Model based calculation for effective cancer radioimmunotherapy.

The major problem of tumour radioimmunotherapy remains the low tumour antibody uptake and this leads to inadequate tumour irradiation. The antibody characteristics which influence uptake have been identified and quantified previously using a non-linear compartmental model that simulates antibody distribution to tumour and body after intravenous injection. The model has now been extended, in combination with MIRD dosimetry tables, to calculate the integral tumour/body radiation dose for a range of antibody masses (1, 10 and 50 mg), sizes (binding site fragments and whole molecules) and affinities (K = 10(9)-10(13) mol-1). Antibody requirements for delivering 60 Gy to the tumour over 11.6 days were calculated for 131I and 90Y-labelled antibodies and included the effect of widely varying dose rates. The model predicted that intact antibodies of high affinity (10(11)-10(13) mol-1) produced effective tumour radiation doses with acceptable whole body radiation levels. By contrast, antibody fragments gave higher body radiation levels and required larger injected activity because of renal excretion. The model predicted higher therapeutic indices for 90Y-labelled antibody compared with 131I.

Reduction in incidence of glove perforation during laparotomy wound closure by 'no touch' technique.

Intact surgical gloves provide an efficient barrier against the HIV and Hepatitis B viruses but glove perforations are common, particularly during mass closure of laparotomy wounds. Attempts to develop gloves immune to perforation have failed. A series of 100 consecutive laparotomy wounds were randomised to mass closure by either the 'hand in' technique currently favoured by many surgeons, or a 'no touch' technique manipulating the wound edges with instruments only. The two groups were similar with regard to grade of surgeon and assistant, proportion of routine and emergency cases, and proportion of clean or dirty cases. The wound lengths in each group were similar, and the time taken to close the abdominal wall was similar in both groups. Although a similar number of perforated gloves occurred in each group while the operative procedure was being performed ('hand in', 9 of 50 vs 'no touch', 12 of 50; P = 0.62); a significantly reduced number of glove perforations occurred in the 'no touch' group during wound closure ('hand in', 16 of 50 vs 'no touch', 3 of 50, P = 0.0017). No touch closure of the abdominal wall may provide protection to surgeons against blood-borne viruses such as HIV and hepatitis B.

Evidence of clonal variants of Helicobacter pylori in three generations of a duodenal ulcer disease family.

Nine members of a family with a high incidence of duodenal ulcer disease were studied by interview, examination of hospital records, endoscopy, and antral biopsy. Helicobacter pylori was confirmed by CLO test, histology and culture. DNA extraction from pure isolates of H pylori was possible in six family members and strain typing was performed by restriction fragment length polymorphism. DNA restriction digestion was followed by vacublotting and then DNA hybridisation, using a cDNA probe complimentary to H pylori rRNA cistrons. Eight of the nine family members were H pylori positive by CLO test and histology. Five had duodenal ulcer disease. Three family members (one from each generation) harboured clonal variants of a single parent strain of H pylori but only two had duodenal disease. The other three members harboured different strains. Intrafamilial clustering of clonal variants of H pylori occurs in some duodenal ulcer disease families. Family members however, may develop duodenal disease irrespective of the colonising strain.

Safety of early pain relief for acute abdominal pain.

OBJECTIVES: (a) to determine the efficacy of papaveretum in treating pain when administered early to patients presenting with acute abdominal pain and (b) to assess its effect on subsequent diagnosis and management. DESIGN: Prospective, randomised, placebo controlled study. SETTING: Walsgrave Hospital, Coventry. SUBJECTS: 100 consecutive patients with clinically significant abdominal pain who were admitted as emergencies to a surgical firm. INTERVENTIONS: Intramuscular injection of up to 20 mg papaveretum or an equivalent volume of saline. OUTCOME MEASURES: Pain and tenderness scores, assessment of patient comfort, accuracy of diagnosis, and management decisions. RESULTS: Median pain and tenderness scores were lower after papaveretum (pain score 8.3 in control group and 3.1 in treatment group, p < 0.0001; tenderness score 8.1 in control group and 5.1 in treatment group, p < 0.0001). Forty eight patients were deemed to be comfortable after papaveretum compared with nine after saline. Incorrect diagnoses and management decisions applied to two patients after papaveretum compared with nine patients after saline. CONCLUSION: Early administration of opiate analgesia to patients with acute abdominal pain can greatly reduce their pain. This does not interfere with diagnosis, which may even be facilitated despite a reduction in the severity of physical signs. These patients should not be denied effective treatment.

Renal transplant biopsy using real time ultrasound guidance.

We describe a safe method of percutaneous renal transplant biopsy using real time ultrasound guidance. The method provides a good histological sample, is straightforward and has a low complication rate.