tbuckley/cabot-search huggingface dataset:
A randomized phase II trial comparing carboplatin pleurodesis with cisplatin pleurodesis in patients with stage IIIB/IV non-small cell lung cancer (NSCLC) with malignant pleural effusions (MPE)
Authors: T. Sasaki, H. Yasuda, K. Nakayama, S. Okinaga, T. Suzuki, M. Asada, A. Kanda, T. Shindo, Y. Ohuchi, M. Yamaya
Journal: Journal of Clinical Oncology (2006)

17012 Background: We previously reported that carboplatin pleurodesis in patients with advanced lung adenocarcinoma with MPE, renal insufficiency, and poor performance status (PS) was an effective palliative therapy. However, the efficacy and toxicity profile of carboplatin pleurodesis in patients with NSCLC with MPE in comparison with those of cisplatin pleurodesis have not been reported. Methods: Thirty patients with stage IIIB/IV NSCLC accompanied with MPE who did not have an indication for systemic chemotherapy because of poor PS more than 2 were randomized to carboplatin pleurodesis (target area under the curve as 5 μg-min/ml using Calvert’s formula) and cisplatin pleurodesis (80 mg/m 2 ) in a single-blind and controlled trial. Enrollment took place between Oct 2004 and Dec 2005. Primary efficacy endpoints were the best confirmed response rate, time to progression (TTP) in controlling MPE and adverse effects. Results: Fifteen of 30 patients were treated by carboplatin pleurodesis, and resting 15 of 30 patients were treated by cisplatin pleurodesis to control MPE. The response rate in carboplatin pleurodesis was not statistically different from that for patients in cisplatin pleurodesis (P = .226). The use of anticancer drugs for pleurodesis was not significantly associated with response rate in logistic regression analysis (relative risk = 14.2, 95% CI: 0.6–320.5, P = .095). Median TTP in carboplatin pleurodesis was not different from that in cisplatin pleurodesis (96 days vs 83 days). The use of carboplatin for pleurodesis (P = .016) and gender (P = .005) were associated with prolongation of TTP in the Cox regression method. Kaplan-Meier analysis showed that the progression free probability curve in carboplatin pleurodesis was not different from that in cisplatin pleurodesis (P = .275). The rate of Grade 3 thrombocytopenia in carboplatin pleurodesis (25%) was higher than that in cisplatin pleurodesis (0%), but there was no statistical significance (P = .096). Conclusions: Carboplatin pleurodesis and cisplatin pleurodesis may be feasible and acceptable toxicity profiles. No significant financial relationships to disclose.
The Surgery of Advanced Pelvic Cancer in Women
Authors: Howard Ulfelder, Joe V. Meigs
Journal: New England Journal of Medicine (1952)

IT has been established that removal of all the pelvic viscera can be accomplished with a mortality of 25 per cent or less and that the resultant physiologic readjustments permit a comfortable and active life.1 The ultimate appraisal will be made in terms of patients who survive for years in good health and without disease. In the interim, however, lessons will be learned and modifications will be introduced if groups of such patients are carefully evaluated from time to time. This paper reports the facts and discusses the conclusions reached from the study of a series of 46 patients on . . .
The Diagnosis and Initial Management of Head Injury
Authors: Jane F. Desforges, Robert J. White, Matt J. Likavec
Journal: New England Journal of Medicine (1992)

SINCE ancient times,1 head injuries have had an almost mysterious quality. Although trauma to the head may cause severe tissue disruption of the scalp, skull, and facial and subcranial structures, the ultimate determinant of survival and functional outcome is the degree and extent of brain damage, alone or in association with other major traumatic injuries.In the United States, a head injury occurs every seven seconds, with a death every five minutes. Head injury is the leading cause of death among people under the age of 24 years.2 Although statistics vary from year to year, approximately 200,000 people die or . . .
Increasing detection rates for diminutive adenomas: are we on the right track?
Authors: Daniel von Renteln, Alan N Barkun
Journal: Gut (2016)

Van Doorn et al recently reported that Endocuff, an endoscopic cap with plastic projections fitted onto the distal end of the colonoscope increases adenoma detection rates (ADRs).1 While the study is of impeccable design and the device demonstrates to be safe and helpful to improve the inspection of colonic folds, there remain open questions concerning the Endocuff as well as for similar novel ADR enhancing modalities currently emerging on the market. Do they merely improve ADR as a function of improved detection of diminutive adenomas, and if so does such an ‘enhanced’ ADR actually contribute to colorectal cancer (CRC) prevention? Are there potential downsides on cost-effectiveness through increased polypectomy rates, possible clinically futile shortened surveillance intervals with potential attendant complication risks?

While ADR has …
PTU-086 Outcomes of all surgery for ulcerative colitis over a 12-month period at a tertiary referral ibd unit
Authors: C Smart, TA Manship, L Warren, N Scott, I Botterill, R Saunders, P Sagar, A Ford, A O’Connor, J Hamlin
Journal: Gut (2015)

<h3>Introduction</h3> 1/4 of patients with ulcerative colitis (UC) will require surgery. We describe an audit of indications and outcomes of UC surgery at LTHT a tertiary referral centre for pouch surgery. <h3>Method</h3> Patients undergoing surgery for UC in 2013 were identified from surgical lists, IBD nurse post-op review and from histopathology database. Data were extracted from electronic records and case notes. <h3>Results</h3> 42 cases, 38 with complete dataset, 25 (59.5%) males. Mean age 42 (range 18–91), mean age at diagnosis 33 (7–68). 21 (55%) had failed &gt;3 therapies and 15 (39%) taking oral steroids at time of surgery. 0 E1 disease, 15 (39.5%) E2, 15 (39.5%) extensive colitis (E3), 8 (21%) extent unclear. 48 procedures on 38 patients within the 12 months, 32 (67%) were elective, 16 (33%) emergency. Of 16 emergencies 11 were sub-total colectomies for acute severe disease (5 open, 6 laparoscopic), 3 EUAs, 1 rectal stump dehiscence and 1 obstructing tumour. At 12 months 23 (61%) completed pouch surgery. Of 40 colectomies 27 (67.5%) were laparoscopic. Indications: failed medical therapy 78.9% (n = 30, one low grade dysplasia), cancer 7.9% (n = 3, 1 = panproctocolectomy transverse colon carcinoma, 1 = pouch with adenocarcinoma cuff, 1 = sub-total colectomy with tumour in rectal remnant), patient choice 5.3% (n = 2), perforation 2.6% (n = 1), other 5.3% (n = 2) One death from pneumonia following emergency procedure. 11 short-term complications in 7 patients having 2-stage pouch surgery (5 wound infections, 2 anastomotic leaks, 1 ileus, 1 chest infection, 1 failure to restore continuity, 1 ureteric damage). 5 had longer-term complications (1 each for pouch dysfunction, high output stoma, strictured anastomosis, pouchitis, peri-anal pain). 7/16 having 3-stage pouch suffered one or more short-term complications (5 wound infection/dehiscence, 5 intra-abdominal complication (collection/sepsis/bleed), 2 ileus and one each of anastomotic leak, chest sepsis, VTE, rectal stump complication, AKI, confusion, pneumaturia, anterior spinal artery infarct). 7/16 patients suffered one or more longer-term complication (3 high output stoma before reversal ileostomy, anaemia n = 2 and and 1 of rectal discharge, SBO, adrenal insufficiency and retrograde ejaculation) <h3>Conclusion</h3> Leeds is a high volume surgical unit performing 23 pouch operations in 12 months compared with the median number of 4 (national IBD audit). Most were laparoscopic as recommended by the IBD service standards. Pouch surgery carries significant short and long term risks and these should be addressed carefully. We recommend that all elective UC surgical patients are discussed at the IBD MDT and ideally reviewed in the combined clinic. <h3>Disclosure of interest</h3> None Declared.
Antacid versus Cimetidine in Preventing Acute Gastrointestinal Bleeding
Authors: Hans J. Priebe, John J. Skillman, Leonard S. Bushnell, Pamela C. Long, William Silen
Journal: New England Journal of Medicine (1980)

Over a 15-month period, 75 critically ill patients at risk of acute gastrointestinal bleeding were randomized into two groups: one group (38 patients) received the H2-blocker cimetidine intravenously at an initial dosage of 300 mg every six hours, and the other group (37 patients) received antacid (Mylanta II) through a nasogastric tube at an initial dosage of 30 ml every hour. Gastric pH was measured hourly and titrated above 3.5. Upper-gastrointestinal-tract bleeding occurred in seven of 38 cimetidine-treated patients but in none of 37 antacid-treated patients (P<0.01). When antacid titration was added to the cimetidine regimen in four of seven patients with bleeding, all four stopped bleeding. Renal failure, sepsis, peritonitis, hypotension, respiratory failure, jaundice, multiple trauma, and major operative procedures were associated with an increased incidence of bleeding. Cimetidine does not adequately protect seriously ill patients from acute upper-gastrointestinal-tract bleeding. Antacid is better for this purpose. (N Engl J Med. 1980; 302:426–430.)
A Study of Mitral Stenosis by Combined Catheterization of the Left and Right Sides of the Heart
Authors: Janet Dickens, George Raber, Asher Woldow, Gilles C. Lorange, Harry Goldberg
Journal: New England Journal of Medicine (1957)

SIMULTANEOUS catheterization of the left and right sides of the heart for evaluation of mitral and aortic stenosis has recently been reported.1 2 3 4 The effects of mitral stenosis upon the pulmonary circulation and cardiac output have been extensively investigated by right-sided catheterization.5 6 7 With the introduction of left-sided catheterization a method of accurate measurement of pressure gradient across a stenotic orifice became available.8 9 10 With the subsequent application of combined heart catheterization a more accurate evaluation of pressure-flow relations, as well as estimation of orifice size, can be obtained.Methods and MaterialsOne hundred and twenty patients with mitral stenosis were studied by . . .
Needs and preferences of breast cancer survivors: A cross-sectional survey.
Authors: D. L. Stan, S. Pruthi, S. Jenkins, K. Lackore, C. A. Thompson
Journal: Journal of Clinical Oncology (2011)

147 Background: The Institute of Medicine recommends development of cancer survivorship care models that are patient centered. We designed a cross-sectional survey to determine the medical and psychosocial needs and preferences of breast cancer survivors. Methods: We identified a random sample, stratified by age and chemotherapy usage, of 600 women from MN, WI, and IA, ages 18-99, within 1-5 years of diagnosis of stage 0-3 breast cancer and seen at our institution. Results: We received 329 surveys (response rate 55%). Respondents were a mean age of 58 years (range 26-89) and a mean of 3.3 years from cancer diagnosis (range 1.2-5.4). 96% were white and stage distribution was: 15% stage 0, 35% stage 1, 32% stage 2, 15% stage 3, and 3% missing. Treatment included mastectomy (60%), lumpectomy (40%), radiation (61%), chemotherapy (55%) and hormonal therapy (50%). Most common treatment-related sequelae were neuropathy (38%), chest wall or arm pain (27%), and lymphedema (26%). Over half (52%) report worry and 45% report fatigue as a problem in the past week. 74% stated that their medical needs were met, whereas 49% said their psychological and spiritual needs were met (p&lt;0.01). 68% understood the follow-up plan after treatment was complete. Perceived barriers to follow up care were anxiety (30%) and lack of coordination (10%). When queried about post-treatment care, the following aspects were considered important (% of patients ranking ≥7 on scale 0-10: 0=not important, 10=very important): breast/chest wall exam (88%); screening for osteoporosis (71%), colorectal cancer (69%), and heart disease (65%); educational materials (64%); mammography (63%); physical therapy (61%); diet and exercise counseling (60%); and complementary/alternative medicine information (53%). Less important were psychology (44%), gynecology (43%), chaplain services (35%), support groups (32%), social work (20%), and infertility experts (4%). 60% expressed interest in attending a survivorship clinic. Conclusions: This survey provides unique data on breast cancer survivors, and efforts should be made to optimize medical and psychosocial care in line with their needs and preferences. These results will be imperative in designing a wellness and survivorship clinic.
Serum Cholesterol Esters and Intestinal Cholesterol Secretion and Absorption in Obstructive Jaundice Due to Cancer
Authors: Malcolm M. Stanley, Esteban P. Pineda, Samuel H. Cheng
Journal: New England Journal of Medicine (1959)

THE serum of normal persons, when analyzed by the Schoenheimer–Sperry method, contains a remarkably constant proportion (70–75 per cent) of the total cholesterol as the ester. Since 19261 the percentage as the ester of the serum cholesterol has been widely used as a liver-function test. A reduction of the magnitude of this fraction of the total serum cholesterol has been held to be indicative of parenchymal damage to the liver.2 3 4 Thus, in the differential diagnosis of jaundice a marked decrease in the ratio of the serum ester to total cholesterol would favor intrahepatic disease rather than posthepatic obstruction.On the . . .
Case 25-2008
Authors: John A. Mills, R. Gilberto Gonzalez, Ronald Jaffe
Journal: New England Journal of Medicine (2008)

A 43-year-old man was seen in the rheumatology clinic because of fatigue and lesions in the pituitary and cerebellum. Diabetes insipidus, hypogonadism, and hypothyroidism had developed beginning 9 years earlier, and lesions had been detected in the region of the pituitary stalk and in the cerebellum. He was treated with glucocorticoids for suspected neurosarcoidosis, but fatigue, ataxia, and neurologic symptoms worsened. Computed tomography of the chest and abdomen disclosed abnormal soft tissue surrounding the aorta, renal arteries, and kidneys. A diagnostic procedure was performed.
Case 14-2010
Authors: Martin A. Samuels, Benjamin J. Pomerantz, Peter M. Sadow
Journal: New England Journal of Medicine (2010)

A 54-year-old woman was admitted to this hospital because of 2 months of episodes of dizziness resulting in falls, which occurred only when standing and were associated with diaphoresis, weakness in the legs, and palpitations. She had a history of borderline hypertension and atrial fibrillation. Physical and neurologic examinations were normal. Orthostatic vital signs showed decreased blood pressure and increased heart rate on standing. Symptoms persisted despite treatment with meclizine, metoprolol, fluid administration, and fludrocortisone. A diagnostic test result was received.
Case 27-2000
Authors: Richard M. Schwartzstein, Eugene J. Mark
Journal: New England Journal of Medicine (2000)

Presentation of CaseA 61-year-old man was admitted to the hospital because of increasing exertional dyspnea.The patient had been in excellent health until three months earlier, when he began to experience mild exertional dyspnea, with an occasional cough productive of clear sputum. Radiographic studies of the chest performed on two occasions showed abnormalities, and different antibiotics were administered on each occasion without improvement. The dyspnea worsened, and anorexia developed, with a weight loss of 7 kg. Three weeks before admission, pulmonary-function studies were performed at another hospital (Table 1). The patient was referred to this hospital.The patient worked . . .
Case 41-1992
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, M.D. Freed, M.E. King
Journal: New England Journal of Medicine (1992)

Presentation of CaseA three-year-old boy was referred to the hospital for cardiac evaluation because of a murmur that was increasing in volume.He was born of a full-term second pregnancy to a mother 28 years of age. His birth weight was 4.0 kg. The child was discharged home with his mother two or three days after birth but was readmitted a few days later because of abdominal swelling. He was found to have bilateral hydronephrosis with megaureters, bladder diverticula, posterior urethral valves, and urinary ascites. A transurethral resection of the valves was performed, with reimplantation of both ureters and . . .
Monoclonality and Abnormal Parathyroid Hormone Genes in Parathyroid Adenomas
Authors: Andrew Arnold, Catherine E. Staunton, Hyung Goo Kim, Randall D. Gaz, Henry M. Kronenberg
Journal: New England Journal of Medicine (1988)

Previous work based on the relative tissue content of glucose-6-phosphate dehydrogenase isoenzymes suggested that parathyroid adenomas, like primary hyperplasia, may be multicellular (not clonal) in origin. We have reexamined this issue by using two independent molecular genetic methods. We report tumor-cell-specific restriction-fragment–length alterations involving the parathyroid hormone gene from two human parathyroid adenomas. These abnormal restriction fragments indicate that in each case a clonal proliferation of cells was present and also suggest that DNA alterations involving the parathyroid hormone locus may be important in the tumorgenesis or clonal evolution of some parathyroid adenomas. In addition, we used a restriction-fragment–length polymorphism in an X-linked gene (hypoxanthine phosphoribosyltransferase) to examine the clonality of eight parathyroid adenomas in women. Of these eight adenomas, six had the DNA hybridization pattern of monoclonality, and two had an equivocal pattern. None of five hyperplastic parathyroid glands had a monoclonal pattern. We conclude that some (and perhaps many) single parathyroid adenomas are monoclonal neoplasms. Our observations suggest that there is a fundamental biologic difference between parathyroid adenomas and primary hyperplasia — a difference that could prove useful in distinguishing these entities clinically. (N Engl J Med 1988; 318:658–62.)
Clonal Identity of Nodular Lymphocyte-Predominant Hodgkin's Disease and T-Cell–Rich B-Cell Lymphoma
Authors: Shigetaka Shimodaira, Eiko Hidaka, Tsutomu Katsuyama
Journal: New England Journal of Medicine (2000)

To the Editor: It has been suggested that nodular lymphocyte-predominant Hodgkin's disease and T-cell–rich B-cell lymphoma are closely related entities.1 Indeed, the lymphocytic and histiocytic (L&H) cells in nodular lymphocyte-predominant Hodgkin's disease and the large cells in T-cell–rich B-cell lymphoma both originate from germinal-center B cells.2–4 We describe a patient in whom T-cell–rich B-cell lymphoma and nodular lymphocyte-predominant Hodgkin's disease were present at the same time, but in lymph nodes at different sites. A 39-year-old man was admitted because of axillary and femoral lymphadenopathy and night sweats. Although he had a 10-year history of inguinal lymphadenopathy, he had only . . .
Treatment of taste alterations in chemotherapy patients using the “miracle fruit”: Preliminary analysis of a pilot study.
Authors: H. P. Soares, M. Cusnir, M. A. Schwartz, J. F. Pizzolato, J. Lutzky, R. J. Campbell, J. L. Beaumont, D. Eton, S. Stonick, R. Lilenbaum
Journal: Journal of Clinical Oncology (2010)

e19523 Background: Patients undergoing chemotherapy often complain of alterations of taste (dysgeusia), for which no conventional therapy exists. The African fruit Synsepalum dulcificum, or "Miracle Fruit" (MF), has been described as a powerful taste alteration product, converting sour to sweet taste. We conducted a single institution trial to assess whether the MF improves dysgeusia. Methods: Patients with a performance status of 2 or less, receiving cyclophosphamide, carboplatin, cisplatinum, gemcitibine, methotrexate, doxorubicin, 5-fluorouracil, paclitaxel, docetaxel, vinorelbine, oxaliplatin, irinotecan or etoposide were included in the study if they complained of dysgeusia. Patients were randomized in a crossover fashion to immediately receive the MF for 2 weeks (group A) or to receive the MF after 2 weeks of supportive measures alone (group B). Endpoints were: improvement in taste (study powered to detect 30% response with MF, as measured by the Wickham questionnaire), weight changes, and quality of life. The fruit was delivered directly from the Fairchild Botanical Garden and stored at the Cancer Center under proper conditions. Results: From October 2008 to November 2009, 28 of the planned 40 patients were enrolled and 23 are evaluable for this analysis (12 in group A and 11 in B). The mean age is 63 years, 52% are male, and 78% have advanced disease. Nine (39%) have GI cancers, 6 breast cancer, and 8 have other cancers. At baseline, 20 (87%) individuals complained of metallic taste and 78% of no taste. The 7 follow-up visits required in the study were completed by 56% of subjects. Based on the questionnaire, 7 of 23 (30%) had improvement in taste, in addition, 8 of 23 (35%) believed that the MF was helpful. When considering at least stabilization of taste, the best response rate was 52%. There was no significant change in weight during the study. No grade 3 and 4 adverse effects were reported. Stomach ache and throat discomfort (grade 1) were reported in 1 patient each. Conclusions: The Miracle Fruit is safe for use in patients undergoing chemotherapy. In our preliminary analysis, the response to the MF fruit appears encouraging. Pending final results, a large confirmatory trial will be undertaken. No significant financial relationships to disclose.
Immediate Angioplasty Compared with the Administration of a Thrombolytic Agent Followed by Conservative Treatment for Myocardial Infarction
Authors: Raymond J. Gibbons, David R. Holmes, Guy S. Reeder, Kent R. Bailey, Mona R. Hopfenspirger, Bernard J. Gersh
Journal: New England Journal of Medicine (1993)

Immediate angioplasty and the administration of a thrombolytic agent followed by conservative treatment are two approaches to the management of acute myocardial infarction, but these methods have not been compared prospectively.
The Effect of Nasal and Sinus Surgery upon the Manifestations of Allergy
Authors: Francis L. Weille
Journal: New England Journal of Medicine (1950)

THE effect of nasal and sinus surgery upon the manifestations of allergy has long been controversial. The purpose of this paper is to present a point of view based upon about twenty years of rhinologic research in the Allergy Clinic of the Massachusetts General Hospital, and upon experience in dealing with a considerable number of patients as a surgeon in the Massachusetts Eye and Ear Infirmary and in private practice. It is easy to report statistical studies in an effort to support an opinion, but scientific truth is rarely reached by such a method. On the contrary, one must observe . . .
The reduced chance of a live birth in women with IBD receiving assisted reproduction is due to a failure to achieve a clinical pregnancy
Authors: S Friedman, P V Larsen, J Fedder, B M Nørgård
Journal: Gut (2016)

We recently reported that for women with UC receiving assisted reproductive technology (ART) treatment, the chance of a live birth after each embryo transfer cycle decreased significantly. In women with Crohn's disease (CD), the chance of a live birth after each embryo transfer cycle also decreased but was not significant in the fully adjusted regression model.1 In our study, we chose the outcome live birth because it was the most important clinical outcome for patients with UC and CD undergoing ART. After demonstrating the negative effects of UC and CD on chances of live birth, we wish to update our readers by exploring where along the process from fertilisation through pregnancy the risk of delivering a live born child decreases. Is the reduced chance of live birth due to (1) a reduced chance of conceiving after an ART cycle? and/or (2) a reduced chance of maintaining a fetus …