Role of Doppler ultrasound flowmetry in the diagnosis of breast lumps

One hundred and five patients with discrete breast lumps were examined with a 10 MHz Doppler ultrasonic flowmeter. Doppler flow signals were analysed on an Angioscan spectrum analyser. Recordings from the opposite normal breast were taken as controls and signals from the two sides compared. In 23 patients signals from the normal breast could not be recorded and therefore results of the remaining 82 patients are reported. These included 39 patients with carcinoma, 20 with fibroadenoma, 12 with cyclical nodularity and 11 with cysts. Malignant lumps exhibited significantly higher peak systolic (S) and minimum diastolic frequencies (D) in comparison to the control breast. Fibroadenoma also had a higher S and D than those of the opposite normal breast. Signals over cysts and cyclical nodularity showed no significant difference from the recordings over the control side. Despite significantly higher systolic and diastolic frequencies in the cancer group in comparison to benign lumps and normal breast, considerable overlap in the values was seen between cancer and other groups. Therefore the patterns on 10 MHz Doppler sonography are not sufficiently specific to discriminate benign from malignant breast lumps.     

Cadmium as an uncoupler of respiration in Ulva lactuca

The effect of cadmium on the respiration of Ulva lactuca was examined using an oxygen electrode. Discs of U. lactuca thallus in filtered seawater were either incubated in the dark for 24 h or treated with 20 μM 3(3,4-dichlorophenyl) 1,1-dimethylurea to inhibit photosystem II dependent noncyclic electron transfer. In both cases, the addition of cadmium, as sulphate, increased respiration, with maximum stimulation occurring at approximately 15 mM; above this concentration respiration declined and at >21 mM inhibitory effects were significant. Dinitrophenol (DNP, 50 μM) and carbonyl cyanide m-chlorophenylhydrazone (CCCP, 10 μM) also uncoupled respiration of U. lactuca, and when these compounds were used in conjunction with Cd the effects were found to be additive. Oligomycin (12.5 μ mL^?1), which inhibits the mitochondrial ATPase, inhibited U. lactuca respiration but subsequent Cd addition (to 6 mM) resulted in a 2.5 × increase in respiration over control values. DNP had a similar effect when used with oligomycin. DNP and CCCP had a negligible effect on the respiration of KCN-treated discs but the addition of Cd restored respiration to control values, probably because of the formation of insoluble Cd(CN)₂. These results demonstrate that Cd can act as a respiratory uncoupler in U. lactuca.     

Transcutaneous oxygen measurements in lower extremity ischemia: effects of position, oxygen inhalation, and arterial reconstruction

Transcutaneous oxygen tension (TcPO2) measurement has been successfully applied to the diagnosis and monitoring of patients with peripheral arterial insufficiency. This study was performed to assess the effects of changes in limb position, oxygen inhalation, and arterial reconstruction on TcPO2 values in patients with peripheral vascular disease. In addition, a TcPO2 index (foot TcPO2/chest TcPO2) was compared with the Doppler-derived ankle-to-brachial index (ABI) to determine which was the more effective monitor of the response to revascularization. Foot TcPO2 values of 22 patients with claudication or rest pain were measured before and after vascular reconstruction. TcPO2 increased after revascularization in both groups regardless of limb position or oxygen (O2) administration. The dependent position and O2 inhalation had an additive effect on TcPO2. Preoperative TcPO2 values in patients with rest pain showed the greatest response to the dependent position, increasing from 14 mm Hg to 33 mm Hg at room air and from 21 mm Hg to 53 mm Hg with O2 inhalation. TcPO2 in both patient groups was remarkably enhanced by O2 administration after revascularization. Postoperative supine TcPO2 values measured at room air increased from 50 mm Hg to 124 mm Hg (148%) in patients with claudication and from 40 mm Hg to 109 mm Hg (173%) in patients with rest pain after O2 inhalation. Comparison of the TcPO2 index with the ABI showed that absolute and normalized TcPO2 values are equally effective in monitoring peripheral arterial insufficiency. This study suggests that placing the limb in the dependent position and administering O2 may augment TcPO2 to levels where symptoms may resolve. The response of TcPO2 to O2 inhalation may be an indicator that reflects the response to revascularization.     

Anaesthetic agents decrease the activity of nitric oxide synthase from human polymorphonuclear leucocytes

Nitric oxide (NO) inhibitors reduce the threshold for anaesthesia. We have investigated the action of anaesthetic agents on human nitric oxide synthase (NOS) activity. Thiopentone reduced mean NOS activity to 36.6 (SD 8.9) % of control at 100 mumol litre-1 (P < 0.001) and 50.9 (20.3) % at 1 mmol litre-1 (P < 0.05). Ketamine showed similar effects, with activity reduced to 67.0 (17.6) % (P < 0.05) and 57.7 (8.5) % (P < 0.001) at 100 mumol litre-1 and 1 mmol litre-1, respectively. Etomidate 100 mumol litre-1 did not significantly alter activity (88.2 (8.1) %) but 1 mmol litre-1 did (60.6 (10.4) %, P < 0.005). Halothane also caused a significant decrease in NOS activity at all concentrations. This effect was specific as other enzymes were unaffected. We conclude that anaesthetic agents have a profound effect on NOS activity and as inhibition of NO release augments anaesthesia, we suggest that this may play a role in the mechanism of anaesthesia in humans.      

Pharmacokinetics of indium-111-labeled B72.3 monoclonal antibody in colorectal cancer patients.

Mean time parameters provide a new approach to plasma pharmacokinetics of radiolabeled Mabs that may show important patient differences affecting diagnosis or treatment. We determined mean time pharmacokinetic parameters for 11 patients entered in a Phase I/II clinical trial for detection of colorectal cancer. Patients were administered 0.5-2 mg of B72.3 anti-TAG-72 radiolabeled with 3.5-5 mCi of 111In, plasma activity was measured over time. Mean time pharmacokinetic parameters were (mean +/- s.e.m.): mean residence time; body (MRTB) 88.9 +/- 7.2 hr, central (MRTC) 73.8 +/- 6.0 hr; mean transit time, central (MTTC) 41.1 +/- 9.0 hr; mean residence time, periphery (MRTP) 15.1 +/- 3.4 hr; intrinsic mean residence time, periphery (IMPTP) 39.0 +/- 7.6 hr; mean transit time, periphery (MTTP) 24.0 +/- 6.7 hr; probability of distribution (PRD) 50% +/- 10%; and n compartmental cycles of 4.54 +/- 2.3 times. In patients with increased circulating specific TAG-72 antigen, MRTC greater than MTTC and n much greater than 1. In patients without specific antigen, MRTC approximately equal to MTTC and n much less than 1. Pharmacokinetic studies may identify patients who do not have the tumor produced target antigen for the specific Mab and may provide an opportunity to select another specific Mab with an increased chance for successful diagnosis or treatment.     

Identifying High Risk Groups and Quantifying Absolute Risk of Cancer After Kidney Transplantation: A Cohort Study of 15 183 Recipients

Transplant recipients have increased cancer risk, but data on risk variation across different patient groups are sparse. Rates and standardized rate ratios (SRR) of cancer (all sites, excluding nonmelanocytic skin and lip cancer) compared to the general population were calculated, using Australia and New Zealand Dialysis and Transplant Registry data. Within the transplant population, risk factors were identified (hazard ratios: HR; 95% CI) and absolute risk estimated for recipient groups. A total of 1642 (10.8%) of 15 183 recipients developed cancer. Risk was inversely related to age (SRR 15-30 children, 2 if >65 years). Females aged 25-29 had rates equivalent to women aged 55-59 from the general population. Age trend for lymphoma, colorectal and breast risk was similar; melanoma showed less variability across ages, prostate showed no risk increase. Within the transplanted population, risk was affected by age differently for each sex (p = 0.007), elevated by prior malignancy (HR 1.40; 1.03-1.89), white race (HR 1.36; 1.12-1.89), but reduced by diabetic end-stage kidney disease (ESKD) (HR 0.67; 0.50-0.89). Cancer rates in kidney recipients are similar to nontransplanted people 20-30 years older, but absolute risk differs across patient groups. Men aged 45-54 surviving 10 years have cancer risks varying from 1 in 13 (non-white, no prior cancer, diabetic ESKD) to 1 in 5 (white, prior cancer, other ESKD).     

Critical Care for Postgraduate Trainees. A. Brooks, K. Girling, B. Riley and B. Rowlands (editors). Published by Hodder Arnold, London. Pp. 173; indexed; illustrated. Price {pound}34.95. ISBN 0-340-80967-1

Critical Care for Postgraduate Trainees is intended to providetrainees in higher surgical, medical and anaesthetic trainingprogrammes with an up-to-date resource in critical care. Itprovides a succinct summary of the key topics in critical caremedicine along with discussion of recent advances, key papersand evidence-based practice where appropriate. Each chapterbegins with a box highlighting possible viva topics for thefacts