tbuckley/cabot-search huggingface dataset:
Efficacy of FOLFIRI3 (irinotecan 100mg/m<sup>2</sup> D1,D3 combined with LV5FU) or other irinotecan-based regimens in oxaliplatin-pretreated metastatic colorectal cancer in the OPTIMOX1 study
Authors: F. Bidard, L. Bengrine, A. Figer, A. Cervantes, T. André, G. Lledo, M. Mabro, C. Tournigand, C. Louvet, A. de Gramont
Journal: Journal of Clinical Oncology (2008)

4059 Background: In metastatic colorectal cancers initially treated with FOLFOX, irinotecan is commonly used as second line. We investigated in an unselected population which irinotecan-based regimen had the best antitumoral activity. Methods: As the choice of the second line therapy was given to the investigators, without any inclusion criterion, various second line regimens were prospectively registered in the phase III OPTIMOX1 study (front-line FOLFOX4 or 7). Simultaneous use of EGFR inhibitors was excluded. Patient’s characteristics (Age, performance status (PS), LDH, ALP and CEA levels before the first line of chemotherapy), first line regimen (FOLFOX4 or 7, oxaliplatin reintroduction, PFS achieved in first line) and type of irinotecan-based regimen were tested for an association with second-line progression-free survival (PFS) and tumor control. Results: Among the 620 patients enrolled in the OPTIMOX1 study, 343 received an irinotecan-based second-line chemotherapy: FOLFIRI-3 (n=101, irinotecan 100mg/m2 days 1 and 3, combined with LV5FU), FOLFIRI-1 (n=49, irinotecan 180mg/ m2 day 1 combined with LV5FU), irinotecan with 5FU or 5FU derivatives (n=49), irinotecan as single agent (n=38) or with other agents (n=9). Waiting for additional information, 96 patients who received irinotecan with unknown 5FU regimen were not analysed. Median PFS was 3.0 months. FOLFIRI-3 regimen was associated in univariate and multivariate analysis with a longer PFS than all other irinotecan-based regimens (p=0.007), together with LDH level (p<0.0001) and PS (p=0.007) at inclusion. Interestingly, the first-line of treatment (FOLFOX4 or 7, presence or absence of oxaliplatin reintroduction, PFS achieved in first line) did not influence PFS. FOLFIRI-3 regimen (p=0.001) and first-line PFS (p=0.009) were associated with a higher rate of tumor control (PR + SD) in multivariate analysis. Conclusions: In unselected patients pretreated with oxaliplatin, the PFS of irinotecan-based chemotherapy regimens might be shorter than described in second-line trials. In this unselected second-line setting, FOLFIRI3 regimen showed higher efficacy than other irinotecan-based chemotherapy regimens. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Amgen, Genentech™ BioOncology, Roche, sanofi-aventis Merck, Pfizer Oncology, Roche, sanofi-aventis
Parental decisions and outcomes regarding disclosing maternal <i>BRCA1</i> and <i>2</i> test results to children
Authors: K. Tercyak, B. Peshkin, T. DeMarco, K. Schneider, H. Valdimarsdottir, J. Garber, A. Patenaude
Journal: Journal of Clinical Oncology (2009)

9582 Background: BRCA1/2 testing is key to hereditary cancer risk management. Though testing is discouraged in children, prior work suggests they are informed of their tested mothers' mutation status; decisions and outcomes of parental disclosure to children remain largely unknown. Methods: We examined predictors of parental disclosure decisions to children ages 8–21 and related outcomes in a large clinical sample (221 tested mothers, 124 untested co-parents). Parents were interviewed prior to mothers' receipt of BRCA1/2 results and 1 and 6 months later. Descriptive analyses were conducted, and bivariate analyses identified candidate predictor variables (demographic, medical, psychosocial) for inclusion in multivariate logistic regression models. Results: 63% of mothers disclosed their results to their children within 1 month of receipt (44% of co-parents also disclosed to children); this increased to 68% by 6 months (55% among co-parents). Within parenting dyads, mothers were significantly more likely than co-parents to disclose to children in the short-term (X 2 =18.6, p&lt;.0001). Predictors of maternal disclosure to children included not being a BRCA1/2 mutation carrier, older child age, stronger intentions to disclose, more favorable attitudes toward pediatric BRCA1/2 testing, a more open parent-child communication history, and a decisional balance favoring disclosure (all p's&lt;.05). When examined simultaneously, mothers who were not mutation carriers (OR=4.02, 95% CI=1.35, 11.94), mothers of older children (OR=1.30, 95% CI=1.13, 1.49), and those with stronger intentions to disclose (OR=1.39, 95% CI=1.10, 1.76) were more likely to communicate. Other outcomes of maternal disclosure included greater satisfaction with the decision to disclose and more open parent-child communication following disclosure (all p's&lt;.05). Conclusions: This is the largest and most well-characterized study on this topic to date. Short-term rates of parental disclosure to children were high, increasing over time. Parental disclosure decisions are determined by a complex array of both child and parent factors, with some benefits identified with disclosure. Findings indicate a need for additional work, including decision support interventions for communication with children. No significant financial relationships to disclose.
Case 17-2007
Authors: Christopher P. Stowell, Jeffrey A. Gelfand, Jo-Anne O. Shepard, Alexander Kratz
Journal: New England Journal of Medicine (2007)

A 25-year-old woman was admitted to the hospital with relapsing fevers, headache, and dyspnea. An elective splenectomy had been performed 4 years earlier for hereditary spherocytosis. Laboratory studies showed leukocytosis, anemia, and multiple intraerythrocytic ring forms on a peripheral-blood smear. The dyspnea worsened, and hypoxemia developed. A therapeutic procedure was performed.
Efficacy of Self-Therapy in Hemophilia
Authors: Peter H. Levine
Journal: New England Journal of Medicine (1974)

To determine the long-term efficacy of self-therapy in hemophilia, 72 patients with hemophilia were studied. New or progressive hemophilic arthropathy occurred in a total of 90.3 per cent, during a year of traditional emergency-room-based therapy. This figure decreased to 12.5 per cent during the most recent year on the self-therapy program. Patients still at risk were older, were often inadequately insured, and were less vigorous in application of therapy than the study group as a whole. Sixty-seven of 72 hemophilic patients required no hospitalizations during the study year, excluding elective surgery. Costs of therapy declined by 40 per cent. The patient-education aspect of the program led to two cases of possibly lifesaving early recognition and therapy of severe emergency, and to two cases of morbidity due to errors in patient judgment. The risk-benefit ratio for properly supervised self-therapy clearly favors this mode of health-care delivery. (N Engl J Med 291:1381–1384, 1974)
Extended left colon resections as part of complete cytoreduction for ovarian cancer.
Authors: N. Bou Zgheib
Journal: Journal of Clinical Oncology (2010)

e15555 Background: Colectomy is a common part of cytoreductive surgery. The most common segment of the colon resected is the rectosigmoid. Extended left-sided colectomies are rarely performed. With increased emphasis on the importance of maximal cytoreductive surgery it is becoming more important to understand the outcomes related to such a procedure. The purpose of this report is to evaluate the quality of life issues related to extended left colectomies. Methods: Data on all patients who underwent cytoreductive surgery between April 2007 and April 2009 was prospectively recorded. 19 patients underwent extended left colon resections. The data from these cases was evaluated with particular attention directed at quality of life issues surrounding postoperative bowel function, and tolerance of postoperative chemotherapy. Results: 9 underwent resection of the left hemicolon plus the hepatic flexure. 6 underwent resection of the left hemicolon, hepatic flexure, and the ascending colon. 4 underwent subtotal colectomies. Temporary diverting loop ileostomies were performed on 18 of the 19 patients each of whom consented for intraperitoneal chemotherapy. No delays in chemotherapy were observed. Median number of bowel movements at 6, 9 and 12 months were 2, 2 and 1, respectively. No fecal incontinence was observed. Patients expressed satisfaction with their bowel surgery and denied any significant decrease in their quality of life due to their bowel function. A single chemotherapy cycle was delayed in 1 patient due to dehydration and electrolyte abnormalities. Each subsequent cycle was given on time with additional days of outpatient hydration. Conclusions: Extended left colon resection is a reasonable technique to include in patients requiring maximal cytoreduction. Quality of life related to bowel function is acceptable and patients express satisfaction with the degree of surgery. With attention to the additional hydration requirements needed after extended left colon resections, chemotherapy can be given on schedule and without delays No significant financial relationships to disclose.
Mitosis and Binucleation in Mast Cells of the Rat&lt;xref ref-type="fn" rid="fn1"&gt;2&lt;/xref&gt;
Authors: Anton M. Allen
Journal: JNCI Journal of the National Cancer Institute (1962)

Mast cells in spreads of mesentery from 16 normal rats were colored with the Feulgen reaction and methyl green to permit identification of these cells and determination of their index of mitosis, deoxyribonucleic acid (DNA) doubling, and binucleation in relation to age and growth of the rats. Experimental induction of mitosis of mesenteric mast cells was accomplished by injection of talc suspension into the peritoneal cavity of additional rats. The results of these studies indicated that mesenteric mast cells undergo considerable mitotic activity and that they divide as a function of the growth of the tissue comprising them, whether the growth be natural or experimentally induced. The findings indicated that 1) the index of mitosis and index of DNA doubling of the mast cells and the index of growth of the rats followed similar decreasing trends as the rats advanced in age from 10 to 120 days; 2) the indexes of DNA doubling and binucleation of mast cells increased in relation to the index of mitosis as the three indexes decreased, which suggested that, as the rats became older and their growth subsided, the initiation of karyokinesis and cytokinesis of some mast cells was somehow delayed; 3) the process of binucleation, or failure of dividing cells to undergo cytokinesis, was a naturally occurring process in mesenteric mast cells of the rat; 4) paired mast cells, resulting from divisions of single mast cells, were separated rapidly in young rats and slowly in older rats by growth of mesentery between them.
The Visible Vessel as an Indicator of Uncontrolled or Recurrent Gastrointestinal Hemorrhage
Authors: William J. Griffiths, David A. Neumann, Jack D. Welsh
Journal: New England Journal of Medicine (1979)

Although endoscopic examination in patients with bleeding of the upper gastrointestinal tract has improved diagnostic accuracy, it has not been useful in predicting clinical outcome and has not been shown to improve the patients' prognoses. This article describes a subgroup of patients with acute upper gastrointestinal bleeding whose clinical outcome can be predicted at the time of endoscopy. In 28 of 317 patients who underwent endoscopy, a "visible vessel" was seen in an ulcer presumed to be the bleeding site. All 28 were later recommended for operation because of recurrent (86 per cent) or uncontrolled (14 per cent) hemorrhage. In contrast, 75 per cent of the remaining 289 patients in whom vessels were not seen, whether or not bleeding from ulcers, had single bleeding episodes managed medically. Since patients with a "visible vessel" can be expected to have uncontrolled or recurrent hemorrhage, surgical treatment should be considered at the time of endoscopy if such a vessel is seen.
Significance of Changes in Serum Muramidase Activity in Megaloblastic Anemia
Authors: Pasquale E. Perillie, Sandra S. Kaplan, Stuart C. Finch
Journal: New England Journal of Medicine (1967)

ERYTHROKINETIC studies in patients with pernicious anemia have demonstrated that the anemia results from a combination of moderately decreased life-span of circulating erythrocytes and inadequate delivery of mature erythrocytes to the peripheral blood.1 Ferrokinetic studies have shown that the inadequate release of mature red cells to the peripheral blood is due to increased destruction of the developing red cells while in the marrow (ineffective erythropoiesis).2 , 3 Little, however, is known concerning the mechanism (or mechanisms) resulting in the leukoneutropenia and thrombopenia not infrequently found in patients with megaloblastic anemia. In general, it has been assumed that inadequate bone-marrow production or delivery . . .
The Staphylococcal Scalded-Skin Syndrome
Authors: Marian E. Melish, Lowell A. Glasgow
Journal: New England Journal of Medicine (1970)

A syndrome of dermatologic response to infection with phage Group 2 coagulase-positive staphylococci with reactions ranging from bullous impetigo to generalized scarlatiniform rash without exfoliation to generalized exfoliative disease was observed in 17 children. Staphylococci isolated from these patients, as well as two additional Group 2 organisms, produced exfoliation in newborn mice. The experimental lesion progressed from the development of a Nikolsky sign to bullous formation and then widespread exfoliation. Histologic sections were characterized by a cleavage plane within the epidermis at the stratum granulosum. Among 36 strains, the capacity to produce exfoliation was unique to staphylococci of phage Group 2. The disease produced in newborn mice reproduces the scalded-skin syndrome. Staphylococci may be recovered from involved animals. Thus Koch's postulates are fulfilled, and staphylococci of phage Group 2 are established as the etiologic agent of this syndrome.
The Consult Guys - A Real Headache: Anticoagulation and a Subdural Hematoma
Authors: Geno J. Merli, Howard H. Weitz
Journal: Annals of Internal Medicine (2016)

Web Exclusives19 April 2016The Consult Guys - A Real Headache: Anticoagulation and a Subdural HematomaFREEGeno J. Merli, MD and Howard H. Weitz, MDGeno J. Merli, MDSearch for more papers by this author and Howard H. Weitz, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/W16-0004 SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.For more videos from and information on The Consult Guys, visit www.annals.org/ConsultGuys.Correction: In The Consult Guys video “A Real Headache: Anticoagulation and A Subdural Hematoma,” the computed tomography image of the head originally shown at 1:56 showed a shift of midline structures in association with a hematoma. This has been replaced with the correct image of a hematoma with no shift of midline structures. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Disclosures: Geno J. Merli, MD, reports the following: Research grants/contracts: Bristol-Myers Squibb, Janssen, Portola; Consultancies: Bristol-Myers Squibb, Janssen. Howard H. Weitz, MD, reports that he has no financial relationships or interests to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCorrection: The Consult Guys - A Real Headache: Anticoagulation and a Subdural HematomaCorrection: The Consult Guys - A Real Headache: Anticoagulation and a Subdural Hematoma Metrics Cited byCorrection: The Consult Guys - A Real Headache: Anticoagulation and a Subdural Hematoma 19 April 2016Volume 164, Issue 8Page: CG1KeywordsComputed axial tomographyDisclosureHeadachesResearch grantsResearch reporting guidelines ePublished: 19 April 2016 Issue Published: 19 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.Loading ...
A history of the evolution of guidelines for reporting medical research: the long road to the EQUATOR Network
Authors: Douglas G Altman, Iveta Simera
Journal: Journal of the Royal Society of Medicine (2016)

Testing medical treatments and other interventions aimed at improving people’s health is incredibly important. However, comparative studies need to be well designed, well conducted, appropriately analysed and responsibly interpreted. Sadly, not all available findings and ‘discoveries’ are based on reliable research.

Our beliefs about best practices for medical research developed massively over the 20th century and ideas and methods continue to evolve. Much, perhaps most, medical research is done by individuals for whom it is not their main sphere of activity; notably, clinicians are expected to conduct some research early in their careers. As such, it is perhaps not surprising that there have been consistent comments on the poor quality of research and also recurrent attempts to raise understanding of how to do research well.

More recently, and increasingly over the last 20 years, concerns about poor methodology1 have been augmented by growing concerns about the inadequacy of reporting in published journal articles.2
Impaired Function of Macrophage Fc<sub>γ</sub>Receptors in End-Stage Renal Disease
Authors: Pedro Ruiz, Francisco Gomez, Alan D. Schreiber
Journal: New England Journal of Medicine (1990)

Infection is a frequent complication in patients undergoing hemodialysis for end-stage renal disease and is the primary cause of mortality among such patients. Macrophages are important in host defense against infection largely because their Fcγ receptors recognize antibody-coated bacteria. We therefore studied macrophage Fcγ-receptor function in vivo and in vitro in 56 patients with end-stage renal disease who were on hemodialysis and in 20 healthy volunteers.
Clinical and Laboratory Studies of Relapsing Vivax Malaria of Pacific Origin
Authors: Harry H. Gordon, Alexander Marble, Stuart W. Lippincott, William B. Hesselbrock, Lester D. Ellerbrook
Journal: New England Journal of Medicine (1946)

SINCE members of the armed forces have been stationed in areas in which malaria is prevalent, many of them will experience symptoms of the disease, either as delayed primary attacks or as relapses, when suppressive treatment is discontinued on their return to nonendemic areas. It seems worth while, therefore, to present a brief summary of the clinical features and laboratory findings in 808 soldiers admitted from Pacific areas to the Malaria Section of the Harmon General Hospital from August, 1943, to March, 1945. Certain of the data have been presented in greater detail in recent articles.1 2 3 4 Type of MalariaAlthough . . .
Surgical Management of Late Closure of Aortofemoral Reconstruction Grafts
Authors: John H. Lyons, Rodger E. Weismann
Journal: New England Journal of Medicine (1968)

Unilateral late graft thrombosis, an infrequent complication after aortofemoral grafting procedures, usually produces incapacitating ischemia of the involved lower extremity. Eighteen patients with this complication were treated surgically. When operation was carried out soon after occlusion, it was possible to re-establish flow through the occluded graft limb and salvage the ischemic lower extremity in a high percentage of cases. This was usually accomplished through incisions confined to the lower extremity. Unsuccessful attempts to restore patency to the graft and its runoff resulted in major amputation or the eventual death of the patient. These unfavorable results were more common in patients with associated femoropopliteal occlusive disease and in those in whom operative intervention had been delayed.
Case 30-2002
Authors: Brian P. O'Sullivan, Lori A. Erickson, John L. Niles
Journal: New England Journal of Medicine (2002)

Presentation of CaseAn eight-year-old girl was admitted to the hospital because of fever, cough, hemoptysis, and pulmonary consolidations.She had been well until six days before admission, when she was visiting El Salvador. A sore throat developed, with mild fever, a dry cough, and anorexia, and she began to vomit once daily. Three days before admission, she traveled by air to Boston, where she lived, and dyspnea developed. The next day, she began to cough up bright red blood and had right-sided otalgia and a sore throat; the low-grade fever persisted. The hemoptysis and dyspnea worsened, and she was . . .
P252 A retrospective evaluation of the diagnostic utility of adenosine deaminase in pleural tuberculosis in a low-prevalence area
Authors: L Marples, P Sivakumar, R Breen, L Ahmed
Journal: Thorax (2015)

<h3>Introduction and objectives</h3> Pleural fluid adenosine deaminase (pfADA) is a validated diagnostic marker for pleural tuberculosis (TB) in high prevalence areas, with good sensitivity and specificity reported at a threshold of 40 U/L. However, in north-west Europe pfADA is not routinely measured, due to a lack of evidence as to its diagnostic utility in areas of low TB prevalence. The aim of this study is to assess the sensitivity and specificity of pfADA in a low-prevalence area, evaluating its diagnostic value for pleural TB. <h3>Methods</h3> A retrospective analysis considered all pfADA-tested suspected pleural TB patients within one hospital trust from 2009–2015. This cohort was then divided into two groups: those with a confirmed diagnosis of pleural TB and those without pleural TB. Those without pleural TB were used as a control group, to determine the sensitivity and specificity of pfADA at various thresholds. <h3>Results</h3> Of 156 patients tested for pfADA, 25 had confirmed pleural TB and 131 did not, with mean pfADA levels of 71.7 (±25.2) and 19.8 (±22.4), respectively. On a Receiver Operating Characteristic (ROC) curve (Figure 1), pfADA of 30 U/L has a sensitivity of 100%, specificity 83%, positive and negative predictive values of 53% and 100% respectively. At a threshold of 40 U/L, sensitivity was 88% with a specificity of 88%. The calculated area under ROC curve is 0.949 (95% CI 0.91–0.982). <h3>Conclusion</h3> Although the positive predictive value of pfADA may be lower in areas of low TB prevalence, its negative predictive value is unaffected, retaining its value as a worthy screening test to exclude pleural TB, allowing focus on obtaining adequate culture samples and biopsies in suspected pleural TB.