Organisational design for an integrated oncological department.

OBJECTIVE: The outcomes of a Strength, Weakness, Opportunities and Threat (SWOT) analysis of three Integrated Oncological Departments were compared with their present situation three years later to define factors that can influence a successful implementation and development of an Integrated Oncological Department in- and outside (i.e. home care) the hospital. RESEARCH DESIGN: Comparative Qualitative Case Study. METHODS: Auditing based on care-as-usual norms by an external, experienced auditing committee. RESEARCH SETTING: Integrated Oncological Departments of three hospitals. RESULTS: Successful multidisciplinary care in an integrated, oncological department needs broad support inside the hospital and a well-defined organisational plan.

Spinal cord compression by extramedullary hemopoietic tissue in pyruvate-kinase-deficiency-caused hemolytic anemia.

Spinal cord compression by extramedullary hemopoietic tissue is a rare complication of hemolytic anemias. This is the first report of this complication in hemolytic anemia caused by pyruvate-kinase deficiency. Indium scan, computed tomography (CT) scan, and myelography were helpful in diagnosis. Surgery and radiotherapy were followed by complete recovery during a follow-up period of 12 months.

Chronic granulocytic leukemia in a renal transplant recipient.

Chronic granulocytic leukemia developed four years after renal transplantation in a patient, who had been treated with immunosuppressive agents since then. The low incidence of leukemia in comparison with malignant lymphoma in renal transplant recipients and some pathogenetic mechanisms are discussed.

Non-Hodgkin's lymphomata: clinical features in relation to histology.

An analysis is given of the clinico-pathological correlations of non-Hodgkin's lymphomata in 332 patients referred to the Netherlands Cancer Institute in Amsterdam and the Rotterdam Radiotherapy Institute. Clinical staging proved to be an important prognostic index. In Stage I the 5 year survival was 55%, in Stage II 25% and in Stages III and IV less than 10%. The presence of follicular structures in non-Hodgkin's lymphomata has similarly an important prognostic significance especially in Stage I and II. In lymphocytic lymphomata a larger cell size is correlated with less favourable prognosis. The presence of macrophages in non-Hodgkin's lymphomata is found in patients with short survival. The histiocytic lymphomata have a different survival pattern from the lymphocytic lymphomata in Stages I and II.

Spread according to histology in non-Hodgkin's lymphomata.

The spread of non-Hodgkin's lymphomata was investigated in a group of 323 cases. Differences were sought between 4 histological groups: lymphocytic vs histiocytic lymphomata and diffuse vs follicular types. Histiocytic and follicular types were rare in childhood. Histiocytic lymphomata, compared with lymphocytic ones, were more often confined to sites above the diaphragm. They exhibited a higher rate of loco-regional recurrences within the first 3 months and also of late recurrence after 4 years. Lymphocytic lymphomata of the follicular type more commonly presented with nodal involvement below the diaphragm as primary or secondary site than the diffuse form. Follicular types of lymphoma compared with diffuse types, occurred more frequently in women. They were more seldom seen as primary or secondary sites in extranodal localizations. They had a smaller chance of late disease recurrence and were associated with a longer survival time after first recurrence. The mediastinum often remained clinically uninvolved. With regard to this mediastinal "skip" no differences were found between the histological groups.