Adult intensive-care patients with 2009 pandemic influenza A(H1N1) infection.

In France, the surveillance of hospitalized cases of pandemic influenza was implemented in July 2009 and restricted to intensive-care unit (ICU) patients in November. We described the characteristics of the 1065 adult patients admitted to ICUs and analysed risk factors for severe outcome (mechanical ventilation or death). Eighty-seven percent of cases were aged 15-64 years. The case-fatality ratio was 20%. The risk for severe outcome increased with age and obesity while this association was negative for chronic respiratory disease. Late antiviral therapy was associated with a severe outcome in ICU patients with risk factors (adjusted OR 2·0, 95% CI 1·4-3·0). This study confirms the considerable contribution of young adults to A(H1N1) 2009 mortality. It shows the role of obesity as an independent risk factor for severe disease, and of early antiviral therapy as a protective factor, at least in patients with risk factors.

Severe hospitalised 2009 pandemic influenza A(H1N1) cases in France, 1 July-15 November 2009.

From 1 July 2009 to 15 November 2009, 244 patients with 2009 pandemic influenza A(H1N1) were admitted to intensive care unit (ICU) and were compared with 514 cases hospitalised in medical wards in France until 2 November 2009. Detailed case-based epidemiological information and outcomes were gathered for all hospitalised cases. Infants and pregnant women are overrepresented among cases admitted to ICU with seven per cent for both groups respectively, and twenty per cent of ICU cases did not belong to a risk group. Chronic respiratory disease was the most common risk factor among cases but obesity (body mass index >or= 30 Kg/m(2)), chronic cardiac disease and immunosuppression were risk factors associated with severe illness after adjustment for age and for other co-morbidities.

[Readmissions to hospital for asthma in France, 2002-2005]. / Les réadmissions pour asthme en France, 2002-2005.

BACKGROUND: Most hospital admissions with asthma are avoidable. The objective of the analysis was to describe hospital readmissions for asthma. METHODS: Using data from the French hospital information system, admissions for asthma or for acute respiratory failure associated with asthma that occurred in 2-44 years-old patients between 2002 and 2005 in France (excluding French overseas departments) were analysed. Readmission rates at 7 days and at 1 year were estimated using the Kaplan-Meier method. RESULTS: The risk of readmission at 1 year was 15.0%. It varied according to age (higher in 2-4 year and 35-44 years-old patients) and sex (higher in 10-34 years-old females) and increased with the length of stay of the index admission. The risk of readmission at 7 days was 1.1% and was higher for the shortest lengths of stay. CONCLUSION: Readmissions for asthma are pertinent indicators for the monitoring of asthma, especially the clinical management of the disease. Using data from an increasing number of years, together with linkage of hospital admissions and asthma drug reimbursement data, should allow a better understanding of severe asthma in France.

[Chronic bronchitis: prevalence and quality of life. Analysis of data from the French Health Interview Survey 2002-2003]. / Bronchite chronique: prévalence et qualité de vie.

INTRODUCTION: Chronic bronchitis is associated with an increased risk of COPD and health-related quality of life (HRQoL) impairment. The objectives of the study were to estimate the prevalence of chronic bronchitis and to describe its relations with quality of life. METHODS: The French Health Interview Survey was conducted in 2003 in a representative sample of households. Data were collected during an interviewer's visits to the home. Respiratory symptoms and HRQoL (SF-36) were assessed in 9,050 adults aged 45 years and older using a self-administered questionnaire. RESULTS: The prevalence of chronic bronchitis was estimated at 3.5%. Chronic bronchitis was associated with an impaired physical component summary score after adjusting for sex, age and dyspnoea. It was associated with a reduced mental component summary score (MCS) among men. In women, this association was only significant in the absence of dyspnoea. CONCLUSION: The prevalence of chronic bronchitis was 3.5% among adults aged 45 years and older. Chronic bronchitis was associated with impairment in health-related quality of life.

Changes in gene expression induced by chemoradiation in advanced cervical carcinoma: a microarray study of RTOG C-0128.

PURPOSE: To evaluate gene expression patterns in patients with advanced cervix cancer before and during chemoradiation in a multi-institutional cooperative group setting. METHODS: RTOG C0128 was designed as a Phase II trial of radiation therapy with concomitant chemotherapy and Celecoxib at 400 mg twice daily for one year. Tumor samples were obtained for microarray gene expression analysis before treatment and at the time of the first implant (paired sample). RNA was extracted, linearly amplified, and purity was assessed by gel electrophoresis. Each sample was hybridized against a universal RNA mixture on a customized spotted array consisting of >10,000 genes. Gene expression pre-treatment was compared with clinical characteristics. Changes in gene expression following radiation were assessed within the paired samples (same patient) and then compared across all paired samples. Data were normalized using the AROMA software, and clustering analysis was performed using Ward's method in Spotfire. Differences in paired samples were calculated with Significance Analysis of Microarrays (SAM). RESULTS: From August 2001 to March 2004, 84 patients were accrued to the trial. Tissue was obtained prior to initiation of therapy from 34 patients (40%). FIGO stages of the patients providing tissue were IB (23%), II (57%), and IIIA-IVA (20%). RNA quality was sufficient in 22 pre-treatment and 14 post-treatment samples. Among pre-treatment samples, no significant differences in gene expression were observed by FIGO stage, age, or race. However, between comparison of histologic subtypes (adenocarcinoma, n=5; squamous cell carcinoma, n=17) demonstrated 45 genes differentially expressed with a false discovery rate of 0.018. Cluster analysis segregated unpaired samples into 2 groups: 18/22 comprising pre-treatment samples and 10/14 in group 2 representing post-treatment samples. In all 13 paired samples, gene expression after chemoradiation was significantly upregulated in 91 genes and downregulated in 251 genes (false discovery rate of 0.0018). Genes significantly upregulated included bax, cdk inhibitor 1, MMP2, and adhesion molecules PECAM1, VCAM1, and ICAM2. Genes significantly downregulated included topoisomerase II alpha, myc, H2AX, MSH2, RAD51, RAD53, PCNA, and cell cycle-regulating molecules chk1, CDK2, cyclinB1, cyclin D3, cdc2, and cdc25. CONCLUSIONS: Microarray analysis was successfully performed in a multi-institutional cooperative group trial. Gene expression significantly correlated with histology, but not stage, age or race. Cluster analysis identified two groups of gene expression profiles correlating with pre or post-treatment acquisition of tissue. Notably, paired samples showed significant changes in gene expression following chemoradiation, including several downregulated radiation response genes. Further analysis comparing gene expression to clinical outcomes, acute and late toxicities awaits maturation of clinical data. Hopefully, this data will lead to the development of molecularly based therapies.

A case series describing common radiographic and pathologic patterns of hard metal pneumoconiosis.

INTRODUCTION: Hard metal pneumoconiosis is a rare but serious disease of the lungs associated with inhalational exposure to tungsten or cobalt dust. Little is known about the radiologic and pathologic characteristics of this disease and the efficacy of treating with immunosuppression. OBJECTIVE: We describe the largest cohort of patients with hard metal pneumoconiosis in the literature, including radiographic and pathologic patterns as well as treatment options. METHODS: We retrospectively identified patients from the University of Pittsburgh pathology registry between the years of 1985 and 2016. Experts in chest radiology and pulmonary pathology reviewed the cases for radiologic and pathologic patterns. RESULTS: We identified 23 patients with a pathologic pattern of hard metal pneumoconiosis. The most common radiographic findings were ground glass opacities (93%) and small nodules (64%). Of 20 surgical biopsies, 17 (85%) showed features of giant cell interstitial pneumonia. Most patients received systemic corticosteroids and/or steroid-sparing immunosuppression. CONCLUSIONS: Hard metal pneumoconiosis is characterized predominately by radiographic ground glass opacities and giant cell interstitial pneumonia on histopathology. Systemic corticosteroids and steroid-sparing immunosuppression are common treatment options.

[Trends in hospital admissions for asthma in France, 1998-2002]. / Evolution des hospitalisations pour asthme en France métropolitaine, 1998-2002.

BACKGROUND: As the quality of asthma care influences hospital admission rates, we described hospitalizations for asthma and studied trends in admission rates in France from 1998 to 2002. METHODS: Using data from the French hospital information system, admissions for asthma were defined by the J45 or J46 codes (ICD-10) as primary diagnosis, and admissions for acute respiratory failure (ARF) associated with asthma by the J96.0 code as primary diagnosis and the J45 or J46 codes as an associated diagnosis. Annual rates of admission adjusted for age and sex were calculated. RESULTS: During the study period, the adjusted asthma admission rate decreased by 5% per year (from 10.8/10,000 in 1998 to 8.6/10,000 in 2002). A significant decrease was observed in children aged 10-14 years (-5%/year) and in older people (from -7%/year in 15-19 years old to -9%/year in people aged 50 years or more), whereas no significant decrease was seen in youngest children (-2%/year in children aged 0-1 or 5-9 years, +0.1%/year in those aged 2-4 years). Although not statistically significant, an increase in admission rate for ARF associated with asthma was observed (+5%/year). CONCLUSION: Admission rates for asthma decreased between 1998 and 2002 in people aged 10 years and older. However, changes in coding practices or admission policies cannot be excluded and the extent to which the observed trends reflect changes in preventive care among patients with asthma remains to be assessed.

Prognostic factors after hospitalization for COPD exacerbation.

INTRODUCTION: Hospitalizations for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are increasing in France. AECOPD are associated with impaired health status and increased health care costs. METHODS: Using data from the French national health insurance information system, we studied mortality, readmissions and lung function testing after discharge among adults hospitalized for AECOPD in 2013. RESULTS: The cumulative probabilities of death and readmission for EACOPD were 21% and 31% respectively. The survival was better among women, even after taking into account the other risk factors (age, previous hospitalization for AECOPD, comorbidities, exacerbation severity). In multivariate analysis, the risk of readmission was increased among men and people living in socially disadvantaged areas. A lung function testing was performed in 34% within 3 months after discharge. Female gender, advanced age, comorbidities and living in a disadvantaged area were associated with a lower frequency of lung function testing. CONCLUSIONS: Women had a better prognosis than men after AECOPD hospitalization. The frequency of lung function testing after discharge remained low, particularly among women and people living in disadvantaged areas.

[Increase in asthma prevalence among young children in France]. / Augmentation de la prévalence de l'asthme chez le jeune enfant en France.

INTRODUCTION: Few data on change over time of asthma prevalence in French children are available. METHODS: Data from the 2012-2013 national health survey of schoolchildren conducted in a random sample of almost 20,000 children in the last year of nursery school were compared to those which had been collected in 2005-2006 in the same grade level using the same methodology. RESULTS: In the 2012-2013 survey, children had a lifetime prevalence of asthma of 11.0% with 11.8% reporting wheezing in the preceding year. Asthma was more frequent and more often uncontrolled in children from families with low socioeconomic status. Compared to the survey conducted in the same grade level in 2005-2006, the prevalence ratios adjusted for children's gender and obesity, family structure, parental unemployment and region were 1.13 [1.05-1.21] for lifetime asthma and 1.12 [1.05-1.17] for past-year wheezing. CONCLUSION: In France, the prevalence of asthma in young children increased between 2005 and 2012. The socioeconomic status of children's parents affects both asthma prevalence and control.

Resistance of resting 3T6 mouse fibroblasts to methotrexate cytotoxicity.

We have compared the relative susceptibility of resting (GO) versus exponentially growing mouse fibroblasts (line 3T6) to methotrexate (MTX) cytotoxicity. Cultures of cells were exposed to different levels of MTX for various intervals. Cloning efficiencies of the cells were then determined in medium containing hypoxanthine and thymidine. We found that growing 3T6 cells exhibit time- as well as dose-dependent cytotoxicity. Greater than 95% of the cells were killed by a 24-hr exposure to 10(-6) M MTX. In contrast resting cells showed no loss of cloning efficiency even at drug concentrations of 10(-3) M and exposure times of 7 days. The resistance of resting cells is not the result of a MTX transport deficiency since extracellular MTX is taken up by both resting and growing cells. Furthermore, intracellular dihydrofolate reductase activity is abolished in both resting and growing cells at similar extracellular MTX dosages.

Pre-Frailty, Frailty, and Multimorbidity: Prevalences and Associated Characteristics from Two French National Surveys.

OBJECTIVE: To estimate the prevalence of pre-frailty, frailty and multimorbidity in individuals without disability in France. To describe independent determinants of each indicators. DESIGN: Two nationally representative cross-sectional French surveys. SETTINGS: Wave 2012 of the Health, Health Care and Insurance Survey (Enquête Santé et Protection Sociale, ESPS) and data from the Disability Healthcare Household section Survey (Enquête Handicap Santé - Ménages, HSM) from 2008. PARTICIPANTS: Two representative samples of the French population aged 55 and older (n=4,328 and n=12,295). MEASUREMENTS: Frailty was assessed using Fried's frailty phenotype and multimorbidity was defined as having had at least two groups of the following groups of comorbidities in the last 12 months (cardio or cerebrovascular disease, diabetes, chronic respiratory disease, arthralgia, depression). Independent determinants were studied using weighted logistic regressions. RESULTS: In the French population over 55 and free of disability, 55 to 62% of individuals were either frail, pre-frail or multimorbid, 22 to 25% being frail or multimorbid. ESPS and HSM prevalences for frailty (11.1% [9.3%-12.1%] and 12.3% [11.5%-13.0%]) and multimorbidity (14.9% [13.6%-16.2%] and 16.8% [15.9%-17.7%]) were consistent across studies. Both frailty and multimorbidity prevalences were associated with age. On the other hand, pre-frailty prevalence varied consistently between studies (from 38 to 48%) and was not significantly associated with age. We found that more than 60% of frail subjects did not present with multimorbidity and around 70% of subjects with multimorbidity were not frail. Determinants of pre-frailty and multimorbidity but not frailty depended on sex. Similar factors were associated with frailty and multimorbidity in women (older age, functional decline, poor mental health, financial difficulties) while only poor mental health was independently associated with both indicators in men. CONCLUSION: Our study highlights that in France, among individuals older than 55 years-old and free of disability, around 25% are either frail or multimorbid; another 30% to 40% being pre-frail. Pre-frailty, frailty and multimorbidity are known to be associated with adverse health outcomes and important economic costs. The health system must adapt to respond to the needs of its aging population. In addition, given the efficient impact of prevention actions, our findings emphasize the need to implement prevention strategies against Frailty and multimorbidity in France.

Routine use of granulocyte colony-stimulating factor is not cost-effective and does not increase patient comfort in the treatment of small-cell lung cancer: an analysis using a Markov model.

PURPOSE: The clinical indications and economic consequences of human granulocyte colony-stimulating factor (G-CSF) prescription during small-cell lung cancer (SCLC) chemotherapy remain controversial. The aim of this study, based on a Markov model, was to assess the impact of routine G-CSF use in the treatment of SCLC on costs and patient comfort. Markov models allow the modeling SCLC chemotherapy, in which the risk of febrile neutropenia (FN) is continuous over time and may occur more than once. PATIENTS AND METHODS: We used a Markov model to compare three strategies: a chemotherapy dose reduction after FN and nonuse of G-CSF ("never" strategy), secondary use of G-CSF ("CSF if FN" strategy) and primary use of G-CSF ("systematic CSF" strategy). Model baseline probabilities were based on a review of medical records for all patients (n = 39) treated for SCLC in our unit during 1993 (when G-CSF was not used) and on published reductions in the incidence of FN obtained by using G-CSF. Two different types of rewards were used: a cost-utility scale that took into account the costs of FN (CFN) episodes and G-CSF (CCSF) courses; and a comfort-utility scale that took into account the discomfort of FN and G-CSF therapy. Costs were analyzed from the health care payer's perspective and utilities were assessed prospectively in standardized interviews with treated SCLC patients. RESULTS: The never strategy was the least costly ($4,875 [United States] versus $5,816 and $7,690 for CSF if FN and systematic CSF) and gave the highest comfort value (378 U v 365 and 327 for CSF if FN and systematic CSF). Sensitivity analyses showed that the never strategy remains the less costly when the probability of a first FN episode was less than 49%, the probability of FN recurrence was less than 60%, or the CFN was less than $6,077, or the CCSF was greater than $863. In terms of patient comfort, the never strategy was the best choice, except for patients who considered that a course of G-CSF caused little or no discomfort, whether or not it prevented FN. CONCLUSION: Routine use of G-CSF during SCLC chemotherapy is not justified by clinical benefits, improved patient comfort, or economic considerations.

Do pulmonary radiographic findings at presentation predict mortality in patients with community-acquired pneumonia?

BACKGROUND: Previous studies have reported conflicting results on whether pulmonary radiographic findings predict mortality for patients with community-acquired pneumonia (CAP). OBJECTIVE: To determine whether pulmonary radiographic findings at presentation are independently associated with 30-day mortality in patients with suspected CAP. METHODS: This study was conducted as part of the Pneumonia Patient Outcomes Research Team multicenter, prospective cohort study of ambulatory and hospitalized patients with clinical and radiographic evidence of CAP. For each patient with CAP, a structured data form was completed by a panel of radiologists to evaluate the radiographic pattern of infiltrate, number of lobes involved, presence of pleural effusion, and 8 other radiographic characteristics. Cox proportional hazards models were used to evaluate the independent association between radiographic findings and 30-day mortality, while controlling for patient demographic, clinical, and laboratory characteristics with a known association with this outcome. RESULTS: Of 2287 patients enrolled in the Pneumonia Patient Outcomes Research Team cohort study, 1906 patients (83.3%) had a pulmonary radiographic infiltrate confirmed by the radiology panel. Overall, 30-day mortality in this cohort was 4.9%. Univariate regression analyses demonstrated the following radiographic characteristics to be significantly associated with 30-day mortality: (1) bilateral pleural effusions (risk ratio [RR], 7.0; 95% confidence interval [CI], 3.9-12.6); (2) a pleural effusion of moderate or greater size (RR, 3.4; 95% CI, 1.4-8.4); (3) 2 or more lobes involved with infiltrate (RR, 2.5; 95% CI, 1.6-3.8); (4) bilateral infiltrate (RR, 2.8; 95% CI, 1.9-4.2); (5) bronchopneumonia (RR, 1.6; 95% CI, 1.0-2.7); and (6) air bronchograms (RR, 0.5; 95% CI, 0.2-0.9). Multivariate analysis of radiographic features and other clinical characteristics showed the presence of bilateral pleural effusions (RR, 2.8; 95% CI, 1.4-5.8) was independently associated with mortality. CONCLUSIONS: In patients with CAP, the presence of bilateral pleural effusions is an independent predictor of short-term mortality. This finding, which is available at presentation, can help guide physicians' assessment of prognosis in CAP.

Verification of electron beam therapy with conventional and storage phosphor images: preliminary experience.

Portal verification images were generated by the photon contamination in electron beams produced by a linear accelerator during treatment of patients receiving high-energy electron radiation therapy. Both conventional and storage phosphor methods yielded projection radiographs in which anatomy of the irradiated and surrounding tissue was demonstrated. Exposed phantoms were used to confirm that the images represent a true projection of the radiation field. A preliminary series of 22 cases was evaluated by two radiotherapists and judged subjectively to be of clinical value. Geometric error, or more importantly, the lack thereof, during high-energy electron treatments was easily confirmed with this method. In three cases, the treatment protocol was corrected based on the images obtained. Because the readout process of storage phosphor images allows for gain adjustments and post-processing, the images obtained with this method were found to delineate anatomy in the treated and surrounding tissues somewhat more consistently than could conventional images.

Nasal resistance in snorers with or without sleep apnea: effect of posture and nasal ventilation with continuous positive airway pressure.

We investigated the effects of posture and nasal ventilation with continuous airway pressure (CPAP) on nasal resistance in snorers with or without obstructive sleep apnea (OSA). Posterior rhinomanometry was performed in 70 snorers referred for polysomnography and in 11 nonsnoring volunteers, (1) in the seated posture; (2) and (3) after 10 minutes in the supine position, before and after inhalation of oxymetazoline; and (4) 10 minutes after return to the seated position. The effect of CPAP on posterior rhinomanometry was also examined in the nonsnorers and in 12 of the snorers. Changing from the seated to the supine position resulted in an increase in resistance in snorers and nonsnorers (resistance supine 182 +/- 10.9% and 128 +/- 6.7% respectively of seated value, p < 0.05). After oxymetazoline instillation, resistance in the supine position decreased but remained higher in snorers than baseline value in the seated position. Effects of posture and oxymetazoline were similar in snorers with or without sleep apnea. During nasal ventilation with CPAP, resistance was 30 +/- 3.8 and 45 +/- 4.4% of value before CPAP in snorers and nonsnorers, respectively (p < 0.05). These effects of posture and CPAP were also observed when resistance was measured with anterior rhinomanometry. In conclusion, nasal resistance measured with posterior rhinomanometry in the supine position is not predictive for OSA. Nasal ventilation with CPAP resulted in an acute and marked decrease in nasal resistance.

Interobserver reliability of the chest radiograph in community-acquired pneumonia. PORT Investigators.

OBJECTIVE: To evaluate the interobserver reliability of pulmonary radiographic findings in patients with community-acquired pneumonia (CAP). DESIGN: A prospective, multicenter study. SETTING: Physician offices, medical walk-in clinics, emergency departments, and inpatient wards affiliated with three university hospitals, one community hospital, and one staff model health maintenance organization in three geographic areas. METHODS: Copies of the initial chest radiograph of patients suspected of having CAP were independently read by two staff radiologists at the coordinating university hospital. Interobserver reliability for the interpretation for radiographic findings was assessed by calculation of agreement rates and the kappa statistic. PARTICIPANTS: Adults (age > or = 18 years) with symptoms or signs of CAP and a pulmonary radiographic infiltrate documented by a local study site radiologist. RESULTS: Among the 282 patients whose initial pulmonary radiographs were evaluated, there was agreement between the two staff radiologists on the presence of infiltrate in 79.4% and on the absence of an infiltrate in 6.0% (kappa = 0.37; 95% confidence interval [CI] = 0.22 to 0.52). For the 224 patients with an infiltrate identified by both radiologists, there was further agreement that the infiltrate was unilobar in 41.5% and multilobar in 33.9% (kappa = 0.51; 95% CI = 0.28 to 0.62), pleural effusion was present in 10.7% and absent in 73.2% (kappa = 0.46; 95% CI = 0.33 to 0.50), and the infiltrate was alveolar in 96.3% of patients and interstitial in no patients (kappa = -0.01; 95% CI = -0.03 to 0.00). Among the 210 patients with an alveolar infiltrate, both radiologists classified the infiltrate as lobar in 74.6% and bronchopneumonia in 2.4% (kappa = 0.09; 95% CI = -0.04 to 0.22), and agreed on the presence of air bronchograms in 7.6% and their absence in 52.9% (kappa = 0.01; 95% CI = -0.13 to 0.15). CONCLUSION: In patients with CAP, two university radiologists identified the presence of infiltrate, multilobar disease, and pleural effusion with fair to good interobserver reliability. However, interobserver reliability for the pattern of infiltrate and the presence of air bronchograms was poor.

Effect of two rating formats in multi-disease ROC study of chest images.

ROC methodology has been expanded in recent years to include multi-disease experiments. To accommodate these changes, different rating formats, general or disease specific, can be used. No experimental data are available concerning the possible effects of the rating format on the results of these studies. We performed a multi-observer, multi-disease study in which 196 chest images were rated using a format where each disease was evaluated individually and one in which the cases were evaluated without scoring a specific disease. The results indicate that for our data set, the overall assessment of accuracy was not significantly affected by the study format used. Thus, in spite of the difficulties in selecting appropriate controls and the necessity of reassessing sample size considerations, the disease-specific format appears to produce an assessment of accuracy equivalent to that produced by the general format. This equivalence permits the use of the disease-specific approach since it more closely simulates the readers' true environment and is more appropriate for comparing imaging systems that may have a relative accuracy that is disease specific.

Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation.

The records of 100 lung transplant recipients (13 heart-lungs, 45 double-lungs, and 42 single-lungs) from September 1990 through April 1992 were reviewed to determine the role of cardiopulmonary bypass (CPB) in early graft dysfunction. Fifty-five patients requiring CPB (CPB group) for 186 +/- 54 minutes were compared with the 45 patients without CPB (no-CPB group). All of the heart-lung and en-bloc double-lung transplantations were performed under CPB, with pulmonary vascular lung disease the principal diagnosis, resulting in a significantly younger age population in the CPB group. All other donor- and recipient-related factors matched well in both groups. Of 38 bilateral single-lung transplantations, CPB was used in 18. In double-lung and heart-lung recipients gas exchange of the allografts was evaluated by the arterial/alveolar oxygen tension ratios at nine intervals during the first 72 hours. The mean arterial/alveolar oxygen tension ratio in the CPB group was 0.48 +/- 0.19, significantly lower than in the no-CPB group with 0.60 +/- 0.22 (p = 0.025). All patients had radiographic interpretation and scoring of pulmonary infiltrates from chest roentgenograms taken within 12 hours after reperfusion. The CPB group had more severe pulmonary infiltrates than the no-CPB group (p = 0.034). Prolonged intubation defined as 7 days or longer occurred significantly more often (29/55) in the CPB group than in the no-CPB group (8/45) (p = 0.003). Actuarial graft and patient survival at 1 month was better in the no-CPB group than in the CPB group (42/45 versus 44/55 [p = 0.05] and 43/45 versus 45/55 [p = 0.033], respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Use of tumor markers for differential diagnosis of mesothelioma and secondary pleural malignancies.

STUDY OBJECTIVE: The aim of the study was to assess diagnosis value of tumor markers for differential diagnosis between mesothelioma and other pleural tumors. DESIGN AND METHODS: Prospective study of 85 patients attending our hospital with malignant pleural effusion. The diagnostic approach involved routine pleurocentesis followed by pleural needle. When precise diagnosis was not achieved, thoracoscopy with pleural biopsies was performed. Carcinoembryonic antigen (CEA), hyaluronic acid, tissue polypeptide antigen and cyfra 21 to 1 were measured in serum and pleural fluid. RESULTS: By using receiver operating characteristics curves and area under curves, the best diagnostic characteristics were obtained with pleural and serum CEA concentrations. The area under the curve was larger for pleural ACE than for serum ACE. The sensitivity and specificity of a pleural CEA level exceeding 3 ng/mL for ruling out the diagnosis of mesothelioma were 100% and 77%, respectively. CONCLUSION: A CEA level above 3 ng/mL in pleural fluid eliminated the diagnosis of mesothelioma, whereas the other markers were not sufficiently discriminant. However, despite a negative predictive value of 100% at a cutoff of 3 ng/mL, CEA assay in pleural fluid only avoids a small number of diagnostic thoracoscopies.

The use of storage phosphors for portal imaging in radiation therapy: therapists' perception of image quality.

Two drawbacks in quality of portal radiographs in radiation therapy are their low contrast and low spatial resolution. These are due to the low differential absorption of body tissues at therapeutic energies and to a relatively large radiation source. We used an experimental, high-contrast sensitivity storage phosphor imaging system (Eastman Kodak Co.) to produce portal images. The system consists of a storage phosphor detector, a high-contrast sensitivity laser scanner (12 bit), an image processing module, and a laser printer (12 bit). Patients undergoing radiation therapy treatments had both a conventional portal image and a storage phosphor image taken. Both were displayed side-by-side and were evaluated independently by three radiotherapists according to quality of information to verify the treatment field. Each of the three radiotherapists rated the storage phosphor images to be better (p less than 0.001) than the conventional images. However, rated improvements of low-contrast storage phosphor images of the pelvis and abdomen (40) were significantly lower than those of high-contrast (head, neck, and chest) images (53).