leukaemia

What is leukaemia?

Leukaemia is a cancer of the tissues which produce blood. In a leukaemic child, large numbers of abnormal white cells are produced, which are unable to carry out their normal function of fighting infection. In addition, these abnormal cells displace the normal production of red cells and platelets, which are vital in supplying oxygen and stopping bleeding respectively.

If leukaemia is not effectively treated, the child will ultimately die. 

Treatments vary from child to child, but unfortunately tend to be unpleasant, and put a child's body under enormous strain. Treatments that depress the immune system leave the body unguarded against illness, and even common infections can be extremely dangerous. 

Happily, most children respond well to drug treatments which "kick-start" the body into producing new, healthy, white blood cells. However, a minority of children will require further help in the form of a Stem Cell Transplant, usually from the bone marrow of a healthy person. This is a difficult procedure and requires the best possible cell match between the leukaemic child and a donor.

Is leukaemia hereditary or can you catch it?

No.

Can leukaemia be prevented? 

At this point in time, unfortunately not. Leukaemia is a very complex disease - its precise causes cannot be pinpointed and will be different for each child. 

What are the chances of survival? 

With modern-day diagnosis and treatment, about 70% of children diagnosed will survive leukaemia in childhood. But that still means for 30% the news is very bad, and currently over 100 children in each year will die a tragic death. Our goal is to get to the point where leukaemia can be prevented, or can always be successfully treated. 

What is CHILDREN with LEUKAEMIA doing about this? 

With the help of people from all walks of life, we raise £ millions each year to fund vital research undertaken by scientists and doctors in specialist centres throughout the country. 

Our research centres include; Paul O'Gorman Centres in Great Ormond Street Hospital for Children, London; The University of Newcastle; Christie's Hospital Manchester and The University of Bristol. 

In addition, the charity provides equipment, facilities and training in order to provide the highest standards of treatment and care for children with leukaemia. 

Help is also given to the UK Coordinating Committee for Cancer research with funding for the most comprehensive childhood cancer study ever undertaken. 

To continue battling against leukaemia, the charity depends entirely on the generosity of the general public. 


What can the general public do?
LRF Annual Conference
University of Keele, Staffs 
20th April 2002 10am-4.30pm 

Immunotherapy: Hype of Hope?

Three years ago the title of our International Research Symposium was Immunotherapy : Hype or Hope. We have unashamedly taken the same title for this year’s LRF Conference at the University of Keele on Saturday, 20th April. 


The challenge for the next decade is to devise new approaches to cancer therapy that do not rely on the “blunderbus” approach of giving patients toxic anti-cancer drugs which indiscriminately kill both healthy and diseased cells. Whilst cure can be achieved by this approach it is at a cost of nasty side effects and there remains an element of chance in the outcome. 

The possibility of harnessing the immune system of both patients and healthy donors to selectively and efficiently attack malignant blood cells is one alternative approach which is now being actively studied worldwide. 

This is not a new concept. In the 1970's there was great excitement that cancer cells could be destroyed by immunological attack but the lack of understanding of how the immune system worked frustrated attempts to turn this into clinical benefit. Thirty years on and our immunological knowledge has progressed sufficiently to justify renewed interest in using Immunotherapy to treat leukaemia, lymphoma and myeloma. 

The speakers at this year’s Conference will explain how the challenge to use the immune system as a therapeutic weapon is being developed. 

Dr Mark Lowdell from the Royal Free Hospital, London is an expert immunologist with a specific interest in how to direct the immune cells in bone marrow transplants to attack and kill leukaemia cells in patients. This will enhance the potential of transplants to not only restore a healthy immune system in patients but also to completely eradicate the leukaemia. Dr Lowdell will explain how the immune system works and how this knowledge is being applied to leukaemia treatment. 

Dr Marc Turner is a Senior Clinical Lecturer at the Western General Hospital, Edinburgh and director of the Scottish Blood Transfusion Service Cell Therapeutics Group. As well as his research interest in finding new ways to make leukaemia cells susceptible to killing by immune cells Dr Turner is also looking at the practical problems that must be overcome before immuno-based therapies can be introduced into the clinic. Dr Turner will discuss how products of the immune system will be prepared for clinical use. 

Dr Steve Mackinnon is a Senior Clinical Lecturer at University College, London. Dr Mackinnon developed his interest in exploiting immunotherapy at the Memorial Sloan Kettering Cancer Center, New York. He is particularly interested in using the immune system of healthy donors to prepare primed immune cells which will kill the cytomegalovirus in patients undergoing a stem cell transplant. CMV infection is a life threatening problem in transplant patients and its control is a high priority to ensure the success of a transplant. Work on this problem will also help similar approaches to using donor cells to attack targets on cancerous blood cells. 

Regular delegates to our Conference know that our speakers treat us to presentations of an exceptionally high standard and always strive to describe their research in wonderfully clear and entertaining ways. We anticipate the same high standard this year. I do hope you will make a date in your diary to join us in Keele on the 20th April. I can promise you a very informative and enjoyable day. See you there! 

Want to join us? More details info@lrf.org.uk 


2001 - Knowledge is power
2000 - The Here & Now 
1999 - Adding Value to MRC Childhood Leukaemia Trials
1998 - From DNA to Treatment 

Annual Conference April 2001, University of Sheffield: Knowledge is power: how research can progress treatment
This year's annual conference considered how research and clinical trials have generated information that can be applied to new therapeutic options for treating leukaemia and lymphoma.

Professor Alan Burnett from the University of Wales described how research allied to clinical trials has guided new treatments for acute myeloid leukaemia (AML). He said scientists had identified a number of features of the leukaemia cells - such as chromosome changes - to help predict how patients will respond to treatment. In a Leukaemia Research Fund (LRF) supported study, he is also looking at whether current treatment can be improved by adding chemotherapy attached to an antibody. 


Dr Tessa Holyoake from the University of Glasgow discussed treatments for patients with chronic myeloid leukaemia (CML). Research has found that 'dormant' stem cells are present in CML patients. There is concern that these cells may be resistant to treatments and cause patients to relapse. Using novel techniques, scientists are now able to identify these dormant or quiescent cells and determine their sensitivity to new drugs. 

Professor Gareth Morgan, Head of Academic Haematology at the University of Leeds and Director of the LRF Molecular Epidemiology programme, discussed the genetics of leukaemia and lymphoma and how they relate to causative factors for the diseases. 




Annual Conference April 2000, UMIST, Manchester:
The Here and Now.

One of LRF’s priorities is to ensure that the transfer of discoveries made in the laboratory into new treatments is as fast and effective as possible. The theme for this first conference in the new millennium will focus on three examples of current research that truly integrate studies in the laboratory with parallel clinical studies. 

Professor David Mason will describe the work of the LRF Immunodiagnostics Unit in Oxford and demonstrate how the specific identification of leukaemia and lymphoma cells is achieved and applied to clinical diagnosis. He will also describe how the pathology laboratory of the future will be part of an international network using information technology to ensure uniform of disease sub types worldwide.

LRF Clinical Senior Lecturer Dr Andy Haynes, from the University of Nottingham, will discuss the latest development in a new approach to stem cell transplant called ‘mini-transplants’. Mini means ‘minimal intensification’ and is the result of research discoveries about the immunological basis of stem cell transplants, in particular the subtle balance between the eradication of residual leukaemia cells in patients and the avoidance of severe graft-versus-host-disease. 

Professor Freda Stevenson from Southampton General Hospital will explain how patients can be vaccinated against their own leukaemia and lymphoma cells. The development and application of DNA vaccines, as they are called, to treat cancers of the blood is rightly attracting much scientific and public interest.

Annual Conference April 1999, University of Leeds:
Adding value to MRC Childhood Leukaemia Trials
This conference considered LRF’s role in supporting laboratory studies as in integral part of national clinical trials for treating children with leukaemia.

The Medical Research Council (MRC) organised the first childhood leukaemia trial in 1963. At this stage the 5-year survival for children treated for leukaemia was no better than 10%.As successive trials gained in importance the LRF Clinical Training Fellowships were introduced to allow promising paediatric haematologists to fill a crucial role as trial coordinators. 

By 1990 5-year survival had increased to 70% mainly as a result of gradually refining the use of cocktails of anti-cancer drugs and radiotherapy. The success of the MRC trials was tempered by recognition that the scientific basis of therapies was poorly understood. As a consequence, the response of each child to the same cocktail of drugs was unpredictable. Furthermore, the non-selective use of toxic chemicals that killed both leukaemia and healthy blood cells had unpleasant side effects and possible long term risks to health. 

The inclusion of up to 2,000 children in a leukaemia trial provides a huge resource of blood and bone marrow samples for laboratory based studies. In the past ten years the LRF has become increasingly involved in the support of long-term studies to address important scientific questions which can add considerable value to the clinical information generated from a trial.

Dr Christine Harrison described the role of the LRF Cytogenetics Database at the Royal Free Hospital, London in characterising the genetic abnormalities which are found in the blood cells of children with acute leukaemia. These abnormalities are being matched to the outcome of a trial so that we can identify features common to children who either respond very well to treatment or relapse. 

Dr Colin Steward of the LRF Minimal Residual Disease Programme in Bristol, described how he is using sophisticated molecular biology to detect any leukaemia cells that may remain in the blood after treatment. The LRF is developing highly sensitive tests which can detect as little as one leukaemia cell in 100,000 normal blood cells. This may be enough to cause the disease to reoccur. We must detect such small numbers of cells in order to continue or be modified therapy until they no longer pose a threat.

Dr Andy Hall at the LRF Molecular Pharmacology Programme, Newcastle explained how he is studying the genetic basis for drug resistance in children. A clear understanding of how each child’s genetic make-up determines how well they respond to particular anti-cancer drugs should allow the individualisation of treatment to reduce toxic side effects while ensuring a cure. 

Annual Conference April 1998, University of Keele: 
From DNA to Treatment
We focused on the development of new treatments which target the underlying genetic abnormalities in leukaemia came under focus. As our understanding of the lesions in the genetic structure of chromosomes in leukaemia cells increases, so our ability to intervene to block the unwanted effects on cell behaviour becomes more feasible.

The use of ‘antisense’ molecules which selectively target sequences of abnormal DNA to prevent them acting has attracted a lot of attention from pharmaceutical companies as a new approach to cancer therapy. LRF researchers showed how bone marrow from patients with chronic myeloid leukaemia may be purged of diseased cells prior to transplant. 

Another approach is to genetically manipulate leukaemia cells so that a patient’s own immune system can recognise the cells as ‘foreign’ and kill them. 

A third approach is to discover how the genetic profile of donor and patient cells can be used to prevent graft-versus-host-disease after transplantation. The genetic approach to therapy is increasingly important and will soon deliver new treatments for leukaemia and the related cancers of the blood. 

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© Leukaemia Research Fund 2000

  Drug Dependency and Addiction:

Contact DoctorInternet for help in this line

Many people are completely confused by the terms "addiction", and "dependency". When a person must increase the dose of a medication for a prolonged period, physical dependency can result. Dependency means that if the drug is stopped, certain symptoms such as sweating, vomiting, or tremors might result, before recovery. It's only in addiction, that dependency becomes a permanent condition.

Why?

People usually start to take drugs for one of two reasons. A doctor may prescribe them the drugs to relieve mental or physical distress, or they may simply be taken to provide a pleasurable mental effect, such as the warm, carefree drowsiness induced by heroin.

Many drugs cause psychological dependency too, in that they produce such pleasurable and satisfying sensations that the user feels unable to manage without them, and is driven to take the drug again and again.

Which Drug?

The most addictive drugs are those such as heroin and morphine, which cause such severe physical and psychological dependency that the user feels compelled to take them not only to recapture the pleasant feelings, but also to avoid physical discomfort

Ask doctor Internet for ways to get rid of this problem.

Many myths surround the use of certain drugs, especially cannabis. These include the incorrect belief that the drug is not addictive. Musicians and other artists sometimes claim that the use of drugs enhances their performance. However, such beliefs are dangerous; many talented musicians have destroyed their health and, in some cases, lost their lives from drug addiction.

Addiction

The body eventually builds up tolerance to many drugs that cause dependency, so that gradually increasing doses is a must, both to maintain the pleasurable effects of the drug and to stave off the unpleasant ones. If the addict’s need for the drug is not satisfied, withdrawal symptoms will result. Withdrawal from such drugs should be supervised medically.

Who is at risk?

Not everyone who takes an addictive drug becomes dependent on it. Genetic differences between people were thought to account for this. The people most likely to become addicted are those who seek to escape from their problems, perhaps through cocaine or heroin. Whatever the drug, by providing a temporary solution to problems, it will be taken more and more often until it becomes a central part of the individual’s life.

What are the symptoms?

Every type of drug produces its own kind of mental and physical symptoms. In general, though, any addiction is likely to cause a gradual deterioration in the quality of the addict’s work and personal relationships. The behavior of addicts is often erratic and their moods are changeable, with periods of restlessness and irritability perhaps alternating with extreme drowsiness. There is often loss of appetite, and the sufferer may seem unreasonably tired.

How common is the problem?

There are no reliable statistics on the number of drug addicts partly because many addicts never receive treatment and obtain drugs illegally. However, more than 50 per cent of all people charged with offences involving drugs are aged 17 to 24 years, with twice as many men as women involved. In the mid-1990s, around 34000 men and women in the UK were notified drug addicts, mostly users of heroin or methadone. Amphetamines are another important category of drugs of abuse. Probably over 3 million have used cannabis at some time.

What are the risks?

• Hard drugs disturb the body’s chemical system and may lead to serious mental illness, including psychoses. There is also a wide range of behavioral and psychiatric symptoms. They can run from agitation and restlessness to anxiety, depression, psychosis, paranoia, and even a preoccupation with suicide

• The incidence of strokes and psychiatric difficulties is greatly increased when cocaine is used. The amount of cocaine or the method that cocaine is used does not appear to have any effect on the problems.

• The neurological problems may be catastrophic, such as seizures and strokes, and there may be no warning that such a disaster is about to occur. Sometimes, the cocaine user may experience temporary blindness, numbness or tingling before the major problem occurs. These episodes may be life threatening, and the symptoms are warnings that should be heeded.

• Death, or at least a permanent loss of health, may be the result. There are many excellent treatment programs available in specialized hospitals connecting to Doctorinternet here in the UK. The person with the cocaine problem may be depending on you to help him get to the root of his symptoms, and will need your support as he works to eliminate cocaine or any other drug from his life.

• Cocaine can cause a fatal heart attack. Regardless of how cocaine is used, whether it is sniffed, smoked, or taken orally, it can enhance catecholamine activity in the body. Catecholamines are naturally produced compounds that affect different systems, including the cardiovascular, and can intensify the response of certain organs, like the heart. This excess of catecholamines can interfere with normal heart rhythms and increase blood pressure. It can also cause an abnormally high heart rate, heart spasm, constricted blood vessels, and even blood clots. These conditions can lead to a blocked coronary artery--and a heart attack--even in a young, previously healthy person who has no history of heart disease. Anyone who already has coronary artery disease greatly increases his risk for heart attack by using cocaine.

• Apart from these risks, however, there are other important health hazards. Users of injected drugs often share needles, syringes and other equipment and do not sterilize them. Sharing needle carries a high risk of transmitting virus diseases, especially hepatitis B and HIV infection (AIDS). Intravenous drug abusers are the main category of victims of AIDS in some parts of the UK.

What should be done?

Anyone addicted to a drug needs help, but addicts are unlikely to seek help. If you have cause for concern about yourself or anyone else, consult Doctorinternet to help you get in touch with professional centers in the UK.

What is the treatment?

No self-help treatment is likely to achieve very much for severe addiction.

Hospital treatment in a special drug unit is often necessary to break a serious addiction. The addictive drug is withdrawn, either immediately or gradually. Once the addict is free of withdrawal effects, psychotherapy and occupational therapy may be given.

Contact Doctorinternet for more detail information regarding treatment in the UK.

 
CARDIAC SURGERY

1- History of Cadriac Surgery

By: M Amrani Senior Lecturer/Consultant Cardiac Surgeon
Royal Brompton & Harefield NHS Trust
United Kingdom

It is important to remember that as compared to other disciplines cardiac surgery is a very new discipline. Indeed the first operations routinely performed date from the 1960's. Over a period of 3-4 decades a spectacular evolution of the specialty has been seen. Almost all acquired and congenital heart disease can be corrected nowadays.

Understanding of the circulation, development of surgical technique the heart/lung machine (which replaces the function of the heart and lungs during the operation), as well as methods of cardiac protection, made cardiac surgery become possible. It is remarkable to notice that prehistoric humans recognised the importance of the heart by pointing out the heart of animals in some hunting frescos. The ancient Chinese had some knowledge of the nature of the pulmonary and systemic circulation. Ancient Egyptians were familiar with the circulation although they did not have the knowledge of the way it functioned. As early as the fourth century BC Hipocrates recognised the heart as having muscles and valves. During the Roman period angina pectoris was described by Seneca when describing his own symptoms. The most remarkable contribution from the Roman period was made by Galen (two centuries AD) based on his observation without performing any dissection or experiment. He recognised the way blood can move in the body. The Arabs made a significant contribution to many disciplines including medicine. Ibn Al-nafis, who lived in the 13th century wrote many medical books and described the physiology of the pulmonary circulation. Al-nafis made two striking observations, namely the way the circulation flows from the right ventricle to the pulmonary circulation and back to the left heart. He also recognised that the heart was also nourished by some blood vessels (coronary artery). Unfortunately Al-nafis' work was refuted by his disciples and forgotten for 200 years. William Harvey resurrected the views of the Arab physician Al-nafis and described both the anatomy of the heart and the circulation.

The Heart/Lung machine

Cold Solutions/Cardioplegia

Heart Transplantation

In some cases when the heart muscle is severely damaged and no surgical correction is possible, heart transplantation is the only option. Cardiac transplantation became available in the late 60's after the first procedure was performed by Barnard in South Africa. In essence cardiac transplantation is performed by using the same principle, namely the heart/lung machine and cardioplegia. In addition it needs immunosuppression drugs to help the donor heart fight against immunological reaction from the recipient. Cardiac transplantation is now considered as a routine operation with excellent results.

What about the future?

Cardiac surgery has several challenges in the 21st century: development of a totally artificial heart and minimally invasive surgery, including robotic surgery and coronary artery bypass graft surgery without a heart/lung machine.