Refractory cold agglutinin-immunohaemolytic anaemia associated to marginal zone lymphoma responding to rituximab

Cold agglutinin immunohaemolytic anaemia (CAIA) responds poorly to standard treatment. We report a case of marginal zone lymphoma complicated by CAIA that responded to rituximab after failing to respond to corticosteroids and chlorambucil.     

Mixed chimerism of bone marrow CD34+ progenitor cells (genotyping,bcr/abl analysis) after allogeneic transplantation for chronic myelogenous leukemia

BACKGROUND: Although CD34 progenitors play a crucial role during bone marrow transplantation (BMT), there is only scant knowledge concerning their lineage-restricted mixed chimerism (MCh). METHODS: An immunohistochemical and fluorescence in situ hybridization study was performed on bone marrow biopsies derived from 11 patients with chronic myelogenous leukemia after sex-mismatched BMT to quantify the CD34 cell population and their expression. After proper identification by a lineage-specific monoclonal antibody, X chromosome- and Y chromosome-specific probes were used for sex typing and for labeling of the locus commercially available detection systems were applied. RESULTS: After successful engraftment, 241 progenitor cells were identified at days 9 to 586 of the posttransplant period. Overall incidence of MCh was 24% with a tendency to decline after day 100 to 15%. The gene was detectable in only 10% of these precursors and decreased to less than 4% after more than 6 months. Approximately 0.5 to 5.5 years after BMT in six patients, a manifest leukemic relapse occurred, which was accompanied by a conversion of donor-to-host-type progenitors. This phenomenon involved up to 94% of the 303 evaluable CD34 cells and also included a retrieval of the translocation gene in approximately 50% of this population. CONCLUSION: The lineage-restricted MCh of progenitors after BMT is in keeping with the assumption that leukemic (bcr/abl ) precursors represent only a fraction of the total host-derived (chimeric) CD34 cells. These residual clonally transformed progenitors survive myeloablative treatment and thus may be the source for a later relapse.     

Association between chronic obstructive pulmonary disease and employment by industry and occupation in the US population: a study of data from the Third National Health and Nutrition Examination Survey

Data from the US population-based Third National Health and Nutrition Examination Survey, conducted from 1988 to 1994, were used to estimate the population prevalence, prevalence odds ratios, and attributable fractions for the association of chronic obstructive pulmonary disease (COPD) with employment by industry and occupation. The aim was to identify industries and occupations at increased risk of COPD. COPD was defined as forced expiratory volume in 1 second (FEV(1))/forced vital capacity <70% and FEV(1 )<80% predicted. The authors used SUDAAN software (Research Triangle Institute, Research Triangle Park, North Carolina) to estimate the weighted population prevalence and odds ratios using 9,823 subjects aged 30-75 years who underwent lung function tests. Odds ratios for COPD, adjusted for age, smoking status, pack-years of smoking, body mass index, education, and socioeconomic status, were increased for the following industries: rubber, plastics, and leather manufacturing; utilities; office building services; textile mill products manufacturing; the armed forces; food products manufacturing; repair services and gas stations; agriculture; sales; construction; transportation and trucking; personal services; and health care. Occupations associated with increased odds ratios for COPD were freight, stock, and material handlers; records processing and distribution clerks; sales; transportation-related occupations; machine operators; construction trades; and waitresses. The fraction of COPD attributable to work was estimated as 19.2% overall and 31.1% among never smokers.     

Smoking reduction,smoking cessation,and mortality: a 16-year follow-up of 19,732 men and women from The Copenhagen Centre for Prospective Population Studies

The authors investigated the association between changes in smoking habits and mortality by pooling data from three large cohort studies conducted in Copenhagen, Denmark. The study included a total of 19,732 persons who had been examined between 1967 and 1988, with reexaminations at 5- to 10-year intervals and a mean follow-up of 15.5 years. Date of death and cause of death were obtained by record linkage with nationwide registers. By means of Cox proportional hazards models, heavy smokers (>or=15 cigarettes/day) who reduced their daily tobacco intake by at least 50% without quitting between the first two examinations and participants who quit smoking were compared with persons who continued to smoke heavily. After exclusion of deaths occurring in the first 2 years of follow-up, the authors found the following adjusted hazard ratios for subjects who reduced their smoking: for cardiovascular diseases, hazard ratio (HR) = 1.01 (95% confidence interval (CI): 0.76, 1.35); for respiratory diseases, HR = 1.20 (95% CI: 0.70, 2.07); for tobacco-related cancers, HR = 0.91 (95% CI: 0.63, 1.31); and for all-cause mortality, HR = 1.02 (95% CI: 0.89, 1.17). In subjects who stopped smoking, most estimates were significantly lower than the heavy smokers'. These results suggest that smoking reduction is not associated with a decrease in mortality from tobacco-related diseases. The data confirm that smoking cessation reduces mortality risk.     

Mucolipidosis II with unusual biochemical parameters

INTRODUCTION: A clinical diagnosis of I-cell disease was established in an infant with coarse face, hyperplastic gums, severe growth deficiency, skeletal deformities and retarded psychomotor development. PATIENT/METHOD: Albeit, enzyme measurements in our patient leukocytes and serum including arylsulfatase, hexosaminidase, alpha-fucosidase, iduronate-sulphatase and beta-galactosidase showed no significant alteration, in serum an increased activity of beta-glucuronidase was detected. Enzyme studies in fibroblasts showed an abnormal intracellular/extracellular distribution of enzyme activities, and significantly decreased activity of UDP-N-acetylglucosamine-1-phosphotransferase confirming the diagnosis of I-cell disease. RESULTS/DISCUSSION: In the mother's next pregnancy at 15th week of gestation lysosomal enzyme activities were determined in amniotic fluid and cultured amniotic cells, and the diagnosis of an unaffected fetus was established. Based on our experience we suggest the use of cell cultures for the diagnostics of this rare disease.     

Height as a proxy for weight in determining azithromycin treatment for paediatric trachoma

Azithromycin (Zithromax, Pfizer Inc., New York, NY, USA) is effective in the control of blinding trachoma. Community-based azithromycin treatment is recommended by the World Health Organization as part of a multipronged strategy aimed at the global elimination of binding trachoma by the year 2020. Paediatric trachoma is treated with azithromycin according to weight at a target dosage of 20 mg/kg. However, conventional weight-based treatment may be problematic in the field due to the logistical difficulties associated with weight scales. We assessed the accuracy of using height as a proxy for weight to determine azithromycin treatment in 4 countries--Viet Nam, Tanzania, Ghana, and Mali--where mass treatment programmes are underway. Population-based data collected from 1988 to 2000 were analysed using least squares regression. Height treatment schedules were developed for each data set. The accuracy of each schedule was evaluated according to the percentage of children receiving treatment within a dosage range of 20-30 mg/kg, a conservative estimate of the safe and effective treatment range for paediatric trachoma. Using height to determine dose, 89-95% of children would receive a dosage of 20-30 mg/kg. In these populations, height-based treatment is a reliable alternative to conventional weight-based treatment. Methods for developing height schedules presented in this analysis could be applied to other regions and therapeutics.     

Short-term folate,vitamin B-12 or vitamin B-6 supplementation slightly affects memory performance but not mood in women of various ages

Based on research demonstrating associations between folate, B-12 and B-6 vitamins and cognition and mood, we investigated the effects of short-term supplementation in 211 healthy younger, middle-aged and older women who took either 750 microg of folate, 15 microg of vitamin B-12, 75 mg of vitamin B-6 or a placebo daily for 35 d. In addition, we examined associations between dietary intake of these vitamins and cognition and mood. Usual dietary intake status was estimated using a retrospective, self-report, quantified food frequency questionnaire. Participants completed alternate forms of standardized tests of cognitive processing resources, memory, executive function, verbal ability and self-report mood measures before and after supplementation. Supplementation had a significant positive effect on some measures of memory performance only, and no effect on mood. Dietary intake status was associated with speed of processing, recall and recognition and verbal ability.     

The development of process-specific risk assessment and control in Germany

After reading the series of articles on a new approach to controlling chemicals, an initiative targeted especially on small and medium-sized businesses, in the Annals of Occupational Hygiene (1998; 42: 355-411), German specialists for health and safety at work realized that problems in this area are very similar in the UK and Germany. Also, in Germany different institutions have developed an array of solutions to help small and medium-sized enterprises during recent years. In this paper, we present these activities and hope to promote an international discussion about practical support for work with chemical substances.     

Biomechanical experiments for measuring traction lengthening of the lumbar spine during weight bath therapy

INTRODUCTION: Weight-bath as an effective traction therapy has successfully been applied in Hungary for nearly a half century, however, it has still been constrained exclusively to empirical bases until the numerical biomechanical analysis of Bene and Kurutz appeared in 1993. Due to their calculations, for cervical suspension in traction bath, the value and distribution of tensile force along the spine became known, however, the most important information, namely, the deformation of spine segments to be stretched by the therapy is so far unknown. AIMS: In this paper the results of a wide-ranging in vivo biomechanical experimental analysis are presented, aimed partly to obtain the traction deformation effects of weight-bath therapy, partly to obtain the biomechanical traction model of human lumbar segments. The analysis aimed to clear the effect of decompression, extra weights, sex, aging, body height and weight. PATIENTS/METHODS: The experiments have been executed during the prescribed 20 minutes long weight-bath treatment of patients having indication for cervical suspension. Patients with other forms of suspension, like armpit bars, have been excluded from the analysis. Two groups of patients have been distinguished: 67 patients without and 88 patients with extra weight loads of 20-20 N (2-2 kgf) applied on the ankles. Extension values of lumbar segments LIII-IV, LIV-V and LV-SI have been measured. Tensile deformations have been specified as the change of the distance between two spinous process of vertebrae, measured by a special subequal ultrasound method developed by the research group. The experimental results have been evaluated by using special software for analyzing ultrasound pictures. More than 3500 ultrasound pictures of 400 lumbar segments of 155 patients have been measured and evaluated. RESULTS: As for the results, at the end of the treatment, elongation of lumbar segments has been demonstrated practically in 60% of patients without and in 75% of patients with extra weights. The mean extension of a lower lumbar segment after a 20 minutes long weight-bath treatment is about 1.2-1.4 mm, while with extra weights it is about 1.3-1.6 mm, in the average of the deformed segments only. In the average of all segments, the above mean extensions are 0.7-0.9 mm, and with extra weights yield 0.8-1.4 mm. CONCLUSIONS: Just being suspended in water, due to the decompression, even without any extra weights, significant extension has been registered: a mean value of 1.0-1.2 mm per segments for the deformable, and 0.4-0.6 mm for all segments. The 20 minutes long treatment time in itself has a significant effect: the average additional extension is 0.2-0.4 mm per segments without, and about 0.5 mm with extra weights. The deformation capacity of lumbar segments decreases with increasing age of patients. Elongations increase with increasing body height. Body weight shows different tendency depending on the sudden elastic and time-dependent viscous deformations. Significant difference has been observed in reaction time of male and female patients: female patients react later, however the final traction effect seems to be equal.     

Results of mammographic screening at the Mammary Center of Debrecen in 1999 and 2000

INTRODUCTION: The screening mammography decreases the mortality of female breast cancer. METHODS: A complex, independent centre of screening mammography has been operating in Debrecen since 1999. RESULTS: The number of the examinations were 10,399 in 1999 and 13,800 in 2000. The number of explored breast cancer cases were 43 (0.41%) in 1999 and 62 (0.45%) in 2000. CONCLUSION: Although the mortality reduction can be exactly measured after several years, we are convinced that the chances for a better life of these 107 women operated on with breast cancer in early state increased thanks to our project. The results of the breast cancer screening program in Debrecen fulfilled the professional requirements of mammographic service-screening.