Excellent long-term survival in patients with early-stage primary bone lymphoma treated with doxorubicin-based chemotherapy and local radiotherapy

Primary bone lymphoma accounts for less than 5% of primary extranodal presentations, and the majority are of the diffuse, large cell, B-cell type. The study presents the authors' 21 years of experience (1979-2000) in ten patients with early stage (IE-IIE) primary bone lymphoma. All patients were treated with doxorubicin-based chemotherapy. Seven received consolidation radiotherapy to an area encompassing the primary tumor with generous margins, including the adjacent soft tissues, and in two stage IIE patients also to the regional lymph nodes. Mean total dose was 3989 cGy. Nine patients are alive with no evidence of recurrent disease. There are no severe late side effects, and only one patient died due to therapy-resistant small cell lung cancer (second primary), while in complete remission from his primary lymphoma. Albeit retrospective in nature with a small patient accrual, this study demonstrates that primary bone lymphoma is a curable disease following aggressive doxorubicin-based chemotherapy. The exact rule of radiation therapy is yet to be determined.     

The program of criminal undercover agents sources in the drug trade

Information and intelligence have always been, and will remain the most essential components of policing, and indeed all law enforcement and security work, including the variety of drug control efforts. Sources of information are many and varied, ranging from everyday interactions of officers of the law with the public, anonymous reports, the use of paid and unpaid informants from the criminal underworld, to the law enforcement and security services' use of agents. This presentation, based on interviews with "handlers" of informants who are offenders and who supply information and evidence against other criminals, who may have been his former "comrades" explores: the dilemmas that the informer, and the handler face at each stage of the "operation" from recruitment to operation in the field, until the agent "fingers" the targets, and becomes a State witness. During each stage of the operation the "agents" motivations, fears, sense of betrayal (being betrayed and betraying others), being a "snitch", the need to protect identity as well as dependency upon the "handler" are the primary issues to be considered and resolved. The "handler" may have to tolerate the agent's commission of crimes during the operation and often may also have to "treat" the informant's spouse. Borrowed identity, which is the main meaning and dynamic of the informant's actions, and of any undercover work, will also be analyzed.     

Tension‐free vaginal tape for stress urinary incontinence: Is there a learning curve?

AIM: To assess the learning curve characteristics of the first 30 tension-free vaginal tape (TVT) procedures carried out in our medical center and to evaluate its safety and short-term effectiveness. METHODS: A total of 30 incontinent women with urodynamically proven SUI were enrolled. None had undergone any previous anti-incontinence procedure. All were operated on by one surgeon, in accordance with the technique described by Ulmsten et al. in 1996. Mean follow-up was 11.4+/- 3.6 months (range, 5-17 months). RESULTS: Five (17%) bladder perforations occurred at the beginning of the study, due to inadvertent insertion of the applicator. All perforations were identified by intraoperative cystoscopy. Five other patients (17%) had increased intraoperative bleeding (>200 mL) necessitating vaginal tamponade. Blood transfusions were not required. Eight (27%) patients had immediate postoperative voiding difficulties, necessitating catheterization for 2-10 days, but none needed long-term catheterization. There was no local infection or rejection of the Prolene tape was found. All patients were subjectively cured of their stress incontinence; however, urodynamic evaluation revealed "asymptomatic genuine stress incontinence" in one patient. Sixteen of 21 patients (80%) with preoperative urge syndrome, had persistent postoperative symptoms. No patient developed de novo urge incontinence. CONCLUSION: The TVT operation is a new, minimally invasive surgical procedure with excellent short- and medium-term cure rates. However, there is a definite learning curve, and we believe that the operation should only be performed by experienced surgeons.     

Tacrolimus placental transfer at delivery and neonatal exposure through breast milk

Aim(s)

The current investigation aims to provide new insights into fetal exposure to tacrolimus in utero by evaluating maternal and umbilical cord blood (venous and arterial), plasma and unbound concentrations at delivery. This study also presents a case report of tacrolimus excretion via breast milk.

Methods

Maternal and umbilical cord (venous and arterial) samples were obtained at delivery from eight solid organ allograft recipients to measure tacrolimus and metabolite bound and unbound concentrations in blood and plasma. Tacrolimus pharmacokinetics in breast milk were assessed in one subject.

Results

Mean (±SD) tacrolimus concentrations at the time of delivery in umbilical cord venous blood (6.6 ± 1.8 ng ml⁻¹) were 71 ± 18% (range 45–99%) of maternal concentrations (9.0 ± 3.4 ng ml⁻¹). The mean umbilical cord venous plasma (0.09 ± 0.04 ng ml⁻¹) and unbound drug concentrations (0.003 ± 0.001 ng ml⁻¹) were approximately one fifth of the respective maternal concentrations. Arterial umbilical cord blood concentrations of tacrolimus were 100 ± 12% of umbilical venous concentrations. In addition, infant exposure to tacrolimus through the breast milk was less than 0.3% of the mother''s weight-adjusted dose.

Conclusions

Differences between maternal and umbilical cord tacrolimus concentrations may be explained in part by placental P-gp function, greater red blood cell partitioning and higher haematocrit levels in venous cord blood. The neonatal drug exposure to tacrolimus via breast milk is very low and likely does not represent a health risk to the breastfeeding infant.     

Poverty Perceptions of Social Workers and Physicians in Israel

This qualitative study comparing poverty perceptions of social workers (SWs) and primary care physicians (PCPs) employed in Israel's public services found that both attributed the poverty of their own clients to similar causes—individualistic, structural, fate, and policy—but differed in most of their perspectives and moral imperatives. The PCPs tended to be more angry, skeptical, and accusatory than the SWs, who were more forbearing and accepting. Both believed that those in a position to work should, but only PCPs held that they should work for any salary. With respect to policy, PCPs looked at the macro, SWs at the micro. The findings suggest that it might be more fruitful to keep inter-professional discussions on the poor and poverty pragmatic, rather than theoretical and principled.     

Success of dental implants placed in intraoral block bone grafts

BACKGROUND: The purpose of this study was to evaluate the survival and success of dental implants placed in alveolar bone following augmentation using intraoral block bone grafts. METHODS: A consecutive retrospective study was conducted on patients who had onlay bone grafts for vertical or horizontal augmentations followed by dental implantation from 1999 to 2001. Files of 50 healthy patients who received 129 implants in augmented sites were reviewed. Implant survival, radiologic implant success (marginal bone loss), and complications were recorded. RESULTS: Follow-up from time of implantation ranged from 6 to 67 months (mean: 24.3 +/- 11.2 months). Ranges of implant widths and lengths were 3.25 to 4.7 mm and 10 to 16 mm, respectively. The overall survival rate was 96.9% (four implants were removed). Marginal bone loss around implants ranged from 0 to 3.3 mm (average: 0.22 +/- 0.45 mm). Only 5% of the implants presented marginal bone loss > or =1.5 mm over the follow-up time. CONCLUSIONS: Intraoral bone block graft surgery is a predictable operation for the use of dental implants. Implant placement in augmented areas presents high survival and radiologic success rates with minimal bone loss.     

Presence of anaerobic bacteria in the urinary tract of catheterized ICU patients

The purpose of our study was to examine the extent of anaerobic bacteriuria in catheterized patients in the intensive care unit (ICU) and to search for risk factors for anaerobic bacteriuria. A urine culture was collected from each patient every 2 days during their ICU stay and incubated under aerobic and anaerobic conditions. Aerobic and anaerobic blood cultures were collected as well. Demographic, clinical, and laboratory data were collected from patient files. Ninety patients were included in this study, 32 women (35.6%) and 58 men (64.4%). A total of 663 cultures were obtained. Twenty-three patients (25.6%) had growth of anaerobic bacteria in a urinary culture at some point during ICU stay, with Bifidobacterium being the most common pathogen. Aerobic urinary cultures were positive in 38 patients (42.2%). A significant statistical correlation was found between the presence of aerobic and anaerobic bacteria in urine culture (p?=?0.0004). Treatment with glycopeptides was found to be inversely associated with anaerobic bacteriuria (p?=?0.0292), and treatment with imidazoles was associated with an increased risk of anaerobic bacteriuria (p?=?0.0186). None of the patients developed bacteremia with the same anaerobic pathogen that was isolated from their urine. Anaerobic bacteriuria is a common phenomenon in catheterized patients in the ICU. Further studies are needed in order to define the clinical significance of these findings in such patients and in other patient groups as well as in healthy people.     

Transabdominal ultrasonographic evaluation of endometrial thickness in clomiphene citrate-stimulated cycles in relation to conception

The possible antiestrogenic effect of clomiphene citrate on endometrial growth was assessed by serial transabdominal ultrasonographic measurements in 46 women with unexplained infertility. A significantly higher (p < 0.05) rate of endometrial growth was observed in the 8 women who conceived compared with the 38 women who failed to conceive. A thicker endometrium (4.6 ± 0.3 mm) was observed from the third day before ovulation as well as a higher average growth rate in the three days prior to ovulation (0.7 ± 0.1 mm/day) in the group that achieved pregnancy compared to a lower endometrium (2.1 ± 0.2 mm) from the third day before ovulation and a slower growth rate in the three days prior to ovulation (0.2 ± 0.0 mm/day) in the group that did not achieve pregnancy (p < 0.05). These data suggest that clomiphene citrate may exert an antiestrogenic effect on the endometrium, and thus interfere with implantation. © 1994 John Wiley & Sons, Inc.     

Multi-system neurological disorder associated with a CRYAB variant

neurogenetics - We report a multiplex family with extended multisystem neurological phenotype associated with a CRYAB variant. Two affected siblings were evaluated with whole exome sequencing,...