A cost-utility analysis comparing intensive chemotherapy alone to intensive chemotherapy followed by myeloablative chemotherapy with autologous stem-cell rescue in newly diagnosed patients with stage II/III multiple myeloma; a prospective randomised phase III study.

A prospective randomised phase III study in patients < or =65 years old with previously untreated multiple myeloma (MM), intensive chemotherapy followed by myeloablative chemotherapy and autologous stem-cell rescue was compared with intensive chemotherapy alone. This economic evaluation was based on detailed data from patient charts and hospital information systems. In the intention-to-treat analysis, mean total treatment and follow-up costs of the myeloablative treatment arm were 81,643 euros compared to 68,802 euros for the chemotherapy arm (P=0.09). Costs per quality-adjusted life year were 51,357 euros versus 37,328 euros. In the clinical study, no significant differences were found in overall survival after a median follow-up of 33 months from randomisation. Intensive chemotherapy is regarded as standard therapy for younger patients with previously untreated MM. Cost-effectiveness of myeloma therapy after 3 years of follow up seems not to be favoured by myeloablative treatment with autologous stem-cell rescue.

Ferumoxide-enhanced magnetic resonance imaging techniques in pre-operative assessment for colorectal liver metastases.

AIM: The objective was to evaluate whether contrast-enhanced magnetic resonance imaging (MRI) techniques used in a pre-operative assessment protocol for colorectal liver metastases are as accurate as spiral computer tomography during arterial portography (CTAP). Pre-operative accuracy and clinical consequences of MRI are described and compared with CTAP. Moreover, post-operative survival rate and tumour recurrence were studied. METHODS: The study group comprised 84 patients which were possible candidates for a partial hepatectomy for colorectal liver metastases. Patients were pre-operatively evaluated by CT of the abdomen, CT of the thorax and spiral CTAP and ferumoxide-enhanced MRI was performed in routine way for all patients. Following this selection, 35 patients underwent a partial hepatectomy with curative intent. All patients were retrospectively evaluated. RESULTS: Ferumoxide-enhanced MRI proved to be at least as accurate as spiral CTAP in 81% of patients. In nine patients (11%) spiral CTAP revealed more intrahepatic lesions than MRI; in only two patients (2%) did these foundings influenced the clinical decision. These patients were considered to have irresectable disease. In seven patients (8%) MRI detected more lesions than spiral CTAP and influenced the clinical decision in three patients (4%) and these did not undergo a laparotomy. The actuarial 3 year overall survival of operated patients was 41% and the actuarial 3 year disease-free survival was 19%. CONCLUSION: Evaluation of the clinical impact of a pre-operative assessment protocol extended with ferumoxide MRI techniques demonstrated that this non-invasive MRI technique is safe and at least as accurate as spiral CTAP. This MRI technique results in comparable clinical decisions and outcome after hepatectomy. We suggest that the performance of routine contrast-enhanced MRI should instead be used in the pre-operative evaluation of colorectal liver metastases.

Creating senior-friendly Web sites.

Older adults are a rapidly growing segment of the on-line community. However, many sites are designed without their needs or characteristics in mind. This brief provides the basics for developing a "senior-friendly" Web site for your organization or program, including tips about design, layout and content.

Assessment of International Psychogeriatrics: the Journal of the International Psychogeriatric Association.

In 1996, new editorial management took over International Psychogeriatrics (IP), only a year after the frequency of its publication increased from semiannual to quarterly. At the request of the editorial board, an assessment of the journal was conducted by comparing it to other journals in the field of geriatrics and, specifically, geriatric psychiatry. The evaluation included both a modified citation analysis and a review of journal content. The study was undertaken in order to identify the position the journal has within its discipline. Further, it was to identify the journal's strengths and weaknesses with the overall goal of recommending changes to IP's current content and format. IP ranked seventh of 15 journals in terms of impact factor. It is primarily oriented towards the publication of original research, and features fewer longer articles than others in the field. Adding a wider variety of content may increase the overall interest in the journal. However, these changes must be weighed against the goals of the journal and its reputation as a source of original research in the field of geriatrics.

Comparison of closed-suction drainage and no drainage after primary total knee arthroplasty.

One hundred thirty-six primary total knee arthroplasty patients were randomized for the use of closed-suction, nonreinfusable wound drains. Blood loss was identical in the drained and undrained groups. Forty percent of undrained wounds compared with 0% of drained wounds required dressing reinforcement. Sixty-nine percent of undrained wounds compared with 39% of drained wounds developed ecchymosis, measuring 92 cm2 in the undrained group and 28 cm2 in the drained group. This study concludes that a simple wound drain effectively minimizes the undesirable accumulation of blood in the surrounding soft tissues and the postoperative wound dressing after total knee arthroplasty.

Functional assessment of CD2, CD3 and CD28 on the surface of peripheral blood T-cells from infants at low versus high genetic risk for atopy.

Recent studies from several laboratories suggest that the rate of postnatal maturation of T-cell function(s) associated with in vitro activation may be slower in children at high genetic risk for atopy (HR), compared to their normal (low risk; LR) counterparts. The present study compared the in vitro activity of the function-associated surface molecules CD2, CD3 and CD28 in panels of 27 HR and 13 LR infants, with a reference panel of 10 adults, employing assay systems involving T-cell stimulation with MoAbs against these molecules. The response maxima induced by saturating levels of the MoAbs were equivalent in all 3 groups, but T-cells from the HR infants required 10-50 fold higher levels of anti-CD3 stimulation to attain their maximum response, relative to adults (p = 0.02); T-cells from LR infants were also less responsive to anti-CD3 than adults, but these differences were smaller and did not attain statistical significance. It is suggested that these differences are attributable to varying proportions of competent T-memory cells (which respond to low levels of anti-CD3) in PBL from these populations, the postnatal accumulation of which proceeds slowest in the HR group.