Reduced charges and costs associated with outpatient autologous stem cell transplantation.

High-dose chemotherapy and stem cell rescue is increasingly being delivered in the outpatient setting. Such intensive outpatient management programs have reduced the total hospital length of stay without compromising clinical outcomes. However, a detailed financial analysis of outpatient programs has not been performed.

A combination of low-dose cyclophosphamide and colony-stimulating factors is more cost-effective than granulocyte-colony-stimulating factors alone in mobilizing peripheral blood stem and progenitor cells.

Background: The use of peripheral blood progenitor cells (PBPCs) instead of autologous bone marrow leads to more rapid engraftment following high-dose chemotherapy. Mobilization regimens differ with respect to toxicity, efficiency, and cost.

Study Design And Methods: Two cohorts of patients with breast cancer received one of two mobilization regimens: granulocyte-colony-stimulating factor (G-CSF) at 10 micrograms per kg was given subcutaneously for 5 days, with leukapheresis begun on Day 6, or low-dose cyclophosphamide followed by sequential granulocyte-macrophage-CSF (GM-CSF) at 5 micrograms per kg for 5 days and by G-CSF at 10 micrograms per kg, with leukapheresis begun on Day 11.

Competitive forces and academic plastic surgery.

Economic constraints developing as a result of rising health care costs in the United States pose significant challenges for and threats to the survival of academic plastic surgery. Declining clinical revenues, competition for patients and resources from other health care providers, and reductions in support of its education and research efforts necessitate a paradigm shift if it is to survive. Questionnaires were used to collect data from 92 of the 100 postgraduate training program directors of plastic surgery in the United States.

Fibroblast variability in photoaged and nonphotoaged facelift skin.

Pre- and postauricular skin was harvested from 25 facelift patients to study fibroblast replicative ability (RA). In tissue cultures, considerable heterogeneity was found in the ability of facial skin fibroblasts to replicate, both from patient to patient, and in the relationship of preauricular and postauricular skin. Fibroblast RA ranged from 8.

Twice-a-day versus four-times-a-day ofloxacin treatment of external ocular infection.

Purpose: The purpose of this study was to compare the efficacies of 0.3% ofloxacin eyedrops, when given twice-a-day (BID) versus four-times-a-day (QID), for the treatment of external ocular disease.

Method: Fifty patients with blepharitis, conjuctivitis, or blepharoconjunctivitis were randomly assigned to treatment with 0.

PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. PROACT Investigators. Prolyse in Acute Cerebral Thromboembolism.

Background And Purpose: To test the safety and recanalization efficacy of intra-arterial local delivery of plasminogen activators in acute ischemic stroke, a randomized trial of recombinant pro-urokinase (rpro-UK) versus placebo was undertaken in patients with angiographically documented proximal middle cerebral artery occlusion.

Methods: After exclusion of intracranial hemorrhage by CT scan, patients with abrupt onset of symptoms of focal ischemia likely to receive treatment within 6 hours who satisfied all clinical eligibility criteria underwent carotid angiography. Patients displaying Thrombolysis in Acute Myocardial Infarction grade 0 or 1 occlusion of the M1 or M2 middle cerebral artery were randomized 2:1 to receive rpro-UK (6 mg) or placebo over 120 minutes into the proximal thrombus face.

New trends in skin tumor surgery.

Over 8 years, 1700 patients were referred from the Mohs' Surgery and Cutaneous Laser Unit after Mohs micrographic skin tumor excision to the Division of Plastic and Reconstructive Surgery. Preoperative coordination between the two divisions was emphasised in wound preparation and timing of reconstruction for maximized patient convenience and outcome. Most repairs of facial and extremity defects were carried out under local anesthesia.

The evolution of antithrombotic therapy in coronary stenting.

A rare but important side effect associated with the use of coronary stents is the development of subacute thrombotic occlusion within the first week after implantation. Recent studies have indicated that the incidence of subacute thrombosis can be reduced with a combination regimen consisting of aspirin and ticlopidine instead of the standard regimen of aspirin and warfarin. The evolution in our understanding of the factors causing subacute stent thrombosis, coupled with the development of new implantation procedures, has permitted the development of a new treatment strategy with less aggressive anticoagulation therapy, fewer side effects, and, it is hoped, lower costs.

Hepatitis C and G co-infection: response to interferon therapy and quantitative changes in serum HGV-RNA.

Hepatitis G virus (HGV), a positive sense RNA virus, is distantly related to hepatitis C virus (HCV): its genetic organization and identity are consistent with the Flaviviridae family. Coinfection with HGV occurs in 10% to 20% of HCV-infected subjects. These similarities raise two theoretical questions.

Sjögren's syndrome. Controversies and progress.

Diagnostic criteria for Sjögren's syndrome (SS) are required by both physicians and patients to (1) provide a rational basis for their symptoms, assess their prognosis, and guide therapy; (2) identify a group of patients who are most likely to share a common etiopathogenesis, in order to identify those genetic and environmental factors that are crucial in pathogenesis; (3) fill out the myriad medical insurance forms that require a diagnosis code; and (4) serve as a "shorthand" code that alerts specialists in different fields (oral medicine, ophthalmology, and a variety of specialists in internal medicine) to search for particular clinical problems found in the SS patient. The key question in this article is whether the term "Sjögren's syndrome" should apply to a rather restricted group of individuals (those with an autoimmune basis for exocrinopathy) or to a rather large group of individuals who share a similar symptom complex of dry eyes and mouth. Primary SS, as defined by San Diego criteria, is a systemic autoimmune disease that is characterized by keratoconjunctivitis sicca and xerostomia resulting from lymphocytic infiltrates of the lacrimal and salivary glands.

Role of autoantibody tests in the diagnostic evaluation of neuropsychiatric systemic lupus erythematosus.

Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) can be defined as a significant and unequivocal change in the baseline neurologic and psychiatric function identified by history and physical examination. NPSLE can involve the central nervous system and/or the peripheral autonomic nervous system. This article reviews the clinical manifestations, pathology, and immunopathogenesis of NPSLE.

An all oral antiemetic regimen for patients undergoing high-dose chemotherapy with peripheral blood stem cell transplant.

The purpose of the study was to assess the toxicity and efficacy of an oral, combination antiemetic regimen including granisetron (Kytril; SmithKline Beecham Pharmaceuticals, Philadelphia, PA, USA) in the setting of highly emetogenic conditioning chemotherapy for stem cell transplantation. Antiemetic prophylaxis consisted of oral granisetron 2 mg once daily, oral prochlorperazine 10 mg q 6 h and oral dexamethasone 4 mg q 6 h, beginning 1 h prior to chemotherapy on each of the 4 days of chemotherapy and continuing until 24 h after the completion of high-dose chemotherapy (HDC). Patients received either CVP (cyclophosphamide 6 g/m2, VP-16 1800 mg/m2 and carboplatin 1200 mg/m2) or CTP (thiotepa 500 mg/m2 in place of VP-16) in four daily doses given over 4 h from days -4 to -1.

Pathogenesis and treatment of Sjögren's syndrome.

The criteria for diagnosis of primary Sjögren's syndrome continue to be controversial, leading to confusion in clinical practice and in the research literature. Among Sjögren's syndrome patients who fulfill the European criteria, only 15% of those would fulfill the San Diego criteria. This difference in disease classification leads to difficulty in evaluating clinical trials and in elucidating pathogenetic mechanisms, because different patient populations are evaluated.

Laparoscopic anatomy of the region of the esophageal hiatus.

Background: The wide patient acceptance of hiatal and gastroesophageal surgery performed by laparoscopy has suddenly generated a large volume of procedures frequently done by surgeons with limited experience in this area. This has resulted in an excessive number of complications. Knowledge of the normal and pathologic laparoscopic anatomy is essential for safe dissection around the esophageal hiatus.

The sleep of long-haul truck drivers.

Background: Fatigue and sleep deprivation are important safety issues for long-haul truck drivers.

Methods: We conducted round-the-clock electrophysiologic and performance monitoring of four groups of 20 male truck drivers who were carrying revenue-producing loads. We compared four driving schedules, two in the United States (five 10-hour trips of day driving beginning about the same time each day or of night driving beginning about 2 hours earlier each day) and two in Canada (four 13-hour trips of late-night-to-morning driving beginning at about the same time each evening or of afternoon-to-night driving beginning 1 hour later each day).

An economic analysis of norfloxacin prophylaxis against spontaneous bacterial peritonitis.

Background/aims/methods: Spontaneous bacterial peritonitis (SBP) is a frequent complication of advanced liver disease and in high-risk patients, it is associated with a mean (per episode) mortality of 29% and a mean 1-year mortality of 82%. The 1-year recurrence rate of SBP can be as high as 30-70%. Selective intestinal decontamination with antibiotic prophylaxis has been shown to significantly reduce the incidence of recurrent SBP.

Laser hair removal in a patient with hypertrichosis lanuginosa congenita.

Background: Hypertrichosis lanuginosa congenita (HLC) is a cutaneous disorder marked by diffuse lanugo-like hair present at birth. Although affected individuals are usually healthy, the excessive hair creates an extraordinary appearance. Permanent eradication of their superfluous hair is therefore a priority.

Catheter-based radiotherapy to inhibit restenosis after coronary stenting.

Background: In animal models of coronary restenosis, intracoronary radiotherapy has been shown to reduce the intimal hyperplasia that is a part of restenosis. We studied the safety and efficacy of catheter-based intracoronary gamma radiation plus stenting to reduce coronary restenosis in patients with previous restenosis.

Methods: Patients with restenosis underwent coronary stenting, as required, and balloon dilation and were then randomly assigned to receive catheter-based irradiation with iridium-192 or placebo.

Physics and safety aspects of a coronary irradiation pilot study to inhibit restenosis using manually loaded 192Ir ribbons.

Radiation therapy has been successfully used in controlling some forms of benign tissue growth. A pilot study has been launched to evaluate the usefulness of localized radiation therapy in reducing restenosis after coronary angioplasty. In this randomized, double-blind study, patients with known restenosis received balloon angioplasty or additional stent implantation and were then randomized to receive either radiation or placebo treatment.