Clonogenic Patterns of Human Pulmonary Adenocarcinoma Cell Lines (PC-9, PC-13 and PC-14) and How They Influence the Results of Test for Chemosensitivity to Cisplatin in the Human Tumor Clonogenic Assay

The clonogenic patterns of three human pulmonary adenocarcinomacell lines (PC-9, PC-13 and PC-l4) were studied by human tumorclonogenic assay (HTCA), and factors which could influence theresults of tests for the chemosensitivity of these tumor cellsto cisplatin in HTCA were determined. The results showed thateach tumor cell line had a characteristic clonogenic pattern.The time intervals for the cells to grow to the plateau phasevaried from 9 to 16 days, depending on the cell line and numberof cells plated. The number of cells plated could substantiallyinfluence the results of chemosensitivity tests. The percentageof surviving colonies increased markedly if too many cells (usually5 x 10⁴ or more/plate) were plated. For continuous exposure,the results of chemosensitivity tests were rather stable after7 days of incubation in each cell line, especially when fewerthan 2 x 10⁴ cells/plate were plated. For 1-hour exposure, theincubation periods for the results to become stable varied from7 to 16 days depending on the cell type, number of cells platedand drug concentration. It was stressed that for the correctevaluation of the chemosensitivity of cultured cell lines inHTCA, the clonogenic pattern of each tumor cell line shouldbe checked in detail before further experiments are conducted.The higher the concentration and the longer the exposure time,the more strongly cis-diamminedichloroplatinum (CDDP) suppressedthe colony growth in each of the three cell lines in HTCA, andit was recommended that CDDP should be used clinically in sucha way as to maintain a high serum level of the active form ofCDDP for a long time.     

Primary care nurse practitioners and the interface with secondary care: a qualitative study of referral practice

In the United Kingdom nurse practitioners are assuming responsibilities traditionally considered to be within the domain of general practitioners. Important amongst these is the referral of patients to medical consultants in secondary care, a responsibility commonly associated with the general practitioner's role as 'gatekeeper' to health care. This paper describes a study designed to identify issues raised by the challenge that a developing nursing role presents to interprofessional working at the interface between primary and secondary care. When invited to comment, study participants (nurse practitioners, nurse educators, medical consultants and general practice registrars) related nursing referrals to issues associated with professional boundary changes, namely: teamwork, regulation of practice, communication, professional conflict and professional relationships. This paper discusses the views of primary and secondary care practitioners about who should take responsibility for the referral of patients in the light of concerns raised about professional competence and accountability. Individual nurse practitioners and their colleagues have found pragmatic ways to manage their work however, although UK government policy supports development of advanced clinical nursing, there remains much work to be done to provide the professional and legal infrastructure to support the role.     

THE VALUE OF UNENHANCED HELICAL COMPUTERIZED TOMOGRAPHY IN THE MANAGEMENT OF ACUTE FLANK PAIN

Purpose

We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute flank pain and suspected ureteral obstruction.

Materials and Methods

During a 25-month interval 417 patients with acute flank pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome.

Results

Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone extraction in 7, additional imaging (excretory urography) was performed in only 1. Additional imaging studies generated by CT were done in 3 cases in which the dictated reports were indeterminate for ureteral stones, including negative excretory urography in 2 and retrograde urography in 1. In 1 patient in whom CT misdiagnosed a ureteral stone unnecessary retrograde urography revealed the calcification to be a gonadal vein phlebolith. Seven patients with false-negative examinations reported spontaneous stone passage with no complications.

Conclusions

Unenhanced helical CT accurately determines the presence or absence of ureterolithiasis in patients with acute flank pain. CT precisely identifies stone size and location. When ureterolithiasis is absent, other causes of acute flank pain can be identified. In most cases additional imaging is not required.     

Attentional modulation of startle in psychosis-prone college students

Attentional modulation of startle eyeblink was studied in college students putatively at risk for psychosis and in normal controls. At-risk subjects had extreme scores on scales for either anhedonia or perceptual aberration-magical thinking (per-mags). Subjects were presented with to-be-attended and to-be-ignored tones; white noise startle probes were presented at lead intervals of 60, 120, 240, or 2,000 ms following the onset of attended and ignored tones and during intertone intervals. Controls showed greater inhibition of startle blink at 120 ms and greater facilitation at 2,000 ms during to-be-attended than to-be-ignored tone, demonstrating attentional modulation of prepulse inhibition and facilitation. Both at-risk groups showed normal overall levels of early inhibition and late facilitation. However, per-mags failed to show attentional modulation of either inhibition at 120 ms or facilitation at 2,000 ms; anhedonics showed no modulation of inhibition and modulation of facilitation was delayed in development. The results for the per-mags are strikingly similar to those observed in schizophrenic patients and suggest that these deficits index a trait-linked vulnerability to disorders in the schizophrenic spectrum.     

术后疼痛护理中的障碍分析及对策

疼痛是医务人员在临床工作中 ,尤其是外科术后经常面临的一个问题。据报道大于 50 %的术后病人在常规医嘱度冷丁、肌注、ＰＲＮ的情况下仍报告疼痛不能缓解[1] ,因此疼痛普遍存在 ,疼痛没有及时治疗普遍存在。最近 ,我们以我院术后第 1天病人的疼痛控制情况作了咨询调查 ,发现 50 %以上的病人有术后医嘱度冷丁、肌注、ＰＲＮ ,仍报告有重度的疼痛 ,导致病人活动、咳嗽、深呼吸障碍 ,而这种情况多数是由于护士没有及时地用止痛药。针对这种状况我们组织护士长、教学护士、护士一起讨论 ,分析原因 ,找出影响术后疼痛护理质量的障碍 ,针对这些…     

METHODOLOGY OF CLINICAL DRUG TRIALS

2nd revised English edition. Alain Spriet, Thérèse Dupin-Spriet and Pierre Simon, translated by Robert Coluzzi, John Young, Richard Edelstein and Michael Weintraub, Karger, Basel, 1994. No. of pages: 269. Price: $113.75. ISBN 3-8055-5856-2     

LUPUS MURINUS

SUMMARY.— The history of the vole type of tubercle bacillus and of the Medical Research Council's trial of vole bacillus vaccine in 1950 is summarized.
Fifteen years after this trial 110 vaccinated subjects were re-examined. Seventeen were found to have granulomatous lesions at the vaccination site. The clinical and histological features of the lesions are described.
No bacteria could be demonstrated in the lesions histologically or by inoculation of voles.
The lesions responded to the administration of antituberculous drugs.
The term lupus murinus is proposed for the dermatological lesion induced by primary inoculation with live Mycobacterium tuberculosis var . muris.     

Left Ventricular Mechanical Assist Devices and Cardiac Device Interactions: An Observational Case Series

Background: Nonpulsatile left ventricular assist devices (LVADs) are increasingly used for treatment of refractory heart failure. A majority of such patients have implanted cardiac devices, namely implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy-pacemaker (CRT-P) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. However, potential interactions between LVADs and cardiac devices in this category of patients remain unknown.
Methods: We reviewed case records and device logs of 15 patients with ICDs or CRT-P or CRT-D devices who subsequently had implantation of a VentrAssist LVAD (Ventracor Ltd., Chatswood, Australia) as destination therapy or bridge to heart transplantation. Pacemaker and ICD lead parameters before and after LVAD implant were compared. In addition, ventricular tachyarrhythmia event logs and potential electromagnetic interference reports were evaluated.
Results: Right ventricular (RV) sensing decreased in the first 6 months post-LVAD. Mean R-wave amplitude preimplant was 10.9 ± 5.25 mV compared with 7.2 ± 3.4 mV during follow-up (P = 0.02). RV impedance also decreased from 642 ± 240 ohms at baseline to 580 ± 212 ohms at follow-up (P = 0.007). There was a significant increase in RV stimulation threshold following implantation of the LVAD from 0.8 ± 0.6 V at baseline to 1.4 ± 1.0 V in the first 6 months postimplant (P = 0.01). A marked increase in ventricular tachyarrhythmia burden was observed in three patients. One patient displayed electromagnetic interference between the LVAD and defibrillator, resulting in inappropriate defibrillation therapy.
Conclusions: LVADs have a definite impact on cardiac devices in respect with alteration of lead parameters, ventricular tachyarrhythmias, and electromagnetic interference.