tbuckley/cabot-search huggingface dataset:
Case 19-1990
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, C.W. Lillehei, M.L. Talbert
Journal: New England Journal of Medicine (1990)

Presentation of CaseA 12-year–old boy was admitted to the hospital because of increasing fatigue and intermittent fever of one month's duration.The patient was a British citizen and had arrived in this country approximately two months earlier. He was in excellent health until one month before admission, while he was visiting in Yellowstone National Park, when fever and fatigue developed and continued for about three days. Increasing fatigue and fever recurred periodically thereafter while the patient was staying in Florida, and he experienced intermittent pain in the right shoulder that was not aggravated by movement. During the two weeks . . .
EPID-11WHO GRADE 3 GLIOMAS: CLINICAL AND MOLECULAR PROGNOSTIC FACTORS
Authors: Ming Chi, Nehaw Sarmey, Lauren Gotterer, Zhijian Chen, Glen Stevens, David Peereboom, Paul Elson, Manmeet Ahluwalia
Journal: Neuro-Oncology (2015)

BACKGROUND: WHO grade 3 gliomas include anaplastic oligodendroglioma (AO), anaplastic astrocytoma (AA), and anaplastic oligoastrocytoma (AOA). There is limited data on prognostic factors for this population. METHODS: WHO grade 3 gliomas diagnosed 2007-2014 were identified through the Cleveland Clinic's IRB approved database. Proportional hazards models with stepwise variable selection were used to identify prognostic factors for overall survival (OS) from diagnosis. RESULTS: Data from 199 patients were analyzed. 57% were male; median age at diagnosis was 49 years (range, 19-86); 72% had Karnofsky performance status (KPS) ≥80. Co-deletion of 1p/19q occurred in 19% (32/159), median Ki-67 expression was 20% (range 1-80) in 168 patients, 28% (45/160) had abnormal EGFR expression; p53 expression was 0-10% in 48% (76/159). 46% of patients had total/near total resections, 20% subtotal resections; 33% biopsy only. 66% of patients received upfront chemoradiation, 17% chemotherapy (10%) or radiation (7%) only; 16% supportive care. Median OS was 63.2 months; 2-year survival 68% ± 4%. Age ( 10%) provided additional prognostic information, which when added to CG resulted in 4 distinct prognostic groups: a very small favorable group (CG 1 and Ki-67 ≤10%, n = 9%, no deaths reported, 24.4 month median follow-up), favorable (CG 1/Ki-67 > 10%, n = 49%, 86% ± 5% 2-year survival), intermediate (CG 2/Ki-67 > 10% or CG 3/Ki-67 ≤ 10%, n = 23%, 54% ± 11% 2-year survival), and unfavorable (CG 3 and Ki-67 > 10%, n = 19%, 0% 2-year survival). CONCLUSION: Older age, poor KPS, AA and unspecified histology, multifocal disease, and positive Ki-67 expression are associated with higher mortality in this population.
Statistical Challenges in the Analysis of Health-Related Quality of Life in Cancer Clinical Trials
Authors: Franck Bonnetain, Frédéric Fiteni, Fabio Efficace, Amélie Anota
Journal: Journal of Clinical Oncology (2016)

Editor’s note: Statistics in Brief articles are short communications regarding statistical methods or issues. They are designed to alert and educate the readership about a method or issue that may be unfamiliar to or underused by the clinical research community. Each article will serve as a short primer and may refer the reader to additional sources for detailed information regarding both background and application.
EPID-20SKULL BASE MENINGIOMAS ARE BIOLOGICALLY MORE BENIGN AND HAVE A LONG-TERM DIVERGING POSTOPERATIVE RECURRENCE PATTERN COMPARED WITH SUPERFICIAL MENINGIOMAS
Authors: Alireza Mansouri, George Klironomos, Shervin Taslimi, Alexandra Kilian, Fred Gentili, Gelareh Zadeh
Journal: Neuro-Oncology (2015)

OBJECTIVE: To identify differences in the recurrence pattern of surgically-resected skull base meningiomas compared with superficial intra-cranial meningiomas. METHODS: A retrospective hospital-based study of all patients referred to our institution from January 1990 to June 2014 for surgical resection of meningiomas was conducted. The database constituted both patients with a first time presentation and those with evidence of recurrence presenting for a surgical evaluation. Tumor proliferation index (based on the MIB-1 index) and the overall time to recurrence of the cohort of surgically-resected skull base and superficial meningiomas was documented. Kaplan-Meier curves and life tables were constructed for analysis of survival. SPSS v22.0 was used for statistical analysis. RESULTS: Overall, 398 intra-cranial meningiomas - 269 (68%) superficial and 129 (32%) skull base - were available for review. Follow up time ranged from 1 week to 250 months. Skull base lesions were found to have a significantly lower MIB-1 index compared with their superficial counterparts (0.0413 vs 0.0620, p 0.001). Meningiomas in all locations demonstrated a recurrence rate of 30% at an average of 100 months of follow-up. Subsequent to this point, however, the recurrence of skull base meningiomas demonstrated a plateau (250 months of follow-up) whereas superficial lesions were found to have a recurrence rate of 80% at 230 months of follow-up (P value: 0.038). CONCLUSIONS: As reflected by the difference in the MIB-1 index, skull base meningiomas demonstrated a less aggressive behavior compared with superficial lesions. This was reflected in the clinical recurrence rate of 80% for the latter. This suggests that while skull base lesions may not necessarily need to be followed beyond 100 months, superficial meningiomas would require a greater long-term follow-up given their higher propensity for recurrence.
Hepatitis-Associated Aplastic Anemia
Authors: Kevin E. Brown, John Tisdale, A. John Barrett, Cynthia E. Dunbar, Neal S. Young
Journal: New England Journal of Medicine (1997)

Hepatitis-associated aplastic anemia is a variant of aplastic anemia in which aplastic anemia follows an acute attack of hepatitis. The aplastic anemia, however, is often fatal if untreated. To characterize the illness, investigate the role of hepatitis viruses, and assess the response to immunosuppressive treatment, we studied patients with the syndrome who were referred to the National Institutes of Health (NIH).
Assessment of the Size of the Liver
Authors: Felix G. Fleischner, Victor Sayegh
Journal: New England Journal of Medicine (1958)

ASSESSMENT of the size of the liver is often erratic. Downward displacement of the lower edge as determined by palpation or the plain roentgenogram is sometimes misleading. It is generally understood that an accurate evaluation of liver size also requires information concerning its upper border as manifested by the position of the diaphragm. What is not commonly appreciated, however, is the fact that other constitutional variations in shape and position of the liver may alter the significance of clinical findings. Thus, in numerous clinical records and published reports one may find statements that "the liver edge was palpable several fingerbreadths . . .
Comprehensive genomic profiling of sarcomas from 267 adolescents and young adults to reveal a spectrum of targetable genomic alterations.
Authors: Deborah Morosini, Juliann Chmielecki, Michael Goldberg, Jeffrey S. Ross, Philip J. Stephens, Vincent A. Miller, Lara Emily Davis
Journal: Journal of Clinical Oncology (2015)

11020 Background: Sarcomas comprise nearly 10% of all cancers (CA) in adolescents and young adults (AYA, age 15-39). Despite high unmet clinical need for better treatments, comprehensive genomic profiling (CGP) of AYA sarcomas has not been reported. To identify the genomic alterations (GA) and potential therapeutic targets, we performed CGP on 267 AYA sarcomas. Methods: DNA and RNA were extracted from 267 AYA sarcomas. CGP was performed on hybridization-captured libraries to a mean coverage depth of > 500X for 405, 315, or 265 (DNA) and 333 (RNA) CA-related genes, plus select intronic regions frequently rearranged in CA. Results were analyzed for base substitutions, insertions/deletions, copy number alterations, and fusions/rearrangements. We compared pediatric (peds) (n = 51), AYA (n = 267) and > 39yo (n = 853) patients and complex karyotype driven (CKD) versus fusion driven (FD) subtypes. Results: In AYA sarcoma, the most common GAs were in TP53 (25%), CDKN2A (16%), and EWSR1 (12%). An average of 3 GAs/sample was found (range 1-12). Clinically relevant GAs (associated with approved drugs or mechanism based trials) were present in 60% of cases. Cell cycle alterations (CCND1,2,3, CCNE1, CDK4/6, CDKN2A/B, RB1) were enriched in > 39 yo (53%) vs AYA sarcomas (33%, p < 0.001, Fisher’s exact test). Comparison of CKD and FD AYA sarcomas revealed differing frequency by age grouping. CKD sarcomas were less frequent in the AYA group (15%) compared to either the peds (20%) or > 39 yo (22%). FD sarcomas seem more frequent in AYA tumors (5%) vs > 39 yo (0.5%), but less frequent than in the peds (35%). FD tumors were enriched for GA in EWSR1 and SS18 corresponding to the frequency of Ewing and synovial sarcoma, respectively, seen in AYA CA. Novel fusions were also found, such as a LMNA-NTRK1 fusion in a YA with metastatic sarcoma, enabling enrollment in a clinical trial of NTRK-specific therapy. Conclusions: A combined DNA and RNA CGP assay can characterize tumor specific GA in AYA sarcomas and guide novel treatment decisions. Further use of CGP in these patients can potentially increase AYA enrollment in clinical trials of targeted therapies and lead to improved outcomes for these aggressive forms of CA.
Prostate Antigen: A Marker for Human Prostate Epithelial Cells&lt;xref ref-type="fn" rid="fn2"&gt;2&lt;/xref&gt;
Authors: L D Papsidero, M Kuriyama, M C Wang, J Horoszewicz, S S Leong, L Valenzuela, G P Murphy, T M Chu
Journal: JNCI Journal of the National Cancer Institute (1981)

Specificity of a previously reported prostate antigen (PA) was assessed by several immunologic procedures. This antigen, restricted in distribution to the prostate gland, was detected within ductal epithelial cells. Continuous established cell lines LNCaP and PC-3 of malignant prostate origin retained the expression of PA. Tumor cells released the antigen in vitro into the culture fluid and also in vivo into the circulation of nude mice preinoculated with LNCaP cells. Prostate cells in culture also specifically accreted immunoglobulin fragments of PA antiserum.
Problems in the Aortographic Diagnosis of Dissecting Aneurysm of the Aorta
Authors: W. H. Shuford, R. G. Sybers, H. S. Weens
Journal: New England Journal of Medicine (1969)

In 44 patients with suspected dissecting aneurysm of the aorta, an aortographic diagnosis of dissection, based on the demonstration of a narrowed true lumen and of a false channel, was made in 23. Aortographic findings were negative for dissection in 11. In the remaining 10 diagnostic difficulties were encountered. In four, eventually shown to have dissection, problems resulted from faint false-channel opacification, unusual tearing of the intima and equal simultaneous opacification of both channels. In one with aortic insufficiency, findings suggestive of false-channel injection were caused by layering of contrast material in the descending aorta. In another, mediastinal rupture of a thoracoabdominal aneurysm simulated thickening of the aortic wall. In the remaining four, a definite diagnosis could not be made. Three of these had thickening of the aortic wall as the only abnormality, and one had a hemothorax obscuring the descending aortic wall.
Combined Medical and Surgical Management of Upper Gastrointestinal Hemorrhage
Authors: Thomas A. Warthin, Richard Warren, Egon G. Wissing
Journal: New England Journal of Medicine (1949)

MANY excellent reviews of the problems in management of upper gastrointestinal bleeding have been presented by various internists and surgeons. Almost without exception the material has been analyzed from the point of view of the internist or the surgeon. Rarely has the combined approach been presented, although recent papers by Jones,1 Heuer,2 Schatzki3 and Hoerr4 have emphasized this. It is our purpose to demonstrate that the most efficient way to deal with massive bleeding is by means of a combined medical and surgical team in conjunction with a well trained roentgenologist. In the Veterans Administration Hospital, West Roxbury, such a . . .
THU0134 Rheumatoid Vasculitis: A Decline in the XXI Century: Table 1
Authors: A. Riveros Frutos, M. Martínez-Morillo, S. Rodríguez Muguruza, J. Sanint, A. Prior, S. Holgado, L. Mateo, J. Cañellas, X. Tena, A. Olivé
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Rheumatoid vasculitis is an extra articular manifestation of rheumatoid arthritis (RA), that occurs during the course of long standing disease. It is associated with a poor prognosis <h3>Objectives</h3> To describe the clinical characteristics, incidence, treatment, and outcome of patients diagnosed with rheumatoid vasculitis (RV) at a Rheumatology service of a University hospital during the last 30 years <h3>Methods</h3> Retrospective study (1984-2014). Location: University hospital. Referral area: 850.000 inhabitants. Medical records of patients with diagnosis of RA were reviewed, from the Rheumatology service data base. Inclusion criteria: patients with RV with histopathological confirmation of vasculitis or high suspicion based on clinical or radiological (arteriography) findings (according to Scott and Bacon criteria) <h3>Results</h3> A total of 18 patients were included: 6 (33.3%) females and 12 (66.7%) males, mean age of 10.13±66.5 (49-83 years). The clinical characteristics of patients are listed in Table 1. The most common clinical presentation was skin involvement with palpable purpura and digital ulcers. Other common manifestations were multineuritis and systemic involvement. Heart, eyes, or pulmonary involvements secondary to RV were absent. Laboratory tests at diagnosis of RV, showed an increased of acute phase reactants and anemia. All patients had a positive rheumatoid factor, citrullinated antibodies were determined only in five (27.8%) cases, being positive in all of them.Histological confirmation was possible in 8 (44.4%) cases, in the other 10 (55.6%) cases the diagnosis was made with clinical or radiological findings. Most patients were treated with pulse steroids associated with other immunosuppressive drugs. Seven (38.9%) patients died. Three of them (16.7%) secondary to vasculitis, and 4 (22.2%) of other causes.The incidence of rheumatoid vasculitis has decreased considerably in the last decade. Just 4 cases were diagnosed during the last 10 years. <h3>Conclusions</h3> RV is a rare complication of RA. Cutaneous and neurological involvement is more common. It is more frequent in male smokers with seropositive and nodular RA. Histological diagnosis is difficult. Currently the incidence is decreasing, however mortality is still high. <h3>Disclosure of Interest</h3> None declared
Familial Type IV Hyperlipoproteinemia
Authors: Paul H. Schreibman, Dana E. Wilson, Ronald A. Arky
Journal: New England Journal of Medicine (1969)

A 17-year-old girl with asymptomatic hyperlipemia was found to have a Type IV hyperpre-beta-lipoproteinemia. The diagnosis was established by measurement of fasting triglycerides and plasma post-heparin lipolytic activity as well as determination of lipoprotein patterns by electrophoresis and analytical ultracentrifugation. After one week on a 90 per cent carbohydrate diet, serum triglycerides demonstrated an exaggerated rise. Twenty-two members in three generations of her family were also studied. Type IV hyperlipoproteinemia occurred in 33.3 per cent, and the mode of inheritance was autosomal dominant with incomplete penetrance. Although children in this family had serum triglycerides as high as 2000 mg per 100 ml, no family member below the age of 70 has shown atherosclerotic complications. This favorable prognosis may be dus to the absence of prominent obesity and glucose intolerance in this kindred.
Case 30-2006
Authors: David T. Scadden, Victorine V. Muse, Robert P. Hasserjian
Journal: New England Journal of Medicine (2006)

A 41-year-old man was admitted to the hospital because of lymphadenopathy, fatigue, and fever, which had worsened during the previous 6 months, with weight loss and a recent onset of cough and dyspnea. He had had multiple sexual partners since a divorce 4 years earlier; there was no recent travel or exposure to ill persons. Evaluation disclosed cervical, axillary, and abdominal lymphadenopathy, hepatosplenomegaly, anemia, and thrombocytopenia. A diagnostic procedure was performed.
Superior Myocardial Protection Using “Polarizing” Adenosine, Lidocaine, and Mg 2+ Cardioplegia in Humans
Authors: Francesco Onorati, Geoffrey P. Dobson, Livio San Biagio, Riccardo Abbasciano, Diego Fanti, Cecilia Covajes, Tiziano Menon, Leonardo Gottin, Fausto Biancari, Alessandro Mazzucco, Giuseppe Faggian
Journal: Journal of the American College of Cardiology (2016)
Dependence of Arterial Pressure on Intravascular Volume in Treated Hypertensive Patients
Authors: Harriet P. Dustan, Robert C. Tarazi, Emmanuel L. Bravo
Journal: New England Journal of Medicine (1972)

Relations between plasma volume and arterial pressure were studied in 16 hypertensive patients during long-term antihypertensive treatment. In five patients who had responded poorly to combined adrenergic blocker and diuretic treatment, plasma volume was either expanded or normal. Intensified diuretic treatment reduced plasma volume below normal and arterial pressure nearly to normal. In 11, who had responded well to treatment either with the same combination (six patients) or with adrenergic blockers alone (five patients), plasma volume was below normal. In the 12 men both systolic and diastolic pressure correlated directly with plasma volume (p less than 0.01 for both). Although adrenergic blocking drugs interfere with cardiovascular adjustments to intravascular volume expansion, reasons for this quantitative relation between pressure and plasma volume did not emerge. However, this study emphasizes the importance of precise volume control in maintaining blood-pressure reductions during treatment.
Hemodynamic Characteristics of Primary Aldosteronism
Authors: Robert C. Tarazi, M. Mohsen Ibrahim, Emmanuel L. Bravo, Harriet P. Dustan
Journal: New England Journal of Medicine (1973)

Abstract As compared with 30 matched patients with essential hypertension, 16 with primary aldosteronism had a higher heart rate (p<0.02), cardiac index (p<0.01) and mean rate of left ventricular ejection (p<0.025). A clinically evident hyperkinetic circulatory state was more frequent in primary aldosteronism (six of 16) than in essential hypertension (four of 30). Cardiac index correlated inversely with diastolic pressure in primary aldosteronism (r = -0.661, p<0.01). Better surgical results were obtained in patients who had the higher cardiac output before operation. Plasma volume was 103 per cent of normal ± 2.7 (S.E.) in primary aldosteronism, 111 per cent ± 2.6 in 10 patients with hypervolemic hypertension, and 86 per cent ± 2.1 in 20 with hypovolemic hypertension. In both the hypovolemic group and primary aldosteronism, plasma volume correlated inversely with peripheral resistance (r = -0.531, p<0.05 and r = -0.610, p<0.02, respectively), so that for any level of resistance, plasma volume was higher...
Case 23-2010
Authors: Hasan Bazari, Eyal C. Attar, Douglas M. Dahl, Raul N. Uppot, Robert B. Colvin
Journal: New England Journal of Medicine (2010)

A 49-year-old man was admitted to this hospital because of perinephric collections of fluid and acute renal failure. Seven years earlier, routine testing revealed an elevated hematocrit; regular phlebotomy was begun. Ten months before admission to this hospital, dyspnea on exertion developed; imaging studies showed pleural effusions and bilateral perinephric cystic lesions. One month before admission, left-flank pain developed suddenly, and the left perinephric collection of fluid had enlarged; a drain was placed, and acute renal failure developed. A diagnostic procedure was performed.
Perivascular sustained release of atorvastatin from a hydrogel-microparticle delivery system decreases intimal hyperplasia
Authors: Ioanna Mylonaki, Francesco Strano, Sebastien Deglise, Eric Allémann, Florian Alonso, Jean-Marc Corpataux, Céline Dubuis, Jacques-Antoine Haefliger, Olivier Jordan, François Saucy, Florence Delie
Journal: Journal of Controlled Release (2016)
Paradoxical ACTH Response to Glucocorticoids in Cushing's Disease
Authors: Horst Lorenz Fehm, Karl Heinz Voigt, Rudolf Ernst Lang, Karl Ernst Beinert, Gerd Wilhelm Kummer, Ernst Friedrich Pfeiffer
Journal: New England Journal of Medicine (1977)

To define further the defect in the steroid feedback mechanism in Cushing's disease, we studied the acute effects of intravenous administration of glucorticoids on plasma ACTH levels in seven patients with this disease after total adrenalectomy. In seven other patients with hypoadrenocorticism ACTH was readily suppressed; a significant decrease (72.5+/-5 per cent, mean +/- S.E.M., P less than 0.002) occurred within 15 minutes of the start of an infusion of 50 mg per hour of cortisol. In contrast, in the seven adrenalectomized patients with Cushing's disease, cortisol induced a transient paradoxical rise in ACTH levels, with a maximum at 15 minutes (347+/-99 per cent,, P less than 0.05). A similar ACTH response was observed with dexamethasone. Cushing's disease is characterized by a paradoxical transient rise in ACTH after glucocorticoid administration. This effect was more pronounced in adrenalectomized than in nonadrenalectomized patients.
Reversed Pulsus Paradoxus
Authors: Rashid A. Massumi, Dean T. Mason, Zakauddin Vera, Robert Zelis, Jorge Otero, Ezra A. Amsterdam
Journal: New England Journal of Medicine (1973)

Abstract The term  pulsus  may be used to describe an inspiratory rise of the arterial systolic and diastolic pressures, presumably related to an inspiratory increase in left ventricular stroke output. We have observed a reversed pulsus paradoxus in three unrelated clinical circumstances: idiopathic hypertrophic subaortic stenosis, isorhythmic ventricular rhythms and during intermittent inspiratory positive-pressure breathing in the presence of left ventricular failure. These unusual respiration-related fluctuations of blood pressure must be differentiated from the usual pulsus paradoxus of cardiac tamponade. (N Engl J Med 289:1272–1275, 1973)
Coronary Stenting plus Platelet Glycoprotein IIb/IIIa Blockade Compared with Tissue Plasminogen Activator in Acute Myocardial Infarction
Authors: Albert Schömig, Adnan Kastrati, Josef Dirschinger, Julinda Mehilli, Ullrich Schricke, Jürgen Pache, Stefan Martinoff, Franz-Josef Neumann, Markus Schwaiger
Journal: New England Journal of Medicine (2000)

Prevention of myocardial damage is the main goal of all reperfusion therapies in patients with acute myocardial infarction. The relative efficacy of various reperfusion strategies is under intensive investigation. We assessed whether coronary stenting combined with the blockade of platelet glycoprotein IIb/IIIa receptors produces a greater degree of myocardial salvage than fibrinolysis with an accelerated infusion of alteplase, a tissue plasminogen activator.