Value of follow-up procedures in patients with large-cell lymphoma who achieve a complete remission.

Salvage therapy for relapsed large-cell lymphoma (LCL) is more effective in patients with minimal disease, suggesting that early detection of relapse might increase the chance of long-term survival. To determine whether current follow-up procedures are effective in identifying preclinical disease, we analyzed patterns of relapse in 139 LCL patients who achieved a complete remission (CR) with high/moderate-dose methotrexate with leucovorin, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (M/m-BACOD). The timing and results of all posttreatment follow-up tests were examined in the 36 patients who relapsed from complete remission (CR) and 46 controls who remain in CR. Despite conscientious posttreatment follow-up, only two of the 36 relapses (6%) were detected before the development of symptoms. Sixty-seven percent of patients relapsed in new disease sites (42% in new and old sites, and 25% in new sites only). Consistent with this observation, the tests most sensitive to clinical relapse were those not targeted to specific sites of disease: gallium scan (sensitivity, 90%), physical examination (80%), and lactate dehydrogenase (LDH) (65%). Of screening tests performed, only LDH was successful in detecting preclinical relapse, with a sensitivity of 42% and specificity of 85% for impending symptomatic relapse. These results indicate that conventional screening was ineffective in detecting preclinical relapse in LCL patients. We recommend prospective evaluation of a strategy that (1) screens with a frequency appropriate to a patient's risk of relapse, (2) uses sensitive test(s) not targeted to specific sites, and (3) limits aggressive screening to those high-risk patients eligible for potentially curative salvage therapy.     

Acute leukemia and pregnancy

The incidence of leukemia in pregnancy is low; however, the prognosis is grim. For this reason, nurses must be prepared to provide care for a woman and her family who are experiencing this complication. This article discusses the effect of leukemia on pregnancy, chemotherapeutic agents commonly used for treatment of acute leukemia, and a case study exemplifying nursing care for the pregnant patient with acute leukemia.     

Whole lung pulmonary angiography in the intensive care unit with two portable chest x-rays

Suspected massive pulmonary embolism requires urgent, accurate diagnosis. We describe a technique for pulmonary angiography in the ICU. Four patients admitted with suspected pulmonary embolism had fulminating cardiorespiratory failure with support requirements precluding transfer. Each patient had a flow-directed pulmonary angiography catheter inserted into the pulmonary artery. In two catheter positions, 25 ml of iopamidol 612 mg/ml was delivered from a portable angiographic injector at a flow of 20 ml/sec. A portable x-ray was taken immediately before completion of syringe excursion. Major central pulmonary emboli were seen in three patients and a negative angiogram was obtained on the fourth. Two of the three positive diagnoses were confirmed at pulmonary embolectomy. The negative diagnosis was confirmed at autopsy. Pulmonary angiography via a flow-directed catheter enabled precise and rapid diagnosis of pulmonary embolism in patients too ill to transfer for formal angiography.     

Three-dimensional wrist imaging: evaluation of functional and pathologic anatomy by computer

The wrist has been studied morphologically and functionally using advanced technology. The osseous morphology of the wrist was investigated by computed tomography and surface reconstruction software. The functional behavior of the wrist in motion was studied using electromagnetic tracker technology. Three-dimensional imaging from CT scans is emerging as a research tool for the study of gross surface morphology, especially for osseous structures. One of the most demanding applications of this technology lies in the human wrist, because of its small size and inherent complexity. We have demonstrated some of the potential of computer graphics and three-dimensional surface reconstructions in the wrist for patients with osseous abnormalities. Acquisition of six-degree-of-freedom kinematic data to describe carpal motion has been made possible by new electromagnetic tracker technology. Analysis of these data in human wrist experiments revealed that the instantaneous center of rotation was not fixed in the head of the capitate, as was previously thought.     

B-adrenergic receptor stimulation increases anti-DNA antibody production in MRL/1 pr mice

To gain insight into a role for excessive B-adrenergic receptor stimulation in the pathogenesis of autoimmune diseases, MRL/1 pr mice were chronically injected with isoproterenol. The mean change of serum antibody levels after one month of treatment was higher in the isoproterenol treated mice than in controls (anti-ssDNA, p less than 0.05; anti-nDNA, p less than 0.04; and antiguanosine antibodies, p less than 0.03) without significant differences in serum IgG levels. Additionally, mean serum creatinine levels were higher and glomerulonephritis more severe in the isoproterenol treated group. Our findings provide the first evidence linking aberrant B-adrenergic receptor activities, serum anti-DNA antibodies, and end-organ pathology in an animal model of lupus nephritis.     

Hospital nursing education. Dispelling the doomsday prophesies

Productivity is uppermost in the minds of most nurse executives. To protect patient caregivers, nurse educator and clinical specialist positions are being cut. Thus, for hospital nursing educational departments to survive, it is essential that the educational process be defined and include the expectations of the organization and employee as well as the means by which these outcomes can be measured. This article briefly analyzes the factors that have helped to create the current crisis, and then reviews the methods by which nurse administrators can provide some solutions without decimating their educational support services.