Self-dilatation of oesophageal strictures.

A new technique for the management of upper and mid-oesophageal benign strictures is reported. A deflated oesophageal balloon catheter coated with steroid paste is passed by the patient through the stricture, the balloon is inflated and then withdrawn. This technique can be used for both strictures caused by tablet or corrosive damage that recur rapidly and where stricturing is the result of a chronic disease not amenable to medical or surgical treatments. Three patients in who this technique has been used with satisfactory patient tolerance and compliance and good relief of symptoms are reported.     

The response to carbogen breathing in experimental tumour models monitored by gradient-recalled echo magnetic resonance imaging.

Gradient-recalled echo magnetic resonance imaging (GRE MRI), which gives information on blood flow and oxygenation changes (Robinson SP, Howe FA, Griffiths JR 1995, Int J Radiat Oncol Biol Phys 33: 855), was used to observe the responses of six rodent tumour models to carbogen breathing. In one transplanted rat tumour, the Morris hepatoma 9618a, and a chemically induced rat tumour, the MNU-induced mammary adenocarcinoma, there were marked image intensity increases, similar to those previously observed in the rat GH3 prolactinoma. In contrast, the rat Walker carcinosarcoma showed no response. In two mouse tumours, the RIF-1 fibrosarcoma and the human xenograft HT29, carbogen breathing induced a transient fall in signal intensity that reversed spontaneously within a few minutes. The rat GH3 prolactinoma was xenografted into nude mice, and an increase in image intensity was found in response to carbogen, suggesting that any effects that carbogen may have had on the host were not significant determinants of the tumour response. The increases in GRE image intensity of the MNU, H9618a and GH3 tumours during carbogen breathing are consistent with increases in tumour oxygenation and blood flow, whereas the responses of the RIF-1 and HT29 tumours may be the result of a transient steal effect followed by homeostatic correction.     

Labeling of sarcoma associated monoclonal antibody with 111In, 67Ga and 125I

Labeling of human sarcoma-associated murine monoclonal antibody (MAb) 23H7 with 67Ga and 111In by the bifunctional ligand method is reported. 67Ga was chelated to the MAb via desferrioxamine B and 111In via the cyclic anhydride of DTPA. Higher specific activity was obtained with 67Ga (4-5 microCi/micrograms) as compared with 111In (2 microCi/micrograms). The binding capacity of the MAb was confirmed by repeated indirect immuno-fluorescence assays performed before and after labeling. A fast blood clearance was observed: 33% recovered dose (R.D.) blood level 3 h post-injection as compared with 56% after injection of control polyclonal IgG. Preliminary results on chemically induced sarcoma bearing mice showed a relatively high tumor uptake of the labeled antibody.     

The effect of intravenous immunoglobulin on the in vitro function of human neutrophils

Three commercially available preparations of human immunoglobulin for intravenous use (IVIgG), namely Gamimune N. Sandoglobulin and Intraglobin F, were tested for their ability to modulate human neutrophil function in vitro. IVIgG consistently stimulated the neutrophil respiratory burst at concentrations of 0.5 to 1 mg/ml, concentrations readily achieved in vivo by moderate-dose therapy. Superoxide (O2-) release was increased by 3.5-4.5 nmol per 5 x 10(5) cells at these concentrations of IVIgG, and H2O2 production increased in a dose-dependent fashion up to 8 mg/ml IVIgG. Luminol-dependent chemiluminescence (CL) was also directly stimulated by IVIgG. In addition, the effects of both soluble and particulate stimulators (N-formyl-methionyl-leucyl-phenylalanine, phorbol myristate acetate and opsonized zymosan) on the neutrophil respiratory burst were enhanced by IVIgG. In a filter assay of neutrophil migration, using a modified Boyden chamber, no consistent effect on neutrophil locomotion or chemotaxis could be demonstrated. The effect of IVIgG on neutrophil metabolism may contribute to its beneficial therapeutic effect in severe, life-threatening infections.     

Microbehavioral approaches to monitoring human experience

Microbehavioral approaches to social science research minimize the complexities of general activity reporting by limiting questions to elementary activity experience in the context of daily life. Time diaries and sampling studies of activity at random moments during the day are two examples of this approach.     

Electronic and disposable patient-controlled analgesia systems

We have compared the performance of the Baxter disposable with the Graseby electronic patient-controlled analgesia system in 30 patients following major gynaecological surgery. Patients were allocated randomly to receive analgesia via the Baxter or Graseby device for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative pain relief or sedation as measured by visual analogue scale. Requirements for antiemetic drugs and patient acceptability were similar. Mean (SEM) morphine demanded over 30 h was 35.7 (6.6) in the Graseby group and 35.1 (8.5) in the Baxter group.     

Impact of a shielded safety syringe on needlestick injuries among healthcare workers.

OBJECTIVES: Evaluate the impact of a shielded 3 cc safety syringe on needlestick injuries among healthcare workers. DESIGN: Surveillance study. SETTING: Three medical centers. RESULTS: The total number of needlesticks from all sources rose from 134 during the baseline period to 140 during the study phase. However, the overall rate of needlesticks involving 3 cc syringes decreased from 14/100,000 inventory units to 2/100,000, and the frequency declined substantially at each of the participating medical centers. CONCLUSIONS: These results suggest that shielded syringes and related technology may offer potential for reducing the risk of needlestick injuries among hospital and other healthcare employees. This study should be viewed as a preliminary effort to assess the potential of shielded-syringe technology for reducing the risk of needlestick injuries among healthcare workers. The results are encouraging, but more clinical experience with this new device and longer follow up are essential to provide the data necessary for a definitive assessment of efficacy.     

Partial resolution of acute interstitial pneumonia in native lung after single lung transplantation.

The case of a 49 year old man presenting with rapidly progressive interstitial lung disease is described. Radiological findings and the lung biopsy specimen were compatible with an acute interstitial pneumonia, as was the relentless clinical course culminating in hypoxic respiratory failure. After right single lung transplantation there was considerable improvement in lung function and radiographic clearing of disease in the native left lung.