Coccygectomy for patients with chronic coccydynia: a prospective, observational study of 98 patients

AIMS

The purpose of this prospective study was to evaluate the outcomes of coccygectomy for patients with chronic coccydynia.

PATIENTS AND METHODS

Between 2007 and 2011, 98 patients underwent coccygectomy for chronic coccydynia. The patients were aged > 18 years, had coccygeal pain, local tenderness and a radiological abnormality, and had failed conservative management. Outcome measures were the Short Form 36 (SF-36), the Oswestry Disability Index (ODI) and a visual analogue scale (VAS) for pain. Secondary analysis compared the pre-operative features and the outcomes of patients with successful and failed treatment, two years post-operatively. The threshold for success was based on a minimum clinically important difference (MCID) on the ODI of 20 points. All other patients, including those lost to follow-up, were classified as failures.

RESULTS

There was significant improvement in all ten components of the SF-36 (p < 0.05), the ODI (23 points) and VAS (39 points) (p < 0.0001). A total of 69 patients (70.4%) met the designated MCID threshold for a successful outcome. The failure group consisted of 25 patients (25.5%) who did not reach the MCID and four (4.1%) who were lost to follow-up. Six patients (6.1%) in the failure group had ODI scores that were no better or worse than that pre-operatively. The patients in whom treatment failed had significantly worse pre-operative scores for the ODI (p = 0.04), VAS (p = 0.02) and on five of ten SF-36 components (p < 0.04). They also had a higher incidence of psychiatric disorders, pre-operative opiate use and more than three comorbidities.

TAKE HOME MESSAGE

Coccygectomy for chronic coccydynia results in significant improvement in patient-reported outcomes at two years. Failure is associated with certain pre-operative characteristics such as psychiatric illness, poor quality of life features, higher levels of pain, and use of opiates.

Abnormal lymphoid organ development in immunodeficient mutant mice

Development of the primary and secondary lymphoid organs is a tightly controlled process. These tissues are highly organized to maximize efficiency of the immune response. Spontaneous and targeted mutations in laboratory mice have led to better understanding of the molecular interactions and signaling pathways essential to the development and organization of lymphoid tissues, and the functional consequences of loss or disruption of the normal structures. On the basis of studies of mutations in mice and other species, it has been determined that a wild-type allele of the Foxn1 gene is required for normal thymic development and function. The Tlx1, Bapx1, Tcf21, Wt1 and Dh genes are essential for development of the spleen, while mutations of Nkx2-3, Lta, Ltb, Ltbr, Map3k14, Relb, Tnf, Tnfrsf1a, Cxcl13, Blr1 (Cxcr5), or cpdm genes result in disruption of normal splenic microarchitecture. The requirements for organized lymph nodes vary according to anatomic location, but most rely on Id2 (Idb2) and Rorc, in addition to lymphotoxins and Tnfrsf11a, Tnfsf11, Relb, Map3k14, Cxcl13, and Blr1 genes. Development of Peyer's patches is dependent on Id2 and Rorc genes, lymphotoxins, and Relb, Map3k14, Il7r, and cpdm genes. Less is known about the requirements for nasal-associated lymphoid tissues (NALT), but Id2 is a requirement. Here we review abnormalities of lymphoid organ development in immunodeficient mutant mice, including spontaneous and targeted mutations of Id2, Rorc, Tnf, Tnfrsf1a, Lta, Ltb, Ltbr, Tnfrsf11a, Tnfsf11, Relb, Map3k14, IL7r, Blr1, and Cxcl13 genes.

The heritability of the expression of two stress-regulated gene fragments in pigs

Pigs reared in commercial production units sometimes encounter stressors that significantly decrease growth performance. It is hypothesized that response to stress challenges could potentially be used as selection criteria. This study aimed to investigate, in a commercial setting, the heritability of two target genes previously shown to be induced in response to stress, and related to growth performance, in an experimental situation. Blood samples (n = 2,392) were collected from three separate breeding lines of pedigreed and performance-tested boars between 24 to 25 wk of age. The expression levels of a novel fragment, '29a,' and the calcitonin receptor gene (CTR) were quantified using quantitative real-time PCR (qRT-PCR) on a subset (n = 709) of the blood samples. Gene expression levels were corrected for the efficiency of PCR reactions and also computed directly from threshold cycle (Ct) values. Resulting data showed a skewed nonnormal distribution of expression levels for the target genes relative to the endogenous control, glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and were highly variable. Analyses were subsequently performed using untransformed and log-transformed data, with outliers identified and deleted in edited data sets. Regardless of the transformation or editing procedures for outliers applied, there was negligible genetic variation for the expression of target genes relative to GAPDH. In contrast, repeatabilities of replicate samples were generally high (between 0.54 and 0.67). Absolute expression levels for GAPDH and 29a were lowly heritable (h2 of about 0.04), although estimates did not exceed their SE. Subsetting the data according to whether the target gene had a higher or lower level of expression than GAPDH was then performed using the relevant Ct values. In the subset where the target gene was more highly expressed than GAPDH, a moderate estimate of heritability (0.18 +/- 0.10) for the log-transformed absolute expression level of 29a was obtained, whereas the estimate for its expression relative to GAPDH was lower (0.09 +/- 0.07). Estimates of heritability did not increase in the subset of low expression data. The limitations of using gene expression measures as potential selection criteria in commercial situations are discussed.

Anomalous unilateral single pulmonary vein: Two cases mimicking arteriovenous malformations and a review of the literature

Total anomalous pulmonary venous drainage is a rare congenital anomaly. It usually involves a pulmonary to systemic venous shunt and most cases have a septal defect in order to survive. Anomalous pulmonary venous drainage with pulmonary venous shunting is an extremely rare and entirely benign entity. We present two such cases, in which there was atresia of the left superior pulmonary vein and drainage via a tortuous collateral vein to the left inferior pulmonary vein. This collateral was mistaken on plain film and CT for a pulmonary arteriovenous malformation. Awareness of this anomalous unilateral single pulmonary vein and its radiological appearances may help in avoiding unnecessary pulmonary angiography.

Use of pharmacists by older people in the community

A random sample of community dwelling elderly people (> 65 years) was interviewed on two occasions, 6 months apart. Four hundred and thirty five completed both interviews. Subjects were asked about their medication, and about the advice sought from community pharmacists, on both drug and non-drug related health issues. Medication had been altered during the 6-month interval in 101 (23%) of people, but only 15 of these had discussed the change with a pharmacist. The majority of those who did discuss their medication, however, found the exchange helpful. Only 1% of the sample had discussed a health problem not related to drugs with a pharmacist in the previous month, although once again such discussions were felt to be useful. Of the total sample, 79% said they would never discuss medication-related issues with a community pharmacist, and 83% would not discuss other health matters. The majority of this sample - 96% - expressed a preference to discuss these issues with their general practitioner.

Additional properties and uses of essential oils

Much evidence has been published supporting the use of mouthwashes in a number of crucial areas of oral health. These areas include antibacterial activity, home irrigation, maintenance of implant health, postsurgery uses, reduction of bacteria in dental aerosols and bacteraemia reduction. Although other commonly used mouthwashes (e.g. chlorhexidine) have been reviewed in other articles in this Supplement, this article concentrates solely on data supporting essential-oil mouthwash use in these oral health areas.

Radiology and the Cancer Services Collaborative--an opportunity awaits

The principles and methodologies used by the Cancer Services Collaborative (CSC) are particularly relevant for radiology departments. A radiology project looking at the provision of barium enema examinations is used to highlight how the principles can be applied to a radiology department. Advice on how to access available CSC literature is offered. The CSC principles and methodologies are an important part of the NHS modernization agenda, and offer an exciting vehicle to improve patient care. It is important that radiologists understand the opportunities offered and the challenges posed by the modernization agenda.

Elliptic flow in Au+Au collisions at square root(S)NN = 130 GeV

Elliptic flow from nuclear collisions is a hadronic observable sensitive to the early stages of system evolution. We report first results on elliptic flow of charged particles at midrapidity in Au+Au collisions at square root(S)NN = 130 GeV using the STAR Time Projection Chamber at the Relativistic Heavy Ion Collider. The elliptic flow signal, v2, averaged over transverse momentum, reaches values of about 6% for relatively peripheral collisions and decreases for the more central collisions. This can be interpreted as the observation of a higher degree of thermalization than at lower collision energies. Pseudorapidity and transverse momentum dependence of elliptic flow are also presented.

Role of the kidney in regulating the metabolism of HDL in rabbits: evidence that iodination alters the catabolism of apolipoprotein A-I by the kidney

To evaluate the factors that regulate HDL catabolism in vivo, we have measured the clearance of human apoA-I from rabbit plasma by following the isotopic decay of (125)I-apoA-I and the clearance of unlabeled apoA-I using a radioimmunometric assay (RIA). We show that the clearance of unlabeled apoA-I is 3-fold slower than that of (125)I-apoA-I. The mass clearance of iodinated apoA-I, as determined by RIA, is superimposable with the isotopic clearance of (125)I-apoA-I. The data demonstrate that iodination of tyrosine residues alters the apoA-I molecule in a manner that promotes an accelerated catabolism. The clearance from rabbit plasma of unmodified apoA-I on HDL(3) and a reconstituted HDL particle (LpA-I) were very similar and about 3-4-fold slower than that for (125)I-apoA-I on the lipoproteins. Therefore, HDL turnover in the rabbit is much slower than that estimated from tracer kinetic studies. To determine the role of the kidney in HDL metabolism, the kinetics of unmodified apoA-I and LpA-I were reevaluated in animals after a unilateral nephrectomy. Removal of one kidney was associated with a 40-50% reduction in creatinine clearance rates and a 34% decrease in the clearance rate of unlabeled apoA-I and LpA-I particles. In contrast, the clearance of (125)I-labeled molecules was much less affected by the removal of a kidney; FCR for (125)I-LpA-I was reduced by <10%. The data show that the kidneys are responsible for most (70%) of the catabolism of apoA-I and HDL in vivo, while (125)I-labeled apoA-I and HDL are rapidly catabolized by different tissues. Thus, the kidney is the major site for HDL catabolism in vivo. Modification of tyrosine residues on apoA-I may increase its plasma clearance rate by enhancing extra-renal degradation pathways.

A phase II trial of mitomycin, ifosfamide and cisplatin in recurrent carcinoma of the cervix

The purpose of this study was to evaluate the efficacy and the toxicity of mitomycin, ifosfamide, and cisplatin in patients with recurrent carcinoma of the cervix. Between July 1992 and March 1995, 20 patients with recurrent cervical cancer were enrolled in this study. No patients had received prior chemotherapy for metastatic disease, except some were exposed to cisplatin as a radiosensitizer at the time of their diagnosis. Mitomycin-C 6 mg/m2, ifosfamide 3 g/m2, and cisplatin 50 mg/m2 were given intravenously every 3 weeks. All patients were assessible for response and toxicity, and none was lost to follow-up. All patients except one had squamous cell carcinoma. The overall response rate was 45% (2 complete remissions and 7 partial remissions). The mean response duration was 35 months, and the median survival from treatment for the whole group was 14 months. Fifteen percent of all cycles produced grade 3 or 4 myelosuppression, and the main nonhematologic toxicity was nausea and vomiting, which was reported in 11.5% of all cycles. One death occurred secondary to chemotherapy-induced septicemia. Three patients are still alive, two with a complete response and one with a partial response. In conclusion, mitomycin, ifosfamide, and cisplatin have a good activity in recurrent carcinoma of the cervix and are comparable to other combination chemotherapy.

Abuse and therapeutic potential of gamma-hydroxybutyric acid

Gamma-hydroxbutyric acid is a compound found in mammalian brain that is structurally related to the neurotransmitters gamma-aminobutyric acid and glutamic acid. Gamma-hydroxybutyric acid effects dopaminergic systems in the brain and may be a neurotransmitter. Gamma-hydroxybutyric acid was first reported as a drug of abuse in 1990 and continues to be abused by bodybuilders, participants of "rave" dance parties, and polydrug abusers. Physical dependence can develop after prolonged, high-dose use, and overdoses have been widely reported. Its use in sexual assaults as a "date rape" drug and availability on the internet have recently emerged. Gamma-hydroxybutyric acid has established efficacy as an anesthetic agent, and preliminary evidence supports its utility in the treatment of alcohol dependence, opiate dependence, and narcolepsy.

MRI assessment of the pre-vertebral soft tissues in acute cervical spine trauma

This pictorial review illustrates the MRI appearances of pre-vertebral haematoma in acute cervical spine trauma. The review is based on 31 patients who underwent MRI within 5 days of injury. MRI showed pre-vertebral haematoma in 24 cases; soft tissue thickening was detected on conventional radiographs in 14 cases. MRI is more sensitive than radiography for the detection of pre-vertebral haematoma.

Magnetic resonance imaging of the painful wrist

This pictorial review illustrates the use of magnetic resonance imaging in the assessment of the painful wrist. Careful technique is essential to optimize the accuracy of MR of the wrist. MR is the investigation of choice in avascular necrosis and has an increasing role in internal derangement, trauma and soft tissue lesions.

Magnetic resonance imaging of acute intraosseous disc herniation

Schmorl's nodes, the result of previous intraosseous disc herniation (IODH), are a common incidental finding on plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). Acute IODH can, however, cause severe back pain, and the radiological features may also lead to inappropriate suspicion of malignancy or infection. We present eight cases of acute IODH in order to illustrate how the correct diagnosis can be made by MRI. In six cases isotope bone scintigraphy had been performed, demonstrating focal increased activity at the site of IODH. MRI can reinforce the concern about serious underlying pathology by the demonstration of marrow oedema, which may be localized around the disc herniation or extensive, extending throughout the vertebral body and into the pedicles. The key to the correct diagnosis is the recognition of the endplate defect and disc herniation. In three cases the diagnosis may have been possible from plain radiographs in which disc calcification visible on previous radiographs had migrated into an intraosseous location.

Sonographic appearances of meniscal cysts

PURPOSE

This study was conducted to define the sonographic appearances of cysts of the tibial menisci.

METHODS

Thirteen cases of meniscal cyst, proven by magnetic resonance imaging (MRI), were assessed using high-resolution sonography, and results of the 2 imaging modalities were correlated.

RESULTS

Seven meniscal cysts were lateral to the joint line, and 6 were located medially. MRI showed all 13 cysts to be associated with a tear of the adjoining meniscus. On sonograms, cyst size varied from 9 to 56 mm. Echotexture varied from uniformly hypoechoic or hypoechoic with echogenic septa to heterogeneously hyperechoic. Septated cysts were demonstrated by MRI and sonography.

CONCLUSIONS

Because of their diverse echo patterns, meniscal cysts may be easily mistaken for soft-tissue tumors, ganglions, or other lesions, which may result in surgery being inappropriately recommended. This is particularly true in the case of echogenic cysts. The cardinal sonographic characteristic of a meniscal cyst is its continuity with the meniscus, not its echotexture.

Paget's disease of the sternum simulating an ectopic adenoma on parathyroid scintigraphy

The authors present the case of a patient with recurrent hyperparathyroidism who was shown on thallium-technetium subtraction scintigraphy, ultrasound, and magnetic resonance imaging to have recurrent parathyroid tissue in the right side of the neck. The thallium scan also showed intense uptake centrally in the chest, mimicking an intrathoracic adenoma. This was subsequently shown on plain films and a radionuclide bone scan to be due to Paget's disease of the sternum. This case illustrates the value of a combined imaging strategy in preventing an unnecessary thoracotomy after a false-positive nuclear medicine scan.

Patient dose reduction by audit of grid usage in barium enemas

Patient dose reduction may be achieved by removal of the antiscatter grid during fluoroscopy when fine detail is not required, such as during the filling phase of barium enemas. A questionnaire revealed that none of 22 trainee radiologists routinely removed the grid for the filling phase of adult barium enemas. Following this, 100 consecutive barium enemas were observed, with assessment of patient radiation dose by means of a dose-area product meter. The grid was removed in only six examinations. Phantom measurements implied a possible 46% reduction in dose for the filling phase by correct grid usage. These data were presented at a local clinical audit meeting, resulting in a change in departmental policy to recommend routine removal of the grid for the filling phase of barium enemas. In a follow-up audit the grid was removed in 96 of 100 consecutive enemas, resulting in a significant 46.5% dose reduction for the filling phase (95% confidence interval 38-61%). Further re-audit has demonstrated continued good practice.

Cervical sagittal range-of-motion analysis using three methods. Cervical range-of-motion device, 3space, and radiography

STUDY DESIGN

Cervical flexion, extension, protrusion, and retraction were comparatively measured in volunteers using a cervical range-of-motion device (Performance Attainment Associates, Roseville, MN), a 3space system (Polhemus, Colchester, VT), and lateral radiographs.

OBJECTIVES

To compare the outcomes of three methods of measurement of cervical flexion, extension, protrusion, and retraction.

SUMMARY OF BACKGROUND DATA

Few studies compare cervical range-of-motion measurement devices with radiographic measurements, and no studies have compared methods of measurement for cervical protrusion and retraction measurement.

METHODS

In 20 asymptomatic volunteers, four end-range sagittal cervical positions (flexion, extension, protrusion, and retraction) were measured simultaneously using a cervical range-of-motion device, a 3Space and lateral cervical radiographs. Measurements were compared, and differences were analyzed.

RESULTS

There were no significant differences for flexion and extension measurements between the cervical range-of-motion device and that radiographic angle determined by an occipital line and the vertical, nor were there any between the 3Space and that radiographic angle between this same occipital line and C7. The cervical range-of-motion device and the 3Space measurements for flexion and extension, however, differed significantly from one another (P < 0.05). For protrusion and retraction, there was no significant difference between the 3Space and radiographic measurements, but these two both differed significantly from the cervical range-of-motion device (P < 0.05).

CONCLUSIONS

Available methods of measurement differ as to whether the cervical spine is isolated or includes upper thoracic motion. Protrusion and retraction can be measured reliably with all three methods studied, but without measurement consistency between devices. Because end-range cervical flexion and extension-cannot occur in isolation from upper thoracic motion, true cervical motion can be measured only with an internally referenced, or landmark-based, methodology such as the 3Space. Even though the cervical range-of-motion device cannot measure isolated cervical flexion and extension, it is nevertheless a reliable clinical tool in measuring flexion and extension as well as protrusion and retraction as long as patient thoracic positioning is standardized to minimize the upper thoracic contribution.

Effect of in vivo administration of IL-3 and IL-6, alone and in combination with G-CSF, GM-CSF or IL-1, on haematopoiesis, graft-versus-host disease and survival after murine haematopoietic stem cell transplantation

We have explored the effect of IL-3 and IL-6, each alone and in combination with G-CSF, GM-CSF or IL-1, on neutrophil and platelet recovery in BALB/c mice (H-2d) given 10 Gy total body irradiation followed by 10(7) bone marrow cells and 10(6) spleen cells from C57BL6 donors (H-2b), as well as the effect of IL-3 alone and IL-6 alone on graft-versus-host disease (GVHD) and survival. Neither IL-3 alone nor IL-6 alone significantly increased the circulating absolute neutrophil count (ANC) at day 6 post transplant when compared with mice given saline injections (ANC 0.31 x 10(9)/l). G-CSF and IL-1, each alone, significantly raised the day-6 ANC (0.58 x 10(9)/l, p = 0.02; 0.67 x 10(9)/l, p = 0.007 respectively). However, IL-3, 200 ng twice daily, significantly increased the day-6 ANC when used in combination with GM-CSF (0.49 x 10(9)/l, p = 0.003) or with IL-6 (0.66 x 10(9)/l, p = 0.004), as well as with G-CSF (0.62 x 10(9)/l, p = 0.007) or with IL-1 (0.49 x 10(9)/l, p = 0.003). Apart from the combination with IL-3, IL-6 significantly raised the day-6 ANC only in combination with G-CSF (0.79 x 10(9)/l, p = 0.007). When used alone, both IL-6 and G-CSF raised the day-6 platelet count (312 x 10(9)/l, p = 0.02 and 309 x 10(9)/l, p = 0.01 respectively) compared with control mice (216 x 19(9)/l). IL-3 alone resulted in a platelet count of 303 x 10(9)/l (p = 0.06). In combination, only IL-3 with G-CSF significantly increased the value over that of saline control mice (328 x 10(9)/l, p = 0.02). IL-3 200 ng alone twice daily and IL-6 200 ng alone twice daily for 14 days post transplant resulted in survival not different from that of mice given saline injections. However, IL-3 500 ng twice daily for 14 days resulted in impaired survival and accelerated weight loss. In summary, while neither IL-3 nor IL-6 (nor GM-CSF) used alone accelerated neutrophil recovery post transplant, the combinations of IL-3 plus IL-6 and IL-3 plus GM-CSF did so. IL-6 (and G-CSF) accelerated platelet recovery post transplant, but combining IL-3 or IL-6 with the other cytokines was generally unsuccessful in this regard. Higher-dosage IL-3 appeared to accelerate graft-versus-host disease and impair survival, thus providing indirect evidence of the involvement of this cytokine in the mediation of GVHD.

Corticosteroid prophylaxis for patients with increased risk of adverse reactions to intravascular contrast agents: a survey of current practice in the UK

There is no definite experimental evidence that prophylactic corticosteroids reduce the frequency or severity of adverse effects from low-osmolar contrast agents in patients at increased risk of reaction. There is no consensus in terms of how prophylaxis should be conducted. We have studied current radiologists' practice in the UK by sending postal questionnaires to 212 radiologists randomly selected from a list of current consultants who are Fellows of the Royal College of Radiologists. One hundred and seventy (80.2%) of the 212 questionnaires were completed. The majority of radiologists routinely use non-ionic low osmolar contrast media for intravenous administration, only 30 (17.6%) routinely using conventional ionic agents and six (3.5%) ionic low osmolar agents. All 170 use low osmolar contrast media for those patients perceived to be at increased risk of adverse reactions. Seventy-six radiologists (44.7%) never use steroid cover. There is no consistent practice amongst the 94 consultants (55.3%) who do use steroid cover. The indications for prophylaxis vary, as do the corticosteroid used and the dose regime employed. The total dose used varied from the equivalent of 7.5 mg to 400 mg of prednisolone, and the duration of prophylaxis varied from a single dose to a 4 day course. One hundred and forty-two radiologists (83.5%) would welcome nationally agreed guidelines for the use of steroid cover. The great variation in the use of steroid cover in the UK reflects the lack of clear evidence of its benefit in combination with low osmolar contrast media.

Strawberry-shaped skull in fetal thanatophoric dysplasia

The sonographic finding of a strawberry-shaped skull is a marker of serious fetal malformation, most commonly associated with trisomy 18. We report a novel association of this sign with thanatophoric dysplasia.

Reduced tamoxifen accumulation is not associated with stimulated growth in tamoxifen resistance

To study tamoxifen resistance-stimulated growth, 30 female ovariectomized nude mice were implanted with tamoxifen-resistant tumors and treated with 10-1000 micrograms/day of tamoxifen citrate subcutaneously. Tamoxifen stimulated MCF-7 tumor growth in a dose-dependent manner, with tumoral tamoxifen concentrations increasing proportionally to the dose (1-13 nmol/g), as measured by high-performance liquid chromatography (HPLC). Flow-cytometric analysis revealed that tamoxifen-resistant tumors had a different DNA content as compared with wild-type MCF-7 cells. In contrast to earlier results, these data suggest that tamoxifen resistance-stimulated growth is associated with increasing rather than decreasing tumoral tamoxifen concentrations. Furthermore, the observed ploidy changes in the tamoxifen-resistant tumors imply that a genetic basis may exist for the development of tamoxifen resistance.

Weekly cisplatin plus external beam radiotherapy and high dose rate brachytherapy in patients with locally advanced carcinoma of the cervix

PURPOSE

Prospective, single arm, Phase I/II trial performed to assess the efficacy and toxicity of the concomitant use of weekly cisplatin and pelvic radiotherapy in patients with locally advanced carcinoma of the cervix.

METHODS AND MATERIALS

Between December 1988 and April 1991, 50 previously untreated patients with bulky, locally advanced, squamous cell carcinoma entered the study. All patients were evaluated by a gynecologist and a radiation oncologist and were submitted to standard pre-treatment staging procedures. The International Federation of Gynecology and Obstetrics stage distribution was as follows: IIA three patients, IIB seventeen, IIIA two, IIIB 25, and IVA three. Radiotherapy consisted of 46 Gy external beam irradiation plus three high dose rate intracavitary treatments given on a weekly basis to a total dose of 30 Gy to point A. Cisplatin 30 mg/m2 was also given weekly starting on day 1 of radiotherapy.

RESULTS

With a median follow-up time of 27 months, complete response was seen in 88% (44/50) of the patients. The actuarial survival rate at 44 months was 65%. Total pelvic failure rate was 26% (13/50). Of the 44 patients who achieved a complete remission, only seven have failed in the pelvis. Distant disease was observed in 24% of the cases. Treatments were well tolerated with no patient requiring an interruption in the radiotherapy. However, the incidence of late gastrointestinal toxicity was high, with 10 patients developing a rectal ulcer (four colostomies for severe bleeding), two patients a small bowel obstruction, and two patients a recto-vaginal fistula. Moreover, gastrointestinal complications appeared sooner than expected, at a median follow-up time of 11 months after completion of treatment.

CONCLUSION

The combination of weekly cisplatin and radiotherapy appears to be a very effective regimen for patients with locally advanced carcinoma of the cervix, but resulted in a relatively high frequency of late gastrointestinal complications.

Tamoxifen stimulates in vivo growth of drug-resistant estrogen receptor-negative breast cancer

An estrogen receptor-negative, multidrug-resistant MDA-MB-A1 human breast cancer cell line was grown in culture with and without a noninhibitory concentration (0.5 microM) of tamoxifen for 122 days. Tamoxifen-treated and control cells were inoculated into opposite flanks of nine nude mice, where they produced measurable tumors in every case. Six of the animals were treated with tamoxifen at 500 micrograms/day for 22 days. Although no inhibitory nor stimulatory effect of tamoxifen was seen in vitro, tamoxifen had a clear tumor-growth-stimulating effect in mice. The most pronounced stimulatory effects were observed in the cells that had been cultured with tamoxifen. Within 3 weeks of the start of tamoxifen therapy, the cells grown in the presence of tamoxifen produced tumors with a mean size of 380 mm2, whereas the cells not pretreated with tamoxifen had tumors of 220 mm2. In contrast, in mice not receiving tamoxifen, the sizes of the tumors were 190 and 140 mm2, respectively. These preliminary results suggest that prolonged in vitro tamoxifen exposure induces cellular changes that result in tumors that are stimulated to grow faster in mice following tamoxifen treatment.

The effect of hemiplegia on blood pressure measurement in the elderly

The blood pressure in both arms of 103 unselected hemiplegic patients was measured using a random-zero sphygmomanometer. Although for the whole sample the mean blood pressure in the paretic and unaffected arm was similar, a significant difference was found when the patients were subdivided according to the tone of the arm. The blood pressure was higher in paretic arms of patients with a spastic stroke and lower in the affected arm if the tone was flaccid. No other characteristics were associated with significant blood pressure differences, so that the findings appear to be directly related to changes in muscle tone. After a stroke the blood pressure should always be measured in the unaffected arm because changes in tone make measurements unreliable.

Cytokine activity after allogeneic bone marrow transplantation. IV. Production of mRNA for IL-3 and GM-CSF by mitogen-stimulated circulating mononuclear cells

The ability of circulating mononuclear cells from recipients of HLA identical sibling marrow transplants to generate messenger (m) RNA for the haemopoietic growth factors interleukin-3 (IL-3) and granulocyte-macrophage colony-stimulating factor (GM-CSF) upon mitogen stimulation was investigated. The amount of IL-3 mRNA per ml of blood and IL-3 mRNA per 10(7) mononuclear cells as well as the amount of GM-CSF mRNA per ml of blood was significantly lower in transplant recipients than in normal volunteers. Lower values for mRNA expression for both IL-3 and GM-CSF were associated with the use of immunosuppressive therapy post transplant. No correlation was found between the expression of message for either cytokine, or the presence or absence of acute graft-versus-host disease at the time of testing. While there was no correlation between the quantity of GM-CSF message produced and time elapsed post transplant, IL-3 message expression increased slightly with increasing time post transplant. These defects of haemopoietic regulators constitute another parameter of impaired cellular immunity occurring after allogeneic marrow transplantation.