Quantitation of primitive and lineage-committed progenitors in mobilized peripheral blood for prediction of platelet recovery post autologous transplant

Leukapheresis collections obtained following one of four mobilization regimens from 90 cancer patients were analyzed for their content of various progenitor cell types including erythroid and granulopoietic colony-forming cells in methylcellulose (total CFC), CFC-megakaryocyte (CFC-Mk), CFC detected after 10, 35 and 56 days in long-term culture (LTC), and total CD34+ cells. The number of each of these progenitor cell types collected from individual patients varied over 1000-fold. Nevertheless, within an individual leukapheresis, there was a significant correlation between the number of CD34+ cells and each progenitor type (except day 56 LTC CFC) suggesting that all of them are mobilized by a common mechanism. Patients who had previously received extensive chemotherapy and/or radiotherapy mobilized fewer of all these cell types than those who had not. For the 65 patients who proceeded to autologous transplantation, the median times to an absolute neutrophil count (ANC) of > or =0.5 x 109/l and the last platelet transfusion post transplant were 13 and 11 days, respectively, with 14 (22%) of patients having platelet recovery delayed beyond day 21. There was no significant difference between patients who had or had not received extensive chemo/radiotherapy or among the different mobilization regimens for time to neutrophil or platelet recovery or the number of platelet or red blood cell transfusions received post transplant. Threshold doses of the different cell types transplanted (per kg of patient weight) which predicted rapid platelet recovery were 2 x 106 CD34+ cells, 5 x 105 total CFC and 2.5 x 104CFC-Mk. Corresponding thresholds for progenitor activity measured in LTC could not be established. These results further support the view that standard mobilization regimens yield progenitor numbers that are, in most cases, nonlimiting for generating neutrophil and platelet recoveries within 2 to 3 weeks after myeloablative therapy. Assessment of the CD34+ cell and/or CFC content of leukapheresis collections may identify patients in whom platelet recovery is likely to be significantly delayed although CFC-Mk enumeration does not appear to offer any unique predictive advantage.

Enhancement of platinum-drug cytotoxicity in a human head and neck squamous cell carcinoma line and its platinum-resistant variant by liposomal amphotericin B and phospholipase A2-II

Platinum drugs comprise one of the main classes of chemotherapy drugs that can induce remissions in various solid tumors. Although tumors often regress on treatment with cis-diamminedichloroplatinum II (cisplatin) or cis-diammine-1,1-cyclobutane dicarboxylate platinum II (carboplatin), they usually relapse as a drug-resistant tumor. Most mechanisms of platinum resistance could be overcome by increasing the amount of drug that is accumulated by tumor cells. Amphotericin B (Amph B) is efficient at increasing platinum drug uptake, but because of nephrotoxicity associated with extended usage, and the potential for synergistic nephrotoxicity when used with platinum drugs, Amph B has not been used clinically for this purpose. A liposomal preparation of Amph B (LipoAmph B), which is substantially less nephrotoxic, was studied for its ability to enhance platinum-drug toxicity to a human oral squamous cell carcinoma line, HN-5a, and its carboplatin-resistant variant, 5a/carbo-15a, in which cisplatin accumulation was reduced by approximately 40%. Amph B at 10 microg/ml enhanced cisplatin accumulation by approximately 100% in both cell lines, enhancing cytotoxicity of the drugs by 35 to 60%, and completely reversed resistance to both cisplatin and carboplatin. LipoAmph B in the presence of phospholipase A(2)-II (PLA2-II) was able to enhance cisplatin and carboplatin cytotoxicity as effectively as free Amph B in both cell lines. At optimal concentrations, LipoAmph B plus PLA2-II enhanced drug uptake sufficiently to abolish resistance in the platinum-resistant line. Because PLA2-II is elevated in some tumor microenvironments and in plasma of ill patients, LipoAmph B has potential clinical usefulness as a modulator of platinum-drug efficacy.

Changes in HIV/AIDS education, knowledge and attitudes among Scottish 15-16 year olds, 1990-1994: findings from the WHO: Health Behaviour in School-aged Children Study (HBSC)

There is concern about the high prevalence of adolescent sexual health problems, such as sexually transmitted diseases (STDs) and unwanted pregnancies, that currently exist in the UK. If young people are to reduce their risk from HIV/AIDS and other STDs it is imperative, in the first instance, they know what the risks are and how they can avoid them. However, effective school-based sex education can only be delivered if there are accurate data on young people's current levels of knowledge and existing sex education needs. This paper details findings from the WHO: Health Behaviours of School-aged Children Study on the changes that have occurred between 1990 and 1994 in Scottish school-children's knowledge, attitudes and perceived educational needs in relation to HIV/AIDS. There have been significant changes in knowledge and attitudes that may affect their sexual behaviour, e.g. in their attitudes to condom use, risk of HIV/AIDS and other STDs, and also other sexual health problems, such as the risk of unwanted pregnancies and abortions. Finally, areas that require future research and recommendations for future sexual health education interventions are highlighted.

Role of percutaneous gastrostomy tubes in the postoperative care of patients with cancer of the oral cavity and oropharynx

OBJECTIVE

The purpose of this study was to document the use and complications of gastrostomy tubes placed following surgery for oral cancer at our institution and to determine preoperative predictors of the procedure.

METHOD

A retrospective chart review of 105 patients treated surgically for oral cancer between March 1990 and June 1995 at St. Joseph's Health Care Centre, London, Ontario was conducted. Twenty patients were studied with regard to timing, indication, and morbidity (n = 24) of the procedure. Regression analysis was performed regarding preoperative predictors of postoperative gastrostomy including tumour site and stage, and the percentage of tongue resected. Outcome measures included time from surgery to gastrostomy, length of postoperative hospital stay, time gastrostomy tube in situ, complications of gastrostomy, and the predicted risk of postoperative gastrostomy tube.

RESULTS

The mean time to gastrostomy tube placement was 17.4 days, and the mean length of hospital stay in gastrostomy patients was 26.8 days. Gastrostomy was temporary in 55% of patients. No significant complications of percutaneous gastrostomy were encountered. Oropharyngeal tumour site and advanced T stage were predictive of the need for postoperative gastrostomy.

CONCLUSIONS

In oral cavity and oropharyngeal cancer patients treated surgically, early postoperative percutaneous gastrostomy tube placement is indicated in those at high risk for significant postoperative dysphagia.

Healthy or druggy? Self-image, ideal image and smoking behaviour among young people

Recent research indicates that there is an important, though complex, relationship between the social image of smoking and young people's self- and aspirational images. This study explored how young people see themselves (self-image), how they would like to be (ideal image), and whether these differ according to age, gender and smoking status. Focus groups were used to elicit attributes which young people use to describe smoking and non-smoking images taken from fashion pages in youth magazines. These attributes were incorporated into a self-completion questionnaire which was administered to 897 young people from three age groups (12-13 years, 15-16 years and 18-19 years). The respondents rated their self- and ideal images on each of these attributes. Overall, there were few differences between the rank order of attributes by age, sex or smoking status. However, there were differences in the trait scores, with males and smokers tending to rate themselves more positively. The two traits which most clearly differentiated smokers and non-smokers were druggy/takes drugs (self- and ideal image) and healthy (self-image). It appears that smokers in general, and male smokers in particular, embraced certain dimensions of self- and aspirational image of which druggy, tough and tarty are signifiers. In contrast, the differences between female smokers and non-smokers were less consistent and differed with age. The implications for health promotion are discussed.

Left-handedness increases injury risk in adolescent girls

In a self-report survey of a representative national sample of 4081 Scottish schoolchildren, injuries requiring medical assistance were more common in left-handers; these were also more severe and likely to involve an overnight stay in hospital. Particularly at risk were adolescent girls with a 32% greater chance of being injured if they were left-handed compared with their right-handed peers. The corresponding relative risk for boys was not significant.

Patterns of unhealthy eating behaviours in a middle aged Scottish population

This paper examines unhealthy eating in a middle aged Scottish population. Data from a 1989 survey of 500 Scottish men and women aged 45 to 59 years are used to explore inter-relations among five items of unhealthy eating, smoking and alcohol consumption. The results show that unhealthy eating behaviours are highly correlated, indicating strong links among certain nutrition habits. The findings also reveal that such patterns of unhealthy eating vary considerably between males and females. Finally, unhealthy eating behaviours were also found to be significantly associated with smoking and alcohol consumption. Implications of these findings for future research in epidemiology and health promotion are considered.

A comparison of the consistency of self-reported behavioural change within a study sample--postal versus home interviews

Much health promotion research is directed towards increasing our understanding of the process of health-related behavioural change. However, little is known about the validity of self-reported changes in behaviour. This study aimed to assess the validity of self-reported changes in five behaviours--diet, cigarette smoking, alcohol consumption, weight control and physical activity--by comparing reports obtained from the same people through postal questionnaires and face-to-face interviews. It was found that overall there was a consistency between self-reports with interviewers confirming that in most cases change had taken place. However, in a large number of cases changes were reported that had occurred before the period specified in the questionnaire. The nature of the change, whether discrete or incremental, as well as the behaviour in question, were found to be related to the accuracy of self-reporting. The possible reasons for the observed discrepancies are discussed.

Misplacement in long stay geriatric care, psychogeriatric care and Part IV accommodation

The dependency and behavioural characteristics of 1,461 elderly people in long stay geriatric and psychogeriatric wards and Part IV accommodation were surveyed. Misplacement, defined as having dependency and behaviour characteristics normally associated with admission to another form of care, was widespread, ranging from 5-51% in the different facilities visited. It was greatest in psychogeriatric wards and least in geriatric wards. In Part IV accommodation there was a significant inverse relationship between length of stay and appropriateness of placement.