tbuckley/cabot-search huggingface dataset:
The Effects of High-Dose Corticosteroids in Patients with Septic Shock
Authors: Charles L. Sprung, Panagiota V. Caralis, Eileen H. Marcial, Margaret Pierce, Mark A. Gelbard, William M. Long, Robert C. Duncan, Moses D. Tendler, Michael Karpf
Journal: New England Journal of Medicine (1984)

To determine whether corticosteroids are efficacious in severe septic shock, we conducted a prospective study of 59 patients randomly assigned to a methylprednisolone, dexamethasone, or control group. Patients were treated 17.5 +/- 5.4 hours (mean +/- S.E.M.) after the onset of shock, and 55 patients required vasopressor agents. Early in the hospital course, reversal of shock was more likely in patients who received corticosteroids than in those who did not. Four (19 per cent) of 21 methylprednisolone-treated, 7 (32 per cent) of 22 dexamethasone-treated, and none of 16 control patients had reversal of shock 24 hours after drug administration (corticosteroid groups vs. control group, P less than 0.05). Patients treated with corticosteroids within four hours after the onset of shock had a higher incidence of shock reversal (P less than 0.05). At 133 hours after drug administration, 17 (40 per cent) of 43 corticosteroid-treated patients had died, and 11 (69 per cent) of 16 control patients had died (P less than 0.05). However, these differences in reversal of shock and survival disappeared later in the course. Overall, 16 (76 per cent) of 21 patients receiving methylprednisolone, 17 (77 per cent) of 22 patients receiving dexamethasone, and 11 (69 per cent) of 16 controls in the hospital died. We conclude that corticosteroids do not improve the overall survival of patients with severe, late septic shock but may be helpful early in the course and in certain subgroups of patients.
Case 15-1991
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, John C. Wain, Eugene J. Mark
Journal: New England Journal of Medicine (1991)

Presentation of CaseA 48-year-old man was admitted to the hospital because of chest pain, dysphagia, fever, and a subcarinal mass.The patient was in good health until six weeks earlier, when dysphagia developed while he was swallowing a piece of hard candy. During the next few days he experienced continual dysphagia and odynophagia on swallowing solids or liquids; his symptoms then diminished. Three weeks before entry he felt relatively well and was able to ski without difficulty. Two weeks before admission fever and chills appeared, with pharyngitis, headache, and myalgia and arthralgia after the patient was exposed to a . . .
11C-Acetate PET/CT Monitoring Therapy of Multiple Myeloma
Authors: Wenjia Zhu, Yonghong Dang, Yanru Ma, Fang Li, Li Huo
Journal: Clinical Nuclear Medicine (2016)

A 67-year-old man with newly diagnosed multiple myeloma underwent both FDG and C-acetate PET/CT sequentially on different days. There was increased FDG activity only in L1 vertebral body, but there was diffuse abnormal C-acetate activity throughout the skeletal system. After the successful therapy, the patient who was on remission clinically underwent follow-up PET/CT scans. Interestingly, L1 remained to have elevated FDG, although with less intensity. In contrast, there was no abnormal C-acetate activity anywhere in the body. The patient remained in remission clinically.
Sublingual Immunotherapy (SLIT) Regulates the Expression of Transcription Factors and Interleukins in Peanut Allergic Children
Authors: Ping Ye, Michael D. Kulis, Rishu Guo, Edwin H. Kim, Brian P. Vickery, A. Wesley Burks
Journal: Journal of Allergy and Clinical Immunology (2016)

RATIONALE:We and others have previously demonstrated that SLIT can effectively desensitize peanut allergic children, albeit its molecular mechanism(s) is not elucidated.We hypothesized that SLIT acts, in part, by regulating transcription factors and interleukins that are critical to lymphocyte functions and allergic responses.METHODS: Peanut-allergic subjects (1.5-10 years old) were SLITtreated, with a brief escalating dose phase, and then maintained with a dose of 2 mg daily for 3 or 5 years.Subjects then were challenged with peanut, and clinically defined as non-sustained unresponsiveness (non-SU) or sustained unresponsiveness (SU).PBMC from the SLIT-treated subjects were contemporaneously obtained, cultured with the individual's own plasma; and their cryopreserved mRNA was RT-PCR analyzed.RESULTS: The abundance of mRNA for Foxp3, Blimp1, and T-bet in PBMC cultures derived from SU subjects (N55), who underwent 3 years of SLIT-treatment, was increased by ;500% (p<0.05),;320% (p<0.05), and ;80% (p<0.05),respectively, as compared to their non-SU counterparts (N54).In PBMC from SU subjects (N54) treated for 5 years, ZNF90 mRNA abundance became moderately increased, being ;150% (p<0.05) of that in non-SU cultures (N59).However, the expression of GATA3 and Bcl-6 did not change.In contrast, IL-5 and IL-13 mRNA abundance was reduced in PBMC of SU subjects treated for 3 years, and further reduced and became statistically significant 5 years after SLIT-treatment.CONCLUSIONS: Peanut SLIT treatment up-regulates the expression of the transcription factors Foxp3, Blimp1, T-bet, and ZNF90, while downregulating IL-5 and IL-13, suggesting that these genes play an important role in SLIT-induced peanut sustained unresponsiveness.
Purification and Partial Characterization of PAS-Positive Inclusion Bodies from the Liver in Alpha<sub>1</sub>-Antitrypsin Deficiency
Authors: Sten Eriksson, Christer Larsson
Journal: New England Journal of Medicine (1975)

Abstract To characterize the periodic acid-Schiffpositive inclusion bodies from cirrhotic livers of patients with homozygous alpha1-antitrypsin deficiency we isolated and analyzed such material. The main component of the inclusion bodies was a protein with approximately the same molecular size as serum alpha1-antitrypsin. Immunologic similarity between the isolated protein and serum alpha1-antitrypsin was established by the isolate's ability to react with fluorescein-isothiocyanate-conjugated antibodies against serum alpha1-antitrypsin and to raise antibodies gainst it in rabbits, and with the double immunodiffusion technic. On agarose-gel electrophoresis hepatic antitrypsin migrated as an alpha2-globulin before and after neuraminidase treatment. Chemical analysis showed a complete absence of sialic acid. Hepatic antitrypsin had a pronounced tendency to form insoluble macroaggregates. An insufficient sialylation of antitrypsin in the liver appears to be one of the basic defects in alpha1-antitrypsin defic...
Compensatory Hyperhidrosis after Sympathectomy
Authors: Walter B. Shelley, Ralph Florence
Journal: New England Journal of Medicine (1960)

THE eccrine sweat glands form a diffuse yet critical thermoregulatory organ for the body. Under the control of the sympathetic nerves, these glands provide the major defense against thermal stress. Numerous studies have demonstrated a close relation between this sweat-gland response and the heat load experienced by the subject.1 Little, however, has been written on the thermal response of the sweat glands after removal of part of the sweat-gland system. Although this thermoregulatory system eludes gross resection, it is still possible to remove varying amounts. This can be achieved by sympathectomy, which effectively eliminates all sweat-gland activity in the areas . . .
John Arbuthnot (1667–1735)
Authors: Robert W. Buck
Journal: New England Journal of Medicine (1960)

DR. John Arbuthnot† was rated by Dr. Samuel Johnson first among his contemporaries as a man of the "most universal genius, being an excellent physician, a man of deep learning, and a man of much humor."Arbuthnot's chief claim to remembrance is that he invented the character of John Bull, "an honest, plain-dealing fellow, choleric, bold and of a very inconstant temper; he dreaded not old Lewis Baboon [Louis XIV] either at back-sword, single falchion or cudgel-play; but then he was very apt to quarrel with his best friends, especially if they pretended to govern him; if you flattered him, . . .
Abstract 19184: Prosthesis-Patient Mismatch and Mitral Regurgitation Persistence Late after Aortic Valve Replacement.
Authors: Emiliano Angeloni, Umberto Benedetto, Simone Refice, Daria Santini, Giuseppino M Ciavarella, Antonino Roscitano, Giovanni Melina, Riccardo Sinatra
Journal: Circulation (2010)

Background: Mitral regurgitation (MR) is a common finding in patients undergoing isolated aortic valve replacement (AVR). In this context, a mild degree of MR in absence of organic disease generall...
Chromosomes and Spray Adhesives
Authors: Jaroslav Cervenka, Hattie L. Thorn
Journal: New England Journal of Medicine (1974)

Abstract Fourteen subjects with occupational exposure to several brands of spray adhesives were examined for chromosomal breaks and abnormal rearrangements. Among 3421 cells in mitosis, 55 breaks and rearrangements were observed, constituting 1.6 per cent aberrant mitoses. Among 1594 mitoses in 10 healthy controls, 22 (1.38 per cent) aberrations were noted. Comparing the data on the occupationally exposed and the control group revealed no statistically significant difference. Furthermore, the types of chromosomal aberrations that occurred suggested that the spray adhesives used by our subjects did not cause detectable chromosomal damage. (N Engl J Med 290:543–545, 1974)
Arterial Oxygen Unsaturation and the Ventilation-Perfusion Defect of Laënnec's Cirrhosis
Authors: Theodore Rodman, Melvin Sobel, Henry P. Close
Journal: New England Journal of Medicine (1960)

THE association of Laënnec's cirrhosis with arterial oxygen unsaturation has been recognized but not satisfactorily explained. We have previously reported observations on a patient with Laënnec's cirrhosis who had intense cyanosis, clubbed fingers and marked arterial oxygen unsaturation.1 The present study was designed to determine the incidence and the pathophysiologic basis of this phenomenon in patients with cirrhosis.Material and MethodsFifty-seven patients were studied. Fifty-six had far advanced Laënnec cirrhosis associated in most cases with a background of excessive alcoholic intake. In the patients in whom the clinical and laboratory findings were equivocal, the diagnosis was confirmed by microscopical . . .
PTU-123 Lessons learnt from a hundred consecutive laparoscopic nissen’s fundoplications
Authors: J Ma, A Rasheed
Journal: Gut (2015)

<h3>Introduction</h3> Laparoscopic Nissen’s fundoplication (LNF) is the procedure of choice in the surgical management of refractory gastroesophageal reflux disease (GORD). Few studies have reported subjective symptomatic outcome and objective investigative outcome postoperatively. The correlation between these two outcome measurements is unclear. The objective of this study is to evaluate a hundred consecutive LNFs in relation to patient’s anatomic and physiologic status after the procedure, patient’s functional outcome, and the rate and pattern of procedure failures. <h3>Method</h3> Patients who underwent LNFs from 2007 to 2014 under a single surgeon were identified retrospectively. Patient demographics, morbidities, follow-up investigations and any redo operation were recorded. Surgical outcome was reported using the Viscik symptom evaluation tool. Patient telephone survey was performed using the validated GERD-HRQL (Health Related Quality of Life) questionnaire to assess patients’ functional outcome. <h3>Results</h3> A total of 100 consecutive patients were identified in the 8 year period. Redo operations had been performed or planned for 11 of these patients. 30 patients underwent postoperative oesophagogastroduodenoscopy (OGD) and 29 patient were investigated with barium studies to evaluate the recurrence of symptoms. 37 patients have been contactable for telephone follow-up survey; 13 of the interviewed patients reported symptoms of gas bloat syndrome; 15 patients experienced a recurrence of their reflux symptoms, while 9 patients experienced a degree of regurgitation. 24 patients were satisfied with the operation, while 8 patients remained neutral. <h3>Conclusion</h3> Postoperative symptomatic evaluation revealed a suboptimal subjective outcome that is inexplicable by the endoscopic/ radiological findings, suggesting the need for a standardised procedure-specific postoperative objective evaluation tool. The high incidence of post operative gas bloat syndrome suggests the need for routine pre-operative evaluation of gastric motility and tailoring the fundoplication accordingly. The higher than expected rate of anatomical failures highlighted the inadequacy of primary hiatorraphy, and the need for selective crural reinforcement. <h3>Disclosure of interest</h3> None Declared.
Case 6-2011
Authors: Athe M.N. Tsibris, Jo-Anne O. Shepard, Lawrence R. Zukerberg
Journal: New England Journal of Medicine (2011)

A 77-year-old man was admitted to the hospital because of increasing dyspnea, weakness, and diaphoresis. Tachycardia, hypotension, hypoxemia, and fever developed, and he was admitted to the coronary care unit. The next day, a diagnostic test result was received.
RARE-12TOXICITY AND RESPONSE IN PATIENTS TREATED ACCORDING TO THE DUTCH SOCIETY FOR NEURO-ONCOLOGY (LWNO) MEDULLOBLASTOMA TREATMENT PROTOCOL WITH NEOADJUVANT CHEMOTHERAPY, RADIATION AND ADJUVANT CHEMOTHERAPY
Authors: L.A. Gravendeel, C.C.D. van der Rijt, D.T. Seute, F.Y.F. de Vos, M.E. van Linde, D.B. Eekers, A.A. Botterweck, W. Boogerd, J.E.C. Bromberg
Journal: Neuro-Oncology (2015)

BACKGROUND: In 2009 the Dutch Society for Neuro-Oncology set up a treatment protocol for newly diagnosed high-risk adult medulloblastoma patients in order to uniformize treatment. The protocol consists of surgery, neoadjuvant carboplatin-etoposide, neuraxis radiotherapy combined with vincristine, and four adjuvant cycles of carboplatin-vincristine-cyclophosphamide. Centers were free to also use the protocol in patients with supratentorial primitive neuro-ectodermal tumors (sPNETs). METHODS: We retrospectively collected clinical data of all patients treated according to the new protocol during the period July 2009-july 2014. We evaluated toxicity, feasibility, response, and outcome of these patients. RESULTS: Ten patients with high-risk medulloblastoma, and 6 with sPNETs were included. Median age at diagnosis was 35.4 years; median Karnofsky performance score (KPS) after surgery was 90. Fourteen of 16 patients received neoadjuvant carboplatin-etoposide, all in full dose. None showed progression during these courses. All received radiotherapy. Thirteen patients started with adjuvant chemotherapy, and 7 completed all cycles. Overall, treatment was stopped in 8 patients; in 6 because of toxicity (decreased performance score (2), bone marrow suppression (3), polyneuropathy (1)). The dose adjuvant chemotherapy was reduced in all but 1 patient because of prolonged myelosuppression. After treatment, 5 patients showed complete remission, 4 partial response and 2 stable disease. Median follow-up of all patients was 1.92 years, with 50% (8/16) patients still alive. One-year survival rate from start of therapy was 88%. CONCLUSIONS: Neo-adjuvant chemotherapy was feasible and did not compromise radiotherapy. During the adjuvant chemotherapy a high percentage of toxicity was found, necessitating dose reduction in nearly all patients. In adult patients the use of adjuvant chemotherapy needs a critical appraisal considering more mature data on survival with respect to the feasibility of these courses.
NIMG-66INTRAOPERATIVE UPDATE OF RESIDUAL TUMOR VOLUME WITHOUT ADDITIONAL IMAGING: A NEW SOFTWARE TOOL FOR SKULL BASE SURGERY
Authors: Niklas Thon, Uli Mezger, Walter Rachinger, Christian Schichor, Jörg-Christian Tonn
Journal: Neuro-Oncology (2015)

BACKGROUND: Intraoperative knowledge about extent of resection (EOR) and correlation with eloquent neuronal and vascular structures is important in skull base tumor surgery, especially when complete removal is not feasible and a combination with radiosurgery/radiotherapy is planned. Currently, ultrasound, computed tomography or magnetic resonance imaging (iMRI) are modalities to assess EOR during surgery. Their use, however, is restricted by limited availability and costs, interruption of workflow, and data interpretation. Purpose of this prospective single-institutional study was to objectify EOR online without the need for additional intraoperative imaging. METHODS: Adult patients undergoing neuronavigated resection of complex skull base tumors were included between September 2014 and March 2015. Entire tumor volume, anticipated residual tumor volume and risk structures were segmented on preoperative 3-dimensional high-resolution MRI. A navigated tool was used to register online the resection cavity and to update the segmented tumor objects in neuronavigation. Simulated EOR was visualized and quantified online during surgery. Data from final update were correlated with results from postoperative MRI as primary end point. Secondary end point was the surgeons' impression of the usefulness for intraoperative decision making. RESULTS: 16 patients (6 male; mean age: 54.6 years) were included (14 meningiomas, 1 clival chordoma, and 1 chondrosarcoma of the petrous bone). Segmentation of objects took 11 min/patient (median). Extent of resection was virtually determined during resection between 1 and 9 times. Complete resection was achieved in 1 patient, and between 22% to 95% tumor removal in the remainder. Correlation with postoperative MRI showed good accordance with simulated residual tumor tissues with a mean conformity index of 1 (range 0.92-2.2). CONCLUSION: The software is easy to use, offers accurate information about residual tumor volume and can be integrated smoothly into the surgical work-flow. These data can serve for online calculation of appropriate treatment plans for radiotherapy/stereotactic radiosurgery.
Epidemiology of Human Rotavirus Types 1 and 2 as Studied by Enzyme-Linked Immunosorbent Assay
Authors: Robert H. Yolken, Richard G. Wyatt, Georges Zissis, Carl D. Brandt, William J. Rodriguez, Hyun Wha Kim, Robert H. Parrott, Juan J. Urrutia, Leonardo Mata, Harry B. Greenberg, Albert Z. Kapikian, Robert M. Chanock, Barbara Barbour, Lula Tatum
Journal: New England Journal of Medicine (1978)

To determine the relative importance of two known serotypes of human rotavirus, we developed an enzyme-linked immunosorbent assay to differentiate serotype-specific rotavirus antigen and antibody.Using this technic, we studied the epidemiology of the two serotypes in acute gastroenteritis.Seventy-seven per cent of 414 rotavirus isolates were Type 2, and the remainder were Type 1.The serotype distribution was similar in specimens from children in Washington D.C., and other parts of the world.Sero-R OTAVIRUS is an important cause of gastroen- teritis of infants and children in many parts of the world.'' 2Because the virus does not grow effi-ci,ently in tissue culture, conventional neutralization "methods cannot be used to examine its serotypic variations.'''Recently, two human rotavirus serotypes were distinguished by complement fixation,' immune electron microscopy' and immunofluorescence. 6The latter two methods are not practical for serotyping of large numbers of rotavirus-positive specimens whereas complement fixation is not sensitive enough for use with low-titered preparations.We recently described the technic of enzyme-linked immunosorbent assay for the detection of rotavirus antigen and antibody.'""This assay is similar in design to radioimmunoassay but uses an enzyme instead of a radioactive isotope to quantitate binding of immunoglobulin.We modified the basic assay for detection of rotavirus serotypes and used this new procedure to study the epidemiology of these viruses. MATERIALS AND METHODS Specimens'Stool specimens containing rotavirus were collected from 278 in-il.nts and children with gastroenteritis living in the Washington, D.C., area.From January, 1974, to October, 1976, only hospitalized patients were studied, whereas from November, 1976, to May, 1978, specimens from both inpatients and outpatients were available.This population has been described in detail.'In addition, 136 rotaviruscontaining specimens were available from children with and without gastroenteritis from other localities throughout the world.Included were rotavirus-positive stool specimens obtained
Prophylaxis against<i>Pneumocystis carinii</i>Pneumonia among Children with Perinatally Acquired Human Immunodeficiency Virus Infection in the United States
Authors: R.J. Simonds, Mary Lou Lindegren, Polly Thomas, Debra Hanson, Blake Caldwell, Gwendolyn Scott, Martha Rogers
Journal: New England Journal of Medicine (1995)

Pneumocystis carinii pneumonia (PCP) remains a common and often fatal opportunistic infection among children infected with the human immunodeficiency virus (HIV). HIV-infected infants between three and six months of age are particularly vulnerable. Current guidelines recommend prophylaxis in children from birth to 11 months old who have CD4+ counts below 1500 cells per cubic millimeter.
Mouse-Dream: Vegf Inhibition is Accompanied By Egfr Activation in Colorectal Cancer Models Independent of Kras Status Providing a Rational for Combinations of Bevacizumab and Erlotinib in the Positive Gercor Phase III Dream Trial
Authors: A.K. Larsen, V. Poindessous, A. Bouygues, D. Muller, A. Savina, B. Chibaudel, C. Tournigand, T. André, A. De Gramont, P. Mesange
Journal: Annals of Oncology (2014)
High Prevalence of Papillomavirus-Associated Penile Intraepithelial Neoplasia in Sexual Partners of Women with Cervical Intraepithelial Neoplasia
Authors: Renzo Barrasso, Jean De Brux, Odile Croissant, Gérard Orth
Journal: New England Journal of Medicine (1987)

Original Article from The New England Journal of Medicine — High Prevalence of Papillomavirus-Associated Penile Intraepithelial Neoplasia in Sexual Partners of Women with Cervical Intraepithelial Neoplasia
Decreased brain metabolism in neurologically intact healthy alcoholics
Authors: N D Volkow, R Hitzemann, G J Wang, J S Fowler, G Burr, K Pascani, S L Dewey, A P Wolf
Journal: American Journal of Psychiatry (1992)

The extent to which cerebral dysfunction in alcoholics is related to the direct effects of alcohol in the brain rather than to indirect mechanisms and/or alcohol withdrawal remains unclear. The purpose of this study was to evaluate whether healthy alcoholics with no evidence of alcohol-associated complications showed changes in brain glucose metabolism.Positron emission tomography and [18F]-fluorodeoxyglucose were used to measure regional brain metabolism. The study group consisted of 22 normal, healthy, right-handed volunteers and 22 neurologically intact, healthy, right-handed alcoholics tested 6 to 32 days after alcohol discontinuation.Alcoholics showed significantly lower whole brain metabolism than normal control subjects. Normalization of regional metabolic values to the whole brain metabolic rate revealed that the left parietal and right frontal cortices were the most affected regions. Although the whole brain metabolic rate was correlated with the amount of time since alcohol discontinuation, the "normalized" decreases in left parietal and right frontal glucose metabolism were not.These findings support the contribution of the direct effect of alcohol as well as alcohol withdrawal on the changes in regional brain metabolism seen in alcoholics. They also provide evidence of cerebral changes in neurologically intact healthy alcoholics.
Poor Skin Turgor
Authors: O M Aguilar, M Albertal
Journal: New England Journal of Medicine (1998)

Figure 1. A 74-year-old man was found unconscious at home and brought to the emergency department. He was obtunded and moved only with painful stimuli. His blood pressure was 95/55 mm Hg, with a heart rate of 115 beats per minute and a temperature of 35.8°C. His mucous membranes were dry, and his skin turgor was markedly decreased. Volume status was evaluated by squeezing the skin of the patient's abdomen (Panel A) and assessing the response 15 seconds (Panel B) and 40 seconds (Panel C) after the pressure was released. The following values were recorded on admission: serum sodium, 186 . . .