Somatostatin analog: effects on hypergastrinemia and hypercalcitoninemia.

A somatostatin analog (SMS 201-995) was used to treat symptomatic patients with a residual tumor burden of gastrinoma or medullary thyroid carcinoma and pathologic elevations of circulating marker peptides associated with these neuroendocrine tumors. Possible inhibitory effects of the analog on marker peptides, patients' symptoms, or tumor progression were studied in a dose-response protocol and during several months of self-injection of SMS 201-995. Both patients reported remarkable relief of secretory diarrhea and other symptoms, and serum gastrin was successfully suppressed by increasing doses of the analog. However, no effect was seen in reduction of hypercalcitoninemia. Morphologic imaging of residual tumor showed no progression of medullary thyroid carcinoma during treatment and, in the case of hepatic gastrinoma metastases, remarkable tumor regression was confirmed. No toxicity or glucose intolerance was experienced. Somatostatin analog shows promise for palliative management of endocrinologic symptoms due to neuroendocrine tumors, and an inhibitory effect can be measured in some but not all peptide markers. Further evidence of its negative trophic effect on tumor blood flow may suggest an antineoplastic potential, as well as palliative use of this new treatment.

The Computerized Notation System (CNS). A microcomputer system for rapid entry of notes by physicians and nurses.

A computerized notation system has been developed to produce a digital medical data base. Use of a separate physical record for every 1-4 patients allows several years of accumulated data to be easily accessible for patient "summaries" or admission "histories and physicals." To facilitate entry of data in the system, the physician is provided with a portable, complete computer system (HP-85, or Epson HX-20), a user-defined two-letter dictionary, and a program that produces all elements of the manual paper charting system. "Overview" and research data bases are developed from the digital medical data base records. In this paper, we report the efficiency of use of this computerized notation system in private outpatient and inpatient practice.

The computerized notation system: a portable, self-contained system for entry of physicians' and nurses' notes.

The Computerized Notation System (CNS) is a portable microprocessor system designed for use in outpatient clinics, hospital wards, and intensive care units. It can produce essentially all written communications required of both physicians and nurses, with printout at the bedside or in the clinic examining room. It is designed to ameliorate several problems which have limited direct computer entry by physicians and nurses (keyboard and processor access, marginal typing skills, lack of immediate printout, and logical restriction of menu choices). The system encourages and simplifies use of the problem-oriented approach to the patient, by producing organized, legible daily notes and patient summaries. Printouts of the system are compatible with the present hospital and clinic "paper charts." Clinical trials have confirmed the applicability, variability, and acceptability of the CNS in both hospital and outpatient practice.