The effect of 'detailing' on physicians' prescribing behavior for postsurgical narcotic analgesia

Physicians have been frequently reported to prescribe inadequately pain medication in the hospitalized patient. A number of methods and techniques have been attempted to alter this phenomenon including audit, standard setting, drug utilization evaluation and sanctioning. The purpose of the following study was to demonstrate the behavioral efficacy of the technique of detailing. We reviewed the postsurgical records of 320 patients for pre-established criteria on the administration of meperidine before and after detailing of the proper prescribing with regard to timing and dose. The data show 30% of the sample meeting the criteria before detailing and 43% after detailing had been given. We conclude the method of detailing can be effective in altering physician's prescribing behavior for meperidine in postoperative surgical patients.

Results from the NOAA National Status and Trends Program on distribution and effects of chemical contamination in the coastal and estuarine United States

The NOAA National Status and Trends (NS&T) Program has been monitoring chemical contamination in fish livers, and surface sediments since 1984 and in molluscan tissue and sediments since 1986. Data from fine-grained sediment at 175 sites are used to describe the spatial distribution of contamination throughout the coastal and estuarine United States. Highest levels are generally found in, and considered representative of, urban areas. It should be noted, however, that these levels are not as high as have been found near discharge pipes or in isolated industrial areas through other monitoring efforts. Dramatic biological responses, such as liver tumors in fish or apparently toxic contaminant levels in sediment, are found infrequently. Subtle biological changes, especially those that affect reproductive ability, are being sought. Data from three annual collections of mollusks have been used to identify early signals of temporal trends in contamination at NS&T sites.

Concentrations of organic contaminants in mollusks and sediments at NOAA National Status and Trend sites in the coastal and estuarine United States

Mean concentrations of PAHs, PCBs, and DDT in mollusks and sediments at sites in the National Status and Trends Program (NST) are distributed in log-normal fashion. The dry weight-based chlorinated organic concentrations in mollusks generally exceed those in nearby sediments by an order of magnitude. PAHs are found at similar concentrations in sediments and mollusks. Highest concentrations of PCBs and DDT in mollusks are in the ranges of 1000 to 4000 ng/g (dry) and 400 to 1000 ng/g (dry), respectively. The highest PAH concentrations in sediments are in the 10,000 to 50,000 ng/g (dry) range. While higher concentrations of contaminants can be found by sampling localized hot spots, the NST data represent the distribution of concentrations over general areas of the coastal United States.

Pioneer growth cone steering decisions mediated by single filopodial contacts in situ

In grasshopper embryo limb buds, the sibling Ti1 pioneers are the first neurons to initiate axonogenesis. The pioneer growth cones migrate from the limb tip to the CNS along a in direction comprising discrete steering events. Filopodial exploration of the cellular terrain in the vicinity of the advancing growth cone appears to be important for steering. Some information is available on the identity of cells and cell types, on cell-surface characteristics, and on the involvement of basal lamina in these steering decisions. In the work reported here, we have used computer-enhanced fluorescence video microscopy to examine filopodial behavior and the process of growth cone migration and reorientation resulting from interactions with the normal guidance cues on the in situ substrate. We observed several different kinds of migration and steering events, which appear to be related to the absolute and relative affinities of the contacted substrates. On a relatively homogeneous substrate of intrasegmental epithelium, growth cones advance by extending veils between filopodia, as is commonly observed on uniform substrates in vitro. Where growth cones confront an orthogonal border between substrates of dissimilar affinity, they remain on the higher-affinity substrate by extending new branches along it. Subsequently, reorientation in the preferred direction on the higher-affinity substrate is accomplished by regression of branches extended in the nonselected direction. By contrast, a single filopodial contact with a very high-affinity substrate, such as a guidepost neuron, can reorient a growth cone, even when it is migrating on a favorable substrate. In this situation, the filopodium that contacts the high-affinity substrate expands in diameter until it becomes the nascent axon.

Nail re-growth in fingertip injuries

One hundred and fifty-five fingertip injuries were treated over a one-year period. Seventy-six patients with 90 fingertip injuries attended for follow-up. Sixty-four of these injuries were suitable for study. In ten cases, the nail was either trimmed and left in-situ, or cleaned and replaced (Group A). In the remaining 54 cases, the nail was either missing, or had been removed at operation (Group B). The two groups were compared in terms of nail re-growth and nail appearance, but no statistically significant difference was found. There was a direct correlation between final outcome and the degree of crush injury. We conclude that it is the severity of the original injury and the accuracy of the primary repair of the nailbed which are the main determinants of the outcome of a nailbed injury. Non-replacement of the nail did not appear to adversely affect nail re-growth and nail appearance.

Prenatal specification and target induction underlie the enrichment of calcitonin gene-related peptide in the trigeminal ganglion neurons projecting to the cerebral vasculature

The neurotransmitter calcitonin gene-related peptide (CGRP) is enriched in the adult rat trigeminal visceral projection to the cerebral arteries compared both to other neurotransmitters in this projection and to the percentage of CGRP-positive trigeminal cells projecting to cutaneous targets. In colchicine-treated ganglia approximately 30% of adult trigeminal ganglion cells projecting to the middle cerebral artery contain CGRP. Several possible developmental mechanisms underlying this enrichment were investigated. Some of this enrichment is accounted for by a prenatal selection of CGRP cells in the cerebrovascular projection. The remainder of the enrichment can be explained by a late (postnatal days 55-90) target-induced expression of CGRP in some trigeminal neurons innervating cerebral arteries. Most surprisingly, the massive postnatal regression in the trigeminal projection to the cerebral arteries (between postnatal days 5 and 55, cell death and axon retraction delete 3/4 of the neurons that innervate the middle cerebral artery neonatally) has no role in the CGRP enrichment in the cells remaining at maturity in this projection. These regressive events appear to affect equally the CGRP-positive and CGRP-negative populations. However, axon retraction is involved in the postnatal loss of CGRP enrichment seen in 1 small subpopulation of the trigeminal projection. Each trigeminal cell in this population sends axon collaterals to both the cerebral artery and the forehead skin neonatally, and then later most of these dually projecting neurons retract only their artery collaterals but do not die. A low percentage of CGRP-containing neurons does not appear to predate artery collateral retraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunoassay for detection of feline immunodeficiency virus core antigen

The feline immunodeficiency virus (FIV) is a recently identified feline lentivirus that has been found at significant levels in domestic cat populations worldwide. A microdilution plate format, monoclonal antibody-based enzyme-linked immunosorbent assay was developed for the detection of the FIV group-associated antigen (gag) designated p24. Assays of serially diluted samples containing disrupted virus showed that the assay had a sensitivity limit of approximately 0.2 ng/ml for FIV p24. The assay was approximately eightfold more sensitive than the assay for viral reverse transcriptase activity when it was tested with diluted tissue culture samples. A qualitative confirmation assay by standard antibody inhibition techniques was coupled to the screening test methodology. The test was used to detect and confirm the presence of virus in cultured feline lymphocytes from infected animals.

An algorithm for generation of implant plans for high-dose-rate irradiators

An algorithm is described for generating a treatment plan with minimal input from the user for a remote high-dose-rate afterloading irradiator. The algorithm generates a plan after locating all catheters involved and an area of interest on each catheter, and two additional numbers are specified: a radial distance and a target dose. The treatment volume becomes the locus of all points that are within the specified radial distance from any point within the area of interest on any catheter (except for the end points). For a single catheter, the volume may be alternately outlined on an x-ray film of the implant. The routine uses a linear programming formulism to compute which dwell positions are to be used, as well as the dwell time at each position, to irradiate the treatment volume to the target dose while minimizing the total volume integrated dose to the patient.

A dosimetric comparison of three compensator design methods for the mantle field

The mid-plane dose was measured in an anthropomorphic phantom for parallel opposed mantle fields as typically used in the treatment of Hodgkin's Disease. Doses were measured for four cases: no compensator, a compensator designed by a three-dimensional CT based treatment planning algorithm, a compensator designed from a port film, and a compensator designed from surface topography. The results showed all three compensators gave a significant better dose distribution than using no compensator at all. Without a compensator, doses varied from 92 percent to 131 percent, with a standard deviation of 10.9 percent for 65 measured points. The treatment planning algorithm gave the best performance with a standard deviation of 3.2 percent with all points but three within 5 percent out of the 65 points measured, and no points outside of 10 percent. The port film compensator was next best with a standard deviation of 4.4 percent, with 19 points outside of 5 percent, and doses from 88 to 106 percent. The surface topography compensator had a standard deviation of 6.1 percent with 31 points outside of 5% and doses from 89 to 114 percent.

An algorithm for design of beam compensators

Beam compensators are optimally designed to give a uniform dose to any plane or midsurface that intersects a single beam, or to give a uniform dose to the volume defined by the intersection of two or more beams. The primary and scatter components are taken into account separately, as well as the patient's shape and internal heterogeneities. The design of the beam compensators is formulated as a linear programming problem and solved with a variation of the Simplex Method. Beam weighting factors are also obtained as part of the solution.

Effect of dietary omega-3 and omega-6 fatty acids on development of azaserine-induced preneoplastic lesions in rat pancreas

We examined the effect of varying the ratio of dietary omega-3 (omega 3) to omega-6 (omega 6) on the development of pancreatic preneoplastic lesions in male Wistar rats given azaserine at 14 days of age. As the ratio of dietary omega 3 to omega 6 fatty acids increased in a diet totaling 20% by weight of fat, the development of preneoplastic atypical acinar cell nodules (AACNs) at 4 months after dosing with azaserine decreased significantly. In addition, serum levels of prostaglandin thromboxane B2, prostaglandin E2, and 6-keto-prostaglandin F1 alpha decreased significantly. The fatty acid composition of the rbc membrane was also significantly influenced by the ratio of dietary omega 3 to omega 6 fatty acids. In a second experiment, we examined the effect of dietary intervention with a different type of fat (corn oil or menhaden oil) 2 months into the 4-month postdosing period on AACN development at the end of the post-dosing period. Intervention of the omega 6 fatty acid-rich diet with the omega 3 fatty acid-rich diet significantly decreased focal development. The opposite was true when intervention involved substituting the omega 3 fatty acid-rich diet with the omega 6 fatty acid-rich diet.

Cooperation and competition during development: neonatal lesioning of the superior cervical ganglion induces cell death of trigeminal neurons innervating the cerebral blood vessels but prevents the loss of axon collaterals from the neurons that survive

In the adult rodent trigeminal ganglion there is a period of postnatal cell death in the population of cells with axons innervating the middle cerebral artery (O'Connor and van der Kooy, 1986b). The superior cervical ganglion (SCG) also has a projection to the middle cerebral artery (MCA; Mayberg et al., 1984; Cowen et al., 1986, 1987; present report). We hypothesized that the trigeminal ganglion cells innervating the MCA may be competing with the superior cervical projection for target area or for a target factor for survival, and thus the removal of the superior cervical projection at birth (sympathectomy) may promote the survival of some of the trigeminal-artery innervating cells that normally would die. Multiple fluorescent retrograde tracing was employed to analyze the postnatal development of the trigeminal projection to the MCA in sympathectomized and sibling control rats. We found that the SCG projection to the MCA exhibits a period of postnatal cell death. The trigeminal ganglion projection exhibits axon degeneration as well as postnatal cell death. Postnatal day 0 (P0) lesioning of the SCG did not prevent cell death or axon loss in the trigeminal projection to the cerebral artery. In fact, increased cell death of the trigeminal-artery projecting neurons was observed in the lesioned animals when compared to nonlesioned sibling controls. By P55, we found that 80% of these trigeminal neurons had died in lesioned animals, compared with 50% in controls. In both control and sympathectomized rats, close to 90% of the trigeminal neurons innervating the artery in the neonate can no longer be retrogradely labeled from the MCA by tracer applications at P25-90. Thus, although the presence of an intact SCG may protect some trigeminal-artery projecting neurons from cell death, it does not prevent axon retraction and does not permit a larger absolute number of trigeminal axons to innervate the arteries in the adult. Thus, separate mechanisms are responsible for the survival of perikarya versus the retraction of their axons from the MCA. Surprisingly, in the neonatally sympathectomized rats almost 20% of those trigeminal cells that maintained a projection to the MCA at P90 also had a projection to the forehead. In contrast, less than 3% of the artery innervating trigeminal cells in the P90 control rats had an axon collateral to the forehead.(ABSTRACT TRUNCATED AT 400 WORDS)

Development and evaluation of immunoassay for detection of antibodies to the feline T-lymphotropic lentivirus (feline immunodeficiency virus)

The feline T-cell lymphotropic lentivirus (feline immunodeficiency virus) is a recently described feline-specific retrovirus that can produce chronic immunodeficiency-like disorders in cats. A microdilution plate format enzyme-linked immunosorbent assay has been developed to detect the presence of antibody to the virus in feline serum or plasma. Temporal studies performed with experimentally infected animals show that seroconversion can be demonstrated 3 to 4 weeks after exposure to the virus. Results of a serosurvey (n = 1,556 samples) indicate that infection is fairly common in both clinic (5.2%) and sick cat (15.2%) populations. Western blot (immunoblot) and sodium dodecyl sulfate radioimmunoprecipitation assays were developed to confirm microdilution plate test results and to identify peptides specific for the feline immunodeficiency virus. All microdilution plate test positive results and selected negative results were confirmed by one or both of these procedures. These data demonstrate that this microassay plate enzyme-linked immunosorbent assay is a very sensitive and specific test for detection of antibody to the feline immunodeficiency virus.

A review of photogrammetry with applications to implant film calibration and seed matching

The basic concepts of photogrammetry, the science of making geometric measurements from photographs, are reviewed with an emphasis on applications to implant dosimetry. A seed matching algorithm is developed using those concepts.

Pathogenesis of experimentally induced feline immunodeficiency virus infection in cats

Feline immunodeficiency virus (FIV; formerly, feline T-lymphotropic lentivirus) is a typical lentivirus resembling human and simian immunodeficiency viruses in morphologic features, protein structure, and reverse transcriptase enzyme. It is antigenically dissimilar, however. The virus is tropic for primary and permanent feline T-lymphoblastoid cells and Crandell feline kidney cells. The virus did not grow in other permanent feline non-lymphoblastoid cells that were tested, or in lymphoid and non-lymphoid cells from man, dogs, mice, and sheep. During short-term inoculation studies in cats, the feline immunodeficiency-like syndrome found in nature was not experimentally induced, but a distinct primary phase of infection was observed. Fever and neutropenia were observed 4 to 5 weeks after inoculation; fever lasted several days, and neutropenia persisted from 1 to 9 weeks. Generalized lymphadenopathy that persisted for 2 to 9 months appeared at the same time. Antibodies to FIV appeared 2 weeks after inoculation and then plateaued. Virus was reisolated from the blood of all infected cats within 4 to 5 weeks after inoculation and persisted indefinitely in the face of humoral antibody response. Virus was recovered from blood, plasma, CSF and saliva, but not from colostrum or milk. Contact transmission was achieved slowly in one colony of naturally infected cats, but not between experimentally infected and susceptible specific-pathogen-free cats kept together for periods as long as 4 to 14 months. The infection was transmitted readily, however, by parenteral inoculation with blood, plasma, or infective cell culture fluids. In utero and lactogenic transmission were not observed in kittens born to naturally or experimentally infected queens. Lymphadenopathy observed during the initial stage of FIV infection was ascribed to lymphoid hyperplasia and follicular dysplasia. A myeloproliferative disorder was observed in 1 cat with experimentally induced infection.

Enrichment of a vasoactive neuropeptide (calcitonin gene related peptide) in the trigeminal sensory projection to the intracranial arteries

Trigeminal sensory innervation of cerebral vessels and the surrounding dura is responsible for most intracranial head pain. Small-diameter fibers containing substance P (Sub P) have been observed in the periadventitia around feline cerebral blood vessels, and it has been suggested that these fibers are the trigeminal substrate for vascular pain associated with cluster and migraine headaches. Calcitonin gene related peptide (CGRP) coexists with Sub P in some of these fibers and with some Sub P containing neurons in the trigeminal ganglion. In addition, a population of trigeminal neurons containing CGRP but not Sub P has been observed. We now report that the population of trigeminal ganglion cells projecting to the cerebral vasculature is enriched in CGRP-containing neurons, and especially in the population of neurons containing CGRP and not Sub P. Using retrograde tracing of fluorescent tracers combined with immunocytochemistry after explant culture, we found approximately 32% of trigeminal ganglion cells projecting to the cerebral vasculature contained CGRP. Approximately 18 and 17% of these cells contained Sub P and cholecystokinin (CCK), respectively. The 32% of ganglion cells projecting to the cerebral vasculature that contain CGRP stands in contrast to the 12% CGRP positive seen in the population of ganglion cells projecting out to another target (the forehead), and the 21 and 23% CGRP positive observed in the mandibular branch and entire ganglion, respectively. Sub P and CCK are not enriched in the trigeminal innervation of the vasculature compared with their presence in cells throughout the ganglia.(ABSTRACT TRUNCATED AT 250 WORDS)

Pattern of intracranial and extracranial projections of trigeminal ganglion cells

The trigeminal sensory innervation of the major cerebral vessels is thought to carry the nociceptive information during a migraine headache, and this pain is usually referred to the forehead area. Using retrograde tracing techniques, we have described the distribution of sensory trigeminal cells that innervate the middle cerebral artery (MCA) and the forehead. Nearest-neighbor analysis of the ophthalmic division of the trigeminal ganglion revealed that cells innervating the forehead tend to be clumped around individual cells that innervate the MCA. An average of less than 1 cell per animal was found to project divergent collaterals to both areas. The close association of ganglion cell bodies innervating the cerebral vasculature and those innervating forehead areas may underlie the convergence of their central processes onto common brain-stem trigeminal nucleus cells, and thus the referral of headache pain. In contrast to the lack of ganglion cells with axonal collaterals to the cerebral vasculature and forehead, a significant population of cells that innervate the MCA also have collateral projections to other cerebral arterial branches (branches of the middle meningeal artery), as well as the surrounding dura. Thus, the innervation targets of individual trigeminal cells are very widespread intracranially (including arteries and dura), but separate cells in the ophthalmic division innervate extracranial targets.

Cell death organizes the postnatal development of the trigeminal innervation of the cerebral vasculature

In the adult trigeminal ganglion single cell bodies that innervate the middle cerebral artery (MCA) are different from but situated near to one or more cell bodies that innervate the forehead (O'Connor and Van der Kooy, submitted). Multiple fluorescent retrograde axonal tracing in postnatal day 3-90 rats was employed to describe the development of this adult pattern of trigeminal projections. We found that close to 90% of the cells that innervate the MCA at postnatal day 5 (PND 5) are eliminated by PND 90. Less than 20% of the ganglion cells innervating the forehead die over the same postnatal period. Subpopulations of cells in the ganglion were observed to have a maximal rate of death during different postnatal periods. First, 15-20% of the cells throughout the ophthalmic division die between PND 5 and PND 10. Second, a small population of cells that had early projections to the contralateral MCA die out completely by PND 22. Third, cells with a projection only to the MCA die primarily between PND 10 and PND 54. Fourth, during the first postnatal week there are many cells that project to both the MCA and the forehead; however, 90% of this population dies by PND 90. This elimination is observed latest in the postnatal period, with these cells exhibiting their greatest rate of cell death between PND 22 and PND 90. Thus, cell death is the primary postnatal mechanism that produces this organization in the ophthalmic division of the trigeminal ganglion and retraction of axonal collaterals is a minor mechanism. We suggest that the latest period of death in cells with divergent artery and forehead projections as well as the ultimate persistence of some artery projecting cells beyond PND 90, may be due to the larger peripheral fields of innervation of these trigeminal ganglion cells.

Polymorphism in a kappa I primary (AL) amyloid protein (BAN)

In an attempt to understand the relationship of amino acid sequence to the formation of primary or multiple myeloma-related amyloid (AL amyloid), we have determined the complete amino acid sequence of amyloid protein BAN. This protein belongs to the kappa I immunoglobulin light chain subgroup and has a polypeptide chain length of 126 amino acids. It encompasses the entire variable region, the joining segment and the first tryptic peptide of the constant region. This protein has two unique features. First, the molecule is glycosylated. At position 61 the usual arginine residue has been replaced by an asparagine with the generation of the signal sequence Asn-Phe-Thr, to which a glucosamine-containing carbohydrate unit is attached. Secondly, the protein is not monoclonal but consists of two chains which have the same variable region but different J-segments. Comparison of the BAN sequence with other amyloid and nonamyloid kappa I proteins reveals a systematic difference between the two groups. In the amyloid proteins, several hydrophilic framework residues have been replaced by hydrophobic residues. These substitutions may provide the nucleation sites for self-aggregation and fibril formation.

Dietary intervention during the postdosing phase of L-azaserine-induced preneoplastic lesions

The effects of intervention by diets with high or low levels of dietary fat on the development of preneoplastic pancreatic lesions were examined. Wistar rats were treated ip at 14 days of age with a 30-mg/kg dose of L-azaserine [CAS: 115-02-6; diazoacetate serine (ester)] and weaned onto the test diets. Animals fed 5% corn oil had fewer preneoplastic lesions compared to animals fed 20% corn oil throughout the 4-month posttreatment period. The strong response observed in rats fed 20% corn oil could be markedly reduced by intervention with a 5% corn oil diet halfway through the posttreatment period. Similarly, the low response in animals fed 5% corn oil could be markedly elevated by intervention with a high-fat diet. These results provide evidence for the hypothesis that tumor development may be modified by dietary means.

Effect of dietary intake of fish oil and fish protein on the development of L-azaserine-induced preneoplastic lesions in the rat pancreas

The effect of dietary intake of fish (menhaden) oil and fish (cod) protein on the development of pancreatic preneoplastic lesions was examined in male Wistar rats. Fourteen-day-old animals were given a single ip injection of 30 mg L-azaserine/kg body weight [CAS: 115-02-6; diazoacetate serine (ester)]. At 21 days of age they were weaned and maintained on dietary treatment for 4 months. Fish protein did not appear to produce a significantly different preneoplastic response when compared to casein as a protein source. However, a 20% menhaden oil diet, rich in omega 3 fatty acids, produced a significant decrease in the development of both the size and number of preneoplastic lesions when compared to a 20% corn oil diet rich in omega 6 fatty acids. This study provides evidence that fish oils, rich in omega 3 fatty acids, may have potential as inhibitory agents in cancer development.

A note on designing tissue compensators for parallel opposed fields

Missing tissue compensators are typically made to correct for the tissue defect separately for each of two parallel opposed radiation fields. Arguments and experimental evidence are provided to show that a more uniform dose distribution is achieved throughout the irradiated volume if the compensator is designed so that each opposed field delivers an equal dose to a surface defining midmass between the opposed body surfaces. An expedient method to approximate this result is to simply divide equally between the two parallel opposed fields the total amount of compensation otherwise required.

An electronic device for digitizing radiotherapy films for the construction of tissue compensators

An electronic device was designed that measures film optical density and may be attached to the sonic pen of an x,y graphics terminal. Therapy portal films may be digitized by moving the assembly across the film by hand. Data is measured at a rate of 40 data points per second; hence, a large film can be digitized in about 5 min. Supporting computer software constructs a matrix array of optical densities covering the area of the film, converts optical density to dose, and plots tissue compensators. The concept of designing compensators from port films is reviewed. Phantom studies were performed to show that the compensators so designed are satisfactory for clinical application.

13C nuclear magnetic resonance study of the pyruvate dehydrogenase-catalyzed acetylation of dihydrolipoamide

The dihydrolipoyl transacetylase component of the pyruvate dehydrogenase complex catalyzes a reversible reaction between acetyl-CoA and dihydrolipoamide that results in the formation of S-acetyldihydrolipoamide. We have used 13C nuclear magnetic resonance to investigate this reaction using exogenous forms of dihydrolipoamide in place of the protein-bound substrate. With substrate levels of dihydrolipoamide and enzymatically generated [1-13C]acetyl-CoA, both 6-S-[1-13C]acetyl- and 8-S-[1-13C]acetyldihydrolipoamide were formed in the transacetylation reaction and both species participated in the reverse reaction to yield [1-13C]acetyl-CoA and free dihydrolipoamide. The 8-S-acetyl derivative was the principal product. It is suggested that acetylation of both the 6- and 8-thiols of dihydrolipoamide results as a consequence of intramolecular migration following acetylation at a single site. After longer periods of reaction, some 6,8-S,S-[1-13C]diacetyldihydrolipoamide also accumulated. We have also found that [1-13C]acetyl-CoA reacts slowly with dihydrolipoamide in a nonenzymatic reaction to yield the two monoacetylated and some diacetylated derivative. In the reverse reaction catalyzed by the dihydrolipoyl transacetylase, it was clear that monoacetyl derivatives were depleted much more rapidly than the diacetyl derivatives, although we could not quantitate the change in the low concentration of the diacetyl derivative.

A clinical trial of BCG immunotherapy as an adjunct to surgery in the treatment of primary malignant melanoma

A preliminary analysis of a controlled trial of BCG immunotherapy as an adjunct to surgery in the treatment of primary malignant melanoma has been carried out. The length of follow-up varied from 5 years to 6 months. No obvious benefit from BCG immunotherapy has been found so far. On the other hand the treatment is painful with an appreciable morbidity. Skin tests for delayed hypersensitivity have shown no recognisable differences in patients treated with surgery and those who also had BCG, or in the pattern of responses in those who developed recurrences and those who did not. In view of these early findings trial entry has been closed.

Immediate reconstruction of a resected segment of the lower jaw, using a compound flap of clavicle and sternomastoid muscle

A brief account is given of the experimental data and the laboratory findings relative to the use of compound bone flaps of clavicle on a pedicle of sternomastoid muscle for restoration of mandibular defects. The clinical data on this method in 18 consecutive patients are presented and discussed.

The use of photogrammetry in tissue compensator design. Part II: experimental verification of compensator design

A computer algorithm for designing sheet lead tissue compensators is described. Corrections are made for scatter within the radiation field as well as the shape of the patient for the mantle fields used in treating Hodgkin's disease. The method was tested experimentally with a phantom and found to be clinically acceptable. The advantages of employing this technique with parallel opposed fields are emphasized.

The use of photogrammetry in tissue compensator design. Part I: photogrammetric determination of patient topography

The surface topography of a patient can be determined by photogrammetry before beginning radiotherapy. The source light of the therapy unit or simulator is used to project a grid pattern onto the patient, and this is then photographed together with control points consisting of miniature light bulbs mounted on a frame suspended from the wedge slot of the therapy machine. When the photograph is projected onto a graphics terminal for data entry into a computer, the three-dimensional topography of the patient's surface can be reconstructed as a two-dimensional matrix of discrete points. A computer algorithm can then design a tissue compensator to fit the individual patient.