The influence of scalp infiltration with bupivacaine on hemodynamics and postoperative pain in adult patients undergoing craniotomy.

Unlabelled: After craniotomy, hypertension may contribute to intracerebral hemorrhage. We studied whether scalp infiltration with bupivacaine during craniotomy reduces postoperative pain and hypertension. In a double-blind fashion, 36 adult patients (ASA physical status II or III) undergoing elective craniotomy were randomly assigned to receive scalp infiltration with either bupivacaine (0.

FADD gene therapy for malignant gliomas in vitro and in vivo.

Fas/APO-1 (CD95), a cell surface cytokine receptor, triggers apoptotic cell death by specific agonist antibody, suggesting that Fas/APO-1 may be a promising target for treatment of tumors. In this study, we show that treatment with anti-Fas antibody effectively induced apoptosis in malignant glioma cell lines with high expression of Fas/APO-1 (n = 3). Malignant glioma cells with low or undetectable expression of Fas/APO-1 (n = 6), however, were resistant to Fas/APO-1-dependent cytotoxicity.

Motoneuron survival after neonatal peroneal nerve injury in the rat-evidence for the sparing effect of reciprocal inhibition.

Sciatic nerve crush at birth results in the death of most of the motoneurons in the sciatic motor pool. It has been proposed that these cells die through excessive activation which can be explained partly by an increased susceptibility to NMDA. However, it is also possible that decreased inhibitory mechanisms resulting from nerve injury may contribute to overactivation of the motoneurons.

The guideline interchange format: a model for representing guidelines.

Objective: To allow exchange of clinical practice guidelines among institutions and computer-based applications.

Design: The GuideLine Interchange Format (GLIF) specification consists of GLIF model and the GLIF syntax. The GLIF model is an object-oriented representation that consists of a set of classes for guideline entities, attributes for those classes, and data types for the attribute values.

Antisense telomerase treatment: induction of two distinct pathways, apoptosis and differentiation.

Telomerase, the enzyme that elongates telomeric DNA (TTAGGG)n, may be involved in cellular immortality and oncogenesis. To investigate the effect of inhibition of telomerase on tumor cells, we transfected the antisense vector against the human telomerase RNA into human malignant glioma cells exhibiting telomerase activity. After 30 doublings, some subpopulations of transfectants expressed a high level of interleukin-1beta-converting enzyme (ICE) protein and underwent apoptosis.

Systemic T cell adoptive immunotherapy of malignant gliomas.

Object: To determine the feasibility, toxicity, and potential therapeutic benefits of systemic adoptive immunotherapy, 10 patients with progressive primary or recurrent malignant glioma received this treatment. Adoptive immunotherapy, the transfer of immune T lymphocytes, is capable of mediating the regression of experimental brain tumors in animal models. In animal models, lymph nodes (LNs) that drain the tumor vaccine site are a rich source of tumor-immune T cells.

Antagonist effect of insulin-like growth factor I on protein kinase inhibitor-mediated apoptosis in human glioblastoma cells in association with bcl-2 and bcl-xL.

Object: Tamoxifen (TAM) has been found to be effective in inhibiting proliferation of glioblastoma cells in vitro, but clinical studies have been disappointing. The purpose of this study was to determine whether insulin-like growth factor I (IGF-I), a potential autocrine/paracrine mitogen produced by glioblastomas, interferes with the antimitogenic actions of TAM.

Methods: Human glioblastoma cells were treated with or without TAM and/or IGF-I in vitro and evaluated for: viability by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenol tetrazolium bromide cleavage assay; apoptosis by histochemical analysis of nuclear morphology and 3'-OH DNA fragments; and expression of the IGF-I receptor, and the bcl-2, bcl-xL, and bax proteins by immunoblot analysis.

Thyroid hormone depletion inhibits astrocytoma proliferation via a p53-independent induction of p21 (WAF1/CIP1).

Background: Clinical hypothyroidism has been associated with prolonged survival in several types of malignancies, but the mechanism of this effect is unknown.

Material And Methods: In vitro studies of thyroid hormone depletion (via culture in medium containing 5% thyroid hormone-depleted fetal bovine serum (FBS)) were carried out using a human glioblastoma cell line (WITG3) which expresses a mutant, non-functional p53.

Results: Thyroid hormone depletion inhibited WITG3 proliferation compared to control medium containing 5% euthyroid FBS.

A study of collaboration among medical informatics research laboratories.

The InterMed Collaboratory involves five medical institutions (Stanford University, Columbia University, Brigham and Women's Hospital, Massachusetts General Hospital, and McGill University) whose mandate has been to join in the development of shared infrastructural software, tools, and system components that will facilitate and support the development of diverse, institution-specific applications. Collaboration among geographically distributed organizations with different goals and cultures provides significant challenges. One experimental question, underlying all that InterMed has set out to achieve, is whether modern communication technologies can effectively bridge such cultural and geographical gaps, allowing the development of shared visions and cooperative activities so that the end results are greater than any one group could have accomplished on its own.

Retroviral transfer of CPP32beta gene into malignant gliomas in vitro and in vivo.

Malignant gliomas are highly aggressive neoplasms that are very resistant to current therapeutic approaches, including irradiation, chemotherapy, and immunotherapy. To improve the prognosis, it is absolutely essential to explore novel modalities of treatment. Recently, we have demonstrated that interleukin 1beta-converting enzyme (ICE), a mammalian homologue of the Caenorhabditis elegans cell death gene ced-3, induces apoptotic cell death in malignant glioma cells.

The Unified Medical Language System: an informatics research collaboration.

In 1986, the National Library of Medicine (NLM) assembled a large multidisciplinary, multisite team to work on the Unified Medical Language System (UMLS), a collaborative research project aimed at reducing fundamental barriers to the application of computers to medicine. Beyond its tangible products, the UMLS Knowledge Sources, and its influence on the field of informatics, the UMLS project is an interesting case study in collaborative research and development. It illustrates the strengths and challenges of substantive collaboration among widely distributed research groups.

Involvement of p53 and WAF1/CIP1 in gamma-irradiation-induced apoptosis of retinoblastoma cells.

Retinoblastoma is an intraocular malignancy of childhood, which is very radiosensitive. gamma-irradiation, however, induces side effects, and the precise mechanisms of tumor cell death after the treatment remain unknown. In this study, we demonstrated that gamma-irradiation induced apoptosis (programmed cell death) in human retinoblastoma cell lines Y79 and WERI-Rb-1.

Maintaining the confidentiality of medical records shared over the Internet and the World Wide Web.

The Boston Electronic Medical Record Collaborative is working to develop a system that will use the World Wide Web to transfer computer-based patient information to clinicians in emergency departments. Maintaining adequate confidentiality of these records while still facilitating patient care is paramount to this effort. This paper describes an explicit protocol that would make it possible to electronically identify patients and providers, secure permission for release of records, and track information that is transmitted.

The CDK inhibitor, p27Kip1, is required for IL-4 regulation of astrocyte proliferation.

IL-4 is a pleiotrophic cytokine that has been shown to affect cells of the central nervous system. We have demonstrated that IL-4 inhibits DNA synthesis and proliferation in human astroglia expressing IL-4 receptors. In this study, we sought to identify mechanisms that could account for the antimitogenic effects of IL-4.

"Just-in-time" clinical information.

The just-in-time (JIT) model originated in the manufacturing industry as a way to manage parts inventories process so that specific components could be made available at the appropriate times (that is, "just in time"). This JIT model can be applied to the management of clinical information inventories, so that clinicians can have more immediate access to the most current and relevant information at the time they most need it--when making clinical care decisions. The authors discuss traditional modes of managing clinical information, and then describe how a new, JIT model may be developed and implemented.

Solitary fibrous tumor of the meninges. Case report and review of the literature.

The authors present the case of a left frontal solitary fibrous tumor of the meninges. The gross appearance of the tumor was very similar to that of a fibroblastic meningioma. Histological examination showed a mixture of spindle-shaped and round cells arranged in a collagen matrix.

Frozen section evaluation of stereotactic brain biopsies: diagnostic yield at the stereotactic target position in 188 cases.

Objective: Use of the image-guided stereotactic brain biopsy has facilitated the diagnosis of previously inaccessible lesions with both safety and reliability. However, few studies have assessed the diagnostic yield of frozen section evaluation of the initial stereotactic target (FS-0). We describe our experience with 188 stereotactic brain biopsies in order to evaluate the diagnostic yield of FS-0.

Computer-assisted endoscopy for neurosurgical procedures: technical note.

Objective: As neuroendoscopy technology evolves, the ventriculoscope is playing a greater role in the diagnosis and treatment of disorders affecting the ventricular system. However, even with direct visualization, correctly orienting and safely navigating an endoscope may be difficult with abnormal anatomy, in small ventricles, or when searching for small periventricular lesions identified on neuroimaging studies. The ability to define the location of the endoscope during such procedures enhances its effectiveness and safety.

Design considerations in migrating an obstetrics clinical record to the Web.

Recently the American College of Obstetricians and Gynecologists (ACOG) embarked on an effort to promote the development of nationally networked obstetrical records. The Laboratory of Computer Science (LCS) is collaborating with them to help achieve this goal through the development of a web-based prototype of an electronic medical record (EMR) which would allow the entry and display of typical clinical information for the obstetric patient. The process of porting a stand alone application to the web environment necessitated the development of a robust software scheme that could exploit the strengths of Web-based technologies and avoid some of the drawbacks inherent in a stateless environment.

Maintaining the integrity of a Web-based medical vocabulary glossary.

Medical vocabulary databases are vital components of electronic medical record (EMR) systems. While their performance and efficiency has been extensively explored by many authors, few have dealt with the maintenance of their semantic integrity. Clinicians' preference for an optimistic system has introduced a need for monitoring and filtering proposed additions to the vocabulary tables.

Puya: a method of attracting attention to relevant physical findings.

Puya is a method that compares the physical exam in an electronic clinical note with a set of stereotypical physical exam sentences that have been previously classified as "normal". The note is then displayed in a web browser with normal findings clearly delineated. The list of stereotypical sentences comes from a set of physical findings found within extensive electronic medical record.

MedWeaver: integrating decision support, literature searching, and Web exploration using the UMLS Metathesaurus.

Integrating functions from disparate and widely-distributed information systems has been an interest of the medical informatics community for some time. Barriers to progress have included the lack of network-accessible information sources, inadequate methods for inter-system messaging, and lack of vocabulary translation services. With the advent of the World Wide Web (WWW) and the evolution of the National Library of Medicine's Unified Medical Language System (UMLS), it is now possible to develop applications that integrate functions from diverse, distributed systems.

Evaluation of a decision support system for pressure ulcer prevention and management: preliminary findings.

A decision support system for prevention and management of pressure ulcers was developed based on AHCPR guidelines and other sources. The system was implemented for 21 weeks on a 20-bed clinical care unit. Fifteen nurses on that unit volunteered as subjects of the intervention to see whether use of the system would have a positive effect on their knowledge about pressure ulcers and on their decision-making skills related to this topic.

Using software agents to maintain autonomous patient registries for clinical research.

A software agent is an application that can function in an autonomous and intelligent fashion. We have used mobile software agents to maintain clinicians' patient research databases (patient registries). Agents were used to acquire data from the clinician and place it into the registries, copy data from hospital databases into the registries, and report data from the registries.