The chemotherapy of lymphoblastic lymphoma

Thirty-two patients treated on consecutive Southwest Oncology Group (SWOG) protocols for malignant lymphoma were subsequently diagnosed as having lymphoblastic lymphoma. Combination chemistry, usually adriamycin-based, produced complete responses (CR) in 17 patients (53%). Median survival was 15 mo. Patients achieving a CR survival significantly longer than patients with partial or no response (p < 0.01). Ten of 24 patients not receiving central nervous system (CNS) prophylaxis developed leptomeningeal lymphoma while none of the seven patients who received prophylactic intrathecal cytosine arabinoside or methotrexate developed CNS lymphoma (p = 0.04). Implications of these results for planning future treatment programs of lymphoblastic lymphoma are discussed.     

Patterns of cell proliferation and cell migration in the Sezary syndrome

The patterns of cell proliferation and cell migration were studied in three patients with the Sezary syndrome using autoradiographic techniques. Cell labeling patterns following pulse labeling with tritiated thymidine in vivo indicated that Sezary cells proliferate actively in skin and in lymph nodes but that few if any Sezary cells proliferate in the peripheral blood. In two of the patients serial samples were obtained. Label dilution patterns in skin and blood over time suggested that circulating Sezary cells originated in extracutaneous sites where cells were proliferating more rapidly than in the skin. Cells labeled in extracutaneous sites of proliferation appear rapidly in the blood, and their transit time through the peripheral blood compartment is short. Circulating Sezary cells may then be deposited in the skin where they resume proliferation at a low rate. Thus, while Sezary cells proliferate in both cutaneous and extracutaneous sites, proliferation appears to be more rapid in extracutaneous sites such as lymph nodes. This suggests that trials of systemic therapeutic approaches should be undertaken.     

Port-Site Pyoderma Gangrenosum – A Rare Complication of Surgical Trauma

We report a case of pyoderma gangrenosum occurring at the site of a laparoscopic port insertion following laparoscopic inguinal hernia repair.     

Early postoperative mortality after 67,548 total hip replacements: causes of death and thromboprophylaxis in 68 hospitals in Norway from 1987 to 1999

Patients in the Norwegian Arthroplasty Register with a total hip replacement (THR) have a lower long-term mortality than the age- and gender-matched Norwegian population. We analyzed the early postoperative mortality after 67,548 THR operations in 68 hospitals reported to the Norwegian Arthroplasty Register between 1987 and 1999. Data on deaths and causes of death were obtained from from Statistics Norway, and on thromboprophylaxis from a separate questionnaire sent to all hospitals. During the years 1987-2000 the 68 hospitals reported use of 6 thromboprophylaxis drugs and 24 different combinations of drugs and stockings. In 1988, only 3 of 29 hospitals reported use of low molecular weight heparin (LMWH), but in 1999, 67 of the 68 hospitals used LMWH. In the first postoperative week, the daily mortality was about 2.5 deaths per 10,000 THR patients. By the 70th postoperative day, the daily mortality had declined to about 0.57 deaths per 10,000 patients. The daily mortality of the age- and gender-matched Norwegian population was 0.95 deaths per 10,000 individuals. Early postoperative mortality increased with age, was higher in men than women, and was usually due to vascular disease. We found only a slight reduction in the 60-day postoperative mortality during the period 1987-1999. All underlying diagnoses for a prosthesis operation had a higher 60-day postoperative mortality than primary osteoarthrosis.     

Practice MRI: Reducing the need for sedation and general anaesthesia in children undergoing MRI

The aim of this study was to evaluate the effectiveness of a practice magnetic resonance unit, in preparing children to undergo magnetic resonance procedures without general anaesthesia (GA) or sedation. The records of children who attended the practice MRI between February 2002 and April 2004 were retrospectively reviewed. Each record was assessed as to whether the child had passed or failed the practice MRI intervention. Those children who were considered to have passed and were proceeded to a clinical non‐GA MRI had the report of the clinical scan reviewed. If the scan had been reported as non‐diagnostic because of movement artefact it was classified as a failed scan, otherwise it was considered a pass. One hundred and thirty‐four children undertook a practice MRI (age range 4.1–16.1 years, median age 7.7 years, 47% boys) and 120/134 (90%) passed the practice session. In all, 117/120 (98%) subsequently had a clinical non‐GA MRI and 110/117 (94%) passed (median age 7.8 years, 47% boys). Preparation is a safe and effective method to reduce the need for sedation and GA in children undergoing a clinical MRI scan. It provides a positive medical experience for children, parents and staff, and results in cost savings for the hospital.     

Knowledge and attitudes of folate, and use of dietary supplements among women of reproductive age in Norway 1998

BACKGROUND: Authorities in many countries, including Norway from March 1998, recommend that women consume supplemental folate before and early in pregnancy to prevent neural tube defects. The aim of this survey was to establish Norwegian baseline data on knowledge, use and attitudes of folate and dietary supplements before implementing national campaigns on folate and pregnancy. METHOD: A telephone survey was carried out in late 1998 among 1,146 Norwegian women of reproductive age. The women were recruited from a nationally representative stratified random sample. RESULTS: Among the women aged 18-45 years, 50.4% had heard about folate, 32.9% knew about its role in pregnancy and 9.5% that it may prevent a malformation. Only 4.0% of the women knew that the critical period for folate supplementation to prevent a neural tube defect is before and early in pregnancy. The strongest determinants of knowledge were closeness to a pregnancy and educational level. Dietary supplements were used daily or almost daily by 53.3% of the women. The most commonly used types were multivitamin supplements and cod liver oil while only 0.9% of the women reported current use of supplemental folate. The women were also asked about use of folate and dietary supplements before or early in their last pregnancy: 44.3% reported that they had used a dietary supplement and 2.4% had used folate. Among the few women who had been pregnant within the last year of the interview, 10.3% reported use of a folate supplement. Overall, 56.0% of the women stated that they would use a folate supplement in a future pregnancy and 66.7% that they wanted more information about folate. CONCLUSIONS: Although about half of Norwegian women had heard about folate in 1998, just below 10% knew that it could prevent a malformation. Use of folate supplements was low in 1998, but more than half of the women stated that they would use folate supplements in a future pregnancy.     

Whole body protein metabolism in children with cancer

Whole body protein synthesis and catabolism were measured using the [ring-2H5]phenylalanine and [1-13C]leucine primed constant infusion technique in 32 paediatric patients with cancer at different stages of treatment. Rates of synthesis (S) and catabolism (C) derived from the [ring-2H5]phenylalanine and [1-13C]leucine models were 4.7 (SD 1.3) (S) and 6.0 (1.5) (C) g/d/kg, and 5.5 (0.8) (S) and 6.8 (1.2) (C) g/d/kg, respectively. These results show that these two tracer techniques give similar results in this study population. Comparison of these values with results previously reported for groups of control children using the [ring-2H5]phenylalanine model (S = 3.69 and 3.93; C = 4.09 and 4.28 g/d/kg) and the [1-13C]leucine model (S = 4.32; C = 4.85 g/d/kg) show that rates of synthesis and catabolism were higher in cancer patients than in controls. Thus whole body protein turnover is increased in children under treatment for cancer. Other indices of metabolism such as plasma amino acids and intermediary metabolites were also measured and showed that, although subjects were in isotopic steady state, there were significant metabolic changes during the course of the primed constant infusions used to measure protein turnover.