tbuckley/cabot-search huggingface dataset:
Hypercalcemia, Nephrocalcinosis and Reversible Renal Insufficiency Associated with Hyperthyroidism
Authors: Franklin H. Epstein, Lawrence R. Freedman, Howard Levitin
Journal: New England Journal of Medicine (1958)

HYPERTHYROIDISM is often associated with osteoporosis,1 2 3 increased urinary excretion of calcium4 and an accelerated turnover of calcium stores.5 Nevertheless, hyperthyroidism is not usually seriously considered in the differential diagnosis of hypercalcemia, and only 4 cases have been recorded in which hypercalcemia was believed to be a consequence of the hyperthyroid state.6 , 7 The present report deals with a patient in whom hyperthyroidism was associated with hypercalcemia, nephrocalcinosis and renal insufficiency. With successful treatment of the hyperthyroidism, the hypercalcemia disappeared, and renal function improved considerably.Case ReportH.M. (44–86–33), a 25-year-old divinity student, 30.5 cm. tall and weighing 56.7 kg. (125 pounds), . . .
Controlled, Randomized, Open-Label Trial of Risk-Stratified Corticosteroid Prevention of Acute Graft-Versus-Host Disease After Haploidentical Transplantation
Authors: Ying-Jun Chang, Lan-Ping Xu, Yu Wang, Xiao-Hui Zhang, Huan Chen, Yu-Hong Chen, Feng-Rong Wang, Wei Han, Yu-Qian Sun, Chen-Hua Yan, Fei-Fei Tang, Xiao-Dong Mo, Kai-Yan Liu, Xiao-Jun Huang
Journal: Journal of Clinical Oncology (2016)

This study evaluated whether a prophylaxis strategy directed by the graft-versus-host disease (GVHD) biomarker might reduce the 100-day incidence of acute GVHD grades II to IV.This controlled, open-label, randomized trial included 228 patients who underwent haploidentical transplantation. On the basis of bone marrow allogeneic graft CD4:CD8 ratios, patients were categorized as low risk (n = 83; group A) or high risk (n = 145). Patients at high risk were randomly assigned to either receive (n = 72; group B) or not receive (n = 73; group C) low-dose corticosteroid prophylaxis.The incidence in group B was 21% (95% CI, 11% to 31%) compared with 26% (95% CI, 16%to 36%; P = .43) in group A and 48% (95% CI, 32% to 60%; P < .001) in group C. Low-dose corticosteroid prophylaxis was significantly associated with a relatively low risk of acute GVHD grades II to IV (hazard ratio, 0.66; 95% CI, 0.49 to 0.89; P = .007) and rapid platelet recovery (hazard ratio, 0.30; 95% CI, 0.23 to 0.47; P < .001). The incidence of moderate-to-severe chronic GVHD in group B (21%) was lower than that in both group A (50%; P = .025) and group C (36%; P = .066). The 100-day corticosteroid doses were 205 ± 111 mg in group B, 229 ± 149 mg in group A (P = .256), and 286.54 ± 259.67 mg in group C (P = .016). Compared with group C, group B showed significantly lower incidences of femoral head necrosis (P = .034) and hypertension (P = .015). Infection rates were comparable among these groups.Our results suggest that risk stratification-directed, low-dose corticosteroid prophylaxis significantly decreased the incidence of acute GVHD grades II to IV, accelerated platelet recovery, and reduced adverse events without increasing infections.
History of Recurrent Sore Throat as an Indication for Tonsillectomy
Authors: Jack L. Paradise, Charles D. Bluestone, Ruth Z. Bachman, Georgann Karantonis, Ida H. Smith, Carol A. Saez, D. Kathleen Colborn, Beverly S. Bernard, Floyd H. Taylor, Robert H. Schwarzbach, Herman Felder, Sylvan E. Stool, Andrea M. Fitz, Kenneth D. Rogers
Journal: New England Journal of Medicine (1978)

As part of a prospective study of indications for tonsillectomy and adenoidectomy, we followed closely 65 children with histories of recurrent throat infection that seemed impressive (at least seven episodes in one year, five in each of two consecutive years or three in each of three consecutive years), but lacked documentation. During the first year of observation, only 11 children (17 per cent) had episodes of throat infection with clinical features and patterns of frequency conforming to those described in their presenting histories. Of the remaining 54 children, 43 (80 per cent) experienced no, one or two observed episodes each, and most of the episodes were mild. We conclude that undocumented histories of recurrent throat infection do not validly forecast subsequent experience and hence do not constitute an adequate basis for subjecting children to tonsillectomy. (N Engl J Med 298:409–413, 1978)
PTU-196 Goodsall’s rule – past its sell-by date?
Authors: K Cuiñas, JG Williams
Journal: Gut (2015)

<h3>Introduction</h3> Successful treatment of an anal fistula requires correct identification of the internal opening and accurate delineation of the course of the fistula in relation to the anal sphincters. Goodsall’s rule states that a fistula with the external opening anterior to an imaginary transverse line across the anus has its internal opening at the same radial position and for an external opening posterior to this line, the internal opening is in the midline posteriorly with a horse-shoe track. The aim of this study was to determine the accuracy of Goodsall’s rule and the relationship between the distance of the external opening from the anal verge and the configuration of the fistula. <h3>Method</h3> We studied a consecutive series of 103 patients (20.4% female, 79.6% male) undergoing their first operation for cryptoglandular anal fistula between 2006 and 2014, by a single colorectal surgeon. The site of the internal and external openings were recorded by reference to hours on a clock (lithotomy position) and the radial distance of the external opening from the anal verge was measured with a thread. A horseshoe fistula was defined as one where the internal and external opening were separated by 2 or more hours. Anterior fistulas lay between 9 and 3 o’clock (58/103; 56.3%), posterior between 4 and 8 o’clock (45/103; 43.7%). <h3>Results</h3> The diagnostic accuracy of Goodsall’s rule was only 66.9%. Goodsall’s rule was correct in 25/58 (43.1%) anterior fistulas and 30/45 (66.8%) of posterior fistulas. Of the transsphincteric fistulas, 31/51 (60.8%) conformed to Goodsall’s rule. The distance between the external opening and the anal verge influenced the accuracy of Goodsall’s rule, being true in 92.9% of those &lt;15 mm, 80.9% of those between 16–25 mm, 70% of those between 26–35 mm and 47.4% of those &gt;36 mm. Distance of the external opening from the anal verge influenced the likelihood of the fistula having a horseshoe course: &lt;15 mm (0%),16–25 mm (9.5%) 26–35 mm (33.3%), &gt;36 mm (57.9%). For fistulas with an external opening in the anterior half of the anus, 4/5 (80%) ≤20 mm from the anal verge had a radial course compared to 29/53 (54.7%) where the distance from the verge was ≥21 mm. For those with an external opening in the posterior half, 18/18 (100%) ≤20 mm from the anal verge had a radial course compared to 18/27 (66.7%) where the distance from the verge was ≥21 mm. <h3>Conclusion</h3> Goodsall’s rule is of limited use in predicting the site of the internal opening of a fistula. The closer the external opening is to the anal verge, the more likely a fistula conforms to the rule. The further a fistula is away from the anal verge, the more likely it follows a horseshoe course and less likely to conform to Goodsall’s rule. <h3>Disclosure of interest</h3> None Declared.
Case 35-1999
Authors: Stephen Hardy, Suzanne B. Keel
Journal: New England Journal of Medicine (1999)

Presentation of CaseA five-month-old girl was admitted to the hospital because of coffee-grounds vomitus and a gastric lesion.She had been born of a full-term pregnancy by spontaneous vaginal delivery and was in good health until 1 1/2 months of age, when she began to vomit “chocolate-like” material, which sometimes contained specks of bright red blood. She passed dark stools that were positive for occult blood. A change to an elemental diet resulted in constipation. Six days before admission, an upper gastrointestinal series showed no abnormalities. On the day of admission, an esophagogastroduodenoscopic examination (Figure 1) revealed an erythematous . . .
Gigantism Due to Pituitary Mammosomatotroph Hyperplasia
Authors: Antoinette Moran, Sylvia L. Asa, Kalman Kovacs, Eva Horvath, William Singer, Uri Sagman, Jean-Claude Reubi, Charles B. Wilson, Robert Larson, Ora Hirsch Pescovitz
Journal: New England Journal of Medicine (1990)

Hypersecretion of growth hormone during childhood causes excessive linear growth and gigantism. Acromegaly results from the hypersecretion of growth hormone after epiphyseal fusion. Children with gigantism may also have acromegalic physical characteristics, such as enlargement of the hands and feet, soft-tissue thickening, prognathism, and coarse facial features.1 2 3 Laboratory findings in children with an excess of growth hormone are similar to those in adults and include elevated serum levels of growth hormone and insulin-like growth factor I (IGF-I), a paradoxical increase in serum levels of growth hormone after the administration of thyrotropin-releasing hormone, and the lack of growth hormone suppression after . . .
63P Phase III SafeHer study subgroup analyses: Safety and tolerability of subcutaneous trastuzumab for HER2-positive early breast cancer in patients with lower body weight and in Asian patients
Authors: M. Shing, K.H. Jung, B. Ataseven, M. Verrill, M. De Laurentiis, H.A. Azim, X. Pivot, N. Al-Sakaff, S. Lauer, J. Gligorov
Journal: Annals of Oncology (2015)
Hypochromic reticulocytes and ferritin index in the diagnosis of cancer- and chemotherapy-related anemia
Authors: H. T. Steinmetz, R. Rohrberg, A. Tsamaloukas, H. Forstbauer, H. Tessen, F. Breuer, R. Röddiger, A. Hinke, S. Schmitz, L. Thomas
Journal: Journal of Clinical Oncology (2008)

20705 Background: Iron monitoring is mandatory in erythropoiesis stimulating factor therapy. Thomas et al. (Clin Chem 2002;48:1066–76) combined the reticulocyte hemoglobin (Hb) content (CHr) with the C-reactive protein (CRP)-dependent ferritin (Fer) index (FI: soluble transferrin receptor/log Fer ratio) in a diagnostic plot. We conducted a prospective phase II trial to analyze the diagnostic value of CHr, FI and the diagnostic plot in anemic chemotherapy (ChT)-treated cancer patients (pts). Methods: The diagnostic plot assigned informed consenting pts with Hb <11 g/dl and Fer >20 ng/ml into 1 of 4 quadrants (Q1–4): those with FI values above threshold (FI ≥2.0 if CRP <5 mg/l, or FI ≥3.2 if CRP ≥5 mg/l) to Q2 (CHr >28 pg) or Q3 (CHr ≤28 pg), and those with subthreshold FI values to Q1 (CHr >28 pg) or Q4 (CHr ≤28 pg). Results: 11 centers recruited 303 pts (median age 65 y, 59% female) from 10/04 to 10/06; 207 (68%) fell in Q1. Only 50 pts (27 Q3 + 23 Q4; 17%) had CHr ≤28 pg; 63 (46 Q2 + 27 Q3; 21%) had an increased FI, indicating relative iron deficiency. Q1–4 assignment did not correlate with age, gender, body mass index, cancer type or stage, measurable metastasis, bone marrow infiltration, performance status, endogenous erythropoietin level, or hematocrit. However, Hb was lower and CRP higher in Q4, RBC was higher in Q2+3, and leukocytes and platelets (PLT) were higher in Q3+4. Transferrin saturation (TSAT) was higher in Q1. Fer correlated positively overall with CRP. Both CHr and TSAT correlated negatively with CRP. Conclusions: Analysis of CRP, FI and CHr in ChT-treated cancer anemia shows unexpectedly few pts (17%) with hypochromic reticulocytes (CHr ≤28 pg), high ferritin and CRP indicative of inflammation-induced functional iron deficiency, but also 21% of pts with inadequate iron stores. Supported by Roche-Pharma AG, Grenzach-Wyhlen, Germany. Hypochromic reticulocytes and ferritin index (mean ± SD) N 303 FI ≥ threshold* FI ≥ threshold* CHr >28 pg Q2 N 46 (15.2%) Q2 N 46 (15.2%) Hb g/dl 10.2 ± 1.1 10.2 ± 1.1 RBC 106/μl 4.1 ± 4.7 4.1 ± 4.7 WBC 103/μl 6.5 ± 9.6 6.5 ± 9.6 PLT 103/μl 238.6 ± 131.3 238.6 ± 131.3 TSAT % 21 ± 16.2 21 ± 16.2 CRP mg/l 32 ± 50 32 ± 50 CHr ≤28 pg Q3 N 27 (9%) Q3 N 27 (9%) Hb g/dl 9.8 ± 1 9.8 ± 1 RBC 106/μl 3.8 ± 0.5 3.8 ± 0.5 WBC 103/μl 9.9 ± 16.9 9.9 ± 16.9 PLT 103/μl 319.5 ± 152.8 319.5 ± 152.8 TSAT % 16.6 ± 13.8 16.6 ± 13.8 CRP mg/l 33.2 ± 43.4 33.2 ± 43.4 * FI ≥2.0 if CRP <5 mg/l, or FI ≥3.2 if CRP ≥5 mg/l Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Roche Amgen, Ortho Biotech, Roche Roche
Adjuvant therapy for early stage breast cancer (EBC): Distant disease-free survival (DDFS) as a predictor of overall survival (OS)
Authors: M. Melisko, A. Lin, H. Rugo
Journal: Journal of Clinical Oncology (2007)

583 Background: OS advantages are often difficult to demonstrate in trials evaluating treatment for EBC, as this requires long follow-up (FU) and large trials. Results are also confounded by factors such as further treatment. DFS, the primary endpoint in many adjuvant trials, is not a consistent predictor of OS and lack of standard definitions renders its interpretation difficult. A better, quicker endpoint is needed as a surrogate for OS. Distant metastases (DM), the most common type of recurrence, are responsible for the initial peak of relapse seen at 2 years post surgery and are associated with the highest risk of death compared to locoregional and contralateral events. DDFS may be a better short-term OS predictor. Methods: The impact of common adjuvant therapies (chemotherapy [CT], tamoxifen [TAM], and aromatase inhibitors [AIs]) on DM risk and OS was examined. Results: CT trials show that improvements in DDFS often precede subsequent improvements in OS. In NSABP B14, TAM significantly improved DDFS at 4 years and OS at 10 years. In ATAC and BIG 1–98, over half of EBC recurrences are DM, but OS differences are limited by short FU. BIG 1–98 showed a significant reduction in DM risk with letrozole versus TAM, but ATAC showed no significant reduction in DM risk with anastrozole in hormone receptor-positive patients. The reason for this difference is unclear. IES initially showed a significant reduction in DM risk, which was later followed by a borderline significant OS benefit in estrogen receptor-positive/unknown patients, favoring exemestane. Conclusion: Data from several adjuvant trials show that improvements in DDFS often precede significant improvements in OS. AIs show superiority over TAM in reducing DM risk (IES, BIG 1–98). DDFS may be a better, more achievable endpoint than OS for women with EBC and could quicken the development of future adjuvant breast cancer therapies. [Table: see text] No significant financial relationships to disclose.
S48 Continuous positive airway pressure titration in awake obese subjects with obstructive sleep apnoea and its impact on neural respiratory drive and breathlessness
Authors: S Xiao, J Bastianpillai, C Ratneswaran, M Pengo, YM Luo, CJ Jolley, J Moxham, J Steier
Journal: Thorax (2015)

<h3>Background</h3> Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea (OSA). We assessed neural respiratory drive (NRD), as measured by the surface electromyogram of the parasternal intercostals (sEMG<sub>para</sub>), during awake CPAP titration to quantify the effect of chest inflation on the load of the respiratory system. <h3>Patients and methods</h3> Obese patients (body-mass-index, BMI &gt;30) with confirmed obstructive sleep apnoea (OSA) were studied and NRD (sEMG<sub>para</sub>) and the surface EMG of the external oblique (sEMG<sub>abd</sub>) were recorded and normalised to baseline activity (awake, supine). The apnoea-hypopnoea index (AHI) and 95<sup>th</sup> percentile of CPAP were determined in sleep studies. The patients were then studied whilst awake and breathing on CPAP (4–20 cmH<sub>2</sub>O, increments of 2 cmH<sub>2</sub>O/3 mins), with the modified Borg score (mBorg) recorded. <h3>Results</h3> 15 patients (age 48 ± 10 years, 12 male, BMI 38.9 ± 5.8) suffering with moderate-severe OSA (AHI 32.2 ± 21.1/h, 95<sup>th</sup> percentile nocturnal CPAP 14.1 ± 3.8 cmH<sub>2</sub>O) were studied. Awake, sEMG<sub>para </sub>declined by 15.1 ± 1.5% from baseline when CPAP was applied, with the nadir at a CPAP of 10.6 ± 3.4 cmH<sub>2</sub>O (p = 0.026). Further increase in CPAP levels led to a rise in sEMG<sub>para </sub>and breathlessness (mBorg at lowest sEMG<sub>para</sub> 0.9 ± 0.8 points, at CPAP of 20 cmH<sub>2</sub>O 2.7 ± 2.7 points, p = 0.02). <h3>Conclusion</h3> The respiratory system is maximally offloaded with subtherapeutic CPAP levels in OSA. Levels of NRD observed at effective CPAP levels are associated with breathlessness which can impact on CPAP compliance.
Black Hairy Tongue
Authors: C C Newman, R F Wagner
Journal: New England Journal of Medicine (1997)

Figure 1. A 66-year-old man who was edentulous and did not wear dentures reported having a yellow tongue. He ate only liquefied foods, his oral hygiene consisted of mouthwashing, and he had not taken oral antibiotics recently. Black hairy tongue was diagnosed. In this disorder, the filiform papillae on the dorsum of the tongue are hyperplastic and dark black. The pigmentation may be the result of trapped chromogenic bacteria, food, coffee, or tobacco.
114P: Expression analysis of tumorspheres from non-small cell lung cancer show significant differences in CSC-markers and signaling pathways
Authors: A. Herreros Pomares, E. Munera Maravilla, B. Lafuente, S. Calabuig-Fariñas, A. Blasco Cordellat, R. Guijarro, R. Farrás, E. Jantus Lewintre, C. Camps
Journal: Journal of Thoracic Oncology (2016)
Effect of Dietary Intake of Fish Oil and Fish Protein on the Development of l-Azaserine-Induced Preneoplastic Lesions in the Rat Pancreas2
Authors: Thomas P. O'Connor, Bill D. Roebuck, Francis Peterson, T. C. Campbell
Journal: JNCI Journal of the National Cancer Institute (1985)

Journal Article Effect of Dietary Intake of Fish Oil and Fish Protein on the Development of l-Azaserine-Induced Preneoplastic Lesions in the Rat Pancreas Get access Thomas P. O'Connor, Thomas P. O'Connor Search for other works by this author on: Oxford Academic PubMed Google Scholar Bill D. Roebuck, Bill D. Roebuck Search for other works by this author on: Oxford Academic PubMed Google Scholar Francis Peterson, Francis Peterson Search for other works by this author on: Oxford Academic PubMed Google Scholar T. C. Campbell T. C. Campbell Search for other works by this author on: Oxford Academic PubMed Google Scholar JNCI: Journal of the National Cancer Institute, Volume 75, Issue 5, November 1985, Pages 959–962, https://doi.org/10.1093/jnci/75.5.959 Published: 01 November 1985 Article history Received: 14 February 1985 Accepted: 17 July 1985 Published: 01 November 1985
Pack years of cigarette smoking as a predictor of survival in 2,013 patients with stage IIIb/IV non-small cell lung cancer (NSCLC)
Authors: Y. Y. Janjigian, K. McDonnell, M. G. Kris, R. Shen, C. S. Sima, N. A. Rizvi, G. J. Riely
Journal: Journal of Clinical Oncology (2008)

8005 Background: Cigarette smoking is a negative prognostic factor for patients with NSCLC. It is unclear how the number of pack years (py) smoked affects survival. EGFR mutations, which have been associated with a good prognosis, are more common in patients who never smoked cigarettes. The frequency of EGFR mutations in patients who smoked up to 15 py is not significantly different from that observed in never smokers (Pham JCO 2006). In order to characterize the relationship between patient survival and pack years of cigarette smoking, we reviewed prospectively collected smoking data for patients with stage IIIb/IV NSCLC. Methods: Detailed smoking history was obtained using a patient-completed smoking questionnaire. Age, gender, stage and survival from time of diagnosis were obtained with Institutional Review Board approval. Results: Smoking history and clinical data were available for 2,013 patients with Stage IIIb/IV NSCLC (1007 women, 1006 men). Median age was 64. Seventy % (1416) smoked >15 py, 14% (270) were former or current smokers who had smoked ≤ 15 py, and 16% (331) were never smokers (<100 lifetime cigarettes). Never smokers had an increased median survival relative to current/former smokers (18 mo vs 11 mo, p<0.0001). Among smokers, patients with ≤ 15 py history of smoking had a longer median survival than patients with > 15 py (14 mo vs 11 mo, p =0.001). These differences for smoking remain significant after adjustment for gender (p<0.001). Increasing py of cigarette smoking was associated with a decrease in overall survival (Table). Conclusions: This is the largest reported evaluation of smoking history in patients with Stage IIIb/IV NSCLC. More cigarette smoking, measured in pack years, was associated with decreased survival after diagnosis. Smoking history, including pack years, should be a stratification factor for randomized clinical trials of patients with NSCLC. Pack Years median survival (months) 95% CI (months) never 18 15–21 <5 16 13–20 6–10 14 10–19 11–15 13 9–15 16- 25 13 10–15 26–50 11 9–11 51–75 10 8–11 >75 11 9–13 No significant financial relationships to disclose.
bmjlearning.com: Hepatitis C
Authors: Kieran Walsh
Journal: BMJ (2004)

BMJ Learning offers online learning resources to help you with your appraisal and revalidation. We have recently published a new module on hepatitis C.

About 300 000 people in England and Wales have hepatitis C infection. Prevalence varies greatly between different sections of the population: for example, up to half of intravenous drug users have hepatitis C. Many former drug users are also infected, and anyone who has used intravenous drugs in the past is at increased risk. Intranasal cocaine use and body piercing are also risk factors for transmission. Other risk factors include a history of blood transfusion in Britain before 1991 and a history of a blood transfusion while abroad. Some countries have a particularly high prevalence of infection—15% in Egypt, for example.

Many patients infected with hepatitis C are asymptomatic, but some have non-specific symptoms such as tiredness and poor appetite, and if cirrhosis develops patients may have severe symptoms and complications. Patients may seek treatment for these symptoms, and asymptomatic patients may ask for lifestyle advice (such as what are the risks of sexual transmission or of vertical transmission from mother to child).

To find out the answers to these and many more questions, try our new learning module on bmjlearning.com.