Selection bias in treatment of soft-tissue sarcoma.

We analysed 256 patients with primary soft-tissue sarcoma of the extremities diagnosed between 1970 and 1990 to see if tumour-related and host-related prognostic factors influenced both the selection of operation and the margin of clearance obtained at surgery. Amputation was more often performed in young patients, in those with distal tumours, and in those with deep-seated tumours. Inadequate surgical margins (those with a high risk of local recurrence) were more common in patients with deep-seated and large tumours than in patients with superficial and small tumours. These features of the tumour and the host, which have been shown to be prognostic for survival, also influenced the choice and performance of surgical procedures.     

Fractures after Stroke

Fractures are a serious complication after stroke. Among patients with femoral neck fractures, a large subgroup have had a previous stroke. This study aimed to investigate the incidence of fractures after stroke. Included in the study were 1139 patients consecutively admitted for acute stroke. Fractures occurring from stroke onset until the end of the study or death were registered retrospectively. Hip fracture incidence was compared with corresponding rates from the general population. Patients were followed up for a total of 4132 patient-years (median 2.9 years). There were 154 fractures in 120 patients and median time between the onset of stroke and the first fracture was 24 months. Women had significantly more fractures than men (χ² = 15.6; p < 0.001). In patients with paresis most of the fractures affected the paretic side (χ² = 22.5; p < 0.001) and 84% of the fractures were cause by falls. Hip fracture was the most frequent fracture and the incidence was 2–4 times higher in stroke patients compared with the reference population. Fractures are thus a common complication after stroke. They are usually caused by falls and affect the paretic side. It is necessary to focus on the prevention of post-stroke fractures, including the prevention of both falls and osteoporosis.     

Comparison of Discrete Cardiovascular Fitness Groups on Plasma Catecholamine and Selected Behavioral Responses to Psychological Stress

Discrete cardiovascular fitness groups consisting of high-fit (n=10) and low-fit (n=9) men performed a well-learned vigilance task and their self-report, performance, and plasma catecholamine responses were compared. No significant differences were observed between the fitness groups on self-report or psychomotor performance responses to the vigilance task. However, the low-fit group took significantly longer than high-fit subjects to complete the first of three sets of anagrams administered immediately after the vigilance task. Plasma norepinephrine but not epinephrine response was greater in the low-fit group compared to their high-fit counterparts. The findings indicate that enhanced cardiovascular fitness may be characterized by an attenuated plasma norepinephrine response to a vigilance task with sustained cognitive performance subsequent to the task.     

Conservation of receptor antagonist anti-tumor activity by epidermal growth factor receptor antibody expressed in transgenic corn seed

Recombinant protein production in plants such as corn is a promising means to generate high product yields at low comparable production cost. The anti-EGFR monoclonal antibody C225, cetuximab, is a well-characterized receptor antagonist antibody recently approved for the treatment of refractory colorectal cancer. We initiated a study to test and compare the functional activity of glycosylated and aglycosylated C225 produced in stable transgenic corn seed. Both corn antibodies were shown to be functionally indistinguishable from mammalian-derived C225 in demonstrating high-affinity binding to the EGF receptor, blocking of ligand-dependent signaling, and inhibiting cell proliferation. In addition, consistent with cetuximab, both corn antibodies possessed strong anti-tumor activity in vivo. Acute dose primate pharmacokinetic studies, however, revealed a marked increase in clearance for the glycosylated corn antibody, while the aglycosylated antibody possessed in vivo kinetics similar to cetuximab. This experimentation established that corn-derived receptor blocking monoclonal antibodies possess comparable efficacy to mammalian cell culture-derived antibody, and offer a cost effective alternative to large-scale mammalian cell culture production.     

Diagnosis and management of acute aortic dissection, clinical and radiological follow-up

A clinical series of acute aortic dissections is presented. Twenty cases were of type A and 10 of type B. Acute severe chest pain was common, in type A also blood pressure difference between the arms and aortic regurgitation. The diagnosis was established by echocardiography, computerized tomography and/or aortography. Antihypertensive therapy was instituted immediately after diagnosis and was in type A cases followed by acute surgery unless definite contraindications existed. Of 14 surgically treated type A patients 13 survived the operation. On follow-up 1.5-3.5 years later, 12 patients were still alive and doing well, but the false channel remained open in all cases where it had not been resected totally. Only one of six conservatively treated type A patients survived. Type B dissections were operated on only if conservative therapy failed. Four of five conservatively and two of five surgically treated type B patients survived.     

Study of nuclear diameters in non-Hodgkin's lymphomas

The mean maximum nuclear diameter (D_max) in 21 cases of non-Hodgkin's lymphoma (NHL) has been determined, using the Reichert-Jung (Kontron) MOP-AMO₃ user-controlled image analyser. Nuclear diameters of high-grade malignancy NHL were found to be considerably greater than those of low-grade malignancy lymphomas, although there was some overlap of their ranges. These findings confirm objectively subjective estimates of nuclear size in NHL. The relative usefulness of the user-controlled (interactive) image analyser for the measurement of nuclei in tissue sections is compared with that of a fully automatic machine.     

Linear performance characteristics of latissimus dorsi muscle: potential for cardiac assistance

Knowledge of the quantitative performance capabilities of skeletal muscle in a linear geometry is necessary to predict the performance and to optimize the design of linearly configured, skeletal muscle powered cardiac assist devices (MCADs). This study determined the performance characteristics of goat latissimus dorsi muscle (LDM) using a linear, ex vivo experimental apparatus. In five goats, the LDM (130.6 +/- 18.8 g) was dissected free of its distal attachments, connected to a series of weights (500 to 2250 g), and maximal tetanic contractions were elicited via thoracodorsal nerve stimulation. Second order polynomial equations were derived to represent each of the following variables versus load: muscle prestretch (range 1.5 to 5.4 cm), contraction duration (220 to 360 milliseconds), contraction shortening distance (13.5 to 10.9 cm), contraction velocity (60 to 31 cm/s), generated stroke power (3 to 7 W), and stroke work (0.7 to 2.4 J). Analysis of the potential stroke volumes obtained with a linearly configured, cylindrically shaped MCAD directly coupled to the circulation indicate that a feasible MCAD operating region exists based on the LDM performance data across a range of device geometries and mean ejection pressures.