that we could cast further light on . . .
Directional Coronary Atherectomy versus Balloon Angioplasty
Authors: John A. Bittl
Journal: New England Journal of Medicine (1993)

Although balloon angioplasty has been an important advance in the treatment of coronary artery disease, this procedure is limited by a high rate of restenosis. In balloon angioplasty, coronary stenoses are dilated but atherosclerotic plaques are not removed. In contrast, directional atherectomy was developed to remove atherosclerotic plaque from coronary arteries and thus overcome the problem of restenosis. Is atherectomy better than conventional balloon angioplasty? Topol and Adelman and their colleagues address this question in two randomized studies in this issue of the Journal1,2. These important studies not only examine the relative merits of directional atherectomy and balloon . . .