Musculoskeletal tumors: follow-up with MR imaging after treatment with surgery and radiation therapy

Magnetic resonance (MR) imaging was used as a follow-up technique in 60 patients who underwent surgery and/or radiation therapy for primary malignant musculoskeletal tumors. MR imaging was performed on a 1.5-T imager with T1- and T2-weighted imaging sequences; MR imaging findings were confirmed by means of posttreatment surgery and histologic analysis or follow-up for at least 1 year. If a low-signal-intensity lesion was seen on T2-weighted images in a patient who had undergone radiation therapy or surgery, the patient usually did not have active tumor (sensitivity, 96%). If a high-signal-intensity lesion was seen after a patient had undergone only surgery, the patient had active tumor (six of six such cases). In patients who had undergone only radiation therapy, however, the presence of a high-signal-intensity lesion may indicate either active tumor or radiation-induced inflammatory changes. Thus, in such cases, differential diagnosis of active tumor may be difficult, if not impossible, to make from MR images.     

Effects of CAMPATH-1 antibodies in vivo in patients with lymphoid malignancies: influence of antibody isotype

The CAMPATH-1 family of antibodies recognize an abundant glycoprotein expressed on virtually all human lymphocytes. All rat IgM and IgG antibodies of this specificity are lytic with human complement, but only IgG2b is active in antibody-dependent cell-mediated cytotoxicity (ADCC). We compared the ability of IgM, IgG2a, and IgG2b to deplete lymphocytes in vivo in two patients with prolymphocytic transformation of B-cell chronic lymphocytic leukemia (CLL). The IgM (CAMPATH-1M) produced transient depletion of blood lymphocytes with consumption of complement but had no effect on solid masses or bone marrow. Similar transient depletion of blood lymphocytes was noted with the IgG2a (YTH34.5). In contrast, the IgG2b (CAMPATH-1G) produced long-lasting depletion of lymphocytes from blood and marrow and improvement in splenomegaly but no detectable changes in complement levels. These differences probably reflect the importance of Fc receptor binding for effective clearance of target cells in vivo. We treated 16 more patients with a variety of lymphoid malignancies and noted consistent effects on blood lymphocytes, marrow infiltration, and splenomegaly. At this dose level, there was comparatively little improvement in affected lymph nodes or extranodal masses. Nevertheless, the in vivo lympholytic ability of CAMPATH-1G is very potent as compared with other monoclonal antibodies (MoAbs) and may have applications in therapy of lymphoid malignancies and as an immunosuppressive agent.     

Changes in plasma glucose and lactate evoked by α and β2-adrenoceptor stimulation in conscious fasted rabbits

In conscious fasted rabbits, the iv infusion of salbutamol (3 micrograms/kg per min) and clonidine (2 micrograms/kg per min) induced a blood glucose increase amenable to blockade, respectively by ICI 118551 (1 micrograms/kg per min) and idazoxan (20 micrograms/kg per min). Amidephrine (10 micrograms/kg per min) and salbutamol mediated an increase in plasma lactate which was attenuated by prazosin (50 micrograms/kg, sc) and ICI 118551 respectively. Clonidine did not alter basal plasma lactate. The iv infusion of adrenaline (0.3 micrograms/kg per min) evoked an increase in plasma lactate more sensitive to blockade by ICI 118551 than by prazosin. ICI 118551 also shortened the hyperglycaemic response to adrenaline, 3-Mercaptopicolinic acid (25 mg/kg) reduced salbutamol- and adrenaline-mediated hyperglycaemia and increased at the same time the lactate/glucose ratio. Our data show that plasma lactate levels may be regulated by alpha 1- and beta 2-excitatory adrenoceptor stimulation. However, only the increase in blood lactate derived from beta 2-adrenergic stimulation seems to contribute to the overall catecholamine-mediated hyperglycaemia.     

Identifying and improving non-adherence in bipolar disorders

Objectives:  To review the definition of non-adherence, its clinical and economic impact and identify its role and impact in clinical practice.
Methods:  A selective review of the literature as conducted of articles and literature known to the authors.
Results:  There is a paucity of studies examining specifically treatment non-adherence and its consequences in bipolar disorder. Few studies have systematically examined ways in which treatment adherence can impact treatment and improve outcome.
Conclusion:  Non-adherence is common in the management of bipolar disorder. Clinicians and Researchers alike need to remain alert and be aware of issues related to non-adherence – in particular suicide. Like other course-modifiers non-adherence has to be considered, sought and addressed, and this is perhaps best done by including psychoeducation in routine clinical care.     

Amino acid profile in Down's syndrome

Fasting plasma and urinary amino acid concentrations were studied under carefully controlled conditions in 22 children with Down's syndrome and in age matched controls. The only significant difference between the groups was a higher mean plasma lysine concentration in Down's syndrome patients compared to controls.