Showing papers by "Royal Devon and Exeter Hospital published in 1985"

Interferon is effective in hairy-cell leukaemia.

Abstract: Seventeen patients with hairy-cell leukaemia (HCL) and peripheral cytopenias were given human lymphoblastoid interferon (Wellferon), 3 megaunits daily or 6 megaunits on alternate days intramuscularly, for 4-24 weeks. Twelve of the patients had undergone splenectomy, three had no palpable spleen and had therefore not been offered surgery, and two patients with substantial splenomegaly were given interferon (IFN) as treatment of first choice. Toxic effects were minor except in one patient who experienced a severe form of somnolence syndrome. In all patients hairy cells (HCs) were cleared from the blood and platelet and Hb levels improved in 2-14 weeks. Neutrophils were improved in 14/17 of the patients. In the two patients with splenomegaly, the spleen became impalpable after 5-8 weeks therapy, and haematological improvement occurred at 12-14 weeks. HC infiltration of the marrow was reduced in all patients, but was complete (less than 5%) in only two, both of whom had impalpable spleens. Immunological surface-marker studies confirmed that light-chain-restricted B cells disappeared from the blood in parallel with the clearance of morphological HCs. There was no evidence of HC maturation and no increase in phenotypic NK cells. T cells were moderately reduced and the relatively greater reduction of Leu 2a+ suppressor cells resulted in increased Leu 3a+/2a+ helper/suppressor ratios in 11/17 of the patients. Early experience in the six patients who have stopped IFN suggests that, after an initial further increase in Hb and neutrophil levels, HCs gradually return with slow deterioration of haematological parameters. Interferon is now the treatment of choice for patients becoming cytopenic post-splenectomy or for patients without splenomegaly. IFN is effective first-line therapy in patients with splenomegaly, but further work is needed to establish whether the agent should replace splenectomy in such patients. Some form of maintenance or re-treatment therapy will probably be necessary.

Oesophageal function in diabetes mellitus and its association with autonomic neuropathy.

Abstract: We have evaluated oesophageal function in 34 diabetics and in 16 non-diabetic controls by a timed bolus transit method derived from dynamic oesophageal scintiscans (water transit time: WTT) and barium swallow. The diabetics were screened for autonomic neuropathy using standard cardiovascular responses and 10 patients were classified as abnormal. WTT was significantly prolonged in autonomic neuropaths compared with other diabetics (p less than 0.01) and controls (p less than 0.001). Abnormal peristalsis on barium swallow was seen more frequently in autonomic neuropaths (9/10) than in other diabetics (11/24, p less than 0.002). WTTs from all diabetic patients correlated with abnormal heart rate responses at rest (Rs = - 0.49, p less than 0.005), on deep inspiration (Rs = -0.48, p less than 0.005), and on standing (Rs = -0.39, p less than 0.025) but not with the Valsalva manoeuvre. A weaker correlation was found between the postural fall in blood pressure (Rs = 0.3, p less than 0.05). Diabetics with autonomic neuropathy frequently have asymptomatic oesophageal dysfunction which may result from a vagal neuropathy in view of its association with abnormalities of vagally mediated cardiovascular responses.

Swallowing difficulties in stroke patients: a new treatment

Abstract: Difficulty with swallowing is one of the most distressing symptoms experienced by patients who have suffered strokes and one which previously has been particularly difficult to help. An intra-oral appliance which stimulates the involuntary swallowing mechanism has been tested with 170 consecutive stroke patients with dysphagia and drooling, and the results show substantial improvement. The appliance is relatively cheap to construct and fit, requiring little professional time. It is worn during the whole day, helping to rehabilitate the swallowing mechanism with saliva as well as with food and drink. The treatment is appropriate for patients in hospital or at home and avoids the use of medication.

Extramedullary plasmacytoma of the lung.

Abstract: Three patients with extramedullary plasmacytoma of the lung are described, one of whom also had cervical lymph node metastasis, with the production of an M-protein. The production of M-protein normalized after successful treatment of the localized disease. In all three patients, the disease was locally controlled with radiation therapy, but it became generalized from 6 months to less than 3 years of the initial presentation.

Acute myelomonocytic leukaemia developing in a patient with psoriasis treated with oral 8-methoxypsoralen and longwave ultraviolet light.

Abstract: Summary Acute myelomonocytic leukaemia developed in a patient with psoriasis treated with oral 8–methoxypsoralen and longwave ultraviolet light (PUVA). The possibility that PUVA may induce haematological malignancies by damaging the DNA of cirulating multipotential haemopoietic stem cells is discussed. We advise increased attention to the haemopoietic system of patients treated with PUVA.

Use of autosuture during oesophageal and pharyngeal diverticulectomy

Abstract: Although autostapling for the gastrointestinal tract is well established, some doubt exists over whether such techniques are suitable for the closure of diverticula cosisting of mucosa alone. Seven cases of paryngeal pouch and 2 cases of oesophageal diverticulum were treated by excision and closure using a stapling device. This has proved to be a satisfactory method of closure when appropriate-size staples are used. Keywords oesophageal diverticula pharyngeal diseases autosuture

Factitious diabetic instability.

Abstract: Factitious diabetic instability is described in four patients. In three the predominant problem was recurrent hypoglycaemia. The fourth presented with apparent insulin resistance and episodes of ketoacidosis. The methods used to make the diagnosis are described, and the factors which contribute to this type of diabetic instability are discussed.

Leishmanin skin testing in the diagnosis of American cutaneous leishmaniasis.

Abstract: Two hundred thirty-three British troops were tested before and 2 months after a 6-month period in Belize. No erythematous indurated reactions developed on the initial tests; four subjects developed such reactions on the second test. Three of these subjects had skin ulcer at the time of the second test the fourth developed an ulcer 2 weeks later. Leishmania braziliensis sp were isolated from all of these ulcers. Two subjects who showed no reaction on either of their tests developed skin ulcers within 1 month of the second test. Leishmania braziliensis sp were isolated from these ulcers. The leishmanin test performed 2 months after return from an endemic area does not provide a satisfactory screening test for leishmaniasis. An indurated reaction correlates well with the presence of disease, but a negative reaction does not exclude this developing later.

Observations on 6-mercaptopurine activity in Saccharomyces cerevisiae.

Abstract: Yeast strains carrying the allele su-pur are sensitive to a number of purine analogues including 6-mercaptopurine (6MP), whereas su-pur+-carrying strains are insensitive [1]. Experimentation into 6MP insensitivity revealed that the agent was being utilized as a nutrient source both by the su-pur+ strain, and by cells with an adenine requirement. As su-pur+ cells reportedly excrete hypoxanthine [1] it is suggested that the biochemistry of 6MP differs in yeast and man, and that degradation of the agent via sulfinic acid to hypoxanthine may occur.