Computer-enhanced video microscopy: digitally processed microscope images can be produced in real time.

Digital processing techniques can be used to greatly enhance the available information in an optical image. Although this technology has been routinely used in many fields for a number of years, little application of digital image-processing techniques have been made toward analysis and enhancement of the types of images seen most often by the research biologist. We describe here a computer-based video microscope system that is capable of performing extensive manipulation and enhancement of microscope images in real time. The types of manipulations possible with these techniques greatly surpass the enhancement capabilities of photographic or video techniques alone. The speed and flexibility of this system enables experimental manipulation of the microscopic specimen based on its live processed image. These features greatly extend the power and versatility of the light microscope.     

Daytime pulsed dose rate brachytherapy as a new treatment option for previously irradiated patients with recurrent oesophageal cancer

The aim of this study was to evaluate the feasibility, effects, and toxicity of pulsed dose rate (PDR) brachytherapy for re-irradiation of oesophageal carcinoma. A total of 16 patients (median age 67 years) with inoperable recurrences from oesophageal cancer after primary radio-(chemo)-therapy (median 50 Gy) were re-irradiated using PDR brachytherapy ((192)Ir, 37 GBq). Treatment was carried out on an outpatient basis applying a weekly 5 Gy daytime schedule (0.5 Gy pulse(-1) h(-1), total dose 15-20 Gy). The dose was prescribed 10 mm from the mid-dwell position and encompassed the clipped tumour extension with 2 cm margins. The use of clips for delineation of tumour extent and catheter movement during irradiations was evaluated. All 61 PDR treatments were applied safely. The median catheter movement was 5 mm, range 2-12 mm. After a median follow-up of 8 months, three patients had a complete and five a partial remission. Body weight increased in 5 of 16 (31%) and was stable in 4 of 16 (25%) patients, respectively. The median grade 2 (RTOG/EORTC) dysphagia-free survival was 17 months. Seven patients experienced grade 1, five grade 2, and one grade 3 late toxicity. Three patients with uncontrolled locoregional disease showed grade 4 complications (oesophago-tracheal fistulae (n=2), fatal arterial bleeding (n=1). Daytime PDR brachytherapy proved to be feasible and provided effective palliation. Toxicity remains a major problem. Thus, total dose should be restricted to <15 Gy in this palliative situation.     

Community-based mammography practice: services, charges, and interpretation methods

OBJECTIVE: The purpose of our study was to accurately describe facility characteristics among community-based screening and diagnostic mammography practices in the United States. MATERIALS AND METHODS: A survey was developed and applied to community-based facilities providing screening mammography in three geographically distinct locations in the states of Washington, Colorado, and New Hampshire. The facility survey was conducted between December 2001 and September 2002. Characteristics surveyed included facility type, services offered, charges for screening and diagnostic mammography, information systems, and interpretation methods, including the frequency of double interpretation. RESULTS: Among 45 responding facilities, services offered included screening mammography at all facilities, diagnostic mammography at 34 facilities (76%), breast sonography at 30 (67%), breast MRI at seven (16%), and nuclear medicine breast scanning at seven (16%). Most facilities surveyed were radiology practices in nonhospital settings. Eight facilities (18%) reported performing clinical breast examinations routinely along with screening mammography. Only five screening sites (11%) used computer-aided detection (CAD) and only two (5%) used digital mammography. Nearly two thirds of facilities interpreted screening mammography examinations on-site, whereas 91% of facilities interpreted diagnostic examinations on-site. Only three facilities (7%) interpreted screening examinations on line as they were performed. Approximately half of facilities reported using some type of double interpretation, although the methods of double interpretation and the fraction of cases double-interpreted varied widely across facilities. On average, approximately 15% of screening examinations and 10% of diagnostic examinations were reported as being double-interpreted. CONCLUSION: Comparison of this survey's results with those collected a decade earlier indicates dramatic changes in the practice of mammography, including a clear distinction between screening and diagnostic mammography, batch interpretation of screening mammograms, and improved quality assurance and medical audit tools. Diffusion of new technologies such as CAD and digital mammography was not widespread. The methods of double-interpretation and the fraction of cases double-interpreted varied widely across study sites.     

Developing a web page: bringing clinics online.

Introducing clinical staff education, along with new policies and procedures, to over 50 different clinical sites can be a challenge. As any staff educator will confess, getting people to attend an educational inservice session can be difficult. Clinical staff request training, but no one has time to attend training sessions. Putting the training along with the policies and other information into "neat" concise packages via the computer and over the company's intranet was the way to go. However, how do you bring the clinics online when some of the clinical staff may still be reluctant to turn on their computers for anything other than to gather laboratory results? Developing an easy, fun, and accessible Web page was the answer. This article outlines the development of the first training Web page at the University of Wisconsin Medical Foundation, Madison, WI.     

Use of low molecular weight heparins and glycoprotein IIb/IIIa inhibitors in patients with chronic kidney disease

Despite aggressive intervention, cardiac causes of death, including acute coronary syndrome (ACS), continue to be a major source of mortality in patients with chronic kidney disease (CKD), including end-stage renal disease (ESRD). Multiple large prospective trials have demonstrated the clinical benefits of both low molecular weight heparin (LMWH) and glycoprotein (Gp) IIb/IIIa inhibitors in treating patients with ACS. Unfortunately patients with significant impairment of kidney function have generally been excluded from these major clinical trials. Consequently relatively little is known about the pharmacokinetics, appropriate dosing, efficacy, and safety of these medications in patients with CKD of various stages. This article examines the available literature regarding the pharmacokinetics, dosing, efficacy, and safety of LMWH and Gp IIb/IIIa inhibitors in patients with CKD.     

Comparative characteristics of stress tests--bicycle ergometry test and psycho-emotional test--in patients with ischemic heart disease

AIM: To compare efficacy bicycle exercise (BE) and psychoemotional tests (PET) in provoking myocardial ischemia and arrhythmia in patients with acute and chronic forms of ischemic heart disease (IHD). MATERIAL AND METHODS: BE and PET (mathematical count test) were performed in 108 IHD patients. 30 patients had stable effort angina (FC II-III), 48 patients had progressing effort angina and 30 patients were at the subacute stage of myocardial infarction. RESULTS: PET was less efficient in detection of myocardial ischemia but is more adequate in detecting episodes of painless ischemia and ventricular rhythm disorders compared to BE. The greatest differences in efficiency of the tests occurred in patients with acute forms of IHD. CONCLUSION: Application of different stress tests in IHD patients raises efficacy of detecting episodes of painful, painless myocardial ischemia and rhythm disorders, specifies mechanisms of coronary failure development.     

Willingness of patients to switch from conventional to daily hemodialysis: looking before we leap

PURPOSE: To evaluate the willingness of patients with end-stage renal disease to switch from conventional hemodialysis to short daily hemodialysis, and to determine what health benefits clinical trials of daily hemodialysis would have to document for patients to switch regimens. METHODS: We studied all patients receiving conventional hemodialysis (defined as three times per week) at three dialysis centers in Philadelphia during a 4-month period. Patients indicated their willingness to switch to daily hemodialysis (defined as six 2- to 3-hour in-center treatments per week) in each of 21 scenarios presented via an interactive computer display. We used conjoint analysis to determine how patients' decisions were influenced by four attributes of daily hemodialysis: predicted life expectancy, quality of life, number of annual hospitalizations, and weekly transportation time to and from the dialysis center. RESULTS: Of 126 patients interviewed, 55 (44%) would not choose daily hemodialysis regardless of its health benefits. The remaining 71 patients (56%) indicated that they would consider switching if daily hemodialysis was shown to yield certain health benefits. Patients were more willing to switch to daily hemodialysis as the associated life expectancy and average quality of life increased, and as the number of annual hospitalizations and weekly transportation time decreased (all P <0.001). CONCLUSION: Although daily hemodialysis has received broad support from nephrologists, funding agencies, and lawmakers as the emerging standard of care for patients with end-stage renal disease, upcoming clinical trials would have to document substantial health benefits in order for patients to switch to daily hemodialysis, and many patients may still decline this regimen regardless of the documented benefits.     

Oncogene addiction: sometimes a temporary slavery

Tumors induced in conditional oncomice can show remarkable different responses to subsequent oncogene deprivation. Complete sustained regression, concomitant with massive differentiation and/or apoptosis, and partial regression are both observed. In the latter case, tumor growth either resumes without being dependent any longer on the oncogene, or requires reactivation of the oncogene in cells that have become dormant. These models reflect many of the features we also witness in human cancer and can therefore assist us in understanding the underlying mechanisms and in designing more effective treatment protocols.