Donor demographic and laboratory predictors of allogeneic peripheral blood stem cell mobilization in an ethnically diverse population

A reliable estimate of peripheral blood stem cell (PBSC) mobilization response to granulocyte colony-stimulating factor (G-CSF) may identify donors at risk for poor mobilization and help optimize transplantation approaches. We studied 639 allogeneic PBSC collections performed in 412 white, 75 black, 116 Hispanic, and 36 Asian/Pacific adult donors who were prescribed G-CSF dosed at either 10 or 16 microg/kg per day for 5 days followed by large-volume leukapheresis (LVL). Additional LVL (mean, 11 L) to collect lymphocytes for donor lymphocyte infusion (DLI) and other therapies was performed before G-CSF administration in 299 of these donors. Day 5 preapheresis blood CD34(+) cell counts after mobilization were significantly lower in whites compared with blacks, Hispanics, and Asian/Pacific donors (79 vs 104, 94, and 101 cells/microL, P < .001). In addition, donors who underwent lymphapheresis before mobilization had higher CD34(+) cell counts than donors who did not (94 vs 79 cells/microL, P < .001). In multivariate analysis, higher post-G-CSF CD34(+) cell counts were most strongly associated with the total amount of G-CSF received, followed by the pre-G-CSF platelet count, pre-G-CSF mononuclear count, and performance of prior LVL for DLI collection. Age, white ethnicity, and female gender were associated with significantly lower post-G-CSF CD34(+) cell counts.     

Comparison of single daily dose of methimazole and propylthiouracil in the treatment of Graves' hyperthyroidism

OBJECTIVE: The present study was to compare the efficacy of a single daily dose of methimazole (MMI) and propylthiouracil (PTU) in the treatment of Graves' hyperthyroidism. BACKGROUND: Antithyroid drugs, MMI and PTU, are widely used in the treatment of hyperthyroidism. Previous studies in the treatment of hyperthyroidism with a single daily dose of antithyroid drugs have demonstrated a more favourable result with MMI. However, the efficacy of a single daily dose of PTU was inconsistent. In this study, we examined the therapeutic efficacy of single daily doses of MMI and PTU on the change of thyroid hormones and thyrotropin receptor antibodies (TRAb) levels. METHODS: Thirty patients with newly diagnosed Graves' hyperthyroidism were randomly divided into two groups, each receiving a single dose of either 15 mg MMI or 150 mg PTU daily for 12 weeks. The therapeutic efficacy was determined by serum total triiodothyronine (TT3), total thyroxine (TT4), thyrotropin (TSH), free thyroxine (FT4), and TRAb levels at baseline and at the end of 4, 8 and 12 weeks during the study period. RESULTS: There was no significant difference in baseline thyroid function parameters. Serum TT3, TT4 and FT4 levels in the MMI-treated group were significantly lower than those of the PTU-treated group after 4 weeks and through the end of the study. MMI also has superior effect on reducing serum TRAb levels than PTU after 8 weeks and at the end of the study. CONCLUSION: During the 12-week treatment of Graves' hyperthyroidism, a single daily dose of 15 mg MMI was much more effective in the induction of euthyroidism than a single daily dose of 150 mg PTU. In the doses used in this study, MMI is preferable to PTU when a once-daily regimen of antithyroid drug is considered for the treatment of Graves' hyperthyroidism.     

Bigger is better: maternal and neonatal predictors of hematopoietic potential of umbilical cord blood units

Umbilical cord blood (CB) is a useful stem cell source for patients without matched family donors. CB banking is expensive, however, because only a small percentage of the cord units stored are used for transplantation. In this study, we determined whether maternal factors, such as race, age, and smoking status have an effect on laboratory parameters of hematopoietic potential, such as viability, cell counts, CD34+ cell counts, and CFU-GM. We studied the effect of neonatal characteristics such as birth order, birth weight, gestational age, and sex of the baby on the same laboratory parameters. Race and maternal age had no effect on these laboratory parameters. In multivariate analysis, babies of longer gestational age had higher cell counts, but lower CD34+ cell counts and CFU-GM. Bigger babies had higher cell counts, more CD34+ cells, and more CFU-GM. Women with fewer previous live births also produced cord units with higher cell counts, CFU-GM, and CD34+ cell counts. Specifically, each 500 g increase in birth weight contributed to a 28% increase in CD34+ cell counts, each week of gestation contributed to a 9% decrease in CD34+cell counts, and each previous birth contributed to a 17% decrease in CD34+ cell counts (all P < 0.05). These data may be used to select the optimal cord blood donors and allow CB banks efficient resource allocation.     

Acute and long‐term clinical and angiographic outcomes of coronary stenting using Palmaz‐Schatz stent and ACS Multi‐Link stent

Acute and long‐term (≥ 3 years) outcomes of coronary artery stenting using Palmaz‐Schatz and Multi‐Link stent implantations between November 1995 and October 1999 were analyzed. There were 655 Palmaz‐Schatz stent implantations in 577 lesions on 477 patients (group A) and 428 Multi‐Link stent implantations in 381 lesions on 326 patients (group B). The baseline characteristics were similar in the two groups. Group B had more complex lesions, longer stenotic lesions, and larger reference vessel sizes than group A. However, both groups had a similar in‐hospital cardiac events. Four hundred and two patients with 488 lesions in group A and 260 patients with 307 lesions in group B underwent a 6‐month follow‐up coronary angiography. The restenotic rate per lesion was 16% in both groups (P = 0.872). A 3‐year angiographic follow‐up was performed in 262 patients of group A (301 lesions) and 139 patients of group B (162 lesions), and restenosis was noted in only 3 patients (1.36%) in group A and 5 patients (4%) in group B, in which the lesion was patent at the 6‐month angiographic follow‐up. Significant increase in minimal luminal diameter was noted from 2.23 ± 0.66 mm at 6 months to 2.33 ± 0.64 mm in group A (P < 0.01), and insignificant increase from 2.23 ± 0.77 to 2.28 ± 0.82 mm was noted in group B (P = 0.27). No differences were noted between the two groups in mortality, reinfarction, recurrent angina, target lesion angioplasty, or elective coronary artery bypass surgery during a follow‐up period of 60 ± 3 months. Forty‐five patients (9.4%) in group A and 18 patients (5.5%) in group B received additional stenting procedures for newly developed lesions. The overall cardiac event‐free survival was 66% in group A and 72% in group B (P = 0.844). In conclusion, the procedural success rate, in‐hospital morbidity, 6‐month angiographic results, and long‐term (≥ 3 years) clinical and angiographic outcomes were similar with coronary stenting using either Palmaz‐Schatz or Multi‐Link stent. The stented lesions were stable; however, late regression of minimal luminal diameter was noted in both groups, and progression of atherosclerotic change in the nonstented site was noted during long‐term follow‐up. Catheter Cardiovasc Interv 2004;62:453–460. © 2004 Wiley‐Liss, Inc.     

Reappraisal of Left Ventricular to Right Atrial (LV-RA) Shunt in Pediatric Patients With Isolated Perimembranous Ventricular Septal Defect

Background The purpose of this study was to investigate the follow-up results of perimembranous ventricular septal defect (VSD) with left ventricular to right atrial (LV-RA) shunt since infancy and to analyze the morphologic variations of this shunt. Methods and Results The study group comprised 232 consecutive pediatric patients with isolated perimembranous VSD and aneurysm, of whom 134 (58%) had LV-RA shunts. Follow-up echocardiography was performed to assess for the size of both the VSD and LV-RA shunt. There were no significant differences between groups in terms of sex, age at the initial echocardiography, follow-up period, number of patients with tricuspid regurgitation, and initial VSD size. There was a significant difference between groups in spontaneous closure (p=0.039). The event-free probability (no surgical repair of the defect) was not significantly different between the groups (p=0.129). Conclusions Perimembranous VSD with LV-RA shunt in infancy is common and associated with less chance of spontaneous closure. Color Doppler echocardiography can greatly improves the diagnostic efficacy and assist in understanding the mechanisms leading to this particular anomaly. (Circ J 2008; 72: 1487 - 1491).     

Primary abscess of the omentum: report of a case and review of the literature

Primary abscess of the omentum is an infrequent disease entity. We report a case of 60-year-old male patient who suffered from left lower quadrant abdominal pain with localized abdominal wall tenderness, nausea and high-grade fever for the previous few days. Computerized tomography scan revealed a heterogeneous lesion that adhered to the abdominal wall. A pre-operative diagnosis of colonic diverticulitis complicated with intra-abdominal abscess was made and a laparotomy was done. At surgical exploration, an indurate mass consisting of abscess within the omentum was identified. The surgical procedure consisted of resection of the omental abscess with abdominal wall debridement, and subsequent antimicrobial therapy was administered. Postoperatively, the patient recovered uneventfully. Clinicians who treated such patients should be aware of this problem because of the difficulty of preoperative diagnosis.     

Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women

OBJECTIVE: The normal body mass index (BMI) range, as defined by the World Health Organization (WHO), is quite wide, and some people within this range may have excessive central fat accumulation and elevated metabolic risks. We hypothesize that the waist-to-height ratio (W/Ht), an effective index for assessing central fat distribution among Japanese people, can be used to identify subjects who are at higher metabolic risk within the normal as well as the overweight range. METHODS: We investigated: (1). the values of BMI, waist circumference, and W/Ht in 6141 men and 2137 women at various age intervals and calculated gender (female to male) ratios for all these anthropometric indices; (2). the relation between age and each anthropometric index, between age and morbidity index for coronary risk factors (sum of the scores for hyperglycemia, hypertension, hypertriglyceridemia, hypercholesterolemia, and low HDL cholesterol; one point for each condition if present), and between morbidity index for coronary risk factors and each anthropometric index; (3). the distributions of the subjects, using various proposed indices of waist circumference (those suggested by WHO, the Japan Society for the Study of Obesity, and the Asia-Pacific perspective), and our proposed boundary value, W/Ht 0.5, among the WHO categories based on BMI; (4). the metabolic risks (coronary risk factors, hyperuricemia, high gamma-glutamyltransferase, and fatty liver diagnosed by ultrasonography), and exercise habits among normal-weight subjects with W/Ht<0.5 or >or=0.5. RESULTS: (1). For the various anthropometric indices in all age groups, the gender ratio for W/Ht was closest to 1, indicating that a single set of values for W/Ht can be used for men and women. (2). Height correlated negatively with age. Among the anthropometric indices, only W/Ht correlated positively with age for both men and women, while age and all anthropometric indices, except height, correlated positively with the morbidity index for coronary risk factors. For both men and women, the highest correlation coefficient was between W/Ht and the morbidity index for coronary risk factors. (3). Nearly all overweight men and women (BMI>or=25) had W/Ht>or=0.5 (98.5% of men and 97.5% of women). None of the underweight subjects had W/Ht>or=0.5. However, 45.5% of men and 28.3% of women of normal weight (BMI 18.5-<25) had W/Ht>or=0.5. W/Ht, of all the indices investigated, was the best index for signaling metabolic risk in the normal-weight subjects as well as the overweight subjects. (4). Age- and BMI-adjusted odds ratios for multiple metabolic risks, and history of no habitual exercise were significantly higher in normal-weight men and women with W/Ht>or=0.5 than in others of normal weight. CONCLUSIONS: Waist circumference is improved by relating it to height to categorized fat distribution of different genders and ages. W/Ht is a simple and practical anthropometric index to identify higher metabolic risks in normal and overweight Japanese men and women.     

Substance Abuse Severity in Female Adolescents

The authors investigated the association between age at menarche and age at onset of substance use with frequency of alcohol consumption in mid-adolescence; age at first DSM-III-R diagnosis of psychoactive substance use disorder (PSUD); severity of physical health, substance use, and psychosocial problems; and psychiatric disorders in female adolescents. Twenty-eight PSUD female adolescents (age 14–18 years) were studied. Chronological age at first substance use, and not age at menarche, was associated with the four variables mentioned above. These findings indicate that substance use in this population is encompassed within significant psychiatric disturbance that most commonly precedes the onset of PSUD.     

Instability of fasting blood glucose values in noninsulin-dependent diabetic patients with long-term insulin treatment

We studied serum free C-peptide immunoreactivity (CPR) and the coefficient of variation (CV) of fasting blood glucose values (FBG) in 26 insulin-treated patients with non-insulin-dependent diabetes mellitus (NIDDM) in relation to the duration of insulin treatment. Serum free CPR responses during 100 g oral glucose tolerance test (OGTT) were significantly lower in patients with insulin treatment for five years or more than in those with insulin treatment for less than five years although their previous immunoreactive insulin (IRI) responses during OGTT before insulin treatment showed no significant difference. CV of FBG was found to be significantly higher at the time of this study (20.6 +/- 7.8%, mean +/- SD) than at the second year of insulin treatment (15.3 +/- 7.7%, P less than 0.05) in the patients with insulin treatment for five or more years but did not show any significant difference in patients with insulin treatment for less than five years at the corresponding times. Thus we measured CV of the FBG in NIDDM patients at various intervals during the long-term insulin or oral hypoglycemic agent treatment in another study. In 20 patients with insulin treatment, CV of FBG was found to be significantly different among the various intervals during insulin treatment (P less than 0.0025). It was significantly higher at the eight year (22.2 +/- 8.6%) and 12th year (21.9 +/- 9.1%) than at the second year (14.9 +/- 6.1%) and fifth year (15.0 +/- 6.7%) of insulin treatment (P less than 0.025, P less than 0.025; P less than 0.05, P less than 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Pneumonia following closed head injury.

Pneumonia is common among patients with artificial airways in place. Most prior studies of such pneumonia involve a heterogeneous group of patients, usually with major medical or surgical illnesses. We studied the incidence of pneumonia in a group of patients with isolated closed head injury (CHI) in an effort to determine the pattern of the problem in the absence of other injuries and to determine whether the pattern of development of pneumonia in these patients was comparable to that in more heterogeneous groups of mechanically ventilated patients. We studied 109 initially comatose patients with isolated CHI who were ventilated 24 h or more. The mean age was 30.3 +/- 20.2 yr, 72% were male, and the admission Glasgow coma score was 4.9T +/- 1.4. Overall, 45 patients (41%) developed pneumonia, with the majority (29/45) occurring during the first 3 days of hospitalization. No patient developed pneumonia after the first week despite the fact that many were still ventilated, others remained intubated, and yet others were extubated but comatose. Patients who developed pneumonia experienced a longer ICU stay (10.5 +/- 5.4 days versus 7.2 +/- 4.3 days, p = 0.001) and hospital stay (34.8 +/- 27.6 versus 22.5 +/- 20.2 days, p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)