No abstract

Of the hemostatic agents tested, QuikClot improved survival and decreased bleeding in a swine model of lethal vascular and soft tissue injury.

No abstract

Islet cell tumors are rare pancreatic or peripancreatic neoplasms that produce and secrete hormones to a variable degree. These tumors are best divided on clinical grounds into those that produce a recognizable, clinically evident endocrine syndrome (ie, functioning) and those that exhibit no clinical evidence of hormone production (ie, clinically silent). Clinically silent tumors produce symptoms due to mass effect because of their large size. They are often partially cystic or necrotic. Functioning islet cell tumors usually manifest earlier in the course of the disease because of the distinctive signs and symptoms of the associated endocrine syndrome. Clinically silent and functioning tumors cannot be histologically distinguished reliably even with the use of immunohistochemical stains. Insulinoma and gastrinoma, the two most common functioning lesions, are typically small homogeneous masses. Other functioning islet cell tumors include glucagonoma, somatostatinoma, vipoma, and adrenocorticotropic hormone-producing tumor. Larger tumors are associated with calcification, cystic degeneration and necrosis, and a more aggressive behavior (local and vascular invasion as well as distant metastases). There are many different techniques for detection and characterization of these lesions that are usually chosen according to the radiologist's experience and preference. Treatment and prognosis of these lesions depend on the hormone produced, their size, and their behavior.

The authors studied intraarterial digital subtraction angiography (DSA), conventional selective angiography, parathyroid venous sampling (PVS), and intraoperative ultrasound (US) as localization procedures for parathyroid adenomas in 53 patients with proved parathyroid adenomas and previous unsuccessful parathyroid surgery. PVS had the highest overall sensitivity as a single study (80%), followed by intraoperative US (78%), angiography (60%), and DSA (49%). Invasive procedures permitted successful localization of adenomas in 41 of 43 patients studied (95%). False-positive studies were uncommon. The optimum sequence of invasive localization procedures is determined by clinical factors and not by the sensitivity of individual tests. The authors recommend DSA be performed first, followed by angiography, PVS, and intraoperative US, in that order.

The purpose of this multi-site qualitative study is to explore how adolescents talk about tobacco use. Sixty-six students in four high schools became co-researchers and led focus group interviews with 205 fellow students. From the interviews, the authors develop a story line that reports how adolescents begin smoking, how smoking becomes a pervasive influence, how attitudes form about smoking, what it means to be a smoker, and, ultimately, student suggestions for tobacco use prevention. Embedded within this story line are complex questions and contradictions. We explore whether peers really are influential, if the media is important, whether smoking is a matter of personal choice, if schools actually promote tobacco use, and whether adolescents can quit smoking.

Radiography and microscopy were used to investigate the hepatic distribution of iodized oil injected into the hepatic artery in a rabbit VX2 tumor model. Iodized oil accumulates within hepatic metastases and in a ringlike fashion around them. Radiographic and histologic appearances were correlated, and it was concluded that ringlike deposition occurs in peritumoral sinusoids. There was no evidence that iodized oil is cleared by hepatic lymphatics. Early clearance of iodized oil into bile may possibly be caused by localized hepatic ischemia from oil microemboli or by direct phagocytosis by Kupffer cells. The remaining oil is washed through hepatic vasculature, circulates systemically, and is cleared by reticuloendothelial cells in lung, spleen, liver, and bone marrow. This mode of clearance, which has not been considered previously, may be important in the prediction of toxic effects caused by lipid and lipophilic antitumor agents administered via the hepatic artery.

Accurate detection of hepatic metastases is necessary to properly stage and follow many malignancies. Nineteen patients underwent computed tomographic (CT) exami nation with ethiodized oil emulsion 13 (EOE-CT) and liver scintigraphy within 1 month of an exploratory laparotomy. The sensitivity, specificity, and accuracy of these two imaging procedures were evaluated statistically. No differences were seen when the patients were scored as positive or negative for metastases. However, in a lesion-bylesion analysis of 58 hepatic lesions, the sensitivity of EOE-CT was 69.0% and the sensitivity of scintigraphy was 32.8% (p < 0.001). All lesions detected by scintigraphy were also detected by EOE-CT. EOE-CT had a size threshold of 1.0-1.5 cm, while liver scintigraphy had a threshold of 2.5-3.0 cm. EOE-CT is a more sensitive examination for detection of small hepatic metastases than liver scintigraphy.Hepatic metastases occur in as many as 24.5% of patients with certain cancers [1]. Accurate detection of these metastases is necessary for the initial staging, treatment, and subsequent follow-up of patients with a wide variety of malignan cies. Various methods are currently available, including imaging procedures (liver scintigraphy, sonography, and computed tomography [CT]) and various labora tory tests. Previous studies have shown no significant differences in sensitivity, specificity, or accuracy among imaging procedures and an inability of any current imaging procedure to detect reliably metastases smaller than 3 cm in diameter [2]. Combining imaging procedures and laboratory tests did not improve the accuracy of detection [3].Ethiodized oil emulsion (EOE) 13 is a liver-and spleen-specific CT contrast agent used at this institution to diagnose hepatic metastases. To clarify the merits of EOE-CT and liver scintigraphy, we identified 19 patients who had both imaging procedures followed by direct surgical examination of the liver at laparotomy and compared the sensitivity, specificity, and accuracy of the two procedures. Materials and MethodsWe retrospectively reviewed the test results and clinical findings of 49 patients who were being evaluated for a primary or recurrent malignancy and were at risk of hepatic metas tases. Our study included only those patients who were undergoing initial staging of their malignancy and who underwent laparotomy within 3 weeks after EOE-CT and within 4 weeks after liver scintigraphy. Nineteen patients were eligible for analysis. Thirteen patients had colorectal cancer, two had pancreatic carcinoma, and one patient each had melanoma, retroperitoneal sarcoma, esophageal carcinoma, and acinar cell parotid tumor. EOE-13 was administered as an intravenous infusion over a 1 -hr period, at a dose of 0.25 EOE-13 is