RESUMEN
BACKGROUND: Children generally lie still enough for magnetic resonance imaging (MRI) only if they are asleep, either under sedation, which is deeper than conscious sedation, or under anaesthesia. Anaesthesia resources, however, are limited, and non-anaesthetists must use sedation frequently. Demand for MRI has increased and the failure of our sedation regimen led to an impractical demand for anaesthesia and unacceptable waiting times for scanning. We have therefore developed a nurse-led sedation service in a designated unit next to the scanner. This study assessed the safety and efficacy of this approach. METHODS: Children who required MRI were sedated in the unit by designated sedationist nurses, who used an oral drug regimen (according to weight and age from conception: weight <5 kg, 50 mg/kg chloral hydrate; 5-10 kg, 100 mg/kg chloral hydrate; 10-20 kg, 1 mg/kg temazepam plus 0.25 mg/kg droperidol; >20 kg temazepam and droperidol as directed by radiologist, maximum doses 20 mg and 5 mg respectively). Nurses checked patients for their suitability, charted and administered the drugs according to a protocol, and monitored the children throughout the sedation. We prospectively audited failure and complications of sedation. FINDINGS: During the 30 month study, there were 1155 sedations. 61 (5%) were unsuccessful, and there were no adverse events relating to the airway or breathing. After scanning had finished all children, in response to gently pinching the nose, could open their mouths to maintain their airway. INTERPRETATION: This study suggests that it is possible to have a nurse-led sedation service for MRI of children that is both successful and safe.
Asunto(s)
Hipnóticos y Sedantes/uso terapéutico , Imagen por Resonancia Magnética/psicología , Enfermeras Anestesistas , Desarrollo de Programa , Anestesia , Servicio de Anestesia en Hospital/organización & administración , Niño , Contraindicaciones , Hospitales Pediátricos/organización & administración , Humanos , Londres , Administración de la Seguridad , Resultado del TratamientoAsunto(s)
Neoplasias/historia , Paleopatología , Neoplasias Óseas/historia , Fósiles , Educación en Salud/historia , Historia del Siglo XV , Historia del Siglo XVI , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Historia Medieval , Humanos , Manuscritos Médicos como Asunto , Neoplasias/diagnóstico , Neoplasias/terapia , Paleontología , Plantas Medicinales , Neoplasias de los Tejidos Blandos/historiaAsunto(s)
Neoplasias/diagnóstico , 1-Naftilamina/análogos & derivados , Carcinoma/diagnóstico , Separación Celular , Femenino , Citometría de Flujo , Fluoresceína , Fluoresceínas , Humanos , Activación de Linfocitos , Linfocitos/fisiología , Neoplasias/inmunología , Neoplasias Ováricas/diagnóstico , Neoplasias del Cuello Uterino/diagnósticoRESUMEN
The modified double-zone SCM technique, developed in these laboratories as an in vitro test for cancer, is based on the differential response to PHA of lymphocytes harvested from two regions of a Ficoll-Triosil gradient. Lymphocyte responses are measured by changes in intracellular fluorescein fluorescence polarisation. We report its continued clinical evaluation in patients hospitalised with malignant and non-malignant diseases, including a blind trial of 78 patients with disorders of the gastrointestinal tract, breast and lung. Overall "false' negative and "false' positive rates from 336 blood samples were 1.8 and 3.3% respectively.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Pulmonares/diagnóstico , Activación de Linfocitos , Adulto , Anciano , Centrifugación por Gradiente de Densidad , Ensayos Clínicos como Asunto , Diagnóstico Diferencial , Femenino , Polarización de Fluorescencia , Enfermedades Gastrointestinales/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Fitohemaglutininas/farmacología , Enfermedades Respiratorias/diagnósticoRESUMEN
Eighty-two patients with histologically confirmed lung cancer were randomly allocated to receive either radiotherapy alone (2400-3200 rads, depending upon cell type) or the same dose of radiotherapy followed by four cycles of adriamycin and 5-fluorouracil. Eighty-one patients were evaluated and for the group as a whole survival was better in the undifferentiated group assigned to receive adjuvant chemotherapy but survival in the patients with squamous tumours was not significantly prolonged. The chemotherapy was not unduly toxic.
Asunto(s)
Carcinoma Broncogénico/radioterapia , Doxorrubicina/uso terapéutico , Fluorouracilo/uso terapéutico , Neoplasias Pulmonares/radioterapia , Carcinoma Broncogénico/tratamiento farmacológico , Carcinoma Broncogénico/mortalidad , Femenino , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana EdadRESUMEN
The immunological state of 30 patients with carcinoma of the bronchus was assessed before and after radiotherapy by lymphocyte response to PHA and E and EAC rosette formation. The results were compared with those from age-matched patients with benign chest disease and a group of healthy control subjects. Differences were found between the three groups and decreased immunological responses were found to correlate with shorter survival times for patients with cancer of the bronchus. These differences were not associated with the extent of the disease, or with the smoking habits of the patients. Significant differences in percentage EAC cell rosetting were demonstrated between lymphocytes from patients with malignant disease (31.3 +/- 2.0) and those for control groups (21.5 +/- 1.9 and 24.0 +/- 2.2). Cancer patients and benign chest disease patients both had significantly decreased mean E rosetting values (59.3% and 55.6%) compared with healthy control subjects (69.7%). The group of cancer patients with a normal percentage of T lymphocytes and total number of lymphocytes after radiotherapy, or those with low percentage EAC cell rosettes, had a greater than 80% survival after seven months compared with less than 50% for the rest of the patients with carcinoma of the bronchus.
Asunto(s)
Neoplasias de los Bronquios/inmunología , Adulto , Neoplasias de los Bronquios/radioterapia , Femenino , Humanos , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Formación de Roseta , FumarRESUMEN
A fluorescence polarisation technique ("S.C.M. test") for detecting responses to phytohaemagglutinin revealed that the responsive lymphocytes from patients with malignant disease had an abnormal distribution after centrifugation through lymphocyte separation medium. In a small blind series the technique accurately distinguished patients with histologically proven malignancies from those with nonmalignant disease and normal people.
Asunto(s)
Linfocitos/patología , Neoplasias/diagnóstico , Adenocarcinoma/diagnóstico , Asma/diagnóstico , Neoplasias de la Mama/diagnóstico , Neoplasias de los Bronquios/diagnóstico , Carcinoma Papilar/diagnóstico , Carcinoma de Células Pequeñas/diagnóstico , Separación Celular/métodos , Centrifugación por Gradiente de Densidad/métodos , Diagnóstico Diferencial , Femenino , Humanos , Linfocitos/efectos de los fármacos , Masculino , Tumor Filoide/diagnóstico , Fitohemaglutininas/farmacología , Sarcoidosis/diagnóstico , Estimulación Química , Neoplasias del Cuello Uterino/diagnósticoRESUMEN
A previous study of the MOD-MEM test showed promising results. We have attempted to repeat the study using a blind coded series of 210 blood samples from normal subjects and patients with either benign or malignant disease. Using standard criteria the false negative rate for cancer patients averaged 43% and the false positive rate for non-cancer patients averaged 34%. The results indicate that the test at the present time, under routine laboratory conditions, is not reliably reproducible and does not have the ability to effectively discriminate between benign and malignant disease. It is suggested that blind coded studies be used more frequently in assessment of tests with cancer detection potential.
Asunto(s)
Electroforesis , Macrófagos/inmunología , Neoplasias/diagnóstico , Antígenos , Electroforesis/métodos , Estudios de Evaluación como Asunto , Reacciones Falso Negativas , Reacciones Falso Positivas , Humanos , Técnicas Inmunológicas , Linfocitos/inmunologíaRESUMEN
In advanced emphysema the reduced lung retractive force permits dynamic compression of the airways during expiration; this gives rise to breathlessness which is often refractory to conventional remedies. Radiotherapy causes shrinkage of lung tissue and has therefore been given as treatment to 10 patients with emphysema. They have been followed for two years, during which time three have died from various causes, but no adverse effect of radiotherapy has been observed. All the patients at some time experienced a reduction in breathlessness on exertion and an increase in the range of their daily activities; the distensibility of their lungs was on average reduced but the response to test exercise was not altered. The possibility that the clinical improvement may have been a placebo effect is now being investigated.
Asunto(s)
Enfisema Pulmonar/radioterapia , Anciano , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Mediciones del Volumen Pulmonar , Masculino , Persona de Mediana Edad , Esfuerzo Físico , Enfisema Pulmonar/fisiopatologíaAsunto(s)
Neoplasias del Cuello Uterino/etiología , Adolescente , Factores de Edad , Neoplasias de la Mama/etiología , Circuncisión Masculina , Coito , Anticoncepción , Estrógenos/efectos adversos , Femenino , Humanos , Higiene , Masculino , Matrimonio , Menarquia , Menopausia , Neoplasias Ováricas/etiología , Embarazo , Estudios Retrospectivos , Factores Socioeconómicos , Espermatozoides , Enfermedades VaginalesRESUMEN
One hundred and twenty cases of cancer of the lung have been tested for their lymphocyte transformation to phytohaemagglutinin (PHA) before and after treatment by radical radiotherapy. The average response of these patients was lower than that of the controls. The fall in the lymphocyte response during treatment was calculated. The pre-treatment lymphocyte response with PHA was not related to survival after treatment. The fall in the lymphocyte response during treatment was related to the survival of the patients after treatment.