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[Photodynamic therapy by coloring laser. Can it represent a therapeutic alternative for small epidermoid cancers of the esophagus?].
Our aim was to assess the efficacy of photodynamic therapy in inoperable patients with small esophageal carcinoma. Eleven patients were treated for squamous cell carcinomas ranging in size from 1 to 3 cm2. Hematoporphyrin (between 3 and 5 mg/kg) was injected intravenously and then the tumor irradiated at endoscopy 72 hours later with a dye laser (630 nm) at an energy of 250 joules/cm2. Complete destruction of the lesion was obtained in 6 cases with negative biopsies at 1 month. In all 6 patients, no recurrence was seen after a median follow-up of 4 months (range: 2-38). Partial destruction of the tumor was obtained in 4 cases while treatment was a complete failure in the last patient. Two instances of mild cutaneous photosensitization occurred. Two patients treated for recurrence after radiotherapy, died of esophageal perforation directly related to the procedure. Photodynamic therapy appears to be a possible effective treatment for esophageal squamous cell carcinoma in inoperable patients when other curative treatment modalities are not possible.
Doppler ultrasonography of malignant melanomas of the uvea.
Doppler shifts were detected using duplex and color Doppler scanning in 41 of 42 patients with malignant melanomas of the uvea. Mean maximum tumor systolic velocity was 18.8 +/- 7.6 cm/s. Time-averaged maximum velocity in the tumor vessels was 12.3 +/- 5.3 cm/s. Maximum tumor velocity increased in four of eight tumors and was unchanged or had diminished in the other four 2 to 3 days after ruthenium plaque irradiation. Doppler shifts were undetectable in three tumors, markedly reduced in three tumors, and unchanged in one tumor 1 to 4 months after treatment. We detected minimal non-pulse-synchronized Doppler shifts in one of three tumors, and no shifts in the remaining two tumors 1 1/2 to 4 years after therapy. Color duplex scanning allowed a rapid overview of tumor vasculature and facilitated study of individual vessels.
Neurocognitive deficits of alcoholism: an intervention.
This study investigated the impact of cognitive retraining on a sample of neurocognitively impaired alcoholics (N = 45). The treatment group received training on a hierarchical cumulative learning program. In this paradigm, the subjects mastered an isolated concept to automaticity, at which point a second and then a third concept were added. The training group demonstrated significantly improved performance over the practice and control groups on the three measures taken from the Wisconsin Card Sorting Test: total number of categories, perseverative errors, and nonperseverative errors. Neither the practice nor the control group exhibited significantly improved performance. These data lend support to an information processing perspective and are at odds with research that infers that neurophysiological substrates preclude normal functioning in alcoholics and argues that mere exposure of alcoholics to training stimuli prompts significant improvements. Treatment implications are discussed.
Tinted lenses and related therapies for learning disabilities--a review.
Research relating to the use of Irlen tinted lenses and coloured overlays for underachievers is reviewed. Many of the studies were not published in refereed journals and were methodologically poor. The weaknesses of the Irlen argument are discussed, including the absence of evidence to support the claims that these tints need to be uniquely prescribed and manufactured. Syntonics is another form of visual colour therapy that has been applied to those with a learning disability. Research on this is reviewed, and is also shown to have procedural irregularities which preclude firm conclusions. Owing to the poor quality of much of this research the claims of the protagonists of these therapies cannot be proved or disproved. A proposed new therapy is normally preceded by a valid theoretical hypothesis; this has been lacking in the present topic. Recently, a feasible explanation has been proposed in terms of 'pattern glare' resulting from mild hypersensitivity to epileptogenic patterns. This, together with potential alternative theories, is discussed. In the conclusion of this review, advice is given for eye-care practitioners who may be consulted on these therapies.
[The color Doppler-guided compression therapy of a large false aneurysm of the femoral artery following left heart catheterization].
A ventrally located false aneurysm (7 x 5.2 x 3.4 cm) of the right common femoral artery occurred, after left-heart catheterization by the Judkins technique via this artery, in an 83-year-old woman with aortic valve stenosis. Colour Doppler sonography demonstrated a puncture canal (neck of the aneurysm) filling in both systole and diastole, as well as turbulent flow within the aneurysm. Flow into the aneurysm was considerably reduced when the transducer head compressed the aneurysm, while flow continued in the femoral artery and vein. This compression, maintained for 25 min, completely thrombosed the puncture canal and aneurysm so that no vascular surgery was required.
Effective interventions for reading disability.
A simple, readily accessible, and inexpensive intervention which produces immediate improvements in the reading comprehension abilities of reading-disabled children has been found. The intervention consists of colored overlays, or overlays which reduce the contrast of printed materials. This intervention produces reading comprehension gains in approximately 80 percent of the reading-disabled children tested.
[Multidisciplinary therapy using interferon and immunological evaluation for glioma patients: two-color analysis of T cell subsets].
We have employed IAR therapy [combination of postirradiation, chemotherapy and interferon (IFN)] for malignant glioma patients. Changes of lymphocyte fractions in patients were evaluated before and after IAR therapy, using a recently developed two-color analysis. Eight malignant glioma patients received irradiation, chemotherapy (ACNU) and immunotherapy (OK-432 and IFN-beta). Peripheral blood lymphocytes taken during hospitalization with IAR therapy (first half and latter half), and every 3 to 6 months for 2 years at the longest after IAR therapy were double-stained with FITC- and PI-labelled antibodies and two-color analysis was conducted by a FACS Analyzer. Six patients out of 8 survived for 6 months to 2 years, 2 died after 3 and 6 months, respectively. Leu-2a (suppressor/cytotoxic T), especially Leu-2a+ 15- (cytotoxic T) showed a high value. Leu-2a level decreased during treatment, and both Leu-2a+ 15- and Leu-2a+ 15+ (suppressor T) values decreased. Two thirds of the patients showing an increased Leu-2a+ 15+ level died. Leu 3a (helper/inducer T), especially Leu-3a+ 8+ (inducer T) level decreased, but Leu-3a+ 8- (helper T) level increased during treatment. The level decreased in the worse patients. Leu-3a/Leu-2a ratio was low, but it increased during treatment as compared with the results of conventional therapy. Leu-7, Leu-11a, NK activity, and gamma-IFN productivity were further studied. Treatment combined with IFN revealed an influence on the T cells resulting in an increase of helper T level and suppression of suppressor T level.
Idiopathic hypertrophic subaortic stenosis and ischemic mitral regurgitation: the value of intraoperative transesophageal echocardiography and Doppler color flow imaging in guiding operative therapy.
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Phenotypic and functional analysis of peripheral blood lymphocytes during interferon-alpha 2b therapy in multiple myeloma patients with low tumor mass.
BACKGROUND: IFN-alpha has recently been shown to prolong the remission phase in MM patients with low tumor mass. So far, it is not known whether IFN-alpha exerts its effect directly on the myeloma cells or is mediated by modulation of the host response. METHODS: The immune status of 12 multiple myeloma patients with low tumor mass (10 in remission phase, 2 with stage IA disease) was investigated by phenotypic and functional analyses before, after 3, and after 6 months of recombinant interferon-alpha 2b (IFN-alpha) therapy. RESULTS: Phenotyping of peripheral blood lymphocytes (PBL) revealed a significant decrease of HLA-DR+ (P = 0.01) and CD20+ (P = 0.04) cells after 6 months of therapy. Two-color phenotyping of purified T cell populations (PBT) showed a significant increase of CD4+ CD11b+ cells (P = 0.01) after 6 months of therapy. Functional analyses were carried out on PBL (NK cell-mediated cytotoxicity) and PBT (alloreactive cytotoxicity, CTL; IL2-induced cytotoxicity, LAK activity). NK and CTL activities were poorly influenced by IFN-alpha treatment, whereas LAK activity showed a significant increase (P = 0.007). Any significant association between these immunological changes and the disease status was questioned by the lack of differences between MM in relapse and MM with stable disease at the sixth month of IFN-alpha therapy. CONCLUSIONS: i) IFN-alpha in MM with low tumor mass may exert its therapeutic activity by directly acting on the tumor cells; ii) the parameters which have been used in this study are not appropriate to monitor the immunological effects (if any) of IFN-alpha therapy.
Color flow Doppler imaging during epoprostenol (PGI2) therapy of primary nonfunction following liver transplantation.
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[Usefulness of the Doppler color technic in the diagnosis of thrombosis in a mitral valve mechanical prosthesis and in the monitoring of the results of thrombolytic therapy].
We report the usefulness of Doppler color echocardiography in diagnosis and follow-up in a case of thrombosis of a prosthetic mitral valve. The patient received thrombolytic therapy for this disorder and a favorable clinical outcome was observed. Integrated echocardiographic techniques (M-Mode, cross-sectional, continuous-wave, pulsed-Doppler and color Doppler) could increase the amount of diagnostic information in these situations.
Valvular emergencies.
Valvular emergencies result from a wide variety of causes, including infectious, inflammatory, ischemic, traumatic, degenerative, and recently iatrogenic processes. In addition, prosthetic valves have brought new valvular emergencies that present unique challenges in diagnosis and therapy. The advent of color Doppler and TEE have provided significant enhancements to our diagnostic armamentarium. Similarly, thrombolytic therapy has also found a place in the treatment of a common prosthetic valve emergency--thrombosed mechanical valves. Because of the likelihood of serious consequences, rapid diagnosis and aggressive management of valvular emergencies are needed, but the results can be very gratifying and lead to excellent short- and long-term outcomes.
Takayasu's arteritis: anatomic change before and after steroid therapy evaluated by angiography and echo-Doppler color-flow.
A 36-year-old Italian woman with active Takayasu's disease presented a bilateral occlusions of subclavian artery and stenosis of bilateral common carotid arteries: the maximal diameter stenosis, measured with echo-Doppler color-flow (EDCF) in the longitudinal section was of 43.5 +/- 2.4% on the right and 61 +/- 1.4% on the left. Prednisolone was administered for 30 months at doses from 25 to 6 mg daily (12.5 mg every two days). During steroid therapy we could monitor by EDCF the anatomic change of the involved vessel and a final decrease in carotid wall thickening of 19.8% on the left and 14.0% on the right side. This work demonstrates for the first time that duplex sonography may be an useful tool to asses possible anatomic changes in the carotid lesions of Takayasu's arteritis in response to steroid therapy.
Internal jugular and subclavian vein thrombosis caused by central venous catheters. Evaluation using Doppler blood flow imaging.
Thrombosis of the internal jugular vein and the subclavian vein is often caused by central venous catheters. Doppler blood flow imaging (duplex sonography and color flow imaging) is very useful to establish the diagnosis, as soon as signs of venous obstruction occur after placing a catheter. Twenty-six patients with clinically suspected thrombosis were examined; in 25 patients thrombosis of the internal jugular or subclavian vein was diagnosed. By means of duplex sonography and color flow imaging, the degree of venous obstruction can easily be determined. The efficiency of therapy can be controlled. With color flow imaging, blood flow direction and velocity can be visualized in color which provides global information about hemodynamics in a short time. Furthermore, color flow imaging is a suitable method to detect even small subcutaneous collaterals.
Ocular digitalis effects in normal subjects.
Several visual functions were examined before and during self-application of therapeutic doses of digitoxin. The ERG recordings showed a reduction of the critical flicker fusion frequency from 70 Hz to 35-40 Hz. Recovery of color vision after macular photostress was examined with Nagel's anomaloscope and Jaeger's tritanomaloscope. After digitoxin intake the matching range at the tritanomaloscope was enlarged. Following macular photostress the recovery time of both the Rayleigh and the Trendelenburg matches was significantly prolonged. The mesoptometer readings did not show any changes during the application of digitalis. This demonstrates that the process of neural adaptation is intact during digitoxin therapy. The error score in the Lanthony desaturated 15 panel test was slightly increased after digitalis application. The Farnsworth-Munsell 100-hue test showed a marked increase in the total error score. There were no changes in the standard panel D-15. The Ishihara pseudoisochromatic plates were read without mistakes after digitalis medication. The chromatic visual acuity for red-green and blue was examined by recording the maximum reading distance for the Velhagen pseudoisochromatic plates "65" (Jaeger's test) and "49". For both plates the reading distance was reduced by 50% during digitoxin therapy. Computerized perimetry by colored stimuli (Tübingen Automatic Perimeter by Aulhorn and Durst) did not reveal any definitive changes in sensitivity thresholds with therapeutic serum levels of digitalis. Spectral increment sensitivity for the isolated blue cone system (Wald-Marré approach) was not influenced by therapeutic doses of digitoxin. Topical digitoxin application (0.02 mg/10 ml) did not interfere with the pupillary light reflex (infrared pupillography) or with the accommodative amplitude or intraocular pressure. It did, however, result in toxic keratopathy with swelling of endothelial cells and edema of the corneal stroma and epithelium. All changes disappeared after withdrawal of digitalis.
[Qualitative and quantitative diagnostic possibilities of papillary colorimetry].
Papillary colorimetry is a qualitative and quantitative diagnostic method that defines the displacement of the temporal and nasal color ranges on the x;y plane of the German Industrial Standard (DIN) color chart. Starting with normal temporal and nasal papillary stain values, there are, for qualitative diagnosis, four different directions in which the color range can shift from normal values on the DIN color chart, i.e., in connection with simple optic atrophies, optic atrophies due to vascular conditions, hyperemic papillae, and deviations of the color range under vasodilative therapy. Quantitative examinations of optic atrophy using papillary colorimetry have so far been conducted (1) with simple descending atrophies, (2) following anemic papillary infarct, and (3), rudimentarily, in cases of glaucomatous optic nerve head. The best correlation between papillary atrophy and loss of visual function was found with simple optic atrophy. Hence this last-mentioned condition represents the principal area of application of papillary colorimetry as an examination method.
Homemade putty for hand exercises.
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