Significant Adverse Influence Research Articles

Influence of Coupling Agent in Polyolefinic Composites from Post-Consumer Waste with Eucalyptus Grandis Flour

This study investigates the feasibility of using recycled high density polyethylene (HDPE) and polypropylene (PP) with wood fiber from species Eucalyptus Grandis (EU) to manufacture experimental composite panels. The use of maleated polyethylene and polypropylene as coupling agent (CA) improved the compatibility between the fiber and plastic matrix and mechanical properties of the resultant composites compared well with only the polymer and composites without compatibilizer. It was evaluate the influence of coupling agent (CA) in polyolefin matrix at different concentrations of HDPE and PP in the composites, checking the physical, mechanical and morphological properties of wood plastic composites (WPC). HDPE and PP post-consumer, wood flour from Eucalyptus grandis (EU) species and graftized polyethylene and polypropylene with maleic anhydride (MA) as CA were used on formulations, being extruded and after injection molding. Results showed that composites with CA had a higher mechanical performance compared to no-compatibilized, it was confirmed also by morphological analysis. The results of contact angle showed that the incorporation of CA led an increase in surface energy of polymeric matrix promoting a better interaction with vegetable filler. Based on the findings in this work, it appears that recycled materials can be used to manufacture value-added panels without having any significant adverse influence on material properties.

Properties of Rubberwood Medium-Density Fiberboard Bonded with Starch and Urea-Formaldehyde

Abstract The objective of this study was to evaluate some of the properties of experimental medium-density fiberboard panels made from rubberwood (Hevea brasiliensis) using a combination of cassava (Manihot utilissima) starch and a low percentage of urea-formaldehyde (UF) resin as a binder. Experimental panels with density levels of 0.65 and 0.80 g/cm3 were made using 10 percent starch, 10 percent starch and 3 percent UF, and 10 percent UF for the control samples. The panels manufactured with 10 percent starch did not have satisfactory physical and mechanical properties based on Japanese Industrial Standards. However, average modulus of elasticity, modulus of rupture, and thickness swelling values of the sample types E and F manufactured using a combination of starch and UF were 2,044 MPa, 22.49 MPa, and 35.50 percent, respectively, which met required limits listed in Japanese Industrial Standard A-5908. The results of this study indicated that starch can be used as a viable alternative binder with limited addition of UF resin without having any significant adverse influence of bending properties of the samples. Based on formaldehyde emission tests, specimens made with 3 percent UF had an average value of 18.5 mg/100 g, while control samples having 10 percent UF resulted in 38.5 mg/100 g.

Retrospective study of rehabilitation outcomes following spinal cord injury due to tumour

Retrospective study. To examine the rehabilitation outcomes for patients with spinal cord injury (SCI) due to tumour, with a focus on the impact of pain on disability and length of stay (LOS). Public hospital inpatient spinal rehabilitation unit, Melbourne, Australia. Retrospective open-cohort case series of consecutive patients admitted between 1/7/1996 and 30/6/2008 with a diagnosis of recent onset tumour causing SCI. In all 108 patients were admitted, of whom 62% (n=67) were male. The median age was 61.5 years (interquartile range (IQR) 53.6-74). Most patients had paraplegia (n=97, 89.8%) and a metastatic tumour (n=71, 65.7%) causing their SCI. For patients with a primary tumour the Rasch motor functional independence measure (FIM) gain between admission and discharge (median 17, IQR 4-23) was significantly greater (P=0.006) than for those with secondary tumour (median 7, IQR from -4 to 15). Pain was present in 52% of patients and had a significant adverse influence on the rehabilitation process, with FIM motor efficiencies of 0.09 in patients with documented pain compared with 0.39 in patients without pain (P=0.01). Patients with pain had significantly prolonged median LOS of 56 days (IQR 32.5-84.5) compared with 42 days (IQR 20.5-72.5, P=0.03) without pain. Patients with SCI due to tumour have the potential to benefit from a focused, specialised SCI rehabilitation programme to optimise their outcomes. Careful patient selection, modifying the focus of team goals and a close relationship with treating oncologists and palliative care teams is essential.

Infant mortality in South Africa--distribution, associations and policy implications, 2007: an ecological spatial analysis.

BackgroundMany sub-Saharan countries are confronted with persistently high levels of infant mortality because of the impact of a range of biological and social determinants. In particular, infant mortality has increased in sub-Saharan Africa in recent decades due to the HIV/AIDS epidemic. The geographic distribution of health problems and their relationship to potential risk factors can be invaluable for cost effective intervention planning. The objective of this paper is to determine and map the spatial nature of infant mortality in South Africa at a sub district level in order to inform policy intervention. In particular, the paper identifies and maps high risk clusters of infant mortality, as well as examines the impact of a range of determinants on infant mortality. A Bayesian approach is used to quantify the spatial risk of infant mortality, as well as significant associations (given spatial correlation between neighbouring areas) between infant mortality and a range of determinants. The most attributable determinants in each sub-district are calculated based on a combination of prevalence and model risk factor coefficient estimates. This integrated small area approach can be adapted and applied in other high burden settings to assist intervention planning and targeting.ResultsInfant mortality remains high in South Africa with seemingly little reduction since previous estimates in the early 2000's. Results showed marked geographical differences in infant mortality risk between provinces as well as within provinces as well as significantly higher risk in specific sub-districts and provinces. A number of determinants were found to have a significant adverse influence on infant mortality at the sub-district level. Following multivariable adjustment increasing maternal mortality, antenatal HIV prevalence, previous sibling mortality and male infant gender remained significantly associated with increased infant mortality risk. Of these antenatal HIV sero-prevalence, previous sibling mortality and maternal mortality were found to be the most attributable respectively.ConclusionsThis study demonstrates the usefulness of advanced spatial analysis to both quantify excess infant mortality risk at the lowest administrative unit, as well as the use of Bayesian modelling to quantify determinant significance given spatial correlation. The "novel" integration of determinant prevalence at the sub-district and coefficient estimates to estimate attributable fractions further elucidates the "high impact" factors in particular areas and has considerable potential to be applied in other locations. The usefulness of the paper, therefore, not only suggests where to intervene geographically, but also what specific interventions policy makers should prioritize in order to reduce the infant mortality burden in specific administration areas.

Exposure to contaminated sediments during recreational activities at a public bathing place

More and more time is spent on recreational activities, but few risk assessments focus specifically on these situations and exposure factor data are often scarce. To assess exposure to contaminants at a public bathing place in an urban environment, we have compiled literature data, conducted observation studies, and analyzed water and sediment samples. The levels of anthropogenic contaminants are high in urban environments and traffic frequently plays an important role. In this study, to characterize variability and uncertainty, the deterministic exposure calculations for metal pollutants were supplemented by a probability bounds analysis for the polycyclic aromatic hydrocarbons (PAH). The results from these calculations show that oral intake is the major exposure route for metals, while skin absorption, with present assumptions, is more important for the PAH. The presently measured levels of contaminants, at this public bathing place, cannot be anticipated to cause any significant adverse influence on public health. This assessment methodology is easy to adapt and can be used routinely in other situations with more heavily contaminated surface sediments and lake water.

Therapeutic devices for fecal incontinence: dynamic graciloplasty, artificial bowel sphincter and sacral nerve stimulation

Fecal incontinence is a disorder with significant adverse influence on normal daily activities and quality of life. Since normal continence requires perfect coordination among several muscular systems and neural pathways, as well as normal stool consistency, various levels of incontinence can result if any of these systems malfunction. Owing to these complex interactions, therapeutic approaches vary; in mild-to-moderate cases, dietary changes and biofeedback sessions accompanied by specific medications can achieve a salutary effect. In cases of severe fecal incontinence, a conservative approach is ineffective and surgical intervention is indicated. Even today the historical rescue solution of permanent colostomy is still employed. However, several technical innovations and devices introduced over the years enable surgeons to offer patients reliable solutions for this functional disorder. While dynamic graciloplasty uses native muscle contraction ability to function as a new sphincter, the artificial bowel sphincter achieves the same goal by an inflatable cuff. A novel approach, which is suitable for selected patients with muscular and neurological defects alike, is the sacral nerve stimulator. Although the exact therapeutic sequence of these new alternatives is unclear, current success rates are encouraging. It is crucial to choose the right procedure as determined by the underlying pathology.

Characteristics of wood–fiber plastic composites made of recycled materials

This study investigates the feasibility of using recycled high density polyethylene (rHDPE), polypropylene (rPP) and old newspaper (rONP) fiber to manufacture experimental composite panels. The panels were made through air-forming and hot press. The effects of the fiber and coupling agent concentration on tensile, flexural, internal bond properties and water absorption and thickness swelling of wood-fiber plastic composites were studied. The use of maleated polypropylene as coupling agent improved the compatibility between the fiber and both plastic matrices and mechanical properties of the resultant composites compared well with those of non-coupled ones. Based on the findings in this work, it appears that recycled materials can be used to manufacture value-added panels without having any significant adverse influence on board properties. It was also found that composites with rHDPE provided moderately superior properties, compared with rPP samples.

Enzyme-histochemical studies of griseofulvin-intoxicated mouse livers.

Enzyme-histochemical studies were conducted on livers of mice chronically fed griseofulvin (GF) in order to produce Mallory bodies (MBs) in hepatocytes. The development of MBs is associated with derangement of the immunohistochemically detectable intermediate filament (IF) cytoskeleton of the cytokeratin (CK) type, although no strict correlation between appearance or involution of MBs and the cytoskeletal alterations exists. Since the function of the IF cytoskeleton and the relationship of its disturbance to cell injury is unknown, the aim of the present study was to correlate the activities of several key enzymes of cellular metabolic pathways with the disturbance of the cytoskeleton architecture. For that purpose enzyme-histochemistry in combination with immunohistochemical CK-IF stainings were performed on identical sections. In GF-intoxicated mouse livers the normal topography of enzyme activities was disturbed, but no strict colocalization of enzymatic and cytoskeletal changes was found. Glucose-6-phosphatase, a microsomal enzyme involved in glucose output and gluconeogenesis, showed elevated activity in MB-free hepatocytes with diminished immunostainable CK-IF cytoskeleton refuting the concept of a disability of those cells to export glucose. It could indeed indicate that those cells without MBs are in the state of recovery. However, these cells could also resemble "hyperactive foci". Glycogen was decreased in MB-containing hepatocytes with disturbed cytoskeleton, and this feature favours the assumption of cell degeneration. On the other hand, the mitochondrial marker enzymes, i.e. succinate dehydrogenase, cytochrome-c-oxidase and 3-hydroxybutyrate dehydrogenase, remained unchanged in altered hepatocytes. Alkaline phosphatase activity at the canalicular pole of GF-intoxicated hepatocytes was elevated, indicating cholestatic features associated with this disorder. However, since altered hepatocytes did not show impairment of oxido-reductase activities, a severe impairment of bile secretion as a consequence of cell damage is unlikely. Unchanged or even increased ATPase activity of altered hepatocytes also indicated their sustained metabolic abilities. The results presented provide indirect evidence that hepatocytes with disturbed IF cytoskeleton do not significantly differ from normal cells with respect to oxidative metabolism, fatty acid synthesis and gluconeogenesis. This suggests that alterations of the IF cytoskeleton associated with GF intoxication and MB formation have no significant adverse influence on the metabolic functions of liver cells, as far as can be assessed by evaluation by enzyme-histochemical staining of several key enzymes.

Evaluation of the Physical and Mechanical Properties of Medium Density Fiberboard Made from Old Newsprint Fibers

The goal of this study was to investigate the use of old newsprint (ONP) fiber as raw material for laboratory made medium density fiberboard (MDF). Effect of ONP fiber mixed with virgin aspen (Populus deltoides) fiber and the press time (3, 4, and 5 min) on the properties of MDF panels were determined. Panels were produced using aspen fibers in surface layer and combination of aspen fibers and ONP fibers in core layer. Physical (thickness swelling) and mechanical properties of the panels were determined according to the procedure of EN standards. This study showed reduction in bending strength and internal bond strength of the panels as ONP fiber was loaded from 35 to 70% in core layer. Thickness swelling of MDF panels was drastically increased with addition of ONP fiber to the panels’ furnishes. Based on the findings of this study, it appears that ONP can be considered as a potentially suitable raw material for manufacturing MDF products without having any significant adverse influence on the panel properties.

Manufacturing particleboard panels from betel palm (Areca catechu Linn.)

Abstract This study is an attempt to investigate the use of betel palm ( Areca catechu Linn.) to manufacture experimental particleboard panels. The panels were tested for their mechanical and physical properties according to the procedures defined by Chinese National Standards [Chinese National Standard (CNS), CNS-2215 Particleboard, Bureau of Standards, Metrology and Inspection, MOEA, Taiwan, ROC, 1999]. The highest modulus of elasticity (MOE), modulus of rupture (MOR), internal bond strength (IB), and screw holding strength values of the samples were found as 2180 N/mm 2 , 14.6 N/mm 2 , 0.78 N/mm 2 and 600 N/mm 2 for the panels made using 10% urea formaldehyde with a target density of 0.70 g/cm 3 , respectively. Overall physical and mechanical properties of both types of panels produced with and without adding wax into the mats resulted in accepted values. Based on the findings in this study, it appears that betel palm can be used to manufacture value-added panels without having any significant adverse influence on board properties.

Influences of working conditions on the performance of sign language interpreters and teachers of deaf students in Oyo State, Nigeria

This study, against the background of some perceived poor working conditions of personnel working with special needs persons, sought to ascertain the impacts of some specific working conditions on the job performances of sign language interpreters and teachers of deaf students. 81 interpreters and teachers constituted the study sample. They were purposively selected from some secondary schools for deaf students, Federal College of Education (Special) Oyo and University of Ibadan, all in Oyo state. One research question and three hypotheses were raised for testing. Section D of the Occupational Stress Questionnaire (OSQ) was administered to the study participants. The section contains 16 items designed to ascertain effects of specific poor working conditions on workers. Findings showed that poor working conditions such as delay in promotion and salary payment and unattractive office accommodation have significant adverse influence on working performance of both teachers and interpreters. Teachers significantly felt the disturbing influence of poor working conditions on their job performance than the sign language interpreters. However, gender and marital status have no significant relationship with the participants' sensitivity to the negative influence of poor working conditions on their work performance. Recommendation were made to initiate a turning around of the working conditions for personnel who work with special needs individuals for the good of these personnel and their clients. African Journal for the Psychological Study of Social Issues Vol. 9(2) 2006: 233-248

Predicitve Value of Pretransplant Testing.

Routine evaluation prior to stem cell transplantation generally includes assessment of left ventricular ejection fraction (EF), pulmonary function, renal function, liver function, and functional status. Patients in whom compromised organ function is detected, are often deemed ineligible for myeloablative transplantation. However, the predictive value of specific pretransplant tests is not well documented, and has not been critically analyzed in patients receiving busulfan-based preparative regimens. We analyzed the prognostic value of the pretransplant evaluation performed in 1035 consecutive patients who underwent autologous (n=444) or allogeneic (n=591) transplantation with busulfan-based regimens between 2/84 and 12/03 for acute (250) or chronic leukemia (198), myelodysplasia (50), multiple myeloma (88), or Hodgkin's (139) or non-Hodgkin's lymphoma (303). Ages ranged from 4–75 (median 41). BuCy was given to 477 and BuCyVP16 to 558 individuals.Ninety three patients had EF < 50%, 61 had DLCO < 65%, 103 had elevated creatine, 130 had elevated tranaminases or bilirubin, and 116 had Karnofsky scores < 80%. For the entire group, multivariable analysis demonstrated only Karnofsky score < 80% (P < .001) and elevated LFTs (P=.04) to have significant adverse prognostic influence on survival. Karnofsky score was significant in patients undergoing autologous (P <.001) or allogenic (P <.001) transplantation. Neither EF nor DLCO were predictive of poor outcome for the overall group (P >.2), nor for the autologous or allogeneic transplant groups. However in patients undergoing transplants from unrelated donors (n=119) DLCO < 65% was a significant adverse prognostic factor (P=.004). There was no association of compromised cardiac or pulmonary function with cardiac or pulmonary failure as a primary cause of death. This study suggests that moderately compromised organ function, particularly cardiopulmonary limitations which might not be clinically apparent, are of limited value in prediction of transplant outcome. Direct clinical assessment, including functional status are of much greater value in prediction of outcome. It is hoped that this investigation will stimulate larger studies of pretransplant predictors of outcome with attention to their relevance to specific preparative regimens, sources of stem cells, and other treatment variables.

It's moving day: factors affecting peripheral blood stem mobilization and strategies for improvement

It's moving day: factors affecting peripheral blood stem mobilization and strategies for improvement

Time factor in postoperative radiotherapy: A multivariate locoregional control analysis in 868 patients

Purpose To study locoregional tumor control in postoperative radiotherapy (PRT) for head-and-neck cancer in relation to the position and duration of treatment gaps, duration of the interval surgery-radiotherapy, and to the other potentially prognostic variables. Methods and materials The retrospective study included 868 patients with cancer of the larynx, oral cavity, oropharynx, and hypopharynx treated in Gliwice between 1980 and 1997. Mean total radiation dose, dose per fraction, overall radiation treatment time (OTT), and the interval surgery-PRT were 62.8 Gy, 2.1 Gy, 45 days, and 63 days, respectively. No interruptions during PRT (except for weekend breaks) appeared in 30% of patients, whereas 19% had more than 5 days of gap. The actuarial locoregional recurrence-free survival (RFS) has been examined using multivariate Cox regression model, and the ultimate locoregional tumor control probability using a logistic model. Results Increased duration of treatment gaps, positive resection margins, pathologically proven metastases to the neck nodes, and extralaryngeal site of cancer were significantly related to a decrease in RFS. The duration of time interval surgery-PRT appeared, by contrast, only borderline significant for RFS. The relative risk of locoregional recurrence was approximately the same for the gaps in days 1–21 as for the “late” gaps (days >21), except in a subgroup of patients with positive clinical margins. The logistic analysis revealed a significant time-related displacement of the dose–response curves for PRT. The detriment from the protraction of OTT appeared to be larger than the benefit from the equivalent shortening of OTT. Conclusions Although the conclusions from this study must be regarded as only hypothesis-generating, we assume that a highly significant adverse influence of radiation treatment gaps on the rate of tumor control is consistent with rapid repopulation of cancer clonogenes during PRT. Lack of significant effect of the position of gaps on locoregional tumor control after radical surgery may suggest that a lag time for the onset of repopulation in PRT is short. A less likely explanation is that the total amount of regeneration during OTT is the same, regardless of the timing of the gap, even if all the repopulation occurred late. The magnitude of the detriment in tumor control from prolonged interval surgery-PRT indicates that repopulation of cancer cells between surgery and radiotherapy is not as fast as between the fractions of radiotherapy.

Evaluation of regulatory influence of four plant growth regulators on the reproductive potential and longevity of melon fruit fly (Bactrocera cucurbitae)

The topical treatment given to freshly emerged (0–1-day-old) male and female adults ofBactrocera cucurbitae (Coquillett), a serious pest of cucurbit crops in tropical countries, with 25, 125, 625 and 3125 ppm concentrations of gibberellic acid (GA3), indole-3-acetic acid (IAA), kinetin and coumarin showed a significant adverse influence on the reproductive potential of this fruit fly. The assessment for reproductive potential was made on the basis of reduction in fecundity and fertility of laid eggs and measured as sterility in females and shortening of the longevity,i.e. ovipositional phase. The strongest influence was with kinetin, followed closely by coumarin, then GA3 and lastly with IAA treatments. It was concluded that although these compounds demonstrate their activities differently in plants and might be following a different mode of action in insects, they ultimately influence the reproductive potential of this insect.

Allogeneic Bone Marrow Transplantation for Chronic Myeloid Leukemia: A Single Center Experience

Background Bone marrow transplantation (BMT) is the therapy of choice for patients with chronic myeloid leukemia (CML) who have a human leukocyte antigen (HLA)-identical donor and are under 50 years of age. Methods Here, 45 patients with CML were treated with busulfan (Bu) 16 mg/kg and cyclophosphamide (Cy) 120 mg/kg before allogeneic BMT from an HLA-identical sibling 27 (60%) or a 1-antigen mismatch donor 18 (40%). Eighteen patients (40%) were in the early chronic phase (CP) and 27 (60%) in late CP. We used cyclosporin-A (CsA) in 20 patients and cyclosporin-A-methotrexate (CsA-MTX) in 25 for graft-vs.-host disease (GVHD) prophylaxis. Results We observed a high incidence of acute and chronic GVHD (69% and 67%, respectively). A multivariate analysis identified differences in the sex of the donor and the recipient ( p = 0.03) and grade III-IV acute GVHD ( p = 0.0001) as significant adverse influences on disease-free survival. Age, sex, chronic GVHD, disease phase, one antigen-mismatch and use of CsA or CsA-MTX had no statistical significance. The 3-year probabilities of relapse, disease-free survival, and overall survival were 11%, 55%, and 60%, respectively. Transplant-related mortality occurred in 31% of the cases. The high frequency of GVHD is explained by HLA determination by serological typing, differences in sex between the donor and recipient, and a high proportion (40%) of 1 antigen-mismatch donors. Conclusions BMT is a procedure feasible for patients with CML in early and late chronic phase and even in those with an HLA non-identical donor. Strategies directed to decrease acute GVHD could improve the outcome of these patients.

Does pneumonectomy for lung cancer adversely influence long-term survival?

Objective: The increased operative mortality associated with pneumonectomy has stimulated the use of lung-sparing operations such as sleeve lobectomy. Whether pneumonectomy adversely affects long-term outcome after lung resection is unknown. Methods: We reviewed the cases of patients who underwent lobectomy/bilobectomy or pneumonectomy because of non–small cell lung cancer between January 1980 and June 1998. Survival curves were compared by the log-rank test. Covariates were determined for operative mortality and survival using logistic regression analysis and Cox proportional hazards estimation, respectively. Results: There were 259 men and 183 women who underwent lobectomy/bilobectomy (340) or pneumonectomy (102). Operative mortality was 36 (8.1%) patients overall, 24 (7.0%) for lobectomy/bilobectomy and 12 (12%) for pneumonectomy. Mean follow-up was 41 months (range 0-222 months). Median survival was worse for pneumonectomy (stage II: 17.9 vs 36.3 months, log-rank P = .05; stage III: 11.7 vs 21.3 months, log-rank P = .07). However, important covariates for survival were age, primary tumor status, regional nodal status, and forced expiratory volume in 1 second. After adjusting for these covariates, survival did not differ significantly between the types of operations (hazard ratio for pneumonectomy 1.21; 95% CI 0.88-1.68). Conclusions: We did not detect a significant long-term adverse influence of pneumonectomy on survival after adjusting for other prognostic factors, but randomized clinical trials would be needed to definitively address this issue. (J Thorac Cardiovasc Surg 2000;119:440-8)

Epstein-Barr Virus-Latent Membrane Protein 1 Expression Has a Favorable Influence in the Outcome of Patients with Hodgkin's Disease Treated with Chemotherapy

The effect of molecular factors in the outcome of Hodgkin's Disease (HD) is being currently studied. In a previous series of HD. including patients treated only with radiotherapy and patients treated with chemotherapy (with or without radiotherapy). we found that a high proliferation index had an adverse influence in overall survival (OS) and in the achievement of a complete remission (CR). Loss of Rb expression also had an adverse prognostie influence in achievement of CR. On the other hand LMPI-EBV expression had a favorable influence for OS. The expression of other molecular factors. P53, be12 and CD15 did not show prognostic influcnce. In the present paper we have studied the effect of the e molecular variables in 110 patients, of the previous series who had been treated with chemotherapy. A retrospective study was performed in these 110 patients with HD treated with chemotherapy (ABVD or variants, 62%. or regimes not containing adriamycin, 38%) with or without adjutant radiotherapy, collected at the 11 centers belonging to the Spanish Collaborative Group for the Study of Hodgkin's Disease. The prognostie value of clinical variables and the expression of p53. be12. CD15. Rb, LMP I-EBV and proliferative fraction demonstrated with sensitive immunohistochemical methods were studied. Cox's multivariate analysis was performed to assess their influence in failure-free survival (FFS) and OS. A multivariate logistic regression analysis was perfomied for studying the effect of the variables in the achievement of a CR.Of the clinical variables, only advanced stage (III/IV) had a significant independent adverse influence in FFS, in OS and in the achievement of CR and advanced age in OS. Of the molecular variables, LMPI-EBV had an independent and strong favorable influence in FFS, in OS and in the achievement of CR. Rb expression had a modest favorable influence in CR. The rest of the molecular variables had no independent influence on the outcome of the disease. In conclusion these results confirm the favorable prognostic value of LMPl -EBV expression in the subset of patients with HD treated with chemotherapy.

Postoperative outcome of 37 patients with lobar intracerebral hemorrhage related to cerebral amyloid angiopathy.

Several recent studies have suggested that neurosurgical procedures are not contraindicated in patients with cerebral amyloid angiopathy (CAA). The purpose of this study was to elucidate the clinical factors influencing the outcome of patients with CAA-related intracerebral hemorrhage (ICH) treated surgically. A total of 50 neurosurgical procedures (42 intracerebral hematoma evacuations, 4 ventriculoperitoneal shunts, 3 ventricular drainages, and 1 brain biopsy) were performed in 37 patients with CAA-related ICH. To ascertain the clinical factors that may influence their postoperative outcome, their clinical data (demographics, medical history, recurrent lobar hemorrhage, radiographic characteristics, multiple lobar hemorrhage, surgical details, and postoperative hemorrhage) were examined retrospectively and subjected to multivariate analysis. Twenty patients (54%) had a good outcome, and only 4 (11%) died. Parietal hematomas, advanced age (>/=75 years), and intraventricular hemorrhages had significant adverse influence on the postoperative outcome. Clinically significant postoperative hemorrhage requiring evacuation occurred after 2 (5%) of 42 intracerebral hematoma evacuations. Postoperative hemorrhage did not have significant adverse influence on the outcome. Neurosurgery can be performed relatively safely in patients with CAA-related ICH, and their postoperative outcome is better than that reported previously. Surgical treatment should be considered for such patients aged <75 years without a parietal hematoma and intraventricular hemorrhage.

Outcome of Patients With Small-Cell Lung Cancer During 20 Years of Clinical Research at the US National Cancer Institute

To determine the outcome of all patients with small-cell lung cancer (SCLC) treated at the US National Cancer Institute between April 1973 and April 1993.We retrospectively analyzed a series of 594 consecutive patients with SCLC treated at a single institution during a 20-year period to assess changes in duration of survival and toxicity related to various treatment regimens.For analysis, patients were grouped by decade, and the duration of survival of patients with limited- and extensive-stage SCLC was examined to assess whether patients treated during the first decade of the study (1973 through 1983), when cyclophosphamide-based regimens were used, had different outcomes than those treated during the second decade (1983 through 1993), when cisplatin-based regimens were used. Patients had a minimal follow-up of 2 years.No significant difference was found in the survival of patients with limited- or extensive-stage SCLC treated during the second decade in comparison with during the first decade of the study. Among patients with extensive-stage SCLC, performance status 3 or 4 and metastatic lesions of the liver and central nervous system had a significant adverse effect on survival in both the first and the second decade. Among patients with limited-stage disease, performance status 3 or 4 had the most significant adverse influence on survival during the overall study period. In addition, in a multivariate analysis, etoposide-cisplatin plus twice-daily chest radiotherapy was significantly associated with prolonged survival (P = 0.003).We noted no significant change in the duration of survival of patients with either limited-or extensive-stage SCLC treated at our institution during a 20-year period. A multivariate analysis showed that patients with limited-stage SCLC given a cisplatin-based regimen plus chest radiotherapy lived modestly longer than similar patients given cyclophosphamide regimens at our institution. No evidence was found of changes in pretreatment factors that would affect survival.