ASO Author Reflections: Geographic Disparities in Referral and Oncologic Outcomes in Intrahepatic Cholangiocarcinoma

Annals of Surgical Oncology -     

Consequences associated with work-to-family conflict: a review and agenda for future research

A comprehensive review of the outcomes associated with work-to-family conflict was conducted and effect sizes were estimated. Atypology was presented that grouped outcomes into 3 categories: work related, nonwork related, and stress related. Issues concerning the measurement of work-family conflict were also discussed. The results demonstrate the widespread and serious consequences associated with work-to-family conflict. On the basis of the results of the review, an agenda for future research was provided.     

Early phase II Gynecologic Oncology Group experience with ifosfamide/mesna in gynecologic malignancies

Starting in July 1985, the Gynecologic Oncology Group conducted a series of phase II trials with ifosfamide/mesna in advanced or recurrent gynecologic malignancies. Previously untreated patients received 1.5 g/m² i.v. ifosfamide daily for 5 days. Mesna was given i.v. q4h×3 following ifosfamide; each dose was 20% of the daily ifosfamide dose. All patients with ovarian and 87% of those with cervical cancer had previously undergone platinum-based therapy. Because of the toxicity encountered in previously treated patients with ovarian carcinoma, the dose of ifosfamide was reduced to 1.2 g/m² daily in all patients who had received prior chemo- or radiotherapy. In epithelial ovarian carcinoma, responses were observed in 8 (20.0%) of 41 evaluable patiens, with 3 (7.0%) complete responses. Response duration was 2.1–20.3+ months, with a median of 6.9+ months. In squamous-cell carcinoma of the cervix, 3 (11.1%) of 27 evaluable patients showed partial responses of 1.8, 2.2, and 3.1 months' duration. Of 26 untreated patients with mixed mesodermal tumors of the uterus, 5 (19.2%) achieved complete and 3 (11.5%) showed partial responses, for an overall response rate of 30.7%. Response duration was 1.4+-8.6 months, with a median of 3.8 months. Toxicity included two deaths due to renal insufficiency and a third related to neurologic impairment. Hematologic toxicity was manageable. Ifosfamide/mesna has activity in a wide range of gynecologic malignancies.Presented at the Satellite Symposium Ifosfamide in Gynecological Tumors of the 5th European Conference on Clinical Oncology and Cancer Nursing, London, September 3–7, 1989     

Comparison of gaseous microemboli counts in arterial, simultaneous and venous heat exchange with a hollow fiber membrane oxygenator

Potential sources of gaseous microemboli during cardiopulmonary bypass are varied. However, it is known that membrane oxygenators generate fewer gaseous microemboli than bubble oxygenators and that bubblers cannot utilize arterial heat exchange without generating significant gaseous microemboli during rewarming. A membrane oxygenator utilizing simultaneous gas and heat exchange raises the concern that concurrent gas and heat exchange would result in a higher production of gaseous microemboli compared to conventional venous heat exchange devices. This in vitro study compared venous, simultaneous, arterial and control (venous) heat exchanger gaseous microemboli counts during rewarming. No significant difference was found between the four heat exchangers when comparing inlet and outlet gaseous microemboli counts. This in vitro study suggests that there is no difference in gaseous microemboli generation when varying the position of the heat exchanger in the extracorporeal circuit incorporating a microporous membrane oxygenator.     

Correlation of ACT as measured with three commercially available devices with circulating heparin level during cardiac surgery

Automated activated clotting time (ACT) is utilized as the primary means of assessing anticoagulation status for cardiopulmonary bypass (CPB) procedures. Influences on the clotting cascade during CPB such as hypothermia, hemodilution, and platelet dysfunction are known to affect ACT. The recently introduced Thrombolytic Assessment System (TAS) has been reported to be less sensitive to changes in hemodilution and hypothermia during CPB than more conventional ACT devices. This study evaluated the ability of TAS, and two other commercially available automated ACT systems, the HemoTec and Hemochron, to correlate with circulating heparin levels. Reference standards for circulating heparin were determined by inactivation of factor Xa assay. Nineteen patients undergoing moderate hypothermic CPB served as subjects for this investigation. Blood samples were obtained for study at four time periods: 1) baseline (control), 2) post heparin administration (300-400 U/kg) prior to CPB, 3) during CPB, and 4) post protamine. Study results demonstrated a high correlation between the HemoTec and Hemochron (r = 0.99), increased heparin dose response on CPB compared to pre-CPB activity (p < 0.05), and a significant (p < 0.05) negative correlation between devices and patient hematocrit during CPB. Additionally, device correlation with anti-Xa assay during collection periods 2 and 3 showed negative correlations in each of the three devices evaluated. We conclude that all automated devices tested demonstrated an inability to predict circulating heparin at levels necessary for CPB, and that these discrepancies become magnified during CPB procedures.     

The radiological diagnosis of meningiomas, the impact of EMI scanning.

A review of the impact of computerized axial tomography on the radiological diagnosis of meningiomas is presented. Seventy-one intracranial and eight orbital cases have been examined by this new method using the 160 X 160 matrix. The diagnostic accuracy of the method is compared with established neuroradiological methods of examination (plain X rays, angiography, pneumography and isotope scanning). The new non-invasive method is undoubtedly the most accurate diagnostic tool yet available. It provided a specific diagnosis of meningioma in 77% of the intracranial cases without contrast enhancement and diagnosed the presence of tumour in a further 19% giving an overall tumour diagnosis of 96%. There were three false negatives (4%). After intravenous injection of contrast medium specific diagnosis of meningioma was made in a further six cases raising the specific diagnostic rate to 86%. Specific identification of intra-orbital meningiomas is more difficult though the presence of retro-orbital tumour was correctly diagnosed in all eight cases examined (100%). In none of our cases was a false positive diagnosis of tumour made. However, there are areas where a specific diagnosis of meningioma can only be made as part of a wider differential diagnosis. Apart from the orbit these include the suprasellar area, the cerebello-pontine angle, and the intraventricular regions. Occasionally also supratentorial gliomas or secondaries can simulate meningiomas.     

VO2max--new concepts on an old theme.

This symposium "VO2max--new concepts on an old theme" is dedicated to the memory of Hermann Rahn, whose inspiration has led many young investigators to explore new horizons. In the debate on factors limiting VO2max at altitude Hermann Rahn stimulated further discussion between those camps supporting the central circulation as limiting VO2max and those proposing a peripheral diffusion limitation.