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After years of relatively little enforcement by the U.S. Department of Health and Human Services (HHS) and its Office for Civil Rights (OCR), 2016 was a banner year for the [...]

Surveying the range of social media and other 'new and improved' ways to engage patients and consumers, it is easy to forget how new these technologies and communication avenues are. [...]

CASE REPORT A 41-year-old man was initially evaluated 6 years previously by his family physician, found to be hypertensive, and managed with pharmacologic agents. Over the next several years, control [...]

Background. Chronic lymphocytic leukemia (CLL) may evolve into large cell lymphoma (Richter's syndrome), prolymphocytic leukemia, acute lymphoblastic leukemia, and myeloma. Methods. A patient with CLL that transformed into a lymphoma of true histiocytic type is described, and the literature on the association of these two disorders is reviewed. Results. Lymphomas of true histiocytic type developing as an aggressive terminal phase of CLL previously have been reported in nine patients. Fever and rapidly increasing lymphadenopathy and splenomegaly were the most common signs and symptoms. As with de novo lymphoma of true histiocytic type, extranodal involvement of the soft tissue, gastrointestinal tract, kidneys, bone marrow, liver, and lungs was documented among the 10 patients with lymphoma of true histiocytic type transformed from CLL. The median interval between diagnosis of CLL and the evolution to lymphoma of true histiocytic type was 25.5 months. Patients with lymphomas of true histiocytic type after CLL were treated with fludarabine and various other combination chemotherapy regimens with only short-lived responses. The median time to death after transformation was only 33 days (range, 10 days to 5 months). Conclusion. Lymphomas of true histiocytic type appear to represent an additional, though uncommon, form of transformation in CLL. Although their presentation is reminiscent of other intermediate to high grade lymphomas, they can be distinguished based on their morphologic and immunophenotypic features. In the patients described in this study to date, transformation of CLL to lymphomas of true histiocytic type is a poor prognostic sign, with survival generally of only days to weeks. Cancer 1995; 76:609-17. Key words: leukemia, lymphocytic, chronic, lymphoma, histiocytic, histiocytosis malignant, transformation, histiocyte, chromosomal aberration.

Background. Follicular lymphoma is a clearly defined type of malignant lymphoma. The many treatment approaches reported in the literature attest to the lack of agreement on its best management. The treatment experiences of patients with Stage I or II follicular lymphoma who were at risk for at least 5 years were reviewed to assess their survival, disease free survival, and patterns of failure. Methods. Between 1974 and 1988, 144 patients with Stage I or II follicular lymphoma were treated at The University of Texas M. D. Anderson Cancer Center. Initial staging studies included lymphangiography in 87% of the patients, computerized tomography of the abdomen and pelvis in 60%, bone marrow biopsy in 98%, and diagnostic or staging laparotomy in 33%. Forty-five patients were treated with regional radiotherapy, 84 patients with combined chemotherapy and radiotherapy, and 15 patients were treated with chemotherapy alone. Results. With a median follow-up of 8.7 years (range, 48-182 months) the actuarial survival rates at 5, 10, and 15 years were 81, 69, and 63%, respectively. The freedom from relapse (FFR) rates were 66, 56, and 46%, respectively. The FFR rate was better for patients treated with chemotherapy-radiotherapy than for patients treated with radiotherapy alone (63 vs. 35% at 15 years). In addition, there were no relapses after 7.5 years in patients treated with chemotherapy-radiotherapy, but relapses continued even beyond 15 years in patients treated with radiotherapy alone. Univariate analysis for each of the treatment groups revealed age to be the only significant prognostic factor. There was no significant difference in survival or disease free survival rates for the three histologic subtypes of follicular lymphoma. Conclusion. The addition of chemotherapy to radiotherapy may have increased the probability of cure for patients with Stages I or II follicular lymphoma. Cancer 1995; 75:2361-7.

On March 13, 2012, the Office for Civil Rights (OCR) carried out its first enforcement action resulting from a breach report required by the Health Information Technology for Economic and [...]

Background. Numerous treatment strategies have been tried with the aim of improving results for patients with intermediate-grade lymphomas (IGL) over those achieved with cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin (CHOP-BLEO), and numerous prognostic models have been developed to identify and separate risk groups. This study reports on a new protocol for Ann Arbor Stages II-IV IGL that consists of CHOP-Bleo alternated with a new regimen of cyclophosphamide, methotrexate, etoposide, and dexamethasone (CMED) and radiation therapy and demonstrates the usefulness of prognostic models for identifying risk groups and comparing treatment programs. Methods. One hundred seventy patients with Ann Arbor Stages II-IV IGL were treated with alternating cycles of CHOP-Bleo and CMED for a total of 12 cycles. Involved field radiation therapy was interspersed with courses of chemotherapy for patients with Stage 11 and Stage III disease. Results were analyzed and compared with those of the authors' previous study of CHOP-Bleo and radiation therapy using the Ann Arbor staging system, their earlier prognostic model, and the recently published International Index. Results. A complete remission occurred in 78% of the patients. The overall 5-year survival rate was 67%. Survival was better for patients with Ann Arbor Stage II disease (80%) than for those with Stage III or Stage IV (67% and 58%, respectively). High tumor burden, above-normal levels of serum lactic dehydrogenase, serum [beta]2-microglobulin, and Ann Arbor Stage IV disease were adverse factors. The International Index and the authors' earlier prognostic model separated four prognostic groups. CHOP-Bleo/CMED was generally well tolerated. Neutropenic fever was the major complication that occurred in 25 patients during treatment. Six of these patients died of sepsis. Conclusions. This study demonstrated that CHOP-Bleo/CMED is a well-tolerated regimen that produced better results than those reported for a former study that used CHOP-Bleo alone. Further, results for CHOP-Bleo/ CMED compared favorably with those of other second- and third-generation regimens. The study also validated the usefulness of prognostic models and, in particular, the new International Index for identifying risk groups. Cancer 1994; 73:2408-16.

Study objective: There is considerable uncertainty about the clinical features, respiratory physiology, and optimal management of patients with asthma requiring mechanical ventilation. Furthermore, the ventilatory and pharmacologic management of asthma [...]

Beta-2 microglobulin (B-2M) is a protein that is found on the surface of most cells in the body. Levels of B-2M can be measured in the blood, and have been found to be increased in patients with many cancers. High levels of B-2M have been associated with poor survival rates in multiple myeloma, a cancer of the bone marrow, and in very aggressive lymphomas. A group of 80 patients with low-grade lymphoma were studied to determine if levels of B-2M were also related to their prognosis. High levels of B-2M were found in patients who experienced the greatest number of treatment failures and who had the shortest time to relapse. Blood levels of the enzyme lactic dehydrogenase (LDH) have previously been shown to correlate to severity of disease in lymphoma; this study found that LDH levels corresponded to B-2M levels. Determining levels of B-2M and LDH in low-grade lymphoma patients should prove to be predictive of response to treatment and time to treatment failure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diffuse large cell lymphoma (DLCL) is a cancer of the lymphatic system. The burden or size of the tumor in DLCL influences survival from this disease. Among 147 patients with early DLCL, treated between 1974 and 1984, 10-year survival was 54 percent for 85 patients with 'bulky' disease or a large tumor burden, and 76 percent for 62 patients without bulky disease. Fourteen of the patients without bulky disease had greater than 80 percent of their tumor removed by surgery in a procedure referred to as surgical debulking. The surgically treated patients without a large tumor burden were compared with 14 patients with bulky disease, who had similar physical and disease characteristics. Patients in both groups received the anticancer agents cyclophosphamide, doxorubicin, vincristine, prednisone, and bleomycin, as well as radiation treatment. At 7-year follow-up, the survival rate was 93 percent in the patients who underwent surgical debulking, and 35 percent among the patients with bulky disease who did not have surgery. Surgical debulking was also associated with a decrease in levels of the enzyme lactate dehydrogenase, which indicated a better prognosis. These findings suggest that surgical debulking is effective in improving DLCL survival in patients without bulky disease. The role of surgical debulking in treatment of bulky DLCL requires further investigation; the frequency and safety of this procedure must be explored. (Consumer Summary produced by Reliance Medical Information, Inc.)

I was in Hawaii giving a speech for the leadership of Washington Mutual Bank. As is usual in my case, after the speech I went to the fitness center for […]

Broadband is the currency in today's commercial real estate market, just as electricity and telephone service were in the past. Tenants rely on it. Reliable broadband connectivity has become the [...]

How fitness professionals can increase retention and attract new clients by fusing fitness and fun. 'You have to stay in shape. My mother started walking five miles a day when [...]

Background: Gastric lymphoma of mucosa-associated lymphoid tissue (MALT) is related to Helicobacter pylori infection and may depend on this infection for growth. Objective: To determine the response of gastric MALT lymphoma to antibiotic treatment. Design: Prospective, uncontrolled treatment trial. Setting: University hospital referral center and three collaborating university and community hospitals. Patients: 34 patients with stage I or stage II N1 gastric MALT lymphoma. Intervention: Two of three oral antibiotic regimens--1) amoxicillin, 750 mg three times daily, and clarithromycin, 500 mg three times daily; 2) tetracycline, 500 mg four times daily, and clarithromycin, 500 mg three times daily; or 3) tetracycline, 500 mg four times daily, and metronidazole, 500 mg three times daily--were administered sequentially (usually in the order written) for 21 days at baseline and at 8 weeks, along with a proton-pump inhibitor (lansoprazole or omeprazole) and bismuth subsalicylate. Measurements: Complete remission was defined as the absence of histopathologic evidence of lymphoma on endoscopic biopsy. Partial remission was defined as a reduction in endoscopic tumor stage or 50% reduction in the size of large tumors. Results: 34 patients were followed for a mean ([+ or -] SD) of 41 [+ or -] 16 months (range, 18 to 70 months) after antibiotic treatment. Of 28 H. pylori-positive patients, 14 (50% [95% CI, 31% to 69%]) achieved complete remission, 8 (29%) achieved partial remission (treatment eventually failed in 4 of the 8), and 10 (36% [CI, 19% to 56%]) did not respond to treatment. Treatment failed in all 6 (100% [CI, 54% to 100%]) H. pylori-negative patients. Patients with endoscopic appearance of gastritis (stage I T1 disease) were most likely to achieve complete remission within 18 months. Tumors in the distal stomach were associated with more favorable response than tumors in the proximal stomach. Conclusions: A subset of H. pylori-positive gastric MALT lymphomas, including infiltrative tumors, may respond to antibiotics. The likelihood of early complete remission seems to be greatest for superficial and distal tumors. Ann Intern Med. 1999;131:88-95., Stomach cancer of the mucosa-associated lymphoid tissue (MALT) is related to Helicobacter pylori infection, depends on it for growth, and seems to respond well to antibiotics, including complete remission in some cases. Of 24 H. pylori positive patients with gastric MALT lymphoma, treated with antibioitics and followed up for a period of between 18 and 70 months, 14 (50%) had complete remission, eight (29%) had partial remission (with eventual failure in four of the eight), and 10 had no response to treatment. (Changing classifications accounts for percentage over 100%) Treatment was not effective in patients without H. pylori.

'I love my job except for 2 times a year when I have to review my eight direct reports.' Do these words sound familiar? If you are like most managers, [...]

PURPOSE: Lymphoma cells usually show cytogenetic abnormalities, but their relationship to prognosis has not been as extensively studied as in leukemia. A group of previously untreated cases of lymphoma with evaluable metaphases was examined for the association between cytogenetic abnormalities and clinical outcome. PATIENTS AND METHODS: The study consisted of 104 patients, from whom fresh tumor samples were obtained for cytogenetic tests. Because of the complexity of lymphoma karyotypes, the cases were divided into four patterns according to the type of abnormality of chromosome 17 or 7 present. Treatment of patients was given based on histologic grade and stage of disease. Response to treatment was evaluated according to previously described methods. RESULTS: Patients with true abnormalities of chromosome 17 or 7 (defined as those with either structural abnormalities of the short arm of these chromosomes or monosomy of these chromosomes with no associated unidentified markers) were observed to have an adverse prognosis. The overall response rate and tumor-related mortality were less favorable for patients with these cytogenetic abnormalities. By applying multivariate analysis, we found that this observation was independent of the effect of serum lactic dehydrogenase level, histologic grade, or tumor burden. CONCLUSION: True abnormalities of chromosome 17 or 7 in patients with lymphoma are associated with a poor response to chemotherapy, short time to treatment failure, and high tumor-related mortality rate. These findings raise the question of the potential involvement of some gene or oncogene, perhaps the p53 oncogene, which might impart a survival advantage to the malignant cells.

After months of long hours, voluminous memos, endless meetings and last-minute glitches, your company's new software application is ready to go. A virtual switch is thrown, and hundreds of workstations [...]

After months of long hours, voluminous memos, endless meetings and last-minute glitches, your company's new software application is ready to go. A virtual switch is thrown, and hundreds of workstations [...]

It is believed that the U.S. Supreme Court's recent decision in the case 'City of Ontario v. Quon' provides guidance on how chief information officers (CIOs) must approach data privacy when managing company-provided mobile devices. The case emerged because of the monitoring of employee communications by the Ontario, California police department.