Clinical experience with the first combined positron emission tomography/computed tomography scanner in Australia.

Metabolic imaging with fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is increasing rapidly worldwide because of superior accuracy compared with conventional non-invasive techniques used for evaluating cancer. Limited anatomical information from FDG-PET images alone dictates that complementary use with structural imaging is required to optimise benefit. Recently, combined positron emission tomography/computed tomography (PET/CT) scanners have overtaken standalone PET scanners as the most commonly purchased PET devices.

Family average income and body mass index above the healthy weight range among urban and rural residents in regional Mainland China.

Objective: To explore the relationship between family average income (FAI; an index of socio-economic status) and body mass index (BMI; a widely used, inexpensive indicator of weight status) above the healthy weight range in a region of Mainland China.

Design: Population-based cross-sectional study, conducted between October 1999 and March 2000 on a sample of regular local residents aged 35 years or older who were selected by random cluster sampling.

Setting: Forty-five administrative villages selected from three urban districts and two rural counties of Nanjing municipality, Mainland China, with a regional population of 5.

Quantification of the magnification and distortion effects of a pediatric flexible video-bronchoscope.

Background: Flexible video bronchoscopes, in particular the Olympus BF Type 3C160, are commonly used in pediatric respiratory medicine. There is no data on the magnification and distortion effects of these bronchoscopes yet important clinical decisions are made from the images. The aim of this study was to systematically describe the magnification and distortion of flexible bronchoscope images taken at various distances from the object.

Enalapril and hydroxyurea therapy for children with sickle nephropathy.

Proteinuria in children with sickle cell anemia (SCA) is an early sign of sickle nephropathy, and portends the development of nephrotic syndrome and chronic renal failure. Enalapril has been shown to reduce proteinuria in adult patients with SCA, but the potential benefits of hydroxyurea in this clinical setting have not been reported. A single institution retrospective analysis was performed.

Quality of reporting of observational longitudinal research.

Observational longitudinal research is particularly useful for assessing etiology and prognosis and for providing evidence for clinical decision making. However, there are no structured reporting requirements for studies of this design to assist authors, editors, and readers. The authors developed and tested a checklist of criteria related to threats to the internal and external validity of observational longitudinal studies.

Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo)radiotherapy in head and neck cancer.

Background: This study evaluates the utility of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) in patients with a node-positive mucosal head and neck squamous cell carcinoma who achieved a complete response at the primary site but had a residual mass in the neck 8 weeks or more after definitive (chemo)radiotherapy.

Methods: Between October 1996 and July 2002, 39 eligible patients were identified. The reference PET scan was performed at a median of 12 weeks (range, 8-32 weeks) after treatment.

Usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography in patients with a residual structural abnormality after definitive treatment for squamous cell carcinoma of the head and neck.

Background: Residual structural abnormalities after definitive treatment of head and neck squamous cell carcinoma (HNSCC) are common and pose difficult management problems. The usefulness of fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) to supplement conventional evaluation with clinical and standard radiologic examination (CE) in such patients was assessed.

Methods: Fifty-three eligible patients were identified with residual structural abnormalities on CE.

Prevention of secondary stroke and resolution of transfusional iron overload in children with sickle cell anemia using hydroxyurea and phlebotomy.

Objective: Transfusions prevent secondary stroke in children with sickle cell anemia (SCA) but also cause iron overload. Alternatives for stroke prophylaxis with effective therapy to reduce iron burden are needed.

Study Design: For 35 children with SCA and stroke, transfusions were prospectively discontinued.

Synthesis, nicotinic acetylcholine receptor binding, and antinociceptive properties of 2'-fluoro-3'-(substituted phenyl)deschloroepibatidine analogues. Novel nicotinic antagonist.

A series of 2'-fluoro-3'-(substituted phenyl)deschloroepibatidine analogues (5a-k) showed high affinity for alpha4beta2 binding with no affinity at alpha7 nAChRs. The most potent compound was 2'-fluoro-3'-(4-nitrophenyl)deschloroepibatidine (5g) which possessed a Ki value of 0.009 nM.

The Australian government's review of positron emission tomography: evidence-based policy-making in action.

The Commonwealth Government constituted the Medicare Services Advisory Committee (MSAC) to implement its commitment to entrench the principles of evidence-based medicine in Australian clinical practice. With its recent review of positron emission tomography (PETReview), the Commonwealth intervened in an established MSAC process, and sanctioned the stated objective to restrict expenditure on the technology. In our opinion: The evaluation of evidence by PETReview was fundamentally compromised by a failure to meet the terms of reference, poor science, poor process and unique decision-making benchmarks.

Chemical and functional analysis of hydroxyurea oral solutions.

The primary hypothesis of the upcoming NIH-sponsored phase III infant hydroxyurea (BABY HUG) trial is that hydroxyurea can prevent chronic organ damage in infants with sickle cell anemia. Since hydroxyurea is currently commercially available only in capsules, a liquid formulation of hydroxyurea is needed for young patients. Hydroxyurea oral solutions were prepared by dissolving the contents of the capsules in water (room temperature or mildly heated) with vigorous stirring, filtering excipients, and adding flavored syrup to a final concentration of 100 mg/mL.

Clinical course and flow cytometric analysis of paroxysmal nocturnal hemoglobinuria in the United States and Japan.

: To determine and directly compare the clinical course of white and Asian patients with paroxysmal nocturnal hemoglobinuria (PNH), data were collected for epidemiologic analysis on 176 patients from Duke University and 209 patients from Japan. White patients were younger with significantly more classical symptoms of PNH including thrombosis, hemoglobinuria, and infection, while Asian patients were older with more marrow aplasia. The mean fraction of CD59-negative polymorphonuclear cells (PMN) at initial analysis was higher among Duke patients than Japanese patients.

Acute parvovirus B19 infection mimicking congenital dyserythropoietic anemia.

Infection with human parvovirus B19 is known to cause transient erythroid aplasia in children with hemolytic anemia but has also been associated with bone marrow necrosis and morphologic changes suggesting myelodysplasia. The authors describe a previously healthy child who presented with severe hypoplastic anemia. Initial bone marrow aspiration revealed erythroid hyperplasia, dyserythropoiesis, and multinucleated erythroid cells with nuclear budding and bridging, consistent with the diagnosis of congenital dyserythropoietic anemia.

Malignancy in patients with sickle cell disease.

Malignancy in patients with sickle cell disease (SCD) has been previously reported, but the types of cancer and its incidence remain undefined. With the advent of hydroxyurea therapy, there is concern about increasing the cancer risk for patients with SCD. The International Association of Sickle Cell Nurses and Physician Assistants identified 52 cases of cancer (49 patients) among 16,613 patients with SCD followed at 52 institutions.

Identification of hemochromatosis gene polymorphisms in chronically transfused patients with sickle cell disease.

Three polymorphic gene mutations in the human hemochromatosis (HFE) gene (C282Y, H63D, S65C) are associated with non-transfusion-related iron overload in Caucasians. More recently, these mutations have also been identified in African-Americans. However, the prevalence of HFE gene mutations in African-Americans with sickle cell disease (SCD) has not been described.

Sustained long-term hematologic efficacy of hydroxyurea at maximum tolerated dose in children with sickle cell disease.

Hydroxyurea improves hematologic parameters for children with sickle cell disease (SCD), but its long-term efficacy at maximum tolerated dose (MTD) has not been determined. Between 1995 and 2002, hydroxyurea therapy was initiated for 122 pediatric patients with SCD including 106 with homozygous sickle cell anemia (HbSS), 7 with sickle hemoglobin C (HbSC), 7 with sickle/beta-thalassemia (HbS/ beta-thalassemia [6 HbS/beta0, 1 HbS/beta+]), and 2 with sickle hemoglobin OArab (HbS/OArab). Median age at initiation of therapy was 11.

Successful use of anti-CD20 (rituximab) in severe, life-threatening childhood immune thrombocytopenic purpura.

Thrombocytopenia with life-threatening hemorrhage in childhood immune thrombocytopenic purpura is rare, but effective therapeutic options are limited for the patient with bleeding. We report the efficacy of humanized anti-CD20 monoclonal antibody (rituximab, Rituxan) therapy for an infant with severe, refractory life-threatening immune thrombocytopenic purpura.

Childhood autoimmune cytopenia secondary to unsuspected common variable immunodeficiency.

Immune thrombocytopenic purpura and autoimmune hemolytic anemia are typically idiopathic processes without underlying systemic illness. Four children with autoimmune cytopenia had low immunoglobulin levels that led to the diagnosis of common variable immunodeficiency. Routine screening of immunoglobulins is suggested for children with chronic or recurrent immune thrombocytopenic purpura and autoimmune hemolytic anemia.

Influence of dietary urea level on digestive function and growth performance of cattle fed steam-flaked barley-based finishing diets.

Four Holstein steers (282 kg) with cannulas in the rumen and proximal duodenum were used in a 4 x 4 Latin square experiment to evaluate the influence of dietary urea level (0, 0.4, 0.8, and 1.

Review of efforts to decrease costly leg wound complications in the medicare population following coronary revascularization.

Background: Current trends show that patients referred for coronary artery bypass grafting (CABG) are significantly older, sicker, and at higher risk for complications than ever before. Eliminating leg wound complications would significantly benefit these patients and reduce the consumption of health care time and dollars. Endoscopic vein harvesting (EVH) decreases the risk of wound complications in patients following CABG and may decrease costly long-term wound-related problems.

In vitro induction of fetal hemoglobin in human erythroid progenitor cells.

Objective: Clinical heterogeneity among patients with sickle cell anemia (SCA) is influenced by the amount of fetal hemoglobin (HbF) within circulating erythrocytes. Current pharmacotherapy focuses on increasing HbF in order to reduce hemolysis and help prevent acute vaso-occlusive events. Hydroxyurea, a known S-phase-specific cytotoxic ribonucleotide reductase (RR) inhibitor, is an effective agent for HbF induction in patients with SCA, but the mechanisms by which hydroxyurea induces HbF in vivo have not been elucidated.

Subclinical parvovirus B19 infection in children with sickle cell anemia.

Purpose: To investigate the prevalence and clinical consequences of previous parvovirus B19 exposure in a large cohort of pediatric patients with sickle cell anemia (SCA).

Methods: Prospective serologic testing for previous parvovirus B19 exposure was performed in steady-state pediatric patients with SCA, either prior to starting hydroxyurea therapy or in preparation for transition to the adult service. A retrospective chart review was performed to ascertain whether patients had a documented history of a transient aplastic crisis.

Increased expression of anti-apoptosis genes in peripheral blood cells from patients with paroxysmal nocturnal hemoglobinuria.

Resistance to apoptosis has been described in neutrophils from patients with PNH and related hematologic disorders (aplastic anemia, myelodysplastic syndrome), but its molecular basis is not understood. Using gene expression analysis, PNH granulocytes had relative overexpression of four anti-apoptosis genes (human A1, hHR23B, Mcl-1, and RhoA) compared to normal controls. These findings were confirmed by RT-PCR analysis and observed in both peripheral blood granulocytes and mononuclear cells of patients with PNH.