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Uncertainty, lack of control and emotional functioning in women with metastatic breast cancer: a review and secondary analysis of the literature using the critical appraisal technique

EUROPEAN JOURNAL OF CANCER CARE, Issue 5 2010
M. WARREN msc, clinical nurse specialist
WARREN M. (2010) European Journal of Cancer Care19, 564,574 Uncertainty, lack of control and emotional functioning in women with metastatic breast cancer: a review and secondary analysis of the literature using the critical appraisal technique A diagnosis of metastatic (or secondary) breast cancer is frequently more distressing than the diagnosis of a primary tumour since it indicates that the cancer is no longer curable. Relatively little is known, however, about women's experiences of this condition in comparison with those diagnosed with primary breast cancer. This paper therefore reports findings from a secondary analysis of the published literature on the topic using tools from the critical appraisal skills programme to identify and analyse appropriate papers, and the constant comparative method as a means of identifying any overarching or dominant themes emerging from the literature. Uncertainty, lack of control and poor emotional functioning emerged as the main themes affecting women with metastatic breast cancer. These are discussed in relation to their antecedents in the original studies and their implications for nursing care. The themes demonstrate that living with metastatic (or secondary) breast cancer is a multifaceted experience that is influenced by a large number of factors, many of which are under-researched in comparison with those affecting women diagnosed with primary disease. It is clear, however, that women affected by the condition need a great deal more support than they currently receive, and new services may be required to meet these needs. [source]

Associations among symptoms of dieback in even-aged stands of ash (Fraxinus excelsior L.)

FOREST PATHOLOGY, Issue 1 2010
J. P. Skovsgaard
Summary The objective of this study was to establish statistically based associations among macroscopic symptoms of crown dieback, cankers due to Chalara fraxinea, and symptoms caused by other pathogens and pests on Fraxinus excelsior. A total of 454 trees were observed in two plots of a 15-year-old experimental stand. The symptoms included: (i) overall extent of crown dieback; (ii) dieback of upper parts of the crown; (iii) canker in upper parts of the crown; (iv) wilting foliage; (v) cankers and bark proliferations at the lower part of the stem; and (vi) discolouration at stump or stem base. The analysis suggested that the observed symptoms of crown dieback are caused by a primary disease. The macroscopic symptoms attributed to dieback and canker in the crown were strongly associated. Moreover, the disease was associated with symptoms of Armillaria gallica, but no associations were found for symptoms of Neonectria galligena, Pseudomonas syringae subsp. savastanoi pv. fraxini, Hylesinus fraxini or H. varius when considered collectively. Dieback was more frequent on trees of average or below-average size, suggesting that individual tree resistance decreased with decreasing growth potential or tree vigour. The extent of canker in the crown depended on site conditions and possibly on silvicultural practices. The development of phytosanitary prescriptions for silviculture should primarily be targeted towards young stands as these represent the most critical phases of stand development. [source]

Profile of opportunistic infections among patients on immunosuppressive medication

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2006
Srinivas REDDY
Abstract Background:, The widespread use of immunosuppressives in treating systemic autoimmune disorders has resulted in opportunistic infections (OIs) following such therapy. Current data regarding the possibility of infection due to these drugs or from the primary disease, per se, is conflicting. Objectives:, We aimed to analyse the profile of patients requiring hospitalization for OIs among those being treated with glucocorticoids and other immunosuppressive agents as part of management of systemic autoimmune disorders and to analyse the host factors in relation to OIs. Method:, In this descriptive analysis, all patients hospitalized the Postgraduate Institute of Medical Education and Research, Chandigarh, India, under medicinal units for OIs that occurred following and during treatment with corticosteroids and other immunosuppressive agents for treatment of systemic autoimmune disorders from February 2002 to January 2003, were studied. All hospitalized patients received antibiotics according to the nature of infection and sensitivity reports. All relevant clinical details were recorded in a standard pro forma. Descriptive statistics were used. The Institute Ethics Committee's permission was secured prior to study commencement. Results:, Nineteen patients (16 female) were admitted because of OIs. Their mean age (± SD) was 37.32 (± 19.9) years. Ten patients had systemic lupus erythematosus (SLE), two had SLE with overlap, five had rheumatoid arthritis, and one each had vasculitis and scleroderma with polymyositis. There were 28 infections. One (5.3%) patient had four infections, one (5.3%) had three, six (31.6%) had two, nine (47.4%) had one, and in two (10.5%) patients the infection was not localized. Of the 19 cases, 10 (52.6%) received > 10 mg of prednisolone each day (median = 1130 mg). The remaining nine (47.4%) were on < 10 mg prednisolone each day (median = 880 mg). Methylprednisolone was given to two (6.3%) patients. Bacteria accounted for most of the infections. There were two fungal infections and one patient each with tuberculosis and peritonitis. Infections occurred predominantly in the chest, urine and skin. Septicemia was diagnosed in three patients. There were two deaths, one each with SLE and rheumatoid arthritis. Conclusion:, Since infections can occur at low doses of corticosteroids, we suggest that these disorders may be, per se, responsible for an increased risk of infection. [source]

Evaluation of the efficacy and safety of laparoscopic nephrectomy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2001
Kazuhiro Yoshimura
AbstractPurpose: To evaluate the efficacy and safety of laparoscopic nephrectomy. Methods: From June 1994 to November 1999, 10 patients underwent laparoscopic nephrectomy at Osaka University Medical Hospital and Osaka Rosai Hospital. Laparoscopic nephrectomy was performed either via transperitoneal or retroperitoneal approach under general anesthesia. These 10 cases were reviewed in respect of primary disease of the kidney, operative time, complications and postoperative convalescence. Results: Of the 10 patients, five were preoperatively diagnosed as having a non-functioning kidney with hydronephrosis, two patients were diagnosed as having an atrophic kidney, two had renal cell carcinoma and one had renal pelvic tumor. The average operative time was 374 min (range 270,675 min). The mean blood loss was 330 mL (range 60,800 mL). One patient required transfusion due to postoperative oozing. The average hospital stay after operation was 7 days. No major postoperative complications were observed. Conclusion: Laparoscopic nephrectomy is an option in surgically managing renal disorders, including malignancies, although it has a longer operative time compared to conventional open surgery. [source]

Neuroimaging and Neurologic Complications after Organ Transplantation

JOURNAL OF NEUROIMAGING, Issue 2 2007
ivkovi
ABSTRACT Neurologic complications are common after transplantation and affect 30-60% of transplant recipients. The etiology of most of the posttransplant neurologic disorders is related to the opportunistic infections, both systemic and involving central nervous system (CNS), toxicity of immunosuppressive medications, and the metabolic insult created by the underlying primary disease and the transplant procedure. Neuroimaging studies are one of the key tools in the evaluation and enable early diagnosis of neurologic complications in transplant patients, especially posterior reversible leukoencephalopathy syndrome, central pontine myelinolysis, intracerebral hemorrhage, and fungal and bacterial abscesses. Magnetic resonance imaging (MRI) is the preferred technique, but each of the available neuroimaging techniques offers a unique insight into the pathophysiologic mechanisms underlying neurologic complications of transplantation. The role of neuroimaging in this population includes early detection of calcineurin inhibitor neurotoxicity, opportunistic infections, neoplasia, metabolic disorders, or cerebrovascular diseases. In addition, we can monitor longitudinal progression of disease and treatment response. [source]

Predictors of length of stay for pediatric liver transplant recipients

LIVER TRANSPLANTATION, Issue 8 2004
John C. Bucuvalas
The resources that are directed towards the care of liver transplant recipients are substantial. Approximately 100 million dollars are spent on the hospitalization of the 400,500 children in the United States who undergo liver transplantation each year. Using length of stay as a surrogate marker for hospital resource use, we sought to identify factors that impact length of stay and assess the trends of hospitalization after liver transplantation for a representative population of pediatric liver transplant recipients. The study population was comprised of 956 patients who underwent primary liver transplantation between 1995 and 2003 and survived at least 90 days. Data were retrieved from the Studies of Pediatric Liver Transplantation data registry. The primary outcome was the length of initial hospitalization after liver transplantation. Independent variables were age, gender, race, pediatric end-stage liver disease score (PELD), year of transplantation, organ type, primary disease, length of operation, and insurance status. The mean and standard deviation of length of stay after liver transplantation was 24.0 ± 24.5 days. Multivariate analyses showed that increased hospital stay was associated with infants less than 1 year of age, fulminant liver failure, receiving a technical variant organ from a cadaveric donor, government insurance, and transplant era (before 1999 vs. 1999 or later). Decreasing height z-scores and increasing length of operation were also associated with increased hospital stay. In conclusion, these parameters accounted for only 11% of the total variance, suggesting that post-transplant complications and course account for much of the variability of resource use in the immediate post-transplant period. (Liver Transpl 2004;10:1011,1017.) [source]

Identification of patients best suited for combined liver,kidney transplantation: Part II

LIVER TRANSPLANTATION, Issue 3 2002
Connie L. Davis MD Associate Professor of Medicine
Liver-kidney transplantation (LKT) should be reserved for those recipients with primary disease affecting both organs. However, increasing transplant list waiting times have increased the development and duration of acute renal failure before liver transplantation. Furthermore, the need for posttransplant calcineurin inhibitors can render healing from acute renal failure difficult. Because of the increasing requests for and controversy over the topic of a kidney with a liver transplant (OLT) when complete failure of the kidney is not known, the following article will review the impact of renal failure on liver transplant outcome, treatment of peri-OLT renal failure, rejection rates after LKT, survival after LKT, and information on renal histology and progression of disease into the beginnings of an algorithm for making a decision about combined LKT. [source]

Cytokeratin 20-positive large cell neuroendocrine carcinoma of the colon

PATHOLOGY INTERNATIONAL, Issue 8 2005
Tomoya Kato
Herein is presented a case of cytokeratin (CK) 20-positive large cell neuroendocrine carcinoma of the colon, in which the tumor was clinically at stage IV and located in the ascending colon. Pathological examination of the resected tumor revealed nested and solid proliferation of large undifferentiated cells with vesicular nucleus and prominent nucleoli. No areas showed differentiation toward adenocarcinoma or squamous cell carcinoma. Tumor cells were immunohistochemically positive for chromogranin A, synaptophysin, CD 56 (focal), and bore electron-dense granules. With these features, the tumor was diagnosed as a large cell neuroendocrine carcinoma of the colon. Liver metastasis and local recurrence progressed, and the patient died of the primary disease 7 months after operation. The autopsy confirmed this diagnosis without detectable tumors in the lungs. Interestingly, more than half of the tumor cells were positive for CK 20, while CK 7 was not expressed. Most neuroendocrine carcinomas do not express CK 20, with the exception of Merkel cell carcinomas, and most colorectal adenocarcinomas express CK 20. To the best of the authors' knowledge, the present case is the first CK 20-positive, CK 7-negative colorectal neuroendocrine carcinoma to be described, suggesting a link between colorectal neuroendocrine carcinoma and conventional adenocarcinoma. [source]

Early recurrence of primary disease after pediatric renal transplantation: Two case reports and a review of the literature

PEDIATRIC TRANSPLANTATION, Issue 2 2007
Supriya Jain
Abstract:, Recurrence of primary diseases such as FSGS or HUS is known to cause early graft dysfunction after pediatric renal transplantation. We report the unusual occurrence of early graft dysfunction following kidney transplant in two pediatric cases. Both subjects had biopsy proven recurrence of CGN in less than a week after transplantation. We were able to sustain the renal function in one of them following aggressive treatment. Hence, early recurrence of CGN should be considered in the differential diagnosis of early graft dysfunction. [source]

The Effect of treatment on survival in patients with advanced laryngeal carcinoma,

THE LARYNGOSCOPE, Issue 7 2009
Christine G. Gourin MD
Abstract Objectives/Hypothesis: Over the last 2 decades, survival from laryngeal cancer has decreased. We sought to identify factors associated with decreased survival in laryngeal cancer. Methods: Patients diagnosed with laryngeal squamous cell carcinoma from 1985 to 2002 were retrospectively reviewed. Results: A total of 451 patients met study criteria. Five-year survival rates were 85% for stage I, 77% for stage II, 51% for stage III, and 35% for stage IV disease. Survival for patients with stage I,III disease was similar for patients treated operatively or nonoperatively (P = .4). However, patients with stage III disease treated nonoperatively had worse survival with radiation alone (XRT) compared to chemoradiation (CR) (P = .006). Patients with stage IV disease had significantly better survival with surgery (49%) than CR (21%) or XRT alone (14%) (P < .0001). Analysis by primary tumor stage demonstrated that survival for T1,T3 disease was independent of treatment modality (P = .2); however, for T4 patients, operative treatment was associated with significantly better survival (55%) than CR (25%) or XRT (0%) (P < .0001). Proportional hazards models confirmed significantly worse survival for stage IV, T4, N2 or N3 disease, and nonoperative treatment. For T4 disease, after controlling for nodal status, nonoperative treatment was the only significant predictor of worse survival. Conclusions: Primary surgical treatment is associated with improved survival for patients with stage IV disease and specifically T4 primary tumors. These data suggest that the observed national decrease in survival from laryngeal cancer may be due to a shift toward nonoperative treatment in that subset of patients with advanced primary disease. Laryngoscope, 2009 [source]

Carcinoma of the Tongue Base Treated by Transoral Laser Microsurgery, Part Two: Persistent, Recurrent and Second Primary Tumors

THE LARYNGOSCOPE, Issue 12 2006
David G. Grant MD
Abstract Objectives: To report the oncologic and functional outcomes of transoral laser microsurgery (TLM) in the treatment of persistent, recurrent, and second primary squamous cell carcinoma of the tongue base. Study Design: A two-center prospective case series analysis. Methods: Twenty-five patients with persistent, recurrent, or second primary squamous cell carcinoma of the tongue base were treated with TLM between 1997 and 2005. Four (16%) patients with persistent disease at the primary site were considered TX. Eleven (44%) patients with recurrent disease were pathologically staged rT1 3/11, rT2 2/11, rT3 4/11, T4 1/11, and TX 1/11. Ten (40%) patients with second primary tumors were staged pT1, 4/10; pT2, 3/10; pT3, 2/10; and pT4, 1/10. Eight (32%) patients underwent neck dissection. Three (12%) patients received adjuvant radiotherapy. Pre- and post-treatment organ function was assessed using a clinical Functional Outcome Swallowing Scale (FOSS) and Communication Scale. Results: The mean follow-up period was 26 months. The 2-year Kaplan-Meier local control and locoregional control estimate was 69%. For those patients presenting with persistent/recurrent or second primary disease, the 2 year local control estimates were 75% and 68%, respectively. For all patients, the respective 2 and 5 year overall survival estimates were 54% and 26%. Two (8%) patients suffered postoperative hemorrhage. The average duration of hospitalization was 3.6 days. The median pretreatment and posttreatment FOSS stage was stage 2 and stage 3, respectively. Conclusions: Transoral laser surgery is a rational and effective treatment in appropriately selected patients with persistent, recurrent, or second primary tongue base cancer. The low morbidity and mortality and shortened duration of hospitalization associated with TLM make it an attractive therapeutic alternative. [source]

Sentinel Lymph Node Biopsy in Head and Neck Squamous Cell Carcinoma

THE LARYNGOSCOPE, Issue 12 2002
Karen T. Pitman MD
Abstract Objectives/Hypothesis Sentinel lymph node biopsy is a minimally invasive method to stage the regional lymphatics that has revolutionized the management of patients with intermediate-thickness cutaneous melanoma. Head and neck surgeons have been encouraged by the accuracy of sentinel lymph node biopsy in cutaneous melanoma and have applied the technique to patients with head and neck squamous cell carcinoma (HNSCC). The objectives of the study were 1) to study the feasibility and accuracy of sentinel lymph node biopsy as a method to stage the regional lymphatics in HNSCC and 2) to determine whether there are qualitative differences between the cutaneous and mucosal lymphatics that would affect the technique used in HNSCC. Study Design Two methods of investigation were employed: a prospective laboratory study using a feline model for sentinel lymph node biopsy and a retrospective review of patients who received lymphoscintigraphy before neck dissection and intraoperative identification of the sentinel lymph node. Methods Lymphoscintigraphy and a gamma probe were used in four felines to study the kinetics of technetium-labeled sulfa colloid (Tc-SC) in the mucosal lymphatics. In the second part of the feline study, eight subjects were studied intraoperatively. Tc-SC and isosulfan blue dye were used to study the injection technique for the mucosal lymphatics and to determine the time course of the dye and Tc-SC to the sentinel lymph node. In Part II of the present study, a retrospective review of 33 patients with HNSCC was conducted. Twenty patients (stage N0) whose treatment included elective neck dissection were studied with preoperative lymphoscintigraphy and underwent intraoperative identification of the sentinel lymph node to determine the accuracy and feasibility of sentinel lymph node biopsy. Eight patients with palpable neck disease and five patients with recurrent or second primary disease whose previous treatment included neck dissection were also studied with lymphoscintigraphy before neck dissection. Results In the feline study, both Tc-SC and isosulfan blue dye traversed the lymphatics rapidly, appearing in the sentinel lymph node in less than 5 minutes. Modification of the injection technique used for cutaneous melanoma was required to depict the sentinel lymph node of the base of tongue. In the human study, the sentinel lymph node was accurately identified in 19 of 20 (95%) N0 patients. On average, 2.9 sentinel lymph nodes (range, 1,5) were identified in 2.2 (range, 1,4) levels of the neck. Sentinel lymph nodes were bilateral in 4 of 19 patients. When the sentinel lymph node was identified, it accurately predicted the pathological nodal status of the regional lymphatics. Three of 20 patients had cervical metastases, and the sentinel lymph node was identified in 2 of 3 patients with pathologic nodes (pN+). Focal areas of radiotracer uptake were identified in seven of eight patients with palpable disease. These areas corresponded to the level with palpable disease in four patients. The lymphatics delineated by lymphoscintigraphy in the five patients with previous neck dissection were outside the levels that had been dissected. Lymphoscintigraphy depicted collateral patterns of lymphatic drainage. Conclusions Sentinel lymph node biopsy is technically feasible and is a promising, minimally invasive method for staging the regional lymphatics in patients with stage N0 HNSCC. Lymphoscintigraphy alone may determine the levels that require treatment in patients with disrupted or previously operated cervical lymphatics. [source]

Phenotypic Expression of Recurrent Disease After Liver Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2010
J. G. O'Grady
Recurrence of the primary disease has become a major focus for transplant hepatologists both when investigating graft dysfunction and when tailoring immunosuppression to maximize graft survival. However, disease recurrence varies in penetrance, can be predictable or random, and does not always conform to the expected pattern of disease. The cholestatic hepatitis syndromes associated with hepatitis B and C are the most dramatic examples of phenotypic change. Being on immunosuppressive drugs may intensify the progression of infectious and malignant diseases, but this effect is not predictable. A significant minority of patients with each of the autoimmune diseases, counter-intuitively, get recurrent disease despite immunosuppression of a potency that is adequate to prevent rejection of the liver graft. Disease patterns emerge after liver transplantation for cryptogenic cirrhosis that shed light on the cause of the native liver disease, for example, nonalcohol-related fatty liver disease and autoimmune hepatitis. The phenotypic expression of disease recurrence can be modified by specific drugs used for immunosuppression and by HLA-antigen matching profiles. Understanding and modifying the phenotypic expression of recurrent disease after liver transplantation is a fertile area for research and continued refinement of clinical care. [source]

Evaluation of the use of prophylactic cranial irradiation in small cell lung cancer,

CANCER, Issue 4 2009
Shilpen Patel MD
Abstract BACKGROUND: Prophylactic cranial irradiation has been used in patients with small cell lung cancer to reduce the incidence of brain metastasis after primary therapy. The purpose of this study was to evaluate the effects of prophylactic cranial irradiation (PCI) on overall survival and cause-specific survival. METHODS: A total of 7995 patients with limited stage small cell lung cancer diagnosed between 1988 and 1997 were retrospectively identified from centers participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Of them, 670 were identified as having received PCI as a component of their first course of therapy. Overall survival and cause-specific survival were estimated by the Kaplan-Meier method, comparing patients treated with or without prophylactic whole-brain radiotherapy. The Cox proportional hazards model was used in the multivariate analysis to evaluate potential prognostic factors. RESULTS: The median follow-up time was 13 months (range, 1 month to 180 months). Overall survival at 2 years, 5 years, and 10 years was 23%, 11%, and 6%, respectively, in patients who did not receive PCI. In patients who received PCI, the 2-year, 5-year, and 10-year overall survival rates were 42%, 19%, and 9%, respectively (P = <.001). The cause-specific survival rate at 2 years, 5 years, and 10 years was 28%, 15%, 11%, respectively, in patients who did not receive PCI and 45%, 24%, 17%, respectively, in patients who did receive PCI (P = <.001). On multivariate analysis of cause-specific and overall survival, age at diagnosis, sex, grade, extent of primary disease, size of disease, extent of lymph node involvement, and PCI were found to be significant (P = <.001). The hazards ratios for disease-specific and all cause mortality were 1.13 and 1.11, respectively, for those not receiving PCI. CONCLUSIONS: Significantly improved overall and cause-specific survival was observed in patients treated with prophylactic cranial irradiation on unadjusted and adjusted analyses. This study concurs with the previously published European experience. Prophylactic cranial irradiation should be considered for patients with limited stage small cell lung cancer. Cancer 2009. © 2008 American Cancer Society. [source]

Hyperthermic intraperitoneal intraoperative chemotherapy after cytoreductive surgery for the treatment of abdominal sarcomatosis

CANCER, Issue 9 2004
Clinical outcome, prognostic factors in 60 consecutive patients
Abstract BACKGROUND Abdominal sarcomatosis is a rare nosologic entity with a poor prognosis. After a Phase I study on cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy (HIIC), the authors reported the results of the treatment of 60 patients using this novel multimodal approach. METHODS Twenty-nine patients had multifocal primary disease and 31 patients had recurrent abdominal sarcoma. Tumor histology was represented by visceral (n = 26 [43%]) and retroperitoneal (n = 34 [57%]) sarcoma. All patients underwent cytoreductive surgery (with no or minimal residual disease) and 90-minute HIIC with doxorubicin (15.25 mg/L of perfusate) and cisplatin (43 mg/L). The clinical outcome and the prognostic value of 11 clinicopathologic variables were analyzed. RESULTS No postoperative deaths occurred. The morbidity rate was 33% and the moderate to severe locoregional toxicity rate was 15%. The median time to local disease progression and the median overall survival were 22 months and 34 months, respectively. Using multivariate analysis, histologic grading and completeness of surgical cytoreduction predicted patient prognosis, indicating that both local progression-free and overall survival were affected significantly by tumor aggressiveness and local disease control. CONCLUSIONS Although these results were encouraging, there was no definitive conclusion reached regarding the therapeutic activity of this locoregional treatment. In addition, the toxicity rate was substantial. In the absence of effective systemic agents, the therapeutic potential of cytoreductive surgery plus HIIC should be explored further in comparative trials. Cancer 2004. © 2004 American Cancer Society. [source]

Performance of a new separator system for routine autologous hematopoietic progenitor cell collection in small children

JOURNAL OF CLINICAL APHERESIS, Issue 6 2007
Volker Witt
Abstract The AMICUSÔ system was recently introduced for peripheral blood stem cell (PBSC) aphereses in adults. We conducted a single center field evaluation to obtain data about the performance of this system in children with a body weight (bw) < 25 kg. Results of blood priming procedures were compared to historical data obtained with the Fenwal CS3000+ (CS 3000). From August, 2001 to February, 2007, 47/178 (26%) PBSC aphereses procedures were performed in our institution with the AMICUSÔ system in 35 small patients (median bw 13.9 kg; range 6.7,24; age 2.78 years; range 0.97,7.06). The patients suffered from various malignant primary diseases or recurrences. We primed the system with packed RBC in case of >30% dilution of the RBC volume (n = 31) or with saline (n = 16). Compared to the CS3000, the AMICUSÔ revealed comparable collection efficiencies (CE) for CD34+ cells (median 67%, range 26,120), lymphocytes (75%, 25,138), monocytes (54%, 23,173), and granulocytes (10%, 1.5,36), MNC (57% 24,125), but a significantly higher erythrocyte and granulocyte, and a lower platelet CE. There was a significant negative correlation between total leukocyte count and CE for MNC (r = ,0.566; P < 0.001) and CD34+ cells (r = ,0.517; P < 0.001). There was no significant statistical or clinical difference between the CE in blood-primed procedures and saline-primed procedures. With the AMICUSÔ we saw statistically less citrate reactions compared to the CS 3000. We conclude that the AMICUSÔ system is safe and efficient to harvest PBSC on a routine basis in pediatric patients, even in children ,10 kg bw. J. Clin. Apheresis, 2007. © 2007 Wiley-Liss, Inc. [source]