A neural network approach to the early detection of cancer.

Early detection of some cancers (especially of the colon) may be achieved by nuclear magnetic resonance (NMR) spectroscopy applied to whole blood samples. Analysis by conventional Fourier signal processing techniques of the data so obtained has proved to be unreliable because of noise within the associated spectrum. This paper describes a neural network approach to analysis of the NMR data. At the present time, this method has proved to be highly reliable in differentiating between patients with an without colon cancer.

Palliative treatment of advanced cancer using multiple nonconfluent pencil beam radiation. A pilot study.

In the era of orthovoltage radiation, multiple nonconfluent pencil beam radiation (GRID) therapy was utilized to minimize superficial normal tissue damage while delivering tumorcidal doses at specified depths in tissues. The success of GRID therapy was based on the fact that small volumes of tissues could tolerate high doses of radiation. Since the development of megavoltage radiation and skin sparing, GRID therapy has been abandoned. In a pilot study, the authors adapted the principles of GRID therapy to megavoltage photon beams to treat patients with massive tumors or recurrent tumors after tolerance doses of radiation. Twenty-two patients have been entered in the study. All patients were symptomatic and had exhaustive conventional surgery, chemotherapy, and radiotherapy approaches to treatment. A 50:50 GRID (open to closed areas) was utilized, and a prescribed dose of 1000 to 1500 cGy to the open areas was given using a single photon field. In four patients, a second GRID treated was delivered at a split course interval of 4 weeks. The follow-up in these patients ranges from 1 month to 18 months. The results of treatment have been remarkable with 20 of 22 patients achieving dramatic relief of severe symptoms, and several patients showing significant objective regression. No acute effects have been observed, including those patients having large volumes of the abdomen irradiated. No unusual skin or subcutaneous early or late damage has been observed in follow-up.

Phenytoin toxicity: predictors of clinical course.

The records of 46 patients who were admitted to a general hospital with the diagnosis of phenytoin toxicity were retrospectively studied to identify factors present at the time of admission which correlated with severity of illness and which would therefore be of prognostic value. Length of hospital stay was used as a measure of severity of illness. Correlations were made between the length of hospital stay and 18 variables studied at the time of admission, including severity of symptoms, use of other drugs (sedative hypnotics, anticonvulsants and phenothiazines), history (seizures, cardiac arrhythmias, and alcohol abuse), laboratory evidence of liver disease or renal disease, electrolyte abnormalities, coagulopathies, prior suicide attempts, glucose levels, and white blood cell counts. Significant correlations related the length of hospital stay with the severity of symptoms, concurrent phenothiazine usage, and the presence of abnormal liver function tests on admission, but not with other factors studied. Admission phenytoin serum levels following an overdose were not a useful predictor of length of hospital stay in this series of patients.

Phenytoin toxicity: a review of 94 cases.

Records of all patients admitted to an urban teaching hospital from 1977-1987 with a diagnosis of phenytoin toxicity were reviewed in order to determine indications for admission and discharge, and to assess the need for therapeutic intervention and monitoring. Of 94 patients identified, 57 were male and 37 were female. Ages ranged from 19 mo to 84 yr. Serum phenytoin levels ranged from 21.4-90 micrograms/ml, with a mean level 44.4 +/- 12.5 micrograms/ml. Ataxia was observed in 59/94 patients (63%), and of these 18 patients had fallen; 9 had suffered injury from falling sufficient to require medical care. No other factors were associated with morbidity. No hemodynamic instability was seen in any of the cases. Electrocardiographic records were available for 71/94 cases (76%). There were no abnormalities due to phenytoin. Symptoms of toxicity resolved with supportive care. There were no deaths in this series. Phenytoin is a relatively safe medication even in the toxic range as determined by baseline phenytoin levels. Hospital admission is indicated in symptomatic cases until a declining serum phenytoin level is observed and ataxia resolves. The data in this series do not support routine electrocardiographic monitoring in cases of phenytoin toxicity.

Antiinflammatory and aldose reductase inhibitory activity of some tricyclic arylacetic acids.

A number of dibenztropone, dibenzsuberone, dibenzoxepin, and dibenzthiepin acetic acids were synthesized and tested for antiinflammatory/analgesic activity and also for their ability to inhibit rabbit lens aldose reductase (AR). It was found that the structural requirements for antiinflammatory/analgesic activity, believed to be mediated by inhibition of cyclooxygenase, were much more stringent than were those for AR inhibition. For example, the introduction of a hydroxyl group into positions 1, 4, 6, 7, or 8 on dibenzsuberone-2-acetic acid (1a) had relatively little effect on AR inhibition, but caused wide variations in antiinflammatory/analgesic activity.

The costs of rheumatoid arthritis. A patient-oriented study of chronic disease costs.

To detail the cost for one year of a chronic disease, 50 patients with Stage III rheumatoid arthritis were surveyed. Direct medical costs for this group were three times the national average, and 58% of these costs were covered by insurance. Indirect costs due to lost income were at least three times the direct medical costs, and transfer payments covered only 42% of these costs. Fifty-eight percent of the study group also sustained a major psychosocial loss. Uncovered income losses were the greatest economic burden for individuals with chronic rheumatoid arthritis. This striking ratio of indirect to direct medical costs has important implications for medical practice and health policy.