Serum interleukin 2 receptor levels in childhood acute lymphoblastic leukemia

The clinical significance of interleukin 2 receptor (IL2R) concentrations in serum was determined for 344 children with newly diagnosed acute lymphoblastic leukemia (ALL). Serum levels of IL2R in patients (267 to 80,000 U/mL, median 2,007 U/mL) were significantly higher than normal control values (170 to 738 U/mL, median 347 U/mL) (P less than .0001). Measurements in cases of T cell ALL were lower than in the non-T, non-B cases (P = .02). Among the 264 patients with non-T, non-B ALL, but not in those with T cell disease, higher serum IL2R levels (greater than 2,000 U/mL) were associated with a poorer treatment outcome (P = .04). In a multivariate analysis, serum IL2R level contributed independent prognostic information beyond that conveyed by leukocyte count, race, and age (P = .04). One explanation for these results is that soluble IL2R competes with normal lymphocyte- integrated IL2R for the ligand and thus could suppress host antitumor immunity.     

An ‘early warning system’ for health needs: surveillance of the quality of clinical services by audit of extra-contractual referrals (ECRs)

Extra-contractual referrals (ECRs) can be a cause of considerable anxiety to purchasing authorities, mainly because of their potential to generate unexpected expenditure. But ECRs can also be used as a tool for monitoring the demand for, and quality of, clinical services. ECRs were studied in the Darlington Health Authority district using a variety of methods including inter-disciplinary meetings, a series of interviews with local GPs, and a questionnaire to general practitioners on 230 consecutive ECRs. The methods and results of the questionnaire study are presented. The commonest reasons for making ECRs included the mistaken belief that a contract existed with the ECR provider, patient dissatisfaction with the local provider, and referral to benefit from shorter waiting lists. ECRs for bone-mass densitometry, orthopaedics, and ear nose and throat services were over-represented. Questionnaire results were validated by comparison with an interview study of all GPs in the district. We conclude that trends in ECRs can be monitored as a convenient ‘early warning system’ to alert purchasing authorities to changes in demand or perceived problems with local provider units. ECR data must be interpreted in the context of further local background information from sources such as GPs and public health physicians. In the case of Darlington, scrutiny of ECRs has led to changes in services and contracts.     

Short term follow up of childhood focal segmental glomerulosclerosis in India

Summary: A retrospective analysis of 67 biopsy proven cases of focal segmental glomerulosclerosis (FSGS) in children was performed. After a mean duration of disease of 48.5 ± 44 months, 20 patients (30%) achieved sustained remission (SR), 23 (34%) had frequent relapses (FR) and 24 (36%) were steroid non-responders (NR). the NR group had a significantly higher mean age of onset 9.1 ± 1.01 years ( P = 0.003) and had higher number of females ( P = 0.0009). They also had a significantly higher prevalence of microhaematuria as compared to FR and SR groups ( P = 0.002). the initial steroid response category ( P <0.00001) and the percentage of glomeruli with segmental sclerosis on histopathology ( P = 0.001) correlated with the subsequent outcome. During this period six children developed progressive renal failure and all of them belonged to NR group (25%). There were four deaths and all of them were non-responders (16.6%). Features predictive of a poor therapeutic outcome in childhood FSGS are age of onset more than 9 years, female sex, microhaematuria, renal dysfunction at onset, initial non-response to steroids and percentage of glomeruli with segmental sclerosis on histopathology.     

Stanley Rowbotham

Stanley Rowbotham was born in 1890 and spent the first years after qualification in 1915 with the Royal Army Medical Corps (RAMC). His career in anaesthesia began after the Armistice, when he was posted with Ivan Magill to Harold Gillies's plastic surgery unit at Sidcup. Together, they laid the foundations of tracheal anaesthesia. A versatile and inventive anaesthetist, Stanley Rowbotham later pioneered in the fields of thyroid anaesthesia, basal narcosis, local and intravenous analgesia and in the use of muscle relaxants. He also introduced cyclopropane into this country.