When wait lists are not feasible, nothing is a thing that does not need to be done.

[Correction Notice: An erratum for this article was reported in Vol 78(3) of Journal of Consulting and Clinical Psychology (see record 2010-10440-011). There is an error in the computation of Equation 4 (p. 1165): z does not equal 2.44 as reported but, instead, equals 1.73. We had not divided by the denominator ( 2). This makes p(one-tailed) .042, not .007 as reported. The interpretation of this computation does not change, although the level of probability does. Rather than being confident that the two studies are from different populations with a p level of .007, we are still likely to see these studies as having obtained significantly different results but at the probability level of p .05.] Clinical psychology practices initially grew through the use of case studies, uncontrolled trials, and eventually through randomized controlled trials (RCTs). The use of a wait-list control group is standard practice in such trials of treatment regimens for psychopathological conditions. However, as knowledge advances regarding the successful treatment of such conditions, best practice guidelines are being developed. These guidelines have predominantly been based on the results of RCTs and use aggregating mechanisms, such as meta-analysis, to derive their conclusions. The authors argue here for statistical methods that allow for comparisons to existing data from wait-list controls for which the continued use of wait-list conditions has become problematic. Using posttraumatic stress disorder (PTSD) as an example, this article proposes various methods for obviating the need for a wait-list control under such circumstances. After conducting separate meta-analyses for both treatment and control conditions, the authors found that wait-list conditions do provide some benefit to participants with PTSD, but current best practice treatment conditions elicit far superior effect sizes. The various methods for evaluating a study without a wait-list control are proposed and demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Classifying meconium-stained liquor: is it feasible?

Four samples each of clear and lightly (thin), moderately, and heavily (thick) meconium-stained amniotic fluid were divided in two portions and submitted twice for assessment to 20 midwives (a total of 320 case assessments). None of the midwives completely agreed with the standard assessment for more than 85 percent of the cases. When disregarding clear samples, for which there was good agreement, each of the midwives classified on average only 35.8 percent of the meconium-stained samples in the same category on each of the four occasions that they were presented to them. Calculation of kappa statistics, which express proportional agreement corrected for chance, indicated that none of the midwives showed very good agreement (kappa > 0.81) with the standard and that fewer than 10 percent showed very good agreement with themselves. The data indicate that grading the severity of meconium staining by visual assessment has such poor accuracy and precision that it cannot provide a valid basis for assigning different care policies to different degrees of meconium staining.     

Gene therapy for hemophilia: feasible in principle but not yet clinically applicable]

The current treatment of haemophiliacs consists of injection of concentrates of blood clotting factors VIII (haemophilia A) and IX (haemophilia B). The inconvenience of the multiple injections needed, and the risk of transmission of infectious agents (HIV, hepatitis) prompted the development of alternative therapies. Gene therapy aims at introducing functional factor VIII and IX genes into the body cells of patients in order to make these cells produce the desired clotting factors. There are two strategies for gene therapy: (a) in the laboratory cells of the patient may be provided with the desired gene, followed by reintroduction of the cells that now produce factor VIII, into the patient (ex vivo strategy); (b) vectors with the desired genes may be injected into the patient in order to induce the modification (in vivo strategy) For both routes, the formal proof-of-principle has been acquired recently in animal experiments: cells modified by factor VIII or IX genes will produce adequate concentrations of the clotting products in plasma and will correct the bleeding tendency. Before the clinical evaluation and widespread application of the technology can be considered many technical problems have to be solved.     

Significance of terminal rinse for rat liver preservation

A terminal rinse (TR) is standard practice in liver preservation with University of Wisconsin solution (UW) to avoid a potassium load. The fact that sodium lactobionate sucrose solution (SLS) is an effective organ preservation solution with a low potassium provided an opportunity to evaluate rat liver preservation without the TR step. Its importance was investigated in 122 rat liver preservation experiments. In study 1, UW and a hydroxyethyl starch-free, modified UW (UWm) were used for 20-hr liver preservation followed by either no TR or Ringer's lactate TR. The 1-week survival was: UW-TR, 2/14; UW-no TR, 1/6; UWm-TR, 0/6; UWm-no TR, 5/5 (P < 0.01). In study 2, livers were stored for 30 hr in SLS, UW, UWm, and UWm + chlorpromazine 5 mg/L, all without a TR. Nine of 11 rats survived 7 days after SLS, but there were no survivors in the other groups (P < 0.05). Study 3 compared no TR with TR with SLS, Ringer's lactate (RL), or a modified Carolina rinse (CRm) after 30-hr SLS preservation. Survival, serum aspartate aminotransferase and alanine aminotransferase, and histology were assessed. One-week survival of 9/11 rats in no TR was significantly better than in the other groups (3/14 in TR-SLS, 0/8 in TR-RL, and 0/14 in TR-CRm, P < 0.01). The values of aspartate aminotransferase (mean +/- SE) 3 hr after transplantation were 1862 +/- 439 U/L, 3334 +/- 817 U/L, 6591 +/- 1944 U/L, and 7028 +/- 1704 U/L, respectively, in no TR, TR-SLS, TR-RL, and TR-CRm. There were significant differences both in aspartate aminotransferase and alanine aminotransferase between no-TR and each of TR-RL and TR-CRm (P < 0.05). Liver specimens from rats killed 3 hr after OLT showed only mild injury in the no TR group and severe injury in the remaining groups. We conclude that a terminal rinse is harmful in rat liver preservation.     

Surgery for lung cancer: age alone is not a contraindication

A retrospective analysis of the clinical features, operative procedures, postoperative complications and subsequent survival of 70 (50 male) elderly patients undergoing surgery for lung cancer compared with 74 (53 male) younger patients treated at the same hospital during the same period was performed, to determine if elderly people with lung cancer are less likely to benefit from and/or tolerate surgery. The elderly group had to wait longer for operation (p = 0.001) and were more likely to have pre-existing disease (p = 0.019). In contrast, they had fewer recognised postoperative complications (p = 0.032) and there was no difference between the two groups in perioperative mortality and subsequent survival. Surgical treatment of localised lung cancer represents the best chance for cure and this study suggests that age should not be a consideration in the decision to operate or not. The patient's general state of health should be assessed and management decisions based on individual status rather than on age.     

Normothermic preservation of "multiple organ blocks" with a new perfluorooctyl bromide emulsion

To evaluate the efficiency of fluorocarbon emulsions as oxygenating media for the normothermic preservation of organs (multiple organ blocks, MOB), a new perfluorooctyl bromide (perflubron) emulsion was compared with a mixture of modified Krebs solution and blood. The fluorocarbon emulsion used (90% w/v of fluorocarbon) contained a low amount of egg yolk phospholipid (EYP, 2% w/v) and was stabilized by a mixed fluorocarbon-hydrocarbon amphiphile C6F13C10H21 (F6H10). Blood of 4 rat MOBs was replaced with a 36% w/v fluorocarbon emulsion which has been complemented with albumin and electrolytes (EMOBs). 5 MOBs were perfused with a mixture of blood and albumin-containing Krebs solution (KBMOBs). Lactate, amylase and creatine kinase were lower (p < 0.05) at 60 and 120 min in EMOBs than in KBMOBs,     

Metastatic endocrine tumors: is there a place for liver transplantation?

Immunotherapy with cytokines may be an additional option in the treatment of primary uveal melanoma or melanoma metastases. A study of the effect of cytokines on cultured uveal melanoma cells may predict the effect that cytokines may have in vivo. Knowledge about the influence of cytokines on HLA expression may be especially beneficial, as HLA expression is essential for immune recognition. However, little is known about the normal expression of the HLA antigens on uveal melanoma cells in tissue culture. We therefore determined the HLA expression on short-term cultures of uveal melanoma cells and compared the results to the expression on tissue sections of the original tumors. In vivo and in vitro expression of the monomorphic HLA class I determinants and of HLA-A (R = 0.77) correlated well. A slightly lower agreement was observed for expression of HLA-B (R = 0.68). In vitro growth was associated with a decrease in expression of the class II determinant HLA-DR. We conclude that expression of HLA class I on cultured melanoma cells corresponds to the expression on the original tumor, allowing the applicability of cultured cells as predictors of responsiveness to cytokines in vivo.     

Ethanol, not fat accumulation per se, increases free radical production in a low-flow, reflow liver perfusion model

Twenty-seven diarrheagenic Escherichia coli (DEC) strains from five closely related, genetically distinct clones (DEC 3, 4, 8, 9, and 10), representing serotypes commonly associated with Shiga-like toxin production, i.e., O15:H-, O26:(H11, H-), O111:(H8, H11, H-), and O157:H7, were evaluated for colicinogeny on Luria agar or Luria agar containing 0.25 microgram/ml mitomycin C to induce colicin production. Ten (37%) of the DEC strains tested were colicinogenic. One of 11 serotype O157:H7 strains, DEC strain 4E, produced a colicin identified as Col D. DEC strains 8B, 9D, and 10B produced Col E1, whereas DEC strain 10A produced Col E2. DEC strains 8A, 8E, 10C, 10E, and 10F produced "untypable" colicins that killed almost all Pugsley Colicin Reference Set strains and the other DEC strains tested. To aid with further characterization of the colicins, plasmids extracted from each colicin-producing (Col+) DEC strain were used to transform E. coli strain DH5 alpha. All Col+ DH5 alpha transformants contained one plasmid ranging in size from 1.3 to 10 kb. Some transformants were stable colicin producers whereas others were unstable. The inhibitory activity and colicin sensitivity and insensitivity profiles of the Col+ transformants were similar to those of the corresponding Col+ donor DEC strains. It appears that the untypable colicins are novel and, thus, warrant further study. Colicin production by some of the DEC strains evaluated partly explains why they were insensitive to standard colicins in a previous study.     

First experience and technical aspects of isolated liver perfusion for extensive liver metastasis

BACKGROUND: New drugs and modalities for locoregional tumor treatment in recent years may offer new potential for isolated liver perfusion in patients with nonresectable liver tumors. The purpose of this study was to prove the feasibility of arterial isolated liver perfusion and to assess the tolerance of perfusion with high-dose tumor necrosis factor (TNF). METHODS: Twelve patients with extensive liver metastases previously treated unsuccessfully with systemic chemotherapy underwent isolated hyperthermic liver perfusion using a heart-lung machine. High doses of mitomycin were administered in the first six and a combination of TNF and melphalan in the last six patients. RESULTS: No operative death occurred and no direct postoperative liver failure was observed in any patient. In cases of variations of the arterial hepatic blood supply, the perfusion was done through the splenic artery or an angiography catheter. Histologic analysis of tumor biopsy specimens obtained on the first postoperative day revealed major tumor necrosis in 8 of 12 patients. CONCLUSIONS: Isolated arterial perfusion of the liver is a complex surgical procedure that is feasible in patients with anatomic variations of the hepatic artery. The remarkable histologic response to perfusion in several pretreated patients, especially after application of high-dose TNF and melphalan, suggests that this modality is very effective in tumor killing.     

Lithium carbonate therapy is not a risk factor for osteoporosis

Lithium carbonate is a widely used drug for affective disorders. It may effect calcium metabolism and alter parathyroid physiology by causing hypersecretion of parathyroid hormone. Patients treated with this medication might therefore be predisposed to osteoporosis. The purpose of this study was to evaluate the effect of either short- or long-term lithium carbonate therapy on parameters of bone metabolism. Parathyroid function and indices of bone metabolism were assessed in 23 patients treated for affective disorders. 10 patients were treated for 0.4-1.0 year (Group 1), and 13 patients were treated for more than 3 years (Group 2). In all subjects, bone mineral density measurements in the hip and lumbar spine regions were performed using dual energy X-ray absorptiometry. Serum thyroid hormone, PTH, LH, testosterone and urine OH-proline, free cortisol, calcium and phosphate excretion were measured. The two groups were well matched for sex, weight, calcium intake, lithium levels and smoking habits, although Group 2 was slightly older. No differences between the two groups were noted in either bone mineral density or other parameters that were assessed. Urinary OH-proline was elevated similarly in both groups. Our results did not detect any effect on bone density after short- or long-term lithium carbonate therapy, although the data does suggest an increase in bone turnover associated with this treatment. Thus, short- or long-term treatment with lithium is not associated with increased risk for osteoporosis.     

Large-volume liposuction and extensive abdominoplasty: a feasible alternative for improving body shape

Forty-two female patients underwent liposuction of large volumes and extensive abdominoplasty during an 18-month period, with an average follow-up period of 9 months. Fifty-two percent of the patients underwent a third surgical procedure, which was basically aesthetic. The average age was 40 years; weight varied between 51 kg and 113 kg, with only 11 percent of the patients at their ideal weight. The tumescent technique was used for performing liposuction, which was done on the loins, trochanters, lumbar, upper scapular, and upper lateral abdominal regions, avoiding liposuction of the abdominal flap in all cases except for one. The abdominoplasty was extensive with detachment to the xiphoid process without detaching liposuctioned areas. Volumes of 1600 ml to 11,200 ml were obtained through liposuction, with an average of 4230 cc, and minimal blood loss. Fatty dermal tissue was removed through abdominoplasty and it varied between 400 g and 5000 g with an average of 1300 g. Only the two heaviest patients required an autologous blood unit, because they underwent breast reduction at the same time. All the other patients were managed exclusively with intravenous crystalloids solutions. No major complications arose, and only five patients had minor complications. Based on these results, we consider it to be feasible to combine the liposuctioning of large volumes with abdominoplasty to improve body shape, even with the addition of a third surgical procedure. Nevertheless, it is essential to use the tumescent technique for liposuction to reduce bleeding to a minimum and to allow us to perform other procedures.