A study of the cellular and humoral immune response in patients with myelofibrosis

There was evidence of impaired cellular immunity in 10 patients with myelofibrosis. In-vitro lymphocyte transformation with phytohaemagglutin, concanavalin A, and dinitrochlorobenzene skin reaction were diminished. Signs of impaired humoral activity were also found, the primary response to a-Helix pomatia haemocyanin being impaired, particularly in the immunoglobulin-A class. Moreover three patients had a benign paraproteinaemia. Immune-complexes (1C) could be demonstrated with various test systems. The indirect granulocyte phagocytosis test was positive in 50%, the Clq-binding in 70% and the polyethylene glycol precipitation test in 50%. In most patients complement levels were normal, although the patient with the most advanced disease had low C3A, C3 and C4 levels accompanied by high levels of IC. No correlation could be shown between impaired immune response or levels of IC when they were related to spleen diameter or degree of anaemia. Some relation however existed between disturbed immune response and IC when they were related to time elapsed since diagnosis. It is suggested that the impaired immune response is the result of primary bone marrow disease and that the presence of IC may reflect the extent of fibrosis.     

Results of a Survey of 5,700 Patient Monopolar Radiofrequency Facial Skin Tightening Treatments: Assessment of a Low-Energy Multiple-Pass Technique Leading to a Clinical End Point Algorithm

INTRODUCTION: Monopolar radiofrequency is an effective means of nonsurgical facial skin tightening. OBJECTIVE: The objective of this study was to determine whether using larger tips at lower energy and multiple passes, using patient feedback on heat sensation and treating to a clinical end point of visible tightening, would yield better results than single passes with small tips at high energy, as measured by patient and physician satisfaction. METHODS: Fourteen physicians from four specialties were surveyed to determine the answers to the following three questions. (1) Is patient's feedback on heat sensation a valid and preferred method for optimal energy selection? (2) Do multiple passes at moderate energy settings yield substantial and consistent efficacy? (3) Is treating to a clinical end point of visible tightening predictable of results? RESULTS: A total of 5,700 patient treatments were surveyed. Comparisons were made using the original algorithm of high-energy, single pass to the new algorithm of lower energy and multiple passes with visible tightening as the end point of treatment. Using the original treatment algorithm, 26% of patients demonstrated immediate tightening, 54% observed skin tightening 6 months after treatment, 45% found the procedure too painful, and 68% of patients found the treatment results met their expectations. With the new multiple-pass algorithm, 87% observed immediate tightening, 92% had the tightening six months after treatment, 5% found the procedure too painful, while 94% found the treatment results met their expectations. CONCLUSIONS: Patient feedback on heat sensation is a valid, preferable method for optimal energy selection in monopolar radiofrequency skin-tightening treatments.     

Cost of diseases in international perspective

This study compares the health care costs of The Netherlandswith the United States and Sweden and estimates the impact ofdemographic change on costs. Total health care costs were allocatedto disease, age, sex and specific subsectors. For The Netherlands75% of the costs in 1988 were assigned to specific diseases.Costs of mental disorders and other chronic non-fatal diseasesdominate, followed by cardiovascular diseases. The effect ofage is strong from age 70 years onwards. The effect of sex,adjusting for age, is small, except for elderly women, who aremore expensive. Both total and disease-specific costs are similarin The Netherlands and Sweden, but differ from those in theUS. The available data suggest that the differences in medicalpractice and health care systems may explain a substantial partof the divergent results; demographic or epidemiologic aspectsseem less important. Ageing induces, in the Dutch case, a modest0.7% annual increase in costs. The contribution of other forcesin the increase of costs is probably more important. A structuralupward pressure on costs also prevails in The Netherlands andSweden, but it is more prominent in the US, due to a large amountof expensive surgery and high administration costs.     

Mortality of patients excluded from the Danish Verapamil Infarction Trial II

The 18 month mortality rate in 2180 patients excluded from theDanish Verapamil Infarction Trial II (DAVIT II) was 25.6%. Innon-consenters (n = 368) this was 15.0% compared with 13.8%in 897 placebo-treated patients (hazard ratio 1.09 [P = 0.60]when adjusting for sex and age). The increased mortality ratein excluded patients is attributed to heart failure (45.8% andother severe diseases (38.9%).     

Preliminary Report on Multidisciplinary Treatment for Esophageal Carcinoma

A cooperative study was conducted to examine the effect of bleomycin(BLM) or FT-207 which was combined with preoperative radiotherapy.To both groups of patients a solid form of BLM was administeredduring surgery and FT-207 after surgery. From July 1978 to June1980, 267 cases of esophageal carcinoma were treated accordingto this protocol. Resective surgery was performed on 199 patients,and in 171 of these, six months had passed after the operation.These 171 cases were studied. There were 79 patients in theBLM group and 92 in the FT-207 group. There was no disparityin fluoroscopic findings, age distribution or sex ratio. TheBLM group had a slightly higher operative mortality. There wasno significant difference in survival or in histological effectin the resected specimen. A total dose of 12,500 mg of suppositoryFT-207 had the same effect as a total dose of 45 mg of BLM.FT-207 is easier to administer to patients with esophageal carcinoma. The members of this group are: Toshifumi lizuka, M.D. (NationalCancer Center Hospital, Mitsuo Endo, M.D. (Tokyo Women's MedicalCollege), Koichi Sasaki, M.D. (Niigata University), Kazuo Karasawa,M.D. (Aichi Cancer Center Hospital), Teruo Kakegawa, M.D. (KeioUniversity), Masaki Arimori, M.D. (The 2nd Tokyo National Hospital)and Tetsuji Sasaki, M.D. (Nagoya Hoken Eisei University).