Same-day or next-day sentinel node biopsy after lymphoscintigraphy for melanoma using 99m Tc-labelled antimony sulphide colloid.

BACKGROUND: Two recent publications have reported that a shorter interval between preoperative lymphoscintigraphy and sentinel node biopsy (SNB) is associated with improved survival of patients with primary cutaneous melanoma. The aims of this study were to analyse prospectively collected survival data for patients who had SNB on the same day as lymphoscintigraphy or the day after; and to assess tracer migration from sentinel nodes to second-tier nodes after lymphoscintigraphy on the previous day. METHODS: Outcome data were obtained for patients who had lymphoscintigraphy and SNB on the same day (time interval less than 8 h) or the next day (interval more than 16 h). In a separate prospective cohort, same-day and next-day lymphoscintigraphic images of sentinel nodes and second-tier nodes were compared. RESULTS: Following lymphoscintigraphy, 2848 patients had same-day and 3328 had next-day SNB. Survival outcomes did not differ between these groups. In a prospectively studied cohort of 30 patients, none had significant tracer migration from sentinel nodes to second-tier nodes on imaging the following day. CONCLUSION: No difference in survival after same- or next-day sentinel node biopsy is seen when 99m Tc-labelled antimony sulphide colloid is used. This may be because of less tracer migration to second-tier nodes.

ANTECEDENTES: Dos publicaciones recientes han señalado que reducir el intervalo entre la linfografía isotópica preoperatoria y la biopsia del ganglio centinela (sentinel node biopsy, SNB) se asocia con una mejor supervivencia en pacientes con melanoma maligno primario. Los objetivos de este estudio fueron los siguientes: (1) analizar los datos de supervivencia recogidos prospectivamente en pacientes en los que se realiza la SNB el mismo día o al día siguiente de la linfografía isotópica, y (2) evaluar la migración del marcador desde los ganglios centinela a los ganglios de segundo nivel a partir de la linfografía del día anterior. MÉTODOS: Se analizaron los resultados de los pacientes a los que se realizó una linfografía isotópica y la SNB el mismo día (intervalo de tiempo < 8 h) o al día siguiente (intervalo > 16 h). En una cohorte prospectiva diferente, se compararon las imágenes de los ganglios centinela y de los ganglios de segundo nivel en linfografías isotópicas realizadas el mismo día o al día siguiente. RESULTADOS: Tras la linfografía isotópica, se realizó la SNB el mismo día en 2.848 pacientes y al día siguiente en 3.328 pacientes. No hubo diferencias en la supervivencia entre ambos grupos. En una cohorte de 30 pacientes estudiada de forma prospectiva, no hubo migración significativa del trazador de los ganglios centinela a los ganglios de segundo nivel en las imágenes obtenidas al día siguiente. CONCLUSIÓN: La mejor supervivencia que se obtiene cuando se realiza la SNB poco después de la linfografía isotópica podría explicarse por una diferencia en la migración del trazador a los ganglios de segundo nivel entre los dos marcadores utilizados: nanocoloide de albúmina humana o coloide de sulfuro de antimonio, ambos marcados con 99mTc. En este estudio y con este último marcador, no se observó migración a ganglios de segundo nivel durante la noche.

Repair of nuclear ruptures requires barrier-to-autointegration factor.

Cell nuclei rupture following exposure to mechanical force and/or upon weakening of nuclear integrity, but nuclear ruptures are repairable. Barrier-to-autointegration factor (BAF), a small DNA-binding protein, rapidly localizes to nuclear ruptures; however, its role at these rupture sites is unknown. Here, we show that it is predominantly a nonphosphorylated cytoplasmic population of BAF that binds nuclear DNA to rapidly and transiently localize to the sites of nuclear rupture, resulting in BAF accumulation in the nucleus. BAF subsequently recruits transmembrane LEM-domain proteins, causing their accumulation at rupture sites. Loss of BAF impairs recruitment of LEM-domain proteins and nuclear envelope membranes to nuclear rupture sites and prevents nuclear envelope barrier function restoration. Simultaneous depletion of multiple LEM-domain proteins similarly inhibits rupture repair. LEMD2 is required for recruitment of the ESCRT-III membrane repair machinery to ruptures; however, neither LEMD2 nor ESCRT-III is required to repair ruptures. These results reveal a new role for BAF in the response to and repair of nuclear ruptures.

Zolpidem for persistent vegetative state--a placebo-controlled trial in pediatrics.

OBJECTIVE: The aim of this study was to determine if zolpidem is associated with improved responsiveness or regional cerebral perfusion in patients with persistent vegetative states. METHODS: Following ethics approval, children with persistent vegetative state were enrolled in a prospective, double-blind, placebo-controlled randomised trial. Patients underwent 2 treatments of 4 days, separated by 10 days. Each child received either a daily dose of zolpidem or placebo with a dosage of 0.14-0.2 mg/kg. Responsiveness and regional cerebral perfusion were the outcomes of interest. These were assessed using the Rancho levels of cognitive functioning scale, the coma/near-coma scale and F (18)-FDG positron emission tomography. These were conducted at baseline and after completion of the treatments. RESULTS: 3 children were enrolled. The Rancho assessment scales showed no change with treatment. The coma/near-coma scale showed a tendency to increase with zolpidem, suggesting reduced responsiveness - when compared to baseline or placebo. The positron emission tomography scans showed no significant changes between treatments. CONCLUSION: Zolpidem was associated with a tendency towards reduced responsiveness in patients with persistent vegetative states. There were no objective changes on positron emission tomography suggestive of an associated increase in cerebral blood flow with zolpidem. It would appear that zolpidem does not offer a beneficial effect in this setting.

Pulmonary inflammatory myofibroblastic tumor after Hodgkin's lymphoma and application of PET imaging.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor with a particular histological pattern of myofibroblasts and mixed inflammatory infiltrate. IMT has been rarely described in association with malignancy. This case report is of a 16-year-old male who had Hodgkin's disease (stage IVA) and who after chemotherapy and radiotherapy developed IMT, 16 months post completion of therapy. The IMT was in the lung in an area which was previously involved with HD and had undergone radiotherapy. PET imaging with F(18)FDG was used in the initial diagnosis and has been used in follow-up after full surgical resection of the lesion.

Prevalence and importance of pneumothoraces visualized on abdominal computed tomographic scan in children with blunt trauma.

BACKGROUND: Chest radiographs are routinely obtained for the identification of pneumothoraces in trauma patients. Computed tomographic (CT) scanning has a higher sensitivity for the detection of pneumothoraces, but the prevalence and importance of pneumothoraces detectable by CT scan but not by chest radiography in children sustaining blunt trauma is unclear. METHODS: We conducted a prospective observational cohort study of children less than 16 years old with blunt trauma undergoing both abdominal CT scan and chest radiography in the emergency department of a Level I trauma center over a 28-month period. All abdominal CT scans were interpreted by a single faculty radiologist. The chest radiographs of all patients with pneumothoraces detected on CT scan as well as a random sample of chest radiographs from pediatric blunt trauma patients without pneumothoraces on abdominal CT scan (in a ratio of four normals per pneumothorax) were reviewed by a second faculty radiologist. Both radiologists were masked to all clinical data as well as to the objective of the study. RESULTS: Five hundred thirty-eight children underwent both abdominal CT scan and chest radiography in the emergency department. Twenty patients (3.7%; 95% confidence interval [CI], 2.3-5.7%) were found to have pneumothoraces on CT scan. Of these 20 patients, 9 (45%; 95% CI, 23-68%) had pneumothoraces identified on initial chest radiography and 11 patients did not ("unsuspected pneumothoraces"). Twelve pneumothoraces were identified in these 11 patients; 6 were graded as minuscule and 6 as anterior according to a previously established scale. One patient with an unsuspected pneumothorax underwent tube thoracostomy. None of the 10 patients (0%; 95% CI, 0-26%) with unsuspected pneumothoraces who were managed without thoracostomy (including two patients who underwent positive pressure ventilation) had complications from their pneumothoraces. CONCLUSION: Less than half of pediatric blunt trauma patients with pneumothoraces visualized on abdominal CT scan had these pneumothoraces identified on initial chest radiograph. Patients with pneumothoraces identified solely on abdominal CT scan, however, uncommonly require tube thoracostomy.

The effect of jury deliberations on jurors' propensity to disregard inadmissible evidence.

The goal of this research was to examine the effect of jury deliberations on juror's propensity to disregard inadmissible evidence. Extant research is inconclusive; some research indicates that jurors do follow judicial instructions to ignore inadmissible evidence, but other research suggests that jurors do not. Two experiments examined whether jurors were affected by inadmissible evidence. The results revealed that although mock jurors were biased by inadmissible evidence prior to deliberations, the bias was tempered following deliberations. In Experiment 1, post deliberation jurors disregarded incriminating evidence that was ruled inadmissible because of due-process concerns. Experiment 2 replicated these results with less incriminating inadmissible evidence and also revealed that jurors did not accurately gauge the impact that the inadmissible evidence had on their verdicts. Theoretical and judicial policy implications are discussed.

Children's use of mental state information in selecting persuasive arguments.

Whether and when children use information about others' mental states to invent or select persuasive strategies were examined. In Study 1, preschoolers, 3rd-graders, and 6th-graders (ns = 11, 12, and 16, respectively; 17 girls) were told about story characters' persuading parents to buy pets or toys. Children were either given or not given information about story parents' beliefs and asked to invent or select appropriate arguments. Older children, but not preschoolers, used belief information to select arguments. Results were replicated in Study 2 (16 kindergartners, 16 3rd-graders; 19 girls). In Study 3, kindergartners and 1st-graders (N = 16; 6 girls) reasoned well on false-belief tasks but not on persuasion tasks, suggesting that failure to consider mental states in persuasion was not due to lack of a belief concept. Findings suggest that mental state understanding may continue to develop after the preschool years; methodological qualifications are also considered.

Isolated intraperitoneal fluid on abdominal computed tomography in children with blunt trauma.

OBJECTIVE: To determine the frequency of isolated intraperitoneal fluid (IIF) on abdominal computed tomography (CT) in pediatric blunt trauma patients and the association between IIF and clinically identifiable intra-abdominal injuries (IAIs) in these patients. METHODS: The authors conducted a prospective observational study of consecutive children <16 years old with blunt torso trauma who underwent abdominal CT scanning while in the emergency department (ED). All patients were evaluated by a faculty emergency physician who documented the patient's physical examination. All CTs were interpreted by a single faculty radiologist masked to clinical data. The volume of intraperitoneal fluid was quantified (small, moderate, large) and the presence of organ injury visible on CT was noted. Patients were considered to have IIF if the CT demonstrated intraperitoneal fluid and no solid organ injury. Patients with IIF were followed through their hospitalizations or telephoned in one week if discharged home from the ED. RESULTS: Five hundred twenty-seven children with blunt trauma were enrolled into the study. The mean age (+/-SD) was 7.4 +/- 4.7 years, and the median pediatric trauma score was 10 (range -2 to 12). Eighty-eight patients (17%; 95% CI = 14% to 20%) had intraperitoneal fluid on CT scan and 42 (48%; 95% CI = 37% to 59%) of these patients had IIF. Of the 42 patients with IIF, five patients (all without abdominal tenderness and with a small amount of IIF on CT scan) were discharged to home from the ED and were well at telephone follow-up; the remaining 37 patients were hospitalized. Of the 42 patients with IIF, 7 patients (17%, 95% CI = 7 to 31%) had IAIs subsequently identified (all gastrointestinal injuries) during their evaluations. Six of the seven patients with IIF and subsequently identified IAIs had abdominal tenderness on examination in the ED. The remaining patient had a decreased level of consciousness. CONCLUSIONS: Isolated intraperitoneal fluid occurs in 8% of pediatric blunt trauma patients undergoing abdominal CT, and IAIs are subsequently identified in 17% of these patients. Patients with a small amount of IIF on CT who lack abdominal tenderness and have a normal level of consciousness are at low risk for subsequently identified IAIs.

Income levels of bad-debt and free-care patients in Massachusetts hospitals.

This study disputes the common notion that many hospitalized patients whose expenses are written off to bad debt are able to pay their bills. By matching 1996 state tax returns to more than 350,000 bad-debt and free-care claims at seven Massachusetts hospitals, we found that most patients involved had incomes below the federal poverty level and thus were presumably eligible for either public programs or hospital-based free care. This suggests that hospitals and public officials need to investigate further why low-income, uninsured patients are not receiving benefits for which they are eligible. Our results also suggest that measurements of indigent care levels in hospitals for purposes of research or regulation should include some portion of bad debt.

Changes in the planning status of births to ever-married U.S. women, 1982-1988.

PIP: Analysis of births reported in the Cycles III and IV of the US National Survey of Family Growth in 1982 and 1988 indicate no statistically significant changes in the proportion of births among women noncontracepting and not seeking a pregnancy. Birth distributions are largely changed among women planning births, which show declines, and women with contraceptive failures, which result in increased births. There were significant increases in ever married women's use of contraception (65% in 1982 and 71% in 1988), and fewer women desiring a pregnancy (6% in 1982 and 3% in 1988). Among those at risk of a unintended pregnancy the proportion using more effective methods of contraception increased from 71% to 73%. The failure rates for less effective methods such as the condom, diaphragm, and spermicides are unchanged between 1982 and 1988. The proportion of unintended pregnancies ending in abortion change very little between 1982 and 1988, according to analysis of data for 1982 and 1987 by Forest and Singh. Analysis of NSFG data on abortions for the 5 years preceding the surveys show a decline, but it is not statistically significant. The analysis suggests that there were indeed more unplanned pregnancies that came to term between 1982 and 1987 than between 1977 and 1981. The unplanned pregnancies are accounted for by the increased number of women at risk of contraceptive failure, the increased failure rates for the pill and for abstinence, and an increased proportion of unwanted pregnancies carried to term between 1982 and 1988. The proportion not using contraception would not appear to have affected the changes in unintended births. Why use-effectiveness of contraception has changed is not known.^ieng

Relinquishment of premarital births: evidence from national survey data.

According to 1982 and 1988 NSFG data, unmarried white women are far less likely than they were in the early 1970s to place their children for adoption. The levels of relinquishment among black women have remained low throughout this period, and relinquishment among Hispanic women may be virtually nonexistent. Multivariate analysis of the determinants of relinquishment among unmarried non-Hispanic white women suggests that having a well-educated mother, being in school at the time of conception, having no labor force experience, and being older are positively associated with placing a child for adoption. Sons were found to be less likely to be relinquished than daughters.

PIP: Researchers analyzed data from the 1982 and 1988 cycles of the National Survey of Family Growth (NSFG) to look at trends in the giving up of children of unmarried women in the US and to examine factors which are linked to the decision to put a child up for adoption. Since the numbers of black and Hispanic women who relinquished a child were so small, the final analysis only included white women. Overall relinquishment fell over time, especially during the 1970s which may have been due to the increased access to abortion in the US in the early 1970s. A higher percentage of women relinquished their children before 1973, during 1973-1981, and 1982-1988 (19.3, 7.6, and 3.2 respectively) than black women (1.5, 0.2, and 1.1 respectively). Hispanic women rarely relinquished their children. Significant factors that influenced unmarried white women to place a child for adoption included month and year of birth (p.01), maternal education (p.01), and opportunity costs of becoming a parent. The most significant opportunity cost that played a role in decision making was conception occurred when the mother was not in school (p.01). The older the woman at time of birth the more likely she would relinquish the child (p,05). Further mother that had paid employment before birth tended to place the child for adoption (p,05). Women with sons were less likely to relinquish them than those with daughters (p.05). The authors suggested that these results be compared with those on decision making involving abortion. Specifically they should look at all behaviors resulting in pregnancy resolution decision as well as the cost and benefits of parenthood and its alternatives. Moreover they should conduct research that assesses attitude toward adoption, since attitude toward abortion among different population groups is well known.