bluuebunny/crossref_metadata_2025 huggingface dataset:
Hematologic toxicity during craniospinal irradiation: The impact of prior chemotherapy
Authors: Marks Lawrence B. , Cuthbertson David , Friedman Henry S.
Published: February 2007

The purpose of this work was to determine the frequency of hematologic toxicity during craniospinal radiation (CSI) and the impact of preirradiation chemotherapy on this frequency. The charts of 37 patients who received CSI were reviewed. Twenty did not have prior chemotherapy (CT—), while 17 did receive 1 to 18 (mean 5) cycles of multi‐agent systemic chemotherapy (CT+). Leukopenia/thrombocytopenia necessitating treatment interruptions occurred in 1/20 (5%) in the CT— group, compared to 8/17 (47%) among the CT+ group. This difference was statistically significant, P < 0.0001 (Fisher's exact two‐tailed test). The duration of treatment interruption in the CT+ patients was 4–24 days (mean 14). Compared to the CT— group, the CT+ group had a statistically significant greater decline in their white blood cell count (WBC), platelet count, and hematocrit (HCT) during CSI (percent reduction per Gy; (P = 0.018, 0.006, and 0.047, respectively). Although not statistically significant, the CT+ group also experienced lower nadir ratios (nadir count/baseline count) in terms of WBC and platelets (P = 0.07 and 0.22, respectively). While the mean pretreatment baseline blood counts were lower in the CT+ group compared to the CT— group, these differences reached statistical significance for the HCT (P = 0.02), but not the WBC (P = 0.59) or platelets (P = 0.43). Leukopenia and thrombocytopenia are very common in patients who receive craniospinal irradiation following multi‐agent systemic chemotherapy. This appears to be due to more rapid and marked reductions in counts during CSI. Since this toxicity may cause treatment interruptions that are potentially therapeutically disadvantageous, aggressive hematologic support with transfusions and growth factors may be necessary. This problem may become more common as combined modality therapy is used more frequently. © 1995 Wiley‐Liss, Inc.
Oral methotrexate and alternate‐day prednisone for low‐risk langerhans cell histiocytosis
Authors: Womer Richard B. , Anunciato Kelly Raff , Chehrenama Mahan
Published: February 2007

Many treatments for low‐risk Langerhans cell histiocytosis (LCH) involve unpleasant side‐effects or risks of late effects. To provide treatment with minimal toxicity and no known risk of late effects, we have used oral alternate‐day prednisone (PDN, 40 mg/sq.m./day) and weekly methotrexate (MTX, 20 mg/sq.m. once weekly) in a series of 13 children with 17 episodes of LCH. Patients were monitored with monthly physical examinations, blood counts and chemistry panels, and radiographs and scans obtained at the treating physician's discretion. Patients who responded had the prednisone tapered and MTX discontinued after three months of treatment. Recurrences while treatment was being tapered, or after its discontinuation, were managed with resumption of MTX and PDN. Treatment was successful in 16 of the 17 episodes, meaning that symptoms resolved and abnormal physical or radiographic findings improved. Symptomatic relief occurred in two weeks or less in 14 of 17 episodes; objective improvement generally occurred within one month, and in all cases by three months. The median duration of treatment was 5 months. Toxicity was limited to slight, transient elevations in hepatic enzymes in three patients. We conclude that oral chemotherapy with alternate‐day PDN and weekly MTX is effective and non‐toxic in patients with low‐risk LCH. © 1995 Wiley‐Liss, Inc.
Use of granulocyte colony stimulating factor to reduce the toxicity of super‐VAC chemotherapy in advanced solid tumours in childhood
Authors: Jones Cheryl A. , Shaw Peter J. , Stevens Michael M.
Published: February 2007

Children with advanced solid tumours at the Royal Alexandra Hospital for Children (RAHC) receive an intensive four drug chemotherapy combination, Super‐VAC (cyclophosphamide, 500 mg/m2, adriamycin, 30 mg/m2, actinomycin‐D, 0.5 mg/m2, all daily for 3 days, and vincristine, 1.5 mg/m2 weekly). The majority of patients respond well to three courses of such therapy, but with considerable morbidity, including fever, neutropenia, and mucositis. In an attempt to reduce the morbidity of Super‐VAC, G‐CSF was added. We documented various parameters in 12 patients who received 28 cycles with G‐CSF and compared them to an historical control group of 37 cycles in the preceding 14 patients who received Super‐VAC. The median duration of each cycle was 23 days with G‐CSF and 28 days without G‐CSF (P = 0.004). However, differences in requirements for inpatient care (median 16 v. 20 days), intravenous antibiotics (median 9 v. 10 days), amphotericin (median 5 v. 3 days), morphine (median 8.5 v. 7 days), or TPN (median 6.5 v. 8 days) did not reach statistical significance. As expected, a significant difference in neutrophil recovery was demonstrated between the two groups (median 11 v. 16 days, P < 0.0001) but not in platelet recovery (median 13 v. 13 days). The use of G‐CSF with Super‐VAC resulted in a shorter cycle length, so increasing the dose intensity. A reduction in morbidity could not be demonstrated. No toxic side effects from G‐CSF were noted. © 1995 Wiley‐Liss, Inc.
Chemotherapy‐induced growth hormone deficiency in children with cancer
Authors: Román Juan , Villaizán Carmen J. , García‐Foncillas Jesús , Azcona Cristina , Salvador Javier , Sierrasesúmaga Luis
Published: February 2007

Background. Chemotherapy (CT) may produce growth impairment, however, the pathogenesis is still unclear.

Methods. A series of 25 patients mean age 13.3 years (6.3–19.8), previously treated for malignant solid tumours with only CT and surgery were studied. Growth hormone (GH) reserve was assessed by two different provocative stimuli (Clonidine and L‐Dopa). Mean time between completion of treatment and GH evaluation was 18.5 months (2–74 months). At that time, all patients were in complete remission.

Results. GH deficiency (GHD), defined by an impaired GH response to both provocative tests was observed in 11 out of 25 patients (44%). At diagnosis, mean standing height was +0.23 ± 1.42 SDS in the GHD group (GHD‐g) and +0.18 ± 1.23 SDS in the non‐GHD group (n‐GHD‐g). At the end of therapy, the mean standing height in the GHD‐g was −0.31 ± 1.22 SDS and −0.17 ± 1.41 in the n‐GHD‐g, differing from the former group (P = 0.05). For a mean follow‐up of 30 months from the end of treatment, the mean standing height was −0.48 ± 1.23 SDS in the GHD‐g and −0.24 ± 1.51 SDS for the n‐GHD‐g (P = 0.03).

Growth rate at the end of treatment was +0.13 ± 1.54 in the GHD‐g and +0.21 ± 1.75 in the n‐GHD‐g. For a mean follow‐up of 30 months from the end of treatment, the growth rate was different between GHD‐g and n‐GHD‐g (−0.31 ±2.72 vs. −0.21 ± 1.93, P < 0.05).

Conclusions. 1) Growth impairment in children treated because of malignant diseases has a multifactorial etiology, but CT‐induced GH deficiency is one potential adverse factor. 2) An endocrine follow‐up should be introduced in order to detect and treat hormonal deficiencies as early as possible. © 1995 Wiley‐Liss, Inc.
Health‐related behaviors of survivors of childhood cancer
Authors: Mulhern Raymond K. , Tyc Vida L. , Phipps Sean , Crom Deborah , Barclay Deborah , Greenwald Carol , Hudson Melissa , Thompson Elizabeth I.
Published: February 2007

The health‐related beliefs and behaviors of long‐term survivors of childhood cancer are important because of vulnerability to adverse late effects from their primary malignancy and its therapy. A health behavior survey was completed by 110 parents of long‐term survivors ranging in age from 11–17 years, and by 40 adult long‐term survivors of childhood cancer ranging in age from 18–29 years. The survey included questions on the former patient's frequency of alcohol and tobacco use, as well as diet, exercise, sleep, dental, and seatbelt habits. The reported prevalence of tobacco and alcohol use was less than 10% among those less than 18 years old. Among the adults, tobacco (17.5%) and alcohol (72.5%) use was greater, but problem drinking was infrequently reported. In order to assess their perceived vulnerability, we asked the parents and the young adult patients to rate the strength of their belief that it is more important for the patient to keep healthy compared to most other children or young adults. Contrary to our expectations, demographic factors such as the patient's gender, socioeconomic level, or time elapsed since completion of therapy exerted minimal influence on their responses. Over 80% of parents and 60% of young adult survivos believed that it was more important for the former patient to remain healthy compared to most other people. However, this shared belief in increased vulnerability was inconsistently expressed in the patient's health behaviors. These results suggest that specific changes are needed in the health assessment and education of long‐term survivors of childhood cancer. © 1995 Wiley‐Liss, Inc.
Fractionated total‐body irradiation preceding high‐dose cytosine arabinoside as a preparative regimen for bone marrow transplantation in children with acute leukemia
Authors: Kamani Naynesh , Bayever Eliel , August Charles S. , Bunin Nancy , Goldwein Joel W. , D'Angio Giulio J.
Published: February 2007

Twenty children with acute leukemia between 3 and 19 years of age underwent allogeneic bone marrow transplantation from HLA‐matched sibling donors after conditioning with total‐body irradiation (1,200 cGy in six fractions of 200 cGy twice daily for 3 days) and high dose cytosine arabinoside (3 g/m2 given every 12 hours for 12 doses). Three patients died with acute toxicity. Six patients developed grade II acute graft versus host disease. With a median follow‐up of 68 months (range 26–96 months), thirteen children (65%) are alive and in remission with Karnofsky scores of 90–100%. A patient with AML in resistant relapse went into remission but relapsed and died 5 months post‐transplantation. Three other patients relapsed, 8, 12, and 16 months post BMT. Our results suggest that this conditioning regimen is associated with high but manageable acute toxicity and may be highly effective in controlling leukemia resistant to conventional chemotherapy. © 1995 Wiley‐Liss, Inc.
Cyclophosphamide in combination with sargramostim for treatment of recurrent medulloblastoma
Authors: Moghrabi Albert , Fuchs Herb , Brown Mark , Schold S. Clifford , Graham Michael , Kurtzberg Joanne , Tien Robert , Felsberg Gary , Lachance Daniel H. , Colvin O. Michael , Oette Dagmar , Allegretta Gary J. , Hockenberger Beverly , Stewart Elizabeth , Ferrell Lee , Kerby Tracy , Duncan‐Brown Margaret , Bigner Darell D. , Friedman Henry S.
Published: February 2007

Thirteen patients with recurrent medulloblastoma were treated with cyclophosphamide in association with Sargramostim. Cyclophosphamide was given at doses ranging between 1.0–2.5 g/m2 daily for two doses. Sargramostim was given at a fixed dose of 250 μg/m2 subcutaneously twice a day beginning 24 hours after the second cyclophosphamide dose and continuing through the leukocyte nadir until the ANC was more than 1,000 cells/μl for two consecutive days. A total of 33 courses were given with toxicity consisting of grade 4 neutropenia in all courses and grade 3–4 thrombocytopenia in 10 of 13 patients. There were no deaths related to infection or bleeding. Four patients were taken off study because of prolonged myelosuppression. Three of these patients were at the 2.5 g/m2 level, and of these three, two developed lung toxicity (grades 2 and 4, respectively). One patient developed an allergic reaction following the first injection of Sargramostim and was also taken off study. Of 10 evaluable patients, there were 9 PR and 1 SD. We conclude that cyclophosphamide at a dose of 2.0 g/m2/day × 2 days q 4 weeks in association with Sargramostim demonstrates marked activity with acceptable toxicity in patients with recurrent medulloblastoma. © 1995 Wiley‐Liss, Inc.
Rapid cytoreduction in childhood leukemic hyperleukocytosis by conservative therapy
Authors: Basade Maheboob , Dhar Anil K. , Kulkarni Samar S. , Sastry P. S. R. K. , Yadav Ram P. , Parikh Bhavana S. , Pai Suresh K. , Nair Chandrika N. , Kurkure Purna A. , Advani Suresh H.
Published: February 2007

Childhood leukemic hyperleukocytosis poses a serious threat to life because of its associated metabolic complications. The present prospective trial utilized conservative management of childhood acute lymphoblastic leukemia with hyperleukocytosis (total white cell count equal or >100 × 109/L) by intravenous hydration, urinary alkalinization, and allopurinol presenting without severe life‐threatening complications. The median reduction in WBC count was 81.51% (range: 66–98.8%) within a median period of 36 hours (range: 12–60 hours) following hospitalization. There were no failures or treatment related complications. Thus we conclude that in childhood acute lymphoblastic leukemia, hyperleukocytosis can be managed safely and effectively with intravenous hydration, urinary alkalinization, and allopurinol before starting any specific anti‐leukemic chemotherapy avoiding risk‐associated cranial irradiation, leukapheresis, and exchange transfusion. © 1995 Wiley‐Liss, Inc.
Nutritional and treatment‐related characteristics of pediatric oncology patients referred or not referred for nutritional support
Authors: Tyc Vida L. , Vallelunga Lori , Mahoney Sherry , Smith Bruce F. , Mulhern Raymond K.
Published: February 2007

Nutritional problems often result from malignancies and aggressive multimodal treatment. Early identification of reliable risk factors associated with malnutrition and need for nutritional support is necessary for development of preventative approaches. Nutritional and treatment‐related characteristics were examined for 173 pediatric oncology patients referred for nutritional support and a comparison sample of 43 patients matched on treatment protocol and/or diagnosis who had never been referred for nutritional support. Abnormally low serum albumin levels, poor oral intake, mucositis, prior radiation therapy, and increased gastrointestinal toxicity were significantly more frequent among referred than non‐referred patients. A discriminant function analysis indicated that poor oral intake was the single best predictor of need for nutritional support. Patients with solid tumors were more nutritionally depleted at the time of referral; all bone marrow transplant patients received nutritional support. Patients with central nervous system (CNS) tumors required nutritional support for longer time periods. We conclude that routine documentation of poor oral intake (i.e., observation of change in a child's eating patterns) is the most reliable indicator of children who eventually require nutritional support and who may benefit from interventions that could delay or prevent nutritional problems. Prophylactic interventions should be tailored to meet the specific needs of individual diagnostic groups. © 1995 Wiley‐Liss, Inc.
Response to high‐dose cisplatin and etoposide in advanced germ cell tumors in children: Results of the Brazilian germ cell tumor study
Authors: Lopes Luiz Fernando , De Camargo Beatriz , Dondonis Miriam , de Araujo Rogerio Agenor , Morinaka Elizabeth
Published: February 2007

A trial was undertaken to assess the efficacy and toxicity of high‐dose cisplatin and etoposide in children with newly diagnosed advanced malignant germ cell tumors. A total of eleven children and adolescents were treated with courses of high dose cisplatin 30 mg/m2/day and etoposide 120 mg/m2/day in five day cycles at 21 day intervals. There were eight girls and three boys, aged between 1 and 16 years (median: 120 months). Of nine unresectable tumors, six were in complete remission after three cycles and were completely resected. All patients are alive (median follow‐up 17 months). Preliminary results shows that high dose cisplatin and etoposide is effective in controlling advanced malignant germ cell tumor. © 1995 Wiley‐Liss, Inc.
Clinicopathological features and management of immunoproliferative small intestinal disease and primary small intestinal lymphoma in pakistan
Authors: Malik Imtiaz A. , Shamsi Zia , Shafquat Azam , Aziz Zeba , Shaikh Hizbullah , Jafri Wasim , Khan M. Ata , Khan A. Haleem
Published: February 2007

This study was performed to confirm the existence of immunoproliferative small intestinal disease (IPSID) in Pakistan. Clinicopathological features of 12 patients with histologically confirmed disease were analysed. Patients were mostly young males with median age of 24.6 years. Two thirds belonged to poor socioeconomic class. Main presenting features were chronic diarrhoea and weight loss. Eleven patients had radiologic evidence of malabsorption syndrome. Endoscopic findings of mucosal thickening, edema, and flattened villi were present in the majority. Patients had both secretory and non‐secretory types of disease. Six patients presented with stage A disease. Four responded to antibiotics or steroids, although mucosal abnormalities persisted in three. Two stage A patients evolved into stage C disease, one was lost to follow‐up, the other is alive with disease. Three patients presented with stage B disease. Two responded completely to chemotherapy, the third refused treatment and expired after 16 months. Three patients had stage C disease at diagnosis. They received aggressive combination chemotherapy and remain in complete remission with a median follow‐up of 2.2 years. This is the first series of patients with IPSID reported from Pakistan. Clinicopathological features and therapeutic results are consistent with the experience elsewhere. Increased awareness may result in early diagnosis and better management. © 1995 Wiley‐Liss, Inc.
DNA index and %S‐phase cells determined in acute lymphoblastic leukemia of children: A report from studies ALL V, ALL VI, and ALL VII (1979–1991) of the dutch childhood leukemia study group and the Netherlands workgroup on cancer genetics and cytogenetics
Authors: Smets L. A. , Slater R. , van Wering E. R. , van der Does‐van den Berg A. , Hart A. A. M. , Veerman A. J. P. , Kamps W. A.
Published: February 2007

DNA per cell content was routinely recorded by single‐parameter flow cytometry in leukemic blasts from 473 children with acute lymphoblastic leukemia (ALL), enrolled in national studies ALL V, VI, and VII (1979–1991) of the Dutch Childhood Leukemia Study Group. The parameters bonemarrow %S‐value and DNA Index were compared with clinical features, with chromosome number based on cytogenetic analyses and with treatment results in study ALL VI. %S‐values, ranging between 1 and 36%, were unrelated to initial white blood cell count, immunophenotype, and DNA index but were lowest in blasts with L1 morphology. In study ALL VI (non‐high risk), the survival of patients with ≦6% S‐phase cells was superior to that of patients with %S‐values of >6 (P = 0.030). Hyperdiploidy, defined by a DNA index ≧1.16, was compared to the cytogenetic hyperdiploid classification of n > 50. Initially there were 25 discrepancies in 189 samples jointly analysed by flow cytometry and cytogenetics. After review only five discrepancies remained unresolved. Hyperdiploidy, independent of the method used, was found to be unrelated to blast morphology and %S‐phase cells but closely associated with c‐ALL and was absent in T‐ALL. In study ALL VI, event‐free survival at 8 years of hyperdiploid patients was 90.6% but was not significantly different from non‐hyperdiploid patients (EFS = 82.1%; P = 0.08). Routine DNA flow cytometry appeared a valuable adjunct to cytogenetic analyses and allowed the identification of a large subset of non‐high‐risk ALL patients in study ALL VI with a DNA index ≥1.16 or %S‐value of ≦6.0 with highest survival probability. © 1995 Wiley‐Liss, Inc.
Is there a gender difference in red blood cell thiopurine methyltransferase activity in healthy children?
Authors: Klemetsdal Bjørg , Flægstad Trond , Aarbakke Jarle
Published: February 2007

We have examined red blood cell (RBC) thiopurine methyltransferase (TPMT) activity in a healthy population sample of Norwegian children, age 1–10 years. Boys had mean RBC TPMT activity of 11.1 ± 2.0 U (n = 87) vs. 10.6 ± 2.2 U (n = 71) in girls, the difference was not significant (P = 0.3). Age was negatively correlated to RBC TPMT activity (rS = −0.2, P = 0.01). As boys with acute lymphoblastic leukemia (ALL) tolerate more 6‐mercaptopurine (6‐MP) than girls and have a higher risk of relapse, we have searched for pharmacokinetic causes of these gender differences. The gender difference in 6‐MP tolerance and clinical outcome in children with ALL cannot be explained by the minor and nonsignificant higher RBC TPMT activity in boys compared to girls. © 1995 Wiley‐Liss, Inc.
Survival and quality of life of paediatric intracranial germ cell tumour patients treated at the Christie Hospital, 1972–1993
Authors: Kiltie Anne E. , Gattamaneni H. Rao
Published: February 2007

From 1972 to 1993, 25 patients under 16 years old were treated at the Christie Hospital for intracranial germ cell tumours (ICGCTs). A retrospective analysis of the case notes was undertaken. The cases comprised 10 germinomas, nine non‐germinomatous germ cell tumours (NGGCTs), and six cases with no histology. Ten patients had either complete or incomplete removal of the tumour. All patients received radiotherapy (20 patients received craniospinal irradiation [CSI]). Thirteen patients received chemotherapy at presentation (six platinum‐based). All marker‐negative pure germinomas treated with CSI survived. The actuarial 5‐year survival for NGGCTs was 44%. Although CSI resulted in spine shortening, the overall effect on growth was not marked and the neuropsychologic sequelae were minimal with good overall functional results. © 1995 Wiley‐Liss, Inc.
Tropisetron in the prevention of nausea and vomiting in 131 children receiving cytotoxic chemotherapy
Authors: Benoit Yves , Hulstaert Frank , Vermylen Christiane , Sariban Eric , Hoyoux Claire , Uyttebroeck Anne , Otten Jacques , Laureys Geneviève , de Kerpel Isabelle , Nortier Damienne , Ritter Linda , de Keyser Paul
Published: February 2007

Tropisetron (Navoban®, Sandoz Pharma Ltd., Basel, Switzerland), a selective antagonist of the serotonin receptor (5‐HT3) dosed once‐daily at 0.2 mg/kg (with a maximum of 5 mg daily), was evaluated in the prevention of chemotherapy‐induced nausea and vomiting in 131 children with a median age of 5 years (age 10 weeks to 21 years). Acute lymphocytic leukemia was the most common malignancy (49%). Most children (82%) had received cytotoxic chemotherapy before enrollment. Patients received tropisetron during one or more courses of chemotherapy (455 courses in total). Tropisetron was administered slowly intravenously as a single dose before the start of chemotherapy on day 1 and intravenously or by mouth the subsequent days as a single daily dose (median treatment duration: 5 days). Response to tropisetron per 24 hour period on the first 5 days of each chemotherapy course was graded as complete (absence of both nausea and vomiting), partial (one to four vomits and/or less than 5 hours of nausea), or failure. Overall complete response on day 1 was observed in 305 out of 455 chemotherapy courses (67%). The patients receiving intravenous chemotherapy (N = 92) had a 70% complete response rate and a 26% partial response rate on day 1, both for course 1 and course 2. The percentage of complete responders increased the subsequent days of the course. Emesis after day 1 was observed primarily during courses with the most emetogenic chemotherapy. No side‐effects of tropisetron other than a single case of diarrhoea were documented in this study. © 1995 Wiley‐Liss, Inc.
Dynamic learning, pricing, and ordering by a censored newsvendor
Authors: Bisi Arnab , Dada Maqbool
Published: February 2007

We address the problem of determining optimal ordering and pricing policies in a finite‐horizon newsvendor model with unobservable lost sales. The demand distribution is price‐dependent and involves unknown parameters. We consider both the cases of perishable and nonperishable inventory. A very general class of demand functions is studied in this paper. We derive the optimal ordering and pricing policies as unique functions of the stocking factor (which is a linear transformation of the safety factor). An important expression is obtained for the marginal expected value of information. As a consequence, we show when lost sales are unobservable, with perishable inventory the optimal stocking factor is always at least as large as the one given by the single‐period model; however, if inventory is nonperishable, this result holds only under a strong condition. This expression also helps to explain why the optimal stocking factor of a period may not increase with the length of the problem. We compare this behavior with that of a full information model. We further examine the implications of the results to the special cases when demand uncertainty is described by additive and multiplicative models. For the additive case, we show that if demand is censored, the optimal policy is to order more as well as charge higher retail prices when compared to the policies in the single‐period model and the full information model. We also compare the optimal and myopic policies for the additive and multiplicative models. © 2007 Wiley Periodicals, Inc. Naval Research Logistics, 2007
Comments on ‘The computation of wavelet‐Galerkin approximation on a bounded interval’
Authors: Zhang Tonghua , Tian Yu‐Chu , Tadé Moses O. , Utomo Johan
Published: February 2007

In this letter, we identify and correct the errors in (Int. J. Numer. Meth. Eng. 1996; 39:2921–2944). And we also develop clearer procedures for the computation of the connection coefficients from the wavelet‐Galerkin scheme. Copyright © 2007 John Wiley & Sons, Ltd.
Gene polymorphisms and behavior
Authors: McGuffin Peter
Published: February 2007

Genetics has a entered golden post genomic era that promises to greatly improve our understanding of the etiology of complex familial disorders. Many forms of behavior are familial but Mendelian disorders are rare, and common conditions have complex inheritance. Twin and adoption studies confirm that major psychiatric disorders such as schizophrenia and bipolar affective disorder are highly heritable. There is also emerging evidence of some overlap between these disorders. Several susceptibility loci for schizophrenia have been identified, at least one of which is also a susceptibility gene for bipolar disorder. The first susceptibility genes involved in major psychiatric disorders have been identified and more will soon follow with the exploitation of emerging technologies that allow whole genome association studies. Pediatr Blood Cancer 2007;48:736–737. © 2007 Wiley‐Liss, Inc.
Rituximab for the treatment of childhood chronic idiopathic thrombocytopenic purpura and hemophilia with inhibitors
Authors: Franchini Massimo , Zaffanello Marco , Veneri Dino , Lippi Giuseppe
Published: February 2007

Rituximab, a monoclonal chimeric antibody to the CD20 antigen, is an effective treatment for non‐Hodgkin lymphomas. Moreover, rituximab has also shown efficacy in various autoimmune disorders. In this review, we will focus on the use of rituximab in childhood disorders of hemostasis associated with inhibitor formation. Although the results presented suggest that rituximab can be useful in the treatment of this subset of pediatric patients, most of the data come from isolated case reports or descriptions of small, uncontrolled series. Therefore, large, prospective, and randomized trials are needed to confirm the positive, preliminary results. Pediatr Blood Cancer 2007;49:6–10. © 2007 Wiley‐Liss, Inc.
Carlisle and District diabetes training in nursing and residential care homes
Authors: Heeley‐creed D , Brown K , Hill J
Published: February 2007

Two consecutive projects targeting nursing homes and residential care homes were initiated in the former East Cumbria. The projects were based on the findings of two audits investigating the prevalence of diabetes in nursing and residential care homes in East Cumbria. The audits highlighted inconsistencies of care and concerns relating to all aspects of diabetes.

One‐off funding was received and provided for a nurse educator, dietitian and secretarial support to plan, implement and evaluate a training programme to meet the needs of the homes involved. Two to three training sessions were delivered on site to 50 homes. The sessions covered all aspects of diabetes care for managers, nurses, carers and catering staff. Specific concerns highlighted by staff during the training resulted in further training sessions being offered to cover hypoglycaemia, blood glucose monitoring and dietary issues.

A positive response was received from all staff with good attendance and commitment to training; certificates of attendance were issued to staff attending all sessions of the training programme. Staff expressed an improvement in their knowledge of diabetes.

Files containing practical information and new blood glucose meters were given to each home. The training programme was tailored to the needs of each home and delivering the training on site enabled the trainers to meet the needs of each home. Every home was left with protocols of care with easily measurable criteria, which could be utilised to assess the quality of diabetes care. Copyright © 2007 John Wiley & Sons.
Importance of sensory symptoms in identifying patients with diabetic peripheral neuropathy
Authors: Schandry R , Lobisch M
Published: February 2007

This report quantifies the relationship between neuropathy sensory symptoms (NSSs) and diabetic peripheral neuropathy (DPN). Diabetes patients with and without DPN used a physician‐administered symptom scale to document the frequency of numbness; insensitivity; burning; warm, dry feet; tightness or aching; bandaged sensation; prickling; tingling; sharp pain; hypersensitivity to touch; and cold sensation. Using these data, we calculated the prevalence of each NSS, and also quantified the association between each NSS and the presence of DPN by determining NSS accuracy, sensitivity, specificity, and positive and negative predictive values. Each NSS was more prevalent and occurred more frequently in patients with DPN (p<0.01), highlighting the importance of physicians inquiring about the presence and frequency of NSSs when seeking to distinguish between diabetes patients with and without DPN. Notably, several non‐painful symptoms (e.g. tingling and prickling) consistently demonstrated strong associations with DPN. Bandaged sensation, warm, dry feet, and the sensation of coldness consistently demonstrated the weakest associations with DPN. NSSs (both painful and non‐painful) distinguish diabetes patients with and without DPN. Identifying NSSs associated with DPN should prompt the physician to explore more fully for the presence of DPN and to initiate more aggressive intervention for diabetes. Copyright © 2007 John Wiley & Sons.
Effectiveness of a computerised assessment tool to prompt individuals with diabetes to be more active in consultations
Authors: Barnard KD , Cradock S , Parkin T , Skinner TC
Published: February 2007

The objective of this study was to assess whether using a computerised touch screen assessment tool prior to outpatient consultation makes patients more active in the consultation.

In a non‐randomised control group design, immediately after consultations, which were recorded, patients and professionals completed a consultation review sheet and the Health Care Climate Questionnaire (HCCQ). Views about the assessment were then elicited. Intervention participants completed the Accu‐Chek Interview (a computerised psychosocial assessment) prior to the consultation.

After completing the Accu‐Chek Interview, participants were more active in the consultation asking twice as many questions (t = 3.167; df = 67.07; p = 0.002), without lengthening the consultations. There was no significant difference in the duration of consultations (t = ‐1.20; df = 129; p = 0.234). Patients valued completing the interview: ‘it does prompt you to ask questions that you may not think of at the time.’ The demographics were similar for both groups and there was no effect on the HCCQs.

It was concluded that the Accu‐Chek Interview seems to activate patients into asking more questions (a marker for better bio‐medical outcomes in a recent meta‐analysis) and is valued by patients to help improve diabetes care.

The Accu‐Chek Interview could be routinely offered to outpatients attending diabetes centres as a tool to improve communication, increase autonomy and potentially improve outcomes. Copyright © 2007 John Wiley & Sons.
Intensive insulin treatment in coronary and intensive care
Authors: Jones C , Fisher M
Published: February 2007

Hyperglycaemia in the setting of acute illness carries a poor prognosis. The first Diabetes and Insulin‐Glucose infusion in Acute Myocardial Infarction (DIGAMI) study demonstrated a reduction in total mortality with intravenous insulin to reduce hyperglycaemia followed by multi‐dose subcutaneous insulin in diabetic patients following myocardial infarction. Unfortunately, there were several problems with the follow‐up DIGAMI‐2 study, so that it is not clear if maximum benefit was obtained by intravenous insulin, subcutaneous insulin, or a combination of both. In the surgical intensive care unit (ICU) setting, intensive insulin to restore normoglycaemia reduced total mortality in patients admitted to a surgical ICU who developed hyperglycaemia. In a follow‐up study in medical ICU patients the results were disappointing, and there was no overall reduction in mortality. There is a need for a study which would combine these two complementary approaches, examining the possible benefits of using very intensive insulin treatment to achieve normoglycaemia following myocardial infarction in patients with diabetes. Copyright © 2007 John Wiley & Sons.
Influences of organometallic polymer‐derived catalyst dispersion on SWNT growth
Authors: Lastella Sarah , Yang Hoichang , Rider David , Manners Ian , Ajayan Pulickel M. , Ryu Chang Y.
Published: February 2007

Catalyst formation kinetics of a ferrocene‐containing homopolymer, polyferrocenylethylmethylsilane (PFEMS), is investigated as it relates to the catalysis of single walled carbon nanotubes (SWNTs) through a chemical vapor deposition (CVD) process. The formation and efficiency of the PFEMS‐based iron catalyst is compared with that of the corresponding polystyrene (PS)‐b‐PFEMS diblock copolymer. The PFEMS homopolymer contains 23 wt % iron, while PS‐b‐PFEMS, with a 25 vol % PFEMS content, is only 6% iron. Despite its lower iron content, spin‐cast PS‐b‐PFEMS films on SiO2/Si substrates produce more active iron sites than spin‐cast PFEMS films during CVD growth of SWNTs. This is related to the self‐assembly of the block copolymer, where PFEMS domains are well dispersed in the PS matrix, which degrades at a CVD temperature of 920 °C to leave catalytically active elemental iron behind. On the contrary, the pure PFEMS films contain a high percentage of iron and silicon, which tend to transform into ceramic‐coated iron at this high temperature, thus rendering the iron inactive towards SWNT growth. © 2007 Wiley Periodicals, Inc. J Polym Sci Part B: Polym Phys 45: 758–765, 2007
Electrospinning of ultrahigh‐molecular‐weight polyethylene nanofibers
Authors: Rein D. M. , Shavit‐Hadar L. , Khalfin R. L. , Cohen Y. , Shuster K. , Zussman E.
Published: February 2007

The electrospinning method has been employed to fabricate ultrafine nanofibers of ultrahigh‐molecular‐weight polyethylene for the first time with a mixture of solvents of different dielectric constants and conductivities. The possibility of producing highly oriented nanofibers from ultrahigh‐molecular‐weight polymers suggests new ways of fabricating ultrastrong, porous, and single‐component nanocomposite fibers with improved properties. © 2007 Wiley Periodicals, Inc. J Polym Sci Part B: Polym Phys 45: 766–773, 2007
Androgen and collagen as growth regulators of the rat ventral prostate
Authors: Müntzing Jonas
Published: February 2007

With the aim of studying a possible role of the fibromuscular stroma as growth regulator for the rat ventral prostate the weight, DNA content, and hydroxyprolin content were analyzed in the ventral prostate of rats of varying age. Exogenous androgen increased the age‐dependent weight and contents only in young and old rats. Orchiectomy reduced prostatic weight, DNA content, and hydroxyproline content although to different extent, and exogenous androgen restored the weight and contents. Exogenous estrogen to intact animals had effects similar to orchiectomy. Estrogen combined with androgen increased DNA content over that found in animals given androgen only, while weight and hydroxyproline content were not changed. It is concluded that the endogenous androgen determines the size of the prostate in young and old animals. Androgen also determines prostatic collagen content. The good correlation between prostatic DNA and hydroxyproline indicates a more or less fixed number of epithelial cells per amount of collagen. A hypothesis suggesting a crucial role for prostatic collagen in the growth‐limiting mechanism in the prostate is presented.
Antagonistic effects of cyproterone acetate and oestradiol on the development of the fetal rat prostate gland induced by androgens in organ culture
Authors: Lasnitzki Use , Mizuno Takeo
Published: February 2007

The influence of cyproterone acetate and 17β‐estradiol on the induction of the rat prostate gland by androgens has been investigated in organ culture. The gland develops from its “anlage,” the urogenital sinus, as epithelial buds projecting from the urogenital epithelium into the surrounding mesenchyme. In 16.5‐day‐old male sinuses explanted in organ culture, testosterone or dihydrotestosterone induced such buds de novo; cyproterone acetate or 17/3‐estradiol combined with the androgens competitively inhibit the bud formation in most explants. In contrast, in 18.5‐day male sinuses both anti‐androgens are ineffective, and prostatic buds develop. The difference in response suggests that in the older tissue, exposure to endogenous testosterone before explanation has already set in motion events leading to the differentiation of the gland that are irreversible.
Interstitial radiation therapy for carcinoma of the prostate
Authors: Whitmore Willet F.
Published: February 2007

Pelvic lymph node dissection and iodine 125 implantation has been systematically utilized at Memorial Sloan‐Kettering Cancer Center (MSKCC) since 1970 as one form of management of selected patients with stage B or stage C prostatic cancer. Experience with the technique is reviewed on the basis of previously published data and on the basis of a five‐year follow‐up of the first 100 patients. The operative procedure has been generally well tolerated, with a low morbidity, with a mortality rate of 0.67% (2/300), and with minimal adverse effects on urinary, rectal, and sexual functions. Thirty‐six percent of the patients had regional lymph node metastasis, and such was associated with a 71% incidence of distant metastasis at five years. However, at five years 14% of patients with positive nodes remain free of evidence of neoplasm, and 38% of patients with negative lymph nodes have evidence of bone metastasis. At five years, 11% of patients have evidence of local recurrence only; 19%, distant metastasis only; and 32%, both local recurrence and distant metastasis. Five‐year survival without stratification relative to lymph node involvement is 100% (16/16) for stage B1, 88% (23/26) for stage B2, 66% (6/10) for stage B3, 33% (2/6) for stage C1, 53% (17/32) for stage C2, and 1/1 for stage C3, but endocrine therapy has presumably contributed to such survival in those patients developing intractable local recurrence and/or symptomatic distant metastasis within the five‐year follow‐up.
Characterization of prostatic carcinoma among blacks: A comparison between a low‐incidence area, Ibadan, Nigeria, and a high‐incidence area, Washington, DC
Authors: Jackson Marvin A. , Kovi Joseph , Heshmat Martin Y. , Ogunmuyiwa T. A. , Jones George W. , Williams A. O. , Christian E. C. , Nkposong E. O. , Rao M. S. , Jackson Aaron G. , Ahluwalia B. S.
Published: February 2007

A comparison of carcinoma of the prostate gland in a low‐incidence Nigerian (Ibadan) population and a high‐incidence U.S. Afro‐American (Washington, D.C.) population was the purpose for this study, initiated in 1973. The frequency of carcinoma (micro‐ and invasive) was determined in consecutive necropsy cases from hospitals in Ibadan, Nigeria, Accra, Ghana and Washington, D.C. The results of these clinical, epidemiologic and morphologic studies are reported.

Clinically, the peak incidence of carcinoma of the prostate in Nigerian males in Ibadan and in American males in Washington, D.C. was in the 65‐74 age group. The median age of patients was 66.4 years in Ibadan and 69.2 years in Washington, D.C. Seventy‐five percent of Nigerian and 49% of American patients were in stages III and IV. Overall, the distribution by grade of neoplasms in surgical material from Ibadan and Washington, D.C. was similar. Plasma testosterone and estrone levels were significantly higher (p < 0.05 and p < 0.001) in U.S. patients than in U.S. controls and higher (p < 0.001 and p < 0.05) in U.S. patients than in Nigerian patients with prostatic carcinoma. Plasma testosterone levels were significantly lower (p < 0.05) in Nigerian patients than in Nigerian controls. Estrone levels were not significantly different in Nigerian patients than controls.

Nigerian patients were more sexually active throughout their lives than American patients; however, they reported a higher incidence of impotence than U.S. patients in the immediate 5 years preceding the diagnosis of prostatic carcinoma. Nigerian respondents (patients and controls) arrived at puberty later than their American counterparts. Within each of the two population groups, the factor with the highest relative risk ratio was lower urinary tract symtoms occurring 10 years or longer before the onset of the present complaints which led to the diagnosis of prostatic carcinoma. Nigerian and U.S. patients were more sexually active than controls.

Microcarcinoma (incidental, latent) of the prostate gland occurred with a frequency of 11.8% and at an age‐adjusted incidence rate (world standard) of 40.6 per 1000 necropsies in the sampled U.S. black male population. The age‐adjusted incidence rate (world standard) for microcarcinoma in the combined West African (Accra and Ibadan) series (36.7/1000) was almost equal to the rate (40.6/1000) in the Washington, D.C. series.
Animal models for prostate cancer
Authors: Pollard Morris
Published: February 2007

Four model systems for prostate adenocarcinomas have been developed in rats: they are designated Dunning, Noble, ACI, and Pollard tumors. They have attributes that make them valuable sources of information, of relevance to the disease in man. The development and use of the Pollard tumors as in vitro and in vivo model systems are reviewed, especially on the phenomenon of metastasis. Specific agents either accelerate or retard the rate and extent of metastatic spread of the prostate tumor cells from extravascular sites to specific target organs. Specific enzymes may be involved in the phenomenon of metastasis.
Virology studies and cell lines for prostate cancer
Authors: Merchant Donald J.
Published: February 2007

Immunological and biochemical probes for viral genomes and products, growth in cell culture, co‐culture methods to activate latent genomes, use of activating agents, and electron microscopy have been used in efforts to demonstrate RNA viruses in prostate cancer. Despite findings of C‐type particles and p30 antigens, the role of RNA viruses appears to be secondary, with activation of the virogene being a relatively uncommon occurrence.

No compelling evidence for Herpes II or cytomegalovirus as etiologic agents has emerged, despite their common presence in the urogenital tract. Though the search for integration of fragments of viral genome into host DNA is still in progress, it appears unlikely that these viruses would account for a significant number of prostate carcinomas.

Progress has been achieved in developing simple, reliable, primary culture methods for human prostatic tissue, using explants or dispersed cells. Three cell lines, all from metastatic foci, have been established, are characterized, and are available for distribution. One neonatal cell strain retains many properties of normal prostate.
A survey of 3,000 examinations by transrectal ultrasonotomography
Authors: Watanabe Hiroki , Date Seiki , Ohe Hiroshi , Saitoh Masahito , Tanaka Shigeki
Published: February 2007

As a routine examination for intrapelvic organs, transrectal ultrasonotomography was performed 3,000 times on 2,331 patients from June 1976 to February 1980. In this series, 57 patients were diagnosed as prostatic cancer by transrectal ultrasonotomography and 54 (94.7%) of them were finally diagnosed as cancer by biopsy. Three hundred twenty‐six patients were diagnosed as suspected prostatic cancer, and cancer was confirmed also by biopsy in 12 (3.7%) of them. Among 1,741 patients with various prostatic diseases on whom cancer was ruled out by transrectal ultrasonotomography, there were 2 (0.1%) false‐negative cancer cases.
The value of perineal punch biopsy in estimating the histological grade of carcinoma of the prostate
Authors: Müller H.‐A. , Ackermann R. , Frohmüller H. G. W.
Published: February 2007

The degree of accuracy of the histological grade of carcinoma of the prostate obtained by perineal punch biopsy was analyzed by comparing the histological findings with those of radical prostatectomy specimens. Biopsy specimens of 97 of 100 patients who underwent radical prostatectomy between 1969 and 1979 were reevaluated. In 43% of the cases, perineal punch biopsy revealed a uniform architectural pattern, which was classified as well‐differentiated adenocarcinoma in 21 cases and poorly differentiated adenocarcinoma in 22 cases. However, of the 21 cases determined by biopsy to be uniformly well‐differentiated adenocarcinomas, only seven (33.3%) were confirmed by evaluation of the radical prostatectomy specimens. A uniform, poorly differentiated adenocarcinoma was ultimately found in only five operative specimens of the 22 patients with this preoperative diagnosis. As one case clearly demonstrated, multifocal origin of carcinoma of the prostate is the main source of the frequently occurring error encountered with perineal punch biopsy in determining the grade of differentiation.
Adjuvant chemotherapy to definitive treatment of prostate cancer
Authors: Loening Stefan , Narayana Ambati
Published: February 2007

Even though surgery and/or radiation has been the treatment of choice for early carcinoma of the prostate, there is conclusive evidence that tumor may recur in a certain number of patients at the primary site and/or at a distant location. The only way to achieve a complete cure in these patients with localized cancer appears to be by addition of relatively safe, effective chemotherapeutic agents. Estracyt and/or Cytoxan appear to be such agents. These two drugs showed definite activity in the treatment of patients with advanced prostatic carcinoma. Chemotherapeutic agents appear effective as adjuvant in the treatment of other solid tumors. It is worthwhile that this modality of treatment be tried in patients with early, curable prostatic carcinoma.