Small-cell lung cancer at the millennium: radiotherapy innovations improve survival while new chemotherapy treatments remain unproven

Because of the systemic nature of small-cell lung cancer, one could predict that treatment advances would mainly come from innovations of chemotherapy. Although combination chemotherapy is better than monotherapy, a clearly superior multidrug regimen has not emerged. Investigations of more intensive chemotherapy with increased drug diversity and delivery have not prospered, and advantages of regimens including new agents have not yet been demonstrated in controlled trials. As we enter the new millennium, twenty-five years have passed since the publication of studies describing the combined used of cyclophosphamide, doxorubicin, and vincristine for small-cell lung cancer. It has been almost 20 years since the publication of the combination of etoposide and cisplatin became the widely accepted standard for the treatment of small-cell lung cancer. Today, both treatment regimens continue to be widely used as standard therapy. Ironically, proven advances in this systemic disease have been associated with innovations of local therapy. Data from limited-stage small-cell lung cancer clinical trials published during the 1990s demonstrated that a number of radiotherapy interventions had significant survival benefits. These radiotherapy interventions include addition of thoracic irradiation to chemotherapy, early delivery of thoracic irradiation concurrently with chemotherapy, more intense thoracic irradiation, and prophylactic cranial irradiation. As we await improved systemic therapy in the next millennium, the prognosis for extensive-stage disease remains guarded, and adherence to optimal radiotherapy detail remains crucial for routine management of limited-stage patients.     

Medical teaching in ambulatory care (second edition). Warren Rubenstein, Yves Talbot. (148 pages, US$36.80.) Springer Publishing Company, 2003. ISBN 0-8261-7691-7

This slim, readable book sets out to help clinicians teach medicalstudents and post-graduate trainees in ‘ambulatory care’(family practice or out-patients). It follows the teaching careerof a hypothetical doctor (Dr ZZ Smith) who enjoyed teachingwhile in     

Ensuring NCLEX-RN success for first-time test-takers.

A major indicator of baccalaureate nursing program effectiveness is the pass rate on the National Council Licensure Examinations, Registered Nurse (NCLEX-RN) among first-time candidates. This article highlights the scope, instructional methods, and outcomes of the remediation program at Georgetown University School of Nursing & Health Studies (GU-NHS). With implementation of the multifaceted program, the NCLEX-RN pass rate for first-time takers at GU-NHS has been consistently above the national mean among all first-time candidates. Although it is impossible to determine which strategy made the greatest contribution to the success of the program, the cumulative effect is impressive and indicates the students are prepared for the challenge of the examination and contemporary nursing practice.     

Estimated distributions for total body surface area of men and women in the United States.

For the U.S. population in the age range 18 to 74 years, we estimated distributions for total body surface area for men and women using Monte Carlo simulations based on estimated bivariate distributions for height and weight. Surface area is well fit by individual lognormal distributions for men and women. These distributions are appropriate for use in public health risk assessments. We also examined the effect of the correlation between height and weight on the surface area distributions.     

Crosslinking of extracellular matrix proteins: a preliminary report on a possible mechanism of argon laser welding

In order to elucidate the biochemical mechanism of laser welding of tissues, we have compared protein profiles from argon laser-treated specimens with controls. Extracellular matrix components from untreated and laser-welded skin and blood vessels were extracted with guanidine hydrochloride and separated by SDS polyacrylamide gel electrophoresis. When compared with matched, untreated tissues, protein electrophoretic profiles from laser-treated samples showed several changes. In both tissue types, argon laser treatment decreased the concentration of a 235 kd protein that migrates between the alpha and beta chains of type I collagen. Laser-treated blood vessels showed significantly more low molecular weight protein at the dye front than in control tissue, whereas significantly more high molecular weight protein appeared in laser-treated skin samples when compared with untreated tissue. These results suggest that the argon laser may either degrade or crosslink proteins in vivo. Laser-induced protein crosslinks may be the biochemical basis of argon laser welding.     

Reproducibility of cardiac output measurement by cross sectional and Doppler echocardiography.

The variability of Doppler echocardiographic estimation of cardiac output at the aortic orifice was investigated in eight healthy subjects. Cross sectional echocardiograms of the aortic orifice and aortic Doppler velocities were recorded and measured by four echocardiographers. Between subject variability was significantly larger than within subject variability for all variables. Variability owing to different echocardiographers and different measurement times was small compared with total variability. Coefficients of variation for aortic annular diameter, aortic velocity integral, and heart rate were 4.1%, 6.4%, and 5.0% respectively. The coefficient of variation for cardiac output was 8.8% and the 95% confidence interval for measurement of cardiac output by the Doppler method was 4.45 to 6.35 l/min. One echocardiographer reanalysed all the recordings and the results showed that recording the echocardiograms introduces a significantly larger source of error than measuring them. Thus serial measurements of cardiac output by the Doppler method can be performed with acceptable reproducibility; this indicates that the technique can be accurately applied in clinical practice.