Choice Of Initial Therapy Research Articles

Terminal deoxynucleotidyl transferase expression in acute non-lymphoid leukaemia: an analysis by immunofluorescence.

Indirect immunofluorescence for terminal transferase enzyme (TdT) was used to study the blasts of 64 patients with acute non-lymphoid leukaemia (ANLL). In 32 patients no TdT positive cells were seen. In 19 cases a small subpopulation of cells expressing TdT was detected; these constituted up to 5% of total nucleated cells, and it was not clear whether these TdT positive cells were part of the leukaemic process or represented residual normal bone marrow lymphoid cells. The remaining 13 patients had TdT positive cells accounting for 7-90% of the total. In two of these cases TdT was expressed on blasts with myeloid features, representing an aberrant expression of TdT by myeloid cells; in contrast, in three cases mixed populations of TdT positive lymphoid blasts and TdT negative myeloid blasts were observed. In the remaining cases it was not possible to determine whether the TdT positive cells had definite lymphoid or myeloid features. Cytogenetic analysis showed no evidence of the Philadelphia chromosome. Response to treatment was assessed in 11 of the 13 patients. Only one patient remitted with the initial choice of therapy (DAT); four failed to respond to initial regimes of vincristine and prednisone (V & P) while the other five patients did not respond to myelotoxic combinations (DAT). Only one patient subsequently entered complete remission on second line therapy (V & P). This group of patients with TdT+ ANLL had a particularly bad prognosis, and appeared to differ from cases of TdT positive acute undifferentiated leukaemia, which often respond to V & P therapy.

Effects Of Preceding Androgen Therapy On Testicular Response To Human Pituitary Gonadotropin In Hypogonadotropic Hypogonadism: A Study Of Three Patients

There is some uncertainty about the choice of initial therapy to induce virilization in men with hypogonadotropic hypogonadism (HH) who may subsequently desire fertility. Three patients with HH and azoospermia are described. All had received long-term androgen therapy in fully virilizing doses, and two also received interval androgen therapy. Spermatogenesis occurred in all three patients after treatment with human chorionic gonadotropin and human pituitary gonadotropin, and the wives of all three conceived. For two patients conception occurred three times in response to gonadotropin therapy, and libido and potency were maintained with testosterone between each conception. It is concluded that preceding long-term therapeutic doses of androgen do not impair subsequent induction of spermatogenesis in patients with HH.

Adult Still's disease

The clinical and laboratory features in six patients with adult Still's disease are presented and compared with those in 52 other cases gathered from the literature. Although there is no pathognomonic abnormality, the condition can be readily recognized by the striking constellation of clinical and laboratory abnormalities. The typical rash occurs in 90 per cent of the cases, arthritis in 88 per cent, a fever with temperatures of 40 °C or more in 83 per cent and leukocytosis of 18,000 cells/mm 3 or more in 67 per cent. One or more of the following are frequently found: lymphadenopathy (48 per cent), splenomegaly (45 per cent), pleuritis or pneumonitis (31 per cent) and pericarditis (26 per cent). The initial therapy of choice is high doses of nonsteroidal anti-inflammatory drugs. This is not an uncommon disease, as was once thought, and awareness of it will avoid unnecessary diagnostic procedures and delay in initiating therapy.

Recurrent breast cancer: Factors influencing survival, including treatment

Factors influencing survival were reviewed in 464 patients with recurrent breast cancer. Site of first recurrence and rate of tumor progression governed prognosis more than choice of initial therapy. Overall median survival was 22--26 months for bone/soft-tissue disease, 10--12 months for pleura/lung, and 4--6 months for liver/brain recurrence. Patients with slow rates of tumor progression at each site had longer survival terms than did rapid progressors. About 50% of patients with bone or soft-tissue recurrence had slow progression and long survival, regardless of whether initial treatment was local or systemic. In visceral recurrence, the number of patients with slow progression was doubled with systemic therapy in comparison to local treatment (from 16--20% for the latter to 37--38% for the former). In addition, long-term survival in patients with similar progression rates was best using initial systemic therapy.

The Choice of Therapy in Toxic Diffuse Goiter

In the routine case of toxic diffuse goiter, the major consideration in the choice of initial therapy is the rate relative to the incidence of hypothyroidism and recurrence. Morbidity, patient convenience, and cost effectiveness must be balanced with relative cure rates. Mortality, as a result of any form of therapy, is extremely rare and largely preventable, and will not be further addressed here. In long-term follow-up studies, the incidence of cure and hypothyroidism after surgical therapy is essentially the same as after treatment with radioactive iodine. There is a low but definite incidence of hypoparathyroidism and recurrent laryngeal nerve damage with surgery, whereas the only established complication of sodium iodide I 131 therapy is hypothyroidism. 1-3 Studies have not revealed any significant increase in carcinoma or subsequent birth defects in patients receiving radioactive iodine. 4-5 Some frequently used diagnostic procedures, such as barium enema or intravenous pylography, deliver as

Treatment of dissecting aneurysms of the aorta: Current status

During the past 7 yr, definitive corrective surgery for acute as well as chronic dissecting aneurysms has developed to the point where, in experienced hands, successful results in the range of 75% can be anticipated. The same 7 yr has seen the introduction and establishment of intensive drug therapy as the initial therapy of choice in all dissecting aneurysms, the primary therapy of choice in many dissecting aneurysms, and a useful adjunctive type of therapy in those patients where definitive surgery is indicated. Definitive diagnosis utilizing aortography to identify the site of the intimal tear and the extent of the dissecting hematoma plus evaluation of the general condition of the patient are the keys to the best use of those two modes of therapy and should lead to a success rate of 90% or better in the near future.