Radiofrequency ablation of liver tumours: systematic review

Thermal ablation by use of radiofrequency energy can be used to achieve necrosis of liver tumours, and increased availability of this technique is leading to more widespread use. Much of the impetus for the use of radiofrequency ablation has come from cohort series that have provided an evidence base for this technique. Here, we give an overview of the current status of radiofrequency ablation for liver tumours, including its physical properties, to assess the characteristics that make this technique applicable in clinical practice. We review the technical development of probe design and summarise current indications and outcomes of reported clinical use. We also provide a profile of side-effects and information on the integration of this technique into the general management of patients with liver tumours. Current evidence suggests that radiofrequency ablation can be done with few side effects; however, although this technique seems to ablate tumours effectively, it should form part of multidisciplinary care for liver cancer. Crucially, the role of radiofrequency ablation in lengthening the survival of patients with liver tumours remains to be assessed.     

Echocardiography in acute limb ischaemia

In a retrospective study carried out over a 5-year period, 88 patients with acute limb ischaemia underwent echocardiography. Of this group, 74 were thought to have an embolic cause of ischaemia on either operative or arteriographic findings. Two-dimensional echocardiography detected a cardiac source in 30 patients (sensitivity 41%, specificity 100%). Clinical examination on admission correctly indicated an embolic source in 36 patients (sensitivity 49%, specificity 36%). The combination of echocardiography and clinical examination detected an embolic source in 60 of 74 (81%) patients. In this study echocardiography complemented clinical examination in the diagnosis of a cardiac source of acute limb ischaemia.     

Factors influencing rehabilitation of arteriosclerotic lower limb amputees

This survey considered 598 arteriosclerotic amputees over a period of 9 years: 267 below-knee; 81 Gritti-Stokes; 195 above-knee; and 55 double amputees. A walking ability index (WAI) ranging from 1 for a normal gait to 6 for inability to walk was determined for these amputees by clinical grading at 3, 6, 9, and 12 months after prosthesis fitting. Amputees with the below-knee operation had better WAI at 3 and more months than those with either Gritti-Stokes or above-knee operations. There was no statistical evidence for a difference between Gritti-Stokes and above-knee operations at any time of assessment of WAI. The 50-59 year-old age group had significantly better WAI at 6, 9, and 12 months than did the 60-69 or 70+ age group, but the 60-69 year-old group was not significantly different from the 70+ age group. On an average, the 78 amputees (14 percent) with ischemic heart disease had a poorer WAI at 6 and more months than did those without it; the 46 amputees (8 percent) with hemiplegia were worse at 12 months than those without hemiplegia; and the 15 amputees (11 percent) with bronchitis were worse at 12 months than those without bronchitis. Double amputees had poorer WAIs at 12 months than those of single amputees.     

Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

Objective

We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation.

Quality of life assessment in patients with chronic pancreatitis receiving antioxidant therapy

AIM:To undertake a baseline study comparing quality of life(QoL) in patients with chronic pancreatitis(CP) on Antox to those with CP,matched for disease duration,who were not on this medication.METHODS:CP was defined according to the Zurich classification.Sixty eight consecutive patients with CP who were taking Antox(antioxidants) were compared with 69 consecutive control CP patients not on Antox.European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core questions 30 and P...     

Randomised, double blind, placebo controlled trial of intravenous antioxidant (n-acetylcysteine, selenium, vitamin C) therapy in severe acute pancreatitis

BACKGROUND: Based on equivocal clinical data, intravenous antioxidant therapy has been used for the treatment of severe acute pancreatitis. To date there is no randomised comparison of this therapy in severe acute pancreatitis. METHODS: We conducted a randomised, double blind, placebo controlled trial of intravenous antioxidant (n-acetylcysteine, selenium, vitamin C) therapy in patients with predicted severe acute pancreatitis. Forty-three patients were enrolled from three hospitals in the Manchester (UK) area over the period June 2001 to November 2004. Randomisation stratified for APACHE-II score and hospital site, and delivered groups that were similar at baseline. RESULTS: Relative serum levels of antioxidants rose while markers of oxidative stress fell in the active treatment group during the course of the trial. However, at 7 days, there was no statistically significant difference in the primary end point, organ dysfunction (antioxidant vs placebo: 32% vs 17%, p = 0.33) or any secondary end point of organ dysfunction or patient outcome. CONCLUSIONS: This study provides no evidence to justify continued use of n-acetylcysteine, selenium, vitamin C based antioxidant therapy in severe acute pancreatitis. In the context of any future trial design, careful consideration must be given to the risks raised by the greater trend towards adverse outcome in patients in the treatment arm of this study.     

Performance and views of examiners in the Applied Knowledge Test for the nMRCGP licensing examination

Background

A new computer-based Applied Knowledge Test (AKT) has been developed for the licensing examination for general practice administered by the Royal College of General Practitioners.

Aim

The aim of this evaluation was to assess the acceptability, feasibility, and validity of the test as well as its transfer to a computerised format at local test centres.

Design of study

Computer-based test and postal questionnaire.

Participants and setting

Panel of examiners, Membership of the Royal College of General Practitioners (MRCGP) examination, UK.

Method

Self-administered postal questionnaires were sent to examiners not involved with the development of the test after completing it. Their performance scores were compared with those of candidates.

Results

The majority of participants (80.9%) were satisfied with the new computer-based test. Responses relating to content and attitudes to the test were also positive overall, but some problems with content were highlighted. Fewer examiners (61.9%) were positive about the physical comfort of the test centre, including seating, heating, and lighting. Examiners had significantly higher scores (mean 83.3%, range 69 to 93%, 95% confidence interval [CI] = 81.9 to 84.7%) than ‘real’ candidates (mean 75.0%, range 45 to 94%, 95% CI = 74.6 to 75.5%), who subsequently took an identical test.

Conclusion

The new computer-based licensing test (the AKT) was found to be acceptable to the majority of examiners. The pass–fail standard, determined by routine methods including an Angoff procedure, was supported by the higher success rate of examiners compared with candidates. The use of selected groups to assess high-stakes (licensing) examinations can be useful for assessing test validity.     

Establishment and characterization of a spindle cell squamous carcinoma cell line

BACKGROUND: Spindle cell squamous carcinoma (SCSC) is a rare and peculiar biphasic malignant neoplasm that occurs mainly in the upper aerodigestive tract. It consists of sarcomatoid proliferation of pleomorphic spindle-shaped cells and squamous cell carcinoma. METHODS: Here, we established a SCSC cell line from a tumour arisen in gingiva. We characterized the feature of a SCSC cell line by immunohistochemistry. To know the biological feature, we examined the cell growth, invasiveness and epithelial-mesenchymal transition markers of a SCSC cell line in comparison with oral squamous cell carcinoma (OSCC) cell lines. RESULTS: By immunohistochemical analyses, the primary tumour expressed cytokeratin and vimentin, indicating carcinosarcoma-like characters. This tumour also showed overexpression of p53 protein. Cultured SCSC cells resulted in bypass of crisis and maintenance over passage 100. The established SCSC cell line was spindle-shaped and showed identical immunohistochemical characters to those of primary tumour cells. Similar to the primary tumour, the cell line showed p53 overexpression and had p53 mutation at codon 132: AAG (lys)-->AAT (asp). The SCSC cell line grew slower than two other OSCC cell lines (MSCC-1 and HSC-2), whereas SCSC cells had remarkable invasiveness in comparison with these cell lines. Moreover, SCSC cells expressed wnt-5a and vimentin mRNA at high levels, but did not express E-cadherin mRNA. This expression pattern of the markers was similar to that of mesenchymal cells, not of epithelial cells. CONCLUSION: In the present study, we newly established a SCSC cell line with strong invasiveness. This is the first report on the establishment of SCSC cell line. The SCSC cell line can be a useful cell model for the study to know the cytodifferentiation and nature of SCSC.