Pulmonary embolism at CT angiography: implications for appropriateness, cost, and radiation exposure in 2003 patients.

PURPOSE: To determine whether thromboembolic risk factor assessment could accurately indicate the pretest probability for pulmonary embolism (PE), and if so, computed tomographic (CT) angiography might be targeted more appropriately than in current usage, resulting in decreased costs and radiation exposure. MATERIALS AND METHODS: Institutional review board approval was obtained. Electronic medical records of 2003 patients who underwent CT angiography for possible PE during 1(1/2) years (July 2004 to February 2006) were reviewed retrospectively for thromboembolic risk factors. Risk factors that were assessed included immobilization, malignancy, hypercoagulable state, excess estrogen state, a history of venous thromboembolism, age, and sex. Logistic regressions were conducted to test the significance of each risk factor. RESULTS: Overall, CT angiograms were negative for PE in 1806 (90.16%) of 2003 patients. CT angiograms were positive for PE in 197 (9.84%) of 2003 patients; 6.36% were Emergency Department patients, and 13.46% were inpatients. Of the 197 patients with CT angiograms positive for PE, 192 (97.46%) had one or more risk factors, of which age of 65 years or older (69.04%) was the most common. Of the 1806 patients with CT angiograms negative for PE, 520 (28.79%) had no risk factors. The sensitivity and negative predictive value of risk factor assessment in all patients were 97.46% and 99.05%, respectively. All risk factors, except sex, were significant in the multivariate logistic regression (P < .031). CONCLUSION: In the setting of no risk factors, it is extraordinarily unlikely (0.95% chance) to have a CT angiogram positive for PE. This selectivity and triage step should help reduce current costs and radiation exposure to patients.

Concordancia entre la Edad Cronológica y Edad Dental Según el Método de Demirjian en Pacientes Mexicanos / Concordance Between Chronological Age and Dental Age by the Demirjian Method in Mexican Patients

RESUMEN: En la práctica forense un dato de gran importancia es la edad cronológica de los pacientes, este puede obtenerse de múltiples formas, algunas son complejas, costosas y tardadas, el cálculo de la edad dental (ED) por vía radiográfica es sencillo y de bajo costo, ha mostrado ser concordante con la edad cronológica (EC), presentando variaciones por sexo y raza. El objetivo de este estudio es establecer la concordancia de la ED y la EC en población mexicana. Este es un estudio transversal, observacional en el que un residente estandarizado evaluó 88 Ortopantomografías (44 femeninos y 44 masculinos) de manera cegada respecto a la EC, del archivo de la clínica de Ortodoncia de la Facultad de Odontología de la Universidad Autónoma de Sinaloa, con edades desde los 3 a los 16 años. Existe una diferencia en meses de 3,36 entre los valores ED y EC en el total de la población (p=0,384) con una concordancia de 94 % entre los valores. Al analizarlos por sexo los masculinos muestran una diferencia de 5,16 (P=0,785) con una concordancia de 96 % y los femeninos de 7,32 (P=0,095) con una concordancia de 92 %. La ED según Demirjian es un método confiable para estimar la EC en esta población.

ABSTRACT: In forensic practice knowledge of chronological age (CA) is an important factor, and it can be estimated by several methods. Some are complex, expensive and time consuming. Dental Age (DA) estimation by radiographic methods is easy and inexpensive, it has shown to be consistent with chronological age (CA), with variations according to sex and race. The objective of this study was to estimate the concordance between DA and CA in Mexicans. This is a cross sectional, observational study, in which a standardized dental resident reviewed 88 Orthopantomographies (44 female, 44 male), blinded to CA, of the Orthodontics School Files of the Universidad Autónoma de Sinaloa, the population was 3 to 16 years of age. The main difference in months between DA and CA was 3.36 (p=0.384) and 94 % of concordance, the analysis by sex for males showed a main difference of 5.16 (P=0.785) and 96 % concordance; for females it showed 7.32 (P=0.095) and concordance of 92 %. In conclusion the DA according to Demirjian is a reliable method to estimate CA in these patients.

Long-term survival in patients with non-small cell lung cancer and synchronous brain metastasis treated with whole-brain radiotherapy and thoracic chemoradiation.

BACKGROUND: Brain metastases occur in 30-50% of Non-small cell lung cancer (NSCLC) patients and confer a worse prognosis and quality of life. These patients are usually treated with Whole-brain radiotherapy (WBRT) followed by systemic therapy. Few studies have evaluated the role of chemoradiotherapy to the primary tumor after WBRT as definitive treatment in the management of these patients. METHODS: We reviewed the outcome of 30 patients with primary NSCLC and brain metastasis at diagnosis without evidence of other metastatic sites. Patients were treated with WBRT and after induction chemotherapy with paclitaxel and cisplatin for two cycles. In the absence of progression, concurrent chemoradiotherapy for the primary tumor with weekly paclitaxel and carboplatin was indicated, with a total effective dose of 60 Gy. If disease progression was ruled out, four chemotherapy cycles followed. RESULTS: Median Progression-free survival (PFS) and Overall survival (OS) were 8.43 ± 1.5 and 31.8 ± 15.8 months, respectively. PFS was 39.5% at 1 year and 24.7% at 2 years. The 1- and 2-year OS rates were 71.1 and 60.2%, respectively. Three-year OS was significantly superior for patients with N0-N1 stage disease vs. N2-N3 (60 vs. 24%, respectively; Response rate [RR], 0.03; p= 0.038). CONCLUSIONS: Patients with NSCLC and brain metastasis might benefit from treatment with WBRT and concurrent thoracic chemoradiotherapy. The subgroup of N0-N1 patients appears to achieve the greatest benefit. The result of this study warrants a prospective trial to confirm the benefit of this treatment.

Culture and spray-drying of Tsukamurella paurometabola C-924: stability of formulated powders.

The nematocidal agent, Tsukamurella paurometabola C-924, was cultured in a 300 l bioreactor. Spray-dried formulations of this microorganism were prepared using sucrose. At an outlet temperature 62 degrees C, survival rates between 12 and 85% were reached with sucrose up to 10% (w/w). The stability study of the powders showed that the best storage condition was at 4 degrees C under vacuum. A new method for the calculation of cell death order for bacteria stored at low temperatures was developed. Powders stored under vacuum showed an Arrhenius behavior in relation to cell death kinetics.

Topical imiquimod as an adjuvant to laser removal of mature tattoos in an animal model.

BACKGROUND: Lasers are a commonly employed method of tattoo removal; however, numerous treatments are often needed and laser treatment may fail to eliminate the tattoo completely. It has been shown in animal studies that topical application of imiquimod cream, alone, fades tattoos. It is suspected that the combination of both imiquimod and laser treatment will result in enhanced tattoo pigment clearance. OBJECTIVE: The objective was to evaluate the efficacy of topical imiquimod cream as an adjuvant to laser removal of mature tattoos. METHODS: Fourteen albino guinea pigs were tattooed with black ink, then randomly assigned into two groups: one underwent sequential laser treatments with a Q-switched alexandrite laser in conjunction with triweekly applications of 5% imiquimod cream, while the other group underwent laser therapy alone. Subjects were evaluated with clinical photographs and skin biopsies after six laser treatment sessions. RESULTS: The combination laser and imiquimod treated group was clinically and histologically rated as having less pigment than the tattoos that were treated with laser alone (p=.012 and p=.047, respectively). Adjuvant imiquimod treatment had greater inflammation (p=.002) and fibrosis (p=.002) on posttreatment skin biopsies. CONCLUSION: Imiquimod appears to be a useful adjuvant to experimental laser tattoo removal in guinea pigs.

Cisplatino y vinorelbina en cáncer avanzado de células no pequeñas de pulmón. Experiencia en el Instituto Nacional de Cancerología / Treatment with cisplatin and vinorelbine in advanced no-small cell lung carcinoma

Para determinar la eficacia y seguridad de un régimen de quimioterapia a base de cisplatino y vinorelbina con o sin radioterapia en cáncer de células no pequeñas de pulmón, revisamos retrospectivamente 16 expedientes clínicos (nueve hombres y siete mujeres; edad media de 53 años; dos en etapa clínica IIIA, 11 en IIIB y tres en IV). Distinguimos tres modalidades de tratamiento: quimioterapia sola (cinco casos), quimioterapia y radioterapia concomitantes (dos pacientes) y quimioterapia de induccción seguida de quimioterapia y radioterapia concomitantes (nueve enfermos). La respuesta global fue 68.7 por ciento (18.7 por ciento completas y 50 por ciento parciales). La mediana de supervivencia global fue 13 meses y la de supervivencia libre de progresión 12 meses. La tasa de supervivencia a un año fue 75 por ciento. Se observó una tendencia a mayor supervivencia global, supervivencia libre de progresión, respuestas globales y supervivencia a un año en quienes recibieron alguna modalidad de radioterapia agregada. La toxicicdad grado 3-4 se distribuyó así hematológica (neutropenia) en seis pacientes, ninguno de los cuales requirió hospitalización ni antibióticos; y no hematológica (náuses y vómitos) en siete enfermos. Hubo neuropatía periférica grado 1-2 en cinco sujetos. No observamos mayor toxicidad asociada a tratamiento combinados. Cisplatino y vinorelbina con o sin radioterapia es un régimen eficaz y bien tolerado