Assessment of regional myocardial uptake and metabolism of omega-(p-123I-phenyl) pentadecanoic acid with serial single-photon emission tomography

The utility of myocardial imaging and assessment of regional myocardial metabolism of omega-(123I-paraphenyl-)pentadecanoic acid (I-PPA) by means of serial single-photon tomography is demonstrated in animal experiments. High quality cross sectional images of dog hearts with clear delineation of left ventricular walls are obtained. Myocardial infarcts are visualized as areas of deficient radioactivity uptake. I-PPA elimination from non-infarcted myocardial regions is significantly (p less than 0.001) prolonged when compared with unaffected controls. Hence, not only localized absence of uptake of free fatty acid by infarcted myocardium can be demonstrated with serial single-photon tomography but also general impairment of cardiac FFA-metabolism.     

Some practical improvements in the continual reassessment method for phase I studies

The Continual Reassessment Method (CRM) is a Bayesian phase I design whose purpose is to estimate the maximum tolerated dose of a drug that will be used in subsequent phase II and III studies. Its acceptance has been hindered by the greater duration of CRM designs compared to standard methods, as well as by concerns with excessive experimentation at high dosage levels, and with more frequent and severe toxicity. This paper presents the results of a simulation study in which one assigns more than one subject at a time to each dose level, and each dose increase is limited to one level. We show that these modifications address all of the most serious criticisms of the CRM, reducing the duration of the trial by 50-67 per cent, reducing toxicity incidence by 20-35 per cent, and lowering toxicity severity. These are achieved with minimal effects on accuracy. Most important, based on our experience at our institution, such modifications make the CRM acceptable to clinical investigators.     

Skin cancers at Tertiary Referral Skin Hospital in Singapore

BACKGROUND: Skin cancer is the seventh most common cancer in Singapore. This study was performed to determine the pattern of skin cancers seen in a tertiary referral skin hospital. METHODS: Histologically confirmed skin cancers, seen between 1980 and 1991, were analyzed according to age, sex, race, site, and presence/absence of preexisting skin conditions. RESULTS: Of a total of 520 patients, the commonest skin cancer was basal cell carcinoma (BCC) (36.5%), followed by squamous cell carcinoma (SCC) (24.4%), Bowen's disease (16.7%), and mycosis fungoides (9.0%). Malignant melanomas (2.7%) were rare. The sharp increase (26.2%) in BCC in the recent 3 years was largely contributed by a fivefold increase of non-resident Caucasian patients with BCC. All types of skin cancers were more common in Chinese (78.1%) and less frequent in the more pigmented races (9.4%). The men to women ratio was 1.72:1. The peak age distribution was in the 51-70-year group, with the exception of mycosis fungoides (31-50 years). The commonest site involved in BCC was the head and neck (67.0%) and in Bowen's disease the trunk (33.3%). Squamous cell carcinoma was found on the head and neck and the lower extremities with equal frequency (29.3%) and 46.2% of all SCC on the lower extremities occurred in leprosy patients with chronic trophic ulcers. Of patients with Bowen's disease involving the nonsunexposed parts (trunk and upper extremities), 42.6% had probable arsenic exposure evident either from the history or clinical examination. Malignant melanomas were commonly located on the foot (71.4%). CONCLUSIONS: The commonest skin cancers seen were BCC, SCC, Bowen's disease, and mycosis fungoides. There were differences in the site distribution of SCC, Bowen's disease, and malignant melanomas in our study when compared to studies in Caucasians.     

Review of liver trauma management in Tasmania: an analysis of risk factors for mortality and morbidity

A review of liver trauma treated by the major trauma care facilities of Tasmania in the 5 year period between 1989 and 1993 is presented. The aim of this retrospective review was to provide an audit of the management of liver trauma in the island of Tasmania and to analyse the risk factors contributing to mortality and major morbidity. Thirty-seven patients were treated with a median Injury Severity Score (ISS) of 14 (range 9-34). The overall mortality rate of this series was 5.8%. Age, mechanism of injury (blunt or penetrating), delay prior to hospital presentation and modality of treatment (operative or non-operative) were not significant risk factors for mortality and morbidity; however, transfusion requirement of over 10 units of blood (P < 0.005), ISS score of over 20 (P < 0.0005), haemodynamic instability at presentation (P < 0.05) and a Hepatic Injury Score (HIS) grade of 3 or more (P < 0.05) were statistically significant risk factors.