Cisplatinum Dose Dependent Response in Germ Cell Cancer Evaluated by Tumour Marker Modelling

This study presents an analysis on longitudinal tumour marker series in twenty-two patients with non-seminomatous germ cell cancers treated with cisplatinum (DDP) based combination chemotherapy. Series of alphafoetoprotein (AFP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH) were analyzed applying a dynamic mathematical marker model. The model analysis provided quantitated values for growth rate and treatment response in the marker producing cells. The analysis showed that LDH had to be above 2 000 U/l to be a trustworthy tumour marker. HCG producing cells tended to grow faster than AFP producing cells, and were 3-5-fold more sensitive to the chemotherapy given than AFP producing cells. Treatment response versus DDP dose appeared to be bi-phasic, but with no significant change in treatment efficiency within the given range of DDP doses.     

Radiological detection of bone and bone marrow metastases

Bone scintigraphy is the primary method for the diagnosis of skeletal métastases. This investigation is sensitive, but the interpretation must be performed in the knowledge that it is also nonspecific. Despite this, a correct diagnosis can usually be achieved. The first-hand supplementary investigation, after a doubtful scintigraphic finding, is radiography. In most cases this is sufficient for a diagnosis. When a scintigraphic abnormality cannot be adequately explained, usually because of a negative radiographic examination, a more sensitive modality must be used. Computerized tomography offers increased sensitivity and specificity, and is primarily used for this purpose. In this way contrast resolution is increased and problems caused by obscuring tissue and complicated anatomy are reduced. Since bone metastases migrate via the active bone marrow an alternative supplementary investigation is bone marrow scintigraphy. Its usefulness is restricted by disturbing activity, from the liver and the spleen, which obscures a significant part of the active marrow, and by the fact that a lesion must be of a certain size to become apparent. Magnetic resonance imaging yields excellent images of the extension of a tumor in soft tissue. Owing to high costs and restricted availability it is still mainly used for preoperative location of metastases.     

Case report: fusion of positron emission tomography (PET) and computed tomography (CT) images for image-guided endoscopic navigation in maxillofacial surgery: clinical application of a new technique.

INTRODUCTION: Surgery based on computed tomography (CT) data is becoming increasingly important in the head and neck region. The technique for hardware fusion between positron emission tomography (PET) and computed tomography (CT) has only been established commercially in the last 4 years. The advantages over CT alone are obvious. The surgeon is simultaneously provided with a map of anatomical as well as of functional (metabolic) details. The fused images offer improved localization of malignant lesions and improved targeting of biopsy, especially for small lesions. PURPOSE: A new technique for image-guided tumour localization for maxillofacial surgery based on PET/CT-image fusion is described. PATIENT AND METHOD: A 78-year-old woman was admitted to this department with a tumour of the skull base. Three dimensional fusion of computed CT with positron PET images on a commercially available navigation system is described. After patient-to-image registration, a high-resolution endoscope was calibrated intraoperatively. Image-guided biopsy specimens were taken under direct visual control. CONCLUSION: PET/CT-image fusion proved extremely helpful to navigate the endoscope to the target lesion and to identify the tumour.     

Evidence for a human IgG1 class switch program

In activated murine B lymphocytes, immunoglobulin class switch recombination occurs as a highly regulated process which is targeted to distinct switch regions. Here we present first evidence that in human B lymphocytes, switch recombination is targeted to distinct switch regions as well. In a panel of clonally unrelated IgG1-expressing human B cells, immortalized by Epstein-Barr virus (EBV) transformation, seven out of nine cells show switch recombination between Sμ and Sγ1 on both alleles, the active and inactive one. The remaining cells show no switch recombination on the inactive IgH locus. The very strong correlation of switch recombination on both alleles of IgG1-expressing cells proves that class switch recombination to IgG1 is not random but directed in human B lymphocytes.     

Efficiency of work of inspiratory muscles in standing and in exercising dogs

The objective of this study was to elucidate the resistive, elastic, and total inspiratory muscle work and mainly the efficiency of the inspiratory muscle work in still standing and in exercising dogs. In 180 experiments with nine mongrel dogs, respiratory and circulatory functions were recorded at rest and during a 1.5-mph walk on a treadmill belt which was inclined by 9 degrees. Each dog had been trained and surgically prepared before the series of experiments started. An electronic pressure transducer together with a fluid-filled catheter was attached to the ribs at the midthoracic level. Airflow was monitored with a pneumotachygraph attached to a face mask. Aortic flow was monitored with an electromagnetic flow transducer. Catheters in the atria, the ventricles, and the pulmonary and systemic vessels were used to determine hemodynamic parameters and blood gas levels. All recorded and all derived functions were evaluated by a dedicated computer. At rest, resistive inspiratory work (0.98 kg cm) was smaller than elastic work (1.36 kg cm). Elastic work did not change with exercise but resistive work increased to 1.46 kg.cm. The increase of total work from 2.33 kg.cm at rest to 2.79 kg.cm during exercise did not reach significance. Inspiratory power increased with exercise. Estimated diaphragmatic oxygen consumption increased from 2.23 ml/min at rest to 3.64 ml/min during exercise. It was 1.6 percent of the total oxygen consumption at rest and 1.7 percent of the total oxygen consumption during exercise. The estimated efficiency of the work of inspiratory muscles was 15.8 percent at rest and 25.8 percent during exercise. These values did not vary substantially between different animals.     

Radiographic prediction of failure after fixation of cervical hip fracture

During 1984-1985, 410 patients with cervical hip fracture were randomized between 2 methods of internal fixation-a single nail (Rydell) or 2 LIH hook pins (LIH). The patients were followed-up prospectively for at least 2 years. Radiographs were taken after 1 week, 1, 3, 6, 12, and 24 months. The radiographs of the 295 paients alive 2 years postoperatively were examined by one of the authors. The sliding and the diversion of the pins and the nail in the anteroposterior projection and the diversion in the lateral projection were measured. In the failure group (non-union, late segmental collapse), the greatest sliding was noted within 1 month postoperatively and the diversion increased up to 3 months. Significant differences between the failure and the non-failure groups could be seen even after 1 week. We also found that the degree of sliding of the LIH pins and the Rydell nail 1 month postoperatively is comparable to the scintigraphic pattern 2 weeks postoperatively in predicting failure after nternal fixation of cervical hip fractures.     

UROLITHIASIS IN AUSTRALIAN ABORIGINAL CHILDREN

Thirty-six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty-five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.     

Impact of early dietary gamma-linolenic acid supplementation on atopic eczema in infancy

Polyunsaturated fatty acids (PUFAs) are components of cell membranes and may play an immunomodulating role in the pathogenesis of atopic dermatitis (AD). The goal was to determine the impact of PUFAs on AD by dietary supplementation of infants. Based on the parents' decision on their babies' primary feeding, mothers and newborns were randomized to the supplementation with gamma-linolenic acid (GLA) or placebo for up to 6 months. Breastfed infants received GLA by supplementing their mothers. Formula diet was commercial whey hydrolysate unsupplemented with PUFAs. Of 131 eligible infants, 24 developed AD within the first year of life. Of these, nine belonged to the exclusively breastfed group (n = 58), 14 to the combined-fed group (n = 53), and one to the never breastfed group (n = 20). We could not find an influence of GLA on the development of AD. In subjects with AD, at 1 yr of age the serum-immunoglobulin E (IgE) was the lowest in the GLA-supplemented group A-subjects. In the GLA-supplemented group, GLA-levels in breast milk were similar in atopic and non-atopic infants. In the non-supplemented group the GLA-content of breast milk was 0.07% of total fatty acids in atopic infants vs. 0.17% in non-atopic infants (p < 0.01). Dietary GLA-supplementation could not prevent AD. Interestingly, the number of infants developing AD was the lowest in never breastfed children. In infants suffering from AD, GLA-supplementation seemed to reduce total IgE in the first year of life.