PIC1 Markov Chain Estimation of Life Expectancy of HIV-Infected Patients: Comparison of Two Treatment Alternatives

In RA clinical trials, functional status is increasingly being used as an outcome measure. While it is rather simple to determine the statistical significance of changes, placing the magnitude of these changes into a clinically meaningful context has not been well documented. MIC is "the smallest difference in score, which patients perceive as beneficial and which would mandate, in the absence of troublesome side-effects and excessive cost, a change in the patient's management" [Jaeschke et al. 1989].
OBJECTIVE: To determine the MIC in functional status, as measured by the Modified Health Assessment Questionnaire (MHAQ).
METHODS: Data from 123 patients were obtained from a randomized clinical trial of a new RA therapy. Outcomes were MHAQ and patient global assessment, measured at baseline and after 4 weeks of treatment. Eight scale items of MHAQ were summed to obtain a total score ranging from 0 to 24. MIC was determined based on unit changes in patient globals. The accompanying change in MHAQ was calculated. Similar analysis was conducted with physician global assessment for comparative purposes.
RESULTS: Changes of 1, 2, and 3 points in patient globals were accompanied by changes of 2.11, 4.14, and 8.4 points in MHAQ. Changes in MHAQ corresponding to patient globals were proportionate, but similar results were not obtained for the physician global.
CONCLUSION: Inconsistencies in patient and physician assessments stress the continued need for including both perspectives in assessments of new RA therapies. For the overall MHAQ score, the MIC was approximately 2. These results should increase the ability to interpret results using MHAQ.     

Bilateral latissimus dorsi flaps for the reconstruction of extensive scalp defects

BACKGROUND:

The reconstruction of large scalp defects is occasionally required. Several methods of scalp reconstruction have previously been described. This paper presents the authors’ experience with two patients in whom traditional methods were not sufficient and in whom bilateral latissimus dorsi free flaps were required.

OBJECTIVES:

To evaluate the effectiveness of a new technique in reconstructing extensive scalp defects.

METHODS:

Two case histories are presented. These include the rationale for the choice of reconstruction used as well as a discussion on the technical features of the surgery.

RESULTS:

Reconstruction was effective in both cases. However, one patient died in the early postoperative period from a pulmonary embolus.

CONCLUSIONS:

Bilateral latissimus flaps can be safely and effectively used in closing massive scalp defects in selected cases.     

Clinically occult, noncalcified breast cancer: serial radiologic- pathologic correlation in 27 cases

A serial radiographic-pathologic correlation based on specimen radiography was performed on 27 consecutive, clinically occult, noncalcified breast cancers to determine the frequency of and correlation between appearances at mammography, pathologic diagnoses, and the features of the histologic margins. Twenty (74%) of the lesions were infiltrating ductal cancers, five (19%) were intraductal cancers, and two (7%) were medullary cancers. Forty-one percent of these malignancies contained microscopic calcifications. Lesions demonstrated at mammography in these 27 cases consisted of a well-defined round mass (n = 1); well-defined lobulated masses (n = 2); indistinct round, oval, or lobulated masses (n = 7); irregular or mixed lesions (n = 7); spiculated masses (n = 9); and architectural distortion (n = 1). Histologic margins of infiltrating and intraductal cancers, created by several types of tumor-fat interfaces and surrounding reactive fibrosis, correlated with these radiographic appearances. Serial specimen radiographic-pathologic correlation can improve our understanding of the appearance of early breast cancer at mammography.     

Advanced multiple-beam equalization radiography in chest radiology: a simulated nodule detection study

To evaluate the efficacy of AMBER, a multiple-beam equalization system for chest radiography, the authors performed a nodule detection study using an anthropomorphic chest phantom. AMBER and conventional images were compared. The images were read by four observers, and analysis was done by means of modified receiver-operating characteristic (ROC) curves (free ROC curves [FROC]). The results of the FROC analysis show a significant increase in the detectability of nodules (P less than .001) projected over the mediastinum with the use of AMBER. No significant difference between AMBER and conventional images was noted in detectability of nodules projected over the lung.     

Diadenosine 5',5'-p1,p4-tetraphosphate deficiency in blood platelets of the Chediak-Higashi syndrome

Diadenosine tetraphosphate (AP4A) is an unusual nucleotide found in a variety of cells, including platelets. It has been suggested that platelet AP4A is stored in the dense granules and is metabolically inactive. We have studied the AP4A content of blood platelets in two patients and three cattle with Chediak-Higashi syndrome (CHS), a hereditary platelet defect with dense granule deficiency. Acid-soluble extractions of whole blood and platelets were neutralized. The adenosine triphosphate (ATP) level was measured by luminescence technique. To measure the AP4A content, the neutralized extract was treated with phosphomonoesterase for removal of ATP. The AP4A content was then measured by coupling the phosphodiesterase and luciferase reaction. The AP4A content was 0.43 nmol/mg protein for normal human platelets and 0.004 nmol/mg protein for CHS platelets. The ATP/AP4A ratio was 67 for normal and 3,023 for CHS platelets. The whole blood AP4A was reduced by 89% in CHS patients who had only a slight decrease in ATP level (26% reduction). Similarly, bovine platelets with CHS showed a marked decrease of AP4A content and a moderate reduction of the ATP level. The platelet ATP/AP4A ratio was 351 and 3,133 for normal and CHS cattle, respectively. Results demonstrate a marked reduction of AP4A in CHS platelets and suggest that AP4A may be a useful marker for the measurement of dense granule content in platelets.     

Eigenimage filtration of intravenous digital subtraction angiograms of the heart. Work in progress

The authors developed a postprocessing technique, eigenimage filtering, to extract phase-dependent information from digital subtraction angiograms of the heart. This technique suppresses the interference from the right ventricle and left atrium and produces an image of the left ventricle and aorta that is substantially free of these overlap artifacts. The resultant eigenimages of the heart appear more like conventional ventriculograms than do digital subtraction angiograms and matched filtered images.     

The chemoattractant activity of rheumatoid synovial fluid for human lymphocytes is due to multiple cytokines

The majority of synovial fluids from 29 rheumatoid arthritis patients were strongly attractive for normal blood lymphocytes judged by assays of polarization and collagen gel invasion. While rheumatoid synovial fluids contained IL-15, IL-8, monocyte chemotactic protein-1 (MCP-1) and macrophage inflammatory protein-1α (MIP-1α) at levels sufficient to attract lymphocytes, inhibition of the activity of any single cytokine using specific antibody did not abolish the activity of the fluid. However combinations of anti-cytokine antibodies used together (anti-IL-15+anti-MCP-1; anti-IL-8+anti-MCP-1 or +anti-MIP-1α) inhibited most of the activity, suggesting that attraction of lymphocytes by the fluids is due to a combination of attractants. Blood lymphocytes required activation by overnight culture to respond optimally, while rheumatoid synovial tissue lymphocytes responded to synovial fluids without a requirement for a period of culture. Lymphocytes derived from rheumatoid synovial fluids were poorly responsive to locomotor stimulants. Most of the responding cells from blood mononuclear cell fractions were T lymphocytes of the CD45RO isotype. Incubation in the presence of cyclosporin A or corticosteroids inhibited the response of lymphocytes to the fluids, but the presence of non-steroidal anti-inflammatory drugs (NSAIDs) and other agents used in therapy of the patients from whom the fluids were taken had no inhibitory effect.     

Chronic wrist pain: evaluation with high-resolution MR imaging

The diagnostic performance of magnetic resonance (MR) imaging in the evaluation of the triangular fibrocartilage complex and the intrinsic and extrinsic ligaments of the wrist was assessed in 43 patients with chronic wrist pain. Forty-one patients underwent correlative arthrography. Twenty-three patients underwent arthroscopy or arthrotomy or both. The normal anatomy of the triangular fibrocartilage and the intrinsic and extrinsic ligaments could be demonstrated effectively with MR imaging. MR imaging was effective in the evaluation of triangular fibrocartilage tears with a sensitivity of 1.0, a specificity of 0.93, and an accuracy of 0.95 when compared with arthrography; 0.89, 0.92, and 0.90, respectively, when compared with arthroscopy and arthrotomy. MR imaging could also be used effectively to evaluate tears of the intercarpal ligaments, particularly the scapholunate ligament. Disruptions of the extrinsic ligaments, articular cartilage defects, and subluxations of the distal radioulnar joint were also well demonstrated. MR imaging is an effective procedure in assessing patients with chronic wrist pain.