Accuracy of implanted port placement with the use of the electromagnetic CathTrack catheter locator system.

PURPOSE: To test whether an electromagnetic guidance system such as CathTrack would allow long-term central venous access devices to be reliably placed at a decreased cost and without radiation exposure to patients and staff. The following study was undertaken to verify accuracy of the CathTrack system for catheter placement and to develop guidelines for its use. METHODS: Twenty-nine consecutive patients were prospectively enrolled in the study and taken to the operating room for implantation of a permanent central venous access port. By protocol, the CathTrack system was used to guide initial catheter positioning using the center of the third intercostal space along the right sternal border as the desired external target. Fluoroscopy was then used to visualize tip position and relocate the catheter tip to the exact position desired by the surgeon. RESULTS: Catheter placement using the CathTrack system was successfully accomplished in 27 out of 29 patients. In two instances CathTrack was abandoned and fluoroscopy utilized because of difficulty in threading the initial guidewire into the superior vena cava. CONCLUSION: The CathTrack electromagnetic locator system can be used to reliably position catheters for the establishment of long-term central venous access. Decreased cost and elimination of radiation exposure are distinct advantages of this system over fluoroscopy.

The role of palliative pelvic exenteration.

A retrospective review was made of pelvic exenterative procedures performed over a 45-month period at a single institution for symptom palliation in 35 patients with previously treated pelvic cancers (21 colorectal, 9 urinary, 5 gynecologic). Preexenterative treatment and nutritional and performance status were determined. The impact of the disease and the symptoms on quality of life both before and after exenteration was evaluated. Symptoms leading to exenteration included pain (n = 12), bleeding (n = 11), fistula (n = 7), or obstruction (n = 6) and were present for a median duration of 12 months before surgery. Procedures included 11 total, 13 anterior, and 11 posterior exenterations, with 17 extended resections. Operative mortality was 3% and overall morbidity was 47%. Quality of life improved in 88% of patients after exenteration. Median overall survival was 20 months, and 43% of patients were still alive after a minimum of 16 months of follow-up.

Adriamycin enhanced in vitro and in vivo photodynamic therapy of mesothelioma.

The ability of Adriamycin (AD) to enhance the known in vitro and in vivo tumoricidal effects of photodynamic therapy (PDT) on the H-MESO-1 human malignant mesothelioma cell line was investigated. In vitro cytotoxicity was determined by incubating H-MESO-1 cells in microtiter plates (2 x 10(5) cells/well, 6 wells/group) with the photosensitizer Photofrin II (PF) and varying concentrations of AD (0, 2.5, 5.0, and 10.0 micrograms/ml) for 24 hr followed by exposure to gold vapor laser light (GVL) at a fluence of 6000 J/M2. [3H]Thymidine (1 microCi) was added to each well 24 hr after treatment. Cells were harvested and counted for thymidine incorporation 24 hr later. PDT alone resulted in a decrease in thymidine incorporation of 23% while the addition of AD to PDT at AD concentrations of 2.5, 5.0, and 10.0 micrograms/ml resulted in decreases of 62, 85, and 69%, respectively (P = 0.005) as compared to untreated controls. H-MESO-1 tumor bearing nude mice (n = 5) were injected ip with PF (5 mg/kg) and AD (5 mg/kg) 24 hr prior to illumination of the tumor site with GVL (120 J/cm2). Control groups (n = 5) received PDT, AD, and/or GVL alone. Tumor surface area was measured as the product of the greatest perpendicular dimensions every 5 days for 30 days. Administration of PDT without AD resulted in a decrease in tumor surface area of 50% on Day 10 with regrowth of tumor by Day 30 while AD alone with or without GVL had no impact on tumor growth.(ABSTRACT TRUNCATED AT 250 WORDS)

DNA content in correlation with postsurgical stage in non-small cell lung cancer.

The relationship between DNA content, TNM stage, tumor size, grade, histology, and disease-free survival was assessed in a retrospective study of patients with non-small cell lung cancer who had undergone resection and complete mediastinal lymph node dissection. Flow cytometric analysis was performed on paraffin-embedded tissue of 90 consecutive patients. The patients were analyzed both as a group and by individual stage. Median follow-up was 11 months (range, 1 to 35 months). Aneuploid tumors were not significantly different from diploid tumors with regard to pathologic TNM stage (p = 0.34), size (p = 0.5), grade (p = 0.5), or histology (p = 0.34). Disease-free survival of patients with aneuploid tumors was not significantly different than that of patients whose tumors had normal DNA content (p = 0.69). DNA content did not correlate with established prognostic factors in patients with non-small cell lung cancer who underwent resection and complete mediastinal lymph node dissection.

Bacillus pumilus in the induction of clindamycin-associated enterocolitis in guinea pigs.

Antibiotic-associated enterocolitis was induced in guinea pigs by the intraperitoneal injection of clindamycin. The colonic and cecal mucosa and feces of acutely ill animals were cultured under aerobic and anaerobic conditions on 5% sheep blood agar plates and on a selective and differential medium for Clostridium difficile. All morphologically distinct colony types were isolated in pure culture and identified. A sterile cell-free filtrate of each isolate was tested for ability to induce morphological changes in cultured monolayers of mouse adrenal cells. The filtrate of a predominant isolate, Bacillus pumilus, induced an alteration of cellular morphology; the sterile filtrate of other isolates were unreactive. Toxin contained in cell-free filtrates of B. pumilus caused a syndrome identical to clindamycin-associated enterocolitis when injected intracecally into guinea pigs. The toxin had a molecular weight of 6,500 daltons as determined by molecular sieve chromatography and was inactivated with pronase, lipase, and trypsin. The minimal inhibitory concentrations of clindamycin and vancomycin for B. pumilus were 50 micrograms/ml and less than or equal to 0.4 micrograms/ml, respectively.