Radiation therapy facilities in the United States

PURPOSE: About half of all cancer patients in the United States receive radiation therapy as a part of their cancer treatment. Little is known, however, about the facilities that currently deliver external beam radiation. Our goal was to construct a comprehensive database of all radiation therapy facilities in the United States that can be used for future health services research in radiation oncology. METHODS AND MATERIALS: From each state's health department we obtained a list of all facilities that have a linear accelerator or provide radiation therapy. We merged these state lists with information from the American Hospital Association (AHA), as well as 2 organizations that audit the accuracy of radiation machines: the Radiologic Physics Center (RPC) and the Radiation Dosimetry Services (RDS). The comprehensive database included all unique facilities listed in 1 or more of the 4 sources. RESULTS: We identified 2,246 radiation therapy facilities operating in the United States as of 2004-2005. Of these, 448 (20%) facilities were identified through state health department records alone and were not listed in any other data source. CONCLUSIONS: Determining the location of the 2,246 radiation facilities in the United States is a first step in providing important information to radiation oncologists and policymakers concerned with access to radiation therapy services, the distribution of health care resources, and the quality of cancer care.     

Changes in coagulation and fibrinolysis during laparoscopic cholecystectomy

BACKGROUND: The influence of laparoscopic cholecystectomy on coagulation and fibrinolysis is debatable. There have been a few but controversial studies and the need for routine antithrombotic prophylaxis is unclear. MATERIALS AND METHODS: In this prospective study we investigated changes in coagulation and fibrinolysis parameters in laparoscopic cholecystectomy. Blood samples taken before, during, and after surgery from 38 consecutive patients were analyzed. Measured parameters included the international normalized ratio, prothrombin time, partial thromboplastin time, antithrombin III activity, platelet count, mean platelet volume, fibrinogen, and D-dimers. RESULTS: Statistically significant changes included increased perioperative international normalized ratio and D-dimers, and postoperative antithrombin III, fibrinogen, and D-dimers, as well as decreased perioperative antithrombin III and fibrinogen and postoperative international normalized ratio, platelet count, and mean platelet volume. Values of partial thromboplastin time had no statistically significant changes. CONCLUSION: Reduced coagulation activity and increased fibrinolytic activity occur during and after laparoscopic cholecystectomy.     

Diagnostic and therapeutic problems in 10 cases of pheochromocytomae.

Ten cases of pheochromocytomae, of which eight were benign and two malignant have been considered. All patients presented with hypertension, either paroxysmal (7 cases) or permanent (3 cases). It is essential to emphasize that the initial symptomatology of these patients on their admission to the hospital was often atypical and misleading: in 2 cases, the symptomatology was urological, in 2 cases psychatric and in one digestive. Quantitative determination of catecholamines and their metabolites was positive in 7 cases out of 10. Retropneumoperitoneal insufflation combined with intravenous urography and tomographies provided valuable information in each case. The surgical removal of these tumours, which was unilateral and in normal position, in each case, was carried out without complications. Sudden blood pressure variations observed during the operation could be controlled without difficulty. In 6 patients, the blood pressure became normal and remained so for 4 years. In 2 other patients, the blood pressure came back to normal after the operation, but presented a slight increase 1 year later. Pheochromocytomae, which are often masked by a misleading symptomatology, must be systematically searched for in all hypertensive patients, despite the characteristics of the hypertension. Surgical removal, if done early enough, produces cure of the hypertension.     

Retroviral vector production in the National Gene Vector Laboratory at Indiana University

The National Gene Vector Laboratory (NGVL) is a US National Institutes of Health initiative charged with providing clinical grade vectors for gene therapy trials. The program was started in 1995 and Indiana University has served as the production site for retroviral vectors and is also accepting applications for production of lentiviral vectors. The facility is designed to produce vectors for Phase I and Phase II clinical trials with the specific mandate to facilitate investigator-initiated research for academic institutions. To date, the facility has generated over 30 Master Cell Banks for gene therapy investigators throughout the United States. This required the facility to develop a system that can adapt to the varied needs of investigators, most of whom request different vector backbones, packaging cell lines, final product volumes, and media. In this review, we will illustrate some of the experiences of the Indiana University NGVL during the generation of retroviral vectors using murine-based packaging cell lines.     

Folate supplementation and twinning in patients with sickle cell disease

Patients with sickle cell disease routinely take folic acid daily as a supplement to maintain effective erythropoiesis. One of the controversial effects of folic acid is its effect on twin gestation rates. In this report, we present our experience in patients with sickle cell disease and twin pregnancy. Our data show that twin pregnancies seem to be associated with folate supplementation.     

Hyperhemolysis during the evolution of uncomplicated acute painful episodes in patients with sickle cell anemia

BACKGROUND: Some patients with sickle cell anemia (SS) experience significant decrease in their hemoglobin (Hb) level and significant increase in reticulocyte count during the progression of uncomplicated acute painful episodes. These changes have been attributed to, but not proven, hyperhemolysis. This study provides evidence of hyperhemolysis in this group of patients. STUDY DESIGN AND METHODS: Hospitalized patients who met the above criteria were identified and followed prospectively, and the measures of red blood cell (RBC) survival were determined. The latter included 1) laboratory measures of hemolysis: Hb level, reticulocyte count, nucleated RBC count, RBC distribution width (RDW), total bilirubin, lactate dehydrogenase (LDH), and aspartate transaminase (AST); 2) determination of RBC survival in vivo by the (51)Cr method in selected patients; and 3) the determination of the RBC Hb:reticulocyte Hb ratio. Baseline values of these measures were also obtained and compared to the crisis data. RESULTS: During the evolution of the painful episode in the selected patients, there was a significant increase in total bilirubin, LDH, AST, nucleated RBC count, and RDW that are indicative of hyperhemolysis. There was a significant decrease in RBC Hb:reticulocyte Hb and (51)Cr RBC survival, which is diagnostic of hyperhemolysis. CONCLUSION: Together, the data indicate that hyperhemolysis occurs during uncomplicated acute painful episodes in some patients with SS. The presence of free plasma Hb, consequent to hyperhemolysis, reduces nitric oxide bioavailability, promotes endothelial dysfunction, and contributes to the development of pulmonary hypertension and vasoocclusion.     

Omalizumab pretreatment decreases acute reactions after rush immunotherapy for ragweed-induced seasonal allergic rhinitis

BACKGROUND: Rush immunotherapy (RIT) presents an attractive alternative to standard immunotherapy. However, RIT carries a much greater risk of acute allergic reactions, including anaphylaxis. OBJECTIVES: We hypothesized that omalizumab, a humanized monoclonal anti-IgE antibody, would be effective in enhancing both safety and efficacy of RIT. METHODS: Adult patients with ragweed allergic rhinitis were enrolled in a 3-center, 4-arm, double-blind, parallel-group, placebo-controlled trial. Patients received either 9 weeks of omalizumab (0.016 mg/kg/IgE [IU/mL]/mo) or placebo, followed by 1-day rush (maximal dose 1.2-4.0 mug Amb a 1) or placebo immunotherapy, then 12 weeks of omalizumab or placebo plus immunotherapy. RESULTS: Of the 159 patients enrolled, 123 completed all treatments. Ragweed-specific IgG levels increased >11-fold in immunotherapy patients, and free IgE levels declined >10-fold in omalizumab patients. Patients receiving omalizumab plus immunotherapy had fewer adverse events than those receiving immunotherapy alone. Post hoc analysis of groups receiving immunotherapy demonstrated that addition of omalizumab resulted in a 5-fold decrease in risk of anaphylaxis caused by RIT (odds ratio, 0.17; P = .026). On an intent-to-treat basis, patients receiving both omalizumab and immunotherapy showed a significant improvement in severity scores during the ragweed season compared with those receiving immunotherapy alone (0.69 vs 0.86; P = .044). CONCLUSION: Omalizumab pretreatment enhances the safety of RIT for ragweed allergic rhinitis. Furthermore, combined therapy with omalizumab and allergen immunotherapy may be an effective strategy to permit more rapid and higher doses of allergen immunotherapy to be given more safely and with greater efficacy to patients with allergic diseases.