Potential contribution of therapy to cancer mortality reduction

Reductions in cancer mortality may come about for a number of reasons, including improvements in treatment. The impact will vary from cancer to cancer. For some, expert curative surgery is crucial, whereas for others, the use of appropriate chemotherapy is a key factor. Examples of the latter, in which there are already discernible reductions in national cancer mortality data resulting from chemotherapy, include testicular cancer and Hodgkin's disease. For more common diseases, such as ovarian cancer, reductions also are being seen. For others, such as breast and colorectal cancer, the current more widespread use of adjuvant chemotherapy may lead to overall mortality reduction in the future. It should be recognized that chemotherapy should be given only by those experienced in its use, and that this facility should form part of a larger provision for health care in relation to cancer, ranging from public education to population screening and from better oncology training for clinicians to greater encouragement to participation in clinical trials. New drug development is clearly a priority, but further advances can be made in many countries already using available forms of chemotherapy if treatment facilities are organized appropriately.     

Delayed neurological symptoms from the spontaneous migration of a bullet in the lumbosacral spinal canal. Case report

In a patient wounded by a gunshot in the abdomen, the bullet was radiologically located intradurally at S1 level. Although she had no neurological deficit at admission, she developed pain and motor weakness a few days later. At operation the bullet was found at L4 level and its removal resulted in complete neurological recovery.     

Effect of occlusion of a tracheotomy tube on aspiration

The effect of a polyclonal antiserum and OMVU10, a monoclonal antibody reactive with Antigen B of Streptococcus sobrinus, on the interaction of polymorphonuclear leukocytes with S. sobrinus was studied, using chemiluminescence and bacterial killing assays. Increased stimulation of neutrophils as measured in the chemiluminescence assays was established when S. sobrinus was preincubated with polyclonal antiserum or when polyclonal antiserum was added to the reaction mixture. Higher counts were measured in comparison to preimmune serum. After 90 min, 52% of S. sobrinus preincubated with polyclonal antiserum was killed. Killing was also increased when polyclonal antiserum was added to the reaction mixture in comparison to the controls. No killing was found when bacteria were preincubated with OMVU10 or when OMVU10 was added to the reaction mixture in comparison to Clone 24, a control antibody.     

Cell-mediated cytotoxicity: a predictor of chronic rejection in pediatric HLA haploidentical renal transplants

BACKGROUND: Recipient antidonor cytotoxic T-cell activity has been associated with graft loss and acute rejection in renal allograft recipients. The role of immunologic mechanisms in the development of chronic graft rejection is controversial. We analyzed all living related renal transplants performed at Children's Hospital (Boston, MA) from 1983 to 1995 to assess whether cell-mediated cytotoxicity, determined in vitro and measured before transplantation, was predictive of chronic rejection. METHODS: Eighty-three patients were studied retrospectively. Fifty-seven patients with one haplotype-matched renal transplants from living related donors were studied to determine the association between cell-mediated lympholysis (CML) level, acute rejection, chronic rejection, and graft failure. Acute rejection was defined by the decision to treat. Chronic rejection was defined by histology and/or the absolute serum creatinine value using an increasing serum creatinine level >1.0 mg/dl for children less than 3, a creatinine level >1.5 mg/dl for children between 3 and 10 years of age, and a creatinine level >2.0 mg/dl for children above 10 years of age. Return to dialysis or retransplantation was considered graft failure. RESULTS: Of the 57 haploidentical patients, there were 33 males and 24 females. The mean age at transplant was 11.1 years (SD=6.7). Twelve patients developed chronic rejection, 24 patients developed acute rejection, and 7 patients had graft failure. Pretransplant cytotoxic T lymphocyte activity was associated with chronic rejection (P=0.001) and graft failure (P=0.013) but only marginally with acute rejection (P=0.058). Controlling for age and sex, Cox's proportional hazards model revealed that CML level was predictive of time to chronic rejection (P<0.01) but not acute rejection (P=0.11). It was estimated that every 1-unit increase in CML level raises the monthly risk of chronic rejection by 7%. Ten children received HLA-identical kidneys from their siblings. There were no episodes of chronic rejection after 5 years. Two patients with high CML levels had episodes of acute rejection; both patients responded to treatment. CONCLUSION: Our data demonstrate an association between pretransplant cell-mediated cytotoxicity and the occurrence of chronic rejection in living related one-haploidentical renal transplants in pediatric patients.