Role of duplex Doppler sonography in diagnosis of acute allograft dysfunction-time to stop measuring the resistive index?

Measurement of vascular resistive index (RI) by duplex Doppler sonography (DDS) has been proposed as a non-invasive technique to detect the presence of acute rejection in renal allograft recipients. Our aim was to evaluate the clinical utility of this technique. From 107 patients we reviewed 159 biopsies that were performed from 1993 to 2001 for the investigation of acute allograft dysfunction.

Transdermal estradiol therapy for advanced prostate cancer--forward to the past?

Purpose: Current hormonal therapies for prostate cancer are associated with significant morbidities, including symptoms of andropause and osteoporosis. Oral estrogens prevented many of these problems but were abandoned due to cardiovascular toxicity attributed to hepatic effect. In contrast, parenteral estrogens prevent first pass hepatic metabolism and substantially reduce cardiovascular risk, and long-term transdermal estradiol therapy is believed to be cardioprotective.

Practical methods for compensating for missed treatment days in radiotherapy, with particular reference to head and neck schedules.

Unscheduled interruption of a radiotherapy treatment can lead to significant loss in local tumour control, particularly in tumours that repopulate rapidly. General guidelines for dealing with such treatment gaps have been issued by the Royal College of Radiologists and more specific advice on the use of compensation methods has been published previously [Hendry et al., Clin Oncol 1996;8:297-307; Slevin et al.

The determination of radiobiologically optimized half-lives for radionuclides used in permanent brachytherapy implants.

Purpose: To use tumor growth kinetics and other biologic parameters in an extended version of the linear-quadratic (LQ) formulation to determine radiobiologically optimized half-lives of radionuclides which might be used in permanent brachytherapy implants.

Methods And Materials: A version of the LQ model suitable for the analysis of permanent brachytherapy implants has been modified to investigate the radionuclide half-lives that will maximize the biologically effective dose (BED) delivered to tumors with repopulation rates (K values) in the range 0.01-1.

Learning from prescribing errors.

The importance of learning from medical error has recently received increasing emphasis. This paper focuses on prescribing errors and argues that, while learning from prescribing errors is a laudable goal, there are currently barriers that can prevent this occurring. Learning from errors can take place on an individual level, at a team level, and across an organisation.

Are changes in admission practices for elective surgery posing a transfusion threat to patients?

There is an increasing emphasis on reducing in-patient hospital stay for elective surgical procedures. As a result, pre-operative stay has shortened, with less time available for performing baseline investigations before surgery, including those required to ensure a supply of safe, compatible blood. We have estimated the frequency of failure to complete 'group and screen' (G&S) testing before surgery where indicated, so that neither group-compatible blood nor crossmatched blood could be provided promptly if an unexpected haemorrhage occurs.

The CDKN2A tumour suppressor gene: no mutations detected in patients with melanoma and additional unrelated cancers.

Germ-line mutations of the CDKN2A tumour suppressor gene have been reported in association with familial melanoma, sporadic melanoma with multiple primary lesions and also pancreatic cancer. We studied the hypothesis that patients with melanoma and additional unrelated cancers may harbour mutations in the CDKN2A gene. Twenty seven patients with histologically confirmed melanoma who also had additional cancers such as breast, colorectal, lymphoma and other neoplasms were studied.

Pegylated liposomal doxorubicin (Caelyx) in recurrent ovarian cancer.

Epithelial ovarian cancer (EOC) is the most common gynaecological malignancy in the Western world and a leading cause of death. Patients with relapsed EOC are incurable and therefore the toxicity of palliative chemotherapy and effects on health-related Quality of Life are important factors. Several newer cytotoxic agents have been used in these patients.

The use of temozolomide in recurrent malignant gliomas.

Gliomas are the most common primary intracerebral tumours and over 60% of these are malignant. Standard treatment in the UK for patients with a good performance status consists of surgery and postoperative radiotherapy, however, recurrence is almost inevitable. Treatment of recurrent malignant gliomas (MG) is limited to further surgery, chemotherapy and novel biological therapies.

Effectiveness and relevance of MR acceptance testing: results of an 8 year audit.

The effectiveness and relevance of independent acceptance testing was assessed by means of an audit of acceptance procedures for 17 MRI systems, with field strengths in the range 0.5-1.5 T, acquired over 8 years.

Overexpression of HER-2 in thick melanoma.

In this study we evaluated the overexpression status of HER-2 and its prognostic significance on survival in patients with thick cutaneous malignant melanoma. The immuno-alkaline phosphatase antigen detection technique was applied to archival diagnostic material from 51 patients with primary lesions measuring >or= 10 mm in Breslow thickness. Eleven additional patients with primary lesions measuring View Article and Find Full Text PDF

Prognostic factors of cutaneous melanoma and a new staging system proposed by the American Joint Committee on Cancer (AJCC): validation in a cohort of 1284 patients.

This study, involving a cohort of 1284 evaluable patients, validates the American Joint Committee on Cancer (AJCC) proposal for the introduction of ulceration of primary cutaneous melanoma as an independent prognostic factor of survival. In univariate analyses, ulceration (Hazard Ratio (HR) 1.983; P<0.

Embolization of bleeding residual uterine vascular malformations in patients with treated gestational trophoblastic tumors.

Purpose: To retrospectively evaluate embolotherapy of bleeding residual uterine vascular malformations in patients with gestational trophoblastic tumors.

Materials And Methods: Fourteen patients were treated over the past 20 years. Embolizations were performed with a common femoral artery approach.

Potential new therapeutic options in Behçet's syndrome.

Behçet's syndrome is a multisystem disorder that causes orogenital ulceration, skin lesions and intraocular inflammation with uveitis and retinal vasculitis. A proportion of affected individuals also develop vascular and central nervous system manifestations, with significant morbidity and mortality. Although the aetiopathogenesis of Behçet's syndrome is poorly understood, the condition is considered to be driven, at least in part, by autoimmune mechanisms.

The role of biologically effective dose (BED) in clinical oncology.

There are many clinical situations in which radiobiological considerations can be usefully applied and all clinicians should be aware of the potential benefits of developing a quantitative radiobiological approach to their practice. The concept of biologically effective dose (BED) in particular is useful for quantifying treatment expectations, but clinical oncologists should recognize that careful interpretation of modelling results is required before clinical decisions can be made and that there is a lack of reliable human parameters for application in some situations. Correct use of the BED concept will, in more complex treatment situations, sometimes involve the use of multiple parameters and BED calculations.

The development of nurses as managers: the prevalence of the self-development route.

Aim: This article identifies ways in which hospital sisters and charge nurses (ward managers) are developed as managers in one London teaching hospital.

Context: Ward managers are practising in the context of increasing management responsibility in which decision-making is being driven to occur as close to the patient as possible. Decision-making about the management development opportunities for ward managers rests with senior nurse managers who have espoused their own preferences about the styles of management development open to ward managers.

Acute erythremic myelosis (true erythroleukaemia): a variant of AML FAB-M6.

Aims: Classic erythroleukaemia (acute myeloid leukaemia M6, or M6 AML) is defined as an excess of myeloblasts in an erythroid predominant background. Leukaemia variants in which the primitive blast cells are demonstrably erythroid are extremely rare and poorly characterised. Variably referred to as "true erythroleukaemia" or "acute erythremic myelosis", they are often included within the M6 AML category even though they do not meet strict criteria for this type of AML.

Acute and convalescent changes in plasma homocysteine concentrations in acute coronary syndromes.

Background: Raised plasma homocysteine is a risk factor for coronary artery disease. Patients with myocardial infarction or unstable angina show greater activation of coagulation, greater troponin release, and a worse outcome.

Objective: To examine variations in plasma homocysteine concentration in relation to C reactive protein (CRP) in patients presenting with acute coronary syndromes.

Anterior cruciate ligament rupture: reconstruction surgery and rehabilitation. A nation-wide survey of current practice.

A database of the current practice of anterior cruciate ligament (ACL) reconstruction surgery in Great Britain was collated from a postal survey. This survey revealed that clear trends are emerging in the United Kingdom (UK) with regard to ACL reconstruction surgery (such as the type of graft used and timing of surgery) and rehabilitation. Certain issues, however, remain controversial, including bracing and knee range of movement.