Need For Individualized Treatment Research Articles

Treatment of Precocious Puberty in a Female with Prader-Willi Syndrome

Prader-Willi syndrome (PWS) is characterized by neonatal hypotonia, hyperphagia, childhood obesity at an early age, short stature, varying degrees of mental deficiency, and hypogonadism. In PWS, puberty is usually delayed and fails to complete, with most females never having regular menstrual cycles. We report a female patient with uniparental disomy, who experienced precocious puberty with menarche at age 8 years. The patient was treated with luteinizing hormone releasing hormone (LHRH) analog, which suppressed pubertal development. From our search of the literature this is the first application of LHRH analog to a female PWS patient for precocious puberty. Use of LHRH analog along with recombinant human growth hormone (rhGH) permitted stature closer to target height. The clinical course of this patient with PWS underscores the need for individualized treatment.

Granulocytic sarcoma: an unusual complication of acute promyelocytic leukemia causing cerebellar hemorrhage

Granulocytic sarcomas are rare tumors that occur primarily in patients with acute myelogenous leukemia or other myeloproliferative disorders, are seldom seen in patients with acute promyelocytic leukemia (APL), and have never been reported to occur in the cerebellum. The authors describe the case of a patient with APL who harbored a hemorrhagic granulocytic sarcoma in the cerebellum. This 39-year-old woman presented with cerebellar ataxia. Magnetic resonance images revealed an intraaxial tumor in the cerebellum. Bone marrow samples showing infiltration by leukemic blast cells and data from hematological tests led to a diagnosis of APL. The patient was treated with chemotherapy and surgery. She had no response to chemotherapy and died of progressive intratumoral hemorrhage. Results of histopathological studies and immunohistochemical staining of the cerebellar tumor confirmed a granulocytic sarcoma. Flow cytometry showed that the blast cells were positive for leukocyte common antigen, CD13, and CD33 markers. Bone marrow cytogenetics revealed that the patient had a 46,XX karyotype. Although no cytogenetic abnormality was present, fluorescence in situ hybridization detected a chimeric fusion of PML and RARA. This is the first report to document a granulocytic sarcoma in the cerebellum as the primary presentation in a patient with APL and abnormal coagulation. As predicted by the unusual clinical manifestations and radiological findings, the patient's survival was short. Although central nervous system complications in patients with APL are rare, the data in this case highlight the need for individualized treatment when such conditions occur.

Colonic inflammatory bowel disease

PREVIEWAdvances in the treatment of inflammatory bowel disease (IBD) in the past decade include 5-aminosalicylic preparations with fewer adverse effects; new, rapidly metabolized corticosteroids; and new agents targeted at refractory or complicated IBD. Dr Tung and Dr Warner discuss the use of these and more traditional drugs in patients with colonic Crohn's disease and ulcerative colitis, stressing the need for individualized treatment.

Anatomic variation of extrahepatic biliary tree structures: importance in treatment planning for radiation therapy.

To demonstrate the variable location of biliary tree components and to assess two treatment planning rules of thumb used for locating porta hepatic nodes for radiation therapy. The distance of the common hepatic duct bifurcation and duodenal papilla from adjacent vertebral bodies was measured on 34 cholangiograms, and their relationships to particular vertebral body levels were recorded. Adequacy of treatment volume to encompass porta hepatic lymph nodes was evaluated in 30 of these cholangiograms by constructing radiation portals according to the two rules of thumb. Location of the common hepatic duct bifurcation and duodenal papilla varied widely. The treatment portal encompassed 13% (four of 30) of cases when the first rule of thumb was used and 80% (24 of 30) of cases when the second rule of thumb was used. The wide variability of location of extrahepatic biliary tree structures suggests the need for individualized treatment planning so that sensitive and dose-limiting healthy tissues can be optimally excluded from radiation treatment portals. Computed tomography and other imaging modalities enable precise location of biliary tree components for radiation treatment planning.

Borderline omnipotence in pathological gambling

Borderline omnipotence in pathological gambling is examined, including psychodynamics of omnipotence, a theory of the client's use of omnipotence in pathological gambling, and the effects of omnipotence on the treatment and recovery of the pathological gambler. Assessment, staff education, and the need for individualized treatment for the pathological gambler are discussed.

Psychologic, physical, nutritional, and technologic aspects of intravenous infusion during labor.

Giving intravenous (IV) fluids in labor is currently an accepted custom in United States hospitals, although most indications for this practice have not been validated by adequate outcome research. This paper discusses the following questions: 1) Does IV therapy add pain to the woman in labor? 2) Does it have an adverse impact on the attitudes of health care workers and on the laboring woman? 3) Does partial immobilization caused by IV lines have adverse effects? 4) Does the practice introduce a possible route of infection and overdose of fluids? 5) Do IV fluids give adequate nutrition in labor? 6) Does glucose administered intravenously sometimes cause psy‐chophysical and neurologic complications? 7) Might forced feeding with glucose in IV fluids in late labor sometimes be harmful? The need for individualized treatment and much more research is emphasized. (BIRTH 15:2, June 1988)

Hairy-Cell Leukemia With the Appearance of Mixed Cryoglobulinemia and Vasculitis

Hairy-cell leukemia has been associated with a number of disorders of the immune system. At least 13 cases of vasculitis and hairy-cell leukemia have been reported. However, the occurrence of cryoglobulinemia and hairy-cell leukemia is rare. We report a case of a patient with the unusual combination of hairy-cell leukemia, vasculitis, and cryoglobulinemia. This case illustrates that hairy-cell leukemia should now be included in the differential diagnosis of patients with the appearance of vasculitis and cryoglobulinemia. The association presents a therapeutic challenge and emphasizes the need for individualized treatment in such patients.

Hairy-cell leukemia with the appearance of mixed cryoglobulinemia and vasculitis

• Hairy-cell leukemia has been associated with a number of disorders of the immune system. At least 13 cases of vasculitis and hairy-cell leukemia have been reported. However, the occurrence of cryoglobulinemia and hairy-cell leukemia is rare. We report a case of a patient with the unusual combination of hairy-cell leukemia, vasculitis, and cryoglobulinemia. This case illustrates that hairy-cell leukemia should now be included in the differential diagnosis of patients with the appearance of vasculitis and cryoglobulinemia. The association presents a therapeutic challenge and emphasizes the need for individualized treatment in such patients. (<i>Arch Intern Med</i>1984;144:1300-1302)

Iatrogenic injury compensation.

The Royal Commission on Civil Liability and Compensation for Personal Injury is expected to report early in 1977. The injuries suffered at the hands of doctors constitute a very small proportion of the total number of injuries, but, by their very nature, have features that distinguish them from accidents on the road, in the factory and in the home. There is an obvious danger that iatrogenic injury, being such a comparatively small issue, may not receive from the Royal Commission and from any subsequent legislation adequate recognition of its unique features. The New Zealand Accident Compensation Act came into operation on 1 April, 1974, but the difficulties of handling cases of medical misadventure are only now becoming apparent. This paper outlines the various methods by which iatrogenic injury might be compensated, considers their pros and cons, and emphasizes the need for individual treatment of this particular facet of injury compensation.

Esophageal Carcinoma: The Value of Staging in Long-Term Survival

A three-stage study of 177 patients in Puerto Rico who had esophageal carcinoma is presented. Those surviving five or more years over a twenty-one-year period were located. Next, the experience at the San Juan City Hospital from 1968 to 1973 was examined. The information obtained from those two groups led to the last stage, a prospective study in which treatment was based on objective staging of the extent of the disease. Only 27% of these patients are really potentially curable upon admission to the hospital, and they should have aggressive therapy. Adequate palliation can be obtained with radiotherapy and chemotherapy in the remainder. The findings that nearly half of the five-year survivors had metastases or tumor extension and that some patients survived for prolonged periods without treatment emphasize the need for individualized treatment and research in tumor immunology.

Treatment of patients with carcinoma of the bladder.

Because of improvements in the technics of ureterointestinal anastomosis, cystectomy and partial cystectomy, there is need for a reevaluation of the indications and contraindications of the various types of treatment for patients with carcinoma of the bladder. A review of 540 patients with carcinoma of the bladder treated at the University Hospital from the years 1932 to 1942, a study of more recent patients treated more radically and a review of the recent literature emphasize the need for individual treatment of these patients. In order to adequately evaluate the various types of therapy, a basis of reference for classifying these tumors is necessary. This has been generally recognized. Jewett and Strong 1 have shown that the microscopic anatomic structure or grade of malignancy of an infiltrating carcinoma of the bladder reveals only the potentiality of the tumor for rapid growth and metastasis but does not, in itself, indicate the presence