- Email: [email protected]
Cuff size and blood pressure
887
anhepatic,
and
post-anhepatic stages. Moreover,
if there is poor
initial graft function, there is often a pronounced increase in blood loss in the post-anhepatic stage. Following reperfusion, in the patients treated with aprotinin the operated area was remarkably dry and haemostasis where needed was rapidly and easily achieved, resulting in reduced operation time. Our findings have implications for the costs of liver transplantation, but more importantly for patient outcome.
Liver Transplantation Unit,
Royal Free Hospital and School of Medicine, London NW3 2QG, UK
S. V. MALLETT D. COX A. K. BURROUGHS K. ROLLES
1. Porte RJ, Bontempo FA, Knott EAR, et al. Tissue type plasminogen activator associated fibrinolysis in orthotopic liver transplantation. Trans Proc 1985; 21: 3542 2. Neuhaus P, Bechstein WO, Lefebre B, et al. Effect of aprotinin on intraoperative bleeding and fibrinolysis in liver transplantation. Lancet 1989; ii: 924-25. 3. Hunt BJ, Cottam S, Segal H, et al. Inhibition by aprotinin of tPA-mediated fibrinolysis during orthotopic liver transplantation. Lancet 1990; 335: 381.
this protocol. Adjuvant radiotherapy has been discontinued by the UKCCSG on the basis of this randomised clinical trial which indicated that it provided no advantage over chemotherapy alone.2 No genetic conditions predisposing to leukaemia were diagnosed in these six patients. Pui et al conclude that the absolute risks of acute myeloid leukaemia were low after solid tumours of childhood. In Britain this conclusion should be modified: while the absolute risk is low after solid tumours other than NHL, among patients treated for NHL during the early 1980s the risk was somewhat high. Childhood Cancer Research Group,
University of Oxford, 57 Woodstock Road, Oxford OX2 6HE, UK 1. Hawkins MM. Second 2.
3.
M. M. HAWKINS cancer
in relation to treatment for childhood cancer in Britain
(abstract). J Cancer Res Oncol 1990; 116 (suppl): 982. Mott MG, Eden OB, Palmer MK. Adjuvant low dose radiation in childhood non-Hodgkin’s lymphoma. BrJ Cancer 1984; 50: 463-69. Ingram L, Mott MG, Mann JR, et al. Second malignancies in children treated for non-Hodgkin’s lymphoma and T-cell leukaemia with the UKCCSG regimens. Br J Cancer 1987; 55: 463-66.
Cuff size and blood pressure SiR,—Your editorial on the effect of cuff size on blood pressure readings (Aug 18, p 410) states that most sphygmomanometers are provided with the standard cuff, which gives higher readings than those obtained with the larger cuff. The large cuff is recommended because this would avoid treatment for many, supposedly normotensive, subjects. You fail to recognise that the standard cuff used to obtain most of the data that determine blood pressure levels for which treatment is indicated. If the larger cuff is used for screening, the criteria defming hypertension should be lowered by the differences in readings due to cuff size. If this is not done, those who warrant treatment based on epidemiological data obtained with the standard cuff will be falsely identified as normotensive and will not get that treatment.
was
4077 Olive Hill Drive, Claremont, California 91711, USA
SYLVAN GOLLIN
Risks of myeloid leukaemia in children treated for solid tumours SIR,-Professor Pui and colleauges (Aug 18, p 417) report the risks myeloid neoplasia (acute myeloid leukaemia [AML] or myelodysplastic syndrome) after treatment for solid tumours in of
childhood. I have reported the risks of second primary leukaemia within a cohort of children (aged under 15 years) diagnosed with cancer in Britain between 1962 and 1983 and surviving at least 1 year.! The number surviving 1 year (and the number of AMLs) after each type of solid tumour were: Hodgkin’s disease 1046
Flow cytometry for measurement of antibodies to spermatozoa in subfertile men SIR,-Prednisolone treatment has been shown to result in a decrease in seminal antibody titres and improved fertility.! However, unreliable tray agglutination and mixed antiglobulin tests were used to measure the antibodies. We suggest the use of flow cytometry to monitor the density of antibody bound on spermatozoa while evaluating patients on steroid treatment. The method can be used to monitor such antibody levels in individuals, or to compare different samples under various flow cytometer laser power/photo multiplier tube voltage settings. To estimate the density of spermatozoan antibody binding, spermatozoa from subfertile patients were labelled with propidium iodide (PI) and fluoresceinisothiocyanate (FITC) conjugated F(ab’), IgG or IgA antibodies. On dual colour analysis the percentage of antibodypositive live cells were noted together with their mean channel numbers. From the mean channel numbers the fluorescein equivalents per cell were read off a standard curve (figure). The average number of antibody molecules per spermatozoa is obtained by division of the number of fluorescein equivalents by the fluorescence/protein ratio (provided by the manufacturer) of the FITC-antibody conjugate. This gives the density of antibody binding on spermatozoa. We have used this method on 6 spermatozoa-antibody-positive patients, in 1 of whom the complete disappearance of IgG
(3), non-Hodgkin lymphoma (NHL) 699 (6), astrocytoma/ medulloblastoma 2258 (5), neuroblastoma 712 (1), and other solid tumours 7036 (0). The Kaplan-Meier cumulative risks of AML during 10 years’ follow-up after surviving 1 year were 0-4% (SE 0-2%) for Hodgkin’s disease, 1-4% (0-5%) for NHL, and 0-3% (01%) for astrocytoma/medulloblastoma. The average follow-up beyond 1-year survival was 7-7 years. The absolute risks estimated from these data are similar to those
reported by Pui et al, although the risk after Hodgkin’s disease may be smaller in the present study; however, myelodysplastic syndrome was not included. The largest cumulative risk of AML was seen after NHL; most patients were treated with
chemotherapy, with or without radiotherapy. The cumulative risks of AML at 5 years from 1-year survival after chemotherapy for NHL in the 1960s, 1970s, and 1980s were 0%, 0-7%, and 5-6%, respectively (test for trend p 0-0068). Among those treated in the 1980s with chemotherapy alone, or with chemotherapy and radiotherapy, the cumulative risks at 5 years from 1-year survival were 2-5% and 82%, respectively. All six patients in whom AML developed were entered into a UK Children’s Cancer Study group (UKCCSG) clinical trial,z and Ingram and co-workers3 have reported the high risk of AML among patients treated according to =
-j
Mean fluorescence channel number Comparison of fluorescence intensity between samples. ’Immuno-Brite’ (Coulter) beads with 31 000 (I), 115 000 (II), 460 000 (III), and 1155 000 (IV) fluorescein equivalents per bead were run on an ’FACS-Star’flow cytometer with low (A) and high (B) photo multiplier tube voltages Mean channel numbers for any bead (I-IV) differ in curves A and B, but log fluorescein equivalents are the same
anhepatic,
and
post-anhepatic stages. Moreover,
if there is poor
initial graft function, there is often a pronounced increase in blood loss in the post-anhepatic stage. Following reperfusion, in the patients treated with aprotinin the operated area was remarkably dry and haemostasis where needed was rapidly and easily achieved, resulting in reduced operation time. Our findings have implications for the costs of liver transplantation, but more importantly for patient outcome.
Liver Transplantation Unit,
Royal Free Hospital and School of Medicine, London NW3 2QG, UK
S. V. MALLETT D. COX A. K. BURROUGHS K. ROLLES
1. Porte RJ, Bontempo FA, Knott EAR, et al. Tissue type plasminogen activator associated fibrinolysis in orthotopic liver transplantation. Trans Proc 1985; 21: 3542 2. Neuhaus P, Bechstein WO, Lefebre B, et al. Effect of aprotinin on intraoperative bleeding and fibrinolysis in liver transplantation. Lancet 1989; ii: 924-25. 3. Hunt BJ, Cottam S, Segal H, et al. Inhibition by aprotinin of tPA-mediated fibrinolysis during orthotopic liver transplantation. Lancet 1990; 335: 381.
this protocol. Adjuvant radiotherapy has been discontinued by the UKCCSG on the basis of this randomised clinical trial which indicated that it provided no advantage over chemotherapy alone.2 No genetic conditions predisposing to leukaemia were diagnosed in these six patients. Pui et al conclude that the absolute risks of acute myeloid leukaemia were low after solid tumours of childhood. In Britain this conclusion should be modified: while the absolute risk is low after solid tumours other than NHL, among patients treated for NHL during the early 1980s the risk was somewhat high. Childhood Cancer Research Group,
University of Oxford, 57 Woodstock Road, Oxford OX2 6HE, UK 1. Hawkins MM. Second 2.
3.
M. M. HAWKINS cancer
in relation to treatment for childhood cancer in Britain
(abstract). J Cancer Res Oncol 1990; 116 (suppl): 982. Mott MG, Eden OB, Palmer MK. Adjuvant low dose radiation in childhood non-Hodgkin’s lymphoma. BrJ Cancer 1984; 50: 463-69. Ingram L, Mott MG, Mann JR, et al. Second malignancies in children treated for non-Hodgkin’s lymphoma and T-cell leukaemia with the UKCCSG regimens. Br J Cancer 1987; 55: 463-66.
Cuff size and blood pressure SiR,—Your editorial on the effect of cuff size on blood pressure readings (Aug 18, p 410) states that most sphygmomanometers are provided with the standard cuff, which gives higher readings than those obtained with the larger cuff. The large cuff is recommended because this would avoid treatment for many, supposedly normotensive, subjects. You fail to recognise that the standard cuff used to obtain most of the data that determine blood pressure levels for which treatment is indicated. If the larger cuff is used for screening, the criteria defming hypertension should be lowered by the differences in readings due to cuff size. If this is not done, those who warrant treatment based on epidemiological data obtained with the standard cuff will be falsely identified as normotensive and will not get that treatment.
was
4077 Olive Hill Drive, Claremont, California 91711, USA
SYLVAN GOLLIN
Risks of myeloid leukaemia in children treated for solid tumours SIR,-Professor Pui and colleauges (Aug 18, p 417) report the risks myeloid neoplasia (acute myeloid leukaemia [AML] or myelodysplastic syndrome) after treatment for solid tumours in of
childhood. I have reported the risks of second primary leukaemia within a cohort of children (aged under 15 years) diagnosed with cancer in Britain between 1962 and 1983 and surviving at least 1 year.! The number surviving 1 year (and the number of AMLs) after each type of solid tumour were: Hodgkin’s disease 1046
Flow cytometry for measurement of antibodies to spermatozoa in subfertile men SIR,-Prednisolone treatment has been shown to result in a decrease in seminal antibody titres and improved fertility.! However, unreliable tray agglutination and mixed antiglobulin tests were used to measure the antibodies. We suggest the use of flow cytometry to monitor the density of antibody bound on spermatozoa while evaluating patients on steroid treatment. The method can be used to monitor such antibody levels in individuals, or to compare different samples under various flow cytometer laser power/photo multiplier tube voltage settings. To estimate the density of spermatozoan antibody binding, spermatozoa from subfertile patients were labelled with propidium iodide (PI) and fluoresceinisothiocyanate (FITC) conjugated F(ab’), IgG or IgA antibodies. On dual colour analysis the percentage of antibodypositive live cells were noted together with their mean channel numbers. From the mean channel numbers the fluorescein equivalents per cell were read off a standard curve (figure). The average number of antibody molecules per spermatozoa is obtained by division of the number of fluorescein equivalents by the fluorescence/protein ratio (provided by the manufacturer) of the FITC-antibody conjugate. This gives the density of antibody binding on spermatozoa. We have used this method on 6 spermatozoa-antibody-positive patients, in 1 of whom the complete disappearance of IgG
(3), non-Hodgkin lymphoma (NHL) 699 (6), astrocytoma/ medulloblastoma 2258 (5), neuroblastoma 712 (1), and other solid tumours 7036 (0). The Kaplan-Meier cumulative risks of AML during 10 years’ follow-up after surviving 1 year were 0-4% (SE 0-2%) for Hodgkin’s disease, 1-4% (0-5%) for NHL, and 0-3% (01%) for astrocytoma/medulloblastoma. The average follow-up beyond 1-year survival was 7-7 years. The absolute risks estimated from these data are similar to those
reported by Pui et al, although the risk after Hodgkin’s disease may be smaller in the present study; however, myelodysplastic syndrome was not included. The largest cumulative risk of AML was seen after NHL; most patients were treated with
chemotherapy, with or without radiotherapy. The cumulative risks of AML at 5 years from 1-year survival after chemotherapy for NHL in the 1960s, 1970s, and 1980s were 0%, 0-7%, and 5-6%, respectively (test for trend p 0-0068). Among those treated in the 1980s with chemotherapy alone, or with chemotherapy and radiotherapy, the cumulative risks at 5 years from 1-year survival were 2-5% and 82%, respectively. All six patients in whom AML developed were entered into a UK Children’s Cancer Study group (UKCCSG) clinical trial,z and Ingram and co-workers3 have reported the high risk of AML among patients treated according to =
-j
Mean fluorescence channel number Comparison of fluorescence intensity between samples. ’Immuno-Brite’ (Coulter) beads with 31 000 (I), 115 000 (II), 460 000 (III), and 1155 000 (IV) fluorescein equivalents per bead were run on an ’FACS-Star’flow cytometer with low (A) and high (B) photo multiplier tube voltages Mean channel numbers for any bead (I-IV) differ in curves A and B, but log fluorescein equivalents are the same