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McKeigue PM, Richards JD, Richards P. Effects of discrimination by sex and race on the early careers of British medical graduates during 1981-7. BMJ (CLINICAL RESEARCH ED.) 1990; 301:961-4. [PMID: 2249025 PMCID: PMC1664175 DOI: 10.1136/bmj.301.6758.961] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the possible effects of discrimination by sex and race on the career patterns of doctors up to six years after qualifying. DESIGN Postal questionnaire follow up survey. PARTICIPANTS 1572 Doctors who graduated from five British medical schools in 1981, 1983, and 1985, including 587 women and 131 doctors from ethnic minorities. MAIN OUTCOME MEASURES Reported success rates of applications for training posts. RESULTS Comparison of the career patterns of women and men yielded no evidence of discrimination against women in competition for posts. In contrast, there were striking differences in career patterns between graduates of native European origin and those of ethnic minority origin. Graduates from ethnic minorities reported lower success rates and more difficulty in obtaining house officer posts, registrar posts, and places in vocational training schemes in general practice. Most of this discrimination seemed to occur at the stage of shortlisting for interview. Graduates from ethnic minorities were more likely than graduates of native European origin to have experienced spells of unemployment while seeking work. They were also more likely to have changed their original choice of career because of difficulty in obtaining suitable training posts or unfavourable career prospects. CONCLUSIONS Discrimination against ethnic minorities occurs in the competition for training posts among graduates from British medical schools. There was no evidence of discrimination against women graduates. Shortlisting procedures based on objective scoring systems may help to ensure equality of opportunity in future.
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McMillan AK, Goldstone AH, Linch DC, Gribben JG, Patterson KG, Richards JD, Franklin I, Boughton BJ, Milligan DW, Leyland MM. High-dose chemotherapy and autologous bone marrow transplantation in acute myeloid leukemia. Blood 1990; 76:480-8. [PMID: 2378981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
For younger patients with acute myeloid leukemia (AML), an allogeneic transplant from a matched sibling may afford the best chance of cure. In patients who are older or without a matched sibling donor, dose intensification can be achieved with an autologous bone marrow transplant (ABMT). We report here the results of a high-dose chemotherapy regime with nonpurged ABMT in 82 adult patients in first remission of AML with a median follow-up of 31 months. The median age was 40 years (range 16 to 57 years). The median interval between remission and ABMT was 5 months (range 1 to 12 months). Twenty-eight of these patients received a second course of the same high-dose chemotherapy and ABMT. The procedure related mortality rate was 6%. The projected leukemia-free survival (LFS) at 5 years is 48% for all 82 patients and 50% for the 76 patients with no known preceding myelodysplastic syndrome. For those patients with primary AML who received a double ABMT the projected LFS is 67%. The interval between remission and ABMT did not predict for either relapse or LFS. ABMT using a multidrug chemotherapy protocol is less toxic than allogeneic BMT yet results in a similar LFS.
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MESH Headings
- Adolescent
- Adult
- Bone Marrow Transplantation
- Combined Modality Therapy
- Cytarabine/therapeutic use
- Daunorubicin/therapeutic use
- Dose-Response Relationship, Drug
- Drug Therapy, Combination
- Female
- Follow-Up Studies
- Hematopoiesis/drug effects
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/surgery
- Male
- Middle Aged
- Prognosis
- Transplantation, Autologous/mortality
- Transplantation, Autologous/pathology
- Transplantation, Homologous/mortality
- Transplantation, Homologous/pathology
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Georgoulakis JM, Akins SE, Richards JD, Guillen AC, Gaffney CL, Bolling DR, Austin VR, Moon JP. A comparison of ambulatory classification systems: a preliminary report. J Ambul Care Manage 1990; 13:39-49. [PMID: 10113250 DOI: 10.1097/00004479-199007000-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gribben JG, Goldstone AH, Linch DC, Taghipour G, McMillan AK, Souhami RL, Earl H, Richards JD. Effectiveness of high-dose combination chemotherapy and autologous bone marrow transplantation for patients with non-Hodgkin's lymphomas who are still responsive to conventional-dose therapy. J Clin Oncol 1989; 7:1621-9. [PMID: 2809678 DOI: 10.1200/jco.1989.7.11.1621] [Citation(s) in RCA: 90] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We commenced a study in September 1981 to investigate the role of high-dose combination chemotherapy in the management of patients with non-Hodgkin's lymphomas who had failed conventional therapy. Fifty patients with diffuse intermediate- and high-grade non-Hodgkin's lymphomas were treated with high-dose combination chemotherapy with autologous bone marrow rescue (ABMT) and have a minimum follow-up of 1 year. Twenty patients had disease that was still responsive to conventional-dose chemotherapy, 15 had achieved a partial response (PR) to first-line therapy, and five were showing PR to salvage therapy after relapse. Twelve of these patients (60%) achieved complete remission (CR) (two following boost radiotherapy) and three patients have nonprogressive masses on computed tomographic (CT) scan as the only abnormality. None of these patients died during the procedure. Twenty-nine patients had disease not responsive to chemotherapy at conventional dosages: 19 had no response to first-line therapy and 10 showed no response to salvage therapy given after relapse. Only three of these patients achieved CR, all of short duration only. Only two patients in this group remain alive more than 2 years after the procedure and both have nonprogressive abnormalities on CT scan. Nine patients (31%) died of sepsis during the procedure. In those patients with disease not responsive to conventional-dose therapy, dose escalation is associated with a high procedure-related mortality and a low response rate. In those patients who still have chemotherapy-responsive disease the response rate is high and mortality is low.(ABSTRACT TRUNCATED AT 250 WORDS)
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31
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Russell SJ, Richards JD. Medical indications for splenectomy. Br J Hosp Med (Lond) 1989; 42:120-3, 125-6, 127. [PMID: 2670025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The spleen, whether anatomically and physiologically normal or diseased, may significantly worsen the clinical picture in a variety of medical disorders. However, splenectomy should be undertaken only after a careful balancing of the short- and long-term risks and potential benefits to the patient, which are discussed in the following review.
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32
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Singer CR, Tobias JS, Giles F, Rudd GN, Blackman GM, Richards JD. Hemibody irradiation. An effective second-line therapy in drug-resistance multiple myeloma. Cancer 1989; 63:2446-51. [PMID: 2720593 DOI: 10.1002/1097-0142(19890615)63:12<2446::aid-cncr2820631214>3.0.co;2-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors report the results of treatment of 41 patients with melphalan-resistant multiple myeloma using single half-body irradiation (HBI) or double half-body irradiation (DHBI). Patients were grouped using prognostic classification reported by the Medical Research Council. Patients in group I and II showed the best response to therapy with reduction in serum of urinary paraprotein and improvement in symptoms, most notably a marked reduction in bone pain. In these groups five patients have survived over 2 years after therapy. The therapeutic response appeared better in those patients who received DHBI as opposed to those whom treated with single HBI. Patients in group III did not achieve prolonged survival but effective relief of bone pain was a consistent finding in these patients also. Thus HBI represents an alternative to combination chemotherapy as second-line treatment of patients with melphalan-resistant multiple myeloma. A comparative study of HBI versus combination chemotherapy is now indicated to establish which therapeutic approach is most effective.
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33
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Selby DG, Richards JD, Marshman JM. ACE inhibitors. Anaesth Intensive Care 1989; 17:110-1. [PMID: 2712263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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34
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Norden AG, Flynn FV, Fulcher LM, Richards JD. Renal impairment in myeloma: negative association with isoelectric point of excreted Bence-Jones protein. J Clin Pathol 1989; 42:59-62. [PMID: 2466054 PMCID: PMC1141792 DOI: 10.1136/jcp.42.1.59] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The isoelectric point (pI) of the major form of Bence-Jones protein excreted by 62 patients with myeloma and six with macroglobulinaemia was measured by combining isoelectric focusing with immunoblotting techniques. The distribution of the pI values for both kappa and lambda type proteins was bimodal, most falling in the ranges 5.0-6.0 and 7.0-7.5. Plasma creatinine and creatinine clearance and the urine excretion of alpha-1-microglobulin and beta-2-microglobulin were measured in 24 of the patients. These patients, who were free of additional factors known to have an association with the development of renal impairment, were followed up for a mean period of 16 months (range three to 28 months). It was found that renal impairment was not related to the pI of the Bence-Jones protein excreted.
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35
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Gribben JG, Goldstone AH, Linch DC, MacMillan AK, Richards JD. Double autologous bone marrow transplantation in acute myeloid leukaemia. Bone Marrow Transplant 1989; 4 Suppl 1:209-11. [PMID: 2653506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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36
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Russell SJ, Giles FJ, Thompson DS, Scanlon DJ, Walker H, Richards JD. Granulocytic sarcoma of the small intestine preceding acute myelomonocytic leukemia with abnormal eosinophils and inv(16). CANCER GENETICS AND CYTOGENETICS 1988; 35:231-5. [PMID: 3180024 DOI: 10.1016/0165-4608(88)90245-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We report a case of preleukemic granulocytic sarcoma of the small intestine preceding the development of acute myelomonocytic leukemia with abnormal eosinophils and inversion of chromosome 16, inv(16)(p13q22). A literature review suggests that this is a recurring cytogenetic-clinicopathologic association and carries a favorable prognosis, especially if treated aggressively with antileukemic therapy at the time of diagnosis.
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37
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MacIntyre EA, Green ES, Richards JD, De Silva PM, Weir WR. Concurrent malaria and bacteraemia in a multiply transfused patient. CLINICAL AND LABORATORY HAEMATOLOGY 1988; 10:355-6. [PMID: 3053009 DOI: 10.1111/j.1365-2257.1988.tb00029.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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38
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Giles FJ, Russell SJ, Worman CP, Goldstone AH, Richards JD, Holton J. Atypical mycobacterial infection in alpha interferon-treated hairy cell leukaemia. Acta Haematol 1988; 80:159-61. [PMID: 3143214 DOI: 10.1159/000205623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A patient whose hairy cell leukaemia had begun to respond to alpha interferon therapy developed overt atypical mycobacterial infection. This eventually responded to combination antimicrobial therapy. The clinical difficulties involved in this unique case included difficulty in isolation of the organism, failure of an empirical trial of antituberculous therapy and false attribution of the patient's infective symptoms to alpha interferon.
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40
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Webster A, Russell SJ, Souhami RL, Richards JD, Goldstone AH, Grüneberg RN. Use of teicoplanin for Hickman catheter associated staphylococcal infection in immunosuppressed patients. J Hosp Infect 1987; 10:77-82. [PMID: 2888816 DOI: 10.1016/0195-6701(87)90036-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Antibiotic-resistant coagulase-negative staphylococci are a frequent cause of infection in indwelling central venous (Hickman) catheters. Teicoplanin has been evaluated in the treatment of 19 immunosuppressed patients with staphylococcal Hickman catheter infections, nine of whom were septicaemic. All infections were eradicated, with minimal side effects. In 16 cases, the catheter was retained until no longer required. Two recurrent infections were eradicated by a second course of teicoplanin. We conclude that teicoplanin is an effective and well-tolerated antibiotic in the treatment of Hickman catheter infections in immunosuppressed patients.
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41
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Lai AP, Martin PJ, Cawley JC, Richards JD, Goldstone AH. Automated leucocyte differential counts in chronic lymphocytic and hairy-cell leukaemias: a comparison of the Hemalog D, H6000 and Coulter S Plus IV. CLINICAL AND LABORATORY HAEMATOLOGY 1987; 9:169-74. [PMID: 3621859 DOI: 10.1111/j.1365-2257.1987.tb01398.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The automated peripheral blood differential counts produced by the Hemalog D, H6000 and Coulter S Plus IV were analysed and compared in 30 cases of chronic lymphocytic leukaemia (CLL) and 12 cases of hairy-cell leukaemia. All three machines were reliable in identifying CLL and HCL as a 'lymphocytosis' and in estimating neutrophil numbers in the disease. The Hemalog D and H6000 produced accurate monocyte counts in the two diseases, but the Coulter S Plus IV was unreliable in this regard since large lymphoid cells were identified as monocytes. The Haemalog D and H6000 were comparable in consistently identifying modestly raised large unstained cells (LUCs) in CLL. The Hemalog D, but not the H6000, was able to distinguish HCL from CLL on the basis of markedly raised LUCs.
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42
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Richards JD, Singer CR, Tobias JS. Management of multiple myeloma. Br J Hosp Med (Lond) 1987; 37:437, 440-2. [PMID: 2437986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article reviews the diagnostic approach to a patient with suspected multiple myeloma. Studies of chemotherapeutic regimens are reviewed and the alternative therapeutic options available at different stages of disease progression are discussed. These include newer modalities of treatment such as hemi-body irradiation as second-line therapy, bone marrow transplantation in plateau-phase and the role of alpha interferon.
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43
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Anderson CC, Goldstone AH, Linch DC, Jones HM, Franklin IM, Boughton BJ, Cawley JC, Richards JD. Autologous bone marrow transplantation for patients with acute myeloid leukaemia and acute lymphoblastic leukaemia--a comparison. Bone Marrow Transplant 1987; 1:271-9. [PMID: 3332138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Forty-two patients with acute leukaemia were treated with autologous bone marrow transplantation (ABMT) using a combination chemotherapy protocol for bone marrow ablation. The response to high-dose chemotherapy and ABMT and its associated morbidity and mortality have been compared in 24 patients with acute myeloid leukaemia (AML) and 18 patients with acute lymphoblastic leukaemia (ALL). In 16 patients with AML treated with ABMT during first complete remission (CR), ten patients (62.5%) remain in unmaintained remission; median follow up is 32 months. In eight patients with ALL treated in first CR, only one remains in remission 32 months post-ABMT, with three patients dying non-leukaemic deaths. Fourteen of 18 patients (AML and ALL) treated after first remission have died of recurrent leukaemia, two died non-leukaemic deaths and two remain well 31 and 55 months post-ABMT; both have ALL. The length of hospital stay and the amount of blood product support were similar in both groups. Haematological recovery post-ABMT was delayed in patients with AML compared to patients with ALL but this difference was not significant. Rapidly progressive lung infection was thought to be the cause of four early deaths (4/18) in patients with ALL but none in patients with AML. Severe gram-negative infections were significantly more common in patients with AML.
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44
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Goldstone AH, Anderson CC, Linch DC, Franklin IM, Boughton BJ, Cawley JC, Richards JD. Autologous bone marrow transplantation following high dose chemotherapy for the treatment of adult patients with acute myeloid leukaemia. Br J Haematol 1986; 64:529-37. [PMID: 3539175 DOI: 10.1111/j.1365-2141.1986.tb02209.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
24 adult patients with acute myeloid leukaemia (AML) were treated with intensive chemotherapy followed by autologous marrow rescue. The procedure was repeated twice in eight patients. 11 of 16 patients treated in first remission continue in first unmaintained remission (9-54 months, median 17 months). Eight patients treated at relapse or second remission have relapsed again and died within 14 months of their first autologous bone marrow transplant (ABMT). This form of intensification therapy would appear valuable for adult AML patients in first remission.
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45
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Armitage RJ, Goldstone AH, Richards JD, Cawley JC. Lymphocyte function after autologous bone marrow transplantation (BMT): a comparison with patients treated with allogeneic BMT and with chemotherapy only. Br J Haematol 1986; 63:637-47. [PMID: 2942170 DOI: 10.1111/j.1365-2141.1986.tb07547.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
T- and B-cell function after autologous bone marrow transplantation (ABMT) was assessed and compared with that found after allogeneic BMT and after chemotherapy only. In all 16 patients with acute leukaemia in remission treated with high-dose chemotherapy and single or double ABMT, T-helper numbers and function in an assay measuring PWM-induced Ig synthesis were grossly defective and closely resembled the defects observed after allo-BMT involving chemoradiotherapy (six patients). T-helper activity was more variable after chemotherapy only (eight patients), but in individual patients the defect was as great as that observed after BMT. In contrast, suppressor activity was comparably increased in all patient groups and increased numbers of Leu 15+ Dr+ Tac- suppressor T cells were consistently observed, suggesting chronic activation of suppressor T cells, the cause of which remains unknown. B-cell function was also uniformly impaired in all patients tested. It is therefore concluded that defective immune function after BMT is not due to alloimmune or radiotherapy-mediated effects. Furthermore, since many patients were studied a prolonged period after BMT and had no T cells with a thymic phenotype and no evidence of infection, it is unlikely that the defects are secondary to cellular immaturity following marrow regeneration or to superadded infection. The gross immune defects observed after various forms of BMT are likely, therefore, to be directly attributable to the chemotherapy involved.
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MESH Headings
- Acute Disease
- B-Lymphocytes/immunology
- Bone Marrow Transplantation
- Cyclophosphamide/therapeutic use
- Humans
- Leukemia, Lymphoid/immunology
- Leukemia, Lymphoid/therapy
- Leukemia, Myeloid, Acute/immunology
- Leukemia, Myeloid, Acute/therapy
- T-Lymphocytes/immunology
- T-Lymphocytes, Helper-Inducer/immunology
- T-Lymphocytes, Regulatory/immunology
- Transplantation, Autologous
- Transplantation, Homologous
- Whole-Body Irradiation
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Lai AP, Martin PJ, Richards JD, Goldstone AH, Cawley JC. Automated leucocyte differential counts in acute leukaemia: a comparison of the Hemalog D, H6000 and Coulter S-plus IV. CLINICAL AND LABORATORY HAEMATOLOGY 1986; 8:33-41. [PMID: 3459604 DOI: 10.1111/j.1365-2257.1986.tb00073.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The automated peripheral blood differential counts produced by the Hemalog D, H6000 and Coulter S-plus IV were analysed in 32 cases of acute leukaemia (22 AML (acute myeloblastic leukaemia); 10 ALL (acute lymphoblastic leukaemia], all with greater than 30% circulating blast cells. All three machines were highly effective in recognizing the presence of an abnormality. With the Hemalog D and H6000, the presence of increased LUC and HPX cells, together with an LPX alarm, was suggestive of acute leukaemia. With the Coulter S-plus IV, multiple alarms indicated the need for further investigation but, since alarms occur in many other situations, their presence was not necessarily suggestive of acute leukaemia. All the machines were of value in distinguishing AML from ALL since 'lymphocytes' were predominant in all cases of ALL and 'neutrophils' the majority cell type in most patients with AML. However, the presence in a minority of cases of AML of large numbers of micromyeloblasts recognized as 'lymphocytes' limited the discriminating power of all three machines. The Hemalog D allowed some definition of subtypes of AML, but the H6000 and Coulter S-plus IV were of no value in this regard.
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Mackintosh W, Richards JD, Jacobs P. T-cell acute lymphoblastic leukaemia in adults. S Afr Med J 1985; 67:450-2. [PMID: 3885423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Of 27 consecutive adult patients with acute lymphoblastic leukaemia (ALL), 7 had T-cell variants on the basis of sheep erythrocyte (E) rosette formation; in 5, a characteristic thymic phenotype was demonstrated by the use of appropriate monoclonal antibodies. All patients were treated with prednisone, vincristine, 1-asparaginase and adriamycin and the peripheral blood cleared of circulating lymphoblasts in a median of 8 days (range 6 - 45 days), a figure which does not differ significantly from that of 7 days (range 3 - 59 days) in those with the common ALL (P greater than 0,5). The complete remission rates were 71% for the patients with T-cell leukaemia and 75% for the E rosette-negative patients; median durations of remission were 35 and 26 weeks respectively and the actuarially predicted median durations of survival were 49 and 39 weeks respectively. Therefore the presence of T-cell markers in adult ALL does not seem to affect the prognosis in the same way that it does in children, and this is likely to be the result of the more aggressive clinical course of ALL of all phenotypes in adults.
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Silber M, Richards JD, Jacobs P. Life-threatening haemolytic anaemia and infectious mononucleosis. A case report. S Afr Med J 1985; 67:183-5. [PMID: 3983760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
A 36-year-old man with infectious mononucleosis presented with massive intravascular haemolytic anaemia. The diagnosis was established by a positive Paul-Bunnell test, the demonstration of IgM antibodies against Epstein-Barr virus capsid, and IgG antibody to early antigen. The direct and indirect antiglobulin tests were negative; the pathogenesis of the severe haemolysis was attributed to the temporary synthesis of anti-i cold agglutinin having a high thermal amplitude. Although life-threatening, the episode was short-lived and responded to supportive therapy with blood transfusion and folate administration only. This case illustrates a rare association between severe haemolytic anaemia and infectious mononucleosis, it emphasizes the value of IgM-specific fluorescent antibody tests in diagnosis when patients have otherwise unexplained haemolysis.
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Tobias JS, Richards JD, Blackman GM, Joannides T, Trask CW, Nathan JI. Hemibody irradiation in multiple myeloma. Radiother Oncol 1985; 3:11-6. [PMID: 3975437 DOI: 10.1016/s0167-8140(85)80003-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Eighteen patients with multiple myeloma were treated by hemibody irradiation using large single fractions, usually to a dose of 10 Gy (lower half) and 7.5 Gy (upper half). All except one patient had previously been treated by multiple courses of conventional chemotherapy with melphalan and prednisone, and were considered to be resistant to further chemotherapy. In most cases, local field irradiation had also been given for symptomatic bone pain. Of the 13 patients who had symptoms at the start of hemibody irradiation, 11 improved sufficiently for their analgesia requirement to be reduced. In eight patients, there was a significant fall in circulating immunoglobulin but no patient with Bence-Jones proteinuria had complete resolution of this biochemical abnormality. Although thrombocytopenia and neutropenia were common, only two patients required platelet transfusion and the treatment was in general extremely well tolerated. Survival following hemibody irradiation was similar to the survival reported from the use of "second-line" chemotherapy and we feel that hemibody irradiation is a more acceptable alternative for most patients.
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Abstract
The well-trained nurse is the central figure in the efficient operation of the Cell Support Unit. This individual is responsible for the safety of those undergoing the procedures, whether they be volunteer donors or patients and has as a prerequisite thorough training and competence in intensive nursing care.
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