An agonist antibody specific for CD40 induces dendritic cell maturation and promotes autologous anti-tumour T-cell responses in an in vitro mixed autologous tumour cell/lymph node cell model.

CD40-mediated interactions play an important role in the response to a variety of diseases, including cancer. Engagement of CD40 on antigen-presenting cells, namely dendritic cells (DC), by CD40L leads to maturation and up-regulation of co-stimulatory molecules B7.1 and B7.2 (CD80 and CD86). These molecules are requisite to subsequent antigen-specific activation of T cells. T-cell activation is a critical aspect of specific anti-tumour immune responses that have become the focus of a variety of cancer immunotherapy approaches. Clinical trials involving immunologic interventions have shown clinical responses confirming that the immune system can be harnessed for the treatment of cancer. However, the clinical response rate has been low, signifying the need for new immunotherapeutic strategies. To this end, an agonist antibody specific for CD40, CP-870,893, has been developed. A fully autologous mixed tumour cell/lymph node cell model was utilized to demonstrate that CP-870,893 promotes the responsiveness of lymph node-derived T cells to autologous tumour. Specifically, T cells from the tumour-draining lymph nodes are not responsive to autologous tumour cells; however, in the presence of CP-870,893, this unresponsiveness is reversed, as indicated by lymph node cell proliferation and cytokine secretion. Monocyte-derived DC treated with CP-870,893 consistently display a mature phenotype: up-regulation of CD80, CD83, CD86 and HLA-DR expression, increased Mip1alpha and IL-12 secretion, and the loss of exogenous antigen-presenting capability subsequent to treatment with the antibody. These data indicate that CP-870,893 binds to and activates DC, ultimately driving a specific anti-tumour T-cell response.

Physical and exercise therapy for treatment of the rheumatoid hand.

OBJECTIVE: To study the short-term effects of physical therapy (ice massage or wax packs, thermal baths, and faradic hand baths) and exercise therapy on the rheumatoid hand. METHODS: The effect of individual physical therapy and exercise therapy programs was evaluated in 50 randomly selected rheumatoid arthritis inpatients (38 women and 12 men). Mean patient age (+/- SD) was 47.94 +/- 11.22 years, and mean disease duration was 5.04 +/- 4.80 years. The control group consisted of 50 randomly selected rheumatoid arthritis outpatients (37 women and 13 men; mean age 48.46 +/- 10.65 years, mean duration of disease 5.23 +/- 4.89 years) who at the time of the investigation were not receiving any physical or exercise therapy. The clinical indices used for evaluation of inflammation included erythrocyte sedimentation rate (ESR), pain intensity, proximal interphalangeal (PIP) joint size, and Ritchie articular index. Hand grip strength, palmar tip-to-tip and key pinch finger strength, finger range of motion, and activities of daily living (ADL) were the parameters used to assess the functional hand status. The study was single-blinded and of 3 weeks duration. RESULTS: In the physical therapy treated group, there was an improvement for most of the observed indices from baseline parameters that achieved statistical significance (P < 0.01 and P < 0.005) after the 3-week study period. ESR and PIP joint size improved clinically but failed to reach statistical significance. Patients had a more significant improvement in hand pain, joint tenderness, and ADL score (P < 0.005) than in range of motion (P < 0.01). All parameters in the control group slightly deteriorated over the study period. CONCLUSION: At least in the short term, physical and, particularly, exercise therapy produce a favorable improvement in the functional status of the rheumatoid hand.

Follow-up of benign results of stereotactic core breast biopsy.

RATIONALE AND OBJECTIVES: The purpose of this study was to obtain long-term follow-up data on women with benign histologic results of a breast stereotactic core needle biopsy (CNB). MATERIALS AND METHODS: Mammography charts of 300 consecutive women who underwent prone stereotactic CNB with digital radiography were reviewed. Women with frankly malignant or suspicious histologic findings (51 patients) or a technically unsuccessful stereotactic CNB (one patient) were excluded. The remaining 248 benign core biopsies in 229 women were included in the study. RESULTS: Follow-up mammograms were obtained for 152 lesions with benign histologic results following stereotactic CNB. The mean length of follow-up after stereotactic CNB was 34.6 months. Cancer was diagnosed in six women who underwent surgical biopsies 1/2 to 30 months after benign stereotactic CNB. An initial chart review demonstrated that no follow-up data were available for 64 lesions, and information was missing for an additional seven. CONCLUSION: SCNB remains a sampling procedure that can result in false-negative histologic results. Intrinsic procedural issues were identified that could minimize the potential for missing a malignancy. Goals for patient compliance with follow-up recommendations fell short of expectations.

Emergency department coverage by academic departments of radiology.

RATIONALE AND OBJECTIVES: The purpose of this study was to survey academic radiology departments to determine how emergency radiology coverage is handled and whether there are any prerequisites for those individuals providing this coverage. MATERIALS AND METHODS: The authors developed a simple two-page survey and sent it to a total of 608 program directors, chiefs of diagnostic radiology, chairpersons, and chief residents at academic departments of radiology. RESULTS: Of the 608 surveys sent, 278 (46%) were returned. More than half of the departments have an emergency radiology section that provides "wet read" coverage during the day, and most academic departments cover the emergency department during the night and on weekends. Nighttime and weekend coverage is handled mostly by residents. Most departments give time off for lunch, with few other prerequisites for faculty who provide emergency coverage. Sixty percent of the departments have teleradiology capability, and many use it for emergency department coverage. CONCLUSION: These results can serve as the basis for discussion and comparison with other institutions regarding a variety of aspects of emergency department coverage.

Common surgical procedures.

This article illustrates some common surgical procedures. Radiologists and other physicians frequently see patients who have had one or more of these operations. We hope to illustrate with drawings and radiographs the basic purpose of the procedures and the relevant anatomy. This is not intended to illustrate or discuss the actual surgical techniques. Our intention is to illustrate one generally accepted way of performing a given type of surgical procedure. For many of these operations, there may be multiple other techniques to accomplish the same result for the patient. Some of the illustrations and text in this monograph were originally published in Radiologic Guide to Medical Devices and Foreign Bodies, edited by T.B. Hunter and D.G. Bragg, St. Louis: Mosby-Year Book, 1994.

Gallery of medical devices.

This article provides an overview of the multitude of medical devices used in patients from head to toe. Simple line drawings show a wide assortment of medical devices. These drawings and the accompanying short descriptions are to be used for quick reference to identify some of the more common medical devices that are certain to appear on everyday radiographs. There is an extensive bibliography for the reader to obtain more detailed information about a particular device or medical apparatus. Knowing the specific name of a device is nearly impossible and is really not necessary, in particular, the eponyms attached to all manner of orthopedic apparatus. Many device names have evolved from their original meaning. What is important is the device's function and the recognition of its presence, as well as an understanding of its use and potential complications.

Patient perceptions of stereotaxic large-core breast biopsy.

RATIONALE AND OBJECTIVES: The authors evaluated the perceptions of patients who underwent stereotaxic core breast biopsy before and after the procedure. METHODS: By using a standard questionnaire, 58 patients undergoing stereotaxic core breast biopsy with a 14-gauge needle were interviewed immediately before, immediately after, and 24 hours and 5 days after the procedure. RESULTS: Discomfort recorded by patients 24 hours after core biopsy correlated with the amount of time needed before normal activities were resumed (P = .001). Only five patients (9%) indicated severe discomfort during the procedure. Patient age, number of core biopsy samples taken, and lesion depth did not correlate with level of discomfort. Fifty-five patients (95%) resumed normal activities within 24 hours. However, 41 patients (71%) had some breast bruising as many as 5 days after the procedure. Overall, patient satisfaction with care was high; 56 patients (97%) stated they would return for another biopsy in the future. CONCLUSION: The morbidity associated with stereotaxic core breast biopsy is low, although the majority of patients in this series experienced bruising lasting as long as 5 days after the procedure. Despite this, almost all patients would return for a core breast biopsy in the future, if indicated.

Occurrence of fibroadenomas in postmenopausal women referred for breast biopsy.

OBJECTIVE: To examine the occurrence of breast fibroadenomas in postmenopausal patients referred for breast biopsy. DESIGN: A retrospective review of breast biopsy outcome and of patient demographics, including menstrual and hormonal status. SETTING: The Tucson Breast Center, a large outpatient breast cancer detection clinic affiliated with the University of Arizona Health Sciences Center in Tucson, Arizona. PARTICIPANTS: All women seen at the Tucson Breast Center between 1985 and 1990 who were referred for breast biopsy. RESULTS: A total of 100 fibroadenomas were found in 709 breast biopsies whose results were known. Fifty-two of these were in premenopausal women and 44 in postmenopausal women; the menopausal status of four women was unknown. In postmenopausal women, 11 of the 44 patients reported hormone use. Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women. Fibroadenomas constituted 10% (44 of 447) of all biopsies in postmenopausal women, including those with breast masses, abnormal calcifications, or other lesions. CONCLUSION: Noncalcified fibroadenomas of the breast are not confined to young women and may constitute a small but noteworthy proportion of lesions coming to breast biopsy in postmenopausal women.

Tubes, lines, catheters, and other interesting devices.

Medical devices (tubes, catheters, lines, prostheses, etc.) are a common finding on radiologic studies. Sometimes they may be misdiagnosed as a pathologic process, or an important observation concerning a medical device may be overlooked because of lack of familiarity with a particular device. This review discusses a variety of tubes, lines, catheters, and other interesting and important medical devices found on everyday radiologic studies. Whenever an unusual radiologic finding is encountered, the first question to be asked is, "Is the finding a film artifact or an artifact of the imaging modality itself (computed radiography, computed tomography [CT], ultrasound, magnetic resonance imaging [MRI], nuclear medicine)? If not, does it represent a medical device or foreign material in or on the patient?" All those who interpret radiologic studies should develop the good habits of obtaining and reviewing the patient's prior studies and should, in addition, read the prior radiology reports. Good reading habits, combined with a knowledge of imaging artifacts, medical devices, foreign bodies, and normal anatomic variants, provide a solid starting point for the interpretation of radiologic studies. One very important factor often not appreciated by radiologists and referring physicians is that, in many instances, the radiologic visibility of a medical device has been given no thought, and the device has been designed with no input from the radiologic community. To compound this problem further, devices are often purchased by a hospital or medical center for the lowest price. Those purchasing devices frequently fail to seek advice from radiologists and other physicians concerning the radiologic detectability of the devices they purchase. Medical devices are manufactured from a variety of substances known as biomaterials. These include various types of metals, polymers, rubbers, ceramics, and composites. Biomaterials are substances brought into contact with living tissue for the purpose of treating a medical or dental problem. They must be compatible with human tissues chemically, mechanically, and pharmacologically. There are many ways to classify biomaterials, such as synthetic versus "natural," permanent versus transient, liquid versus solid, hard versus soft, and so forth. Although most life-support devices are within the patient's heart, blood vessels, lungs, or pleura, miscellaneous tubing, clamps, syringes, electrocardiograph (ECG) leads, and other apparatus often lie on or under the patient and appear on radiographs, especially chest studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Selective use of low-osmolality contrast agents for i.v. urography and CT: safety and effect on cost.

OBJECTIVE: The purpose of this study was to determine if the selective use of low-osmolality contrast material for excretory urography and CT is safe and if it saves money. MATERIALS AND METHODS: At the University Medical Center in Tucson, a questionnaire was developed to identify high-risk patients who would benefit from the use of a low-osmolality contrast agent. High-risk patients were defined as those with a history of a reaction to contrast material, severe allergies, asthma, severe cardiac disease, multiple myeloma, sickle cell disease, polycythemia, pheochromocytoma, or renal impairment. Beginning in March 1993, the questionnaire was given to all adult outpatients scheduled for daytime excretory urography and routine CT studies of the head and body. Only patients identified as high risk were given a low-osmolality (non-ionic) contrast agent. All other patients received high-osmolality (ionic) contrast material. The contrast agent chosen for a patient was determined by the person administering the questionnaire, usually a radiologic technologist. RESULTS: From March 1993 through December 1993, 1114 adult daytime outpatient excretory urographic and contrast-enhanced CT studies were examined at our institution. In 235 (21%) of the studies, a low-osmolality agent was used and in 879 (79%) studies, a high-osmolality agent was used. This represented a reduction in the use of low-osmolality agents from more than 90% of patients to 21%, an annual cost reduction from $288,000 to $60,480. We observed no untoward reactions to contrast material that could be specifically attributed to the increased use of high-osmolality agents. CONCLUSIONS: Selective use of low-osmolality contrast agents during excretory urography and CT can provide substantial cost savings and is not associated with a significant risk of major complications.

Film labels: a new look.

Every diagnostic image should be properly labeled. To improve the labeling of radiographs in the Department of Radiology at the University Medical Center, Tucson, Arizona, a special computer program was written to control the printing of the department's film flashcards. This program captures patient data from the hospital's radiology information system and uses it to create a film flashcard that contains the patient's name, hospital number, date of birth, age, the time the patient checked into the radiology department, and the date of the examination. The resulting film labels are legible and aesthetically pleasing. Having the patient's age and date of birth on the labels is a useful quality assurance measure to make certain the proper study has been performed on the correct patient. All diagnostic imaging departments should institute measures to assure their film labeling is as legible and informative as possible.

Radiologists' perception of professional journals.

RATIONALE AND OBJECTIVES: We assessed radiologists' perceptions of radiologic and general medical journals. METHODS: Five thousand randomly chosen radiologists (4,200 American College of Radiology (ACR) members and 800 members in training) were surveyed by mail concerning their opinion of selected radiology and major medical journals. The mail survey was followed up by a phone survey of 45 previously unsurveyed radiologists from a smaller list of a similar ACR population. RESULTS AND CONCLUSIONS: Of the 5,000 surveys mailed out, 987 (20%) were completed and returned. There were no systematic differences in the questionnaire results between those surveyed by phone and those surveyed by mail. In general, academic radiologists, private practice radiologists, and radiologists in training did not differ in their assessment of professional journals. The respondents picked Radiology as their first choice if they were allowed to read only one journal. The respondents believed that Radiology published the best clinical research and Investigative Radiology the best basic science research. American Journal of Roentgenology (AJR), Radiology, and Journal of Computer Assisted Tomography ranked highest for sureness and rapidity of manuscript acceptance and publication, while Radiology, New England Journal of Medicine, and the Journal of the American Medical Association ranked highest in terms of exposure and prestige.

Sonographic image degradation after barium enema.

RATIONALE AND OBJECTIVES: The authors previously showed that barium does not interfere with abdominal sonography performed after a biphasic upper gastrointestinal tract examination. This study was designed to assess the impact of a barium enema (BE) examination on the quality of abdominal sonography performed immediately after the barium enema. METHODS: Forty patients scheduled for routine barium enemas (22 air contrast and 18 solid column) were prospectively examined with abdominal sonography before and after their BEs. The resulting 80 sonograms were randomized; three radiologists blindly assessed the quality of images of each of six anatomic areas (aorta, pancreas, porta hepatis, gallbladder, and the right and left lobes of the liver). RESULTS: There was no statistically significant degradation of the images for the right and left lobes of the liver and the pancreas. However, the images for the gallbladder, porta hepatis, and aorta had a statistically significant (P < .05) degradation of their ultrasound quality following barium enema. CONCLUSIONS: Unlike upper gastrointestinal tract examination, BE examination does interfere with the quality of a subsequent abdominal ultrasonography. Thus, when both studies are required, sonography should be performed first.

The computer in the radiologist's office.

Today, the radiologist is able to equip his or her office with a powerful personal computer system equivalent to the large mainframe computers of just a few years ago. If funds permit, purchase of a 486 equivalent system with 200-300 Mbytes of hard-disk storage, 16 Mbytes of random access memory (RAM), a high-resolution color video card and monitor, and a laser printer is recommended. The practical uses for such a system are almost limitless and include word processing, spreadsheet and data-base management, telecommunications, multimedia presentations, business applications, teleradiology, resident and medical student education, and research applications. No matter how much one becomes involved in computer applications, it is essential to establish good habits for backing up critical data files and programs. Becoming familiar with computer technology is not easy at first. Finding a good computer buddy, taking simple night school courses, and reading computer articles and magazines are good ways to get started. Computers are wonderful devices. The day is fast approaching when they will become a necessary tool for every radiologist.