Meeting your needs,now and in the future

President Obama has repeatedly said that healthcare reform is not a luxury that can be postponed but a necessity that cannot wait. Healthcare change is all around us, and ASHRM is continually working to assist its members with opportunities to demonstrate their value and leadership within their respective organizations.     

A Family with Hemoglobin I

Hemoglobin I was recently found in a Negro family. The amino acidsubstitution was shown to occur in the sixteenth residue of the chain (lys asp) and to be identical with hemoglobin I described by Murayama.¹⁰ Theminor component, I₂, was demonstrated by agar gel electrophoresis.

Submitted on January 9, 1963 Accepted on April 3, 1963     

Effect of mesalazine on mucosal immune biomarkers in irritable bowel syndrome: a randomized controlled proof-of-concept study

Background  Intestinal immune infiltration contributes to symptoms in patients with irritable bowel syndrome (IBS).
Aim  To assesses the effect of mesalazine (mesalamine) on mucosal immune cells in patients with IBS, through a pilot study.
Methods  A randomized, double-blind, placebo-controlled trial in 20 patients with IBS in tertiary care setting. Patients were randomized to receive placebo or 800 mg mesalazine three times daily for 8 weeks. The primary endpoint was a significant reduction in total colonic immune cells on biopsies obtained at the end of treatment compared to baseline. Secondary endpoints included effects on subsets of immune cells, inflammatory mediators and symptom severity. Intention-to-treat analysis was performed.
Results  Mesalazine markedly reduced immune cells as compared with placebo ( P  = 0.0082); this effect was ascribed to a marked inhibition of mast cells ( P  = 0.0014). Mesalazine significantly increased general well-being ( P  = 0.038), but had no significant effects on abdominal pain ( P  = 0.084), bloating ( P  = 0.177) or bowel habits. No serious drug-related adverse events were reported during the study.
Conclusions  Mesalazine is an effective and safe approach to reduce mast cell infiltration and may improve general well-being in patients with IBS. These results support the hypothesis that immune mechanisms represent potential therapeutic targets in IBS.     

The Development of Large Immature Mononuclear Cells in Mixed Leukocyte Cultures

1. When leukocytes from two normal, unrelated subjects are mixed together and cultured, some of them transform into large basophilic cells thatcan synthesize DNA and undergo mitosis.

2. The stimulus for this change is the presence of two sets of leukocytes.Foreign erythrocytes, plasma or platelets have no effect.

3. Studies with mixtures of leukocytes from pairs of identical and nonidentical twins indicate that the reaction may be related to genetic differencesbetween the two subjects.

4. It is suggested that the reaction in leukocyte mixtures may be relatedto homograft immunity.

Submitted on July 10, 1963 Accepted on September 17, 1963     

Physiologic Basis of Host Susceptibility

Host defense mechanisms are reviewed with examination of aspects particular to the increased susceptibility found in neonates. Three main factors contributing to this increased susceptibility are identified: inexperienced immune system, immature phagocytosis, and an inability to localize infection.     

Does Sentinel Lymphadenectomy Improve Staging and Alter Therapy in Elderly Women With Breast Cancer?

Background: Routine axillary lymph node dissection (ALND) for elderly women with invasive breast cancer has been questioned because it rarely alters therapy yet carries a significant morbidity rate. Sentinel lymphadenectomy (SLND) improves axillary staging and alters therapy in women with T1 breast cancer, but it is not clear whether SLND alters therapy in elderly women with breast cancer.Methods: A prospective breast cancer data base was used to identify women 70 years old and older who underwent SLND for axillary staging of invasive breast cancer between 1991 and 1998.Results: There were 75 invasive breast cancers in 73 women. The mean patient age was 74.5 years (range, 70–90 years). Median tumor size was 1.4 cm (range, 0.1– 6.2 cm). Of the 75 tumors, 42 (56%) had favorable primary characteristics; the remaining tumors had unfavorable characteristics. SLND was performed alone in 17 cases (23%) and was followed by completion ALND in 58 cases (77%). Positive lymph nodes were identified in 32 cases (43%); 26 (81.3%) were detected by hematoxylin and eosin stains, and 6 (18.7%) were detected by immunohistochemistry alone. Five patients (6.9%) received adjuvant chemotherapy. Seven patients (9.6%) received axillary/supraclavicular radiation for positive nodes. Ten (13.7%) of 73 patients had obvious alterations in therapy because of axillary nodal status. As a result of SLND, 3 (13.6%) of 22 patients with tumors 1.0 cm or smaller received tamoxifen, and 7 (15%) of 46 patients with tumors between 1.0 and 3.0 cm in size had changes in therapy. When patient and tumor characteristics were analyzed to determine relationships to therapeutic decision-making, nodal status was the variable most significantly associated with changes in therapy (P 5 .0001).Conclusions: SLND improves axillary staging in elderly women with invasive breast cancer. Results of immunohistochemistry do not alter therapy in this group of individuals (P 5 .6367). In patients with small primary tumors, SLND alters therapy by increasing the number of patients receiving tamoxifen. In addition, SLND affects adjuvant systemic chemotherapy and regional radiotherapy in a significant number of patients with larger tumors, particularly tumors between 1.0 and 3.0 cm.