Comparison of the findings on preoperative dipyridamole perfusion scintigraphy and intraoperative transesophageal echocardiography: implications regarding the identification of myocardium at ischemic risk

The evidence of myocardium at potential ischemic risk on preoperative dipyridamole perfusion scintigraphy was compared with that of manifest ischemia on intraoperative transesophageal echocardiography in 26 patients at high risk of a coronary event undergoing noncardiac surgery. The clinical outcome was also assessed. Induced intraoperative wall motion abnormalities were more common in patients and myocardial segments with, than in those without, a preoperative reversible perfusion defect (both p less than 0.05). Conversely, a preoperative reversible perfusion defect was more common in patients and segments with, than in those without, a new intraoperative wall motion abnormality (both p less than 0.05). Six patients, five with a reversible scintigraphic defect but only three with a new wall motion abnormality, had a hard perioperative ischemic event. Events occurred more often among patients with, than in those without, a reversible perioperative scintigraphic defect (5 [33%] of 15 vs. 1 [9%] of 11) but this difference did not reach significance (p = 0.14), probably owing to the sample size. Intraoperative wall motion abnormalities were all reversible and did not differentiate between risk groups; these findings were possibly influenced by treatment. These preliminary data support the known relation between reversible scintigraphic defects and perioperative events and identify another manifestation of ischemic risk in the relation between reversible scintigraphic defects and induced intraoperative wall motion abnormalities. The value of intraoperative echocardiography in identifying ischemia and guiding therapy in patients with a reversible scintigraphic abnormality should be further assessed.     

Time-course of the pancreatic changes following long-term stimulation or inhibition of the CCK-A receptor

Summary Cholecystokinin (CCK) reportedly induces both hyperplastic and hypertrophic changes in the pancreas. Blockade of the CCK receptor results in decreased pancreatic secretion and atrophy. The aim of this study was to evaluate the time-course of the effects of stimulation and inhibition of the CCK-A receptor in the rat exocrine pancreas. Male rats had infusion of sulfated CCK-8, the CCK-A receptor antagonist devazepide, or sodium chloride by osmotic minipumps. After 36 h, 3, 7, or 28 d the rats had ip injections of thymidine, and 1 h later they were sacrificed. The pancreas was excised, weighed, and its content of protein, DNA, water, and enzymes was analyzed. Histologic samples were prepared for autoradiography. Pancreatic weight, protein, and DNA were increased at 36 h after the start of CCK infusion and throughout the study period. CCK stimulation also increased the content of trypsin at days 3 and 28. The labeling index of pancreatic acinar cells was increased at 36 h. Blockade of endogenous CCK by the receptor antagonist devazepide led to decreased pancreatic weight from the third day of infusion, whereas the protein content was decreased from the seventh day. At day 28, the DNA content was decreased by devazepide. However, the labeling index of acinar cells decreased transiently already at 36 h. Neither CCK nor devazepide caused any changes of protein content: DNA content ratio during the study. Continuous infusion of CCK caused pancreatic hyperplasia already after 36 h. Stimulation up to 28 d did not cause any further effects. The adverse changes found after blockade of the CCK-A receptor showed much of the same time-course.     

Randomised phase II study of epirubicin-vindesine versus mitoxantrone-vindesine in metastatic breast cancer

The purpose of this study was to compare the activity and toxicity of epirubicin-vindesine (EV) with mitoxantrone-vindesine (MV) in patients with metastatic breast cancer. A total of 295 patients was randomly allocated to treatment with vindesine 3 mg/m² combined with either epirubicin 40 mg/m² or mitoxantrone 10 mg/m². All drugs were given by intravenous push, treatment cycles were repeated at 3–4 week intervals. 255 patients were available for response, and 283 for toxicity. EV and MV yielded similar objective response rates (34 and 26%, respectively), response durations, times to progression and survival. Median time to remission was 1.8 and 3.1 months (P = 0.006) with EV and MV, respectively. In patients with visceral metastases, response rate was higher with EV than MV (40 versus 23%; P = 0.03). Patients receiving MV had less nausea/vomiting (P = 0.007) and alopecia (P = < 0.001) of WHO grade 2. Bone marrow, cardiac and other toxicities were mild with both treatments. The observed differences in activity and toxicity between the two regimens appear to have clinical relevance. EV proved to be more active in visceral disease and to be able to induce remissions more rapidly. Accordingly, patients with visceral metastases or severe tumour-related symptoms may benefit from epirubicin-based treatment. Subjective toxicities, i.e. nausea/vomiting and alopecia, were less frequent and severe with MV. Thus, MV may prove useful in patients with more indolent disease and appears to warrant phase III evaluation in such patients.     

Is there a religious factor in health care utilization?: A review

This paper reviews more than 30 studies of health care utilization in which the effects of religion variables are examined, an area previously unreviewed. The authors found that over three-quarters of these studies reported significant religious differences in rates of utilization. The most common operationalization of religion was religious affiliation (typically Protestant vs Catholic vs Jewish), although the effects of religious attendance and religiosity were occasionally examined. Most major areas of health care use are represented in this literature, including psychiatric care, maternal and child health services, dental care, and physician and hospital utilization. Despite the preponderance of significant findings, it is difficult to isolate any consistent trends, although low-order analyses seem to suggest that Jews are higher utilizers than non-Jews. New findings presented from a study in Appalachiia were inconclusive. The authors discuss the conceptual limitations inherent in ways in which health services researchers typically investigate the effects of religion. Drawing on recent work in the epidemiology of religion, several recommendations are offered regarding the prospect of future research in this area.     

Inter- and intra-observer variability of Doppler peak velocity measurements: an in-vitro study

To determine the variability of pulsed Doppler peak velocity measurements, four radiologists with differing experience were tested using a calibrated flow phantom. Two ultrasound units, three probes and eight velocity rates varying between 40.5 and 78 cm/sec were studied, with a total of 303 measurements. The results were normalized against a set of 106 separate measurements made under highly-controlled conditions. The residual error standard deviation (not attributable to any systematically varied factor, including the velocity rate) was 6.8 cm/sec, with most of the remaining variation due to changing transducer or machine. Observer/equipment interactions accounted for 15.8% of the observed variability. The duration of the radiologist's Doppler experience had no significant effect.     

Does the method of data collection affect patients' evaluations of quality of care?

The aim of the study was to compare two methods of data collection—personal interviews and self‐administered questionnaires—with patients' evaluations of the quality of care they received. The sample consisted of 41 matched pairs of inpatients at a medical clinic. In each pair, one patient was interviewed and one responded to a questionnaire. Data were collected using the questionnaire ‘Quality from the Patients Perspective’ (QPP). The QPP consists of 54 items designed to measure the following four quality dimensions: (i) the medical–technical competence and (ii) the degree of identityorientation in the action of the caregivers; (iii) the physical–technical conditions; and (iv) the sociocultural atmosphere of the care organization. Results showed that patients who were interviewed had significantly less favourable scores on the ‘softer’ quality dimension scales—the identity‐oriented approach of the caregivers and the sociocultural atmosphere of the care setting. Possible reasons for this were discussed, including the possibility that the questions designed to measure these two dimensions were more abstract and emotionally loaded than the items of the other two quality dimensions.