Partially mismatched related donor transplants as salvage therapy for patients with refractory leukemia who relapse post-BMT.

Patients who relapse post-ABMT are usually resistant to conventional therapy, and a potentially curative therapy with allogeneic BMT is limited due to availability of a matched donor. To assess whether such patients can be salvaged using partially mismatched related donors (PMRD), eight patients age 6-50 years old underwent PMRD-BMT. All patients ALL (n = 3) and AML (n = 5) were in relapse 7-31 months after first BMT.

Purging of peripheral blood stem cell grafts.

The shortage of HLA-matched sibling donors for bone marrow transplant patients has stimulated interest in the use of alternative donors. As a result, there has been a dramatic increase in the use of autologous marrow transplantation, which avoids the complications of graft-versus-host disease, but may deprive the patient of a potentially beneficial graft-versus-disease response and runs the risk of returning occult tumor cells with the graft. There is increasing evidence that these cells may be associated with disease relapse post-transplant, and many methods have been developed for their removal ex vivo.

Characterization of acute bone marrow graft rejection in T cell-depleted, partially mismatched related donor bone marrow transplantation.

The purpose of this study was to characterize the phenotype and clonality of the T cell population in patients who experience acute rejection (AR) following bone marrow transplantation (BMT) from a partially mismatched related donor (PMRD). Phenotypic analysis was performed using flow cytometry, assignment of donor/host lineage by cytogenetics or HLA-specific flow cytometry, and analysis of the T cell receptor (TCR) by reverse-transcriptase polymerase chain reaction (RT-PCR). We have previously reported the initial appearance in the blood of AR patients of host CD8+brightCD3low T cells that progressively express increasing amounts of CD3+ cells.

Planning and organizing a multidisciplinary psychosocial oncology service.

Providing psychosocial care to patients with cancer and their families is a formidable task given the current fiscal environment in hospitals. As the pool of available resources shrinks and populations shift from inpatient to outpatient, psychosocial staff are challenged to find creative, versatile, and efficient ways to deliver quality services and programs. This article describes the efforts to plan and implement psychosocial care at a cancer center facing the constraints of limited staff and decreasing resources.

1995 Gaston Labat Lecture. Ropivacaine. White knight or dark horse?

Background And Objectives: Ropivacaine, a new local anesthetic now under Federal Drug Administration review for clinical release, is a unique drug designed to take advantage of cardiac sodium channel stereoselectivity. The Labat lecture, honoring the father of regional anesthesia, pays tribute to the master by tracing the evolution of knowledge transfer from basic science frontiers to safer clinical practice.

Methods: A survey was made of pertinent English-language literature on stereoselectivity of bupivacaine isomers and the evaluation and validation of ropivacaine, including a stereoisomerism primer for the nonscientist.

T cell-mediated immune mechanisms in myositis.

Advances in molecular biologic techniques and the availability of novel immunologic reagents have allowed new approaches to understanding the pathogenesis of human autoimmune diseases, including the idiopathic inflammatory myopathies. Indirect evidence that autoreactive T cells mediate muscle inflammation in the human myositis syndromes has been strengthened by recent studies describing restricted T cell receptor gene expression in certain clinical and/or serologic groups of myositis patients. These findings are supported by other investigations documenting abnormal patterns of cytokine, adhesion molecule, and major histocompatibility complex antigen expression within inflammatory lesions.

Current nursing practice of point-of-care laboratory diagnostic testing in critical care units.

Background: The development of user-friendly laboratory analyzers, combined with the need for rapid assessment of critically ill patients, has led to the performance of in vitro diagnostic testing at the point of care by personnel without formal laboratory training.

Objectives: To determine the range of laboratory testing performed by critical care nurses and their attitudes toward this role.

Methods: A survey of critical care nursing consultants was conducted, using a modified Likert scale, to assess objective measures of point-of-care testing practice in critical care units and to determine nurses' attitudes toward the practice of point-of-care testing.

Radiohumeral arthrodesis for salvage of failed total elbow arthroplasty.

Ulnohumeral arthrodesis is the standard technique for elbow fusion. The geometry and surface area of the distal humerus and proximal ulna enhance the chances of fusion while maintaining some wrist motion. A case of a patient with multiple failed elbow procedures in which the standard ulnohumeral fusion was not possible is presented.

The role of continuous infusion loop diuretics.

Objective: To evaluate the role of continuous infusion loop diuretics in selected patient populations, discuss the advantages and disadvantages associated with continuous infusion, and recommend monitoring parameters for the use of continuous infusion therapy. Current dosing guidelines for continuous infusion loop diuretics have not been established, but a summary of previously studied doses is provided.

Data Sources: A literature search using MEDLINE, International Pharmaceutical Abstracts, as well as additional references found in pertinent articles.

Responsibilities in point-of-care testing. An institutional perspective.

The development of "user-friendly" laboratory analyzers, combined with the need for rapid assessment of critical care patients, has led to the performance of in vitro diagnostic testing at the point of care. This strategy has been well received by most physicians who desire rapid turnaround times for laboratory tests, especially in the critical care areas. Since the primary care-giver in most critical care units is the registered nurse, much point-of-care testing has been delegated to nursing personnel.

Calculation of dose in asymmetric photon fields.

A method is introduced to calculate monitor units to points off axis. Extensive data are presented comparing this method with measured values of dose per monitor unit on the central ray of asymmetric fields produced by a variety of linear accelerators. The technique demonstrates improvement over existing methods that use large-field profile data.

Developing, implementing, and evaluating a handbook for parents of pediatric hematology/oncology patients.

This article details the development of a parent handbook for pediatric hematology and oncology patients. The planning and content development are discussed. Adult learning principles were incorporated throughout the handbook.

Primary infertility and oral contraceptive steroid use.

Objective: To determine the association between combined monophasic oral contraceptive (OC) use and primary infertility.

Design: Case-control.

Setting: Women serving as controls of the Cancer and Steroid Hormone Study.

Immunotherapy with donor leukocyte infusions for patients with relapsed acute myeloid leukemia following partially mismatched related donor bone marrow transplantation.

Donor leukocyte infusions (DLI) were used to treat 2 patients with AML who relapsed within 4 months of treatment with partially mismatched related donor (PMRD) BMT representing 1-2 HLA-mismatches. No other form of cytoreductive therapy was given to these patients. Both patients developed GVHD (grade II-III) following DLI requiring steroid therapy.

Good grieving--an intervention program for grieving children.

Purpose/objectives: To describe a program for grieving children including the agenda, activities, and logistics of organizing the program.

Data Sources: Clinical observations and evaluations from the program; literature review.

Data Synthesis: A series of four seasonal programs were designed to promote a child's normal grieving process and enhance adjustment to the loss.

The effects of a support group on selected psychosocial outcomes of bereaved parents whose child died from cancer.

Group support for bereaved parents whose child died from cancer has been suggested as a means of helping parents express emotions about their loss and improve their coping. Using a quasi-experimental design, we sought to determine the selected psychosocial effects of participation in a support group for bereaved parents whose child died from cancer. Five bereaved parents completed the Emotions Profile Index, the Family Adaptability and Cohesion Evaluation Scales, and the Social Adjustment Scale Self-Report before and after the seven group sessions.

Diffuse arterial thrombosis in a young man with elevated lipoprotein(a) and minimal atherosclerosis.

An increased incidence of premature atherosclerotic arterial occlusive disease was recently reported in young adults. This condition is characterized by early occurrence of severe symptoms, lower incidence of typical cardiovascular risk factors for atherosclerosis, different natural course of arterial disease vis-a-vis older population, and poor outcome of a standard treatment. This report describes a young man with aggressive arterial occlusive disease in the lower extremities and symptom-free occlusions of coronary and renal arteries in association with high levels of lipoprotein(a).

Immunologically based methods for the elimination of tumor cells from autologous stem cell grafts.

There is currently renewed interest in the potential of tumor cells within autologous hematopoietic grafts to contribute to relapse of cancer post-transplant. This has prompted the development of a wide variety of techniques for the ex vivo removal or purging of malignant cells from bone marrow and peripheral blood progenitor cell grafts. Both negative selection, in which tumor cells are eliminated, and positive selection, in which hematopoietic stem cells are enriched, are under examination as purging modalities.

The aftermath of bone marrow transplant for parents of pediatric patients: a post-traumatic stress disorder.

Purpose/objectives: To describe the characteristics of a child's bone marrow transplant (BMT) experience that may precipitate a post-traumatic stress disorder (PTSD) in the parent.

Data Sources: Published articles, books, and the authors' clinical experience.

Data Synthesis: When viewed from the PTSD framework, parental reactions to a child's BMT offer striking parallels that include assessment of the event as traumatic, re-experiencing the event, intrusive thoughts, and a variety of emotional and cognitive responses.

Reorganization of a patient financial services department.

The patient accounts department at Richland Memorial Hospital recently completed a reorganization process. This process took approximately four months to complete and involved retraining 46 full-time employees (FTEs) and creating five new positions in the department.

Rare presentation of anastomotic iliac artery false aneurysm: rupture with formation of ilio-iliac arteriovenous fistula.

A rare complication of aortoiliac bypass procedure resulting in the formation of an acute ilio-iliac arteriovenous fistula was presented. The latter was a first manifestation of anastomotic iliac pseudoaneurysm. This is only the second such case reported in the English literature.