A pilot study of CODOX-M/IVAC in primary refractory or relapsed high-grade non-Hodgkin's lymphoma. A Scotland and Newcastle Lymphoma Group Study.

Background And Objectives: The prognosis in patients with primary refractory or relapsed high grade non-Hodgkin's lymphoma (NHL) is very poor--the 5-year survival being generally reported at 10%.

Design And Methods: Multiple salvage regimens have been investigated and, while response rates of 50-80% have been noted in selected patients, the long-term prognosis remains poor. Following the encouraging results in high risk Burkitt's and Burkitt-like lymphoma using the CODOX-M and IVAC protocols, we performed a pilot study using a similar regimen in patients with primary refractory or relapsed high grade NHL.

Phase II study of imatinib in patients with small cell lung cancer.

Purpose: The purpose of our study was to assess the objective response to imatinib administered to patients with small cell lung cancer (SCLC).

Experimental Design: Eligible patients were those with SCLC who either had chemotherapy-naive extensive-stage or had SCLC in a sensitive relapse. Patients enrolled on the trial were treated with 600 mg of imatinib daily.

Physical functioning over three years in knee osteoarthritis: role of psychosocial, local mechanical, and neuromuscular factors.

Objective: To identify factors that predict a poor physical function outcome over 3 years in individuals with knee osteoarthritis (OA), in an effort to aid in the development of strategies to prevent such functional limitations and consequential disability.

Methods: Community-recruited individuals with knee OA underwent baseline, 18-month, and 3-year assessments of candidate risk factors and physical function. Risk factors were age, body mass index (BMI), knee pain intensity (on a visual analog scale [VAS]), local mechanical and neuromuscular factors (varus-valgus laxity, malalignment, proprioceptive inaccuracy, quadriceps strength, hamstring strength), activity level (Physical Activity Scale for the Elderly, amount of aerobic exercise), and psychosocial factors (Short-Form 36 [SF-36] mental health and role-functioning emotional subscales, self-efficacy using the Arthritis Self-Efficacy Scale physical function subscale, and social support using the Medical Outcomes Study Social Support Survey).

A pilot study on the effects of exercise in patients with systemic lupus erythematosus.

Objective: A pilot study was designed to assess the efficacy and safety of different exercise therapies on patient-reported fatigue and functional status.

Methods: Ten patients with systemic lupus erythematosus (SLE) were randomly placed in either an aerobic exercise group (group 1: n = 5) or a range of motion/muscle strengthening (ROM/MS) exercise group (group 2: n = 5). Outcome measures assessed at baseline and the end of the study were fatigue, functional status, disease activity, cardiovascular fitness, isometric strength, bone mineral density (BMD) of the lumbar spine and femoral neck, and parathyroid hormone and osteocalcin as representative bone biochemical markers for bone resorption and bone formation, respectively.

Racial/ethnic differences in rates of depression among preretirement adults.

Objectives: We estimated racial/ethnic differences in rates of major depression and investigated possible mediators.

Methods: Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders.

Results: African Americans (odds ratio [OR] = 1.

Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer.

Background: Two-stage exchange arthroplasty remains the standard treatment of infection at the site of a total knee arthroplasty. The clinical and functional outcomes associated with the use of an articulating antibiotic spacer for two-stage revision for infection are not well established. We conducted a retrospective study to evaluate the outcomes associated with the use of the PROSTALAC articulating spacer between the first and second stages.

Evaluation of cumulative prognostic scores based on the systemic inflammatory response in patients with inoperable non-small-cell lung cancer.

A score based on the combination of the systemic inflammatory response and albumin hazards ratio (HR) 1.70, 95% CI 1.23 - 2.

A phase II study of carboplatin and vinorelbine in patients with poor prognosis small cell lung cancer.

Aim: The aim of this study was to evaluate the activity of the combination of carboplatin and vinorelbine in patients with poor prognosis small cell lung cancer (SCLC). Patients with good prognosis disease were included who were not medically fit to tolerate conventional chemotherapy. Activity was assessed primarily as response rate and secondarily in terms of toxicity, time to progression and survival.

Acute compartment syndrome: diagnosis and immediate care.

Acute compartment syndrome is an uncommon but potentially limb-threatening condition whose early recognition and treatment can prevent or reduce serious complications. Identifying at-risk patients and appropriate investigation is the key.

Tension-free inguinal hernia repair: the design of a trial to compare open and laparoscopic surgical techniques.

Background: Inguinal hernia is a common condition in men and represents a large component of health-care expenditures. Approximately 700,000 herniorrhaphies are performed each year in the United States. The most effective method of repair of an inguinal hernia is not known.

The development of a clinical trial to determine if watchful waiting is an acceptable alternative to routine herniorrhaphy for patients with minimal or no hernia symptoms.

Background: This article describes the development and implementation of a randomized clinical trial designed to answer the question: Is watchful waiting an acceptable alternative to operation for men with asymptomatic or minimally symptomatic inguinal hernias?

Study Design: A clinical trial has been designed to compare watchful waiting and operation for men with an asymptomatic or a relatively asymptomatic inguinal hernia. Men are randomized to watchful waiting or a standard open operation, the Lichtenstein tension-free hernia repair, and are followed for a minimum of 2 years. The target sample size of 753 patients was chosen so that the trial would have power sufficiently high to detect a clinically meaningful difference between treatment groups in either of the two primary outcomes as measured at 2 years: pain or discomfort interfering with normal activities and the physical component summary score of the SF-36 health-related quality-of-life survey.

Quadriceps strength and osteoarthritis progression in malaligned and lax knees.

Background: Quadriceps muscle strengthening is a common goal in the management of knee osteoarthritis. In healthy knees, strength protects against new osteoarthritis. In arthritic knees, greater strength may protect joints and thereby delay osteoarthritis progression.

Health care utilization among older adults with arthritis.

Objective: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect.

Methods: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician's visit or a joint replacement not associated with a hip fracture.

Techniques to improve the shear strength of impacted bone graft: the effect of particle size and washing of the graft.

Background: When fresh morselized graft is compacted, as in impaction bone-grafting for revision hip surgery, fat and marrow fluid is either exuded or trapped in the voids between particles. We hypothesized that the presence of incompressible fluid damps and resists compressive forces during impaction and prevents the graft particles from moving into a closer formation, thus reducing the graft strength. In addition, viscous fluid such as fat may act as an interparticle lubricant, thus reducing the interlocking of the particles.

Racial disparities in joint replacement use among older adults.

Background: Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

Objective: This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

Allosteric regulation of mouse brain serine racemase.

Serine racemase, purified from mouse brain, consisted of two isoforms. They had similar enzymatic properties and had molecular weights of about 55 kDa based on size exclusion chromatography. This is about twice that reported from its electrophoretic mobility on SDS gels or from the amino acid sequence of the recombinant enzyme.

The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease.

Objective: Varus and valgus malalignment increase the risk of medial and lateral osteoarthritis (OA) progression, respectively. The impact of a mechanical factor such as alignment depends not only on the factor itself, but also on the state of the joint. The less-damaged joint of mild OA may be less vulnerable to malalignment effects than the more-damaged joint of moderate OA.

Impaction grafting of the femur in two-stage revision for infected total hip replacement.

We report the mid-term results of femoral impaction grafting which was used in 53 patients during the second stage of a two-stage revision for an infected total hip replacement. We reviewed all cases performed between 1989 and 1998. All patients underwent a Girdlestone excision arthroplasty, received local and systemic antibiotics and subsequently underwent reconstruction, using femoral impaction grafting.

Impaction grafting with morsellised allograft and tricalcium phosphate-hydroxyapatite: incorporation within ovine metaphyseal bone defects.

An ovine model was used to investigate the in vivo properties of impacted tricalcium phosphate-hydroxyapatite (TCP-HA) aggregates, varying in chemical composition (ratio of TCP to HA) and particle size distribution (8 versus 3 particle size ranges). All pellets were impacted to a standard compactive effort. Eight sheep underwent implantation of pellets in 4 metaphyseal defects in both rear limbs.

Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions.

Objectives: To evaluate the relation of chronic conditions, gender, and race to the incidence of activities of daily living (ADLs) limitation in older adults.

Design: The 2-year cumulative incidence of functional limitation was estimated from survival analysis methods by using elders without baseline functional limitations.

Setting: Longitudinal Study of Aging (LSOA).

ChlVPP/EVA hybrid versus the weekly VAPEC-B regimen for previously untreated Hodgkin's disease.

Purpose: To test the hypothesis that a chemotherapy regimen of relatively low toxicity and 11 weeks' duration (doxorubicin, cyclophosphamide, etoposide, vincristine, bleomycin, and prednisolone [VAPEC-B]) is at least as effective in terms of disease control as 6 months' treatment with chlorambucil, vinblastine, procarbazine, and prednisone/etoposide, vincristine, and doxorubicin (ChlVPP/EVA hybrid), which is associated with a high risk of permanent sterility.

Patients And Methods: Two hundred eighty-two patients with previously untreated Hodgkin's disease, clinical stages I/II (plus mediastinal bulk and/or B symptoms) and clinical stages III/IV were randomized at three United Kingdom and one Italian center to receive either six monthly cycles of ChlVPP/EVA hybrid or 11 weekly cycles of VAPEC-B. After chemotherapy and a restaging evaluation, radiotherapy was administered to sites of previous bulk or residual radiographic abnormality before patients were observed off treatment.

Gender and ethnic/racial disparities in health care utilization among older adults.

Objective: We examine the role of economic access in gender and ethnic/racial disparities in the use of health services among older adults.

Methods: Data from the 1993-1995 study on the Asset of Health Dynamics Among the Oldest Old (AHEAD) were used to investigate differences in the 2-year use of health services by gender and among non-Hispanic White versus minority (Hispanic and African American) ethnic/racial groups. Analyses account for predisposing factors, health needs, and economic access.