The relationship between prognosis and scintigraphic evidence of bone metastases in neuroblastoma

The clinical records, scintigrams, radiographic skeletal surveys, and bone marrow aspiration and trephine results of 30 children with neuroblastoma were reviewed to determine the relationship between the result of the scintigram and the clinical outcome of the patient. The nine patients with normal radiographic skeletal surveys and no evidence of bone metastases on scintigraphy are alive and well having been off treatment for between 14 and 83 months. Eleven of the 13 children who had bone metastases on scintigraphy and radiography have died, as have seven of the eight patients who had positive scintigrams and normal radiographs. Scintigraphic evidence of bone metastases is associated with a very poor prognosis irrespective of the results of other investigations.     

Prospective payments to hospitals: should emergency admissions have higher rates?

Systematic variation in patient resource use can be a significant problem for a system based on diagnosis-related groups (DRG's) if this variation is not evenly distributed across hospitals. If certain hospitals routinely treat patients who require more services than average under DRG's, the long-run financial viability of these hospitals will be threatened. In this study, the authors examine whether patients who are admitted on an emergency or urgent basis represent an identifiable group of patients whose costs are systematically higher than those of electively admitted patients, controlling for DRG. Alternative approaches for incorporating admission status into a DRG payment system are developed and tested.     

Artificial intelligence in the diagnosis of low back pain.

Computerized methods are used to recognize the characteristics of patient pain drawings. Artificial neural network (ANN) models are compared with expert predictions and traditional statistical classification methods when placing the pain drawings of low back pain patients into one of five clinically significant categories. A discussion is undertaken outlining the differences in these classifiers and the potential benefits of the ANN model as an artificial intelligence technique.     

Ultrasonic and comparative angiographic appearances of a spontaneous aorto-caval fistula

A 71-year-old man with an atherosclerotic abdominal aortic aneurysm developed a spontaneous aorto-caval fistula. The ultrasound appearances showing a direct fistulous communication between the inferior vena cava and the aorta are presented and these are correlated with the angiographic appearances.     

Neurinoma of the jugular foramen

Summary The complementary predications of modern imaging techniques, CT, MRI and intraarterial digital subtraction angiography (i.a. DSA), in the differential diagnosis of a neurinoma of the jugular foramen are described.     

Occurrence of IgA and IgG antibodies to select peptides representing human papillomavirus type 16 among cervical cancer cases and controls

We used an enzyme-linked immunosorbent assay to test sera from 186 cases of invasive cervical cancer and 172 age-matched controls for IgG and IgA antibodies to an human papillomavirus 16 E7 peptide and to peptide 245, representing an epitope in E2. Cases had significantly higher mean absorbance values than controls for both immunoglobulin isotypes to E7 and elevated mean values for IgG to peptide 245. Since absorbances were not normally distributed we analyzed cervical cancer risk for seropositive and seronegative women. Of the traditional cervical cancer risk factors, cigarette smoking, educational level, number of pregnancies, time interval since last Papanicolaou smear, and age at first intercourse influenced the distribution of seropositivity to some of the viral antigens. Adjusting for these variables, the odds ratios of cervical cancer associated with IgG to E7 was 5.28 [95% confidence (95% CI) = 2.4-11.6] and that with IgA to E7 was 2.67 (95% CI = 1.3-5.3). IgG to peptide 245 was less strongly associated, odds ratio 1.68 (95% CI = 1.2-3.3), and IgA to peptide 245 was not significantly associated with disease. These findings suggest that antibodies to E7 are markers for invasive cervical cancer. However, seropositivity correlated poorly with clinical state, survival, or the presence of human papillomavirus DNA in the cancer tissue.