tbuckley/cabot-search huggingface dataset:
Comparison of Medical and Surgical Treatment for Unstable Angina Pectoris
Authors: Robert J. Luchi, Stewart M. Scott, Robert H. Deupree
Journal: New England Journal of Medicine (1987)

We conducted a multicenter, randomized, prospective study comparing medical therapy alone with coronary-artery bypass surgery plus medical therapy in 468 men with unstable angina pectoris. Patients were entered in the study from June 1, 1976, to June 30, 1982. Among those assigned to surgery who received bypass grafts, operative mortality was 4.1 percent. Arteriography performed after one year of follow-up revealed that 74.8 percent of the grafts studied were patent. The cumulative rate of crossover from medical to surgical therapy after two years was 34 percent; the operative mortality among patients crossed over was 10.3 percent. Nonfatal myocardial infarction occurred in 11.7 percent of the patients treated surgically and 12.2 percent of those treated medically (no significant difference). Most of the nonfatal myocardial infarctions in the surgical group occurred in the perioperative period. Overall, the two-year survival rate computed by life-table analysis did not differ between the two groups. However, the curves reflecting mortality as a function of left ventricular ejection fraction were significantly different (P = 0.03); surgery was associated with a significantly reduced mortality among patients with lower ejection fractions. We conclude that patients with unstable angina pectoris have a similar outcome after two years whether they receive medical therapy alone or coronary bypass surgery plus medical therapy. However, patients with reduced left ventricular ejection fractions may have a better two-year survival rate after coronary bypass surgery.
Transvenous Caval Interruption with Umbrella Filter
Authors: Kazi Mobin-Uddin, George M. Callard, Hooshang Bolooki, Richard Rubinson, David Michie, James R. Jude
Journal: New England Journal of Medicine (1972)

For prevention of pulmonary embolism, transvenous interruption of the inferior vena cava by the umbrella filter was performed in 100 patients between July, 1968, and June, 1970. Filter dislodgment and migration did not occur, and there were no late complications. The recurrent embolism rate was 2 per cent, with a single recurrent fatal embolism. The 30-day hospital mortality was 16 per cent, with an additional late-death rate of 19 per cent. No deaths were directly related to the procedure. The mortality figures reflect the seriousness of the underlying pathologic process. Of 10 patients in whom phlebitis developed after filter insertion, seven had had phlebitis previously. Transvenous caval interruption by the umbrella filter thus seems a safe and effective procedure for prevention of pulmonary embolism.
A Morphologic Classification and Incidence of Spontaneous Ovarian Neoplasms in Three Strains of Mice&lt;xref ref-type="fn" rid="fn2"&gt;2&lt;/xref&gt;
Authors: C H Frith, R E Zuna, K Morgan
Journal: JNCI Journal of the National Cancer Institute (1981)

Ovarian tumors were reviewed and classified in 5,404 control inbred BALB/c, C57BL/6, and C3H mice. In descending order of frequency, the most common types in the C3H mice were the tubular mesothelioma (adenoma), thecoma, luteoma, granulosa cell tumor, and cystadenoma. In descending order the most common types in the BALB/c mice were the luteoma, tubular mesothelioma, granulosa cell tumor, thecoma, and cystadenoma. The tubular mesothelioma was the only ovarian tumor of significance in the C57BL/6 mice. Most of the ovarian tumors were rare before 1 year of age, but they increased with age after 1 year.
A Square Peg in a Round Hole
Authors: Sanjay Saint, Somnath Saha, Lawrence M. Tierney
Journal: New England Journal of Medicine (1998)

A 51-year-old woman had had blurring of vision, polyuria, and anorexia for approximately six weeks. She had lost 9 kg (20 lb) in weight over the previous three months without the use of diet or exercise. Other symptoms included vaginal discharge and gum irritation. Her physician made a diagnosis of diabetes mellitus (on the basis of a random glucose measurement of 317 mg per deciliter [17.6 mmol per liter]) and candidal vaginitis. Other laboratory studies done at that time revealed a hematocrit of 41 percent, with a mean corpuscular volume of 74 fl.This sounds like a case . . .
Case 28-1966
Authors: William C. Moloney, Benjamin Castleman
Journal: New England Journal of Medicine (1966)

Presentation of Case First admission. A thirty-nine-year-old woman entered the hospital because of pain in the abdomen. She had been anorectic for seven months. Three months before admission increasing fatigue began, with intermittent sharp pains in the left upper quadrant of the abdomen. Two weeks before entry her husband noticed that she had a large mass in the left side of the abdomen. Firm, nontender lymph nodes were felt in the preauricular, cervical, supraclavicular and axillary regions. The edge of the liver was palpable 12 cm. below the right costal margin; the spleen descended to a level below the . . .
M17 Improve accuracy of Chronic Obstructive Pulmonary Disease (COPD) diagnosis by offering quality assured spirometry
Authors: A Gulati, C Crocker, J Carrett, T Win
Journal: Thorax (2015)

<h3>Background and objective</h3> Spirometry is a commonly performed diagnostic test in the primary care with variable quality. Around a quarter of the spirometry done in the community is inaccurate and in up to one half of the cases referred to secondary care, diagnosis is changed when spirometry is repeated. We conducted this study to look at the impact of educational intervention in improving the accuracy of COPD. <h3>Methods</h3> Seventeen practices across 2 regions in East of England participated in the study. Nurses from these practices underwent educational intervention in the form of attending a structured training to perform Spirometry. Spirometry data and confidence scores in performing and interpreting procedure were collected pre and post training. <h3>Results</h3> Clinician’s confidence in performing spirometry improved from 5.1 to 7.6 (p = 0.001) on a visual analogue scale post intervention. Confidence to interpret Spirometry improved from 4.3 to 6.5 (p = 0.001). Following intervention tracing improved in thirty nine percent of patients who had poor quality of tracing pre-intervention. Twenty two percent of patients had a change in diagnosis post intervention with medication changes in 33% of the patients. <h3>Conclusions</h3> Educational intervention with a structured spirometry course improves the quality and accuracy of spirometry in the primary care. Study support quality assured spirometry for all healthcare providers who are involved in doing the procedure in primary care.
Association of Cytomegalovirus Infection with the Postperfusion Syndrome
Authors: David J. Lang, Edward M. Scolnick, James T. Willerson
Journal: New England Journal of Medicine (1968)

A mononucleosis-like illness was seen in four patients recovering from open-heart surgery. In this so-called perfusion syndrome a viral etiology has previously been suspected. In all four of our patients, cytomegalovirus was recovered from urine between seven and 25 weeks after operation. In three cases virus was found in blood associated with circulating leukocytes. Significant changes in the titer of complement-fixing antibody to cytomegalovirus took place. These retrospective observations support an etiologic role for cytomegalovirus in the postperfusion syndrome, but controlled prospective studies will be needed to establish causality.
A Novel EGFR C797 Variant Detected in a Pleural Biopsy Specimen from an Osimertinib-Treated Patient Using a Comprehensive Hybrid Capture–Based Next-Generation Sequencing Assay
Authors: Roopika Menon, Judith Müller, Petra Schneider, Sotirios Lakis, Kenneth Thress, Jürgen Wolf, Lukas Heukamp, Johannes M. Heuckmann, Frank Griesinger
Journal: Journal of Thoracic Oncology (2016)
Diffuse Pulmonary Injury Associated with Gold Treatment
Authors: Richard H. Winterbauer, Kenneth R. Wilske, Roger F. Wheelis
Journal: New England Journal of Medicine (1976)

Two patients had diffuse, reversible pulmonary injury possibly owing to gold sodium thiomalate treatment: a 32-year-old woman with chronic inflammatory arthritis compatible with seronegative rheumatoid arthritis and a 32-year-old man with shoulder arthralgia. The patients had received 420 mg and 325 mg of gold sodium thiomalate, respectively. Cough and dyspnea began in the seventh and fifth weeks of therapy, respectively. In both patients x-ray study showed bilateral pulmonary infiltrates, with no evidence of pleural disease. The woman had no other manifestations of hypersensitivity to gold. The man had exfoliative dermatitis, fever and anemia. Lung biopsies from both patients revealed lymphocytes and plasma cells infiltrating the alveolar septa and interstitial fibrosis. The woman improved slowly during four months after discontinuation of therapy. Pulmonary symptoms recurred after additional gold therapy, and again resolved when gold was discontinued. The man, treated with prednisone, showed prompt remission and remains well without medication. (N Engl J Med 294:919–921, 1976)
PTH-262 Laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy
Authors: T Nakamura, T Sato, A Tsutsui, H Miura, N Ogura, M Naito, T Yamanashi, M Watanabe
Journal: Gut (2015)

<h3>Introduction</h3> In 2004, we started to perform total mesorectal excision and prophylactic lateral dissection by open surgery after preoperative chemoradiotherapy in patients with advanced lower rectal cancer. Since 2010, we have extended the radiation field to include the lateral lymph nodes and performed laparoscopic surgery for rectal cancer. Since 2013, we have laparoscopically performed lateral lymph-node dissection in patients who have enlarged lateral lymph nodes before surgery. Preoperative chemoradiotherapy can reduce tumour size, allowing a good visual field of the pelvic cavity to be obtained. <h3>Method</h3> We focused on techniques for obtaining a good visual field of the intrapelvic cavity and on procedures for perirectal dissection and safe transection of the rectum during laparoscopic surgery for rectal cancer in patients who had received preoperative chemoradiotherapy. The study group comprised 50 patients who underwent laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy from 2010 through 2014. The primary tumour was located below the peritoneal reflection (Rb) in 40 patients and above and below the peritoneal reflection (Rab) in 10. Up to 2010, laparoscopic rectal surgery was indicated for the treatment of clinical T2 disease. Subsequently, we extended the indication to include advanced rectal cancer after chemoradiotherapy in patients with no enlarged lateral lymph nodes. From 2013 onward, we laparoscopically performed lateral lymph-node dissection in patients with enlarged lateral lymph nodes before surgery. A temporary ileostomy was performed in patients who underwent anastomosis. <h3>Results</h3> The surgical procedures performed were low anterior resection in 29 patients, Miles’ operation in 20, and Hartmann’s surgery in 1. The operation time was 351 min. The blood loss was 125 mL. The median postoperative hospital stay was 13 days. Nine patients (18%) had postoperative complications. Suture failure occurred in 3 patients (10%) and improved after internal drainage. Ileus developed in 2 patients (4%), and perineal wound infection occurred in 2 patients (4%). The response to chemoradiotherapy was Grade 1 in 25 patients, Grade 2 in 11, and Grade 3 in 14. The pathological stage was complete response in 13 patients (26%), stage I in 12, stage II in 15, stage IIIa in 8, and stage IIIb in 2. <h3>Conclusion</h3> Surgery for rectal cancer after chemoradiotherapy provided good results in terms of clinical response and postoperative short-term outcomes. Tumour shrinkage allowed a good field of vision to be easily obtained; surgery could thus be performed more safely and reliably. <h3>Disclosure of interest</h3> None Declared.
Death from Attempted Abortion with a Potassium Permanganate Douche
Authors: Walter W. Jetter, Francis T. Hunter
Journal: New England Journal of Medicine (1949)

ALTHOUGH potassium permanganate is commonly employed as a disinfectant and deodorant and for local application in the treatment of dermatitis, fatal poisoning from its use is rare. As evidence of this, Green and Warr,1 in reviewing the literature from 1899–1941, were able to find only 8 fatal cases. On the other hand, these authors reported 31 cases in which potassium permanganate was ingested, none of which resulted fatally. Except in children, the poison was invariably swallowed with suicidal intent, since the intense blue color of even a very dilute solution tends to make disguise difficult.Within recent years, necrotizing injury . . .
Prevalence of nonalcoholic fatty liver disease in the middle eastern area: What is the exact estimation?
Authors: Mohammadreza Naderian, Hedyeh Ebrahimi, Amir Ali Sohrabpour
Journal: Hepatology (2016)

Potential conflict of interest: Nothing to report. Author names in bold designate shared co‐first authorship. To the Editor: We read with great interest the admirable work presented by Younossi et al.1 This study emphasizes the burden of nonalcoholic fatty liver disease (NAFLD) by demonstrating a high prevalence in different continents. In the Middle East, the obesity epidemic is a growing problem,2 and the change from a traditional to an industrialized diet is evident3 with likely implications on the epidemiology of NAFLD. The prevalence of NAFLD in Iran has been explored in several studies. Apart from the single article pointed to by the authors,4 three more Iranian studies encompassing a population of over 13,500 fulfill the inclusion criteria of their study and should be taken into account5 (Table 1). They were conducted between 2008 and 2011 among the adult population of three distinct regions across Iran. The prevalence of NAFLD was determined to be 21.5% in Shiraz,5 43.8% in Amol,6 25.3% in Zahedan, and 42.3% and 34.8% in the urban and rural areas of Amol, respectively.7 Table 1 - Prevalence of NAFLD in Three Distinct Studies, Iran Authors Publication Year Region Participants (n) Study Design Sample Source Age (Mean) Sex (% Male) Diagnosis Technique Prevalence (%) Lankarani et al. 2013 Shiraz (urban) 819 Cross‐sectional Population‐based 43.10 41.5 Ultrasonography 21.5 Amirkalali et al. 2014 Amol 5,023 Cross‐sectional Population‐based 45.35 56.7 Ultrasonography 43.8 Ostovaneh et al. 2015 Zahedan (urban) 2,078 Cross‐sectional Population‐based 37.27 48.5 Ultrasonography 25.3 2015 Amol (urban) 2,911 Cross‐sectional Population‐based 40.85 46.7 Ultrasonography 42.3 2015 Amol (rural) 2,734 Cross‐sectional Population‐based 40.66 54.1 Ultrasonography 34.8 We believe the prevalence of NAFLD in Iran is higher than what Younossi et al. have considered in their work, and including the three mentioned studies gives a more accurate estimation on NAFLD epidemiology in the Middle East and the importance of this emerging issue in the coming years.
BMET-04LEPTOMENINGEAL CARCINOMATOSIS IN MELANOMA
Authors: Elisa Aquilanti, Corey Gill, Sandro Santagata, Donald Lawrence, Keith Flaherty, Daniel Cahill, Ryan Sullivan, Priscilla Brastianos
Journal: Neuro-Oncology (2015)

Leptomeningeal carcinomatosis (LM) is a rare complication of melanoma that is associated with a poor prognosis. Given limited data in LM in melanoma, we sought to characterize overall survival in patients with primary melanoma who developed LM. We performed a retrospective review at our institution of LM melanoma patients from 1993 to 2014. Inclusion criteria included patients with documented melanoma and LM as diagnosed by cytology or imaging. Median age was 49.5 years (range, 22-79) in 55 patients, 35 male and 20 female. LM was diagnosed by positive cytology in 20 patients (36.4%) or imaging in 52 patients (94.5%). Median survival from diagnosis of LM to death was 9.7 weeks. Additionally, median time from diagnosis of primary melanoma to LM was 27.3 months (range, 0-109) and from stage IV melanoma 7.5 months (range, 0-46). In univariate analysis, serum lactate dehydrogenase (LDH), Eastern Cooperative Oncology Group (ECOG) performance status, and LM treatment (no treatment, radiation, chemotherapy) influenced survival. In multivariate analysis, abnormal LDH (p < 0.035) remained a significant predictor of poor survival, while LM treatment with chemotherapy compared to no treatment conferred a survival advantage (p < 0.019). Treatment with radiation and ECOG performance status were no longer significant. Our data offer the largest series of melanoma patients with diagnosed LM and help to characterize the clinical presentation of this devastating late-stage complication of cancer. More effective treatments for this complication are necessary.
P153 Fluticasone propionate/formoterol pressurised metered-dose inhaler ‘2–3–4’ training paradigm aids correct inhaler technique
Authors: D Bell, L Mansfield, M Lomax, S Dissanayake
Journal: Thorax (2015)

<h3>Background</h3> Inhaler technique is crucial to effective disease control. Amongst the most frequent mistakes made with all inhalers are the failure to exhale adequately, an insufficient breath-hold and, with pressurised metered-dose inhalers (pMDIs), the failure to inhale “slowly”. We present an easy to remember ‘2–3–4’ training paradigm, designed to address these errors, that was used in an open-label, cross-over study comparing patient handling of fluticasone propionate/formoterol (FP/FORM; <i>flutiform</i>®) breath-actuated inhaler (BAI) and pMDI devices. Here we present the pMDI data. <h3>Methods</h3> The study was carried out in 311 patients (≥12 years) with persistent asthma (64%), COPD (28%), or both asthma and COPD (8% of patients). Patients were randomised to one of two sequences (BAI/pMDI or pMDI/BAI). Patients were trained to correctly use each device prior to an assessment of correct handling according to prespecified criteria. Eight steps were assessed including, but not limited to: exhale ≥2s; inhale ≥3s; hold breath ≥4s: the 2–3–4 technique. Patients were assessed on a single device (BAI or pMDI) at each visit, with 7–21 days between the two visits. <h3>Results</h3> Overall, 77.2% of patients demonstrated correct performance of all steps of FP/FORM pMDI use at their first attempt post-training (N = 307); a further 14.0% required 2 attempts. 99.3% of patients were successfully trained within 15 min. Step 2 (Removes cap) and steps 4–6 (Places upright in mouth; starts inhaling and actuates; inhales for at least 3 s) were considered critical steps, and 82.4% of patients demonstrated correct performance of all 4 critical steps at their first attempt post-training. 96.1%, 87.6% and 95.8% of patients correctly followed each component of the ‘2–3–4’ training paradigm with the pMDI at the first attempt post-training (exhale ≥2s, inhale ≥3s; hold breath ≥4s, respectively). <h3>Conclusions</h3> Almost all patients can be rapidly taught to use a pMDI (within 15 min) using a simple training method suitable for all clinical settings. An easy to remember, sequential “2–3–4” paradigm is effective in encouraging patients to exhale to residual volume, to inhale slowly, and to breath hold satisfactorily: manoeuvres that are frequently performed incorrectly without such instruction. <h3>Sponsor</h3> Mundipharma Research Ltd.
2,4-Diaminoanisole Sulfate: Early Effect on Thyroid Gland Morphology and Late Effect on Glandular Tissue of Fischer 344 Rats&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: R P Evarts, C A Brown
Journal: JNCI Journal of the National Cancer Institute (1980)

F344 female rats were fed 2,4-diaminoanisole sulfate (2,4-DAA) (a hair dye component) at three concentration levels up to 86 weeks. The administration of hair dye was interrupted after 10 weeks' feeding for 15 animals at the highest concentration level. Both the early effect of 2,4-DAA on the thyroid gland and the late effect on thyroid, mammary, clitoral, and pituitary glands were studied. In a few weeks, 2,4-DAA showed goitrogenic effects on the thyroid gland. However, the nodular phase of the goiter did not develop. Cystic colloid-filled follicles became lined with basophilic flattened epithelium that continued to proliferate and to form adenomatous or papillary neoplasms. Only 10 weeks of feeding at the high level of 2,4-DAA produced a 42% tumor incidence, and one-fourth of the animals had thyroid tumors. Dark pigment in the thyroid epithelium was still present 70 weeks after the feeding of 2,4-DAA had been interrupted. Feeding of high levels of 2,4-DAA for 82 weeks produced a 78% thyroid tumor incidence. Mammary tumor incidence was nearly five times higher at the 0.24% 2,4-DAA feeding level than among controls. At this same feeding level, 45% of the rats had clitoral tumors. Lesions of the pituitary gland were present in all groups, but tumors were encountered only among the 2,4-DAA-fed animals.
Effect of High-Dose Ibuprofen in Patients with Cystic Fibrosis
Authors: Michael W. Konstan, Pamela J. Byard, Charles L. Hoppel, Pamela B. Davis
Journal: New England Journal of Medicine (1995)

Since the inflammatory response to chronic infection contributes to lung destruction in patients with cystic fibrosis, we hypothesized that antiinflammatory therapy might slow the progression of lung disease.
Transplantable Metastasizing Prostate Adenocarcinomas in Rats&lt;xref ref-type="fn" rid="fn2"&gt;2&lt;/xref&gt;
Authors: M Pollard, P H Luckert
Journal: JNCI Journal of the National Cancer Institute (1975)

Three spontaneous prostate adenocarcinomas from aged, randombred, germfree Lobund Wistar rats were transplanted, without change, through several series of conventional Lobund Wistar rats. One tumor type differed histologically from the other two tumor types. Rats with subcutaneously transplanted tumors developed metastatic tumors in the lymph nodes and lungs. No microbial agent was detected in the tumor cells.
Reduced Coronary Vasodilator Function in Infarcted and Normal Myocardium after Myocardial Infarction
Authors: Neal G. Uren, Tom Crake, David C. Lefroy, Ranil de Silva, Graham J. Davies, Attilio Maseri
Journal: New England Journal of Medicine (1994)

The ability of the coronary vascular bed to dilate and thus increase blood flow to the myocardium may be impaired in coronary artery disease, even in regions of myocardium supplied by an angiographically normal coronary artery. If this kind of vasomotor dysfunction was present or accentuated after acute myocardial infarction, it might influence the extent of ischemia and necrosis in areas not directly injured by the infarction.
Absolute Lymphocyte Count As an Independent Prognostic Factor of IPI and NCCN-IPI in DLBCL Patients
Authors: Kazuya Okada, Shinichi Ochi, Takashi Nagayama, Shogo Nabe, Kazuya Sakai, Hiroyuki Muranushi, Yusuke Okamoto, Hiroyuki Sugiura, Aki Sato, Takayuki Sato, Takeshi Maeda, Tatsuhito Onishi, Yasunori Ueda
Journal: Blood (2014)
Pathogenesis of Diseases Induced by Human Lymphotropic Virus Type I Infection
Authors: Jeffrey S. Flier, Lisa H. Underhill, Per Hollsberg, David A. Hafler
Journal: New England Journal of Medicine (1993)

Although retroviruses were among the earliest viruses discovered,1,2 they were linked to human disease only in the early 1980s,35 with the study of T-cell lines from patients with the lymphoproliferative disorder adult T-cell leukemia6. T cells from these patients were shown to release a retrovirus, later known as human T-cell lymphotropic virus type I (HTLV-I), the first member of a new class of human viruses7. This led to the investigation of a number of idiopathic disorders. In 1985, tropical spastic paraparesis, an endemic disease in the West Indies,8 was associated with immune reactivity to HTLV-I in . . .