Chest radiography: a survey of techniques and exposure levels currently used

In diagnostic radiology, the routine measurement of exposure levels for a reference patient is an important part of an effective quality assurance program. In the United States, chest radiography is the most frequent examination and has the lowest exposure level of all radiologic examinations. We estimated the amount of exposure an average patient received from both manual and automatic exposure-controlled radiographic techniques by using a "patient-equivalent" chest phantom during measurements. A densitometric procedure was used to assess processor performance. The mean exposure from 194 chest systems was 20 mR (5.16 X 10(-5) C/kg); the mean film density, 1.38; and the mean processing speed, 108. It is interesting to note that a wide range of radiographic techniques, processing conditions, and screen-film speeds are currently being used. With the information given in our study, investigators can begin to identify the problems that lead to unusual exposure levels and, perhaps, poor image quality.     

Making short-term international medical volunteer placements work: a qualitative study

Background

International medical volunteering has grown in recent decades. It has the potential to benefit and harm the volunteer and host countries; but there is a paucity of literature on the impacts of international medical volunteering and a need to find ways to optimise the benefits of such placements.

Aim

In this study, one example of international medical volunteering was examined involving British GPs on short-term placements in Nepal. The intention was to explore the expectations and experiences of the local health workers, volunteers, and host organisation to try and understand what makes volunteer placements work.

Design

Qualitative study of key informant interviews.

Setting

Stakeholders of a short-term international medical volunteer (IMV) placement programme in Nepal.

Method

Key informant interviews were carried out via face-to-face or telephone/internet interviews with five previous volunteers, three representatives from a non-governmental organisation providing placements, and five local health workers in Nepal who had had contact with the IMVs. Interviews were recorded, transcribed, and analysed using standard thematic framework approaches.

Results

All the stakeholders had their own specific motives for participating in the IMV programme. The relationship between volunteers and the Nepalese health workers was complex and characterised by discrepant and occasionally unrealistic expectations. Managing these different expectations was challenging.

Conclusion

Contextual issues and cultural differences are important considerations in medical volunteer programmes, and this study highlights the importance of robust preparation pre-placement for the volunteer and host to ensure positive outcomes.     

Antimicrobial, Wound Healing and Antioxidant Activities of Anthocephalus Cadamba

Anthocephalus cadamba (Roxb.) Miq. Syn A. chinensis (Lamk) A. Rich (Rubiaceae) is ethnomedicinally widely used in the form of paste by tribe in western Ghats for treating skin diseases. In this context, antimicrobial potential of A. cadamba against a wide range of microorganisms was studied. To validate the ethnotherapeutic claims of the plant in skin diseases, wound healing activity was studied, besides antioxidant activity to understand the mechanism of wound healing. The alchoholic and aqueous extract of this plant showed significant antibacterial and antifungal activity against almost all the organisms: Micrococcus luteus, Bacillus subtilis, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and four fungi Candida albicans, Trichophyton rubrum—dermatophyte fungi, Aspergillus niger, Aspergillus flavus and Aspergillus nidulans—systemic fungi, with especially good activity against the dermatophyte (Trichophyton rubrum) and some infectious bacteria (Escherichia coli, Proteus mirabilis and Staphylococcus aureus) with an MIC of 2.5 µg/disc. The results show that A. cadamba extract has potent wound healing capacity as shown from the wound contraction and increased tensile strength. The results also indicated that A. cadamba extract possesses potent antioxidant activity by inhibiting lipid peroxidation and increase in the superoxide dismutase (SOD) and catalase activity.     

Focal fatty infiltration of the liver simulating metastatic disease

Two cases are reported in which multiple, well-defined lesions of the liver, as seen on computed tomographic (CT) scans and sonograms, were thought to represent metastatic malignancy. Results from radionuclide scans and biopsies (and surgery in one case) indicated the correct diagnosis was fatty infiltration of the liver. Focal fatty infiltration should be considered in cases of multiple discrete hepatic lesions, especially in patients with a predisposing condition. Radionuclide studies and biopsies may be needed to confirm the diagnosis by CT.     

Evidence that the local effect of ultraviolet radiation on the growth of murine melanomas is immunologically mediated.

We had reported previously that the outgrowth of melanoma is enhanced when melanoma cells are injected into UV-irradiated skin of syngeneic mice. To determine whether this effect was specific for melanomas, we compared the growth of 13 different tumor cell lines (3 melanomas, 6 fibrosarcomas, 2 undifferentiated skin tumors, a squamous cell carcinoma, and a spontaneous hepatocarcinoma) in UV-irradiated and nonirradiated syngeneic mice. C3H/HeN(MTV-) mice were exposed to 4.8 kJ/m2 UV-B (280-320 nm) radiation twice a week for 3 weeks; the tumor cells were injected into the UV-irradiated pinna 24 h after the final UV irradiation. The growth of all the melanomas and 4 of the fibrosarcomas was enhanced in UV-irradiated mice, indicating that the effect of UV radiation was not specific for melanomas or tumors of a particular etiology. Using an in vivo immunization and challenge assay, we found that the 7 tumors exhibiting enhanced development in UV-irradiated skin were highly immunogenic, whereas the remaining 6 tumors were not. This suggested that enhanced tumor outgrowth resulted from an immunosuppressive effect of the UV radiation. When tested further, we found that UV-B radiation had no effect on melanoma outgrowth in congenitally athymic mice, sublethally X-irradiated mice, or mice depleted of Thy1+ cells in vivo. These results indicate that immunological mechanisms play a role in the effect of UV radiation on the growth of murine melanomas.     

Active specific immunotherapy against occult brain metastasis

We determined whether lyophilized High Five (H5) insect cells engineered to produce IFN-beta (H5BVIFN-beta) could induce systemic immunity against occult brain metastases. C3H/HeN mice were injected s.c. with syngeneic UV-2237M fibrosarcoma or K-1735M2 melanoma cells. Intralesional injection of 2 x 10(6) lyophilized H5BVIFN-beta cells produced complete regression of the s.c. tumors. Six weeks later, UV-2237M fibrosarcoma cells or K-1735M2 melanoma cells were injected into the internal carotid artery of naive or treated mice. UV-2237M brain metastases developed in naive mice or mice cured of K-1735M2 tumors but not in mice cured of UV-2237M tumors. Similarly, K-1735M2 brain metastases developed in naive mice or mice cured of UV-2237M fibrosarcomas but not in mice cured of K-1735M2 melanoma. In the next set of studies, mice were injected s.c. with UV-2237M fibrosarcoma cells. On day 7, UV-2237M fibrosarcoma cells or K-1735M2 cells were implanted into the internal carotid artery, and on day 10, the s.c. tumors were injected with lyophilized H5BVIFN-beta. Both the s.c. tumors and the occult brain metastases produced from carotid injections were eradicated in a tumor-specific manner. The regression of the brain metastases was abrogated by depletion of CD4(+) or CD8(+) cells from immunized mice. These results demonstrate that specific systemic immunity can be induced by lyophilized H5BVIFN-beta and that the resultant immune response can eliminate established brain metastasis.     

实证医学与中医药研究和开发

临床疗效是衡量一切防治措施价值的最高准则,也是决定一个医疗卫生体系效益的最基本因素。实证医学的核心就是任何有关疾病防治的整体策略和具体措施的制定都应基于现有最严谨的关于其临床疗效的科学证据之一。使用无效甚至有害的防治措施在伦理上是不能接受的,更是对人类宝贵医疗资源的浪费。因此,中医药研究和开发应从临床疗效的验证开始。机理的研究、有效成份的探索和剂型的改进是重要的,但应以证实临床有效为前提。本文从 ４个方面进行了论证： １、一个防治措施若没有防治作用,就没有其相关的作用机理可被发现,也没有其相关的有效成份可被探索,更没有改进剂型的必要。２、中医药临床疗效评价,为从中医药中开发新药提供一个经济的、快捷的途径。因为它节省了用于无临床疗效的药物的临床前研究所需要的大量资源。同时也大大缩短了一个新药从开发到临床使用的时间。３、中医药临床疗效评价具有巨大的经济效益。临床上无效的防治措施被淘汰,而有效的被进一步推广。从而一个医疗体系会因减少使用无效的防治措施而提高效益。４、对中医药临床疗效的评价也是对其理论体系在实践上的检验。