Peptide receptor radionuclide therapy with (90)Y-DOTATATE/(90)Y-DOTATOC in patients with progressive metastatic neuroendocrine tumours: assessment of response, survival and toxicity.

BACKGROUND: Peptide receptor radionuclide therapy (PRRT) is an established treatment for patients with metastatic neuroendocrine tumours (NETs), although which factors are associated with an improved overall survival (OS) remains unclear. The primary aim of this study is to determine to what extent a radiological response to (90)Y-DOTATOC/(90)Y-DOTATATE PRRT is associated with an improved OS. The association of biochemical and clinical response to OS were assessed as secondary outcome measures. METHODS: A retrospective analysis was conducted on 57 patients: radiological response was classified using RECIST criteria, biochemical response was classified using WHO criteria and clinical response was assessed subjectively. Responses were recorded as positive response (PR), stable disease (SD) or progressive disease (PD), and survival analysed. RESULTS: Radiological response was achieved in 71.5% (24.5% PR, 47% SD) and was associated with a greater OS (51 and 56 months, respectively), compared with PD (18 months). A biochemical or clinical response post PRRT were not associated with a statistically significant improvement in OS. However, when combined with radiological response a survival benefit was observed according to the number of outcomes (radiological, biochemical, clinical), in which a response was observed. Mild haematological toxicity was common, renal toxicity was rare. CONCLUSION: In patients with progressive metastatic NETs receiving (90)Y-DOTATOC/(90)Y-DOTATATE PRRT, a radiological response with either a PR or a SD post therapy confers a significant OS benefit.

The MMPI and MMPI-2 as predictors of psychiatric diagnosis in an outpatient sample.

The MMPI and MMPI-2 were compared as predictors of psychiatric diagnosis in 100 male and 100 female outpatients who completed the test items in a single session. Test profiles and the clinical diagnosis were grouped into five categories (normal, neurotic, character disordered, psychotic, and other). The MMPI and MMPI-2 code types were in the same category in 75% of the cases. Both the MMPI and MMPI-2 had a 39% agreement rate with category of clinical diagnosis (p < .0001). Discriminant function analyses based on Scales L, F, K, 1, 2, 3, 4, 6, 7, 8, and 9 accounted for significant variance in diagnostic group, (p < .02), and two functions correctly classified 49% and 50% of the cases for the MMPI and MMPI-2, respectively. The rate of correct classification for normals was more than 70%. The rate of correct classification for psychotics was 55% for the MMPI and 30% for the MMPI-2. For both the MMPI and MMPI-2, it appears important not to rely on test findings alone as a basis for diagnostic decisions.

The MMPI and MMPI-2 in an outpatient sample: comparisons of code types, validity scales, and clinical scales.

Two hundred (N = 200) outpatients completed MMPI (W.G. Dahlstrom, Walsh, & L.G. Dahlstrom, 1989) and MMPI-2 (Butcher, W.G. Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) items at one time, permitting comparison of alternate forms. The concordance rate for elevated codetypes was 58%; for 2-point codetypes independent of elevation, it was also 58%. Only 50% of the men compared to 66% of the women showed concordance between forms. Of the 200 cases, 72 (36%) had codetypes that were both elevated and "well defined." The concordance rate among these 71 cases was 72%. Comparison of mean raw scores for the validity and clinical scales showed a small difference for MMPI versus MMPI-2 (Form) on Scales 2 and 5, small differences for Gender on Scales 1, 2, and 3, and no Gender by Form interactions. There were significant MMPI versus MMPI-2 differences for T-scores on all scales, and there were significant Gender by Form interactions for T-scores on all scales except Scale L, Scale K, and Scale 6 (excluding Scale 5). Comparison of mean T-scores (excluding Scale 5) showed no significant differences for Gender on the 12 scales. In spite of significant mean differences, correlational analyses show correlations above .96 for the raw scores and T-scores for each gender, indicating that rank ordering of cases is maintained between forms. These results are discussed in terms of the issues for use of the MMPI-2 compared to the MMPI.

Forensic psychological examination of the child witness in cases of alleged sexual abuse.

The examination of child witnesses in cases of sexual molestation involves complexities at psychological and legal levels and requires rigorous analysis and assessment to safeguard the rights and interests of the alleged victim and of the accused. Legal, procedural, and psychological issues are reviewed, and a methodological strategy for the investigation and evaluation of child sexual molestation is outlined.

Fantasy and reality of staff involvement in organizational change.

Clinical staff at the lower levels of agencies are more likely to initiate and implement organizational changes if they operate from a sound conception of accountability. Change agents are in danger of becoming modern day Don Quixotes unless they focus on creating accountability systems that support agency efforts to change. Designing systems capable of changing is the challenge for all levels of staff.

Simultaneous bilateral retinal arterial occlusions treated by exchange transfusions.

Bilateral retinal vascular occlusions occurred simultaneously in a 25-year-old man. They were treated by exchange transfusions. After the transfusions, the patency of the previously occluded vessels was reestablished. Subsequently, the patient recovered good central vision. It is interesting to speculate how exchange transfusions, used during the past few years for treatment of life-threatening situations, may be useful for the treatment of retinal arterial occlusions in patients with sickle cell disease.

Reversal of diabetes in rats using fetal pancreases stored at -196 C.

Fetal rat pancreases frozen to and stored at -196 C were used for transplantation into streptozotocin-induced diabetic syngeneic adult recipients. Transplantation was carried out either directly after thawing from -196 C, or after a 21-day growth period in a syngeneic, normoglycemic adult carrier. All transplants were placed under the kidney capsule. A single, frozen fetal rudiment was sufficient to restore blood glucose, urine volume, and urine glucose to normal, provided it had first been grown for 21 days in a normal carrier. It vitro perfusion studies showed that fetal pancreases stored at -196 C were equivalent to fresh rudiments in their responses to a glucose stimulus.

Toward a social psychology of program design.

Underlying each aspect of the design of social programs, whether the fund-raising apparatus or the accountability system, is a conception of human behavior. These conceptions, generally implied, are seldom examined, yet their validity determines to a great extent the effectiveness of programs. We have lacked an operational means of translating our behavioral assumptions about clients, staff, organizations, and groups into concepts whereby the merits and deficits of various designs can be evaluated. Viewing social programs and policies as forms of exchange where resources are invested for potential benefits offers a promising bridge between behavior and design.