Biomedical subjects
Publications and source records attributed to P Parikh.
Percutaneous transluminal coronary angioplasty of protected left main coronary artery stenosis is usually performed by an antegrade approach. In this case report, we describe left main coronary artery stenting by a retrograde approach through a saphenous venous graft in a patient in whom the antegrade approach was considered less appropriate due to chronic ostial occlusion.
A 4-month-old infant presented with aneurysm of patent ductus arteriosus (PDA) which was causing obstruction of the left main bronchus. The patient had elevated pulmonary vascular resistance (PVR) at 6.1 um2. The aneurysm was resected on cardiopulmonary bypass. The patient required phenoxybenzamine and prostacycline after the operation for elevated PVR. Postoperative progress was prolonged but 12 months after surgery the patient is well, growing normally without any respiratory symptoms.
The authors report a case of overwhelming Pseudomonas pneumonia with sepsis and death in a 54-year-old male; death resulted from jacuzzi exposure in an immunocompetent host. The patient died 24 hours after hospital admission from gram negative sepsis shock.
A total of 42 adults with acute lymphoblastic leukemia were treated with an aggressive induction/consolidation chemotherapy (MCP-841) between June 1986 and December 1991. 32 patients (76.19%) achieved complete remission at the end of induction. There were 9 induction deaths, 6 of them due to infection. All patients received cranial irradiation in the dose of 20 Gy and intrathecal methotrexate for CNS prophylaxis. Twelve patients relapsed, 10 in the bone marrow, one case had isolated CNS relapse and the other relapsed in the bone marrow and CNS. The actuarial overall survival of all patients at the end of 5 years was 41.94%. Patient characteristics including age, sex, FAB morphology, phenotype, WBC count, platelet count and LDH did not influence survival significantly.
Primary orbital lymphomas are rare. We report nine such cases (4 with DWDL, 3 with DPDL, 1 with DHL and 1 unclassifiable lymphoma). All patients achieved clinical complete remission (CR). Of those who completed treatment more than a year ago, three continue to be in CR at 17, 24 & 25 months and two are lost to follow up.
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In a single centre, 52 newly diagnosed patients with acute myeloid leukemia (AML) under the age of 56 years received induction chemotherapy commencing with high-dose cytosine arabinoside (Ara-C) and etoposide (Protocol BF11), followed by Ara-C, 6 thioguanine (6TG). A total of 67% of patients entered remission using these drugs. An anthracycline was added for those patients not in remission. The overall remission rate (CR) was 86.5% (45/52), with a minimum follow-up of 90 days. Patients are hospitalised for relatively short periods, and consequently require less blood product and antibiotic support. Patients in continuing first remission following induction with Ara-C and etoposide are similar in number to those in continuing first remission who initially received an anthracycline. This would imply that the efficiency of Ara-C and etoposide in inducing long-term disease-term survival is comparable with anthracycline-containing regimens. We conclude that high-dose Ara-C and etoposide used in the first induction cycle for treating AML have good antileukaemic effect with acceptable toxicity.
Cyclosporine was used to induce graft-versus-host disease (GVHD) in patients with acute myeloid leukaemia (AML) receiving autologous bone marrow transplantation (ABMT). Nine consecutive patients with AML in remission were conditioned with either busulphan and cyclophosphamide or melphalan and total body irradiation (TBI) followed by ABMT. Cyclosporine, 1 mg/kg daily from days 1-28 was administered intravenously in four patients and orally in five. Acute GVHD of the skin, confirmed by histological and immunological criteria occurred in three patients, 4-28 days after ABMT and lasted 8-18 days. Incidence and severity of GVHD were independent of cyclosporine levels. Three patients subsequently relapsed, of whom two had had evidence of GVHD. All of these patients were in second remission at time of graft, and therefore poor risk. The potential of cyclosporine to induce GVHD in the AML autograft setting is demonstrated, although the significance of this observation in terms of an antileukaemia effect needs clarification.
We report three pregnancies with successful outcomes in two women following allogeneic bone marrow transplantation (BMT) for acute leukaemia using high dose melphalan alone as conditioning therapy. The increasing application and success of BMT together with the instigation of conditioning regimens that do not include total body irradiation should increase such cases. These and previous cases document that a normal outcome of pregnancy is likely in these patients.
There is no general agreement about the effect of an enlarged spleen on the outcome after bone marrow transplantation (BMT) for chronic myeloid leukaemia (CML). In this retrospective analysis, we compared rate of engraftment, haematological recovery and survival in 42 CML BMT recipients, 19 with splenomegaly and 23 without. Other variables analysed included interval from diagnosis to BMT, disease status at BMT, conditioning regimen, additional splenic irradiation, marrow cell dose, donor recipient ABO match and graft-versus-host disease. In multivariate analysis, the only significant variable was the presence or absence of splenomegaly. Splenomegaly was significantly correlated with delayed engraftment and graft failure. Patients with delayed engraftment experienced higher mortality, largely due to sepsis. These results emphasize the adverse impact of splenomegaly upon BMT survival in CML, and suggest that splenic irradiation does not favourably affect the early outcome after BMT.
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