Single high dose intraoperative electrons for advanced stage pancreatic cancer: phase I pilot study

Phase I toxicity studies with intraoperative radiotherapy proved to be a feasible adjunct to surgery for unresectable malignancies of the pancreas at Howard University Hospital. There have been minimal side effects or complications related to the combination of limited surgical decompression and intraoperative radiotherapy alone. The procedure has now become a standard operation for the surgical radiotherapeutic team as well as the other support members, including anesthesiology, nursing and housekeeping. The toxic effects of intraoperative radiotherapy on normal tissues is being assessed on a dose volume basis. Doses of 2000–2500 rad in a single exposure to include the pancreas, regional nodes and duodenum are acceptable if the total treatment volume is less than or equal to 100 cm³ The tumoricidal effects on the cancer are demonstratable when one reviews the pathological specimens that illustrate massive tumor necrosis and fibros replacement, but in all cases reviewed, viable cancer was noted. Intraoperative radiotherapy, therefore, represents a significant “boost” dose for resectable, partially resectable or non-resectable tumors when added to conventional external beam irradiation and/or chemotherapy. Preliminary clinical data and minimal toxicity justifies further investigation.     

Ultrasonic identification of sources of gaseous microemboli during open heart surgery

An ultrasonic transducer was used to detect gaseous microemboli during open heart surgery. When placed over the carotid artery of patients during surgery it was recognized that gaseous emboli were released into the systemic circulation following recognizable surgical procedures and from the oxygenator during bypass. Fixation of the transducer on the arterial return from the oxygenator demonstrated that the two types of disposable bubble oxygenators and disc oxygenators tested delivered microbubbles in the arterial blood. Some factors affecting the number of bubbles released were recognized and are discussed. Case reports of two patients who received large volumes of gaseous microemboli from different sources are presented.     

A case control study of carcinoma of the ovary.

There is increased concern over the apparent rise in incidence of patients with carcinoma of the ovary, particularly in older women. In an attempt to identify aetiological factors 300 women with cancer of the ovary diagnosed at laparatomy were studied. A questionnaire was administered to these women (Group A) and to two control groups matched by age. The first control group (Group B) comprised patients in a gynaecological ward and the second (Group C) comprised were shown in the obstetric history of the three groups. Fewer of the women in Group A had married and fewer had ever been pregnant and the family size was smaller. Significantly fewer of them recollected an attack of mumps, measles, or rubella. In all, only 81 of the whole series of 900 had used oral contraceptives, 19 of Group A and 31 in each of the control groups, a statistically significant deficiency. These findings support those of other investigations and suggest lines of further inquiry.     

Myocardial depressant effects of sodium acetate

Sodium acetate produced a direct, dose-related decrease in myocardial contractile force in the dog and isolated rabbit papillary muscle. In the dog, there was also a decrease in blood pressure which was attributed primarily to the fall in contractile force. However, sodium acetate was found to have weak vasodilator properties as shown by the decreases in hind-limb perfusion pressure.     

High sibling correlation on methylphenidate response but no association with DAT1-10R homozygosity in Dutch sibpairs with ADHD

BACKGROUND: A minority of patients with attention-deficit hyperactivity disorder (ADHD) do not respond favorably to methylphenidate. This has been partially associated with homozygosity for the Dopamine transporter (DAT1) 10-repeat allele and the presence of one or two Dopamine D4 receptor (DRD4) 7-repeat alleles. This study examined the sibling correlation of methylphenidate response rate and the possible association between response rate and these risk alleles. METHODS: A sample of 82 Dutch children with ADHD, from 54 families, (including 30 singletons and 28 sib pairs), who used methylphenidate, was phenotyped according to DSM-IV criteria. Patients were members of affected sib pairs and were genotyped for DAT1 and DRD4. The sibling Intraclass Correlation Coefficient for methylphenidate response rate was calculated. The association between individual response rates and the risk alleles was examined using linear regression techniques. RESULTS: The Intraclass Correlation Coefficient was significant (r=.563, p=.001). No evidence was found establishing an association between methylphenidate response and DAT1-homozygosity. There was a positive trend towards association with the presence of one or two DRD4-7R alleles. CONCLUSIONS: The sibling correlation may indicate a familial clustering of methylphenidate response. This response is possibly associated with the presence of one or two alleles at the DRD4-7R locus, but not with DAT1-10R homozygosity in the Dutch population.     

Anoxic versus traumatic brain injury: amount of tissue loss, not etiology, alters cognitive and emotional function

Research in neuropsychology suggests that the etiology of a neurologic injury determines the neuropathological and neuropsychological changes. This study compared neuropsychological outcome in subjects who had traumatic brain injury (TBI) with subjects who had anoxic brain injury (ABI), who were matched for age, gender, and ventricle-to-brain ratio. There were no group differences for morphologic or neuropsychological measures. Both groups exhibited impaired memory, attention, and executive function, as well as slowed mental processing speed. Intelligence correlated with whole brain volume, and measures of memory correlated with hippocampal atrophy. There was no unique contribution of hippocampal atrophy on neuropsychological outcome between the groups. In the absence of localized lesions, the amount of neural tissue loss, rather than etiology, may be the critical factor in neuropsychological outcome.