bluuebunny/crossref_metadata_2025 huggingface dataset:
Systemic lupus erythematosus and cancer: associated or not?
Authors: Abu-Shakra M , Ehrenfeld M , Shoenfeld Y
Published: October 2002

The frequency of cancer in patients with SLE is between 2.5 and 13.8%. A literature review has identified nine full-length studies that estimated the overall risk of cancer in SLE patients compared with the general population. Five of them have not noted an increased risk for the development of overall cancers among SLE patients compared with the general population. One study identi”ed a 30% increased risk (SIR or 1.3) for occurrence of cancer among 1585 SLE patients followed over 10 807 patient-years. Taken together, it is controversial whether the risk of all cancers is increased in SLE patients compared with the general population.

Increased risk of lymphatic malignancies has been shown in multiple large series of SLE patients, but SLE is not associated with an increased risk for the development of most of the solid tumors.

Pathogenic mechanisms involved with the development of lymphoproliferative malignancies in association with SLE include a common etiologic agent for both diseases, environmental factors as the use of cytotoxic or immunosuppressive agents, genetic variables, and immunologic factors as immunoregulatory disturbances of the immune system.
Shwartzman phenomenon in a patient with active systemic lupus erythematosus preceding fatal disseminated intravascular coagulation
Authors: Riemekasten G , Ziemer S , Häupl T , Melzer C , Loddenkemper K , Hauptmann S , Burmester G R , Hiepe F
Published: October 2002

The recurrence of widespread and diverse vascular lesions is a hallmark of systemic lupus erythematosus (SLE). Inflammatory and thrombotic mechanisms almost invariably associated with circulating antiphospholipidantibodies play a role in the pathogenesisof SLE-related vascular disease. Both mechanisms can coexist in the same patient. Vasculitis is most commonly induced by the local deposition of immune complexes. However, some SLE patients have an inflammatory complement-mediated vascular injury in the absence of immune complex deposition.

We report on a fatal case of disseminated intravascular coagulation (DIC) in a young woman with active SLE. Hemorrhagic lesions due to localized intravascular coagulation (Shwartzman phenomenon) preceded disseminated intravascular coagulation accompanied by disseminated cardiac necrosis. Immune complex ‘independent’ and other mechanisms of vascular injury and states of hypercoagulability will be discussed.
Cardiovascular autonomic function in systemic lupus erythematosus
Authors: Hogarth M B , Judd L , Mathias C J , Ritchie J , Stephens D , Rees R G
Published: October 2002

Aim: To determine whether cardiovascular autonomic function is impaired in systemic lupus erythematosus (SLE).

Methods: A case–control study of 23 patients with SLE was performed. Autonomic symptoms were assessed using a standard questionnaire. Cardiovascular autonomic function was measured using 10 non-invasive investigations.

There were significant differences between patients and controls in three out of 24 parameters measured during the different tests (P < 0.002). These were reduction in systolic blood pressure at 5 min on head-up tilt, and heart rate responses to isometric exercise and cutaneous cold. Eleven out of 23 patients had an abnormal heart rate, blood pressure or Valsalva response (value below the age corrected 5th centile) while testing compared with six of the controls. Plasma adrenaline and noradrenaline levels were significantly lower in patients vs controls in both the supine (P < 0.05) and tilt position (P < 0.01). Twenty-one of the 23 patients had one or more symptoms that may be attributable to abnormalities in autonomic function. There was no significant association between the number of symptoms and presence of autonomic dysfunction.

Cardiovascular autonomic impairment may be demonstrated in some patients with SLE. Symptoms attributable to autonomic dysfunction are common in SLE and autonomic assessment may be required.
Protective effect of hydroxychloroquine in systemic lupus erythematosus. Prospective long-term study of an Israeli cohort{
Authors: Molad Y , Gorshtein A , Wysenbeek A J , Guedj D , Majadla R , Weinberger A , Amit-Vazina M
Published: October 2002

Systemic lupus erythematosus-associated irreversible organ/system damage was previously associated with various clinical and demographic features. We analysed the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI) in a cohort of 151 Israeli patients followed for a mean (§ s.d.) period of 45.7§ 37.4 months. Mean score of SLICC/ACR DI at the first and last encounters were 0.17§ 64 and 1.64§ 2.1, respectively (P < 0.0001). Multiple logistic regression analyses disclosed a statistically significant positive correlation with corticosteroid and cyclophosphamide therapy. Hydroxychloroquine therapy was significantly associated with lower SLICC/ACR DI. Although the size of our study group did not allow us to find specific organs/systems which were associated with the protective effect of hydroxychloroquine, we suggest this is due to the antiatherogenic effects attributed to antimalarial therapy in SLE.
Production and characterization of human monoclonal anti-idiotype antibodies to anti-dsDNA antibodies
Authors: Zhang W , Frank M B , Reichlin M
Published: October 2002

Anti-dsDNA autoantibodiesare the hallmark of systemic lupus erythematosus(SLE) and frequently correlate with disease activity. In this study we report the isolation and characterization of human anti-Id monoclonal antibody fragments as single-chain Fv fragments (scFv) against anti-dsDNA antibody. The anti-Id monoclonal antibodies, specific for anti-dsDNA antibodies, have been cloned from phage display antibody scFv libraries derived from a patient with SLE. The V gene repertoires were derived from the RNA obtained from the B cells of an SLE patient with anti-Ro/SSA and anti-La/SSB antibodies. Affinity-puri”ed anti-dsDNA antibodies were used for selection of bacterial clones producing specific scFv antibody fragments against anti-dsDNA antibodies and little reactivity with normal IgG and other IgG antibodies by ELISA. The anti-Id antibody recognizes a public idiotope that is broadly cross-reactive with polyclonal and monoclonal anti-dsDNA antibodies. This binding was largely inhibited by dsDNA antigen. The anti-Id antibody inhibited anti-dsDNA binding to dsDNA antigen in immunoassays and in the Crithidia luciliae assay. The anti-Id scFv antibody fragments derived from human genes could modulate the pathogenicity of anti-dsDNA autoantibodies and may have therapeutic implications in SLE. They may also be used as probes in studies of the structure of the idiotype.
Antiribosomal P protein antibodies in Chilean SLE patients: no association with renal disease
Authors: Massardo L , Burgos P , Martínez M E , Pérez R , Calvo M , Barros J , González A , Jacobelli S
Published: October 2002

The objective of this work was to determine the frequency and clinical associations of antiribosomal P protein antibodies (Anti-P) in a cohort of Chilean patients with systemic lupus erythematosus (SLE). Between 1996 and 1998, 141 consecutive patients with SLE were examined prospectivelyaccording with a standard protocol. Disease activity was measured by MEX-SLEDAI in 138 patients. Anti-P positivity was determined by double immune diffusion or Western blot and ELISA. Anti-P was found in 21 (15%) patients. In the Anti-P positive patients recent onset SLE (disease duration of 1 year or less) was more frequent (P=0.018). Anti-P was found in 23% of 83 patients with active SLE vs 4% of the 55 patients with inactive SLE (Yates corrected P=0.00479). An association with anti-dsDNA antibodies by Farr assay was observed. Anti-P positive patients had a median Farr of 65 IU/ml (1.4–1240) and Anti-P negative of 12 IU/ml (1.4–992; P-value=0.0084). During the study only two patients had lupus psychosis and they were Anti-P positive. No association was found with liver disease (six patients, two with Anti-P antibodies) or active glomerulonephritis(22 patients, four with Anti-P). Our data shows that the presence of Anti-P antibodies supports the clinical diagnosis of lupus psychosis.
Proportional hazards models with random effects to examine centre effects in multicentre cancer clinical trials
Authors: Yamaguchi T , Ohashi Y , Matsuyama Y
Published: October 2002

In randomized clinical trials comparing treatment effects on diseases such as cancer, a multicentre trial is usually conducted to accrue the required number of patients within a reasonable period of time. The fundamental point of conducting a multicentre trial is that all participating investigators must agree to follow the common study protocol. However, even with every attempt having been made to standardize the methods for diagnosing severity of disease and evaluating response to treatment, for example, they might be applied differently at different centres, and these may vary from comprehensive cancer centres to university hospitals to community hospitals. Therefore, in multicentre trials there is likely to be some degree of variation (heterogeneity) among centres in both the baseline risks and the treatment effects. While we estimate the overall treatment effect using a summary measure such as hazard ratio and usually interpret it as an average treatment effect over the centre, it is necessary to examine the homogeneity of the observed treatment effects across centres, that is, treatment-by-centre interaction. If the data are reasonably consistent with homogeneity of the observed treatment effects across centres, a single summary measure is adequate to describe the trial results and those results will contribute to the scientific generalization, the process of synthesizing knowledge from observations. On the other hand, if heterogeneity of treatment effects is found, we should carefully interpret the trial results and investigate the reason why the variation is seen. In the analyses of multicentre trials, a random effects approach is often used to model the centre effects. In this article, we focus on the proportional hazards models with random effects to examine centre variation in the treatment effects as well as the baseline risks, and review the parameter estimation procedures, frequentist approach - penalized maximum likelihood method - and Bayesian approach - Gibbs sampling method. We also briefly review the models for bivariate responses. We present a few real data examples from the biometrical literature to highlight the issues.
Partitioning and peeling for constructing prognostic groups
Authors: LeBlanc Michael , Jacobson Joth , Crowley John
Published: October 2002

We investigate methods for identifying groups of patients with different prognosis. Our focus is on procedures that yield interpretable descriptions for groups of patients and corresponding regions of the predictor space. These strategies include tree-based methods and techniques which construct a single prognostic group through ‘peeling’ or refining of a larger group patients. The peeling methods are relatively new and are developed in detail. Simulations and examples for describing groups of patients with poor outcomes using data from a clinical trial for patients with multiple myeloma are presented.
Alemtuzumab (Campath-1H, Campath1) for the treatment of lymphoid malignancies: chronic lymphocytic leukemia and T-cell prolymphocytic leukemia
Authors: Wu Helen T
Published: October 2002

Objective. To provide a comprehensive review of the clinical pharmacology and toxicology of the monoclonal antibody alemtuzumab, with particular reference to its use in its approved indication, B-cell chronic lymphocytic leukemia, as well as the non-approved indication, T-cell prolymphocytic leukemia.

Data Sources. A MEDLINE search was conducted using the terms ‘alemtuzumab’ and ‘Campath.’ All data available from MEDLINE were reviewed. The reference lists from retrieved articles were reviewed and other relevant papers identified. The abstract books from the annual meetings of the American Society of Hematology were also reviewed.

Data Extraction. The aim of the review was to be comprehensive and descriptive. Studies containing information deemed to be of interest were reviewed by the author.

Data Summary. CD52 is a surface antigen expressed on all B- and T-lymphocytes. Because of the presence of this surface antigen on both normal and malignant lymphocytes, the use of antibody as a treatment option is then possible. Alemtuzumab (Campath-1H, Campath1) is a humanized anti- CD52 antibody that has been shown to be active against certain hematological malignancies, particularly lymphoproliferative diseases in the blood. The overall response rate for patients with chronic lymphocytic leukemia relapsed after fludarabine or alkylating therapy ranged from 33% to 70%, with most patients entering partial remission. The average duration of response is approximately 11 - 12 months. For patients with T-cell prolymphocytic leukemia failed first-line chemotherapy, overall response rate to alemtuzumab therapy ranged from 76% to 31%, with majority of patients entering complete remission. The average duration of response is approximately 7-9 months. Major adverse effects of alemtuzumab include infusion-related reactions, prolonged lymphopenia, and opportunistic infections (CMV, Herpes zoster, and PCP). Prophylactic use of acyclovir and trimethroprim/sulfamethoxazole are recommended while patient is receiving alemtuzumab and continued for 2 months after alemtuzumab therapy is completed.
Cortisol is increased in postmortem cerebrospinal fluid of multiple sclerosis patients: relationship with cytokines and sepsis
Authors: Erkut Z A , Endert E , Huitinga I , Swaab D F
Published: October 2002

Hypothalamo-pituitary-adrenal (HPA) axis activity is altered in patients with multiple sclerosis (MS), resulting in elevated basal levels and enhanced response of cortisol in stimulation tests. HPA axis hyperactivation in MS is thought to be the result of complex interactions of genetic, immunologic, and neuroendocrinological mechanisms. In order to investigate whether cytokine levels in the central nervous system are associated with the activation of the HPA axis in MS, we measured cortisol, interleukin (IL)-6, IL-10 and TNF-α levels in postmortem cerebrospinal fluid (CSF) of 18 patients with severe MS and 50 controls. We also investigated the cortisol and cytokine levels in the CSF of a group of MS patients and controls who died with sepsis, in order to see whether acute infectious situations affect the association between cortisol and cytokines. The cortisol levels in MS patients were increased by 80% in comparison to controls (p =0.008). There was no difference in IL-6 levels between the groups, while IL-10 and TNF-α levels of the majority of subjects were below detection limits. There was a positive correlation between cortisol and IL-6 only in control patients with sepsis (r=0.89, p =0.019), but not within the MS patients with sepsis or MS and control groups without sepsis. Cortisol levels in postmortem serum and CSF were highly correlated (r >0.78, p <0.001). We concluded that the basal level of cortisol is significantly increased in the CSF of MS patients and that IL-6 is not responsible for this rise. The relationship between cortisol and IL-6 in sepsis is discussed.
Cerebral blood flow velocity changes to visual stimuli in patients with multiple sclerosis
Authors: Uzuner N , Özkan S , Gücüyener D , Özdemir G
Published: October 2002

We assessed the blood flow velocity (BFv) changes to visual stimuli using transcranial Doppler (TCD) in patients with multiple sclerosis (MS) during an exacerbation period by means of vasoneuronal coupling. Eighty-four patients (19 men, 75 women) and 45 healthy subjects (14 men, 31 women) were studied. Both posterior cerebral arteries (PCAs) were simultaneously monitored by TCD sonography during 10 cycles of 20 s eyes open observing complex moving visual images, and 20 s eyes closed at the end of every cycle. TCD sonography was performed at least at the first 2 days of exacerbation. Mean cerebral BFv throughout the procedure (p =0.003, p =0.001; right and left sides, respectively), velocity at rest (p =0.001, p <0.001), and velocity at stimulation (p =0.021, p =0.01) on both PCAs were significantly lower in patients than controls. However, BFv changes to visual stimulation on both sides were significantly higher in patients (p =0.01, p =0.031) compared to controls. There were negative correlations between P100 latencies and relative blood flow changes on both sides, but it was not significant on the left side. These results may suggest that patients with MS during exacerbation have more reactive vessels in the posterior circulation and/or more reactive neurons in the occipital cortex.
Metabolic differences between multiple sclerosis subtypes measured by quantitative MR spectroscopy
Authors: Pan J W , Coyle P K , Bashir K , Whitaker J N , Krupp L B , Hetherington H P
Published: October 2002

We used quantitative magnetic resonance (MR) spectroscopic imaging with T1-based image segmentation to evaluate the subtypes of multiple sclerosis (MS) (eight patients each group of relapsing-remitting [RR], secondary progressive [SP] and primary progressive [PP]). There was no significant difference in age between the PP group with the RR, SP or control group. We found that the metabolite ratio of choline/NA from the periventricular white matter region was not significantly different between the RR and SP groups. Using an ANOVA, the ratios of periventricular choline/NA or creatine/NA of these combined groups were significantly higher than the PP and control groups. Quantification of these data suggest that the major cause of the elevation of these parameters is due to an increase in choline and creatine in the RR group while NA is decreased in the SP group. Thus, early PP disease appears to be relatively intact with respect to neuronal loss.
Cerebral plasticity in multiple sclerosis: insights from fMRI
Authors: Cifelli A , Matthews P M
Published: October 2002

Functional magnetic resonance imaging (fMRI) allows noninvasive localization of cerebral activation with relatively high spatial and temporal resolution. The considerable potential for the elucidation of the mechanisms of brain function has made it a useful tool to investigate the neural substrate of motor, sensory and cognitive functions. Understanding derived from these basic cognitive neuroscience investigations is beginning to be applied to clinically relevant problems. In this article, applications to multiple sclerosis (MS) are reviewed, which address the challenging notion that adaptive cerebral plasticity may have an important influence on the relationship between MS pathology and its clinical expression.
Postmethionine-load homocysteine determination for the diagnosis hyperhomocysteinaemia and efficacy of homocysteine lowering treatment regimens
Authors: van der Griend René , Biesma Douwe H , Banga Jan-Dirk
Published: October 2002

Substantial epidemiological evidence supports the vision that moderate hyperhomocysteinaemia is a graded and independent cardiovascular risk factor. The additional value of the methionine loading test for the assessment of hyperhomocysteinaemiacontinues to be disputed.

This overview presents the historical background for the rationale of the methionine loading test and describes determinants and variability of the postmethionine-load homocysteine concentration. The association of postmethionine-load homocysteine concentrations and the risk of cardiovascular events is discussed. Furthermore, the results of homocysteine lowering treatment on postmethionine-load homocysteine are given.

Up to 50% of subjects with hyperhomocysteinaemia can only be detected after performing a methionine loading test; these subjects have a normal fasting homocysteine. Both fasting and postmethionine-load homocysteine concentrations are influenced by serum folate and creatinine concentrations and by the methylenetetrahydrofolate reductase genotype, and may be subject to a wide intra-individual variability (20%).

Cross-sectional studies suggest that cardiovascular risk may increase gradually from post-methionine-load homocysteine concentrations above 38 m mol/l. Supplementation with folic acid 0.5 mg daily adequately reduces postmethionine-load homocysteine; addition of pyridoxine appears to have no further homocysteine lowering effect.

Prospective studies supporting the clinical significance of the methionine loading test for individual patient counselling are lacking; it seems, therefore, prudent to restrict this test for research purposes.
Brachial arteriomegaly and true aneurysmal degeneration: case report and literature review
Authors: Schunn Christian D , Sullivan Timothy M
Published: October 2002

While brachial artery aneurysms are rare and usually of infectious, post-traumatic or iatrogenic etiology, true aneurysms of the brachial artery are even more unusual. We report on a large brachial artery aneurysm complicated by chronic contained rupture and partial outflow obstruction. This was observed 19 years after ligation of a radiocephalic (Brescia-Cimino) arteriovenous fistula for hemodialysis that had existed for 2 years. Of 581 brachial artery reconstructions performed at the Cleveland Clinic Foundation between January 1989 and December 2000, only three involved repairs of brachial artery aneurysms; only the reported case was a true aneurysm of degenerative origin for an incidence of 0.17% (1/581). The management of brachial artery aneurysms is described and the pertinent literature was reviewed.
Potential energy saving for a side-lit room using daylight-linked fluorescent lamp installations
Authors: To Daniel Wah Tong , Sing Leung King , Chung TM , Leung CS
Published: October 2002

The high frequency (HF) electronic ballast has been replacing the conventional magnetic ballast for operating fluorescent lamps. It has the advantage of low energy consumption, running the lamps free from stroboscopic effects, low noise production, being light weight and allowing the lamps to be dimmed. This study shows that for a cellular office at the perimeter of a building lit by a dimmable HF electronic ballast lighting, about 40% of the lighting energy could be saved under Hong Kong’s daylight conditions. A saving of 40% at the perimeter amounts to an overall lighting energy saving of about 10% if the perimeter area is about one quarter of the total floor area. Lighting energy normally accounts for about 30% of the total energy consumption for office buildings. For a shallow plan office building, the amount of saving using a daylight linked system could be significant.
Child abuse: recognizing the injuries
Authors: Sunderland R
Published: October 2002

The social, biological and historical context of non-accidental children’s injuries is discussed. Clinical features of physical, emotional, sexual and artefactual abusive injuries are presented. The importance of considering natural, disease and accidental causes is stressed.
Development as freedom: the spaces of Amartya Sen
Authors: Corbridge Stuart
Published: October 2002

The field of development studies owes a great debt to Amartya Sen. This paper reviews the strengths and weaknesses of Sen’s account of ‘development as freedom’. It considers how Sen has developed his arguments in terms of four key ‘spaces’: what he calls the space of economic or moral evaluation, and what I call the spaces of geography, culture and politics. If there are problematic areas in Sen’s work, they lie in his treatments of authoritarian rule, of the rights to difference of certain social groups, and of political power, and in the indeterminacy of some of his policy recommendations.
‘Greening the Emirates’: the modern construction of nature in the United Arab Emirates
Authors: Ouis Pernilla
Published: October 2002

As part of the project of postcolonial national modernization, the United Arab Emirates has seen the transformation of significant areas of the country’s desert environment into green landscapes, with enormous resources devoted to agricultural development, park landscaping and nature reserves. In addition, recent years have also seen the creation of a number of social institutions dealing with environmental issues. This paper critically considers this dual ‘greening of the emirates’. Analysing the material, cultural and social construction of this green nature, I argue that it must be seen in the context of a shift from a premodern to a modern relationship to nature. However, whilst in part this has meant the use of oil money to import what are seen as Western environmental technologies and ideas, it has also involved the construction of a distinctive Emirati form of modern nature. The paper concludes with a discussion of how this represents a case of the ‘glocal’ geographies of ecological modernization.
Evaluation of Guidelines for Ordering Prothrombin and Partial Thromboplastin Times
Authors: Auble Thomas E. , Taylor David McD. , Hsu Edbert B. , Yealy Donald M.
Published: October 2002

Objectives: Existing clinical practice guidelines for ordering prothrombin time (PT) and partial thromboplastin time (PTT) tests in the emergency department (ED) include physician expectation of an invasive procedure as a criterion. This study sought to determine whether this criterion accurately identifies patients who undergo an invasive procedure and whether an amalgam of these guidelines identifies patients at low risk of an adverse medical outcome. Methods: A prospective observational cohort study of adults treated in a university medical center ED between July 1997 and March 1998. Physicians were surveyed at order placement to determine the presence of guideline criteria. Adverse clinical outcomes defined as an International Normalized Ratio [INR] > 1.3 or PTT > 39.9 seconds combined with consequent directed medical therapy were abstracted from ED and the first 24 hours of inpatient medical records. Results: The sensitivity of ED physician expectation of an invasive procedure was 60.0%; therefore, it was excluded from both the PT and PTT guidelines. There were 553 patients with a PT test order; test order indications were absent in 190 (34.4%), of which one (0.5%, 95% CI = 0.1% to 2.9%) had adverse outcomes. There were 547 patients with a PTT test; test order indications were absent in 226 (41.3%), of which three (1.3%, 95% CI = 0.4 to 3.8%) had adverse outcomes. All three were taking warfarin when they presented to the ED. Conclusions: Emergency department physician expectation of an invasive procedure for patients with PT or PTT test orders is an insensitive predictor of patients who undergo such procedures. Clinical practice guidelines that exclude this criterion identify ED patients at the time of ED presentation at low risk for adverse medical outcomes in the ED or shortly after admission.
Emergency Department Resuscitative Procedures: Animal Laboratory Training Improves Procedural Competency and Speed
Authors: Custalow Catherine B. , Kline Jeffrey A. , Marx John A. , Baylor Michael R.
Published: October 2002

Certain resuscitative procedures can be lifesaving, but are performed infrequently by emergency medicine (EM) residents on human subjects. Alternative training methods for gaining procedural proficiency must be explored and tested. Objective: To test whether animal laboratory training (ALT) is associated with sustained improvement in procedural competency and speed. Methods: After watching an educational videotape of saphenous cutdown (SAPH), thoracotomy (THOR), and cricothyroidotomy (CRIC), EM residents were randomized to receive either a tutored ALT session on live anesthetized pigs (Group A) or no ALT session (Group B). Residents were tested six months later by performing procedures on live anesthetized pigs. Videotaped procedures were evaluated by blinded examiners for the number of critical steps, complications, and procedure times. Results: Group A (n = 10) achieved a higher number of critical steps compared with Group B (n = 8) for SAPH (15.4 ± 0.7 vs. 9.0 ± 1.8, p = 0.03) and THOR (17.4 ± 0.6 vs. 12.3 ± 1.6, p = 0.009), but not CRIC (18.1 ± 0.4 vs. 16.2 ± 1.0, p = 0.1). Group A completed procedures in less time than Group B for SAPH (Wilcoxon χ2= 4.0, p = 0.04) and THOR (χ2= 4.4, p = 0.04), but not CRIC (χ2= 0.9, p = 0.3). There was no difference in the number of complications for any of the procedures. Conclusion: Residents with animal laboratory training six months prior to testing demonstrated improved procedural competency and speed in the performance of resuscitative procedures.
Low Prevalence of Chlamydia trachomatis by Urinary Ligase Chain Reaction in Women Patients in the Emergency Department
Authors: Doezema David , Hepworth Edward , Young Stephen A. , Arguelles Carlos A. , Brillman Judith C. , Tandberg Dan
Published: October 2002

Recent studies suggest that women with acute urethral syndrome or abdominal pain, presenting to emergency departments (EDs), have a high prevalence of Chlamydia trachomatis. Objectives: To estimate the prevalence of C. trachomatis in women presenting to an ED and to see whether those with dysuria or abdominal pain have a higher prevalence of C. trachomatis. Methods: The authors conducted a prospective cross‐sectional study of C. trachomatis in the urine of women aged 18 to 50 years who had a urinalysis performed at a university/county ED from February through May 1998. Urine specimens were labeled for the presence of symptoms and analyzed for C. trachomatis by ligase chain reaction (LCR). Polymerase chain reaction (PCR) testing of cervical swabs for C. trachomatis was done for usual clinical indications. Difference in proportions of positive LCR tests among patients was tested with Fisher's exact test. Agreement between PCR and LCR was measured using Cohen's kappa statistic. Results: Of 397 women whose urine was tested, 280 had symptoms of dysuria, abdominal pain, or both, and 117 had no symptoms. The overall prevalence of C. trachomatis by LCR was 3.8% (95% CI = 2.1% to 6.2%); and the combined PCR—LCR prevalence was 4.3% (95% CI = 2.5% to 6.8%). The presence of symptoms was not associated with a positive LCR test for C. trachomatis (p = 0.26, power = 0.8, alpha = 0.05, difference 3% vs. 12%). In the 172 patients who had both a PCR cervical swab and urine LCR, agreement was excellent (kappa = 0.67, 95% CI = 0.45 to 0.90). Conclusions: This ED had a surprisingly low prevalence of C. trachomatis. Women with symptoms were not more likely to test positive than those without.
Injury Mortality Following the Loss of Air Medical Support for Rural Interhospital Transport
Authors: Mann N. Clay , Pinkney Kerrie A. , Price Daniel D. , Rowland Donna , Arthur Melanie , Hedges Jerris R. , Mullins Richard J.
Published: October 2002

Objectives: This study evaluated variation in mortality among interfacility transfers three years before and after discontinuation of a rotor‐wing transport service. Methods: A retrospective cohort assessment was conducted among severely injured patients transferred from four rural hospitals to a single tertiary center in regions with continued versus discontinued rotor‐wing service. Thirty‐day mortality following discharge from the receiving tertiary facility served as the primary outcome measure. Results: Discontinuation of rotor‐wing transport decreased interfacility transfers and increased transfer time. Transferred patients were four times more likely to die after (compared with before) rotor‐wing service was discontinued (p = 0.05). No difference was noted in the region with continued rotor‐wing service [odds ratio (OR) = 0.53, p = 0.47]. Conclusions: Injury mortality increased with loss of air transport for interfacility transfer in a rural area.
Untreated Hypercholesterolemia in an Emergency Department Chest Pain Observation Unit Population
Authors: Chandra Abhinav , Compton Scott , Sochor Mark , Puri Sankalp , Zalenski Robert J.
Published: October 2002

Objectives: To describe the prevalence of hypercholesterolemia in a predominantly African American, innercity chest pain observation unit (CPOU) patient population, and to estimate the percentage of patients eligible for cholesterol‐lowering therapy as indicated by the 2001 National Cholesterol Education Program guidelines.

Methods: A cross‐sectional study design utilizing a convenience sample of patients from a high‐volume urban hospital CPOU. Patients with chest pain suspicious of cardiac etiology who had negative initial electrocardiograms and cardiac markers were assigned to the chest pain protocol. Consenting subjects were screened for hypercholesterolemia through capillary blood point‐of‐care testing with a cutoff of 190 mg/dL. Those who tested positive had four‐hour fasting complete lipid profiles performed by the central laboratory. Results: There were 112 patients enrolled in this study (mean age = 51 years; 57% male; and 83% African American). Elevated values on the screening test were obtained on 28 [25%; 95% confidence interval (95% CI) = 16.9 to 33.0] of these patients. These patients were found to have a mean four‐hour fasting total cholesterol level of 224 mg/dL, a low‐density lipoprotein (LDL) level of 138 mg/dL, a high‐density lipoprotein (HDL) level of 52 mg/dL, and a triglyceride level of 168 mg/dL. Of the patients identified through the screening test, 54% proved eligible for cholesterol‐lowering medications and 91.7% of these patients reported an interest in initiating therapy. Conclusions: In this study, approximately 25% of inner‐city CPOU patients are possible candidates for cholesterol‐lowering interventions. Benefits of initiating therapy during this potential “teachable moment” in a CPOU should be investigated in a subsequent multicenter randomized trial.
Efficacy and Costs of Two Forms of Stress Management Training for Cancer Patients Undergoing Chemotherapy
Authors: Jacobsen Paul B. , Meade Cathy D. , Stein Kevin D. , Chirikos Thomas N. , Small Brent J. , Ruckdeschel John C.
Published: October 2002

PURPOSE: Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy. The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver.

PATIENTS AND METHODS: Four hundred eleven patients about to start chemotherapy were randomly assigned to receive usual psychosocial care only, a professionally administered form of stress management training, or a patient self-administered form of stress management training. Quality-of-life assessments were conducted before randomization and before the second, third, and fourth treatment cycles. Intervention costs were estimated from both payer and societal perspectives.

RESULTS: Compared with patients who received usual care only, patients receiving the self-administered intervention reported significantly (P ≤ .05) better physical functioning, greater vitality, fewer role limitations because of emotional problems, and better mental health. In contrast, patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only. Costs of the self-administered intervention were estimated to be 66% (from a payer perspective) to 68% (from a societal perspective) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy.

CONCLUSION: Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment.
Pyothorax-Associated Lymphoma: A Review of 106 Cases
Authors: Nakatsuka Shin-ichi , Yao Masayuki , Hoshida Yoshihiko , Yamamoto Satoru , Iuchi Keiji , Aozasa Katsuyuki
Published: October 2002

PURPOSE: Pyothorax-associated lymphoma (PAL) is a non-Hodgkin’s lymphoma developing in the pleural cavity after a long-standing history of pyothorax. Full details of PAL are provided here.

PATIENTS AND METHODS: Clinical and pathologic findings were reviewed in 106 patients with PAL collected through a nationwide survey in Japan.

RESULTS: Age of the patients with PAL was 46 to 82 years (median, 64 years), with a male/female ratio of 12.3:1. All patients had a 20- to 64-year (median, 37-year) history of pyothorax resulting from artificial pneumothorax for treatment of pulmonary tuberculosis (80%) or tuberculous pleuritis (17%). The most common symptoms on admission were chest and/or back pain (57%) and fever (43%). Laboratory data showed that the serum neuron-specific enolase level was occasionally elevated (3.55 to 168.7 ng/mL; median, 18.65 ng/mL), suggesting a possible diagnosis of small-cell lung cancer. Histologically, PAL usually showed a diffuse proliferation of large cells of B-cell type (88%). In situ hybridization study showed that PAL in 70% of the patients was Epstein-Barr virus (EBV)-positive. PAL was responsive to chemotherapy, but the overall prognosis was poor, with a 5-year survival of 21.6%.

CONCLUSION: This study established the distinct nature of PAL as a disease entity. PAL is a non-Hodgkin’s lymphoma of exclusively B-cell phenotype in the pleural cavity of patients with long-standing history of pyothorax, and is strongly associated with EBV infection. Development of PAL is closely related to antecedent chronic inflammatory condition; therefore, PAL should be defined as malignant lymphoma developing in chronic inflammation.
Quality of Life of Long-Term Survivors of Non–Small-Cell Lung Cancer
Authors: Sarna Linda , Padilla Geraldine , Holmes Carmack , Tashkin Donald , Brecht Mary Lynn , Evangelista Lorraine
Published: October 2002

PURPOSE: To describe the quality of life (QOL) among survivors of non–small-cell lung cancer (NSCLC).

PATIENTS AND METHODS: One hundred forty-two 5-year minimum self-reported disease-free survivors of NSCLC completed QOL instruments (QOL-Survivor and Medical Outcomes Study 36-Item Short Form [SF-36]) and assessments of emotional distress (Center for Epidemiologic Studies Depression Scale [CES-D]), comorbid disease, and tobacco use. Pulmonary function was assessed with a hand-held spirometer. Multivariate regression methods were used on total QOL-Survivor scores and physical (PC) and mental (MC) component scores of the SF-36.

RESULTS: The majority (71%) of survivors described themselves as hopeful, and 50% viewed the cancer experience as contributing to positive life changes (QOL-Survivor). Comorbidity was common (60% ≥ one condition); 22% had distressed mood (CES-D ≥ 16). Most were former smokers (76%); 13% continued to smoke. Half had moderate/severe pulmonary distress (forced expired volume in 1 second [FEV1] < 70% of predicted). Regression models including the set of variables (age, sex, living alone, education, smoking status, pulmonary function category, distressed mood, time since diagnosis, and comorbidity) accounted for 37%, 48%, and 29% in the QOL-total, MC, and PC scores, respectively. Primary predictors of lower QOL scores were white ethnicity and distressed mood (CES-D ≥ 16) (34% of the variance explained). The primary predictor of lower MC scores was distressed mood (R2 = 0.45). Lower PC scores were associated with older age, living alone, FEV1 less than 70% of predicted, distressed mood, time since diagnosis, and more comorbid diseases (R2 = 0.28).

CONCLUSION: These findings provide the first description of the QOL of long-term survivors of lung cancer. Risk factors for poorer QOL are strongly linked to distressed mood, which is a potential target for intervention.
Combined-Modality Treatment and Selective Organ Preservation in Invasive Bladder Cancer: Long-Term Results
Authors: Rödel Claus , Grabenbauer Gerhard G. , Kühn Reinhard , Papadopoulos Thomas , Dunst Jürgen , Meyer Martin , Schrott Karl M. , Sauer Rolf
Published: October 2002

PURPOSE: To evaluate our long-term experience with combined modality treatment and selective bladder preservation and to identify factors that may predict treatment response, risk of relapse, and survival.

PATIENTS AND METHODS: Between 1982 and 2000, 415 patients with bladder cancer (high-risk T1, n = 89; T2 to T4, n = 326) were treated with radiotherapy (RT; n = 126) or radiochemotherapy (RCT; n = 289) after transurethral resection (TUR) of the tumor. Six weeks after RT/RCT, response was evaluated by restaging-TUR. In case of complete response (CR), patients were observed at regular intervals. In case of persistent or recurrent invasive tumor, salvage-cystectomy was recommended. Median follow-up was 60 months (range, 6 to 199 months).

RESULTS: CR was achieved in 72% of patients. Local control after CR without muscle-invasive relapse was maintained in 64% of patients at 10 years. Distant metastases were diagnosed in 98 patients with an actuarial rate of 35% at 10 years. Ten-year disease-specific survival was 42%, and more than 80% of survivors preserved their bladder. Early tumor stage and a complete TUR were the most important factors predicting CR and survival. RCT was more effective than RT alone in terms of CR and survival. Salvage cystectomy for local failure was associated with a 45% disease-specific survival rate at 10 years. Cystectomy because of a contracted bladder was restricted to 2% of patients.

CONCLUSION: TUR with RCT is a reasonable option for patients seeking an alternative to radical cystectomy. Ideal candidates are those with early-stage and unifocal tumors, in whom a complete TUR is accomplished.
Results of a Phase II Study With Doxorubicin, Etoposide, and Cisplatin in Patients With Fully Characterized Small-Cell Carcinoma of the Prostate
Authors: Papandreou Christos N. , Daliani Danai D. , Thall Peter F. , Tu Shi-Ming , Wang Xuemei , Reyes Adriana , Troncoso Patricia , Logothetis Christopher J.
Published: October 2002

PURPOSE: To determine the activity and toxicity of doxorubicin in combination with cisplatin and etoposide in patients with small-cell prostate carcinoma (SCPCa) and to characterize the clinicopathologic features of SCPCa.

PATIENTS AND METHODS: Patients with SCPCa (pure or mixed), measurable disease, good organ function, and no prior treatment with doxorubicin, etoposide, or cisplatin were treated every 4 weeks with doxorubicin 50 mg/m2 as a 24-hour intravenous (IV) infusion followed by etoposide 120 mg/m2/d and cisplatin 25 mg/m2/d IV on days 2 to 4.

RESULTS: Thirty-eight patients (36 assessable for response) were treated for a median of four cycles. Twenty-nine (81%) of 36 patients had prior hormonal therapy. Study patients had visceral metastases, lytic bone disease, and relatively low serum prostate-specific antigen (PSA). We observed 22 partial responses (response rate, 61% in an intent-to-treat analysis); toxicity was severe (grade 3 or 4 neutropenia 100%, thrombocytopenia 66%, mucositis 21%, and infection 68%). Three patients died of toxicity. Median time to progression and overall survival time were 5.8 months and 10.5 months, respectively. Performance status, serum albumin, and number of organs involved (but not PSA, carcinoembryonic antigen, or neuroendocrine markers) were predictors of survival.

CONCLUSION: SCPCa presents unique clinicopathologic features. Addition of doxorubicin to the etoposide/cisplatin regimen caused higher toxicity in this patient population and failed to improve outcome. Given these results, we do not recommend further development of this regimen for patients with SCPCa. Improvement in therapy will come from understanding the biology of SCPCa progression and integrating new targeted therapies into the treatment of SCPCa.
Phase III Study of Concurrent Versus Sequential Thoracic Radiotherapy in Combination With Cisplatin and Etoposide for Limited-Stage Small-Cell Lung Cancer: Results of the Japan Clinical Oncology Group Study 9104
Authors: Takada Minoru , Fukuoka Masahiro , Kawahara Masaaki , Sugiura Takahiko , Yokoyama Akira , Yokota Soichiro , Nishiwaki Yutaka , Watanabe Koshiro , Noda Kazumasa , Tamura Tomohide , Fukuda Haruhiko , Saijo Nagahiro
Published: October 2002

PURPOSE: To evaluate the optimal timing for thoracic radiotherapy (TRT) in limited-stage small-cell lung cancer (LS-SCLC), the Lung Cancer Study Group of the Japan Clinical Oncology Group conducted a phase III study in which patients were randomized to sequential TRT or concurrent TRT.

PATIENTS AND METHODS: We treated 231 patients with LS-SCLC. TRT consisted of 45 Gy over 3 weeks (1.5 Gy twice daily), and the patients were randomly assigned to receive either sequential or concurrent TRT. All patients received four cycles of cisplatin plus etoposide every 3 weeks (sequential arm) or 4 weeks (concurrent arm). TRT was begun on day 2 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm.

RESULTS: Concurrent radiotherapy yielded better survival than sequential radiotherapy (P = .097 by log-rank test). The median survival time was 19.7 months in the sequential arm versus 27.2 months in the concurrent arm. The 2-, 3-, and 5-year survival rates for patients who received sequential radiotherapy were 35.1%, 20.2%, and 18.3%, respectively, as opposed to 54.4%, 29.8% and 23.7%, respectively, for the patients who received concurrent radiotherapy. Hematologic toxicity was more severe in the concurrent arm. However, severe esophagitis was infrequent in both arms, occurring in 9% of the patients in the concurrent arm and 4% in the sequential arm.

CONCLUSION: This study strongly suggests that cisplatin plus etoposide and concurrent radiotherapy is more effective for the treatment of LS-SCLC than cisplatin plus etoposide and sequential radiotherapy.
Impurity profiling of pholcodine by liquid chromatography electrospray ionization mass spectrometry (LC-ESI-MS)
Authors: Denk Oliver M , Skellern Graham G , Watson David G
Published: October 2002

Previously, a dimorpholinoethyl pholcodine manufacturing impurity was reported to be present in some samples of pholcodine. Apart from this impurity and morphine, other unknown impurities were detected in all the samples analysed by HPLC and micellar electrokinetic capillary chromatography. In this study, liquid chromatography mass spectrometry (LC-MS) analysis of samples of pholcodine showed that two of the previously unidentified compounds had mass spectra with molecular ions which differed from pholcodine by 16 amu. From this observation and other experimental data it was concluded that they are hydroxy derivatives of pholcodine. 10-S-hydroxy-pholcodine, which was synthesized by the oxidation of pholcodine with chromic acid, had the same chromatographic properties as one of these compounds. An early eluting compound in the LC-MS chromatograms of pholcodine was identified as pholcodine-N-oxide by matching chromatographic and mass spectral data of a synthesized pholcodine-N-oxide standard. The reaction of pholcodine with m-chloroperoxy-benzoic acid not only produced the mono N-oxide, but also pholcodine-di-N, N′-oxide.
The effects of creatine on the retrogradely perfused isolated rat heart
Authors: Kilian G , Jana A-K , Grant G D , Milne P J
Published: October 2002

Although the role of creatine in muscle metabolism is well understood, there is still uncertainty as to its effects at supplemented levels. With this in mind, this study was designed to investigate the direct effects of commercially available creatine on the isolated rat heart, retrogradely perfused and infused with varying concentrations of creatine (1.25, 2.5, 5 and 10 mM) to determine its effects on heart rate, coronary flow and ventricular pressure. Furthermore, tissue from these hearts was used to investigate the cardiotoxic potential of supplemented levels of creatine. Results indicate that creatine directly improves the functioning of the heart under normal conditions with respect to heart rate and ventricular pressure, but may be detrimental to the functioning of energy-deprived hearts. It also showed no cardiotoxic properties since it increased the baseline levels of adenosine triphosphate (ATP) and decreased the levels of isocitrate dehydrogenase (ICD), indicating a decrease in cellular death compared with non-supplemented control hearts.