Digital beam attenuator technique for compensated chest radiography

The feasibility of producing patient-specific beam attenuators for chest radiography has been investigated using an anthropomorphic phantom and a human volunteer. A low-dose test exposure is digitized, processed, and used to print a small cerium filter, which is placed in the x-ray beam near the collimator. The final radiograph is recorded on film. The technique results in relatively uniform film exposure, so that structures in all regions of the chest are simultaneously displayed with optimal film contrast. The equalized exposure improves image quality in the normally underpenetrated regions and reduces the role of cross-scatter from the lungs. The image is analogous to optical or computer-processed unsharp masking techniques, but the processing is accomplished in the x-ray beam and results in an improved exposure distribution, giving advantages that cannot be achieved with image processing techniques alone.     

Foraminal spurs: a normal variant in the lumbar spine

A normal variant, the foraminal spur, is described in five patients. It was seen on computed tomographic studies as a bony process extending from either the pars or the pedicle into the neuroforamen dorsal to the nerve root. In four of the cases it was seen bilaterally. None of the patients had any symptoms related to these spurs. No associated disease of the neuroforamen or facet was present. These spurs most likely represent ossification of the ligamentum flavum at its point of insertion and should not be mistaken for osteophytes, free disk fragments that have calcified, or fracture fragments. Sagittal reformations are helpful in visualizing the extent of the foraminal spurs.     

Lysis by activated lymphocytes of melanoma and small cell lung cancer cells surviving in vitro treatment with mafosfamide

Six short term-cultured melanoma cell lines and one small cell lung cancer cell line were treated in vitro with the alkylating agent mafosfamide. The sensitivity of the surviving cells to in vitro lysis by recombinant interleukin 2-activated autologous and allogeneic lymphocytes was then investigated. In no case did chemo-surviving tumor cells appear less sensitive to lymphocyte-mediated lysis than untreated counterparts. In three of seven cases (two of which were derived from the same patient), chemo-selected cells were even more sensitive to cytotoxic lymphocytes, a difference not explained by a different distribution of neoplastic cells in the various cell cycle phases. We also studied the inhibitory activity of activated lymphocytes on the clonogenic potential of chemo-surviving tumor cells by the human tumor clonogenic assay. Inhibitions of tumor cell growth in the two patients tested were 100 and 94%, respectively; the activity of lymphocytes was dependent on the coculture time and the effector/target cell ratio. These data indicate that in vitro treatment with mafosfamide does not select cells resistant to the action of activated lymphocytes and that, given the right experimental conditions, these immune effectors can completely lyse tumor cells.     

Treatment and prognosis in a series of primary extranodal lymphomas of the ocular adnexa

Background: The aim of this study was to assess clinicopathological characteristics and outcome in a series of primary ocular adnexal lymphomas (POALs).Patients and methods: Nineteen patients with localised (stage IE) POAL were followed for a median of 96 months (24–156). The diagnosis was based on surgical biopsies followed by immunohistochemistry in 16 cases or fine-needle aspiration followed by immunocytophenotypic analysis in three cases. Twelve patients were treated with local radiotherapy (RT), five with chemotherapy (CT), and two refused further therapy after apparently radical tumour removal achieved by the diagnostic excisional biopsy.Results: The histological and immunological pattern was consistent with a diagnosis of MALT-type lymphoma (11 cases), follicular center non-Hodgkin's lymphoma (three cases), a large-cell variant of Burkitt's lymphoma (one case), and large-cell transformed MALT lymphoma (one case). Low-grade lymphoma was diagnosed in the three cases which underwent fine-needle aspiration biopsy. All of the patients achieved and maintained complete remission except for those treated with surgical excision alone (two MALT conjunctival lymphoma cases): one of these relapsed locally, the other experienced the systemic spread of a transformed diffuse large-cell lymphoma and died 72 months after diagnosis. The side effects consisted of two cases of RT-related cataract after 52 and 72 months.Conclusions: Regardless of histology, prognosis was excellent when surgery plus RT was adopted, and CT seems to be a valid alternative to RT. Surgery alone may be sub-optimal.     

The impact of cancer treatment guidelines on actual practice in Italian general hospitals: the case of ovarian cancer

Over the past ten years the Italian National Research Council (C.N.R.) has carried out an educational program based on the preparation and dissemination of guidelines to facilitate delivery in community hospitals of the most up-to-date care to patients with ovarian cancer. In 1988 an assessment was begun to determine (a) whether the guidelines reached the target physician population; (b) whether they were accepted by those they reached, and (c) whether treatment patterns thereafter conformed to the guidelines. Overall results of this evaluation provide no evidence of clinically relevant effects of the program. The guidelines were not widely disseminated: only 44% of responders were aware of them. Moreover, analysis of practice patterns showed serious deficiencies in diagnostic procedure and surgical staging (information on grading and residual tumour was available only in 30% and 45% of cases, respectively, and only 10% of the patients had random biopsies as part of their surgical staging). The only observation supporting some effect of this educational intervention in terms of knowledge modification was of certain therapeutic preferences among those aware of the guidelines. This finding, however, is highly susceptible to confounding by other factors (e.g. physicians' greater expertise, spillover effect of the program) not entirely avoidable in an observational study. We conclude that any assessment of procedures based on dissemination of information must include a careful analysis of the method of dissemination. The availability of clinically applicable information must also be realistically appraised before the guidelines approach can be accepted as the most effective.     

腹部及盆腔急性出血的介入治疗

目的探讨腹部急性出血选择性血管造影诊断及介入治疗价值。方法回顾性分析80例行选择性动脉血管造影及血管内介入治疗的腹部及盆腔急性出血患者的临床资料。结果80例均采用Seldinger技术,经股动脉插管后作选择性血管造影,用碘化油、明胶海绵或弹簧圈栓塞治疗,80例中完全止血68例、再出血9例、无效3例。结论介入方法不仅可确定出血部位,而且可达到止血目的,效果确切。     

Immunochemical characterization of Glycine max L. Merr. var Raiden, as a possible hypoallergenic substitute for cow's milk-allergic patients

Background Cows' milk allergy (CMA) is the most common cause of food allergy in infancy. The only proven treatment is the complete elimination of cows' milk proteins (CMPs) from the diet by means of hypoallergenic formulas. Soybean‐based formulae are widely used although intolerance to soy has been reported to occur in 15–40% of infants with CMA. Objective The aim of this work was to analyse the in vitro reactivity of the soybean cultivar Raiden, which naturally lacks glycinin A₄A₅B₃, to evaluate whether this genotype could be a safe CMP substitute for CMA patients. Methods The reactivity of conventional soybean (CS) and Raiden soybean (RS) genotypes and also recombinant glycinin A₄A₅B₃ and αβ‐conglycinin with casein‐specific monoclonal antibodies and CMP‐specific polyclonal serum was evaluated by immunoblotting and ELISA. A sequential competitive ELISA with the polyclonal antiserum and different soluble inhibitors was performed. In addition, an indirect ELISA with sera of atopic children with CMA was carried out to analyse the IgE‐binding capacity of the different soybean components. Results We have shown that CS contains four components that cross‐react with CMP, while RS has only one. The remaining cross‐reactive component in RS was identified as α‐subunit β‐conglycinin. By means of inhibitory ELISA, we demonstrated that CS, RS and the α‐subunit β‐conglycinin extracts inhibited the binding of CMP‐specific antibodies to the CMP‐coated solid phase. Finally, we showed that CS, RS and the recombinant proteins were recognized by human CMP‐specific IgE antibodies. Conclusion This work shows that although Raiden has fewer cross‐reactive components than conventional soybean, it still has a residual cross‐reactive component: the α‐subunit β‐conglycinin. This reactivity might make this genotype unsuitable to treat CMA and also explains adverse reactions to soybean in CMA infants.