Dietary folate deficiency and bilateral retinal haemorrhages.
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Biomedical subjects
Marie Hughes
Publications and source records attributed to Marie Hughes.
Outcomes of discretionary laboratory requesting of serum protein electrophoresis.
BACKGROUND: Discretionary laboratory requesting of serum protein electrophoresis (SPE) is widespread throughout the UK despite limited evidence to support clinical usefulness. We aimed to examine the clinical usefulness of discretionary SPE requesting on serum samples with globulins>45 g/L by documenting the number of discretionary tests performed and the number of paraproteins identified in an audit period, by determining if such findings led to further investigation/specialty referral, and by identifying the final diagnosis and subsequent management of these patients. METHODS: A retrospective one-year audit from July 2002 to June 2003 was carried out using information from biochemistry databases and review of medical records. RESULTS: Of 1332 discretionary SPEs performed in one year, 72 paraproteins were identified (5.4%). Further clinical information could be obtained in 66 cases. Appropriate follow-up occurred in 84% of cases. The most common diagnosis was monoclonal gammopathy of undetermined significance (56%). Eighteen percent of patients with an identified paraprotein were diagnosed with B-cell malignancies that warranted treatment. A further 6% progressed to requiring treatment during follow-up. CONCLUSION: Using screening criteria of serum globulins>45 g/L, one in 20 discretionary laboratory requests resulted in a clinically relevant finding. These results suggest such requesting is worthwhile and should aid future debate on the appropriateness of this practice.
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Primary bladder lymphoma: management and outcome of 12 patients with a review of the literature.
Primary bladder non-Hodgkin's lymphoma (NHL) is rare. Optimal management remains controversial. Using the Scotland and Newcastle lymphoma group database, 12 patients with primary bladder lymphoma were identified between 1980 and 2001, the largest single group of patients available to date. Histology and immunocytochemistry was reviewed in 9 of the 12 cases. Six cases were low-grade extranodal marginal zone lymphoma, 4 diffuse large B-cell lymphoma, one an ALK 1 positive anaplastic large cell lymphoma (ALKoma) and one a low-grade lymphoma unspecified. Two patients (low-grade NHL) were treated with oral antibiotics (n=1) or diathermy (n=1) alone with complete resolution of disease. One patient with high-grade NHL gained complete remission without conventional therapy. Nine patients were treated with single or combined modality surgery, chemotherapy and/or radiotherapy. Overall survival was 75%, mean follow up of 4.8 (range 1-10) years. A review of 88 additional cases in the literature support the findings that primary bladder lymphoma is associated with a good prognosis. Patients with low-grade extranodal marginal zone lymphoma may respond well to simple therapies. Patients with diffuse large B-cell lymphoma respond well to first-line chemotherapy regimens. Ureteric obstruction and acute renal failure are serious complications. Repeat cystoscopy is mandatory for follow-up.
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