Recombinant human DNase I in cystic fibrosis patients with severe pulmonary disease: a short-term, double-blind study followed by six months open-label treatment.

Chronic pulmonary infection is the major cause of morbidity and mortality in cystic fibrosis (CF). Recombinant human deoxyribonuclease (rhDNase) in vitro has been shown to dramatically reduce the viscoelasticity of the sputum from CF patients. Phase II and III clinical trials have shown the drug to be safe, and that patients with a forced vital capacity (FVC) of > 40% predicted show an improvement in pulmonary function when receiving rhDNase. The current study evaluates the safety and efficacy of rhDNase in the most severly ill CF patients (FVC < 40% predicted). A double-blind, randomized, placebo-controlled trial in which patients received either 2.5 mg rhDNase twice daily or placebo for a period of 14 days followed by a 6 month open extension period (OEP) is reported. Seventy patients were recruited for the double-blind study, and 64 entered the OEP of whom 38 completed. During the OEP, all patients received 2.5 mg rhDNase twice daily. In both the double-blind period and the OEP the drug appeared to be safe. During the double-blind study, forced expiratory volume in one second (FEV1) and FVC improved in both groups but there was no statistically significant difference between the groups. In the OEP, there was mean improvement in percentage predicted FEV1 and FVC, 9 and 18%, respectively, for all patients participating. In conclusion, DNase is safe when administered in conjunction with a rigorous regimen of chest physiotherapy to severely ill patients (FVC < 40% predicted) with CF. The double-blind, 14 day study showed no significant improvement in pulmonary function but some patients may have improved after longer administration of rhDNase.

Radiation therapy and clinical physics practices in the midwest (1982-1986).

As a part of an on-site physics review procedure, the Midwest Center for Radiological Physics (MWCRP) interviewed midwest clinical radiotherapy physicists and radiation therapists in institutions that participated in federally funded Cancer Control Programs. Information from 77 institutions was compiled regarding types of megavoltage units, daily patient load, radiotherapy personnel, treatment planning responsibilities, dosimetric practices, and treatment planning computers. Even though some practices, such as frequency of patient charge checks, were consistent throughout the midwest, other practices varied considerably such as patient load with the number of megavoltage units. This information may be useful either for planning a new facility, considering the needs for staff, or for comparing existing practices and responsibilities.

Scatter radiation exposure during knee arthrography.

Knee arthrography, as performed at the authors' institution, was simulated and scattered radiation exposure to a radiologist's gonads, thyroid, and eye lens was measured with a sensitive ionization chamber. Results show that radiologists who regularly conduct knee arthrography examinations can incur doses to the gonads that are less than 6% of the U.S. limits, and to the thyroid and eye that are approximately 10% of the U.S. limits. Since the scatter radiation from overhead imaging of stress views constituted most (greater than or equal to 60%) of the dose to the lens of the eye and the thyroid, spot imaging was evaluated as a substitute for overhead imaging in the assessment of the anterior cruciate ligament. This substitution resulted in no loss of clinical information and has now completely replaced overhead imaging of stress views at this institution.