Positron Emission Tomography in Grading Soft Tissue Sarcomas

Soft tissue sarcomas present with varied radiological appearances. Positron imaging with [F-18] fluorodeoxyglucose (FDG PET) has recently made promising contributions to management of patients by providing a noninvasive means for evaluating tumor metabolism and providing important biological information about soft tissue malignant tumors. PET imaging not only gives quantitative data on metabolic rates of tumors but can also readily provide semiquantitative data of uptake of tumors by measuring uptake ratios. These values have been helpful for noninvasively grading tumors. This value is called the tumor standard uptake value (SUV). The tumor grades (low, intermediate, high) mean SUV values show a high level of significance in discrimination among tumor grade groups.     

The role of C-reactive protein in graft dysfunction after renal transplantation

PURPOSE: We investigated whether serial daily measurements of serum C-reactive protein could help differentiate episodes of transplant dysfunction due to rejection, infection, cyclosporin A nephrotoxicity or acute tubular necrosis in renal allograft recipients. MATERIALS AND METHODS: Morning serum was obtained daily from 134 patients during the first 30 days after renal transplantation. All episodes of graft dysfunction were recorded and compared to transplant biopsies. C-reactive protein concentrations were correlated with postoperative graft function and the various causes of graft dysfunction. RESULTS: All patients demonstrated an increase in C-reactive protein in response to surgery and a maximum level was reached on day 2 after transplantation. Mean C-reactive protein concentration was significantly increased for delayed (61.50 microg./ml.) compared to primary (mean 38.01) graft function (p = 0.001, Mann-Whitney U test). There were significant increases in C-reactive protein for bacterial infections other than asymptomatic bacteriuria (33.98 microg./ml), interstitial graft rejection (16.43) and acute tubular necrosis (30.50) compared to uneventful courses. C-reactive protein was unchanged for viral infections or cyclosporin A toxicity. CONCLUSIONS: Serial C-reactive protein measurements help to identify renal transplant dysfunction of different origins. However, rejection, infection and acute tubular necrosis show similar patterns of C-reactive protein increase. Thus, C-reactive protein is unable to discriminate the causes of renal graft dysfunction. Biopsy remains the gold standard for the differential diagnosis of renal allograft dysfunction.     

Perioperative blood transfusions after allogenic renal transplantation

Summary The requirement of blood transfusions was evaluated in a two compartment (retrospective/prospective) study in our renal transplantation program. Between July 1st, 1993 and December 31st, 1994 (observation period I) we retrospectively investigated 110 patients with end stage renal disease and anemia undergoing kidney transplantation. Between January 1st, 1995 and December 31st, 1996 (observation period II) the requirement of blood transfusions was followed prospectively in 134 patients after allogenic renal transplantation. The amount of blood drawn for preoperative diagnostic investigations was in observation period I significantly higher (280 ml) than in observation period II (150 ml) (p = 0.02). For postoperative diagnostic tests in observation period II significantly less blood (240 ml) was needed than in observation period I (510 ml) (p = 0.01). The intraoperative bloodloss was similar in both periods (170 ml vs. 190 ml; p = 0.6). The need for closer graft observation was the reason for significantly increased amount of blood transfusions in patients with delayed graft function. The number of blood transfusions was significant lower in patients with primary graft function (p = 0.0001). There was no correlation between blood transfusions and the use of ATG/OKT3, surgical complications and reoperations. With an improved management of blood drawing for diagnostic tests after allogenic kidney transplantation the number of perioperative blood transfusions can be reduced significantly.      

Using drug-usage evaluation to improve drug use

Quality and the issues that surround its assessment and accountability are complex matters requiring thoughtful analysis and action. The translation of concept into practice evades most practitioners, because the detail of how to accomplish the transition has been missing. Drug-usage evaluation may not be the ultimate answer. The concept has inherent limitations. However, well constructed, systematic DUE programs that focus on enhancing patient care, establishing effective communication networks, and containing constructive intervention methods can help improve drug use. Drug-usage evaluation can be an important link between process and outcome evaluation. For pharmacists, DUE is an opportunity to use their expertise and existing clinical practice to begin to develop a pharmaceutical care system. Drug-usage evaluation is a step in the right direction. The profession should move decisively to play an active role in improving patient outcomes.     

Effects of cell surface receptor-altering agents on the binding and biological activity of 12-O-tetradecanoylphorbol-13-acetate in isolated epidermal cells

Isolated epidermal cells were incubated with a variety of compoundsknown to interfere with or alter the ultrastructure of cellsurface receptors, and the ability of 12-O-tetradecanoyl-phorbol-13-acetate(TPA) to bind to these cells and induce epidermal ornithinedecarboxylase (ODC) activity was investigated. The - and ß-adrenergicantagonists, phentolamine and propranolol, and the cholinergicantagonist, atropine, which competed effectively for the bindingreceptors of [³H]dihydro--ergocryptine, [³H]dihydroalprenolol,and [¹⁴C]acetylcholine, did not inhibit the induction of ODCactivity by TPA or the specific binding of [³H]TPA to the cells.Neuraminidase treatments caused a time- and dose- related releaseof sialic acid from the cells and enhanced the stimulatory effectof cholera toxin on basal and TPA-induced ODC activities asmuch as the monosialoganglioside GM₁. Neuraminidase and theother membrane-altering agents, fucosidase, galactosidase, galactoseoxidase, phospholipases A2 and C, and NaIO₄, were used aloneand/or in various combinations in our studies. All treatmentstested inhibited the specific binding of several ¹²⁵I-labeledhormones and epidermal growth factor to the cells. In contrast,none of these treatments was able, in the same cell system,to affect either the binding or the biological activity of TPA.Therefore, these results suggest that the primary interactionof TPA at the plasma membrane level as well as its biologicaleffect in the intact cell do not proceed through adrenergicor cholinergic receptors and do not require the integrity ofthe cell surface glycoconjugates and phospholipids. In addition,the inhibitory effect of retinoic acid on TPA-induced ODC activityremained unaffected by some of the above treatments, suggestingthat retinoic add is unlikely to interfere with TPA interactionsat the plasma membrane level.     

Anticipatory problem solving: models for clinical practice and research

Summary Problem solving that anticipates a client's future is a fundamental component of primary care. However, adequate models for clinical practice and for research are needed. A paradigm of anticipatory care conceptualized as an interpersonal problem solving process is used as a framework for critical analysis of existing models and for the specification of conceptual and practical bases of new models of anticipatory care. The paper addresses questions concerning problem solving for the model of anticipatory guidance presented by the American Public Health Association and the model developed by Caplan, and the models of preparatory communication developed by Janis and by Leventhal and Johnson. The questions that are used to critique existing models and to specify new ones deal with identification and specification of issues for anticipatory care; its goals, functions, and intended outcomes; appraisal of readiness to participate in and worthwhileness of anticipatory care; the characteristic features of a model's solution phases and strategies of preparation; and the evaluation of the adequacy of anticipatory care.