High dose intravenous immune globulins and plasma exchange in Guillain-Barré Syndrome.

We report the effects of treatment with plasma-exchange (PE) and intravenous immune globulins (IVIg) in 36 out of 50 patients with Guillain-Barré syndrome (GBS) recruited by an incidence study in the Emilia-Romagna region of Italy. Comparison of the patients treated with PE and IVIg showed no significant differences in terms of effectiveness in improving the clinical course of GBS: at one month, respectively 11.1% and 25% had recovered, and 55.5% and 58.3% had improved by at least one grade. These results are in agreement with those of the Dutch GBS trial. No relapses were observed in either group. Moreover, our results showed no difference in clinical outcome at 1 and 3 months between the patients receiving only one therapy and those receiving two; a second cycle of therapy did not seem to improve the clinical course of the disease significantly. We conclude that PE and IVIg are both safe and effective therapies for GBS.

Competency-Based Certification Project. Phase III: content validity, standard setting and criterion-related validity.

This is the final article in a three-part series explaining the CAMRT's Competency-Based Certification Project--an effort to make the Association's certification process more job-relevant. The first article (Journal, August 1994) explained the job analysis process used to specify and validate the list of duties and tasks required of entry-level medical radiation technologists, the imaging and treatment procedures they perform, and the equipment they use. The second article (Journal, October 1994) explained the process for developing an examination blueprint by reviewing the CAMRT's examinations and summaries of clinical experience in the context of competency-based evaluation and the job analysis validation in each discipline. This article examines the development of assessment standards for certification examinations and summaries of clinical experience. It provides an overview of the steps necessary to develop a valid and defensible licensure/certification process after development of the examination content is complete.

Competency-Based Certification Project. Phase II: Examination blueprint.

This is the second of three articles explaining the C.A.M.R.T.'s Competency-Based Certification Project--an effort to make the certification process more job-relevant. The first article (August 1994 Journal) explained the job analysis process used to specify and validate the list of duties and tasks of entry-level medical radiation technologists, the imaging and treatment procedures they perform, and the equipment they use. This article discusses how the results of the project's job analysis will help determine the content of the certification process. It explains the work involved in reviewing the C.A.M.R.T.'s examinations and summaries of clinical experience in the context of competency-based evaluation and the job analysis validation in each discipline. The resulting "examination blueprint" will become a key document for persons involved in the C.A.M.R.T.'s certification process. This article briefly describes the examination blueprint's components and related concepts. The third and final article of this series will examine the development of assessment standards for certification examinations and summaries of clinical experience.

Competency-based certification project. Phase I: Job analysis.

The Canadian Association of Medical Radiation Technologists (C.A.M.R.T.) is transforming its existing certification process into a competency-based process, consistent with the knowledge and skills required by entry-level radiography, radiation therapy and nuclear medicine technology practitioners. The project concurs with the change in focus advocated by the Conjoint Committee on Allied Medical Education Accreditation. The Committee supports new accreditation requirements that, among other things, place more emphasis on competency-based learning outcomes. Following is the first of three papers prepared by the C.A.M.R.T. to explain the project and the strategy for its implementation, focusing respectively on each phase. This paper discusses Phase One: the job analysis.

Parietal inflammatory infiltrate in peripheral aneurysms of atherosclerotic origin.

Clinical and histological analyses were made of 18 consecutive cases of peripheral artery atherosclerotic aneurysms (PAAA) (common, deep femoral and popliteal arteries) and compared to a group of 10 specimens obtained from the atherosclerotic, non aneurysmal femoral arteries of 10 cadavers with similar characteristics to the 18 patients. Although neither the clinical nor the macroscopic morphological data indicated the presence of an inflammatory process in the PAAA, the histological examination revealed the presence of a considerable infiltrate (greater than 11 inflammatory cells/2116 microns2) in a surprisingly high percentage of cases (4 cases, 22.8%). In 5 other cases (27.7%) the presence of lymphomonoplasmonocytic cells, although less pronounced, was greater than normally seen in atherosclerotic arterial walls (greater than 4 and less than 11 inflammatory cells/2116 microns2). The median number of inflammatory cells present in the media and adventitia varied from 2.2 +/- 0.3 to 13.2 +/- 0.3 per 2116 microns2. These values are significantly different compared to the results of atherosclerotic arteries at the same level (P less than 0.001 Mann-Whitney's U test). These findings of lymphomonoplasmocytic infiltrates in the absence of other pathology, together with an analysis of the data in the literature, makes it possible to presume that the inflammation present is associated with atherosclerosis and is more common in aneurysmal rather than stenotic forms. The pathogenesis may be determined by immune reaction phenomena.

Inflammatory abdominal aortic aneurysms: does an early stage exist?

Inflammatory aneurysms are characterised by a peculiar clinical (i.e. abdominal-lumbar pain, weight loss and increased ESR) and morphological picture (whitish wall, adhesion to the surrounding organs and thickness greater than 0.5 cm). The lymphomonoplasmacellular infiltrate and the interstitial deposits of collagen define the histological picture of these lesions. The authors describe three abdominal aortic aneurysms macroscopically characterised by parietal edema, hyperemia and hypertrophy of the preaortic lymphnodes. Histological study revealed a conspicuous and widespread lymphomonoplasmacellular infiltrate and interstitial edema. The abdominal-lumbar pain, the increase in ESR and the reactive C protein defined the clinical and laboratory aspects. Serological tests for syphilis, rheumatoid arthritis and lupus erythematosis were negative. The question which arises from these observations is whether these forms represent separate entities or an early stage in the evolution of inflammatory abdominal aortic aneurysms with fibrosis.

Angiosarcoma in a limb with arteriovenous fistulas and elephantiasis.

Angiosarcoma is a rare malignant tumor of the soft tissues (less than 1% of sarcoma). It may affect various parenchymae (bones, liver, breast), the soft tissues or the skin. In the latter case it may be associated with lymphedema. Onset in the arm is typical with postmastectomy lymphedema (Stewart-Treves syndrome). The forms occurring in limbs with chronic lymphedema not associated with mastectomy are much rarer, with a total of 38 cases occurring in patients with an average age of 46.8 years and with lymphedema present for an average of 20 years. The survival rate for 5 years is 16.6%. The case observed by us had the characteristic onset of the malignant neoplasm on a pre-existing "angiomatosis lymphangiomatosis" pattern also featuring angiographycally detected arteriovenous fistula.

Multifocal diffuse glomus tumor. A case report of glomangiomyoma and review of the literature.

The case examined was a multifocal diffuse glomus tumor covering most of the right leg of a 24-year-old woman. The lesion, present at birth, had never caused any symptoms. Macroscopically, it had a simulangiomatous aspect, whereas histologically it was identified as a glomangiomyoma. The Authors have examined 26 (46.4%) of the 56 cases of multiple tumors reported to date. Multiple glomus tumors are benign lesions, which generally appear at an early age (70% by the age of 20), with no clear distinction between the two sexes. The lesions usually occur on the upper limbs, which account for 80% of the cases. Pain is reported in half of the cases. There are 3 histological types: "sensu strictu" glomus tumor, glomangioma and glomangiomyoma; the glomangioma being the most frequent (80.8%) as compared to 19.2% for the glomangiomyomatosis type. No case of "sensu strictu" glomus tumor was observed.

Elastic modulus in young diabetic patients (ultrasound measurements of pulse wave velocity).

Aim of this study is to confirm the validity of non-invasive evaluation with Doppler C.W. in the study of arterial diseases and in the identification of pre-clinical arterial lesions. We studied twenty-eight children suffering from diabetes mellitus, and dependent on insulin and a control group composed of twenty-eight healthy persons. All subjects were studied using the methodology of the transit time for the determination of the elastic modulus of the lower limb arterial wall and results were analysed according to a statistical method. Although the groups were small, an increase in pulse wave velocity was noted in diabetic children and a significative correlation was found between the elastic modulus and duration of diabetes.

Variable error: variance-covariance heterogeneity, block size and type L error rates.

The degree to which blocked (VE) data satisfies the assumptions of compound symmetry required for a repeated measures ANOVA was studied. Monte Carlo procedures were used to study the effect of violation of this assumption, under varying block sizes, on the Type l error rate. Populations of 10,000 subjects for each of two groups, the underlying variance-covariance matrices reflecting a specific condition of violation of the homogeneity of covariance assumptions, was generated based on each of three actual experimental data sets. The data were blocked in various ways, VE calculated, and subsequently analyzed by a repeated measures ANOVA. The complete process was replicated for four covariance homogeneity conditions for each of the three data sets, resulting in a total of 22,000 simulated experiments. Results indicated that the Type l error rate increases as the degree of heterogeneity within the variance-covariance matrices increases when raw (unblocked) data are analyzed. With VE, the effects of within-matrix heterogeneity on the Type l error rate are inconclusive. However, block size does seem to affect the probability of obtaining a significant interaction, but the nature of this relationship is not clear as there does not appear to be any consistent relationship between the size of the block and the probability of obtaining significance. For both raw and VE data there was no inflation in the number of Type l errors when the covariances within a given matrix were homogeneous, regardless of the differences between the group variance-covariance matrices.