Lack of association between morphology and T-cell ALL in children.
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Antigens, Surface↗
Biomedical subjects
D R Miller
Publications and source records attributed to D R Miller.
Prognostic significance of vacuoles in L1 lymphoblasts in childhood acute lymphoblastic leukaemia: a report from Children's Cancer Study Group.
From February 1975 to February 1977, 880 patients with acute lymphoblastic leukaemia were enrolled on Children's Cancer Study Group protocol 141 designed to evaluate prognostic factors and more intensive therapy for patients with poor prognosis. 765 diagnostic bone marrow aspirates from 23 institutions were available for classification using the French-American-British system. 60 of 615 patients with L1 morphology had vacuolated lymphoblasts. Patients with vacuolated lymphoblasts had a better disease-free survival (P = 0.14) and a significantly better survival (P = 0.03) but the presence of vacuoles was associated with a low initial WBC and an age range associated with improved prognosis for disease-free and over-all survival.
Bone Marrow↗
Role of the polymorphonuclear leukocyte in periodontal health and disease.
This review presents evidence for lysosomal enzymes being at least partly responsible for the tissue destruction seen in periodontal disease. However, many other inflammatory and immunologic mechanisms have been identified that can contribute to tissue destruction (Nisengard 1977). The relationship of PMN to the periodontal tissues is equivalent to the proverbial double-edged sword. The localized tissue destruction that may be due to the extracellular release of PMN enzymes in individuals with normal cell function must be weighed against the role of PMN in containment of gingival bacteria and their products. The consequences of qualitative and/or quantitative abnormalities of neutrophils are far more undesirable for the periodontium. It therefore seems logical to propose that the role of polymorphonuclear leukocytes in the gingival tissues is primarily a defensive one. The presence of neutrophils in the gingival crevice has been shown to reflect the inflammatory condition of the tissues. Due to their availability, it may prove beneficial to use gingival crevicular PMN activity as a reliable clinical index of disease activity. The development of appropriate tests to measure PMN may eventually lead to better diagnostic criteria, including the definition of active versus inactive disease.
Animals↗
A new hearing assistance device.
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Correction of Hearing Impairment↗
Identification of fibronectin in preparations of osteoarthritic human cartilage.
Several high molecular weight proteins were observed in dissociative extracts of osteoarthritic, but not of normal, human cartilage. By gel electrophoresis, by DEAE-cellulose and gelatin-agarose chromatography, and immunologically, they were found to be identical to fibronectin. Incorporation of tritiated proline into these proteins indicated that this material was not a synovial fluid contaminant. Interactions with the proteoglycans suggested that, in articular cartilage, the role of fibronectin may be more closely associated with proteoglycans than with collagen. The appearance of fibronectin in the diseased cartilage suggests that this may be a feature of the chondrocyte's repair response to the loss of extracellular matrix.
Cartilage, Articular↗
Water supply and sanitation: effect on diarrhoeal diseases.
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Child, Preschool↗
Lack of an elevated risk of malignant melanoma in relation to oral contraceptive use.
Epidemiologic and laboratory data suggest an effect of oral contraceptives (OC) on the risk of malignant melanoma. This relationship was explored in a hospital-based case-control study of 160 women with malignant melanoma and 640 matched controls, all of whom were white and 20-59 years of age. A total of 63 cases (39%) had used OC compared with 270 controls (42%), yielding a relative risk estimate of 0.9 (95% confidence interval: 0.6-1.3). When a number of potential confounding factors were simultaneously controlled, the relative risk estimate was 0.8 (0.5-1.3). For use that lasted 5 or more years the estimate was 0.9 (0.5-1.6). The level of tumor invasion was not related to OC use. The evidence from this study suggests that OC, even when used for 5 or more years, do not increase the risk of malignant melanoma.
Canada↗
Primary hepatic or hepatosplenic non-Hodgkin's lymphoma in children.
Non-Hodgkin's lymphoma confined to the liver is unusual in adults and has not been reported in children. Two children with primary hepatic and one with hepatosplenic NHL are described. All three patients are males, and both tumors examined for cell surface markers were of B-cell origin. Two patients, treated with chemotherapy and radiation, developed disseminated disease and died with 7 months of diagnosis. A third patient treated aggressively with radiotherapy and multiagent chemotherapy (LSA2-L2 protocol) remains in complete continuous remission 22 months after initiation of therapy. Hepatic NHL, even if well localized at diagnosis appears to warrant an aggressive therapeutic approach.
Adolescent↗
Myocardial infarction in women under 50 years of age.
Risk factors for first nonfatal myocardial infarction (MI) in women younger than age 50 years were evaluated in a case-control study of 255 women with MI and 802 controls. The relative risk of MI increased with the amount smoked. The estimated risk of MI for current smokers of 35 or more cigarettes per day was ten times that of women who never smoked; an estimated 65% of MIs were attributable to cigarette smoking. The relative risk of MI increased markedly with increasing levels of total plasma cholesterol and decreasing levels of high-density lipoproteins, and the effects of the two factors appeared to be independent. Other factors significantly associated with MI were hypertension, angina pectoris, diabetes mellitus, blood group A, and a history of MI or stroke before age 60 years in a mother or sibling. Factors not significantly associated with MI were obesity, history of preeclamptic toxemia, and type A personality. Women who were postmenopausal appeared to have a lower risk of MI than premenopausal women of similar ages. Of the identified risk factors, the most prominent was cigarette smoking, a habit that is amenable to change.
ABO Blood-Group System↗
The effect of different types of intrauterine devices on the risk of pelvic inflammatory disease.
A case-control study of 155 women with pelvic inflammatory disease (PID) and 305 controls with other conditions was carried out. Compared with other methods of contraception, the age-adjusted relative risk estimate for use of any intrauterine device (IUD) within one month of admission was 8.6 (95% confidence limits, 5.3 and 13.8); for past use, the estimate was 1.6 (confidence limits, 0.6 and 4.0). The estimated risk was highest for users of the Dalkon Shield (11 cases and two controls), lowest for users of copper-containing devices (40 cases and 34 controls), and intermediate for users of other IUDs, principally the Lippes Loop (32 cases and 23 controls). Compared with copper-containing IUDs, the relative risk estimate for the Dalkon Shield was 6.5 (confidence limits, 1.5 and 27.5). When the Dalkon Shield and copper-containing IUDs were compared, in turn, with the Lippes Loop, the estimated risk was increased for the former and reduced for the latter, but the differences were not statistically significant. Nine of the 11 cases using the Dalkon Shield (82%) had severe PID (diagnosed at surgery or because of purulent cervical discharge), compared with 12 of 40 copper device users (30%) and nine of 32 Lippes Loop users (28%). The risk of PID did not seem to be related to duration of use of any of the three IUDs. This study confirms that IUD use increases the risk of PID. It also suggests that the Dalkon Shield is more harmful than other devices.
Adult↗
LSA2-L2 protocol treatment of stage IV non-Hodgkin's lymphoma in children with partial and extensive bone marrow involvement.
Forty-one previously untreated children with Stage IV non-Hodgkin's lymphoma were studied from January 1971 to April 1979. All patients had bulky disease histologically proven to be non-Hodgkin's lymphoma with bone marrow involvement. They were separated into two groups according to the extent of bone marrow involvement. Group IVA included 14 patients with 25% or less lymphoblasts in the bone marrow. Group IVB included 27 patients with more than 25% blasts in the marrow. Their clinical characteristics with regard to age, sex, hemogram, histology, primary site, and blast morphology are compared. All were treated with the LSA2-L2 protocol with radiation therapy to one or more bulky sites of involvement. The disease-free actuarial survival for Group IVA was 64% with a median observation time of 49 months while that for Group IVB was 65% with a median observation time of 66 months. There was no statistical difference in the survival rates between the two groups. Hence, we conclude that the extent of bone marrow involvement does not affect the prognosis in Stage IV non-Hodgkin's lymphoma. It appears that radiation therapy may have contributed to the improved survival in our series. Furthermore, a subset of patients in Group IVB (24/27) who could be considered as high-risk acute lymphoblastic leukemia on the basis of age, initial leukocyte count, hemoglobin, mediastinal mass or T- or B-cell markers showed an improved survival (73% versus 43%) when compared to patients treated with conventional leukemia regimens.
Adolescent↗
Prognostic factors and therapy in acute lymphoblastic leukemia of childhood: CCG-141. A report from childrens cancer study group.
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Age Factors↗
Unfavorable prognostic significance of hand mirror cells in childhood acute lymphoblastic leukemia. A report from the childrens Cancer Study Group.
The prognostic significance of hand mirror cells (HMCs) in childhood acute lymphoblastic leukemia was determined by quantifying the percentage of these cells in the diagnostic bone marrow aspirates of previously untreated children entered on the Childrens Cancer Study Group protocol 141. Of 664 examinable patients, 39 (5.9%) had greater than 10% HMCs, and only four (0.6%) had greater than 30% HMCs. Compared with the entire study population, a greater proportion of children with more than 10% HMCs were older than 10 years of age, had hemoglobin levels greater than 10 g/dL, and had undifferentiated lymphoblast morphology. The children with more than 10% HMCs had a higher rate of bone marrow relapse, poorer disease-free survival, and shorter survival than patients with less than 10% HMCs. By multivariate analysis, HMC morphology was an independent, unfavorable prognostic factor.
Age Factors↗
Total bile duct obstruction. Prompt diagnosis by hepatobiliary imaging.
The value of hepatobiliary imaging for the early diagnosis of total bile duct obstruction is not well known. Four hundred eighteen technetium Tc 99m iprofenin (Pipida) hepatobiliary scans were reviewed, and the anatomic diagnosis was established by postmortem examination, laparotomy, endoscopic retrograde cholangiopancreatography, transhepatic cholangiography, or ultrasound. Sixty cases demonstrated the technetium Tc 99m iprofenin pattern of total bile duct obstruction. Of these, 41 had total bile duct obstruction, 14 had advanced hepatocellular disease, four had massive liver metastasis, and one had portal vein thrombosis. The test was 100% sensitive for the detection of total bile duct obstruction. When the bilirubin level was less than 10 mg/dL, the predictive value was 100%. As the bilirubin level rose to 15 and 20 mg/dL, the predictive value fell to 92% and 88%, respectively. If performed early, hepatobiliary scanning is the preferred test for suspected total bile duct obstruction.
Bilirubin↗
Biochemical features of pseudomembrane at the bone-cement interface of loosened total hip prostheses.
Biochemical features of pseudomembrane formed at the bone-cement interface of 13 failed total hip replacements were studied and histological examination of the pseudomembrane was conducted. The results of biochemical analyses revealed on average hydroxyproline, 86 micrograms/mg; water content, 57%; hexosamine, 12 micrograms/mg; glucosamine/galactosamine, 1.4%; and calcium, 2.1%. Approximately 78% of collagen was extracted with pepsin, whereas only 8 and 0.3% collagen were extracted with acetic acid and neutral salt, respectively. On further differential salting out of the extracted collagen, about 77% was type I collagen, 19% type III, and 2.6% type V. Unlike pseudoarthrosis of fracture, no type II collagen was identified. Overall biochemical features in the light of the histological appearance suggested that pseudomembrane resembles granulation tissue. Bone healing mechanisms at the bone-cement interface appear to differ from that of fracture healing.
Adult↗
The effect of methylmercury on the distribution and excretion of selenium by the guinea pig.
The influence of methylmercury (MeHg) on the tissue and subcellular binding of selenium was determined. Adult female guinea pigs received either 75Se (as sodium selenite) or MeHg (as chloride) followed 5 h later by an equimolar dose of 75Se. Animals were sacrificed 1, 3, 7, and 13 days after administration. Pretreatment with MeHg significantly altered the organ distribution of 75Se, particularly during the first week of the study. 75Se concentrations were markedly reduced in most organs of animals receiving both 75Se and MeHg except the liver, which contained markedly elevated 75Se levels. The subcellular distribution of 75Se was also altered by MeHg. Within liver, kidney and brain, 75Se was primarily bound to nuclear and mitochondrial fractions in both treatment groups, but nuclear binding was higher in animals receiving both compounds. Within nuclear fractions, most 75Se was bound to insoluble-nonhistone proteins. In the presence of MeHg, total nuclear binding of 75Se increased, but total binding to insoluble-nonhistone proteins decreased. MeHg also reduced the total 75Se binding to high molecular weight proteins of the soluble fraction. Alterations in tissue and subcellular binding of MeHg and Se may contribute to the lower degree of toxicity observed in animals receiving both compounds.
Animals↗
Demethylation and excretion of methyl mercury by the guinea pig.
Female guinea pigs were dosed po with 1.0 mg CH3 203Hg/kg as methylmercuric chloride, 10 times over a 3-week period. Tissue distribution, excretion, and accumulation of inorganic and organic mercury were studied. The highest concentration of mercury was found in the kidney. The greatest decreases of mercury levels were observed in the small bowel, red blood cells, liver, and cerebrum. The half-life of whole body clearance, based on a single compartment model, was 31.6 days. Mercury in the kidney, liver, and cerebrum was bound mainly by nuclear and soluble fractions. The highest ratio of inorganic to total mercury was seen in the kidney, 60% of this being as inorganic mercury. Excretion of mercury in the feces was measured throughout the experiment. The relationship of organic to inorganic mercury was relatively constant at about 1:3. Data on the effects of methyl mercury on tissue concentrations of zinc and copper show that the only change in the copper content was a marked increase in the kidney.
Animals↗
Acute lymphoblastic leukemia in children: current status, controversies, and future perspective.
Disease-free survival (DFS) in childhood ALL is 60%, and survival in good, average, and poor prognostic groups defined by initial WBC and age is 90, 60, and 45%, respectively. Additional immunological, morphological, biochemical, cytokinetic, and cytogenetic factors have been identified, illustrating the heterogeneity of ALL and its derivation from malignant clones at various stages of differentiation and with varying rates of proliferation. Of biologic importance, these factors may refine further the characteristic features of clinically-determined prognostic groups. Multivariate analysis of large prospective trials with homogeneous therapy will be required to determine the independent prognostic importance of these factors. Current treatment strategies in ALL include (1) tailoring therapy and its intensity to prognostic groups; (2) multiple-drug combinations in induction; (3) early use of intrathecal (IT) methotrexate (MTX); (4) CNS prophylaxis with IT MTX alone in good prognosis patients and combined cranial radiation (CXRT), 1800 rads plus IT MTX, in average and poor prognosis patients. Current studies show a CNS relapse rate of 5% in all prognostic groups. Late neuropsychological defects caused by cranial XRT and IT MTX have prompted programs designed to reduce the potential late toxicity of CNS prophylaxis. More pronounced in younger children, these abnormalities include decreased IQ, visual-motor incoordination, poor performance in mathematics, and memory dysfunction. Until 1980, more intensive induction, consolidation, and maintenance therapy had failed to prolong DFS in children with a poor prognosis. In West Germany (Berlin-Frankfurt-Muenster protocol) a 70 to 75% DFS is seen in all patients regardless of initial WBC, suggesting that effective therapy will override prognostic factors. Ultra-high-dose MTX, without cranial radiation, is also showing promise in poor prognosis patients. Other issues include the optimal duration of therapy, the role of testicular biopsies, and prophylactic testicular radiation. Recent studies suggest that prognostic factors lose their significance after 2 years of continuous complete remission and that 2 years of maintenance therapy is adequate. Bilateral open-wedge testicular biopsies have identified occult testicular disease in 8 to 10% of males. A unified approach to children with leukemia/lymphoma, a group with a particularly poor prognosis, utilizing NHL-type therapy may be more effective than conventional ALL therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗