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1.  5-{4′-[(5-Benzyl-2H-tetra­zol-2-yl)meth­yl]biphenyl-2-yl}-1H-tetra­zole monohydrate 
In the title compound, C22H18N8·H2O, the dihedral angle between the tetra­zole rings is 69.58 (1)° while the terminal phenyl ring makes dihedral angles of 26.98 (8) and 39.75 (8)° with the other benzene rings. The rings of the biphenyl unit subtend a dihedral angle of 55.23 (8)°. In the crystal, the solvent water mol­ecule is linked to the main mol­ecule via an N—H⋯O hydrogen bond. In addition, C—H⋯N and O—H⋯N hydrogen bonds link the components into chains along [010]. The crystal structure also features C—H⋯π and π–π inter­actions, with centroid–centroid distances of 3.6556 (9) and 3.826 (1) Å.
doi:10.1107/S1600536813009963
PMCID: PMC3648274  PMID: 23723894
2.  2-[4-(Morpholin-4-ylmeth­yl)phen­yl]benzonitrile 
In the title compound, C18H18N2O, the morpholine ring adopts a chair conformation with the exocyclic N—C bond in an equatorial orientation. The dihedral angles between the central benzene ring and the morpholine ring (all atoms) and the cyano­benzene ring are 87.87 (7) and 52.54 (7)°, respectively. No significant inter­molecular inter­actions are observed in the crystal structure.
doi:10.1107/S1600536812050957
PMCID: PMC3588350  PMID: 23476389
3.  OUTCOME OF HEMATOPOIETIC STEM CELL TRANSPLANTATION AS SALVAGE THERAPY FOR HODGKIN’S LYMPHOMA IN ADOLESENCE AND YOUNG ADULTS AT A SINGLE INSTITUTION 
Leukemia & lymphoma  2010;51(4):664-670.
For patients with relapsed Hodgkin Lymphoma, high dose chemotherapy with stem cell rescue may improve survival over chemotherapy alone. We assessed outcomes of HDCT-SCT in 37 consecutive adolescent and young adult patients with relapsed HL whose malignancy was categorized based on sensitivity to chemotherapy. We determined whether current outcomes supported the use of HDCT-SCT in all of our patients or just those patients with lower risk characteristics such as chemosensitivity. With a median follow up of 6.5 years, the 2 year overall survival was 89% (95% CI: 62%–97%) for the chemo-sensitive patients (n=21). Whereas for patients with resistant disease (n=16) OS was 53% (95%CI: 25%–74%). Both autologous and allogeneic transplants were well tolerated, with 100 day treatment related mortality under 10%. Our data show encouraging outcomes for patients with chemosensitive relapsed HL who receives HSCT and supports the value of the procedure even when the disease is chemoresistant.
doi:10.3109/10428190903580410
PMCID: PMC2932472  PMID: 20367182
Hodgkin’s Lymphoma; Stem Cell Transplant; Salvage Therapy
4.  Race and Outcomes of Autologous Hematopoietic Cell Transplantation for Multiple Myeloma 
Blacks are twice as likely to develop and die from multiple myeloma (MM) and are less likely to receive an autologous hematopoietic-cell transplant (AHCT) for MM compared to whites. The influence of race on outcomes of AHCT for MM is not well described. We compared the probability of overall survival, progression-free survival, disease progression and non-relapse mortality among black (N=303) and white (N=1892) recipients of AHCT for MM, who were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1995 to 2005. The black cohort was more likely to be female, had better Karnofsky performance scores but lower hemoglobin and albumin levels at diagnosis. Black recipients were younger and more likely to be transplanted later in their disease course. Disease stage and treatment characteristics prior to AHCT were similar between the two groups. Black and white recipients had similar probabilities of 5-year overall survival (52% vs. 47%, P=0.19) and progression-free survival (19% vs. 21%, P=0.64) as well as cumulative incidences of disease progression (72% vs. 72%, P=0.97) and non-relapse mortality (9% vs. 8%, P=0.52). In multivariate analyses, race was not associated with any of these endpoints. Black recipients of AHCT for MM have similar outcomes compared to whites, suggesting that the reasons underlying lower rates of AHCT in blacks need to be studied further to ensure equal access to effective therapy.
doi:10.1016/j.bbmt.2009.11.007
PMCID: PMC2833344  PMID: 19922808
Autologous hematopoietic cell transplantation; multiple myeloma; race; survival; progression-free survival
5.  Sinus pericranii presenting with macrocephaly and mental retardation 
We present a rare case of right parietal sinus pericranii in a 2-year-old female child who presented with a compressible swelling on the right side of the scalp since 3 months of age, with a large head. Magnetic resonance imaging along with venography and conventional angiogram was performed, which confirmed the diagnosis.
doi:10.4103/1817-1745.66665
PMCID: PMC2964807  PMID: 21042507
Digital subtraction angiography; macrocephaly; magnetic resonance imaging; sinus pericranii
6.  Sigmoid sinus thrombosis presenting with posterior alexia in a patient with Behçet's disease and polycythaemia: a case report 
Introduction
A 59-year-old Caucasian woman presented with an acute onset of alexia, noticed whilst driving. She described how while she could read car number plates, she had lost the ability to read and understand words on roadside advertisements and car window stickers.
Case presentation
Neurological examination was unremarkable apart from the inability to read full words or sentences. Imaging of the brain, initially computed tomography, followed by magnetic resonance venography, confirmed a diagnosis of sigmoid sinus thrombosis with associated venous infarction. The patient's past medical history revealed that she had suffered an ischemic stroke and following investigation for this, had undergone a nephrectomy for renal cell carcinoma. This was complicated by postoperative deep venous thrombosis. She had a persistent polycythaemia that was managed with venesection, and recently she had been diagnosed with Behçet's disease. Prior to this presentation, she had recently stopped her prophylactic antiplatelet medication as she was due to undergo a total knee replacement for osteoarthritis. She was managed with weight-adjusted, low molecular weight heparin followed by oral anticoagulation, and made a good recovery from her symptoms.
Conclusion
This case illustrates a classical neurological syndrome, highlights the importance of cerebral venous and sinus thrombosis as a cause of stroke, and the importance of remaining vigilant to a person's changing risk of venous thrombosis with evolving comorbidity.
doi:10.1186/1752-1947-2-175
PMCID: PMC2413258  PMID: 18500981
7.  Laparoscopic splenectomy using conventional instruments 
Introduction:
Laparoscopic splenectomy (LS) is an accepted procedure for elective splenectomy. Advancement in technology has extended the possibility of LS in massive splenomegaly [Choy et al., J Laparoendosc Adv Surg Tech A 14(4), 197–200 (2004)], trauma [Ren et al., Surg Endosc 15(3), 324 (2001); Mostafa et al., Surg Laparosc Endosc Percutan Tech 12(4), 283–286 (2002)], and cirrhosis with portal hypertension [Hashizume et al., Hepatogastroenterology 49(45), 847–852 (2002)]. In a developing country, these advanced gadgets may not be always available. We performed LS using conventional and reusable instruments in a public teaching the hospital without the use of the advanced technology. The technique of LS and the outcome in these patients is reported.
Materials and Methods:
Patients undergoing LS for various hematological disorders from 1998 to 2004 were included. Electrocoagulation, clips, and intracorporeal knotting were the techniques used for tackling short-gastric vessels and splenic pedicle. Specimen was delivered through a Pfannensteil incision.
Results:
A total of 26 patients underwent LS. Twenty-two (85%) of patients had spleen size more than 500 g (average weight being 942.55 g). Mean operative time was 214 min (45–390 min). The conversion rate was 11.5% (n = 3). Average duration of stay was 5.65 days (3–30 days). Accessory spleen was detected and successfully removed in two patients. One patient developed subphrenic abscess. There was no mortality. There was no recurrence of hematological disease.
Conclusion:
Laparoscopic splenectomy using conventional equipment and instruments is safe and effective. Advanced technology has a definite advantage but is not a deterrent to the practice of LS.
doi:10.4103/0972-9941.16529
PMCID: PMC3004107  PMID: 21206648
Laparoscopy; minimal access surgery; splenectomy
8.  A lung cyst following blunt chest trauma 
Postgraduate Medical Journal  2000;76(891):45-47.
doi:10.1136/pmj.76.891.45
PMCID: PMC1741465  PMID: 10622785
9.  The collar sign 
Postgraduate Medical Journal  2000;76(891):53-55.
doi:10.1136/pmj.76.891.53
PMCID: PMC1741460  PMID: 10622789
10.  Cutaneous metastases of lung cancer. 
Postgraduate Medical Journal  1995;71(842):741-743.
The reported incidence of skin metastases from lung cancer varies from 2.8-7.5%. In the present study 8.7% of patients had skin metastases, with head and neck being the most common sites, nodular lesions the most common, and adenocarcinoma the most frequent histology. Although most patients develop these lesions during the course of a known progressive disease, they may be the presenting manifestation of a primary tumour in the lung. The occurrence of skin lesions in lung cancer announces an ominous prognosis. The response to chemotherapy is poor, possibly due to poor blood supply to the skin; monitoring response to chemotherapy, however, is easier when such lesions are present.
Images
PMCID: PMC2398294  PMID: 8552539
11.  Spinal ganglioneuroblastoma--complete response to chemotherapy alone. 
Postgraduate Medical Journal  1993;69(815):746-748.
Ganglioneuroblastoma in the spinal region is rare, the treatment of choice being surgical excision. We present a 21 year old male who was diagnosed to have this condition in the dorsolumbar spinal region. The tumour was extending intraspinally and was unresectable. Combination chemotherapy with Adriamycin (doxorubicin hydrochloride), vincristine, cyclophosphamide, etoposide, ifosfamide and cisplatin resulted in histologically proven complete remission. No radiotherapy or curative resection was done. The patient is alive without evidence of disease 24 months later. Never before has chemotherapy been successfully used as the sole modality of treatment in this condition. Our report raises important questions about the management of this rare condition, particularly in a situation of unresectability.
Images
PMCID: PMC2399772  PMID: 8255850
12.  Efficacy of deferred dosing of granulocyte colony-stimulating factor in autologous hematopoietic transplantation for multiple myeloma 
Bone Marrow Transplantation  2013;49(2):219-222.
Routine administration of G-CSF following autologous hematopoietic SCT (ASCT) expedites ANC recovery and reduces hospitalization by 1–2 days; it has no impact on febrile neutropenia, infections, morbidity, mortality, event-free survival or OS. To determine whether delayed G-CSF dosage could result in equivalent ANC recovery and thereby improve cost effectiveness, we deferred the administration of G-CSF until WBC recovery had begun. A total of 117 patients with multiple myeloma received ASCT from January 2005 to September 2012. Of these, 52 were in the conventional dosing group (CGD) and received G-CSF from Day +7 for a median of five doses. In the deferred dosing group (DGD), 65 patients received G-CSF from median day 14 post transplant for a median of zero doses. There was no difference between groups in the incidence or duration of febrile neutropenia, duration of ⩾grade III mucositis, weight gain, rash, engraftment syndrome or early death (100 days). The DGD group had a significantly longer time to neutrophil engraftment than the CGD group (15 days vs 12 days; P<0.0001), a longer period of severe neutropenia (<100/μL; 8 days vs 6 days; P<0.0001), longer treatment with intravenous antibiotics (7 days vs 5 days; P=0.016) and longer hospital stay (19 days vs 17 days; P=<0.0001). Although the cost of G-CSF was lower in the DGD group (mean $308 vs $2467), the additional hospitalization raised the median total cost of ASCT in this group by 17%. There was, however, no adverse effect of deferred dosing on the rate of febrile neuropenic episodes or Day 100 survival, so that deferred dosing of G-CSF may be suitable for patients receiving ASCT as outpatients, for whom longer hospital stay would not be an offsetting cost.
doi:10.1038/bmt.2013.149
PMCID: PMC3915247  PMID: 24096822
multiple myeloma; autologous transplant; G-CSF

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