A prosthetic contact lens in the treatment of ocular manifestations of albinism

A patient with severe ocular albinism was fitted with a prosthetic soft contact lens which improved both photophobic symptoms and facial cosmesis.     

Dose-intensity meta-analysis of chemotherapy regimens in small-cell carcinoma of the lung.

To determine if chemotherapy dose intensity (DI) influences treatment outcome, 60 published studies in limited- and extensive-stage small-cell carcinoma of the lung (SCCL) were retrospectively analyzed for relationship between intended DI and response (complete response [CR] or partial response [PR]) or median survival (MS). Agents used in the regimens included cyclophosphamide (C), doxorubicin (A), vincristine (V), etoposide (E), and cisplatin (P). Relative DI (RDI) of each study regimen was calculated against a reference regimen, and weighted regression analysis was used. Additionally, analysis of individual drug RDI within combinations was performed. For CAV, increasing RDI of the regimen showed no correlation with outcome. For the individual drugs, C RDI correlated positively, while A RDI correlated negatively with attainment of CR in limited disease, but both only after unduly influential observations were eliminated. In extensive-stage disease, A RDI correlated positively with CR+, PR but only in randomized trials, and this correlation lost statistical significance after unduly influential observations were eliminated. For CAE and CAVE, the RDI of the regimens correlated positively with MS in extensive-stage disease as did the C RDI. In limited disease, the C RDI correlated negatively with MS. For EP, no significant correlations were seen. We conclude that DI-outcome correlations are not consistent for these chemotherapy regimens in SCCL. Meta-analysis of retrospective data can generate hypotheses for testing in prospective clinical trials, but study sample and method of analysis can appreciably affect conclusions.     

Anxiety in patients undergoing MR imaging

To determine and quantify the major sources of anxiety for patients undergoing magnetic resonance (MR) imaging and to suggest means by which to eliminate or diminish their negative effects, the authors studied anxiety in 46 subjects. Of these, 20 randomly selected subjects who successfully completed the examination participated in exit interviews. Six subjects who terminated the examination before completion also completed exit interviews. Pre-imaging and postimaging questionnaires (state-trait anxiety inventory) were administered to measure anxiety in the 20 other subjects. Anxiety was associated with the constrictive dimensions of the magnet bore, examination duration, coil noise, and temperature within the bore. Preparation at the point of referral was consistently absent, incomplete, or misleading. Patients used identifiable strategies to cope with the examination: blinding, breathing relaxation techniques, visualization of pleasant images, and performance of mental exercises.     

Cerebrospinal fluid rhinorrhea: depiction with MR cisternography in dogs

Canine cerebrospinal fluid rhinorrhea, which occurs frequently in purebred beagles, was demonstrated in two dogs on magnetic resonance images after cisternal introduction of gadolinium-DTPA dimeglumine.     

Frequency Analysis of Ventricular Fibrillation and Resuscitation Success

SUMMARY In 56 patients, frequency analysis of the electrocardiogramof ventricular fibrillation exhibited power spectra with a distinctdominant frequency. The greatest success for resuscitation fromventricular fibrillation is recorded when ventricular fibrillationdevelops after the patient comes under coronary care. Of the41 patients in whom the onset and first 8 s of ventricular fibrillationwere artefact-free the mean dominant frequency of primary ventricularfibrillation (no cardiogenic shock or cardiac failure) in 21patients was 6.2±0.2 Hz, significantly higher than themean dominant frequency of the first 8 s of secondary ventricularfibrillation (cardiogenic shock or heart failure) (4.0±0.2Hz, 20 patients, p =0.0001). In these patients the peak-to-troughamplitude (ECG) of the first 8 s of ventricular fibrillationwas similar in both primary and secondary ventricular fibrillationas was the mean duration of ventricular fibrillation prior tothe first DC shock. There was a significantly lower successrate for resuscitation from secondary ventricular fibrillation(6 of 20 patients) compared with resuscitation from primaryventricular fibrillation (18 of 21 patients, x² 17.8, p=0.001).Of the remaining 15 patients who were collapsed between 3 and20 min before the arrival of the mobile coronary care unit,the dominant frequency of the first 8 s of ventricular fibrillationfell with increased duration of collapse (from 5.5 Hz at 3 minto a mean of 2.1 Hz at 20 min). Four of these 15 patients whosurvived the initial arrest had a mean dominant frequency of5.2±0.3 Hz, which was significantly higher than the meandominant frequency (3.1±0.3 Hz, p<0.01) of the 11patients who were not resuscitated. This study shows that low frequency ventricular fibrillationis indicative of a poor chance of successful resuscitation.Alteration of the frequency may increase resuscitation success.     

Impact of an infection consultation service for bacteraemia on clinical management and use of resources

Since 1993, the infection consultation service for bacteraemia has seen 310 patients in the Medical and Surgical Directorates at Ninewells Hospital and Kings Cross Hospital. A random sample of 100 was audited. Case-notes were incomplete for five patients, leaving 95 fully-audited patients. Clinical outcome measures were death from infection, and readmission within 2 weeks of discharge. Initial treatment was inconsistent with antibiotic policy in 46 patients (48%). Antibiotic treatment was changed in 37 (80%) of these patients: increased in intensity in 19 (41%) and decreased in 18 (39%). Changes were also made in 30 (61%) of the 49 patients whose initial treatment was consistent with sepsis policy-increased in seven (14%) and decreased in 23 (47%). Median daily antibiotic costs were lowered in patients whose initial treatment was consistent with sepsis policy (pounds 10.10 vs. pounds 7.28, p = 0.0274). However, in the other patients, savings were balanced by increases (p = 0.7696). Consultation required one consultant session per week (3.5 h) and the audit required an additional 16 consultant sessions. Seven patients died, but only one death was directly related to infection. Six patients were readmitted to hospital within 2 weeks, in three due to recurrence of infection. Changes to treatment were recommended in the majority of patients, regardless of whether initial treatment complied with the sepsis policy. The service primarily redistributed resources rather than reducing costs. A fully audited service requires considerable consultant time, but we believe such time is well spent.