Small-cell carcinoma of the lung: patterns of treatment failure in patients treated primarily by chemotherapy

Treatment failure patterns in 75 patients with small-cell carcinoma of the lung who were treated primarily by chemotherapy were reviewed. Of 10 patients with localized disease who underwent complete staging work-ups, six had metastases to the chest, four to the central nervous system, four to bone, and one to the lymph nodes. Of 32 patients with disease considered to be localized but who did not undergo complete staging work-ups, 23 had metastasis to the chest, 11 to the central nervous system, four to bone, and two to the lymph nodes. Of 33 patients with documented distant metastasis 23 had metastasis to the chest, 14 to the central nervous system, 15 to bone, and six to the lymph nodes. Median survival times of patients showing complete response to treatment was 17 months; for those showing partial response it was 7 months.     

Examination of occupational exposure to medical staff (primarily nurses) during 131I medical treatments

Recently, a new amendment to protect against radiation damage to humans has been enacted based on a 1990 recommendation by the ICRP. Consequently, the dose limits of occupational exposure to medical staff were cut down sharply compared with conventional readjustments. This amended bill, however, may be triggering a reduction in the number of applicants, which hope to engage in radiotherapy. This being the case, we measured the dose levels of the occupational exposure to medical staff (doctor's group, nuclear medicine technologist's group, nurse's group and pharmacist's group) from 1999 to 2002. Moreover, we investigated what the main factor is in nurse's occupational exposure to 131I. The highest doses of occupational exposure were 3.640 mSv to doctors, 7.060 mSv to nuclear medicine technologists, 1.486 mSv to nurses and 0.552 mSv to pharmacists. According to our results, it was clear that the highest doses in each group were far below the legally mandated upper limits of exposure doses. Although we investigated the correlations between the factors of nurse's occupational exposure to 131I with the number of inpatients, the amount of 131I and the number of servicing times for patients, there were no correlations found. Furthermore, to analyzing the factors in detail, it became clear that the main factor in the nurse's occupational exposure was due to the existence of patients who needed many more servicing times for their care than ordinary patients.     

Patient's rights in Poland against the background of new regulations

Patient rights are the specification of general human rights. The rights define the patient position in relation to health institutions or medical professions providing, broadly understood, health services. The protection system of patient rights outlined by international legal and ethical regulations is detailed to specific social, political and economic realities by internal legal systems of individual states. Imperfections of the Polish health care system in relation to achieving adequate protection of patient rights, resulting, inter alia, from the lack of comprehensive regulation of the matter of patient rights, led the legislature to introduce new regulations concerning this aspect to the Polish legal order. The new Act of 6 November 2008 on Patient Rights and the Patient Rights Ombudsman (binding from 5 March 2009) is the first universally binding legal act in the Polish legal system entirely dealing with the matter of patient rights. It regulates the rights of the patient and correlated with them obligations of health care providers (public and non-public) irrespectively of both the legal form providers, as well as the sources of funding of the benefits provided. In particular, the Act states: the patient right to health services, right to obtain information, right to confidentiality of patient-linked information, right to consent to obtain health services, right to respect privacy and dignity of the patients, right to medical records and objecting to the doctor's opinion or decision, right to respect private and family life, right to pastoral care. The new regulations--besides the specification of the catalogue of patient rights--reinforced the institutional protection of patient rights by establishing a new central public administrative body having jurisdiction to protect patient rights--the Patient Rights Ombudsman. Poland, like other European countries, makes an attempt to improve the protection of patient rights. The introduction of the Act entirely devoted to patient rights is undoubtedly an important step towards creating the optimum protection of the patient.     

Forensic web watch 3

Since the publication of the first 'Forensic Web Watch' article a new search engine has become available, free of charge at the time of writing, to surfers of the Internet (Net). Fast Search claims to seek out sites of interest for the user from 'all the Web, all the time trade mark ' as opposed to parts of the Net as is more common with other search machines. It is easy to use, extremely fast but as it searches so much more of the Net, the end result is considerably larger. This, in turn, may lead to a longer time to seek out useful information as opposed to the obscure. Having said this, it is recommended to add to your search engine bookmarks. A search for sites on issues related to 'Police Surgeons' will yield limited information, as each country will have a different person filling this role, all referred to by different terms. The one common feature, however, to all such groups as well as forensic pathologists and scientists, is that they will work with, or in some cases for, the police services of their respective country. Thus, in this article we will look at sites related to the police which may have useful information related to their work, specific cases of interest and research and development which may effect our practice.     

Neuroendocrine-immune interactions and responses to exercise

This article reviews the interaction between the neuroendocrine and immune systems in response to exercise stress, considering gender differences. The body's response to exercise stress is a system-wide effort coordinated by the integration between the immune and the neuroendocrine systems. Although considered distinct systems, increasing evidence supports the close communication between them. Like any stressor, the body's response to exercise triggers a systematic series of neuroendocrine and immune events directed at bringing the system back to a state of homeostasis. Physical exercise presents a unique physiological stress where the neuroendocrine and immune systems contribute to accommodating the increase in physiological demands. These systems of the body also adapt to chronic overload, or exercise training. Such adaptations alleviate the magnitude of subsequent stress or minimize the exercise challenge to within homeostatic limits. This adaptive capacity of collaborating systems resembles the acquired, or adaptive, branch of the immune system, characterized by the memory capacity of the cells involved. Specific to the adaptive immune response, once a specific antigen is encountered, memory cells, or lymphocytes, mount a response that reduces the magnitude of the immune response to subsequent encounters of the same stress. In each case, the endocrine response to physical exercise and the adaptive branch of the immune system share the ability to adapt to a stressful encounter. Moreover, each of these systemic responses to stress is influenced by gender. In both the neuroendocrine responses to exercise and the adaptive (B lymphocyte) immune response, gender differences have been attributed to the 'protective' effects of estrogens. Thus, this review will create a paradigm to explain the neuroendocrine communication with leukocytes during exercise by reviewing (i) endocrine and immune interactions; (ii) endocrine and immune systems response to physiological stress; and (iii) gender differences (and the role of estrogen) in both endocrine response to physiological stress and adaptive immune response.     

Walking to the beat of different drums: practical implications for the use of acoustic rhythms in gait rehabilitation

Acoustic rhythms are frequently used in gait rehabilitation, with positive instantaneous and prolonged transfer effects on various gait characteristics. The gait modifying ability of acoustic rhythms depends on how well gait is tied to the beat, which can be assessed with measures of relative timing of auditory-motor coordination. We examined auditory-motor coordination in 20 healthy elderly individuals walking to metronome beats with pacing frequencies slower than, equal to, and faster than their preferred cadence. We found that more steps were required to adjust gait to the beat, the more the metronome rate deviated from the preferred cadence. Furthermore, participants anticipated the beat with their footfalls to various degrees, depending on the metronome rate; the faster the tempo, the smaller the phase advance or phase lead. Finally, the variability in the relative timing between footfalls and the beat was smaller for metronome rates closer to the preferred cadence, reflecting superior auditory-motor coordination. These observations have three practical implications. First, instantaneous effects of acoustic stimuli on gait characteristics may typically be underestimated given the considerable number of steps required to attune gait to the beat in combination with the usual short walkways. Second, a systematic phase lead of footfalls to the beat does not necessarily reflect a reduced ability to couple gait to the metronome. Third, the efficacy of acoustic rhythms to modify gait depends on metronome rate. Gait is coupled best to the beat for metronome rates near the preferred cadence.     

奶山羊乏情期诱导发情效果研究

为使处于乏情期的奶山羊发情,采用孕酮阴道释放装置和孕马血清促性腺激素(PMSG)处理对三原莎能奶山羊种羊场的73只母羊进行诱导发情。试验羊分为三组,将含有孕激素的阴道栓置于试验羊阴道中9d,分别在撤栓前48h、撤栓前24h和撤栓同时(即Oh)配合肌肉注射PMSG 300 IU/只,研究孕马血清促性腺激素不同使用时间的诱导发情效果。结果三组羊的发情率分别为52.63%、78.79%和85.71%;同期率分别为42.11%、69.71%和76.19%,三者差异显著(P<0.05);羊只的发情时间集中在撤栓后48 h左右,以48 h为峰值呈现正态分布;发情羊发情持续时间分别为34.81 h、36.46 h和30.67 h。试验结果表明在撤栓同时配合肌肉注射PMSG的发情率和同期率最高,发情持续期最短,是可以在奶山羊生产中应用的诱导发情程序。     

Gewahrsamstauglichkeit, Vernehmungsfähigkeit, Verhandlungsfähigkeit

Ability to undergo custody refers to the relatively short period of police custody, while ability to undergo detention refers to the ability to undergo pre-trial confinement or penal confinement. Ability to undergo custody indicates that the psychological and physical condition of the subject allows a relatively limited police confinement. Ability to undergo interrogation is considered to be the capacity to understand the sense of the questions posed during police investigations and at court, and to answer such questions meaningfully. In a civil court procedure, ability to undergo trial is the capacity to participate in legal proceedings. The capacity to undergo legal proceedings is bound to contractual capacity. Ability to undergo trial refers to the accused in criminal proceedings (principal proceedings). The German Federal High Court (BGH) defines ability to undergo trial as a state of mental clarity and freedom, so that it is possible to proceed against the accused according to criminal law. He must be in a position to represent his own interests reasonably, to maintain his rights, to conduct his defence in a reasoned and understandable manner and to deliver procedural declarations as well as to understand such. In addition, the carrying out of the principal proceedings may not endanger his life nor result in irreparable severe damage to his health.     

Apnoeic heart rate responses in humans. A review

Research examining the heart rate response of humans to apnoea and apnoeic immersion in water has tended to produce equivocal results. Controversy exists in relation to the existence and onset, course and ultimate extent of apnoeic bradycardia, either at rest or during exercise. The reduction in heart rate that has been observed in response to apnoea and apnoeic immersion is considered by some to be a component of an oxygen conserving mechanism termed the mammalian dive reflex. Doubt has been expressed, however, as to whether humans do possess the complex cardiovascular response evident in diving mammals. A bradycardial response to apnoea at rest is reasonably well established. Reports conflict with regard to apnoeic responses to exercise in both terrestrial and aquatic environments, and for the temporal onset of apnoeic bradycardia in general, and the time course required for the maximal development of the response. It is suggested that the existing discrepancies with regard to heart rate responses to apnoea are due in part to the large variety of research protocols employed, with, in many cases, a lack of control of those factors said to modify apnoeic heart rates, and in part to a lack of uniformity in the interpretation of the obtained results. Conflicting evidence exists for almost all of the factors said to modify the apnoeic heart rate response in humans. Factors implicated in the phenomenon of apnoeic bradycardia include the influence of temperature and the physical condition of the individual, varying lung volumes, the depth of immersion in water, the body position during the apnoeic episode, and the psychological state of the individual. The influence of the sex and age of the subjects is equally contentious. Finally, the role of breath-holding capacity as it influences the extent of bradycardia remains to be examined further. Additional research requires the adoption of an integrative, holistic approach if a comprehensive understanding of apnoeic heart rate responses is to be achieved.     

Elite female athletes’ experiences and perceptions of the menstrual cycle on training and sport performance

The purpose of the current study was twofold (a) to examine elite female athletes’ experiences of their menstrual cycle, with a focus upon the impact on training and competition performance and (b) the openness of conversation pertaining to the menstrual cycle with coaching and support staff. Following receipt of institutional ethical approval, individual semi‐structured interviews were conducted with 17 elite female athletes (25.5 ± 4.7 years) from multiple sports. Results revealed athletes’ experiencing a natural menstrual cycle reported physical symptoms alongside mood disturbances and reduced motivation to train. The decision to actively control the menstrual cycle was often triggered by a desire to reduce the effect on competition, to lessen anxieties about making required weight or reduce distraction to manage during competition. Athletes indicated an openness to talk about the menstrual cycle to other females, however, there was variation in the comfort athletes experienced regarding talking to male coaches. Overall, the findings highlight the need to educate elite athletes and coaches on the menstrual cycle, considering it in the same light as other physiological functions in sport to improve health, well‐being, and performance. Furthermore, providing education on how to construct positive conversations, equipping individuals with the correct terminology, and confidence to talk about the menstrual cycle will reduce some reservations identified through improved knowledge and understanding.     

Analysis of radiation scatter during angiographic procedures: evaluation of a phantom model and a modified radiation protection system

PURPOSE: To study the radiation scattering associated with the digital subtraction angiography (DSA) unit in angiographic procedures and to design an effective radiation protection shield based on these data. MATERIALS AND METHODS: The number of scattered photons was measured at three points relative to the operator's position. Anteroposterior abdominal and lateral cranial fluoroscopy were evaluated. As protective devices, a lead curtain, sliding shields, and a brim-shaped image intensifier (II) hood were designed. RESULTS: In abdominal fluoroscopy, radiation was found to scatter to the operator's lower limbs from the underside of the catheter table, to the abdomen from the side of the patient's body, and to the head and neck from the table surface adjacent to the patient. The use of protective devices reduced exposure from 2.89 to 0.058 mR/min for the operator's lower limbs, from 0.987 to 0.069 mR/min for the operator's abdomen, and from 0.696 to 0.139 mR/ min for the operator's head and neck area. With lateral cranial fluoroscopy, radiation was detected to scatter to the operator's lower limbs from the underside of the catheter table, to the abdomen from the patient's temporal area, and to the head and neck from the patient's face. The use of protective devices reduced exposure from 0.248 to 0.010 mR/min for the operator's lower limbs, from 0.129 to 0.010 mR/min for the operator's abdomen, and from 0.162 to 0.018 mR/min for the operator's head and neck area. CONCLUSIONS: The characteristic directions of scattering to the operator were identified. An effective modified radiation protection system was designed based on this information.     

1.5 T MR in the diagnosis of parotid masses: comparison with ultrasonography

Twenty-two patients who presented with laterocervical retromandibular enlargement were examined with both US and MR imaging to assess the intrinsic/extrinsic relationship of the mass to the parotid gland, the involvement of the facial nerve and adjacent structures, as well as the nature of the mass. Both US and MR imaging proved to be poorly specific in the characterization of the inflammatory lesions. Within the mass, both methods revealed high sensitivity (100%) in identifying the lesions, even very small ones. MR imaging allowed the lesion to be accurately located, the facial nerve to be identified, and its possible infiltration to be evaluated, with higher reliability than US, thanks to its higher contrast resolution and to its multiplanarity. Neither US nor MR imaging allowed the benign/malignant nature of the lesion to be assessed. On the basis of their experience, the authors suggest the use of T2-weighted MR sequences, with long TR and TE, to differentiate pleomorphic adenomas from other histotypes, after US assessment of the solid nature of parotid masses.     

Dental class 3 intercept clinic: a model for treating dental class 3 soldiers

OBJECTIVE: Dental Fitness Classification (DFC) 3 indicates that a soldier has a dental condition that, if not treated, is expected to result in a dental emergency within 12 months. Forty-two percent of Army recruits have DFC 3 conditions as reported by the 2000 Tri-Service Center Recruit Study. Initial entry training schools allow minimal time for dental care. The Fort Hood Class Three Intercept Clinic (CTIC) was created to treat DFC 3 conditions prior to soldiers being assigned to their units. The purpose of this study was to evaluate CTIC's ability to make soldiers dentally deployable before joining their new units at Fort Hood, Texas. MATERIALS AND METHODS: A retrospective review of the CTIC daily sign-in logs for the period of January 1999 to May 2001 was used to identify DFC 3 soldiers. The data were analyzed to determine frequency of DFC 3 by rank, DFC after CTIC visits, distribution of treatment type needed to establish dental readiness, and to identify soldiers whose DFC 3 conditions were not treated. Additionally, for the 6 months between November 2000 and April 2001, all soldiers who remained a DFC 3 when released to their units were followed to assess how long it took for them to attain a DFC 1 or 2 status. RESULTS: The retrospective review of the CTIC records identified 5,851 DFC 3 soldiers who in-processed to Fort Hood from January 1999 to May 2001. CTIC successfully converted 86.9% (N = 5,083) of the soldiers to DFC 1 or 2. Of a sample of 185 DFC 3 soldiers released to their units as a DFC 3, only 54% had converted to DFC 1 or 2, with 60.5 days being the mean days to convert. CONCLUSIONS: Trainees have large demands for dental care with minimal time to seek treatment during Initial Entry Training. A CTIC, or hybrid, can provide the necessary emergent dental care to remove soldiers from DFC 3 prior to their being assigned to their first permanent duty station.     

Potential victim's role in the prevention of rape

The 'It can't happen to me' attitude of women towards rape results in their ignorance concerning the action to take when confronted by a rapist. They can either resist, hoping to repel the rapist, or they can obey his commands, hoping he will depart without maiming or killing them. The view is put forward that a woman's best strategy is to resist. Intimidation is the rapist's best weapon, a necessary procondition to rape. The potential victim should refuse to be intimidated. Rapists are on the lookout for women who are vulnerable to attack. The perception of vulnerability differs from one rapist to another. Rapists test, then threaten. Testing is crucial for the rapist, for if he guesses wrongly about whether a woman can be intimidated he will lose his opportunity to rape her. Most rapists are not murderers. It is important that the potential victim should resist at the beginning of the attack and should not look vulnerable on the street. The potential victim should be advised to know her own strength, to be prudent, prepared and to have the necessary knowledge that will enable her to protect herself.     

Ultrasonography of the tendons: from image to pathology

Radiology allows to define etiologies of tendon injuries and authorize a most suitable treatment. For that reason, the use of the sonography has been developed from several years and has four main purposes to define the type of injury and to orient the treatment: to confirm the real existence of the tendon tear, to need the exact location the same one, to determine the gravity of the lesion, and finally, to evaluate its acute or chronic character. In this paper, we will try to define the normal pattern of the tendon and describe the more frequent lesions of the shoulder or the ankle: complete or partial tear, tendinopathy, dislocation and enthesopathy.     

The problem with medical research on tissue and organ samples taken in connection with forensic autopsies in France

Currently, in France, it is legally impossible to conduct scientific research on tissue and organ samples taken from forensic autopsies. In fact, the law schedules the destruction of such samples at the end of the judicial investigation, and the common law rules governing cadaver research cannot be applied to the forensic context.However, nothing seems in itself to stand in the way of such research since, despite their specific nature, these samples from forensic autopsies could be subject, following legislative amendments, to common law relating to medical research on samples taken from deceased persons. But an essential legislative amendment, firstly to allow the Biomedicine Agency to become authorized to issue a research permit and secondly, to change the research conditions in terms of the non-opposition of the deceased to said research.Such an amendment would be a true breakthrough because it would allow teams to continue to move forward calmly in research, and allow this research to be placed within a legal framework, which would promote international exchanges.     

Availability and improvement of a vacuum-type immobilization device in pediatric CT

The essential factors for an immobilization device in pediatric CT are 1) absence of artifacts, 2) safety, 3) no disturbance of the patient's sedation, and 4) ease of handling. We evaluated the suitability of a commercially available vacuum-type immobilization device designed for radiation therapy (Vac-Lok) that meets these requisites. There were no artifacts in scans of the water phantom. The device easily immobilized the patient, was quick to release, and was superior to previous immobilization systems, according to replies to a questionnaire administered to physicians, technologists, and nurses. Schedule delays were reduced by using this device to examine sedated patients (up to 1 year of age). Despite these advantages, the device was too small to immobilize both extremities together when examining older patients. In order to overcome this problem, we invented a special immobilization device for pediatric CT. The new device could be applied to taller patients, up to 85 cm in height(the average height of 2-year-old infants), and was able to contribute to efficient utilization of the examination room.