Comparison of Cancer Diagnoses Between the US Solid Organ Transplant Registry and Linked Central Cancer Registries.

US transplant centers are required to report cancers in transplant recipients to the transplant network. The accuracy and completeness of these data, collected in the Scientific Registry of Transplant Recipients (SRTR), are unknown. We compared diagnoses in the SRTR and 15 linked cancer registries for colorectal, liver, lung, breast, prostate and kidney cancers; melanoma; and non-Hodgkin lymphoma (NHL). Among 187 384 transplants, 9323 cancers were documented in the SRTR or cancer registries. Only 36.8% of cancers were in both, with 47.5% and 15.7% of cases additionally documented solely in cancer registries or the SRTR, respectively. Agreement between the SRTR and cancer registries varied (kappa = 0.28 for liver cancer and kappa = 0.52-0.66 for lung, prostate, kidney, colorectum, and breast cancers). Upon evaluation, some NHLs documented only in cancer registries were identified in the SRTR as another type of posttransplant lymphoproliferative disorder. Some SRTR-only cases were explained by miscoding (colorectal cancer instead of anal cancer, metastases as lung or liver cancers) or missed matches with cancer registries, partly due to recipients' outmigration from catchment areas. Estimated sensitivity for identifying cancer was 52.5% for the SRTR and 84.3% for cancer registries. In conclusion, SRTR cancer data are substantially incomplete, limiting their usefulness for surveillance and research.

Low-power, high data rate transceiver system for implantable prostheses.

Wireless telemetry is crucial for long-term implantable neural recording systems. RF-encoded neurological signals often require high data-rates to transmit information from multiple electrodes with a sufficient sampling frequency and resolution. In this work, we quantify the effects of interferers and tissue attenuation on a wireless link for optimal design of future systems. The wireless link consists of an external receiver capable of demodulating FSK/OOK transmission at speeds up to 8 Mbps, with <1e-5 bit-error rate (BER) without error correction, and a fully implanted transmitter consuming about 1.05 mW. The external receiver is tested with the transmitter in vivo to show demodulation efficacy of the transcutaneous link at high data-rates. Transmitter/Receiver link BER is quantified in typical and controlled RF environments for ex vivo and in vivo performance.

Cancer incidence among semiconductor and electronic storage device workers.

AIMS: To evaluate cancer incidence among workers at two facilities in the USA that made semiconductors and electronic storage devices. METHODS: 89 054 men and women employed by International Business Machines (IBM) were included in the study. We compared employees' incidence rates with general population rates and examined incidence patterns by facility, duration of employment, time since first employment, manufacturing era, potential for exposure to workplace environments other than offices and work activity. RESULTS: For employees at the semiconductor manufacturing facility, the standardised incidence ratio (SIR) for all cancers combined was 81 (1541 observed cases, 95% confidence interval (CI) 77 to 85) and for those at the storage device manufacturing facility the SIR was 87 (1319 observed cases, 95% CI 82 to 92). The subgroups of employees with > or =15 years since hiring and > or =5 years worked had 6-16% fewer total incidents than expected. SIRs were increased for several cancers in certain employee subgroups, but analyses of incidence patterns by potential exposure and by years spent and time since starting in specific work activities did not clearly indicate that the excesses were due to occupational exposure. CONCLUSIONS: This study did not provide strong or consistent evidence of causal associations with employment factors. Data on employees with long potential induction time and many years worked were limited. Further follow-up will allow a more informative analysis of cancer incidence that might be plausibly related to workplace exposures in the cohort.

Risk of cancer among women with AIDS in New York City.

To evaluate the risk of cancer among women with AIDS in New York City (NYC), we compared the cancer experience of AIDS-infected women in NYC with that of the general population of women in NYC by matching the population-based New York State Cancer Registry with the New York City AIDS Registry. A probabilistic algorithm was used to match names, birth dates, and, where available, Social Security numbers between 15,146 women with AIDS and 232,902 women with cancer. Standardized incidence ratios (SIR) were calculated as the ratio of observed to expected cancer cases in the population of NYC women matched for age, race, and calendar period of cancer diagnosis. Period-specific relative risks (RR) of cancer prevalence prior to AIDS, and incidence at or after AIDS were calculated to determine which cancers increased in proximity to an AIDS diagnosis, a surrogate marker of increasing immunodeficiency. Analysis was limited to women between the ages of 15 to 69 who were diagnosed with AIDS between 1981 and 1994. Among 15,146 women diagnosed with AIDS, we found 1,194 matches with the Cancer Registry. For cancers included in the 1993 AIDS case definition, the SIR was 178.49 for Kaposi's sarcoma, 48.97 for non-Hodgkin's lymphoma, and 9.20 for invasive cervical cancer. The overall SIR for all non-AIDS-defining cancers was 2.20. Among non-AIDS-defining cancers, elevated SIRs were found for cancers of the lung (7.95), esophagus (7.69), multiple myeloma (7.37), oral cavity and pharynx (6.55), Hodgkin's disease (5.65), leukemias (4.52), and rectal/anal cancers (3.23). Statistically significant increases in period-specific risks were found for all non-AIDS-defining cancers combined, but not for individual cancers. Dual screening by two registries and unknown behavioral factors complicate the ascertainment of cancer risk. Our results show significantly elevated risks for several non-AIDS-defining cancers; these results are consistent with other studies of cancers among persons with AIDS. Extension of the time period of analysis is required to test for the effects of new anti-viral treatments and their association with cancer development among HIV-infected women.

India ink pinprick experiments on surface organization of cricoarytenoid joints.

Collagen fiber organization in the articular surfaces of the cricoarytenoid joint (CAJ) was studied using a pinpricking technique used in biomechanical research in orthopedics. Four male human formalin preserved specimens (3 months to 20 years) and 6 male freshly autopsied specimens (19 to 30 yrs) were studied. Specimens were dissected using the stereomicroscope. Distinctive patterns of articular cartilage slits reflect the orientation of collagen fibers in the cricoid and arytenoid articular surfaces. The orientation of the collagen fibers reinforces the articular surfaces along the principle path of CAJ motion. No age related differences were found. This suggests that the orientation of collagen fibers in the CAJ articular surfaces is prenatally determined rather than significantly influenced by postnatal mechanical factors.

India ink pinprick assessment of age-related changes in the cricoarytenoid joint (CAJ) articular surfaces.

Age-related changes in the articular surfaces of the cricoarytenoid joints (CAJ) of 12 human Caucasian male larynges (6 age 19 to 30 years; 6 age 50 to 80 years) were investigated. Differences in color, roughness, ossification, and surface fiber organization were studied. These were correlated with changes in collagen fiber arrangement on the articular surfaces determined by an India ink pinprick technique. Consistent patterns of orientation of collagen fibers in CAJ surfaces were identified in young and old groups. Older articular surfaces exhibited extensive fibrillation and ossification, suggesting that articular cartilage undergoes alteration in ground substance and/or fiber structure as a function of age. CAJ cartilage changes in older males may limit range of motion of arytenoid cartilages and reduce degree and extent of vocal fold closure. These structural changes may produce negative functional consequences during voice production such as diminished vocal quality and reduced vocal intensity due to air leakage through incompletely or loosely approximated vocal folds.

Epidural intracranial pressure monitoring: a new system.

An intracranial pressure (ICP) monitoring system has been developed, consisting of an epidural sensor acting as a pneumatic flow switch connected by tubing to a pneumatic system and microprocessor-based monitoring unit. The frequency response to the system is 8 Hz at 10 mmHg measured peak to peak. ICP and arterial pressure data are collected and maintained in memory. The ICP in memory can be scrolled across a 2-hour or 24-min graphic and digital video display. When memory is not being recalled, the previous 2 hours or 24 min of data are displayed on the screen in graphic form. High and low ICP, low cerebral perfusion pressure, and abnormal pressure waves trigger alarms. Calibration of the system is maintained automatically by periodic rezeroing of all transducers to air. Changes in volume within the pneumatic system indicate a leak, and airflow ceases. The software management and alarm systems, as well as available memory, represent the latest in computerized technology.

Clinical experience with a new transvenous atrial lead.

Although systems using atrial pacemakers offer potential clinical advantages for many patients now receiving ventricular devices, atrial systems have been used in less than 1% of the implantations of permanent pacemakers. The unavailability of clinically successful, easily positioned atrial leads is regarded as the most significant factor in the underutilization of atrial pacing systems. A permanent transvenous atrial lead has been developed and has performed well in 16 months of evaluation in 28 patients. Acute thresholds for voltage at a pulse width of 1 msec ranged from 0.40 v to 2.0 v (average, 1.1 v). Acute peak-to-peak amplitudes of the atrial electrogram were notably high, ranging from 2.5 mv to 7.5 mv (average, 5.1 mv) as measured oscilloscopically. Intermittent failure of sensing occurred in three patients during the period immediately after implantations. Spontaneous dislodgment of the lead from the right atrial appendage occurred in two patients. Atrial sensing and pacing functions remained intact in the first case, and no revision was performed. The lead was repositioned in the second patient and has remained in good position. No complications relating to the lead have been noted in the remaining patients.

Recording auditory-nerve potentials as an office procedure.

Recording auditory-nerve potentials from human subjects is already a routine procedure in the laboratory. In order to bring such recording capabilities into the office of practicing otologists, a number of difficulties had to be overcome. First, a small signal averager was built and incorporated into a stimulus generating and response recording system. The entire system was made portable and self-sufficient. The effects of electrical interference and background acoustic noise were shown to be tolerable. After studies of how responses vary with electrode location, electrodes were designed to be placed on the ear canal so that no invasive procedures were necessary. Methods were found to simplify the procedure so that recordings can be made in a matter of minutes by one person working alone.