Diagnosis of liver cirrhosis with US: receiver-operating characteristic analysis of multidimensional caudate lobe indexes

To assess the utility of changes in the volume of the caudate lobe in the sonographic diagnosis of liver cirrhosis, the authors studied 58 patients with histologically proved cirrhosis, 18 patients with fatty liver, 28 patients with liver metastases, seven patients with lymphomatous liver involvement, and 75 healthy individuals. The longitudinal (CL), transverse (CT), and anteroposterior (CAP) diameters of the caudate lobe and the transverse diameter of the right lobe (RL) were measured, and one-, two-, and three-dimensional caudate lobe indexes and ratios were calculated. The analysis of the diagnostic performance of these criteria, compared by means of receiver-operating characteristic curves, revealed that the ratio of the three-dimensional caudate index (CI3) to the right lobe diameter (CI3/RL = [CL X CT X CAP]/RL) was superior to all other calculated criteria. At a specificity of 95%, the sensitivity of CI3/RL was 94.7%, compared with 73.3% for CT/RL. No significant differences were found between the control group and patients with fatty liver, metastases, or lymphomatous involvement. The study suggests that CI3/RL is the most reliable quantitative criterion for the US diagnosis of liver cirrhosis.     

The use of biosynthetic human growth hormone to augment ovulation induction with buserelin acetate/human menopausal gonadotropin in women with a poor ovarian response

The present study has demonstrated the usefulness of GH in augmenting buserelin acetate/hMG to stimulate the rate of growth of follicles in women regarded as poor responders. The PR achieved was extremely encouraging in a group of patients whose prognosis was otherwise poor. Further studies are required to confirm these preliminary data.     

ANTIHYPERTENSIVE EFFECTS OF dl- TETRAHYDROPALMATINE: AN ACTIVE PRINCIPLE ISOLATED FROM CORYDALIS

1. The effects of dl -tetrahydropalmatine (dl -THP) on cardiovascular function and hypothalamic release of monomines were assessed in rats under urethane anaesthesia. 2. Intravenous administration of dl -THP (1-10 mg/kg) produced hypotension, bradycardia, a decrease in hypothalamic serotonin and noradrenaline release and in increase in hypothalamic dopamine release in rats. 3. Intrahypothalamic administration of DOI (a serotonergic 5-HT₂ receptor antagonist) or apomorphine (a dopamine D₂-receptor agonist) produced the opposite effects and reversed dl -THP-induced hypotension and bradycardia. 4. The data suggest that dl -THP acts through the 5-HT₂ and/or D₂-receptor antagonism in the hypothalamus to induce hypotension and bradycardia in rats.     

Multiplanar arc boost radiation therapy for prostate cancer

Localized prostatic carcinoma may be treated with either radical surgery or radiation therapy. Radiation therapy techniques for localized prostatic carcinoma include mega-voltage external irradiation or interstitial implantation, usually with iodine-125 seeds. Two external-beam techniques, multiplanar arc and biplanar arc, are additional options for the treatment of localized prostatic carcinoma. Film dosimetry measurements were made in pelvic phantoms to compare the isodose distributions of various external-beam radiation therapy techniques for boost treatment of prostate target volumes. Idealized calculations were performed to determine the isodose distribution of an I-125 implant. A comparison of these techniques shows that the multiplanar and biplanar arc techniques produce isodose distributions that may be useful in the treatment of prostate carcinoma.     

The microchemical detection of carbonic anhydrase in corneal epithelia.

Carbonic anhydrase (CA) activity has been detected and quantified in the corneal epithelia of various mammalian species using a microchemical assay. The highest levels were found in the rabbit, followed by man, dog, sheep, and cat. Enzyme levels in the rabbit epithelium were approximately one-third the amount found in the endothelium, perhaps explaining earlier failures to find CA in the epithelium. Selective inactivation of CA-II in tissue homogenates with bromopyruvic acid allowed determination of CA-I/CA-II ratios. The ratios in corneal epithelia from two species (rabbit and dog) approximated that in the erythrocyte. Although CA levels in the epithelium are low they are perhaps functional in the transfer of CO2 across the cornea.     

Acknowledgement to referees

Acknowledgement to referees     

Continuing professional development amongst dental practitioners in the United Kingdom: how far are we from lifelong learning targets?

This study was conducted to identify the extent to which qualified dental practitioners in the UK currently undertake three distinct activities of Continuing Professional Development (CPD): reading professional journals; attending courses; and undertaking retraining courses. Also, to determine the impact of gender, age, length of time since qualification, current working hours and career breaks upon the extent to which dental practitioners engage in CPD. Data were analysed from a questionnaire survey of a systematic sample of one in 10 dentists taken from the Dentists Register of the UK General Dental Council. The response rate was 66.6%. Only dentists practising at the time of the survey were included in the analysis (N = 1550). A high proportion of the sample reported regularly undertaking activities related to CPD. Approximately 87% read professional journals at least once per month; just over half had attended five or more days at professional meetings and courses in the last year. Only a small proportion of dentists (12%) had undertaken a retraining course in the past three years. Those dentists who had been qualified for between 21 and 30 years, those who had gained additional qualifications after qualifying as a dentist, and those who had taken a career break at some point in their life were more likely to read professional journals. Attendance at postgraduate dental courses was related to being male, not having taken a career break, possessing an additional qualification, longer working hours, and not being a General Dental Practitioners (GDP). Attendance at a retraining course was less likely for those who had taken a career break, those who had attended fewer courses in the last year and for those who worked 30--40 h per week. A large proportion of dental practitioners are currently undertaking sufficient CPD to meet the UK requirements of recertification. Greater attention should be directed towards identifying the barriers to CPD among female dentists and those who have been qualified for longer periods. More research is needed in assessing the long-term CPD consequences of those who have returned to dentistry following a career break.     

Ethical issues of randomized clinical trials

Randomized clinical trials are an accepted form of experimentation on human subjects to determine the effectiveness of new treatment regimens or drugs. The Declaration of Helsinki, adopted by the World Medical Association, has established guidelines to safeguard humans used as subjects in medical experimentation. The ethical issues of informed consent, the physician-patient relationship and the potential for abuses in research must be considered prior to agreeing to participate in human experimentation.     

Absolute quantification of cerebral blood flow with magnetic resonance, reproducibility of the method, and comparison with H2(15)O positron emission tomography.

While H2(15)O positron emission tomography (PET) is still the gold standard in the quantitative assessment of cerebral perfusion (rCBF), its technical challenge, limited availability, and radiation exposure are disadvantages of the method. Recent work demonstrated the feasibility of magnetic resonance (MR) for quantitative cerebral perfusion imaging. There remain open questions, however, especially regarding reproducibility. The main purpose of this study was to assess the accuracy and reproducibility of MR-derived flow values to those derived from H2(15)O PET. Positron emission tomography and MR perfusion imaging was performed in 20 healthy male volunteers, who were chronic smokers, on day 1 and day 3 of a 4-day hospitalization. Subjects were randomly assigned to one of two groups, each with 10 subjects. One group was allowed to smoke as usual during the hospitalization, while the other group stopped smoking from day 2. Positron emission tomography and MR images were coregistered and rCBF was determined in two regions of interest, defined over gray matter (gm) and white matter (wm), yielding rCBF(PET)gm, rCBF(MR)gm, rCBF(PET)wm, and rCBF(MR)wm. Bland-Altman analysis was used to investigate reproducibility by assessing the difference rCBFday3 - rCBFday1 in eight continual-smoker volunteers. The analysis showed a good reproducibility for PET, but not for MR. Mean +/- SD of the difference rCBFday3 - rCBFday1 in gray matter was 6.35 +/- 21.06 and 0.49 +/- 5.27 mL x min(-1) x 100 g(-1) for MR and PET, respectively; the corresponding values in white matter were 2.60 +/- 15.64 and -1.14 +/- 4.16 mL x min(-1) x 100 g(-1). The Bland-Altman analysis was also used to assess MRI and PET agreement comparing rCBF measured on day 1. The analysis demonstrated a reasonably good agreement of MR and PET in white matter (rCBF(PET)wm - rCBF(MR)wm; -0.09 +/- 7.23 mL x min(-1) x 100 g(-1)), while in gray matter a reasonable agreement was only achieved after removing vascular artifacts in the MR perfusion maps (rCBF(PET)gm - rCBF(MR)gm; -11.73 +/- 14.52 mL x min(-1) x 100 g(-1)). In line with prior work, these results demonstrate that reproducibility was overall considerably better for PET than for MR. Until reproducibility is improved and vascular artifacts are efficiently removed, MR is not suitable for reliable quantitative perfusion measurements.