Usefulness of serial carcinoembryonic antigen (CEA) determinations in monitoring chemotherapy

Serial carcinoembryonic antigen (CEA) levels were measured during chemotherapy for metastatic cancer in 94 patients. Criteria for chemotherapy responses were those used by the Central Oncology Group. Patients were classified according to changes in CEA levels and response to chemotherapy. Four categories represented a positive correlation: (1) increasing abnormal CEA with progressing disease, (2) decreasing abnormal CEA with disease regression, (3) unchanged abnormal CEA with stable disease, (4) change from normal to abnormal CEA with progressive disease. Positive correlation of serial CEA levels with clinical responses occurred in 71% of patients with GI cancer, 51% with breast cancer, 42% with sarcoma, 50% with respiratory cancer, and 25% with melanoma. These data indicate that serial CEA determinations may be of value as an additional parameter of response to chemotherapy in gastrointestinal cancer.     

Usefulness of molecular markers for detecting population bottlenecks via monitoring genetic change

It is important to detect population bottlenecks in threatened and managed species because bottlenecks can increase the risk of population extinction. Early detection is critical and can be facilitated by statistically powerful monitoring programs for detecting bottleneck-induced genetic change. We used Monte Carlo computer simulations to evaluate the power of the following tests for detecting genetic changes caused by a severe reduction in a population's effective size (Ne): a test for loss of heterozygosity, two tests for loss of alleles, two tests for change in the distribution of allele frequencies, and a test for small Ne based on variance in allele frequencies (the 'variance test'). The variance test was most powerful; it provided an 85% probability of detecting a bottleneck of size Ne = 10 when monitoring five microsatellite loci and sampling 30 individuals both before and one generation after the bottleneck. The variance test was almost 10-times more powerful than a commonly used test for loss of heterozygosity, and it allowed for detection of bottlenecks before 5% of a population's heterozygosity had been lost. The second most powerful tests were generally the tests for loss of alleles. However, these tests had reduced power for detecting genetic bottlenecks caused by skewed sex ratios. We provide guidelines for the number of loci and individuals needed to achieve high-power tests when monitoring via the variance test. We also illustrate how the variance test performs when monitoring loci that have widely different allele frequency distributions as observed in five wild populations of mountain sheep (Ovis canadensis).     

Modified in situ perfusion of the kidney using balloon catheters

Experiences with the in situ hypotherme perfusion in the operative treatment of calculus in kidneys and calices are reported. A modified technique is presented using an inflatable Swan-Ganz-ballon catheter for simultaneous blocking of renal blood flow and perfusion.     

Usefulness of gastric intramucosal pH for monitoring hemodynamic complications in critically ill children

OBJECTIVE: To assess the efficacy of gastric intramucosal pH for the evaluation of tissue perfusion and prediction of hemodynamic complications in critically ill children. DESIGN: Open prospective study without controls. SETTING: Pediatric intensive care unit (ICU) of a tertiary care university pediatric hospital. PATIENTS: Thirty critically ill children (16 boys and 14 girls), age range: 3 months-12 years. MEASUREMENTS AND RESULTS: A tonometry catheter was placed in the stomach of all patients on admission to the pediatric ICU. Simultaneous tonometry and arterial gas measurements were made on admittance and every 6-12 h throughout the study; a total of 202 measurements were made. The catheter was removed after extubation and/or when the patient was hemodynamically stable. Intramucosal pH was calculated using the Henderson-Hasselbalch equation based on the pCO2 of the tonometer and arterial bicarbonate. Intramucosal pH values between 7.30 and 7.45 were considered to be normal. The patient's condition was analyzed using the Pediatric Risk Mortality Score (PRISM). The relations between intramucosal pH and the presence of major hemodynamic complications (cardiopulmonary arrest, shock), minor hemodynamic complications (hypotension, hypovolemia or arrhythmia), death, PRISM score and the duration of the stay in the pediatric ICU were analyzed. Intramucosal pH on admission was 7.48 +/- 0.15 on average (range 7.04-7.68). Five patients (16%) had an intramucosal pH lower than 7.30 on admission; these patients did not have a higher incidence of hemodynamic complications. The 16 patients (53%) who had an intramucosal pH of less than 7.30 at some time during the course of their disease had more hemodynamic complications than the patients who did not have pH lower than 7.30 (p < 0.0001). Every case of cardiopulmonary arrest and shock was related to intramucosal pH of less than 7.30. Patients with major complications (cardiopulmonary arrest and shock) had lower intramucosal pHs than those with minor hemodynamic complications (p = 0.03); similarly, they had low intramucosal pH readings more often than those with minor complications (p = 0.0032). Intramucosal pH values less than 7.30 had a sensitivity of 90% and a specificity of 98% as a predictor of hemodynamic complications. There was no relation between intramucosal pH lower than 7.30 and either PRISM or the duration of the stay in the pediatric ICU. Patients with intramucosal pH less than 7.20 had a higher PRISM than the patients who did not have pH lower than 7.20 (p < 0.05). A patient who died during the study due to cardiopulmonary arrest had prior intramucosal pH measurements of 7.23 and 7.10, and three patients died of late complications after the end of the study. Hemodynamic complications were not detected with arterial pH. Gap pH (arterial pH-intramucosal pH) and standard pH measurements yielded the same results as gastric intramucosal pH. CONCLUSION: Intramucosal pH could provide a useful early indication of hemodynamic complications in critically ill children.     

Usefulness of central venous oxygen saturation monitoring during cardiopulmonary resuscitation. A comparative case study with end-tidal carbon dioxide monitoring

The usefulness of continuous monitoring of central venous oxygen saturation (ScvO2) in comparison with the capnogram during cardiopulmonary resuscitation (CPR) was demonstrated in a cardiac arrest patient. ScvO2 and end-tidal carbon dioxide (ETCO2) decreased following cessation of chest compression or increased during recovery of systemic circulation. During the complete stasis of systemic circulation, when defibrillation was done, ScvO2 did not change, while ETCO2 gradually decreased. However the larger decrease in ScvO2 temporally occurred when chest compression was resumed. And also the ScvO2 monitoring had great advantage to detecting peripheral tissue oxygenation. ScvO2 seems to be no less accurate and reliable monitoring than the capnogram during CPR procedures. Since the capnogram is non-invasively and easily used in cardiac arrest patients, ScvO2 monitoring combined with the capnogram is a more preferable method for assessing the efficacy of ongoing CPR.     

Pleurodesis with iodized talc for malignant effusions using pigtail catheters

OBJECTIVE: To assess the efficacy of using an iodized talc slurry as a sclerosing agent instilled into the pleural space via a 12-French pigtail catheter for controlling malignant pleural effusions. DESIGN: A prospective study in which patients were followed until their death. SETTING: A university-affiliated tertiary-care teaching hospital. PATIENTS: Medical oncology patients admitted with symptomatic malignant pleural effusions were considered for iodized talc pleurodesis. MAIN OUTCOME MEASURES: The control of pleural effusion. Treatment failure was defined as any reaccumulation of fluid in the pleural space. RESULTS: Fifteen patients were treated for a total of 17 instillations. The median follow-up on all patients until death was 6 months (range 1-20). The most frequent adverse effect in the study group was pleuritic chest pain (60%). The probability of control of effusion, as determined by the method of Kaplan-Meier, was 81% (SEM 9.7%). The cost of preparing 5 g of iodized talc was $4.32 (US). CONCLUSIONS: Iodized talc slurry instilled through a small-bore pigtail catheter is a safe, economical, and effective treatment for malignant pleural effusion.     

Percutaneous transhepatic portal embolization using newly devised catheters: preliminary report

OBJECTIVES: The purpose of this study was to develop a method to identify persons at high risk for acquiring new sexually transmitted infections. METHODS: Computerized medical records from sexually transmitted disease clinics in Dade County, Florida, were used to conduct a retrospective cohort study. For all patients who visited in 1987, risk factors were identified for returning to the clinics within a year with a new sexually transmitted infection. Predictor variables were derived from the index visit and any visits in the year prior to the index visit. Logistic regression was used to develop a model that was applied to all patients who attended in 1989. RESULTS: Of 24,439 patients attending in 1987, 18.5% returned within a year with a new infection. Return rates were highest for 15- to 19-year-old Black males (31.8%). The highest odds ratios for returning were a diagnosis or treatment for an infection in the previous year and a diagnosis or treatment for infection at the index visit. The patients predicted to be at highest risk had a 39% return rate. There were as many new infections among the 2893 patients at highest risk as there were among the 13,326 patients at lowest risk. CONCLUSIONS: We developed a model that identifies persons at very high risk for sexually transmitted infection. These persons should be targeted for intensive intervention to reduce their risk.     

Usefulness of micronucleus assay in radiosensitivity tests using human cancer cell lines

BACKGROUND: Recently, micronucleus assay is expected to be one of the radiosensitivity tests. The usefulness of micronucleus assay was compared with MTT assay and clonogenic assay using 5 human derived urological cancer cell lines, NBT-2, T24, PC3, OS-RC-2, and RERF-LC-AI in vitro. The correlation between the results in vitro assay and the radiation effects of nude mouse in vivo was investigated. METHODS: In vitro, the micronucleus frequency of 2 Gy radiation was scored in micronucleus assay. The survival fraction of 2 Gy radiation was obtained in MTT assay and clonogenic assay. The correlation between 3 assays was investigated. In vivo, cancer cells was inoculated to nude mouse and the tumor volume was measured at 3-7 days interval in control group and 10 Gy irradiated group. The tumor volume ratio in irradiated group to control group was calculated as a radiation effect in each cell lines, the correlation between this ratio in vivo and each value of 2 Gy radiation in vitro was studied. RESULTS: The correlation between micronucleus frequency and survival fraction in clonogenic assay was statistically significant (r = 0.941, p = 0.0169). But the correlation of the survival fraction between MTT assay and clonogenic assay is not statistically significant. The correlation between micronucleus frequency and the tumor volume ratio in vivo was statistically significant (r = 0.990, p = 0.0011). The correlation between survival fraction in clonogenic assay and the tumor volume ratio in vivo was also statistically significant (r = 0.914, p = 0.0298). However, the correlation between survival fraction in MTT assay and the tumor volume ratio in vivo was not statistically significant (r = 0.782, p = 0.118). CONCLUSION: In this 5 cell lines, micronucleus assay was most correlated to nude mouse radiation effect. This result suggested the possibility of micronucleus assay to be a better predictive method than clonogenic assay for radiosensitivity test.     

Patient-controlled epidural analgesia after caesarean section using a disposable device

We have evaluated the use of a disposable device, the Patient Controlled Epidural Infusor, for patient-controlled epidural analgesia (PCEA) using pethidine, for pain relief in the first 24 hours after elective Caesarean section. Patients using the Patient Controlled Epidural Infusor (n = 20) were compared with a control group (n = 20) who received PCEA using a standard electronic device. Efficacy, as assessed by visual analogue scores, was comparable to that achieved in the control group. Patient and nursing satisfaction was high and similar to that in the control group. There was a low incidence of side-effects with both devices. Patients using the disposable device used less pethidine than patients using the electronic device (median (interquartile range) 181 (100-275) mg versus 238 (213-375) mg; p = 0.035). Use of this disposable device is an acceptable alternative to more expensive and bulkier electronic devices for PCEA after Caesarean section.     

Standardization of digital radiologic images

The need for uniform digital formats of radiologic images obtained from the human body by the various methods (CT, MRI, DF, DSA, NM) is felt by both the manufacturers and the radiologists since a long time. The ACR-NEMA standard was initially established to overcome this problem, however it was not fully satisfactory. Its up-dated version, DICOM 3 seems a more successful approach to the solution of the problem. The rationale on which DICOM 3 is based, the main guidelines with some reference to the various parts of the new standard, are analyzed. Its advantages as well as disadvantages are considered in view of a future complete integration of data and images of a radiology department within a hospital information system. In the appendix, a list of DICOM components and addresses where to find the original documentation are supplied.     

Automated scheduling of radiologic procedures

The dramatic advances in radiology have increased the number and type of machines and of daily performed exams. Consequently, workload and management organization problems have also markedly increased. Automated, computerized scheduling of radiologic exams is certainly a step forward in a modern rational management of a Diagnostic Imaging service: the relationship with the patient is improved with the optimization of care delivered and of the radiologist's work, who with the new technology is able to rapidly consult the previous exams as well as the list of exams to be performed. The advances in health care information technology imply communications at a distance. From each ward of the hospital, requests for radiologic exams can be automatically scheduled or kept on a dynamic waiting list for automated input in future work shifts. Via the same system, reports (and also radiologic images) can by rapidly transmitted to the wards. At the "Università Cattolica del S. Cuore" from several years, an integrated information system has been implemented for management of patient data, exams and care delivered. Radiology represents one of major departmental systems of the network for the number of machines installed and the amount of information supplied. The system will be soon able to store images from all digital and nondigital machines, and visualize on dedicated workstations the images of ongoing exams or stored previous ones.     

Microwave hepatic tumor coagulation therapy during stoppage of hepatic blood flow using balloon catheters

The usefulness of microwave hepatic tumor coagulation therapy (MTC) with stoppage of hepatic blood flow using a balloon catheter was assessed. By placing a 5-French balloon catheter in a hepatic artery and 6-French balloon catheter in a hepatic vein, hepatic arterial and portal venous flow of the liver segment including the tumor was interrupted. The effects of balloon occlusion were evaluated by CT during arterial portography. MTC with stoppage of hepatic flow was performed for two patients with metastatic liver tumor 2 cm in diameter. Enhanced CT obtained after MTC showed no enhancement of the tumor, indicating complete necrosis. There were no complications and the two patients were discharged within 4 days after MTC. MTC with stoppage of hepatic blood flow is effective for treatment of hepatic metastatic tumor.     

MRI monitoring of laser ablation using optical flow

The optical flow method is used for visualizing and quantifying the dynamics of tissue changes observed by MRI during thermal ablations. An approach was implemented for parallel two-dimensional optical flow calculations including the replacement of spurious velocities. Velocity magnitude results were found to be accurate in low-noise cases in tests using series of synthetic images. Optical flow results are presented from thermal ablation experiments utilizing a homogeneous polyacrylamide gel phantom and heterogeneous rabbit liver tissue in vivo, exhibiting heating and cooling with the accompanying quantitative characterization of the dilation and contraction of the thermally affected region. Results demonstrate that optical flow is capable of noninvasive real-time monitoring and control of interstitial laser therapy (ILT).