In-111-labeled monoclonal antibody immunoscintigraphy in colorectal carcinoma: safety, sensitivity, and preliminary clinical results

A phase I/II prospective clinical trial was performed with indium-111-labeled monoclonal antibody (MoAb) conjugate B72.3-glycyl-tyrosyl N-epsilon-diethylenetriaminepentaacetic acid (CYT-103) in 28 preoperative patients with biopsy-proved or suspected colorectal carcinomas. Immunoscintigraphy was performed 2-7 days after infusion of 4.1 mCi (152 MBq) of In-111 labeled to CYT-103 at doses of 0.5, 1.0, 2.0, and 20.0 mg. Surgical and histologic confirmation was available in all cases. Use of In-111 CYT-103 made possible detection of 75% of colorectal carcinomas at doses of 1.0 mg and higher, compared with only 20% detection at the 0.5-mg MoAb dose. Immunohistochemical staining for tumor-associated glycoprotein (TAG)-72 in resected carcinoma tissues demonstrated a positive correlation between MoAb imaging and the percentage of cells that expressed TAG-72. One patient suffered an adverse reaction after MoAb infusion. Human antimouse response to CYT-103 developed in 16% of patients.     

A survey of accident and emergency reporting: results and implications

Surveys have shown a consistent error rate in the detection of radiographically demonstrable abnormalities by casualty officers. A high incidence of medical litigation is related to casualty departments. For these reasons, a survey of hospitals in England and Wales was carried out to determine when and whether accident and emergency radiographs are reported. The practice in 146 hospitals was analysed. It was found that two-thirds of hospitals report all radiographs within 48 h. Seven per cent of hospitals either do not report any radiographs, report only radiographs of certain areas, or delay reporting for over 1 week. It is suggested that the patients attending as many as a quarter of all hospitals as casualties are at increased risk from errors which will inevitably be recognised late, and that these errors are directly attributable to shortage of staff.     

Prosthetic devices within radiotherapy fields: planning implications and results

Prosthetic devices made of plastic or silicon are occasionally present in patients requiring radiotherapy (RT). The effect of RT on these devices and the potential implications of their presence on RT planning are relatively unknown. Three examples are presented in which various devices were included in RT fields. In two of the examples in vitro testing of the devices with high single doses of radiation was undertaken. Radiotherapy was given to all patients with high doses received by the devices. Minor adjustments were made to the planning techniques to reduce the doses to the devices. Neither significant complications nor any malfunctions of the devices were noted subsequently.     

In-111-labeled liposomes: dosimetry and tumor depiction

Neutral phospholipid vesicles (liposomes) were loaded with 0.5 mCi (18.5 MBq) indium-111 and administered to 24 patients with various types of cancer. The median diameter of the liposomes was 77 nm, and lipid dose was 0.78-6.25 mg/kg. Scans obtained 24 and 48 hours after injection of In-111 liposomes showed gradual blood clearance with homogeneous uptake in the normal liver and spleen. Dosimetric estimates for these organs were 2.3 +/- 1.1 and 2.3 +/- 1.4 rad (.02 +/- .01 Gy), respectively, with a whole-body estimate of 0.28 rad (.003 Gy). Radiation dose did not correlate with lipid dose. Total renal excretion of In-111 was less than 2% of the injected dose in all but two patients. Transient eosinophilia occurred in two patients. Tumor was seen in the scans of 22 of 24 patients (unbinded readings). In-111-labeled liposomes may enable the demonstration of suspected or unsuspected sites of tumor.     

Percutaneous excimer-laser and excimer-laser-assisted angioplasty of the lower extremities: results of initial clinical trial

Percutaneous peripheral excimer-laser angioplasty at 308 nm was used for treatment of 30 patients with peripheral vascular disease. Twenty-eight patients underwent laser-assisted balloon angioplasty, and two patients underwent laser angioplasty alone. Acute angiographic and clinical success was achieved in 24 of 31 (77%) femoropopliteal stenoses and occlusions. Seven of nine (78%) stenoses, six of seven (86%) short (0-5 cm) occlusions, seven of eight (88%) medium-length (6-10 cm) occlusions, three of four (75%) long (11-15 cm) occlusions, and one of three (33%) extreme (greater than 15 cm) occlusions were successfully treated. Inability to treat total occlusions was in each case related to a failure to maintain coaxial position and subintimal passage of the fiber. These cases demonstrate the feasibility of safely performing percutaneous peripheral excimer-laser or excimer-laser-assisted angioplasty. The overall frequency of restenosis after a mean follow-up period of 9.1 months was 29%. The data suggest that these procedures may be useful for the treatment of peripheral vascular disease in selected patients.     

Current clinical results of the Tsukuba BNCT trial.

Nine high grade gliomas (5 glioblastomas and 4 anaplastic astrocytomas) were treated with BSH-based intaoperative boron neutron capture therapy (IOBNCT). BSH (100 mg/kg body weight) was intravenously injected, followed by single fraction irradiation using the mixed thermal/epithermal beam of Japan Research Reactor 4. The blood boron level at the time of irradiation averaged 29.9 (18.8-39.5)microg/g. The peak thermal neutron flux as determined by post-irradiation measurements varied from 1.99 to 2.77x10(9) n cm(-2)s(-1). No serious BSH-related toxicity was observed in this series. The interim survival data in this study showed median survival times of 23.2 months for glioblastoma and 25.9 months for anaplastic astrocytoma, results which are consistent with the current conventional radiotherapy with/without boost radiation. Of the 4 residual tumors, 2 showed complete response (CR) and 2 showed partial response (PR) within 6 months following BNCT. No linear correlation was proved between the dose and the occurrence of early neurological events. The maximum boron dose of 11.7-12.2 Gy in the brain related to the occurrence of radiation necrosis. The clinical application of a mixed thermal/epithermal beam and JRR-4 facilities on BSH-based IOBNCT proved to be safe and effective in this series.     

Free-breathing cardiac MR imaging: study of implications of respiratory motion--initial results

The respiratory motion of several anatomic regions (right hemidiaphragm, left ventricle of the heart, chest wall, abdominal wall) was investigated during free breathing in 10 healthy volunteers by using multinavigator technology and real-time magnetic resonance (MR) imaging. The respiratory motion shows hysteretic effects, which are strongly subject dependent and might have some effect on the quality of cardiac MR images.     

Diagnostic accuracy of 99mTc-sestamibi breast imaging: multicenter trial results.

Although mammography is well established as a first-line tool for breast cancer screening and detection, efforts to develop complementary procedures continue. Observation of 99mTc-sestamibi tumor uptake provided the impetus for its evaluation as an adjunctive technique. This trial's objectives were to determine in a multicenter trial the diagnostic accuracy of 99mTc-sestamibi in women with suspected breast cancer and to investigate factors influencing diagnostic accuracy. METHODS: Our multicenter trial enrolled 673 women (387 with nonpalpable abnormalities; 286 with palpable abnormalities) scheduled for excisional biopsy or mastectomy. Blinded and unblinded interpretations of scintigraphic images were compared with core laboratory established histopathologic diagnoses to define the diagnostic accuracy of 99mTc-sestamibi breast imaging. RESULTS: Blinded readers' diagnostic accuracy was 78%-81%. Inter-reader agreement was excellent, ranging from 95% to 100% (kappa = 0.82-0.99). Overall institutional sensitivity and specificity for 99mTc-sestamibi breast imaging were 75.4% and 82.7%, respectively. In this population with a 40.1% disease prevalence, the positive predictive value was 74.5% and the negative predictive value was 83.4%. The negative predictive value was 94% in patients with a 40% or lower mammographic likelihood of breast cancer. Sensitivity was higher for palpable abnormalities; specificity was higher for nonpalpable abnormalities. Sensitivity was decreased for tumors <1 cm in largest dimension but appeared not to be affected by patient's age. CONCLUSION: As an adjunct to current procedures, 99mTc-sestamibi breast imaging may contribute to patient management decisions in selected populations, including women with dense breasts, mammographically indeterminate lesions >1 cm, and palpable abnormalities.     

Preliminary colon cleansing for small-bowel examinations: results and implications of a prospective survey

The findings in 133 consecutive patients having a small-bowel barium follow-through examination are presented. Two conclusions are drawn: colon cleansing does not decrease transit time to the caecum and colon cleansing does not affect the examination quality.     

Exercise therapy for osteoporosis: results of a randomised controlled trial.

OBJECTIVE: To define the effects of therapeutic exercise on bone density and back complaints. METHODS: A randomised controlled trial with parallel groups was conducted in an outpatient clinic, Medical School, University of Vienna. Ninety two sedentary post-menopausal women with back problems were randomly allocated to either exercise (groups 1 and 2) or control (group 3, no exercise, n = 31); the exercise group was retrospectively subdivided into compliant (group 1, n = 27) and not fully compliant patients (group 2, n = 34). Regular, initially supervised therapeutic exercise aimed at restoring biomechanical function was performed for four years. Bone density in the forearm was measured by single photon absorptiometry at entry and after four years; subjective back complaints were documented. RESULTS: A significant decrease in bone density was observed in groups 2 and 3; no change was noted in group 1; back complaints decreased in group 1 only. CONCLUSIONS: Sedentary postmenopausal women may benefit from regular long term therapeutic exercise in terms of subjective back complaints and slowed loss of bone mass.     

Thermography in breast carcinoma: results of a blind reading trial.

This paper presents the results of a blind reading trial of thermographic detection of breast cancer. Thermograms from women with no known breast disease, those with benign disease and those with carcinoma have been analysed using a previously described method for examination and assessment. Each record was read blind by three observers and the resulting scores compared for the three groups of women. It was found that, using the scoring system devised, 69 per cent of carcinomas gave scores in the range considered to indicate a high risk of breast disease but that 33 per cent of the scores for the normals also fell into this range. No differentiation between benign and malignant groups could be achieved. A significant number of the carcinomas were also found to show few detectable signs on thermography, resulting in an appreciable false negative rate.