Prognostic use of preoperative and immediate postoperative carcinoembryonic antigen determinations in colonic cancer

Preoperative and postoperative carcinoembryonic antigen (CEA) concentrations are useful in predicting the likelihood of recurrence in patients undergoing curative operations for cancer of the colon. The incidence of recurrence was studied in three groups of patients followed for 6 to 18 months after such an operation: 36 patients (group 1) had preoperative and postoperative plasma CEA concentrations less than 2.5 ng/ml; 11 patients (group 2) had a preoperative CEA value above but a postoperative value below 2.5 ng/ml; and 11 patients (group 3) had preoperative and postoperative concentrations greater than 2.5 ng/ml. Cumulative rates of recurrence at 6, 12 and 18 months after operation were as follows: 0, 3 and 17% in group 1; 0, 9 and 21% in group 2; and 27, 79 and 79% in group 3. Statistically there was no difference in the recurrence rate between groups 1 and 2, but the rate was significantly lower in group 2 compared with group 3. The data show that patients in whom the immediate postoperative CEA concentration returns to normal have a much lower incidence of recurrent cancer of the colon than patients whose CEA concentration remains elevated.     

Combined evaluation of preoperative serum sialyl-Tn antigen and carcinoembryonic antigen levels is prognostic for gastric cancer patients

A clean-up procedure to obtain a minimal detectable concentration of 5-10 ng bupivacaine enantiomer per milliliter human plasma is described. The procedure consists of precipitation of plasma proteins using acetonitrile, followed by solid-phase extraction using a cyano column. The eluate is then made alkaline, and bupivacaine is extracted using n-hexane. After evaporation of n-hexane, the residue is redissolved in the eluent used for HPLC analysis. The HPLC method has been described previously. The minimal detectable concentrations using this method are ca. 8 and 10 ng/ml for R-(+)- and S-(-)-bupivacaine, respectively. For both enantiomers, r2 is > 0.995 over the range of 9.5-760 ng/ml enantiomer.     

Radiologic diagnosis and preoperative staging of esophageal cancer

For the treatment of esophageal carcinoma it is important to determine the length and depth of the spread. On the basis of comparable, reproducible studies the classification can be defined, which differs in Western countries from that in Japan. Conventional radiological methods such as upper-GI studies with barium sulfate and more advanced methods such as CT, echoendoscopy and MRI are discussed regarding their possibilities and limits.     

Plasma carcinoembryonic antigen in an Australian hospital population

Plasma carcinoembryonic antigen (CEA) levels have been determined by the zirconyl phosphate gel (Z-gel) method, using materials provided by Hoffman-LaRoche Inc., on 512 samples from 425 hospital patients, and on single samples from 124 normal controls (98 blood donors and 26 healthy staff members). Of the controls, 98% had CEA levels less than 5 ng/ml. Forty-six hospital patients had CEA levels above 20 ng/ml; 45 (98%) had known present or past cancer. Nineteen patients had levels between 10 and 20 ng/ml; 11 (58%) had present or past cancer. Sixty-seven patients had levels between 5 and 10 ng/ml, and most of these had non-malignant diseases; only 34% had present or past cancer. Cigarette smoking was associated with elevated CEA levels among patients with non-neoplastic diseases, notably those with cirrhosis of the liver and chronic renal disease. There was a gradation of increasing specificity for cancer with increasing levels of CEA from 5 to over 20 ng/ml; but, on the other hand, higher levels were associated with more disseminated cancer, which would be less amenable to cure.     

Immunological responsiveness and adjunct immunotherapy in lung cancer

Immunocompetency was assessed before and after the operation in 40 patients with lung cancer by skin reaction against tuberculin (PPD) and dinitrochlorobenzene (DNCB), lymphocyte response to PHA, proportion of T-cells, macrophage migration inhibition test (MIT) and the presence of blocking factor. MIT was positive in 27 per cent and blocking factor was positive in 42 per cent. Immune response paralleled the clinical stage of the lesion. In curative resection cases, the immune response rose postoperatively, but declined in non-resectable or recurrent cases. The influence of postoperative radiation therapy, cancer chemotherapy and host mediated agents on the patients was observed. The feasibility of adjuvant specific immunotherapy is discussed.     

Goal attainment scaling as an adjunct to counseling.

T. J. Kiresuk and R. E. Sherman (see record 1970-04099-001) have proposed a method of evaluating programs and counseling that combines theoretical approaches that may be beneficial to the counseling process itself. The present study hypothesized that counseling with these Goal Attainment Scaling evaluation procedures would improve the conduct of counseling. The Personal Orientation Inventory, Nowicki and Strickland Children's Locus of Control Scale, a consumer satisfaction questionnaire, and behavioral measures were used to assess outcome of counseling for 20 13-17 yr olds with adjustment problems. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meditation as an adjunct to a happiness enhancement program

Arginine vasopressin (AVP) plays an important role in the control of a gonadal hormone-dependent communicative behavior in the Syrian hamster (Mesocricetus auratus) called flank marking. Previous studies have shown that gonadal hormones alter the amount of flank marking stimulated by the microinjection of AVP into the medial preoptic area-anterior hypothalamus (MPOA-AH). The purpose of the present study was to determine if testicular hormones alter the amount of flank marking stimulated by the microinjection of AVP into two other sites involved in the control of flank marking, the lateral septum-bed nucleus of the stria terminalis (LS-BNST) and the central gray. The data of the present study indicate that testicular hormones may influence the amount of AVP-stimulated marking in the central gray and LS-BNST; however, these effects are subtle and appear to occur primarily at high concentrations of AVP. When taken together with previous studies, these data indicate that gonadal hormones have greater effects on AVP-stimulated marking in the MPOA-AH than in the LS-BNST or central gray.     

Intergenerational work as an adjunct to psychoanalysis and psychotherapy

Psychotherapy and psychoanalysis are opportunities for individuals to repair faulty aspects of their development that have resulted in symptoms or other difficulties in living. Although transference is the major therapeutic tool in this work, it is not the only one. The potential resources for healing that exist in family relationships is great, especially as these relationships go on long after therapy has ended. We are all living longer; families of three and four generations are no longer uncommon. There are many adult patients who have one or both parents alive and well. Intergenerational work can be a useful adjunct where there is no severe narcissistic pathology or psychosis in either patient or parent. It is especially helpful in cases where there is severe resistance and insight is not effective in promoting change. "By focusing constantly on the patient's transference distortions and ignoring reality elements we undermine self-esteem and make him feel he is always wrong, sick or crazy" (Greenson, 1978b,p. 434). The addition of intergenerational work in the course of psychoanalysis/psychotherapy can shorten the time of therapy and be another tool for dealing with resistance. This work has theoretical implications for the modification of the place that transference has in psychoanalytic therapy. By placing greater emphasis on the patient's real relationships in influencing intrapsychic change we pave the way to exciting clinical and theoretical possibilities.     

Preoperative carcinoembryonic antigen is related to tumour stage and long-term survival in colorectal cancer

Evidence as to the value of preoperative carcinoembryonic antigen (CEA) in guiding treatment for patients with colorectal cancer is conflicting. The aim of this prospective study was to investigate the value of preoperative CEA in predicting tumour factors of proven prognostic value and long-term survival in patients undergoing surgery for colorectal cancer. Preoperative serum CEA, tumour ploidy, stage and grade were ascertained in 277 patients undergoing colorectal cancer surgery. This cohort of patients were followed up for a minimum of 5 years, or until death, in a dedicated colorectal clinic. Patients with an elevated CEA had a 5 year survival of 39%. This increased to 57% if the CEA was normal (P=0.001). The proportion of patients with a raised CEA increased with a more advanced tumour stage (P < 0.000001) and a poorly differentiated tumour grade (P < 0.005). Once stage had been controlled for, CEA was not a predictor of survival. No relationship between tumour ploidy and CEA was found. In conclusion, a raised preoperative serum CEA is likely to be associated with advanced tumour stage and poor long-term survival, compared with patients with a normal value.     

Risperidone as an adjunct to clozapine therapy in chronic schizophrenics

BACKGROUND: Some treatment-resistant schizophrenic patients improve enough to remain out of the hospital but continue to have significant positive or negative symptoms. METHOD: The goal of this study was to assess the safety and potential efficacy of risperidone as an adjunct for schizophrenic patients treated with clozapine. In an open 4-week trial involving 12 DSM-III-R-diagnosed patients, the addition of risperidone to clozapine was well tolerated and did not affect serum clozapine concentrations significantly. RESULTS: Total Brief Psychiatric Rating Scale (BPRS) scores and subscales measuring positive symptoms, negative symptoms, and depressive symptoms were significantly reduced from baseline. Ten of 12 participants had a 20% or greater reduction in the total BPRS score. CONCLUSION: In this open trial, the addition of risperidone to clozapine was well tolerated and produced significant reduction of symptoms, suggesting that this may be a useful clinical approach. Because this was an open trial, the improvement we observed must be replicated in a controlled trial.     

Ketamine as an adjunct to morphine in the treatment of pain

A double-blind multidose trial of the addition of ketamine (0-40 mg, i.m., 8 times per day) to intramuscular morphine therapy was undertaken in a 61-year-old man with chronic back pain related to osteoporosis who had received inadequate pain relief from anterior interbody fusion, dorsal column stimulation and morphine alone. The patient reported only mild side effects. Nausea, tiredness and well-being were not significantly influenced by the ketamine dose level. Visual analogue pain scores prior to each dose were not associated with the ketamine dose level, but pain scores 30 min after doses were significantly reduced in a dose-related manner. In addition, the amount of morphine used by the patient was significantly reduced as the ketamine dose increased. This patient experienced substantial benefit from the addition of ketamine to intramuscular morphine therapy.     

Regional lymph node classification for lung cancer staging

Recommendations for classifying regional lymph node stations for lung cancer staging have been adopted by the American Joint Committee on Cancer (AJCC) and the Union Internationale Contre le Cancer. The objective was to unify the two systems that have been in common use for the past 10 years; that is, the schema advocated by the AJCC, adapted from the work of Tsuguo Naruke, and the schema advocated by the American Thoracic Society and the North American Lung Cancer Study Group. Anatomic landmarks for 14 hilar, intrapulmonary, and mediastinal lymph node stations are designated. This classification provides for consistent, reproducible, lymph node mapping that is compatible with the international staging system for lung cancer. It is applicable for clinical and surgical-pathologic staging.     

Hypnosis as an adjunct to cognitive-behavioral psychotherapy: A meta-analysis.

A meta-analysis was performed on 18 studies in which a cognitive–behavioral therapy was compared with the same therapy supplemented by hypnosis. The results indicated that the addition of hypnosis substantially enhanced treatment outcome, so that the average client receiving cognitive–behavioral hypnotherapy showed greater improvement than at least 70% of clients receiving nonhypnotic treatment. Effects seemed particularly pronounced for treatments of obesity, especially at long-term follow-up, indicating that unlike those in nonhypnotic treatment, clients to whom hypnotic inductions had been administered continued to lose weight after treatment ended. These results were particularly striking because of the few procedural differences between the hypnotic and nonhypnotic treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)