An absolute requirement for serum macromolecules in phytohaemagglutinin-induced human lymphocyte DNA synthesis

We have examined the effect of different variables such as tissue culture media, with or without various supplements, lymphocyte isolation techniques, lymphocyte contamination by autologous red blood cells and platelets, and lymphocyte numbers, on the requirement for serum during phytohaemagglutinin (PHA) induced DNA synthesis in human lymphocytes. At all mitogen doses tested, we have found that dialysable constituents of serum enrich the ability of all tissue culture media to support lymphocyte DNA synthesis; however, human lymphocytes display an absolute requirement for nondialysable macromolecular constituents of serum in order to synthesize DNA.

Improved food intake and reduced nausea and vomiting in patients given a restricted diet while receiving cisplatin chemotherapy

Administration of cisplatin alone or in combination with other cytotoxic agents commonly produces intractable nausea and vomiting, which is currently controlled through high-dose antiemetic drugs. However, patients often refuse continued therapy because of suboptimal control of nausea and vomiting and substantial decline in nutritional status. In this pilot study, 19 patients receiving cisplatin were evaluated for nausea and vomiting, amount of food intake, and subjective assessment of well-being. The study group received a colorless, odorless, predetermined meal three times daily; the meal included cottage cheese, apple sauce, vanilla ice cream, and other selected foods. Control-group patients selected their own meal. Study-group patients exhibited higher overall food intake, decreased nausea and vomiting, and a higher scored estimation of well-being. The findings of this preliminary study indicate that the study diet helps provide nutrition care to cancer patients receiving cisplatin chemotherapy and helps create an atmosphere where the patient believes he or she has some control in the treatment outcome.

Douglas Altman's 2009 Grand Lecture: Can we trust our literature?

Recent studies of the medical literature have revealed numerous and serious problems. Errors in the design, methods and interpretation of studies can frequently be identified. A huge hidden problem is publication bias, the tendency for positive articles to be published, while negative articles are either not written or submitted. This can systematically lead to an overestimation of the value of treatments, of diagnostic or prognostic studies. Even more worrisome is selective reporting: only a subset of a wide array of tested hypotheses are presented (the ones that turned out to be positive with significance testing). This is particularly true for secondary endpoints and subgroup findings, but even the primary endpoints of trials have been modified when publications are compared to protocols. The peer-review process is fallible. Even if it were strengthened, reviewers cannot examine what is not reported. Hence many problems can only be mitigated with better reporting. Numerous initiatives have proposed guidelines to promote transparent reporting, but progress is slow.

Inter- and intraobserver variability in the assessment of brain arteriovenous malformation angioarchitecture and endovascular treatment results

BACKGROUND AND PURPOSE

Several angiographic features of brain arteriovenous malformations (BAVMs) have been associated with an increased risk of hemorrhage. However, interpretation of these features may not be consistent between observers. We conducted a study to determine inter- and intraobserver agreement of various angioarchitectural characteristics of BAVM.

MATERIALS AND METHODS

Two experienced interventional neuroradiologists independently reviewed pre- and post-endovascular treatment angiograms from 50 consecutive patients. Axial CT and/or MR images before treatment were included. We collected the following data: Spetzler-Martin grades, number of involved arterial territories, associated aneurysms by location (circle of Willis, feeding artery, intranidal, and venous), and nidus reduction after endovascular treatment (<33%, 33%-66%, and >66%). The reviewers were compared with each other, and 1 was compared with himself after a 3-month interval. Measures of agreement were performed by using the kappa statistic (kappa) for nominal data and the weighted kappa for ordinal data.

RESULTS

Inter- and intraobserver agreement were higher for assessment of the Spetzler-Martin grade (weighted kappa = 0.70/0.75) and nidus size reduction after endovascular treatment (kappa = 0.74/0.77). Inter- and intraobserver agreement were inferior for findings concerning feeding artery aneurysms (kappa = 0.19/0.36), intranidal aneurysms (kappa = 0.34/0.35), and venous aneurysms (kappa = 0.50/0.67).

CONCLUSION

Angiographic characteristics of BAVMs considered as risk factors for hemorrhage, such as aneurysms, are not reliably detected on global angiograms between different observers. In contrast, the Spetzler-Martin grading system and angiographic results of endovascular treatment can be used with high observer agreement.

Arterial injuries in transsphenoidal surgery for pituitary adenoma; the role of angiography and endovascular treatment

PURPOSE

To define the role of angiography and embolization in the treatment of patients who have arterial injuries during transsphenoidal surgery.

METHODS

We retrospectively studied the arterial hemorrhagic complications, their management, and the clinical outcomes that occurred in 21 of the more than 1800 patients who had transsphenoidal surgery for pituitary adenomas.

RESULTS

Of the 21 patients who had complications, 17 had internal carotid injuries and four had injuries of the sphenopalatine artery. Angiography was performed in 18 patients. Bleeding occurred and was controlled during surgery in 16 cases. Delayed epistaxis occurred in 10 patients, including five whose surgery was uneventful. After internal carotid injury, the most frequent angiographic findings were carotid occlusion (eight patients), stenosis (five patients), and false aneurysms (three patients). Internal carotid balloon occlusion was performed in five patients. No rebleeding occurred in patients who had complete carotid occlusion either from surgical packing or balloon embolization. Two of the patients who had carotid stenosis after surgical packing had delayed epistaxis necessitating balloon occlusion. Injuries to the sphenopalatine artery were successfully treated by surgery (one patient) or by endovascular treatment (three patients) without complication. Three deaths and five permanent deficits were directly related to the arterial injury or its treatment.

CONCLUSION

Profuse bleeding during and after transsphenoidal surgery should be investigated by angiography. Lesions of the sphenopalatine arteries are effectively treated by embolization. Internal carotid injuries are best treated by carotid infusion to prevent life-threatening epistaxis.

Cell surface adenosine 5'-triphosphatase as an in vitro marker of the lineage and cytodifferentiation of oncogenic epithelial cells from rat liver parenchyma

The relationship between the oncogenicity and the surface properties of cultured liver epithelial cells has been studied with the newborn Wistar rat-derived euploid line, RL34, and its heteroploid variants. An oncogenic variant, RL34HT, appeared to be more functionally active than its nononcogenic counterparts with respect to cell surface adenosine 5'-triphosphatase (ecto-ATPase) as well as to cytoplasmic enzymes such as tyrosine aminotransferase, gamma-glutamyl transpeptidase, and alkaline phosphatase. The cell surface of RL34HT was distinguished from those of nononcogenic and marginally oncogenic cell populations by the presence of abundant microvilli and by the absence of large external transformation-sensitive protein (fibronectin). High-Km and high-Vmax Ca2+-Mg2+ -ecto-ATPase was found in RL34HT. All nononcogenic cell lines had a flat granular surface membrane with high levels of fibronectin and also exhibited ecto-ATPase activity with low Km and low Vmax. When RL34HT was grown in dibutyryl cyclic adenosine 3',5'-monophosphate and theophylline, the external cell surface was partially restored to the polypeptide compositions of RL34, and there was an increase in Vmax of ecto-ATPase without a change in Km. The high-Km ecto-ATPase may be a useful indicator reflecting the lineage and cytodifferentiation of oncogenic liver epithelial cells, since it is also known to be localized at the bile canalicular microvilli of normal adult hepatocytes.

Radiation doses to patients in neurointerventional procedures

PURPOSE

To evaluate stochastic and deterministic risks associated with neurointerventional procedures for the patient.

METHODS

Eight neurovascular interventional procedures were evaluated to determine the entrance skin dose and effective dose for the patient. Dosimetry was done with thermoluminescence dosimeters. The highest dose on the patient's head was recorded as the maximum entrance skin dose. The equivalent dose was obtained by conversion of the dose-area product using published conversion tables.

RESULTS

The maximum entrance skin dose varied from 129 to 1335 mGy. The mean effective dose was 1.67 mSv with a range of 0.44 to 3.44 mSv. No deterministic effect has been encountered. Stochastic risk linked to the highest effective dose value was approximately one death by fatal cancer for every 6000 procedures, according to the new International Commission on Radiological Protection coefficient.

CONCLUSIONS

Because no deterministic effect has been detected, and stochastic risks were very low, radiation hazard to the patient is a minor consideration in deciding whether to undertake a neurointerventional procedure.

Nutrition for the first Total Artificial Heart patient: implications for future patients

Since the mid-1960s, millions of dollars in federal funds have been used for research in the development of the Total Artificial Heart (TAH). Significant advances in bio-materials and pump and energy systems, as well as animal experimentations, have led to the clinical reality of the TAH's use in man. On December 2, 1982, Dr. Barney Clark became the first recipient of a permanent TAH. He had been suffering from terminal congestive heart failure secondary to idiopathic cardiomyopathy. No other treatment was available, since, at the age of 61, he was too old for heart transplant. Dr. Clark's 112-day hospitalization was complicated by pulmonary problems, renal insufficiency, seizures, nosebleeds, and a broken heart valve. Dr. Clark appeared malnourished before surgery, and his numerous postoperative complications confounded attempts at nutritional support. Standard nutritional assessment techniques were inadequate or inappropriate in the face of severe edema, renal failure, and multiple transfusions. Although nitrogen balance was achieved intermittently, for the majority of his hospitalization Dr. Clark remained in negative nitrogen balance, due mainly to renal insufficiency. Some of the nutritional complications seen in the first TAH patient might have been preventable with early nutritional assessment and more aggressive support. The Artificial Heart Management Team at the University of Utah now includes a nutritionist, and future protocols outline detailed nutrition monitoring.

The cecal diaphragm

A detailed radiologic, colonoscopic, and histologic analysis is described in the case of a cecal web presenting as a "cecal mass." The demonstration of a transverse band-like lucency proximal to the ileocecal valve should prompt careful double-contrast barium studies, to which endoscopy may be added, enabling a correct diagnosis to be made.

[Helicobacter pylori infection in children of developing countries]

A characteristic feature of Helicobacterpylori infection in developing countries is early acquisition of the bacteria during childhood. Recent study has documented the frequency of transient infection in young children in particular during the first year following eradication therapy. Children living in developing countries present several risk factors for acquisition including crowding, young age, and recurrent gastroenteritis. The risk of infection increases significantly in function of the number of infected persons in a child's family. Using molecular biology techniques based on gene sequencing, we have shown that strains in different members of the same family were identical not only between parents and children but also between siblings. The relationship between chronic diarrhoea, retarded growth, iron-deficient anaemia, and Helicobacter pylori infection in children especially from developing countries remains controversial. Gram staining of biopsy smears to detect Helicobacter pylori is an efficient diagnostic method and can be a good alternative when culture is unfeasible. Respiratory testing and detection of antigens in stools are effective and appear to be well suited to diagnosis of Helicobacter pylori infection. In developing countries Helicobacter pylori is a common infectious agent warranting further study to gain insight into clinical presentation, epidemiological features, and treatment requirements including sensitivity to antibiotics

Implementation of a computerized information system in a long-term care facility

The successful implementation of computerized nursing information systems requires the completion of many tasks and the participation of many persons. In 1989, Pulliam and Boettcher described a six-step process for introducing computerized information systems into long-term care facilities. This article describes the process, particularly the implementation phase, as it actually happened in a 124-bed facility in a mid-Atlantic state. This facility found that successful implementation requires a systems coordinator who is a professional nurse who understands the needs of the patients, can integrate information with the computer system, and can provide on-going support for the users.