Primary malignant pulmonary hemangiopericytoma.

A primary malignant pulmonary hemangiopericytoma was diagnosed in a 45-year-old woman who complained of 10 months of cough and exertional dyspnea. One year after resection of the mass, a metastatic lesion was removed from the contralateral lung. The literature on this unusual pulmonary lesion is reviewed.

Physician-hastened death. Advisory guidelines for the San Francisco Bay area from the Bay Area Network of Ethics Committees.

Recent high court opinions and pending Supreme Court rulings on the legality of physician-hastened death necessitate a pragmatic response from the medical profession. Adopting a "harm reduction" perspective on this contentious topic, the Bay Area Network of Ethics Committees developed practice guidelines for responding to a patient request for hastened death. The guidelines will be offered to the local medical community for use by individuals and health care institutions if the practice of physician-hastened death becomes legal. A multidisciplinary consensus process was used in developing the guidelines, which address clinical, ethical, and procedural concerns.

The Northern California Conference for Guidelines on Aid-in-Dying.

End-of-life care in the United States is inadequate. Long-standing and unresolved issues in the care of the terminally ill have led to debates that have become major bioethical issues. Recognizing that practical solutions to deal with these issues are desperately needed, the Stanford University Center for Biomedical Ethics organized and convened a consensus development conference for health care professionals and health care institutions on Sept. 27 and 28, 1996.

Report of the Northern California Conference for Guidelines on Aid-in-Dying: definitions, differences, convergences, conclusions.

In September 1996, the Stanford University Center for Biomedical Ethics convened a conference entitled "Comprehensive Care of the Terminally Ill: The Northern California Consensus Development Conference for Guidelines on Aid-in-Dying." The regionally based, multidisciplinary conference gathered people from a variety of disciplines and diverse perspectives on physician aid-in-dying. This report documents important points of convergence, disagreement, and uncertainty that emerged from the conference and provides commentary on crucial issues: the definition of terminal illness, ensuring adequate palliative care, psychiatric challenges, coping with family pressures, the doctor-patient relationship, the managed care context, the role of ethics committees, and institutional challenges. Should physician aid-in-dying become a legal practice in California, the report will provide guidance to health care organizations, health professionals, and public policy officials engaged in local or state guideline or policy development.

How accurate are computed tomographic scans in assessment of changes in tumor size?

The computed tomographic scan plays an integral part in the diagnosis and management of tumors; however, its potential has not yet been fully exploited. With a computer-assisted volume determination method, the reproducibility of derived volume calculations was assessed, and radiologists' standard interpretations of interval change on serial scans were compared with the investigators' calculations of tumor volume change. Interobserver reproducibility of tumor volume calculations of the mean of two repeated volume determinations was satisfactory (mean of 3 percent, median of 1 percent). There were 29 comparisons (47 scans of 19 patients with liver tumors) of computed tumor changes with the radiologists' computed tomographic reports of consecutive scans. In only 41 percent (12 of 29) of the cases did the radiologists' interpretations and the computer-assisted volume determinations agree. It is concluded that objective computer-assisted volume determination provides a potentially more sensitive assessment of tumor change and that such precise, specific, reproducible determination of tumor volume should further clinical research and improve patient care.

5-Fluorouracil + Oncovin + Adriamycin + mitomycin C (FOAM): an effective program for breast cancer, even for disease refractory to previous chemotherapy. A Northern California Oncology Group (NCOG) Study.

One hundred and thirty-one patients (118 evaluable) with disseminated breast cancer were treated with a combination of 5-fluorouracil + Oncovin + Adriamycin + mitomycin C (FOAM). The objective response rate for 82 evaluable patients whose disease was refractory to previous CMF or L-PAM chemotherapy was 35%; that for 36 evaluable patients who had not previously received chemotherapy, 56%. The hematologic toxicity of this therapy was generally mild and acceptable. It is believed that FOAM is an effective therapy for patients whose tumors are resistant to CMF.

Volumetric CT analysis of hepatic tumors.

Current methods of measuring hepatic volume and the percent of hepatic parenchyma replaced by tumor are crude, yet clinical decisions are often based on these imprecise measurements. We describe a new computed tomographic (CT) assisted volume calculatory program to accurately assess hepatic volume and a new computer program to discriminate tumor from normal liver and thus provide tumor volume measurements. The potential usefulness of these techniques is illustrated by an analysis of pre- and post-therapy CT scans and calculation of changes in hepatic volume and in the volume of hepatic tumor. Analysis revealed small changes in liver volume could be accompanied by substantial changes in tumor volume and vice versa. We conclude (a) quantitative CT techniques allow for rapid, reproducible measurements of liver and tumor volume, and (b) small changes in organ volume may be accompanied by substantial changes in tumor volume.

Meningeal carcinomatosis in breast cancer presenting as central hypoventilation: a case report with a brief review of the literature.

Meningeal carcinomatosis can appear with a variety of neurologic signs and symptoms. Alterations in respiratory control have not been reported in this syndrome or in neurologic syndromes associated with systemic cancer. The authors report on a case of documented leptomeningeal carcinoma from breast cancer presenting as apnea; they note its successful treatment with radiation and intrathecal chemotherapy. The authors conclude that respiratory failure can be considered as part of the syndrome of leptomeningeal carcinomatosis.

Successful therapy of an ACTH-producing gastric carcinoid APUD tumor: report of a case and review of the literature.

A case of a patient with a metastatic ACTH (adrenocorticotrophic hormone)-producing gastric carcinoid APUD (amine precursor uptake and decarboxylation) tumor is presented. The patient presented with Cushing's syndrome and very high levels of ACTH. The Cushing's syndrome was controlled medically, and when the patient deteriorated clinically she received treatment with a combination of BCNU, adriamycin, and ftorafur. She responded dramatically with marked clinical improvement and normalization of plasma ACTH levels. The current status of the APUD cell concept is discussed, with its overall implications for treatment of this group of malignancies.

Ultrasonography and computed tomography in the evaluation of hepatic microabscesses in the immunosuppressed patient.

The computed tomographic body scans and ultrasonograms from two patients with hepatic microabscesses are discussed. During ultrasonography a "target" appearance, typical of metastatic disease, was noted. The usual appearance of hepatic abscesses as well as a differential diagnosis for these lesions is presented.

Measurement of blood flow in skin with an intact vascular pedicle.

An experimental model was devised to confirm directly the validity of total skin blood flow measurement, as postulated by Sejrsen. A section of skin in the groin of the rat was prepared, which contained an intact artery and vein. Both of these were direct branches of the femoral vessels. When 133Xe was injected intradermally in saline solution, it was demonstrated that a sham isolated vascular pedicle cleared the isotope, and that the clearance was biexpoential, suggesting two compartments. When the vascualr pedicle was ligated, thereby removing direct blood flow to the piece of skin, the 133Xe clearance curve was monexponential. It is concluded that the rapid portion of the biexponential clearance curve, as analyzed by Sejrsen, does represent the dermal vascular components of isotope clearance, and that measurement of cutaneous blood flow by this method is a valid and useful technique. Results using this technique to follow rejection in a new skin transplant model are presented.

Cell surface: transfer of cellular adhesive properties from cell to cell by induced membrand altrations (38496).

Lymphocytes formed aggregates around Sepharose beads to which Concanavalin A had been coupled. Many of these aggregates consisted of multilayers of cells. The cell-cell interactions distal to the beads appeared to be a result of an induced membrane change at the cell-Sepharose bead interface.