Childhood cancer incidence in Australia, 1982–1991

The data of the Australian Paediatric Cancer-Registry on childhood cancer incidence in Australia for the 10-year period 1982–1991 are presented. The crude average annual incidence of cancer in children under the age of 15 years was 13.8 per 100,000. The incidence of childhood cancer in Australia is rising. Significant increases were seen in acute non-lymphoblastic leukaemia, astrocytoma and melanoma. The age-standardised incidence of 14.4 per 100,000 is about 34% higher than in the UK. Most types of cancer had a higher incidence in Australia than in the UK, and the difference was significant for acute lymphoblastic leukaemia, astrocytoma and melanoma. Of particular interest is malignant melanoma, whose incidence in Australia is more than 5 times that in the UK, as a result of excessive UV exposure. Australia has a higher incidence of Ewing's tumour than osteosarcoma, nearly twice that of the UK. International comparative studies may help to elucidate the aetiology of these tumours. © 1996 Wiley-Liss, Inc.     

Terrible Triad Fracture-Dislocations of the Elbow

Management of terrible triad injuries of the elbow has improved in the last 2 decades based on an understanding of injury patterns, fracture morphology, and management pitfalls. But some intimidation with these injuries remains, in part because some of the surgical techniques are challenging and because there is still debate about certain steps in surgery and choices in management. This article highlights important aspects of the care of terrible triad injuries to clarify the anatomy and patho-physiology, to highlight pitfalls of treatment, and to point out areas that might benefit from innovation.     

Predictors of Return after Cast Removal in Patients with a Nonoperatively Treated Distal Radius Fracture

Patients with a nonoperatively treated fracture of the distal radius are often scheduled for a follow-up appointment after cast removal to assess function and outcome. Our experience is that, once the cast is off, many patients do not return. The purpose of this study was to determine which variables significantly influence return for a scheduled visit after cast removal. Thirty-seven patients enrolled in a prospective cohort study (27 men and 10 women) with an average age of 49?years (range, 19 to 82) had a distal radius fracture immobilized in a cast. During the visit at which the cast was removed, arm-specific disability, misinterpretation of nociception, and symptoms of depression were measured using validated questionnaires. Eleven of 37 patients did not attend the final scheduled office visit and the only predictor of a return visit was older age.     

Prognostic significance of BCL-2 expression and bcl-2 major breakpoint region rearrangement in diffuse large cell non-Hodgkin's lymphoma: a British National Lymphoma Investigation Study

The Bcl-2 protein is capable of preventing apoptosis, and in vitro evidence suggests a role in drug resistance. It is expressed and the gene is rearranged in a proportion of cases of large-cell non-Hodgkin's lymphoma (NHL), but the clinical significance of these findings is controversial. The purpose of this study was to determine the influence of both Bcl-2 expression and major breakpoint region (MBR) bcl-2 rearrangement in a large cohort of prospectively accrued patients with intermediate-grade B-cell NHL treated in a standardized manner. All patients with Working Formulation F, G, or H NHL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy in British National Lymphoma investigation studies between July 1974 and April 1992 were considered for this study if the appropriate paraffin blocks were available. Paraffin sections from the diagnostic specimen were analyzed for evidence of MBR rearrangement using a polymerase chain reaction-based method, and for Bcl-2 expression using immunohistochemistry. Failure to achieve complete remission (CR), relapse, death from NHL, and deaths from all causes were used as end points to measure CR rate, actuarial relapse rate, actuarial survival from NHL, and actuarial overall survival. One hundred sixty-one suitable patients were identified and tested for the bcl-2 MBR translocation, with 27 (17%) found to be positive; 153 of these patients were tested with immunocytochemistry, and 84 (55%) showed evidence of Bcl-2 expression. For patients who achieved CR from the initial treatment, the relapse rate was significantly higher in those with Bcl-2 expression than in those without. In addition, multivariate analysis identified Bcl-2 expression as the only factor significantly related to relapse rate in the subjects measured. The cause-specific survival for NHL in the series as a whole was significantly lower in patients with Bcl-2 expression than in those without. MBR status had no significant influence on any of the outcome measures, but the number of MBR-positive patients was relatively small, and larger studies are required. In conclusion, in Working Formulation F, G, and H NHL of B-cell type, expression of Bcl-2 protein predicted independently for relapse.     

Prolonged unconjugated hyperbilirubinaemia associated with the haem oxygenase‐1 gene promoter polymorphism

Aim: To elucidate the genetic factors causing hyperbilirubinaemia in prolonged jaundice of the newborns, we investigated whether the HO‐1 gene promoter polymorphism is a cause in unexplained pathological or prolonged jaundice. Methods: Three groups were defined: healthy newborns with no clinical jaundice, newborns hospitalized for jaundice without any identifiable pathological cause and newborns with prolonged jaundice associated with breast milk. Genomic DNA was extracted from the white blood cells and the promoter region of the HO‐1 gene was amplified using PCR and their allelic repeats were determined. Results: We did not detect any significant difference in the allele frequencies between the healthy newborns and the newborns whose serum total bilirubin levels were >12.9 mg/dL. However, the patients with short (<24 GT) dinucleotide repeat in the HO‐1 gene promoter on either allele had significantly higher prolonged unconjugated hyperbilirubinaemia than the healthy newborns. There was no significant difference between the groups 2 and 3. Conclusion: The results indicate that polymorphism of HO‐1 gene promoter region can be an underlying cause of the prolonged unconjugated hyperbilirubinaemia associated with breast milk. In this patient population, short repeat alleles of the HO‐1 gene promoter polymorphism were associated with prolonged jaundice.     

Red cell collection by apheresis technology

To determine the feasibility of collecting 2 units (450 mL) of red cells per donation by apheresis technology, apheresis red cell collections were compared to whole-blood donations. Forty blood donors were equally divided between the two study arms on the basis of gender and iron supplementation (650 mg ferrous gluconate/day vs. no supplementation). During the 1-year study period, the apheresis participants donated 450 mL of red cells three times, and the whole- blood donors gave 225 mL of red cells (1 unit of blood) on six occasions. There were no reported side effects during the 102 whole- blood donations, whereas symptoms were noted in 83 percent of the 59 apheresis procedures. The most common symptoms were numbness and tingling, which were relieved by a decrease in the plasma-return rate or by the administration of oral calcium supplements. Seven donors dropped out or were deferred during the study. Two whole-blood donors left with medical problems unrelated to the study, one apheresis donor and one whole-blood donor dropped out of the study because of excessive fatigue, and three non-iron-supplemented whole-blood donors had unacceptably low hematocrit levels. By the end of the study, 70 percent of the apheresis donors considered the procedure acceptable, 15 percent were undecided, and 15 percent thought it was not acceptable. As measures of iron balance, the serum ferritin and the red cell zinc protoporphyrin:heme ratios were significantly more abnormal in the non- iron-supplemented donors than in the iron-supplemented donors. However, there were no differences in iron balance according to the donation method.     

杂交瘤细胞在玻璃微载体培养中生物特性观察

本文报道以玻璃微载体小珠(CMB,Class microcarrier beads)作为载体培养杂交瘤细胞方法的建立。结果表明4株杂交瘤细胞在GMB培养显示GNB法上清中特异性单克隆抗体的滴度。OD值较单层培养法为高。比较培养7d后的杂交瘤细胞数,也以GMB法获得细胞数为多。各株细胞都诱生出高滴度腹水。亚类鉴定方面,GMB法培养的4株杂交瘤细胞上清内McAb所属亚类,又都保持了与单层法培养者完全相同的结果。表明杂交瘤细胞在CMB培养中,细胞迅速增殖,且保持各细胞株分泌其特异的McAb的生物特性,细胞活力旺盛,为今后体外培养杂交瘤细胞,制备McAb,提供了新的途径。     

Antegrade ureteral catheterization prior to complicated ureteral surgery

Ureteral surgery in a region of previous injury or inflammation is sometimes unsuccessful due to difficulties in dissecting the ureter without injuring it. Placing a catheter into the ureter can facilitate such surgery. In 2 such cases antegrade ureteral catheterization following percutaneous nephrostomy was used to facilitate surgery. In both cases retrograde ureteral catheterization was impossible.     

Guidelines for treatment of atopic eczema (atopic dermatitis) Part I

The existing evidence for treatment of atopic eczema (atopic dermatitis, AE) is evaluated using the national standard Appraisal of Guidelines Research and Evaluation. The consensus process consisted of a nominal group process and a DELPHI procedure. Management of AE must consider the individual symptomatic variability of the disease. Basic therapy is focused on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti‐inflammatory treatment based on topical glucocorticosteroids and topical calcineurin inhibitors (TCI) is used for exacerbation management and more recently for proactive therapy in selected cases. Topical corticosteroids remain the mainstay of therapy, but the TCI tacrolimus and pimecrolimus are preferred in certain locations. Systemic immune‐suppressive treatment is an option for severe refractory cases. Microbial colonization and superinfection may induce disease exacerbation and can justify additional antimicrobial treatment. Adjuvant therapy includes UV irradiation preferably with UVA1 wavelength or UVB 311 nm. Dietary recommendations should be specific and given only in diagnosed individual food allergy. Allergen‐specific immunotherapy to aeroallergens may be useful in selected cases. Stress‐induced exacerbations may make psychosomatic counselling recommendable. ‘Eczema school’ educational programs have been proven to be helpful. Pruritus is targeted with the majority of the recommended therapies, but some patients need additional antipruritic therapies.     

Epstein-Barr-Virus-assoziierte proximale Radialisparese

Irreparable peripheral nerve palsies rarely present as neurological complications in infectious mononucleosis. A case of isolated proximal radial nerve palsy resulting from an acute infection with Epstein-Barr virus is reported. The hand function was restored by multiple tendon transfer surgery.