Establishment of a novel anaplastic large-cell lymphoma-cell line (COST) from a 'small-cell variant' of ALCL.

Anaplastic large-cell lymphoma (ALCL) is a distinct biological and cytogenetic entity with a broad spectrum of morphological features (common type, small-cell variant and lymphohistiocytic variant). Few cell lines of ALCL are available and they all originate from primary tumors demonstrating the common type morphology (ie large-sized lymphoma cells). We established a new ALCL cell line (COST) from the peripheral blood of a patient with a small-cell variant of ALCL, at diagnosis. Cells growing in vitro and in SCID mice consisted of two populations, that is, small- and large-sized cells as seen in the patient's tumor. Both large and small malignant cells were positive for CD43/MT1 T-cell associated antigen, perforin, granzyme B and TIA-1, but negative for CD2, CD3, CD5, CD7, CD4 and CD8 antigens. Standard cytogenetic studies as well as multiplex FISH confirmed the presence of the canonical t(2;5)(p23;q35) translocation, but also revealed additional numerical and structural abnormalities. The COST cell line is the first ALCL small-cell variant cell line, and thus provides a potentially useful tool for further functional and molecular studies that should improve our understanding of the small-cell variant of ALCL, which is more frequently complicated by a leukemic phase.     

Acute tubular necrosis due to captopril

Angiotensin-converting enzyme (ACE) inhibitors are standard therapy for congestive cardiac failure. ACE inhibitors have been used worldwide and are usually safe and have relatively few side effects. Hypotension can develop with the first dose of captopril and can lead to symptomatic renal hypoperfusion with subsequent acute renal failure (ARF). The case of a 65-year-old patient with congestive heart failure who developed acute renal failure following the first dose of captopril is described. He required hemodialysis for 8 weeks for the improvement of his renal function and urinary output. The renal biopsy confirmed the presence of acute tubular necrosis. The reversibility of captopril-induced ARF is confirmed and the patient made an uneventful recovery. An immunoallergic mechanism is not thought to have been responsible for this adverse effect. It is advised that caution should be exerted in giving ACE inhibitors to elderly patients with congestive heart failure, particularly if they are on diuretics. Routine biochemical monitoring is suggested before and during captopril therapy.     

Paradoxic response to diazepam in complex partial status epilepticus

BACKGROUND: Antiepileptics including benzodiazepines have long been recognized to provoke seizures and precipitate status epilepticus occasionally. This has a special clinical importance in the case of diazepam because of its use as first choice medication in its management. This report is intended to highlight the clinical importance of such a situation. METHODS: The clinical course of a 28-year old man with complex partial status, which lasted for two months, is described in detail. RESULTS: Paradoxic response to diazepam was documented under EEG monitoring. A similar response was also noted for midazolam, and had probably contributed in exacerbating and prolonging the duration of status. CONCLUSION: Paradoxic response to diazepam and midazolam is rare, but may be under-recognized. It should be considered in the setting of refractory status epilepticus.     

The performance of the Center for Epidemiologic Study Depression Scale (CES-D) in an Arab female community

BACKGROUND: The purpose of this study was to investigate the psychometric properties of the Arabic version of the CES-D. METHODS: Three samples of young Arab females were chosen from different young female populations (n =450). The translated version of the CES-D, sociodemographic and risk factors questionnaires were applied to the above three samples. A subsample was selected (n = 30) to re-rate the scale items and the same sample was interviewed by the SCID. The internal consistency and test-re-test reliability were estimated as well as the factor structure of the Arabic CES-D. The discriminative and criterion validity of the scale was also investigated using the ROC analysis. RESULTS: Seventy five percent (n = 350) of the subjects completed the scale. Alpha coefficient was found to be 0.88 and the split-half reliability was 0.83. The average re-test reliability (ICC = 0.59). Factor analysis yielded three factors: interpersonal problems, mixed affective/somatic factor and the positive affect factor. There was significant differences in mean total score between depressed and non-depressed subjects as classified by SCID as well as by self-perception of depression and the need for treatment. ROC analysis revealed that a cut-off point of 21 discriminated best between depressed and non-depressed subjects (sensitivity= 82%, specificity = 83% with AUC of 84%). CONCLUSION: The Arabic CES-D was found to possess reasonable reliability and reasonable discriminative and criterion validity.     

Portfolio Theory and Cost-Effectiveness Analysis: A Further Discussion

OBJECTIVES: Portfolio theory has been suggested as a means to improve the risk-return characteristics of investments in health-care programs through diversification when costs and effects are uncertain. This approach is based on the assumption that the investment proportions are not subject to uncertainty and that the budget can be invested in toto in health-care programs. METHODS: In the present paper we develop an algorithm that accounts for the fact that investment proportions in health-care programs may be uncertain (due to the uncertainty associated with costs) and limited (due to the size of the programs). The initial budget allocation across programs may therefore be revised at the end of the investment period to cover the extra costs of some programs with the leftover budget of other programs in the portfolio. RESULTS: Once the total budget is equivalent to or exceeds the expected costs of the programs in the portfolio, the initial budget allocation policy does not impact the risk-return characteristics of the combined portfolio, i.e., there is no benefit from diversification anymore. CONCLUSION: The applicability of portfolio methods to improve the risk-return characteristics of investments in health care is limited to situations where the available budget is much smaller than the expected costs of the programs to be funded.     

Realities of respite care.

Respite care in the form of day care centres, in-home respite and institutional care, has been the cornerstone of care for the disabled elderly. Evidence for its effectiveness in helping carers or disabled clients is hard to come by. In this paper, a proposition is put forward for a carefully designed study to answer some of the important points often raised by the providers of such services.     

An exploration of relative health stock in advanced cancer patients.

OBJECTIVE: The authors sought to empirically test whether relative health stock, a measure of patients' sense of loss in their health due to illness, influences the treatment decisions of patients facing life-threatening conditions. Specifically, they estimated the effect of relative health stock on advanced cancer patients' decisions to participate in phase I clinical trials. METHOD: A multicenter study was conducted to survey 328 advanced cancer patients who were offered the opportunity to participate in phase I trials. The authors asked patients to estimate the probabilities of therapeutic benefits and toxicity, their relative health stock, risk preference, and the importance of quality of life. RESULTS: Controlling for health-related quality of life, an increase in relative health stock by 10 percentage points reduced the odds of choosing to participate in a phase I trial by 16% (odds ratio = 0.84, 95% confidence interval = 0.72, 0.97). CONCLUSION: Relative health stock affects advanced cancer patients' treatment decisions.     

GENDER AND AGE DIFFERENCES IN ANEMIA PREVALENCE DURING THE LIFECYCLE IN KUWAIT

Anemia remains a significant worldwide public health problem. Most studies of anemia and iron deficiency, the major cause of anemia, have targeted small children and reproductive age women. Much less is known about anemia in other lifecycle groups, especially preschool age children, prepubertal boys and girls, or in older adults. Yet recent studies indicate that anemia may increase the risk for chronic diseases and accelerate declining function in older adults. We examined anemia throughout the lifecycle in Kuwait by analyzing data from the 2002 Kuwait Nutrition Surveillance Program. Over 13,000 individuals of both sexes representing all ages were studied. The prevalence of anemia was higher in females than males between 6 months and 3 years. From age 4 to 14 years, there was a reversal with males having a higher rate of anemia. Older females had a lower prevalence of anemia than younger females. These results imply certain policy options.     

A comparison of prognoses of FIGO stage IB adenocarcinoma and squamous cell carcinoma

OBJECTIVES: The objective of this study was to compare clinical and pathologic variables and prognosis of FIGO stage IB adenocarcinoma and squamous cell carcinoma of uterine cervix. METHODS: A retrospective review was performed of 521 patients with stage IB squamous cell carcinoma and adenocarcinoma of cervix who treated primarily by type 3 hysterectomy and pelvic and/or para-aortic lymphadenectomy at Hacettepe University Hospitals between 1980 and 1997. RESULTS: Age, tumor size, grade, depth of invasion, lymph node metastasis, parametrial, vaginal, and lymphvascular space involvement (LVSI) were not different between two cell types except number of the lymph nodes involved. Metastasis to three or more lymph nodes was significantly higher in adenocarcinoma. Overall and disease-free survival were 87.7%, 84.0% versus 86.4%, 83.1% for squamous cell carcinoma and adenocarcinoma, respectively (P > 0.05). The rate and site of recurrence were not different between two cell types. Multivariate analysis of disease-free and overall survival revealed independent prognostic factors as tumor size, LVSI, number of involved lymph node, and vaginal involvement. CONCLUSION: Prognosis of FIGO stage IB cervical cancer patients who were treated by primarily radical surgery was found to be same for those with adenocarcinoma and squamous cell carcinoma.