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Biomedical subjects

J H Scarffe

Publications and source records attributed to J H Scarffe.

124 records · Page 7Linked to original sources
PubMed1980

Relationship between the pretreatment proliferative activity of marrow blast cells and prognosis of acute lymphoblastic leukaemia of childhood.

Pretreatment marrow blast cells were studied in 38 boys and 27 girls (aged 1-14) with acute lymphoblastic leukaemia by flow cytometry after staining with propidium iodide.The percentage of blast cells in the S phase of the cell cycle ranged from 1% to 40% (median 6%). A correlation was found between the percentage of cells in S and the morphological classification of the French American British Cooperative Group (FAB), presence of T or B cell markers, haemoglobin concentration, blast size, bone pain, platelet count, and an inverse correlation with coarse granule and block staining with Periodic-acid-Schiff (PAS).63 of the 65 children attained complete remission. During the first 24 months of follow up there were fewer relapses (P = 0·054), and deaths (P = 0·004) in those children with 6% or fewer blasts in S phase. The difference was most marked in the first 12 months with 4 relapses out of 33 in the group with 6% or fewer cells in S compared with 13/30 in the group with > 6% cells in S.In order to investigate the prognostic significance of the pretreatment proliferative studies in greater detail, remission duration was correlated with 17 presenting features. Each feature was correlated individually and then the simultaneous effect of all the features was assessed by stepwise multiple regression.Only 3 features of the disease at diagnosis were individually correlated with duration of remission. These were% cells in S (P < 0·001), log white cell blood count (WBC) (P < 0·01) and the presence of T- or B-cell surface markers (P < 0·05). However, the multiple regression analysis showed that cell markers were not an independent prognostic feature, whereas the percentage cells in S and log WBC were independently and significantly correlated with duration of first remission (P < 0·001 in each case).

Acute Disease↗
PubMed1979

Spinal-cord compression in myeloma.

Clinical records of 47 patients in whom spinal-cord compression was the presenting feature of plasma-cell myeloma were analysed retrospectively. Patients were referred during 1954-78. Median survival was 30 months and prognosis was best for those in whom the site of cord compression was the thoracic region. Early laminectomy and decompression followed by adequate radiotherapy resulted in complete or good partial response in over a third of patients who presented with complete paraplegia. Improvements in supportive care and more effective chemotherapy allow spinal-cord compression in myeloma to be treated promptly and vigorously, thus improving duration and quality of survival in a substantial proportion of patients.

Female↗
PubMed1979

Abnormal peripheral blood lymphocytes and bone marrow infiltration in non-Hodgkin's lymphoma.

The blood lymphocytes of 21 normal blood specimens, 20 patients with various malignant disorders and 63 patients with non-Hodgkin's disease lymphoma, all with lymphocyte counts below 6 x 10(9)/l, were examined by sheep red cell rosetting, fluorescent antisera to surface immunoglobulin and for sensitivity to colchicine. The results were correlated with bone marrow infiltration and lymph node histological findings. The ratio of kappa to lambda light chains in the surface immunglobulin was used to determine if an abnormal clone of lymphocytes was present. In the normals and the non lymphoma controls the expected normal ratio of approximately 2K to 1 lambda was found with a narrow spread. In non-Hodgkin's lymphoma cases there was a wide spread of ratios with half the cases outside the range of the controls. These cases were considered to have a clone of abnormal lymphocytes in the blood although their routine blood and differential counts were usually normal. There was a very significant correlation of the presence of a clone with ultrasensitivity to colchicine and with involvement of the bone marrow. 81% of the cases with a histological diagnosis of well-differentiated diffuse lymphocytic lymphoma, 64% of those with poorly differentiated diffuse but only 22% of those with diffuse histiocytic had an abnormal lymphocyte clone demonstrated by an abnormal K:lambda ratio.

Adolescent↗
PubMedDate not supplied

Factors affecting remission and survival in patients with advanced Hodgkin's disease treated with MVPP.

One hundred and fourteen patients with clinical or pathological stages IIIB and IV Hodgkin's disease have been treated with MVPP chemotherapy followed by radiotherapy to sites of previously bulky disease. The minimum follow-up is 2 years with a median of 5 years. The overall remission rate was 92 per cent with 74 per cent achieving CR. A discriminant analysis showed that the presence of bulky disease was the only independent factor that predicted a lower chance of CR (66 per cent vs 82 per cent, P = 0.045). The 5-year survival was 70 per cent overall and 85 per cent for CR patients. A Cox multivariate analysis demonstrated that stage III disease, age less than 36 years and female sex were all variables which independently predicted a more favourable prognosis in terms of overall survival. However, a similar analysis for survival of CR patients showed that age less than 36 years and the absence of bulky disease were the only two factors to independently predict a more favourable outcome. Of 14 patients who did not receive the chemotherapy according to protocol 5 have relapsed compared to 7 of 70 who did. A Cox analysis confirmed that this variable was the only one of significant prognostic import in predicting relapse-free survival. Using the Cox analyses we have been able to devise a scoring system which accurately predicts the outcome for these patients. This model may be useful in determining which patients have a worse prognosis following treatment with MVPP thus allowing more intensive therapy to be given to such patients while minimising treatment for those with favourable features.

Adolescent↗
PubMedDate not supplied

Non-secretory multiple myeloma: a report of 13 cases with a review of the literature.

The clinical features of 13 patients with non-secretory myeloma from a series of 172 consecutive multiple myelomas are presented. The non-secretors survived significantly longer that the secretors, median 46 months versus 21 months (p less than 0.01). Non-secretory myeloma was associated with a higher incidence of neurological presentation, minimal lytic bone disease, a lower median percentage of plasma cells in the marrow and a lower incidence of hypogammaglobulinaemia. The median survival of the non-secretors with minimal lytic bone lesions was 74 months compared to 21 months for those with extensive bone disease. The superior survival of non-secretors is thus thought to be due to earlier presentation possibly as a result of a tendency to form symptomatic local tumours. Retrospective immunoperoxidase staining of stored tissue was performed in nine cases. In only one of these was a monoclonal immunoglobulin not detected indicating that true 'non-production' is rare. In four patients who produced a biochemically detectable paraprotein during the course of their disease and in whom immunoperoxidase data was available the immunoglobulin was of the same type. Immunoperoxidase staining may help in the initial diagnosis of non-secretory myeloma but did not contribute any prognostic information.

Adult↗
PubMedDate not supplied

VAD chemotherapy--toxicity and efficacy--in patients with multiple myeloma and other lymphoid malignancies.

Thirty-three patients with multiple myeloma (11 untreated, 15 refractory and seven relapsed patients) have received vincristine and adriamycin infusion therapy with oral dexamethasone (VAD). The median number of course received was five. In addition 16 patients with lymphoid malignancy have received a median of four courses of VAD. Three patients who relapsed after VAD have received further VAD therapy making 52 patient treatments assessable for toxicity. Ten per cent had nausea, 4 per cent vomiting, 4 per cent total alopecia, 25 per cent constipation, 33 per cent paraesthesiae, 8 per cent proximal myopathy, 33 per cent dyspepsia, 23 per cent proven bacteraemia, and 19 per cent chest infections. Infections were not usually associated with neutropenia. Shingles was seen in four patients with myeloma, but none of the patients with lymphoid malignancy. The response rate in myeloma was 9/11, for previously untreated patients, 3/7 for relapsed, and 8/15 for refractory patients. Responses have been seen in other lymphoid malignancies-1/2 patients with relapsed acute lymphoblastic leukaemia had a complete remission. Two out of seven patients with chronic lymphocytic leukaemia achieved a partial remission, and a further three had a clinical improvement. Three out of six patients with non-Hodgkin lymphoma and one patient with macroglobulinaemia achieved a partial remission.

Adult↗
PubMedDate not supplied

The prognostic significance of X-ray changes at presentation and reassessment in patients with multiple myeloma.

The relationship between presenting skeletal X-ray findings and survival in multiple myeloma was assessed in 172 consecutive patients treated at this institute. All patients were investigated, treated and followed up according to one protocol. The shortest survival was seen in those with normal X-rays (3-year actuarial 11 per cent) and the longest in those with minimal lytic changes (3-year actuarial 44 per cent). Patients with osteoporosis alone and those with extensive lytic lesions had intermediate survivals of 32 per cent and 33 per cent respectively. Of the other major prognostic features only anaemia demonstrated a significant correlation with X-ray findings in terms of survival (p less than 0.001) suggesting that those with normal X-rays may have a more diffuse marrow involvement accounting for their poor prognosis. The response on bone X-rays in 102 patients who completed nine cycles of chemotherapy was also analysed. Patients with evidence of healing had a 3-year actuarial survival of 37 per cent, those with progression 36 per cent and those with stable X-rays 65 per cent (p less than 0.01). Normal bone X-rays at presentation and radiological evidence of healing following therapy appear to be bad prognostic signs in multiple myeloma.

Actuarial Analysis↗
PubMedDate not supplied

Experience with the Portacath.

Fifty Portacaths have been inserted in patients undergoing prolonged outpatient chemotherapy, most for haematological disease. Twenty-one are still working at a median duration of 12 months (range 1-27) and a further 15 were functioning normally at the time of the patients death (median survival 6 months). Four functioning Portacaths have been removed, three suspected of causing septicaemia and one believed erroneously to have occluded. Ten have ceased to function and nine of these have been removed. The causes of these failures are nearly all avoidable and are discussed in detail; many occurred early in our experience. With careful attention to detail and with management by trained and interested staff, the Portacath is a safe and reliable device for intermittent vascular access.

Antineoplastic Agents↗
PubMedDate not supplied

Failure of lithium to reduce period of neutropenia during induction therapy of acute myeloid leukemia.

Fifty-four patients treated with daunorubicin, cytosine arabinoside and thioquanine for acute myeloid leukemia were randomly assigned to receive oral lithium carbonate 1200 mg daily or no lithium. The duration of neutropenia (less than 0.5 x 10(9)/L) was similar between controls (median 22.5 days) and patients treated with lithium (median 24 days). The number of remissions, relapse-free survival and survival were similar for the lithium treated and control groups of patients. There was no apparent clinical efficacy in the use of lithium to reduce the period of neutropenia in patients undergoing remission induction therapy for acute myeloid leukemia.

Adult↗
PubMedDate not supplied

Central venous catheter placement: extending the role of the nurse.

OBJECTIVE: To improve the quality of the percutaneous tunnelled central venous catheter placement service for patients being treated for malignant disease. DESIGN: A clinical nurse specialist was specially trained to insert percutaneous tunnelled central venous catheters according to predetermined guidelines. Catheters were inserted under local anaesthetic in the outpatient department or the ward. The quality of the service was analysed and compared with the pre-existing service provided by junior medical staff. SUBJECTS: Two hundred adult patients with malignant disease seen between January 1995 and January 1996 at the Christie Hospital Trust. MAIN OUTCOME MEASURES: Success of the procedure, insertion-related infection rates and waiting times compared to historical controls. RESULTS: The rate of failed insertions fell from 20% to 3% with a concomitant reduction in surgical referrals; for 97% of patients waiting time was reduced to less than one working day compared with 80% previously. Line-related infection rates in the first thirty days following insertion fell from 10 episodes per 72 lines inserted to two episodes per 200 lines inserted. CONCLUSIONS: Training and using a clinical nurse specialist has improved the quality of service and gives junior doctors more opportunity to become competent in the technique of central venous catheter placement. The introduction of guidelines has encouraged a standard approach that facilitates audit.

Adult↗