Tumour size measurement in an oncology clinical trial: comparison between off-site and on-site measurements.

AIM: To evaluate the degree of variability between lesion measurements obtained by a single observer compared with multiple observers, and in selected cases evaluate which of the two measurements more accurately represented the lesion size. MATERIALS AND METHODS: In this study we compared the performance of a single off-site observer to multiple on-site observers during measurement of 300 abdominal and thoracic lesions. Lesion measurements that were larger than 1cm(2), differed by more than 50%, but by less than 100%, were compared by a single adjudicator, who was blinded to the measurement source (n=46). RESULTS: Measurements of the 300 lesions differed by an average of 109% (SD 251%). Of 266 lesions larger than 1cm(2), results of the single observer compared with multiple observers differed by more than 10% for 249 lesions, more than 30% for 169 lesions, more than 50% for 126 lesions, and more than 100% for 66 lesions. Forty-six lesions were compared by the adjudicator. The adjudicator selected the measurement of the single observer for 37 lesions (80.4%), and the measurement determined by one of the multiple observers for nine lesions (19.6%; p=0.00002). CONCLUSION: Measurement of lesion size by a single observer compared with multiple observers reveals a high degree of variability. An adjudicator selected the measurement of the single observer more frequently than that of multiple observers, with statistical significance. These findings suggest that studies designed to quantify imaging features should limit the number of observers.

Fatal anaphylactic reaction to hair dye.

We present the first reported case of fatal anaphylaxis resulting from the application of hair dye. A 68-year-old woman had a history of anaphylactic reaction to hair dye 2 years before her death. After using a different hair dye preparation, the patient experienced shortness of breath, collapsed, and died. Autopsy findings were consistent with anaphylaxis. Pathogenic mechanisms are reviewed.

Changes in bladder and external urethral sphincter function after spinal cord injury in the rat.

Spinal cord injury (SCI) in humans results in inappropriate contractions of the external urethral sphincter muscle (EUS) during micturition (bladder-sphincter dyssynergia), leading to urinary retention. The major goal of this study was to determine whether SCI in rats has similar detrimental effects on micturition. After chronic SCI, urethan-anesthetized rats had a significantly (15-fold) increased bladder capacity and impaired voiding (31-fold increase in residual volume) compared with control rats. Bladder contractions in SCI rats were accompanied by abnormal tonic EUS electromyographic activity, whereas the EUS electromyograms of control rats exhibited a burst pattern (4-8 Hz) during voiding. Suppression of EUS activity with neuromuscular blockade did not improve the fraction of urine voided in SCI rats and reduced the fraction voided in control rats. Therefore, both tonic activity and complete quiescence of the rat's EUS appear to be detrimental to voiding, suggesting that the normal bursting EUS activity facilitates bladder emptying. In summary, rats and humans exhibit similar micturition dysfunctions after SCI (e.g., bladder-sphincter dyssynergia and impaired voiding).