Showing papers by "William Wallace published in 1999"

Immunoreactive interleukin 4 and interferon-gamma expression by type II alveolar epithelial cells in interstitial lung disease.

Abstract: Cryptogenic fibrosing alveolitis (CFA), extrinsic allergic alveolitis (EAA), and sarcoid are all immunologically mediated forms of interstitial lung disease. In contrast to most patients with EAA and sarcoid, patients with CFA show relentless pulmonary fibrosis which is unresponsive to immunosuppressive therapy. Previous studies have indicated a possible role for epithelial-derived cytokines in the regulation of immunological and fibrotic responses in the lung. This study has examined lung biopsy specimens from patients with CFA, EAA, and sarcoid for immunoreactive interleukin 4 (IL4) and interferon-γ (INFγ) expression by type II alveolar epithelial cells, as these cytokines have been suggested to have in vitro stimulatory and inhibitory effects on fibroblast function. In addition, mRNA in situ hybridization was performed on the CFA lung biopsies to confirm transcription of these cytokine genes within the cells. The results show that type II epithelial cells in EAA and sarcoid show up-regulation of immunoreactivity for both IL4 and INF-γ, but that in CFA only IL4 is detectable. The mRNA in situ hybridization results indicate that this may represent post-transcriptional regulation of INFγ expression in CFA. These results are consistent with previous observations of a paucity of INFγ and a predominantly type II (Th2-like) pattern of immune response in patients with CFA and suggest a possible imbalance of pro-fibrogenic cytokines in the distal lung of patients with this condition, compared with those with EAA or sarcoid. Copyright © 1999 John Wiley & Sons, Ltd.

Totally implantable central venous access devices for paediatric oncology patients

Abstract: Background. Totally implantable central venous access devices (ports) have been available for over 10 years but have not achieved wide-spread use in paediatric oncology patients. We reviewed our experience with these devices over 9 years to assess their safety and acceptability. Procedure. We conducted a retrospective review of insertion technique and reasons for removal of all ports placed in paediatric oncology patients in this hospital between 1989 and 1996, with follow-up until 1998. Acceptability of both ports and external catheters was assessed by a questionnaire in a subgroup of families attending the oncology clinic. Results. One hundred forty-nine ports were inserted during the study period. The median catheter life was 399 days (4-1,406), with a total of 69,342 catheter days. Sixty-nine percent of ports were removed electively at the end of treatment; 8% required removal because of infection and 5% because of blockage. No ports were accidentally dislodged or damaged. Children experienced significantly less restriction of activity with a port compared to an external catheter and greatly preferred the cosmetic appearance. The need for needle insertion to access the port was not seen as a disadvantage by most families. Conclusions. Ports can provide satisfactory central venous access for the majority of paediatric oncology patients, with a low risk of line-related complications and a high degree of acceptability to children and their parents.

Short-term changes in lower leg length in children treated for acute lymphoblastic leukaemia

Abstract: The lower leg length velocity (LLLV) of 14 children with a median age of 4.5 yr who were undergoing chemotherapy (CT) for acute lymphoblastic leukaemia (ALL) was studied for a median duration of 56 weeks (range 14-112). Nine children were studied over the first 6 months, six over the first year, four over the full 2-year course and nine children over the 3 months before and after the end of CT. Over the first month of CT, during induction, median LLLV was 0 mm/wk (P5, P95: -1.6, 0.11); during the fourth month of CT, at the end of CNS-directed therapy, there was a significant rise to 0.38 mm/wk (P5, P95: -0.04, 0.81; p = 0.01, WSR). In the children measured following the end of CT, median LLLV rose from 0.46 mm/wk (P5, P95: -0.02, 0.79) in month 23 to 0.84 mm/wk (P5, P95: 0.72, 1.12) (p = 0.03). There was a positive relationship between neutrophil count and LLLV during continuation chemotherapy (r = 0.4, p = 0.0002); median LLLV was 0.2 mm/ wk (P5, P95: -0.15, 0.5) when the neutrophil count was less than 1 x 10(9)/l and 0.65 mm/wk (P5, P95: 0.1, 1.0) (p = 0.01) when the count was above 1 x 10(9)/l. No significant differences in LLLV were observed between children randomised to different UKALLXI regimens. Intensive chemotherapy for ALL adversely affects lower leg growth. Growth was subnormal during the first few weeks of chemotherapy, but was comparable to healthy children during CNS directed and continuation therapy. There was a significant relationship between growth velocity and neutrophil count during continuation chemotherapy. On discontinuation of chemotherapy there was a further acceleration in lower leg length velocity to supranormal levels ("catch-up" growth).

Congenital hemihypertrophy and epithelioid haemangioendothelioma in a 10-year-old boy: a case report

Abstract: Epithelioid haemangioendothelioma has not been previously described in a patient with congenital hemihypertrophy and diabetes mellitus. Hepatic nodules were incidentally discovered on a routine US examination searching for known associated abnormalities. Pulmonary nodules were present on chest X-ray and CT of the lungs. The diagnosis was confirmed by open biopsy of a hepatic nodule. Despite significant disease progression the patient remains symptom free.