Amifostine (WR-2721) shortens the engraftment period of 4- hydroperoxycyclophosphamide-purged bone marrow in breast cancer patients receiving high-dose chemotherapy with autologous bone marrow support

4-Hydroperoxycyclophosphamide (4-HC), a commonly used marrow-purging agent, is active against many tumors, but is also toxic to normal marrow progenitors. Amifostine (WR-2721) is a sulfhydryl compound with chemoprotectant activity. Preclinical studies using suspensions of bone marrow and breast cancer cells demonstrated that ex vivo treatment with amifostine followed by 4-HC resulted in protection of marrow progenitors, with no compromise in the antitumor effect of 4-HC. This fact stimulated the development of a clinical trial. Bone marrow was harvested from 15 poor-prognosis breast cancer patients and randomly assigned to ex vivo treatment with amifostine followed by 4-HC (amifostine + 4-HC), or treatment with 4-HC alone. High-dose chemotherapy was then administered followed by infusion of the purged autologous bone marrow support (ABMS). Leukocyte engraftment, defined as a white blood cell count > or = 1 x 10(9)/L, was achieved in an average of 26 days for patients whose marrow was purged with amifostine + 4-HC versus 36 days for patients whose marrow was purged with 4-HC alone (P = .032). The average number of platelet transfusions (12 v 29; P = .017) and days of antibiotic therapy (28 v 40; P = .012) were significantly less for patients whose marrow was exposed to amifostine + 4-HC, compared with 4-HC alone. Unpurged backup marrow fractions were infused into three patients whose marrow was purged with 4-HC alone, because of inadequate marrow recovery. None of the patients who received amifostine + 4-HC-purged marrow required a backup marrow fraction. Complete remissions were achieved in 83% of patients with measurable disease, with no difference between the two cohorts. Forty- three percent of patients remained alive and progression-free at a mean of 13 months posttransplant. There was no significant difference in the rate or pattern of relapse for patients whose marrow was purged with amifostine + 4-HC compared with those whose marrow was purged with 4-HC alone. Ex vivo treatment of marrow with amifostine significantly shortens the time to marrow recovery, thereby reducing the risk of myelosuppressive complications in breast cancer patients receiving high- dose chemotherapy and 4-HC-purged ABMS. Since supportive care requirements are also significantly decreased, amifostine may reduce the cost of such therapy.     

重度肥胖患者胃肠分流术后低氧血症机制的分析

目的　研究重度肥胖对胃肠分流术后动脉血氧分压的影响。方法　对 6 1例进行胃肠分流术的重度肥胖患者及 5 5例择期腹部手术的正常体重患者进行术前肺功能、术前及术后 1～ 5d的血气分析检测。结果　肥胖组术后1～ 5d、对照组术后 1～ 2d的动脉血氧分压较术前显著下降 (P <0 .0 5 ) ;肥胖组术后 1～ 2d动脉血氧分压与其最大分钟通气量及腰臀比显著相关 (P <0 .0 0 0 1)。结论　重度肥胖者较正常体重患者在腹部手术后发生低氧血症的程度较严重且持续时间长。     

膝关节周围骨肿瘤手术的肢体康复

0　引言　膝关节周围是骨原发恶性肿瘤的好发部位 .病变组织广泛侵袭 ,切除肿瘤造成骨与软组织缺损 ,各种重建方法都需最大限度地保留膝关节功能 .如何采取早期系统的康复治疗 ,是临床骨肿瘤保肢手术的重要内容 .1　对象和方法　 1992 - 0 5 / 1999- 0 3,膝关节周围恶性骨肿瘤患者 6 4例接受保肢手术治疗 .男 38例 ,女 2 6例 ;骨肉瘤 5 2例 ,恶性骨巨细胞瘤 5例 ,尤文瘤 3例 ,母细胞瘤 2例 ,原发神经外胚层肿瘤 2例 .手术方式 :异体半关节移植术 37例 ;异体骨段移植术 16例 ;复合异体骨段的人工全膝关节表面置换术3例 ,动力旋转铰链式人工全…     

Randomized, Evaluator-Blind, Split-Face Comparison Study of Single Cross-linked versus Double Cross-linked Hyaluronic Acid in the Treatment of Glabellar Lines

BACKGROUND At present, various hyaluronic acids are being used to rejuvenate facial skin. There is no comparative study of single cross-linked hyaluronic acid (SCHA) versus double cross-linked hyaluronic acid (DCHA). The objective of our study is to compare the effectiveness and complications of SCHA versus DCHA in the treatment of glabellar lines.
METHODS Ten female patients were enrolled in this randomized, evaluator-blind study. One side (left vs. right) of each patient's glabellar lines was treated with SCHA and the other side was treated with DCHA. Two independent blinded observers reviewed the clinical photographs at 3, 6, 9, and 12 months after the treatment and assessed for degree of improvement as well as complications.
RESULTS The two products were equally effective in producing an optimal cosmetic result, although at 6, 9, and 12 months posttreatment, a higher proportion of patients showed over 50% improvement with DCHA than with SCHA. At 12 months posttreatment, DCHA was considered superior in 70% of patients, whereas SCHA was superior in 10% of patients.
CONCLUSIONS Both SCHA and DCHA are equally effective in producing an optimal cosmetic result. DCHA provides a more durable esthetic improvement when compared to SCHA in the treatment of glabellar lines.     

ALLERGEN AVOIDANCE IN THE PRIMARY PREVENTION OF ATOPY

SUMMARY Atopy development cannot yet be predicted with certainty, and primary prophylaxis has to be directed at every ‘at-risk’ infant. However, substantial progress has been made in identifying environmental factors associated with allergic disorders. The process of sensitisation to common allergens may begin in utero. The influence of adjuvants, especially passive smoking, is considerable in individuals with established atopic disease. This article examines the role of intervention during pregnancy and the first year of life in the primary prevention of atopy and suggests a number of measures based on the current evidence.     

Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi,Pakistan (South Asia)

Background  

Liver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC) and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications) between patients of Dengue who have mild/moderate (ALT 23-300 IU/L) v/s severe acute hepatitis (ALT > 300 IU/L).