Revised health guidelines for athletes approved by sports medicine committee.
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Biomedical subjects
Publications and source records attributed to J R Sullivan.
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Five cases of primary lymphocytic lymphoma of the lung are described. One patient died 14 years after diagnosis, with spread of the tumour to the opposite lung. The remaining four patients were alive and well 18 months to 25 years after diagnosis. The pathological features of these five cases are described and the nature, diagnosis, therapy, and prognosis are considered in relation to experience in the literature. The tumor is rare. It is important because of its good prognosis and diagnostic difficulty.
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A continuous flow blood separator was used for leucapheresis in two patients with chronic myeloid leukaemia, complicated by pregnancy and leukastasis respectively, and for thrombocytopheresis in a patient with megakaryocytic myelosis. The cases described, outline some of the clinical uses of this machine in the myeloproliferative syndrome.
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Fifty-eight patients with a variety of haematological lymphoproliferative or myeloproliferative disorders were given bivalent subunit influenza virus vaccine, and their antibody responses after vaccination were compared with those of a normal control group. Although geometric mean titres of the patient group showed lower initial antibody levels, smaller increments, and lower final titres, after vaccination 83% of this group achieved satisfactory antibody levels to the A/Pt Chalmers strain, and 57% to the B/Hong Kong strain. The lowest antibody levels and smallest responses occurred in patients with non-Hodgkin's lymphoma, Hodgkin's disease, and multiple myeloma. Four of seven patients who showed low antibody levels, and no response to the first injection, responded to a second dose.
Eighty-six adults with malignant disease were given high doses of methotrexate with folinic acid rescue, with acceptable toxicity. Protocal violations in two cases led to death. The results of therapy in some diagnostic groups are encouraging.
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Creation of an artificial subcutaneous arteriovenous fistula was attempted in five patients with malignant haematological disorders (two with Hodgkin's disease, two with acute lymphatic leukaemia, and one with acute myeloid leukaemia). The average time from the start of treatment to attempted creation of the fistulae was four years. Neither direct arteriovenous anastomosis nor an interposition mandril graft was successful in any patient. Failure was attributed to impaired venous run-off secondary to previous episodes of thrombophlebitis induced by the intravenous administration of cytotoxic drugs. The use of an arteriovenous fistula early in the course of the disease might minimize these later problems.
Two patients with multiple myeloma died in acute liver failure. Both had been treated with the anabolic steroid oxymetholone and both subsequently developed severe cholestatic hepatitis. In one the histological lesion progressed despite cessation of oxymetholone therapy. Myeloma infiltration of the liver and peliosis hepatis were not seen. As a fatal outcome from cholestatic hepatitis due to oxymetholone is rare it is possible that an unknown potentiating factor is present in multiple myeloma that can lead to a fatal outcome. If oxymetholone therapy is to be used in such patients then close clinical and laboratory assessment of liver function should be carried out in an attempt to prevent this unusual and fatal complication.
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The therapeutic armamentarium in the treatment of cancer is now expanded to include surgery, radiotherapy, chemotherapy and immunotherapy. The aim is to achieve cure where possible. For some cancers the concept of cure can be questioned, and for many patients, cancer must be regarded as a chronic disease. A vigorous approach to palliation, particularly in regard to special problems such as hypercalcaemia, yields good dividends. Human values remain of paramount importance, and active antitumour treatment with attendant side effects must not be continued where there is no expectation of worthwhile response.
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A series of 77 gallium-67 citrate (67Ga citrate) scans of the abdomen revealed lymphoma in 12 cases (nine of non-Hodgkin's lymphoma, three of Hodgkin's disease). Scanning was undertaken (i) to confirm the suspicion of lymphoma, or (ii) as part of a staging procedure when the diagnosis of lymphoma had been established, or (iii) as a follow-up investigation after treatment of lymphoma. The diagnosis of lymphoma in the upper part of the abdomen is difficult with conventional techniques such as lymphography, and it is in this area that 67Ga citrate scanning is shown to be of value.
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81 patients, 24 with sarcoidosis and the remainder with various other diseases, were tested with three batches of Kveim material prepared from the same spleen. Positive Kveim tests were observed in sarcoidosis, tuberculosis, Hodgkin's disease, ulcerative colitis, rheumatoid arthritis, and Weber-Christian disease. These results show that a positive Kveim reaction to the material under test was not specific to sarcoidosis.
The clinical and pathological features of histiocytic medullary reticulosis (HMR) are described in five patients. Treatment by splenectomy and the MOPP routine resulted in a transient improvement in platelet and neutrophil counts and resolution of anaemia and apparent prolongation of survival in two of the five patients. The relationship of HMR to other histiocytic disorders is discussed. HMR is defined as a unique malignant histiocytosis in which malignant histiocytes engage in phagocytosis of eryrhrocytes, leucocytes and platelets.