Serial plasma carcinoembryonic antigen measurements in the management of metastatic colorectal carcinoma

Serial carcinoembryonic antigen (CEA) measurements were evaluated in a group of 263 patients undergoing systemic chemotherapy for metastatic colorectal carcinoma. Initial CEA levels were not found to be of value in predicting the likelihood of subsequent tumor response. Although a general relation between serial CEA measurements and clinical tumor measurements was noted, these measurements were discordant in a substantial proportion of patients. Tumor measurements as an index of response to therapy were strongly correlated with survival, whereas changes in CEA values and patient survival were not correlated at a statistically significant level. Serial CEA measurements were perhaps of some value in predicting progression of malignant disease, and were roughly comparable to serum alkaline phosphatase assay in assessing response of liver metastasis to chemotherapy. Overall, serial CEA measurements added little to the standard clinical assessment of patients with advanced colorectal carcinoma receiving chemotherapy.     

Uptake and biodistribution of technetium methylene-[P]diphosphonate during endosteal healing around titanium, stainless steel and hydroxyapatite implants in rat tibial bone

Early evaluation of intraosseous implant success and failure is critical, but, until now, there have been no reliable systems of measurement. The present study assessed whether the use of ^99mtechnetium methylene-[³²P]diphosphonate (^99mTcMD³²P), a marker for both bone formation and mineralization, can indicate if an implant is bone-bonding or non-bonding. Moreover, this study examined how bone-bonding (titanium and hydroxyapatite) and non-bonding (stainless steel) implants affected the normal healing of bone after marrow ablation, as measured by uptake of ^99mTc and ³²P. Titanium, hydroxyapatite and stainless steel implants were placed in the right tibiae of Sabra strain rats following ablation of the marrow, and ^99mTcMD³²P was injected 18h before harvest. At 3, 6, 14, 21 and 42 d (and in some experiments, on days 28 and 35) post-injury, the treated and contralateral tibiae were removed and cleaned of soft tissue. The uptake of ^99mTc and ³²P was measured in the whole bone, as well as in its organic and inorganic phases. Effects of the implants were assessed by comparing the treated to the untreated tibia in each rat. The distribution of ^99mTc and ³²P varied with each implant. After the insertion of titanium, increased ^99mTc uptake was seen in whole bone and in the inorganic and organic phases at days 6–14. ³²P uptake in whole bone and in the inorganic phase increased only at day 6, and ³²P uptake was decreased in the organic phase at that time. In tibiae implanted with hydroxyapatite, ^99mTc and ³²P uptake was seen in the whole bone at days 6 and 14. While ^99mTc uptake was increased in both the organic and inorganic phases, ³²P uptake into the organic phase was decreased at both day 6 and day 14. In tibiae implanted with stainless steel, effects were observed only on day 6. The increased ^99mTc uptake in whole bone reflected increases in both the organic and mineral phases. Increased ³²P uptake was observed in whole bone as well, due to an increase in the ³²P uptake in the mineral phase only; incorporation of ³²P in the organic phase was comparable to that found in the contralateral limb. The results of this study indicate that implants alter bone healing, as indicated by the uptake of ^99mTc and ³²P in the different bone compartments. Moreover, decreased ³²P uptake by the organic phase in the presence of bone-bonding implants suggests that cleavage of ^99mTcMD³²P into its technetium and methylene diphosphonate moieties was inhibited, perhaps as a function of the onset of calcification in the newly synthesized osteoid. The effect of the implants on bone healing was observed on days 6–14, when active bone formation and mineralization were occurring, supporting the hypothesis that these materials modulate events associated with initial calcification. Uptake of ^99mTc varies as a function of time, and uptake of ³²P varies with time and distribution in the mineral or organic phase of bone, suggesting that these parameters may be useful as indicators of bone-bonding.     

Factors affecting immediate mortality of patients with acute myocardial infarction: a nationwide study.

The hospital mortality was evaluated for 21 days in all patients with a first attack of acute myocardial infarction (AMI) in Israel. Total mortality was 21.1 percent. The following factors were associated with relatively better prognoses: age, young; sex, male; marital status, married; ethnic origin, European; site, subendocardial; history of smoking, and, to a certain degree, hypertension; low levels of white blood cells, blood sugar, serum transaminase and cholesterol; and anticoagulant therapy.     

Esophageal cancer in Israel: selected clinical and epidemiological aspects.

Records of all patients diagnosed as having carcinoma of the esophagus in Israel between 1960 and 1966 were reviewed. The mean annual incidence was 2.3/100,000, with a male/female ratio of 1.6:1. Incidence was higher among the Asian-born segment of the population below 60 years of age. The most frequent localization was in the middle third of the esophagus, followed by the lower third. More than two thirds of the patients were considered unsuitable for surgery. Overall 5-year survival was 5.8%.     

Pericytes and the pathogenesis of diabetic retinopathy

Pericytes provide vascular stability and control endothelial proliferation. Pericyte loss, microaneurysms, and acellular capillaries are characteristic for the diabetic retina. Platelet-derived growth factor (PDGF)-B is involved in pericyte recruitment, and brain capillaries of mice with a genetic ablation of PDGF-B show pericyte loss and microaneurysms. We investigated the role of capillary coverage with pericytes in early diabetic retinopathy and the contribution to proliferative retinopathy using mice with a single functional allele of PDGF-B (PDGF-B(+/-) mice). As assessed by quantitative morphometry of retinal digest preparations, pericyte numbers in nondiabetic PDGF-B(+/-) mice were reduced by 30% compared with wild-type mice, together with a small but significant increase in acellular capillaries. Pericyte numbers were reduced by 40% in diabetic wild-type mice compared with nondiabetic wild-type controls. Pericyte numbers were decreased by 50% in diabetic PDGF-B(+/-) mice compared with nondiabetic wild-type littermates, and the incidence of acellular capillaries was increased 3.5-fold when compared with nondiabetic PDGF-B(+/-) mice. To investigate the effect of pericyte loss in the context of ongoing angiogenesis, we subjected mice to hypoxia-induced proliferative retinopathy. As a result, PDGF-B(+/-) mice developed twice as many new blood vessels as their wild-type littermates. We conclude that retinal capillary coverage with pericytes is crucial for the survival of endothelial cells, particularly under stress conditions such as diabetes. At high vascular endothelial growth factor levels, such as those in the retinopathy of prematurity model, pericyte deficiency leads to reduced inhibition of endothelial proliferation in vivo.     

Infusion technology: a cause for alarm

BACKGROULD: Volumetric infusion pumps are widely used in paediatric practice. Tissue extravasation is a hazard. The occlusion pressure limit alarm, although not intended to detect extravasation, is the only warning sign present to indicate flow faults in the infusion systems. METHODS: Extravasations were created in the subcutaneous plane of 20 limbs of five piglets with normal saline via an infusion pump. Five flow rates were used with each piglet allocated to one: 100 ml.h-1, 200 ml.h-1, 300 ml.h-1, 400 ml.h-1, 500 ml.h-1. The occlusion pressure limit was first set at low and adjusted to medium, then to high, upon alarm activation. Line pressure at 5-min intervals and upon alarm activation and volume of infusate given were measured. Limb diameters before and after infusion were measured. RESULTS: Six out of 20 cases failed to activate any alarm. The low, medium and high occlusion pressure limit alarms were activated in 14, 1 and 0 instances, respectively. The incidence of alarm activation is higher in the forelimb compared with the hindlimb (P=0.001). The tissue compliance and volume infused at alarm activation are significantly lower in the former (P < 0.05). Line pressure increases with increase in flow rates for the same limb (P=0.013 Fore, P=0.005 Hind). CONCLUSIONS: Occlusion pressure limit alarm cannot reliably detect extravasation especially at sites with high compliance, low flow rates, even at low occlusion limit. Line pressure depends on interplay of site (compliance) and flow rate and is independent of volume extravasated. Users must be aware of the set occlusion pressure limit. Repeated clinical assessment remains vital.     

Exertional heat stroke--the prevention of a medical emergency

In most cases, exertional heat stroke (EHS) can be prevented in the military setting. The actions taken by the Israel Defense Forces (IDF) and their outcome prove this well. Unfortunately, despite the available information, there are still incidents of failure of command in conducting physical exercise, leading to EHS. In our experience, most incidences are a consequence of disregarding safety regulations. The application of simple and reasonable measures will not only prevent accidents from happening, but will also result in better trained soldiers.     

Conservative treatment of adenocarcinoma of the endometrium in young patients. Is it appropriate?

Few reports have suggested that nulliparous young patients with endometrial cancer may be treated conservatively to preserve fertility. We present a young nulliparous woman with a well differentiated adenocarcinoma of the endometrium treated with progestins. Since she did not respond, a definite operation was performed revealing involvement of the uterine isthmus, thus necessitating adjuvant radiotherapy.