Pamidronate infusions as single-agent therapy for bone metastases: a phase II trial in patients with breast cancer.

Pamidronate is a potent biphosphonate which modulates tumour-induced osteolysis (TIO) by inhibiting osteoclast-mediated bone resorption. In a phase II trial, 69 breast cancer patients with symptomatic progressive bone metastases were given infusions of pamidronate 60 mg over 1 or 4 h every 2 weeks for a maximum of 13 infusions or until progressive disease (PD) at any site. No other systemic anticancer therapy was allowed.

Four channel foetal ECG data collection system.

Recently there has been an increased interest in the development of improved techniques for the diagnosis of foetal distress during labour. Many of the techniques have been based on extracting extra information from the foetal ECG obtained from a scalp electrode. To fully develop and test the prototypes of these systems requires recorded data from patients.

Hearing loss in Grand Prix motorcyclists: occupational hazard or sports injury?

The prevalence of noise-induced hearing loss (NIHL) in current motorcycle grand prix racers was investigated. A total of 44 riders was randomly recruited and underwent interview, otological examination and pure tone audiometry. The median age was 28 (range 18-37) years and median racing experience was 10 (range 2-21) years.

Intravenous pamidronate: infusion rate and safety.

In view of previous animal studies showing that pamidronate (Aredia) can cause renal damage, and human data indicating that pamidronate in doses of 60-90 mg is more effective in the control of tumor-induced hypercalcemia than when given at lower doses, we decided to investigate whether pamidronate 90 mg infused over 60 minutes at weekly intervals had any adverse effects on renal function in patients with bone metastases. Twelve patients, 7 female (all with breast cancer) and 5 male (4 with prostate cancer, 1 with bladder cancer) were entered into the trial. Each patient received weekly intravenous infusions of pamidronate 90 mg in 250 ml normal saline over 60 minutes for 4 weeks.

Role of pamidronate in the management of bone metastases from breast cancer: results of a non-comparative multicenter phase II trial. Aredia Multinational Cooperative Group.

Bone metastases are a common cause of morbidity in patients with breast cancer. In an open, phase II, non-comparative trial to investigate the effects of repeated infusions of pamidronate (Aredia) on pain, mobility, analgesic consumption, bone healing and bone metabolism, 69 patients with breast cancer and bone metastases received pamidronate 60 mg intravenously in 250 ml normal saline over 1 or 4 hours every 2 weeks for a total of 13 infusions, until either progressive disease or a serious adverse event. Improvement in pain score was seen in 33 of 54 evaluable patients (61%) as measured by a linear analogue pain scale, and in 28 of 56 evaluable patients (50%) as measured on a 6-point pain scale: 18 (30%) of 60 evaluable patients showed reduction in a 6-point analgesic score, while 28 patients (50%) showed some improvement in mobility, as assessed by a questionnaire.

Hearing protection for motorcyclists.

An investigation to ascertain the most suitable earplug and its efficacy for use by motorcyclists was undertaken. To qualify for testing the earplugs had to be both easily available and cost less than 10 Pounds. Consequently, three types of earplugs ('Silisoft', EARfit and AQUAfit [both Cabot Safety Ltd]) were tested for sound attenuation scores using an 'insertion loss' technique both with and without a motorcycle helmet and scored for comfort by the test subjects.

Plymouth randomized trial of cardiotocogram only versus ST waveform plus cardiotocogram for intrapartum monitoring in 2400 cases.

Objective: The physiology of changes in the ST waveform of the fetal electrocardiogram has been elucidated in extensive animal and human observational studies. A combination of heart rate and ST waveform analysis might improve the predictive value of intrapartum monitoring. Our purpose was to compare operative intervention and neonatal outcome in labors monitored by the conventional cardiotocogram with those monitored by ST waveform plus the cardiotocogram.

Changes in recording electrode impedance during anaesthesia have no effect on evoked electromyographic responses.

Changes in electrical impedance at the recording electrodes have been blamed for the failure of evoked electromyographic responses to return to baseline during the offset of neuromuscular block, but a relationship between electrode impedance and electromyographic responses has never been shown. In 50 fit adults, the resistive and capacitive (reactive) components of the impedance of the recording electrodes were measured during electromyographic monitoring of neuromuscular transmission under enflurane anaesthesia. In 25 patients six 1 mm-deep punctures were made in the skin under both active recording electrodes, and in the other 25 no puncture was made.

Randomised trial of cardiotocography alone or with ST waveform analysis for intrapartum monitoring.

It is possible to record the fetal electrocardiographic waveform (ECG) from the scalp electrode used in labour for detection of fetal heart rate. Animal and observational studies of changes in the ST waveform of the ECG during hypoxia suggest that a combination of heart rate and ST waveform analysis might improve the predictive value of intrapartum monitoring. In a randomised trial, we have studied intervention rates and neonatal outcome for high-risk labours monitored either by conventional cardiotocography (CTG) or by ST waveform analysis plus CTG.

An evoked compound electromyogram simulator with external microprocessor control facility.

A circuit for an evoked electromyogram simulator is described, which produces a biphasic triangular waveform similar to the evoked compound action potential seen during clinical quantitative neuromuscular monitoring. The device can produce a fading train-of-four sequence, which can be controlled using a single externally-derived voltage. The simulator is useful for bench-testing of closed loop muscle relaxant administration systems, and for teaching aspects of neuromuscular monitoring in anaesthesia.

Casodex: a pure non-steroidal anti-androgen used as monotherapy in advanced prostate cancer.

Casodex, a pure potent non-steroidal anti-androgen, has been shown in a phase II clinical trial program to be very well tolerated and to have fewer side-effects compared with other anti-androgens. The most commonly reported side-effects (prompted by direct questioning) were breast tenderness (63.4%), breast swelling (52.

A multicenter randomized trial comparing the luteinizing hormone-releasing hormone analogue goserelin acetate alone and with flutamide in the treatment of advanced prostate cancer. The International Prostate Cancer Study Group.

A prospective randomized trial was conducted to compare the effects of the nonsteroidal antiandrogen flutamide (250 mg. 3 times daily) plus the luteinizing hormone-releasing hormone analogue goserelin acetate (Zoladex) (3.6 mg.

Toe-nail avulsion.

This trial compares the efficiency of Comfeel Ulcer Dressing (Coloplast Ltd), a hydrocolloid dressing, with a chlorhexidine acetate impregnated dressing on iatrogenic wounds produced by toe-nail avulsion followed by treatment with phenolisation of the germinal matrix and nail bed.

Toe-nail avulsion.

This trial compares the efficiency of Comfeel Ulcer Dressing (Coloplast Ltd), a hydrocolloid dressing, with a chlorhexidine acetate impregnated dressing on iatrogenic wounds produced by toe-nail avulsion followed by treatment with phenolisation of the germinal matrix and nail bed.

Suitability of fetal scalp electrodes for monitoring the fetal electrocardiogram during labour.

As the limitations of heart-rate based intrapartum monitoring have become apparent, there is renewed interest in analysis of the fetal electrocardiographic waveform as obtained from a fetal scalp electrode. A high quality ECG signal is necessary for waveform analysis. This study examined the suitability of five commonly available scalp electrodes for collecting this signal by examining their physical and electrical characteristics, together with a randomised clinical trial in which the ECG trace quality was assessed in 50 patients.

Cryptosporidiosis--an educational experience.

Eleven children aged 7 to 8 years from one school class developed diarrhoea and vomiting after an educational visit to a dairy farm. Three required hospital admission and intravenous fluid replacement for dehydration. Cryptosporidium oocytes were found in the faeces of these three children and from one classmate when the remainder of the class was tested between 16 and 21 days after the visit.

Duplex ultrasound of the abdominal aorta--a neglected tool in aortic dissection.

The use of duplex ultrasound for the diagnosis and assessment of abdominal aortic dissection and visceral arterial involvement is discussed. Ultrasound is simple and non-invasive and may be superior to aortography in diagnosis; it should be performed after ultrasound assessment of the aortic root. It also provides an effective means of follow-up evaluation if conservative treatment is employed.

A modified synchronous shielding technique in rotation therapy.

Synchronous shielding in rotation radiotherapy involves the movement of an absorber across the X-ray beam profile during a rotation treatment. This procedure can shape the cross-section of a cylindrical treatment volume to avoid nearby radiosensitive structures but often produces unacceptable dose variations within the treatment volume. These effects may be reduced by modifying the dose rate profile of the beam using wedge-shaped filters attached to the absorbers.

Psychomotor recovery after three methods of sedation during spinal anaesthesia.

In a double-blinded study, we have investigated psychomotor recovery after three sedation schemes during spinal anaesthesia for transurethral resection of prostate. Thirty-nine patients were allocated randomly to receive i.v.

A maze test as a measure of recovery from anesthesia.

This study investigated whether a paper and pencil maze test measuring the path length traced in 1 minute is a useful test of postoperative recovery from anesthesia. Fifty volunteer nonsurgical subjects were tested with four similar mazes to detect any improvement of scores with practice and learning. This improvement was found to occur in 46% of subjects and could be compensated for by a single practice attempt before taking the baseline score.

Outpatient diagnostic hysteroscopy.

Outpatient diagnostic hysteroscopy with endometrial sampling was performed in 160 women. The aim was to assess patient acceptance of the procedure when performed under para-cervical block. The most common indication was abnormal uterine bleeding.