Vitamin B12-binding proteins in the serum of normal subjects and of patients with chronic myelocytic leukemia have been compared. The in-vivo-bound B12 was utilized to identify the binding protein. Column protein chromatography and block and paper electrophoresis were employed individually and in combination to characterize the B12-binding protein. B12 was found to be bound primarily to an alpha-l globulin in both normal individuals and in patients with chronic myelocytic leukemia. No qualitative difference was found in these proteins. The increased amounts of B12-binding protein in the serum of patients with chronic myelocytic leukemia would seem to be attributable to abnormal metabolism of the same protein that binds B12 in normal serum.
BackgroundThe potential of technology to aid integration of care delivery systems is being explored in a range of contexts across a variety of conditions in the United Kingdom. Prostate cancer is the most common cancer in UK men. With a 10-year survival rate of 84%, there is a need to explore innovative methods of care that are integrated between primary health care providers and specialist teams in order to address long-term consequences of the disease and its treatment as well as to provide continued monitoring for recurrence.ObjectiveOur aim was to test the feasibility of a randomized controlled trial to compare a model of prostate cancer continuing and follow-up care integration, underpinned by digital technology, with usual care in terms of clinical and cost-effectiveness, patient-reported outcomes, and experience.MethodsA first phase of the study has included development of an online adaptive prostate specific Holistic Needs Assessment system (HNA), training for primary care-based nurses, training of an IT peer supporter, and interviews with health care professionals and men with prostate cancer to explore views of their care, experience of technology, and views of the proposed intervention. In Phase 2, men in the intervention arm will complete the HNA at home to help identify and articulate concerns and share them with their health care professionals, in both primary and specialist care. Participants in the control arm will receive usual care. Outcomes including quality of life and well-being, prostate-specific concerns, and patient enablement will be measured 3 times over a 9-month period.ResultsFindings from phase 1 indicated strong support for the intervention among men, including those who had had little experience of digital technology. Men expressed a range of views on ways that the online system might be used within a clinical pathway. Health care professionals gave valuable feedback on how the output of the assessment might be presented to encourage engagement and uptake by clinical teams. Recruitment to the second phase of the study, the feasibility trial, commenced March 2017.ConclusionsTo our knowledge, this study is the first in the United Kingdom to trial an online holistic needs assessment for men with prostate cancer, with data shared between patients and primary and secondary care providers. This study addresses recommendations in recent policy documents promoting the importance of data sharing and enhanced communication between care providers as a basis for care integration. We anticipate that this model of care will ultimately provide important benefits for both patients and the National Health Service.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 31380482; http://www.isrctn.com/ISRCTN31380482 (Archived by WebCite at http://www.webcitation.org/6s8I42u5N)
Incontinentia pigmenti is a rare disease.Because it is regarded as a dermatologic problem, few cases have been reported in the pediatric literature. This case is presented to illustrate the multisystem involvement which may be seen in the infant. Report of CaseA 9-month-old white girl was admitted to Michael Reese Hospital on Feb. 28, 1957. The family history was negative, the mother had not been ill during pregnancy, and the delivery was normal. The history of illness dates from the second day of life, when a generalized vesicular eruption appeared and a diagnosis of epidermolysis bullosa was considered. She was treated with oral hydrocortisone (Cortef) and Mazon (a combination of phenolic substances and organic mercury compound) and Terra-Cortril (an ointment containing 3% oxytetracycline HCl and 1% hydrocortisone, free alcohol) ointments. She was also placed on hypoallergenic soya formula (Sobee) feedings. As the bullae disappeared, a generalized eruption was noted consisting of purpuric, urticarial, papular, and warty characteristics. The child did well until age 5 months. She gained satisfactorily in both height and weight, had good head control, and was able to sit without support.Her cutaneous lesions aroused interest, and she was presented before a meeting of the Indiana Dermatological Society. The diagnoses suggested were incontinentia pigmenti and pachyonychia congenita.* At age 5 months she developed a tem¬ perature of 105 F, a bulging fontane!, and con¬ vulsions, and she was hospitalized. Spinal fluid examination revealed pleocytosis, mostly lympho¬ cytes, an elevated protein, and normal glucose. Bacteria and fungi were not found on smear or culture. No fluid was obtained on subdural tap.At this time pox-like lesions were noted on the forehead, and smears of these revealed inclusion bodies when stained with Giemsa's reagent. A serum complement-fixation titre of 1 :64 for herpes sim¬ plex was obtained at the laboratories of the State Board of Health, Indianapolis. Treatment with chloramphenicol and penicillin was started and continued until an intermediate strength and second strength P. P. D. were found positive. At this time isoniazid (INH) and streptomycin were started and continued for three months. She was then transferred to the Indiana University Medical Center for further evaluation. The diagnosis at the time of transfer was incontinentia pigmenti and possible chronic pachymeningitis due to herpes simplex. Significant findings on this hospital admis¬ sion were streaked pigmentations located on the trunk and extremities, strabismus, nystagmus, optic atrophy, poor head control, mild opisthotonos, hyperactive tendon reflexes, a wailing cry, and a right hemiparesis. Subdural taps were performed, yielding substantial amounts of bloody fluid from the right side and clear fluid from the left, with a high lymphocyte count. Several lumbar punctures again showed pleocytosis, elevated protein, and negative culture for pyogenic and acid-fast organ¬ isms. An electroencephalogram revealed rather marked asymm...
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