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D Tait

Publications and source records attributed to D Tait.

At least 55 records · Page 3Linked to original sources
PubMed1998

Sonographic features of ovarian remnants.

Ovarian remnants occur after a portion of ovarian tissue is left behind unintentionally after oophorectomy. The ovarian remnant may be functional and cystic, producing pelvic pain and, in some patients, extrinsic compression of the distal ureter. Ovarian remnants frequently are associated with adhesions from previous pelvic surgery for endometriosis or pelvic inflammatory disease. Ovarian remnants also may be included within pelvic peritoneal inclusion cysts. In this retrospective study, the sonographic features of ovarian remnants in 10 patients with surgical proof or clinical follow-up data are described. Most ovarian remnants were simple cysts (seven of 10), three had multiple septations, and six had a rim of presumably ovarian tissue with arterial and venous flow. Three patients with ovarian remnant masses that were aspirated had symptomatic relief without recurrence. In one patient, guided aspiration was unsuccessful, probably owing to the presence of organized hemorrhage within the mass. Extrinsic compression of the distal ureter was observed in one patient, who was treated with gonadotropin releasing hormone agonist (Lupron). The sonographic findings of a completely cystic or multiseptated pelvic mass with a rim of vascularized solid tissue in a postoophorectomy patient, although such cases are rare, suggest the diagnosis of an ovarian remnant. If the diagnosis can be established with a high degree of certainty, sonographically guided aspiration may be attempted in an effort to provide symptomatic relief. Otherwise, sonography is useful in serial assessment of these masses in patients receiving medical treatment.

Adult↗
PubMed1997

Similarities of specificity and cofactor dependence in serum antiphospholipid antibodies from patients with human parvovirus B19 infection and from those with systemic lupus erythematosus.

OBJECTIVE: To assess the phospholipid specificity and immunoglobulin isotype of antiphospholipid (aPL) antibodies in patients with acute parvovirus B19 infection. METHODS: Specificity of aPL and isotype distribution in the negatively charged phospholipids, cardiolipin and phosphatidyl serine, and in the neutral phospholipid, phosphatidyl ethanolamine, were measured in the sera of patients with acute parvovirus B19 infections (n = 12), in those with other acute viral infections (n = 10), and in those with syphilis (n = 15) by enzyme-linked immunosorbent assays. The dependence of anticardiolipin (aCL) binding on the presence of beta 2-glycoprotein I (beta 2-GPI) as a binding cofactor was assessed in these same groups, and was compared with sera from systemic lupus erythematosus (SLE) patients (n = 11) with raised aCL antibody reactivity. RESULTS: Antibodies against any of the 3 phospholipids were found in all 3 groups of patients with infections (B19 in 11 of 12 patients, other viral infections in 8 of 10 patients, and syphilis in 14 of 15 patients). B19 patients' sera contained predominantly IgG antibodies against the negatively charged phospholipids, cardiolipin and phosphatidyl serine, and differed in their specificity and isotype distribution from those found in the other 2 patient groups. B19-associated aCL increased their binding to antigen in the presence of beta 2-GPI as a binding cofactor, similar to aCL found in SLE patients, but unlike antibodies from patients with other viral infections or from those with syphilis. CONCLUSION: The results show the remarkable similarity in specificity of aPL antibodies between B19-infected patients and SLE patients, and raise the question of whether parvovirus infection may be a trigger for the development of aPL antibodies in autoimmune diseases.

Antibodies, Anticardiolipin↗
PubMed1997

HIP-I: a huntingtin interacting protein isolated by the yeast two-hybrid system.

We report the discovery of the huntingtin interacting protein I (HIP-I) which binds specifically to the N-terminus of human huntingtin, both in the two-hybrid screen and in in vitro binding experiments. For the interaction in vivo, a protein region downstream of the polyglutamine stretch in huntingtin is essential. The HIP1 cDNA isolated by the two-hybrid screen encodes a 55 kDa fragment of a novel protein. Using an affinity-purified polyclonal antibody raised against recombinant HIP-I, a protein of 116 kDa was detected in brain extracts by Western blot analysis. The predicted amino acid sequence of the HIP-I fragment exhibits significant similarity to cytoskeleton proteins, suggesting that HIP-I and huntingtin play a functional role in the cell filament networks. The HIP1 gene is ubiquitously expressed in different brain regions at low level. HIP-I is enriched in human brain but can also be detected in other human tissues as well as in mouse brain. HIP-I and huntingtin behave almost identically during subcellular fractionation and both proteins are enriched in the membrane containing fractions.

Amino Acid Sequence↗
PubMed1997

melphalan, single-fraction total-body irradiation and allogeneic bone marrow transplantation for acute leukemia: review of transplant-related mortality.

Causes of treatment-related death were studied amongst 138 patients with acute myeloid (n = 90) or lymphoblastic (n = 48) leukemia allografted from HLA-identical siblings in first (n = 107) or second (n = 31) remission after a conditioning regimen comprising 110 mg/m2 melphalan and 1050 cGy single-fraction total-body irradiation (TBI) prescribed as maximum lung dose. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine (n = 78) or cyclosporine-methotrexate (n = 60). Eighty-one patients died of causes other than relapse 16-2917 days (median 77) after transplantation. The actuarial probability of non-relapse mortality was 62% at 5 years. The major primary causes of death were pneumonitis (n = 38, 47%), GVHD (n = 18, 22%), and sepsis (n = 11, 14%). Pneumonitis contributed to 42 of the deaths (52%), and its etiology was infective (n = 27), idiopathic (n = 14), or a combination of the two (n = 1). On multivariate analysis, GVHD prophylaxis with cyclosporine alone was associated with a higher overall toxic death rate. The use of cyclosporine alone and a low infused cell dose (<2.5 x 10(8) total nucleated cells/kg or <0.6 x 10(8) mononuclear cells/kg) were associated with a higher risk of death from pneumonitis. We conclude that the use of cyclosporine alone as GVHD prophylaxis is associated with increased transplant-related toxicity, and the addition of methotrexate and infusion of a higher number of cells decrease the incidence of fatal pneumonitis.

Acute Disease↗
PubMed1996

Paediatric tumours in the adult population: the experience of the Royal Marsden Hospital 1974-1990.

Adult patients (greater than 18 years), referred to the Royal Marsden Hospital between 1974 and 1990 with embryonal tumours, have been reviewed. The aim of the study was to document the presentation, management and outcome for this group of patients and to compare these parameters with those of tumours of the same histology arising in the paediatric population. The study population consisted of 15 patients with medulloblastoma, 15 with Ewing's sarcoma, three with neuroblastoma, seven with rhabdomyosarcoma and two with nephroblastoma. Actuarial survival, at 5 years, for adults with medulloblastoma was 80%, which compares very favourably with the outcome for children treated over the same time span. In addition, salvage therapy after relapse was in some cases successful. In the Ewing's sarcoma group the outcome was less favourable, with 5-year actuarial survival of 50%. This is disappointing in view of the lack of tumours with poor prognostic features and may be an area in which these tumours differ from those that arise in children. The number of patients with the diagnosis of neuroblastoma, rhabdomyosarcoma and Wilms' tumour was too small for statistical analysis and they are presented as case reports. Embryonal tumours arising in adults provide an opportunity to study clinical behaviour and biology from an extreme standpoint. This may provide useful information with regard to aetiology, natural history and treatment response. The establishment of registers facilitate the collection of relevant data and also offers the opportunity to improve the treatment received by patients with these rare tumours.

Adult↗
PubMed1996

Accuracy of pelvic radiotherapy: prospective analysis of 90 patients in a randomised trial of blocked versus standard radiotherapy.

The aim of this study was to assess the accuracy of pelvic radiotherapy during a trial of blocked radiotherapy at the Royal Marsden Hospital, UK. Prospective evaluation was performed on 90 patients receiving CT planned pelvic radiotherapy using weekly anterior-posterior and lateral portal films. Field placement errors (FPEs) were calculated by comparing field centres of each film with a designated point of interest. Data was evaluated to calculate the overall treatment simulator differences, the number of error free treatments, and mean treatment-simulator position and to evaluate the role of systematic versus random errors. Age, weight, disease site, position of treatment, fractionation, blocked versus conventional techniques were assessed for their effect on treatment accuracy. The mean absolute error between treatment and simulator films was anterior right-left (ARL) 0.25 cm, anterior superior-inferior (ASI) 0.32 cm, lateral anterior-posterior (LAP) 0.42 cm, and lateral superior-inferior (LSI) 0.28 cm. On average the field centre was displaced by 0.66 cm (standard deviation, S.D. = 0.34) from that intended. On each treatment day 29% of anterior films and 45% of lateral films had at least one 0.5 cm error. Overall 59% of treatments had at least one 0.5 cm error and 9% a 1.0 cm error. The field centre was more than 0.5 cm from the position intended in 66% of treatments and over 1 cm for 14% of treatments. Analysis of variance showed that both random and systematic errors occurred in all directions. Though random errors were of similar magnitude in all direction (variance sigma 2 = 0.06-0.09 cm2); systematic errors showed a 4-fold variation being greatest in the LAP direction (sigma 2 = 0.19 cm2) and least the ARL direction (sigma 2 = 0.048 cm2). No factor consistently predicted for worse outcome in all directions. Hypofractionated treatments were less accurate in the LSI direction (P > 0.05). Systematic errors were associated in the ARL direction with hypofractionation (P < 0.01) and, in the LSI direction with weight (P < 0.03) and age (P < 0.05). We conclude that significant random and systematic errors can occur during pelvic radiotherapy especially in the LAP direction. These results suggest that in the absence of a customised immobilisation device, to cover 95% of errors, margins of 0.6 cm for RL and SI directions and 0.9 cm for AP direction should be allowed between the planning and clinical target volumes. However, ideally, each centre should determine their own margin requirements according to local clinical practice.

Age Factors↗
PubMed1996

MRI in the evaluation of late bone marrow changes following bone marrow transplantation.

Measurements of MR spin-lattice (T1), and spin-spin (T2) relaxation times in lumbar vertebrae have been performed in a pilot study on six adult patients, treated for acute myeloid leukaemia (AML). All patients were treated with initial chemotherapy and then proceeded to bone marrow transplantation (BMT), conditioned with Melphalan and total body irradiation (TBI). MR measurements were made between 21 and 89 months after TBI. The relaxation times in the six patients were compared with those in six healthy age-matched volunteers to establish whether there were differences between the two groups. Average T1 values in the vertebrae of the treated patients are significantly shorter (p < 0.01) than in the healthy volunteers. This is consistent with the observation of a relatively hyperintense vertebral bone marrow in the T1 weighted images and is likely to be a consequence of treatment induced fatty replacement of marrow. Shorter T1 values tend to be distributed within the centre of the lumbar vertebrae compatible with observations, made by others, which suggest that the peripheral zone of the vertebral body has been repopulated with bone marrow cells whereas the central zone, around the basivertebral vein, is predominantly fat. Histogram displays of vertebral body relaxation time distributions (T1, T2) for both patients and healthy age-matched volunteers are similar in that both patients and volunteers give histograms that are only slightly skewed. This similarity is probably a reflection of the fact that the patients have been in remission for over a year and have generally healthy bone marrow.

Acute Disease↗
PubMed1996

Renal dysfunction following autologous bone marrow transplantation in adult patients with acute leukemia.

The serum creatinine level was used to determine the incidence of renal dysfunction in 70 adults with acute leukemia who were alive and well one year following autologous bone marrow transplantation (ABMT). Creatinine measurements at the time of ABMT, one year post-ABMT and at the last follow-up (12-128 months, median 35) were recorded, and a level of >120 micromol/l arbitrarily defined as clinically significant renal impairment. The incidence of renal impairment was 2.9% (n = 2) at 1 year, and 4.3% (n = 3) at the last follow-up in continuous remission. Significant renal impairment occurred after relapse in 8 of 12 patients, but was seen in only 3 of 58 patients who remained in remission (p < 0.001, Fisher's exact test), suggesting subclinical renal damage which became obvious with further nephrotoxic therapy. We conclude that clinically significant renal dysfunction is an uncommon long-term complication of ABMT, and should not be a concern in recommending this therapy to eligible patients.

Acute Disease↗
PubMed1996

Central nervous system relapse after bone marrow transplantation for acute leukemia in first remission.

Four hundred and eighty-seven patients undergoing allogeneic or autologous BMT for acute leukemia in first remission received no prophylactic intrathecal chemotherapy after BMT. The conditioning regimen included total body irradiation in 433 (89%). Patients with acute lymphoblastic leukemia received cranial irradiation if they had no central nervous system (CNS) disease and all patients with CNS disease received craniospinal irradiation. Eleven of 311 patients examined had CNS disease at presentation, but none had active CNS disease at the time of BMT. Lumbar punctures were performed in 93 patients 1-2229 days (median 98) after BMT because of suspected CNS infection, hemorrhage or relapse (n = 65), or after systemic relapse (n = 28). CNS disease was seen in seven patients at 217-1209 days (median 340), none of whom had CNS disease pre-transplant. Systemic relapse had preceded CNS relapse by 4-207 (median 128) days in all seven and no isolated CNS relapse was seen. The actuarial risk of CNS and systemic relapse at 5 years was 2.9 and 35.9%, respectively. We conclude that CNS relapse is uncommon after BMT for acute leukemia in first remission, and that isolated CNS relapse is likely to be extremely uncommon. Therefore, routine prophylactic intrathecal chemotherapy is not warranted after BMT for acute leukemia in first remission.

Actuarial Analysis↗
PubMed1996

Total lymphoid irradiation as rescue therapy after heart transplantation.

BACKGROUND: Allograft dysfunction develops in a proportion of heart transplant recipients without significant cellular infiltrate in endomyocardial biopsies and with normal coronary arteries at angiography. The mechanisms responsible for this presentation are unclear, and the prognosis is poor. We report encouraging experience with total lymphoid irradiation given in addition to cyclosporine A, cyclophosphamide, and prednisolone therapy in three heart transplant recipients with poor graft function with normal endomyocardial biopsies and coronary angiography. METHODS: Three patients who had severe allograft dysfunction after orthotopic heart transplantation, with normal endomyocardial biopsies and coronary angiography, were successfully treated with total lymphoid irradiation. Biventricular failure developed in each patient despite immunosuppression with cyclosporine A, azathiaprine, oral prednisolone, cyclophosphamide, and intravenous methylprednisolone therapy. Total lymphoid irradiation was given with standard mantle and inverted y fields over 10 treatments to achieve a cumulative dose of 8 Gy. RESULTS: Each patient had a significant improvement in clinical response and in ventricular performance after total lymphoid irradiation, which was well tolerated in each case. The patients remain well at 8, 9, and 12 months after completion of treatment. CONCLUSIONS: Total lymphoid irradiation should be considered as adjunct therapy to conventional immunosuppression for heart transplant recipients with poor graft function in the absence of cellular rejection or coronary artery disease.

Adult↗
PubMed1996

Melphalan-total body irradiation and autologous bone marrow transplantation for adult acute leukemia beyond first remission.

Forty-four adults with AML (n = 18) or ALL (n = 26) beyond first remission underwent unpurged (n = 39) or purged (n = 5) autografting after 110-140 mg/m2 melphalan and 1050 cGy TBI. ALL patients were eligible to receive maintenance chemotherapy with 6-mercaptopurine and methotrexate for 2 years after hematologic recovery. The duration of first remission was 1-167 months (median 11). The median time to 50 x 10(9)/I platelets was 76 days, and that to 0.5 x 10(9)/I neutrophils 31 days. Eight patients died of transplant-related toxicity; seven within 1 year. Twenty-two patients relapsed at 1-20 months (median 2.5 months). The 3-year probabilities (95% CI) of relapse and disease-free survival are 58% (43-75%) and 31% (17-45%), respectively. The duration of the first remission (< 1 year vs > or = 1 year) and the stage of transplant (second remission vs other) had no effect on relapse or disease-free survival. There was a trend towards higher relapse rates (76 vs 34%) and poorer disease-free survival (19 vs 49%) among ALL patients compared with AML which did not reach significant levels due to small patient numbers. We conclude that melphalan-TBI is a suitable conditioning regimen for autografting in advanced leukemia. The outcome of AML patients is comparable to standard regimens, but the outcome of ALL patients is poor and measures to enhance the anti-leukemic efficacy are necessary.

Acute Disease↗
PubMed1996

Long-term follow-up of patients undergoing allogeneic bone marrow transplantation for acute myeloid leukemia in first complete remission after cyclophosphamide-total body irradiation and cyclosporine.

Eighty-five patients (median age 28 years) with acute myeloid leukemia (AML) in first remission underwent allogeneic bone marrow transplantation (BMT) from HLA-identical siblings between 1978 and 1987 after cyclophosphamide and single-fraction total body irradiation with cyclosporine for graft-versus-host disease (GVHD) prophylaxis. The actuarial probabilities of development of acute and chronic GVHD were 57% and 47%, respectively. Twenty-six patients died of transplant-related complications at a median of 3.5 months, and two of unrelated causes. Seventeen patients relapsed at a median of 6.5 months. Forty patients were alive and well at 74-197 months (median 157) after BMT; seven (18%) with limited chronic GVHD requiring therapy. The actuarial 10-year probabilities of transplant-related death, relapse, and disease-free survival were 33%, 25% and 48% respectively. In multivariate analysis, infusion of a lower cell dose, development of GVHD, and age > 35 years were associated with increased transplant-related mortality, donor-recipient ABO incompatibility with a lower relapse rate, and age > 35 years and a lower cell dose with poorer disease-free survival. We conclude that with long-term follow-up, allografting in AML after cyclophosphamide-TBI and cyclosporine has resulted in disease-free survival that is comparable to most currently reported series. Patients who are alive and well 3-4 years after BMT have excellent prospects of long-term survival.

Adolescent↗
PubMed1995

Cytokine-mediated immunotherapy with or without donor leukocytes for poor-risk acute myeloid leukemia relapsing after allogeneic bone marrow transplantation.

Six patients with high-risk acute myeloid leukemia (AML) relapsing after allogeneic bone marrow transplantation (BMT) were treated with interferon-alpha 2b to stimulate graft-versus-leukemia reactions. Additionally, donor mononuclear cells were infused with or without interleukin-2 as first-line treatment or upon failure of interferon-alpha 2b in 5 patients. Two patients developed clinical acute graft-versus-host disease (GVHD) after a combination of donor leukocytes and interferon-alpha, and one developed de novo chronic GVHD after interleukin-2 and interferon-alpha. Complete remission was attained in 4 patients whereas 2 patients showed no response. Two of the responding patients relapsed rapidly. Four patients died of a combination of complications of immunotherapy and progressive disease. Two patients are alive in remission with chronic GVHD (Karnofsky performance scores of 80%) 8 and 18 months after immunotherapy. We conclude that cytokine-mediated immunotherapy with or without donor cell infusions may be effective in some cases of AML relapsing after allogeneic BMT, and may result in long-term survival. With limited data, it appears that development of chronic GVHD after immunotherapy is essential for continued remission.

Acute Disease↗
PubMed1995

Autologous bone marrow or peripheral blood stem cell transplantation followed by maintenance chemotherapy for adult acute lymphoblastic leukemia in first remission: 50 cases from a single center.

The aim of this study was to evaluate the use of maintenance chemotherapy after autotransplantation in adult acute lymphoblastic leukemia (ALL), and to compare the relative durability of marrow and peripheral blood stem cell grafts to chemotherapy. Fifty consecutive ALL patients received 200 mg/m2 melphalan alone or 110 mg/m2 melphalan with total-body irradiation in first remission, followed by autologous marrow (ABMT, n = 38) or peripheral blood stem cells (PBSCT, n = 12). After hematologic recovery, 6-mercaptopurine and methotrexate were administered for 2 years. 6-mercaptopurine could be given to 78.9% of ABMT recipients at a median daily dose of 33.5 mg/m2, and to 91.7% of PBSCT recipients at a median daily dose of 44.1 mg/m2. ABMT recipients started 6-mercaptopurine at a median of 58.5 days post-transplant, and PBSCT recipients at 32 days (P = 0.002). 52.6% of ABMT recipients and 75% of PBSCT recipients received weekly methotrexate. No graft failure was seen as a result of chemotherapy. The actuarial 5-year probabilities of overall survival, survival in first remission and relapse were 56.2, 53.2, and 30.6%, respectively. We conclude that administration of maintenance chemotherapy after autografting in adult ALL may reduce relapse. A randomized study is required to evaluate the relative efficacy of PBSCT vs ABMT, and the role of post-transplant maintenance chemotherapy.

Adolescent↗
PubMed1995

Autologous bone marrow transplantation for acute myeloid leukemia in first remission: identification of modifiable prognostic factors.

Seventy-four consecutive patients (median age 31 years) with acute myeloid leukemia (AML) undergoing unpurged autologous bone marrow transplantation (ABMT) in first remission after melphalan and total-body irradiation were studied to assess the impact of 14 modifiable and non-modifiable prognostic factors on relapse and disease-free survival. Thirty patients were alive in continuous CR at a median of 37.5 months (range 3-94), 14 died of transplant-related toxicity at a median of 5.5 months (range 0.5-18), and 30 relapsed at a median of 7.5 months (range 2-23). The actuarial 5-year probabilities of relapse and disease-free survival were 53.4 and 34.2%, respectively. On multivariate analysis, administration of two or more courses of consolidation chemotherapy prior to the harvest and transplant was found to be the most significant factor associated with decreased relapse (relative risk 2.62, P = 0.0012) and improved disease-free survival (relative risk 3.03, P = 0.0009). A nucleated cell dose of > 2 x 10(8)/kg improved disease-free survival (relative risk 2.17, P = 0.045) by decreasing transplant-related mortality (P = 0.047). We conclude that adequate consolidation of remission before ABMT is the most important factor associated with continuing remission after ABMT. Short-term therapy of AML with two courses of consolidation therapy followed by ABMT requires comparison with repeated courses of intensive chemotherapy for efficacy and cost-effectiveness.

Adolescent↗
PubMed1994

Long-term follow-up of young children with brain tumors after irradiation.

PURPOSE: Young children with brain tumors are at high risk of developing late sequelae after curative radiotherapy. A retrospective study was undertaken to determine the frequency and severity of neurological deficits, endocrine dysfunction, and intellectual disabilities. METHODS AND MATERIAL: One hundred and fifty-six children age < or = 3 years were treated between 1952 and 1986 with radiotherapy. Of the 57 survivors, 47 had surgery, 12 chemotherapy and 24 children received cranio-spinal radiotherapy. Late radiation side effects were assessed with a clinical examination, blood tests and an interview. RESULTS: The median follow-up was 13 years and the actuarial survival at 5 and 10 years was 49% and 44%, respectively. No, or only a mild, handicap was noted in 24 patients, while 21 had moderately severe and 16 severe disabilities. Children with supratentorial tumors had more abnormal neurological findings compared to those with infratentorial malignancies (p < 0.001). Eighty percent of children had endocrine abnormalities, which were more marked in children with parasellar tumors (p < 0.001). Twenty-one children were mentally retarded. In a multivariate analysis epilepsy emerged as the only significant variable independently associated with poor cognitive function. CONCLUSION: Long-term morbidity was found to be disabling in 58% of the surviving children. These findings encourage the development of treatment strategies designed to reduce toxicity.

Adolescent↗
PubMed1994

Risk factors for requiring cataract surgery following total body irradiation.

In order to determine the incidence of cataract surgery following total body irradiation (TBI), questionnaires were mailed to 173 surviving patients who had received single fraction TBI for haematological malignancies. All patients had undergone bone marrow transplantation at the Royal Marsden Hospital, Surrey, between 1977 and 1991. Replies were received from 135 patients (78%). Fifty-four patients had required cataract surgery. The probability of requiring surgery for cataract at 2, 5 and 10 years post TBI was 5%, 39% and 58%, respectively. No cataract surgery was performed at less than 2 years after the time of TBI, and 12 years is the longest interval, prior to surgery, recorded so far. From a number of potential risk factors, those found to predict independently for cataract surgery, and their relative risk (RR) factors, were: cranial radiotherapy preceding TBI (RR 4.2 for patients irradiated in year prior to TBI, 3.3 for others irradiated); skull dose (RR 2.3 for patients over 25 years at time of TBI); TBI dose rate (RR 2.1 for dose rate > 3.5 cGy/min). An additional 31 patients (22%) reported the presence of cataracts which had not yet required surgery.

Adult↗