A prospective evaluation of treatment with Selective Internal Radiation Therapy (SIR-spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy

Background  

To prospectively evaluate the efficacy and safety of selective internal radiation (SIR) spheres in patients with inoperable liver metastases from colorectal cancer who have failed 5FU based chemotherapy.     

Dermatologic Surgical Research and the Institutional Review Board

BACKGROUND: Dermatologic surgical techniques have transformed cosmetic surgery over the last two decades. Many of the advances in cutaneous laser surgery, botulinum toxin injections, tumescent liposuction, and the latest filler agents have been evaluated on willing volunteers as part of organized trials under the auspices of an Institutional Review Board (IRB). OBJECTIVES: To review the developmental history of today's IRB and to provide relevance to cosmetic dermatologic research. RESULTS: Although an IRB must evaluate the "voluntariness" of a proposed research protocol, the risk-benefit ratio, particularly of elective cosmetic dermatologic surgical human studies, is of even greater importance. CONCLUSION: As more dermatologic surgeons become involved in clinical research, an understanding of the function and purpose of the IRB has become increasingly important. Research relating to cosmetic dermatologic procedures raises challenging and perplexing problems for an IRB.     

Volunteer, lay tutors' experiences of the Chronic Disease Self-Management Course: being valued and adding value

Chronic disease is a public health issue that could be addressed, in part, by increasing the ability of individuals to better manage their condition and its consequences on a day-to-day basis. One intervention designed to facilitate this is the Chronic Disease Self Management Course (CDSMC) that is delivered by volunteer, lay tutors who themselves have a chronic disease. Although there is growing evidence of course effectiveness for participants, the experiences of tutors have been neglected. This study aims to address this omission. Telephone interviews were conducted with 11 (six male) tutors: all interviews were transcribed and thematically analysed. Being a volunteer lay-tutor was perceived to be an enjoyable and valuable experience despite the challenges associated with course delivery, such as organizational demands and managing the diverse needs of mixed groups of chronic disease participants that led to a tension between disease-specific needs and the generic approach of the course. Being valued and adding value to the lives of others were key benefits of being a volunteer tutor, along with increased confidence that they were doing something positive for others. Course delivery prompted the initiation and maintenance of tutors' own self-management behaviours.     

Benign and malignant cartilage tumors of the hand

Primary bone tumors of the hand and wrist are unusual but if present are frequently chondrogenic in origin. Enchondroma is the most common primary bone tumor of the hand and can be treated by curettage and bone grafting. Chondrosarcoma is rare and most likely the result of malignant degeneration of a pre-existing lesion. Wide en bloc resection is appropriate for chondrosarcoma and typically involves ray resection or partial hand amputation.     

Controlled trial of hyperbaric oxygen treatment for alkali corneal burn in the rabbit

Purpose: To evaluate the efficacy of hyperbaric oxygen therapy in the treatment of alkali‐induced corneal burns in an animal model. Methods: Twenty‐four rabbits were randomized into a control group (n = 12) and hyperbaric oxygen treatment group (n = 12). After induction of anaesthesia, the alkali burn model was established by application of 1 N sodium hydroxide to one eye of each rabbit. The hyperbaric oxygen treatment group was treated each day for 21 days with hyperbaric oxygen at 2.4 Atmospheres Absolute (ATA) for 1 h. The eyes of the animals were examined daily for 2 weeks and then weekly until the end of the trial. The principal endpoint was that of perforation of the cornea at which time the animals were killed with a lethal dose of either intravenous or intraperitoneal barbiturate and the eyes immediately enucleated and fixed in 10% neutral buffered formalin. All animals in which complete healing took placed were also killed, the eyes removed, fixed and examined histologically. Photographs were taken of the rabbit's eyes at weekly intervals and the area of vascularization and epithelial defects in the hyperbaric and control groups were compared. Results: Equal numbers (seven) of the control and hyperbaric oxygen treated groups had perforated corneas and there was no statistical difference in the mean time to perforation (control 30.1 days; treated 30 days). There was also no statistical difference between the two groups with respect to epithelial defect size. Conclusion: Treatment with hyperbaric oxygen for 1 h daily for 21 days had no beneficial effect on alkali‐induced corneal burns.     

Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment

OBJECTIVE: To evaluate the evidence for and against androgen insufficiency as a cause of sexual and other health-related problems in women and to make recommendations regarding definition, diagnosis, and assessment of androgen deficiency states in women. DESIGN: Evaluation of peer-review literature and consensus conference of international experts. SETTING: Multinational conference in the United States. PATIENT(S): Premenopausal and postmenopausal women with androgen deficiency. INTERVENTION(S): Evaluation of peer-review literature and development of consensus panel guidelines. RESULT(S): The term "female androgen insufficiency" was defined as consisting of a pattern of clinical symptoms in the presence of decreased bioavailable T and normal estrogen status. Currently available assays were found to be lacking in sensitivity and reliability at the lower ranges, and the need for an equilibrium dialysis measure was strongly emphasized. Causes of androgen insufficiency in women were classified as ovarian, adrenal, hypothalamic-pituitary, drug-related, and idiopathic. A simplified management algorithm and clinical guidelines were proposed to assist clinicians in diagnosis and assessment. Androgen replacement is currently available in several forms, although none has been approved for treatment of sexual dysfunction or other common symptoms of female androgen insufficiency. Potential risks associated with treatment were identified, and the need for informed consent and careful monitoring was noted. Finally, the panel identified key goals and priorities for future research. CONCLUSION(S): A new definition of androgen insufficiency in women has been proposed along with consensus-based guidelines for clinical assessment and diagnosis. A simplified management algorithm for women with low androgen in the presence of clinical symptoms and normal estrogen status has also been proposed.     

A study of whole blood platelet and white cell aggregation using a laser flow aggregometer

Both platelet aggregation and white blood cell aggregation are involved in pathological processes such as thrombosis, atherosclerosis and chronic inflammation. People in older age groups are likely to suffer from cardiovascular diseases and may have increased white cell and platelet aggregation which could contribute to this increased risk. This study aimed to compare white cell and platelet aggregation between different age and gender groups. Whole blood white cell aggregation and platelet aggregation were carried out on healthy volunteers using cytometric techniques. It was found that both white cell and platelet aggregation in the elderly group (white cell aggregation median value, 0.08; range, 0.02-0.14; platelet aggregation median value, 0.32; range, 0.1-0.39) were significantly higher (P = 0.017 for white cell aggregation, P = 0.007 for platelet aggregation) than in the younger group (white cell aggregation median value, 0.05; range, 0.01-0.14; platelet aggregation median value, 0.18; range, 0.07-0.36). No significant differences were found between the gender groups.     

Imaging characteristics of cystic adventitial disease of the peripheral arteries: presentation as soft-tissue masses

OBJECTIVE: Our purpose was to identify the characteristic imaging features of cystic adventitial disease of the peripheral arteries. CONCLUSION: Patients with cystic adventitial disease of the peripheral arteries often present for evaluation of soft-tissue masses involving the extremities. Noninvasive imaging reveals a characteristic appearance allowing confident diagnosis.     

"It's like an addiction first thing...afterwards it's like a habit": daily smoking behaviour among people living in areas of deprivation

The paper draws on qualitative interviews with a sample of male and female smokers who live in areas of disadvantage in Edinburgh, Scotland, to examine their perceptions of habit and addiction and the implications for smoking behaviour. The paper shows how smokers have a sophisticated understanding of these concepts and the way in which they affected their smoking behaviour across the course of a 'typical' day. The paper argues that daily contexts which smokers inhabit either constrain or facilitate smoking and as such play a central role in the way in which they smoke. In contexts where smoking was constrained (by externally or self-imposed restrictions) smokers described how they employed various strategies to achieve and maintain what they perceived to be a desirable level of nicotine intake, such as by anticipatory smoking. Where restrictions on smoking were absent, men's and women's smoking appeared remarkably similar. However, for the most part, the contexts which men and women inhabited over the course of the day differed, with women assuming the largest share of domestic and child care responsibilities. Apparent gender differences in smoking behaviour appeared to be related to the different daily contexts which men and women inhabited. Crucially, the influences on smoking described by respondents in this study were closely related to circumstances of socio-economic deprivation.