Knee confidence in youth and young adults at risk of post-traumatic osteoarthritis 3-10 years following intra-articular knee injury.

OBJECTIVES: To examine differences in knee confidence between individuals with a history of youth sport-related knee injury and uninjured controls. DESIGN: Historical cohort study. METHODS: Participants include 100 individuals who sustained a youth sport-related intra-articular knee injury 3-10 years previously and 100 age-, sex- and sport-matched uninjured controls. Outcomes included: Knee confidence (Knee Osteoarthritis and Outcome Score); fat mass index (FMI; dual-energy X-ray absorptiometry); and weekly physical activity (modified Godin-Shephard Leisure Time Questionnaire). Mean within-pair differences (95% CI) were calculated for all outcomes. Unadjusted and adjusted (FMI and physical activity) conditional (matched-design) logistic regression (OR 95% CI) examined the association between injury history and knee confidence. RESULTS: Median age of participants was 22 years (range 15-26) and median age at injury was 16 years (range 9-18). Forty-nine percent (95% CI; 39.0, 59.0) of previously injured participants were bothered by knee confidence, compared to 12% (5.5, 18.5) of uninjured participants. Although there was no between group difference in physical activity, injured participants had higher FMI compared to controls (within-pair difference; (95% CI): 1.05kg/m2; (0.53, 1.57)). Logistic regression revealed that injured participants had 5.0 (unadjusted OR; 95% CI; 2.4, 10.2) and 7.5 times (adjusted OR; 95% CI: 2.7, 21.1) greater odds of being bothered by knee confidence than controls. CONCLUSIONS: Knee confidence differs between individuals with a previous youth sport-related knee injury and healthy controls. Knee confidence may be an important consideration for evaluating osteoarthritis risk after knee injury and developing secondary prevention strategies.

The body composition phenotype of Irish adults aged 18-81 years.

BACKGROUND: Regional distribution of adiposity and lean tissue mass are predictors of health risk that cannot be defined by body mass index but can be attained by dual-energy X-ray absorptiometry (DXA). Age and sex-related adult ranges of whole-body and regional adiposity and lean tissue are not available for Irish men and women. AIMS: The aim of this study was to construct a DXA-based body composition profile of Irish adults, focusing on age- and sex-related difference in total and regional adiposity and lean tissue mass. METHODS: The study population comprised a convenience sample of 1606 participants, aged 18-81 years participating in the University of Limerick Body Composition study. Data were analysed to construct stature-normalised indices of body fat mass (BFMI), site-specific visceral adiposity, lean tissue mass (LTMI) and appendicular lean tissue mass (ALTMI). RESULTS: Compared to the young adult (18-29 years), BFMI was higher in women (p < 0.001) but plateaued in men aged >50 years. For men, age-related difference in LTMI was not evident but ALTMI was significantly lower in those >50 years. For women, there was evidence of significantly lower LTMI with advancing age and, similar to men, significantly lower ALTMI in those >50 years. CONCLUSIONS: These data provide an insight into the age-related anthropometric phenotype of Irish adults. Centile data have been constructed that provide informative data of the age and sex-specific range of adiposity and lean tissue mass. These data may assist in identification of those at risk of aberrant, body composition-related disease.

Evaluation of the addition of rituximab to CODOX-M/IVAC for Burkitt's lymphoma: a retrospective analysis.

BACKGROUND: Burkitt's lymphoma (BL) is a highly aggressive B-cell non-Hodgkin's lymphoma (NHL) that may be cured with intensive chemotherapy. The addition of the CD20-directed monoclonal antibody rituximab to CODOX-M/IVAC (cyclophosphamide, vincristine, doxorubicin, and high-dose methotrexate, alternating with ifosfamide, etoposide, and cytarabine) has not been studied despite efficacy in other aggressive CD20-positive NHLs. PATIENTS AND METHODS: Eighty adult BL patients treated with or without rituximab were identified at our institutions. Response rate, overall survival (OS), and progression-free survival (PFS) are calculated. RESULTS: There were fewer relapses in rituximab-treated patients (3 of 40 versus 13 of 40, P = 0.01). There was a trend for improvement in outcome favoring rituximab-containing therapy, with 3-year PFS (74% versus 61%) and 3-year OS (77% versus 66%), although these did not reach statistical significance. Advanced age and central nervous system involvement were associated with poorer OS on multivariable Cox regression analysis, adjusting for treatment, human immunodeficiency virus (HIV) involvement, and risk group. CONCLUSIONS: CODOX-M/IVAC, with or without rituximab, is a highly effective regimen for the treatment of adult BL. Rituximab decreased the recurrence rate and showed a trend in favor of improvement in PFS and OS. HIV-infected patients achieved outcomes comparable with those of their non-HIV-infected counterparts.

End-of-treatment but not interim PET scan predicts outcome in nonbulky limited-stage Hodgkin's lymphoma.

BACKGROUND: Early interim positron emission tomography (PET) scans appear powerfully predictive of outcome in Hodgkin's lymphoma (HL), particularly in advanced-stage disease where it has been predominantly studied. The prognostic value of interim PET in limited-stage patients with nonbulky disease has not been well established. PATIENTS AND METHODS: Ninety-six patients with nonbulky limited-stage HL were identified who had interim and end-of-treatment PET scans. Response rate, overall survival (OS), and progression-free survival (PFS) were calculated. RESULTS: Four-year PFS and OS for the entire cohort were 88% and 97%, respectively. Interim PET did not predict outcome, with PFS in positive and negative patients 87% versus 91% (P=0.57), respectively. End-of-treatment PET result was predictive of outcome, with PFS of 94% in end PET-negative patients versus 54% in end PET-positive patients (P<0.0001). Four-year OS was 100% in end PET-negative patients and 84% in end PET-positive patients (P<0.0001). CONCLUSIONS: Interim PET scans were not predictive of outcome, compared with scans carried out at completion of therapy. End-of-treatment PET was highly predictive of PFS and OS, regardless of interim PET result. In this low-risk patient population, even patients with interim positive PET scans show a favorable prognosis.

Phase I study of sequentially administered recombinant tumor necrosis factor and recombinant interleukin-2.

The purposes of this study were to determine the maximally tolerated dose (MTD) of IL-2 when sequentially administered following TNF (at its MTD), to identify any unique toxicities, and determine the immunomodulatory effects of this combination. Patients with metastatic cancer were treated with 160 micrograms/ml rTNF by rapid i.v. infusion for 5 days, followed by rIL-2 therapy daily at doses up to 18 x 10(6) IU/m2/day for 5 days and 6 x 10(6) IU/m2/day for 7 days. Cycles were repeated at 3- or 4-week intervals until progressive disease or unacceptable toxicity developed. Fifteen patients received 46 cycles of therapy (range 1-8, median 3). Major toxicities included hypotension, weight loss, and decreased performance status comparable to that reported with rIL-2 alone. No novel toxicities were identified. Two of 14 patients who received two cycles of therapy had objective responses (1 complete, 1 partial). Both occurred in patients with malignant melanoma, lasted 30 and 75 weeks, respectively, and included a complete response in liver metastasis. Dosage reductions of IL-2 were necessary for 3 patients over 11 treatment cycles (23%), and rTNF in 1 patient for 1 cycle (2%). The MTD of 5-day infusional rIL-2 was determined at 18 x 10(6) IU/m2/day. rTNF did not augment natural killer/lymphokine-activated killer activities beyond that commonly seen with IL-2 infusions. We conclude that full doses of rTNF can be combined with escalating rIL-2 infusions in an outpatient setting without additive toxicity and with clinical activity in patients with malignant melanoma.

A comparison of esterified estrogens with and without methyltestosterone: effects on endometrial histology and serum lipoproteins in postmenopausal women.

OBJECTIVE: To compare the efficacy and safety of esterified estrogens with and without methyltestosterone. METHODS: Twenty-six women participated in a double-blind randomized trial for 6 months. Outcome measures included serum total and lipoprotein-bound cholesterol, vasomotor symptoms, vaginal cytology and endometrial histology, and chemistry values. Analysis of variance and t test statistics were used to assess differences. RESULTS: After 6 months of therapy, the treatment groups were comparable with regard to symptom scores, vaginal cytology and endometrial histology scores, and clinical laboratory test values. Treatment with esterified estrogens plus methyltestosterone significantly decreased total cholesterol, high-density lipoprotein cholesterol (HDL), HDL2, HDL3, and apolipoprotein A1 compared to esterified estrogens alone. CONCLUSIONS: Esterified estrogens with or without methyltestosterone were effective at reducing menopausal symptoms and were well tolerated over 6 months of continuous treatment. A significant decrease in cholesterol and apolipoproteins in the estrogen plus methyltestosterone group suggests a potentially adverse impact on the beneficial effect normally imparted by estrogen therapy.

The effect of maternal glucose administration on the specificity of the nonstress test.

To determine whether maternal glucose administration can decrease the incidence of false positive nonstress tests, 296 nonstress tests were performed on 235 high-risk obstetric patients in a prospective controlled study. Patients were alternately given a 50 gm oral glucose drink or an equal volume of water 30 minutes prior to the commencement of each test. Among "fed" patients (last meal within 2 hour of the nonstress test) whether receiving glucose or water, and "fasted" patients who received glucose, there was no significant difference in the percentage of reactive tests at either 20 minutes (65.2%) or 40 minutes (87.3%) of testing. However, patients fasting and receiving water had a significantly decreased percentage of reactive tests, both at 20 minutes (48.3%, P less than 0.01) and at 40 minutes (76.7%, P less than 0.05). Glucose administered to fasted patients resulted in an increase in the incidence of reactive tests, although this was not statistically significant. Glucose administration had no effect on the nonstress test results when administered to fed patients.

The role of a trial of labor with a positive contraction stress test.

During a 28 month period 812 patients underwent antepartum FHR testing. Twenty-eight patients had a positive CST. There were two antepartum fetal deaths and 11 patients had a cesarean section without a trial of labor. Fifteen patients had a trial of closely monitored labor (continuous FHR and fetal scalp blood sampling when indicated) and 11 of these (73%) were delivered vaginally. The CST records were examined for: per cent late deceleration, baseline FHR, presence of FHR accelerations, duration of the latency period (time from onset of contraction to onset of deceleration), and amplitude of deceleration. The absence of accelerations (nonreactive CST) and a latency period of less than 45 seconds both predicted persistent late deceleration during labor or fetal death in utero but statistical significance was found only for the latter parameter.