Factors associated with practice of procedures in pediatric-related areas among certified pediatricians

BACKGROUND: Medical care in pediatric-related areas in which physicians other than pediatricians, such as surgeons, otolaryngologists, ophthalmologists, orthopedists and dermatologists, can also participate is one of the fields of pediatric primary care. Independent factors associated with the practice of specific procedures in pediatric-related areas by certified pediatricians in Japan were evaluated. METHODS: Data were collected from a nationwide survey of 1116 pediatricians who were selected by systematic sampling from the list of certificated members of the Japan Pediatric Society. The survey included questions relating to full- or part-time practice, types of practice setting, practice with or without pediatric subspecialty interest, numbers of procedures performed among 15 procedures in pediatric-related areas, and attitude toward practice of those procedures. RESULTS: Of 79% of respondents, 73% were analyzed (n=810). Among 15 procedures in pediatric-related areas, seven procedures performed by more than 30% of certificated pediatricians were evaluated. In comparison with certified pediatricians who annually performed three or less procedures (n=410), certified pediatricians who annually performed four or more procedures (n=400) were more likely to be young and male, working full-time and in a general hospital setting, practicing with a pediatric subspecialty interest. In multiple logistic regression analyses, young age (odds ratio [OR]: 0.8 per 10 years of age; 95% CI: 0.6-0.9), positive attitude toward practice (OR: 1.7; 95% CI: 1.6-1.9), male (OR: 1.7; 95% CI: 1.1-2.5), full-time practice (OR: 3.2; 95% CI: 1.5-6.9), and practice in general hospital setting (OR: 1.7; 95% CI: 1.2-2.4) were independently associated with more extensive practice of procedures in pediatric-related areas. CONCLUSIONS: A positive attitude toward medical care in pediatric-related areas is one of the most important factors associated with practice of procedures in these areas. An educational strategy for pediatricians to keep their motivation high for improved medical care in these areas should be planned in Japan.     

Utility of the Inferior Vena Cava Diameter as a Marker of Dry Weight in Nonoliguric Hemodialyzed Patients

We have previously reported that the maximal inferior vena cava(IVC) diameter during quiet expiration(IVCe) measured by ultrasonography correlates well with the amount of body fluid, especially the circulating blood volume[1] and proposed using the criteria of IVC diameter to determine dry weight(DW) in anuric hemodialyzed (HD) patients: standard IVCe of pre-and post-HD are (14.9±0.4) and (8.2±0.3) mm, respectively[2]. However, the same post-HD IVC criterion should not be applied to nonoliguric HD patients because it could result in rapid deterioration of residual renal function due to forced dehydration. Although the biochemical DW marker plasma atrial natriuretic peptide (ANP) is useful to evaluate hypervolemia but not hypovolemia,both hyper-and hypovolemia can be detected by IVC measurement.……     

HIGH FREQUENCY OF APOPTOSIS IN INFANTILE CAPILLARY HAEMANGIOMA

Infantile capillary haemangioma (ICH) is a well-established clinicopathological entity which often regresses spontaneously. To elucidate the cause of spontaneous involution of ICH, the apoptotic and proliferative activities in seven cases of ICH were compared with those in five cases of lobular capillary haemangioma (LCH), using formalin-fixed paraffin-embedded tissue sections. The number of apoptotic cells detected by the modified in situ end-labelling method was significantly higher in ICH than in LCH, while the proliferative activities evaluated with mitosis and Ki-67 antigen expression did not differ significantly. Lewis^y (Le^y) antigen, an apoptosis-associated marker, was expressed in all cases of ICH but in none of LCH, while labelling for p53 protein and bcl-2 protein was almost completely negative in both tumours. These findings clearly demonstrate a much higher apoptotic activity in ICH than in LCH and suggest that apoptosis might be a cause of the spontaneous involution of ICH.     

Pretreatment serum level of HER2/nue as a prognostic factor in metastatic prostate cancer patients about to undergo endocrine therapy

BACKGROUND: Overexpression of the HER2 receptor protein and amplification of the HER2 gene has been implicated in tumor development and progression, and has been associated with a poor prognosis in several types of cancer. The aim of this study was to evaluate whether pretreatment serum HER2 levels can be used to predict biochemical recurrence-free survival in prostate cancer patients about to undergo endocrine therapy. METHODS: The study population consisted of 379 untreated patients with histologically diagnosed prostate cancer: 197 with T2N0M0, 93 with T3N0M0, 19 with TxN1Mx, and 70 with TxNxM1. Serum HER2 levels were assessed in the prostate cancer patients prior to treatment as well as in a control group of 100 patients with histologically confirmed non-cancer. Biochemical recurrence-free curves for the patients were investigated separately using the Kaplan-Meier method. RESULTS: The mean level of HER2 in serum was significantly higher in prostate cancer patients than non-prostate cancer patients (P = 0.006). Also, the serum HER2 level was significantly higher in bone metastatic cancer patients (14.3 +/- 6.3 ng/mL) than in non-metastatic patients (T2: 11.9 +/- 2.3 ng/mL, P = 0.003; T3: 12.2 +/- 2.8 ng/mL, P = 0.011). The metastatic patients were divided into those with low and high HER2 levels using a cutoff value of 12.6 ng/mL based on receiver-operating characteristic curves. The biochemical recurrence-free rate was significantly poorer in patients with a high HER2 level (P = 0.0078, log-rank test). Multivariate Cox logistic regression analysis demonstrated that the pretreatment serum HER2 value (P = 0.022), serum prostate-specific antigen value (P = 0.018), and extent of disease score (P = 0.027) were independent predictors of recurrence. CONCLUSIONS: The pretreatment serum HER2 level may be a useful independent prognostic factor that is associated with a high risk of biochemical recurrence in metastatic prostate cancer patients about to undergo endocrine therapy.     

A Preliminary Report of Phase I and II Study of N4-Behenoyl-1-{beta}-D-arabinofuranosylcytosine (BH-AC) in Patients with Acute Leukemia and Other Malignancies

N⁴-Behenoy1-1-ß-D-arabinofuranosy1cytosine (BH-AC)was administered to 11 patients with acute leukemia and fivepatients with other malignancies in a Phase I and TI clinicaltrial. Among 16 patients, 14 received BH-AC after being refractoryto prior therapies, and two with acute leukemia received BH-ACfor their first remission induction therapy. The starting dose was 1.5mg/kg administered as a single i.v.infusion of three hours. The doses were then escalated up to5.0 mg/kg. No side effects were noted with single i.v. infusions.Daily consecutive infusions of 2.0 mg to 6.0 mg/kg for fourto 21 days resulted in two patients experiencing nausea, twoanorexia and one developing skin eruptions. Significant hematologicaleffects were noted by the daily infusions. One patient withacute myeloblastic leukemia achieved complete remission with5.0 mg/kg BH-AC administered daily for 21 days. BH-AC is active in acute leukemia and may play a role in thecombination regimens for this disease.     

Phase II Study of Oral Administration of 5'-Deoxy-5-Fluorouridine (5'-DFUR) for Solid Tumors

A phase II trial of 5'-deoxy-5-fluorouridine (5'-DFUR), a newfluorinated pyrimidine analog which has been demonstrated tohave potential superiority over 5-FU and tegafur for chemotherapyof murine tumors, was performed in patients with advanced non-smallcell carcinoma of the lung and metastatic pulmonary tumors.5'-DFUR at a dose of 800 mg/m² was given per os every day formore than four weeks. None of 15 evaluable patients with non-smallcell carcinoma of the lung and 15 evaluable patients with metastaticpulmonary tumors showed a complete or partial response. Toxiceffects of 5'-DFUR included anorexia (29%), diarrhea (26%),nausea (23%), vomiting (10%), leukocytopenia (10%), generalfatigue (10%), liver disorder (6%) and thrombocytopenia (6%). ^**Present address: Third Department of Internal Medicine, Schoolof Medicine, Toku-shima University, Kuramoto-cho 3-chome, Tokushima770, Japan.     

Clinical significance of hepatitis G virus infection in patients on long-term haemodialysis

Infection with the newly discovered hepatitis G virus (HGV) was analysed in 163 patients on long-term haemodialysis to clarify its prevalence and clinical significance. Hepatitis G virus RNA in serum was measured by polymerase chain reaction with primers corresponding to the putative non-structural 5’ region. Of the 163 patients, three (1.8%) were positive for hepatitis B surface antigen, 40 (24.5%) were positive for hepatitis C virus (HCV)-RNA and 16 (9.8%) were positive for HGV-RNA. Five of the 16 patients with HGV-RNA were also positive for HCV-RNA. Patients with HCV and HGV coinfection had undergone a longer duration of haemodialysis (P=0.001) and had higher units of transfusion (P=0.031) compared with those without hepatitis virus infection. Transfusion history was significantly higher (P=0.039) in patients with only HGV infection than in those without hepatitis virus infection. Hepatitis C virus RNA concentration was higher (P=0.032) in patients with HCV and HGV coinfection than in those with HCV infection only, but alanine aminotransferase (ALT) levels were similar between these two groups. In conclusion, about 10% of patients on haemodialysis were infected with HGV and the infection was closely associated with transfusion history.     

Serum Glycoprotein Profile before and after Radical Surgery in a Case of Giant Cell Carcinoma of the Lung

Profiles of serum glycoproteins ₁-acid glycoprotein (₁-AG),₂-HS-glycoprotein (₂-HS), ß₂-glycoprotein I (ß₂-G),haptoglobin (HP), hemopexin (HX), and prealbumin (PA) alongwith the concentration of sialic acid were followed sequentiallyin a case of giant cell carcinoma of the lung, before and afterradical surgery. Before surgery, ₁-AG levels in the serum ranged from 2.1 to2.7 times the upper limit of the normal range. However, in contrastwith the usual mode of reaction of these kinds of proteins,the serum concentration of ₁-AG failed to increase after surgeryand showed a progressive fall after the 7th postoperative day.Concentrations of ₂-HS showed a significant elevation aftersurgery. ß₂-G showed a slight increase over normalbefore surgery but showed no consistent changes as a resultof surgery. HP levels in serum fell progressively to the normalrange during the course of this study, irrespective of surgery.The levels of PA in the serum were subnormal preoperativelybut gradually increased to the normal range after surgery. Theserum sialic acid concentration closely paralleled that of HPor ₁-AG. Analytical isoelectric focusing in polyacrylamide gel,from pH 2.9 to 5.0, was carried out for serum acid proteins.There was a tendency toward a gradual preoperative increaseand postoperative decrease in the acidic component.     

Preliminary Phase II Study of 1-(2-Chloroethyl)-3-(MethylAlpha-D-Glucopyranos-6-Yl)-1-Nitrosourea (MCNU) Against Primary Lung Cancer and Metastatic Pulmonary Tumors

A phase II study of 1-(2-chloroethyl)-3-(methyl--D-glucopyranos-6-yl)-1-nitrosourea(MCNU) was conducted with 16 patients with primary lung canceror metastatic pulmonary tumors who had failed to respond toconventional therapy. MCNU was administered by a single intravenousinjection at a dose of 120 mg/m². There were no patients whoshowed any objective responses. Although stabilization was achievedin 12 patients, four patients with primary lung cancer experiencedprogressive disease. Gastrointestinal toxicities such as anorexia,nausea and vomiting were mild or moderate and readily subsidedwithout any treatment. The major toxic side effects were leukocytopeniaand thrombocytopenia. Five patients (38.4%) had leukocytopeniaof less than 2,000/mm³ and six patients (46.1%) had thrombocytopeniaof less than 5.0x10⁴/mm³.