Evaluation of seven tumour markers in pleural fluid for the diagnosis of malignant effusions

Carcinoembryonic antigen (CEA), carbohydrate antigens 15–3, 19–9 and 72–4 (CA 15–3, CA 19–9 and CA 72–4), cytokeratin 19 fragments (CYFRA 21–1), neuron-specific enolase (NSE) and squamous cell carcinoma antigen (SCC) were evaluated in pleural fluid for the diagnosis of malignant effusions. With a specificity of 99%, determined in a series of 121 benign effusions, the best individual diagnostic sensitivities in the whole series of 215 malignant effusions or in the subgroup of adenocarcinomas were observed with CEA, CA 15–3 and CA 72–4. As expected, a high sensitivity was obtained with SCC in squamous cell carcinomas and with NSE in small-cell lung carcinomas. CYFRA and/or CA 15–3 were frequently increased in mesotheliomas. Discriminant analysis showed that the optimal combination for diagnosis of non-lymphomatous malignant effusions was CEA + CA 15–3 + CYFRA + NSE: sensitivity of 94.4% with an overall specificity of 95%. In malignant effusions with a negative cytology, 83.9% were diagnosed using this association. The association CYFRA + NSE + SCC was able to discriminate adenocarcinomas from small-cell lung cancers. Regarding their sensitivity and their complementarity, CEA, CA 15–3, CYFRA 21–1, NSE and SCC appear to be very useful to improve the diagnosis of malignant pleural effusions. © 1999 Cancer Research Campaig

New insights into the role of age and carcinoembryonic antigen in the prognosis of colorectal cancer

The aim of this study was to verify through relative survival (an estimate of cancer-specific survival) the true prognostic factors of colorectal cancer. The study involved 506 patients who underwent locally radical resection. All the clinical, histological and laboratory parameters were prognostically analysed for both overall and relative survival. This latter was calculated from the expected survival of the general population with identical age, sex and calendar years of observation. Univariate and multivariate analyses were applied to the proportional hazards model. Liver metastases, age, lymph node involvement and depth of bowel wall involvement were independent prognosticators of both overall and relative survival, whereas carcinoembryonic antigen (CEA) was predictive only of relative survival. Increasing age was unfavourably related to overall survival, but mildly protective with regard to relative survival. Three out of the five prognostic factors identified are the cornerstones of the current staging systems, and were confirmed as adequate by the analysis of relative survival. The results regarding age explain the conflicting findings so far obtained from studies considering overall survival only and advise against the adoption of absolute age limits in therapeutic protocols. Moreover, the prechemotherapy CEA level showed a high clinical value

Safety Assessment of Pharmaceutical Distribution in a Hospital Environment

Many of the catastrophic errors in health care are related to inadequate procedures. Robust preventative actions are therefore required to minimize the risks inherent to the prescribing, dispensing and administration of medicines. The redesigning of subsystem processes is a goal that should be undertaken to improve the overall safety of hospitals. Many organizations are beginning to apply traditional aerospace engineering methodologies to the study of patient safety. In a hospital setting, the pharmacy department is responsible for the procurement, distribution, and control of all medicines used within the organization. Pharmacists should ensure that medicines are delivered to patient care areas in a safe and secure manner and that they are available to the administration within a time frame that meets the essential needs of patients. A Failure mode analysis applied to pharmaceutical distribution has been carried out in the S.G.Battista Hospital in Turin (Italy), from the receiving of the goods stage to the delivery to the departments. Two main high risk activities have been identified from risk matrices and risk priority number analysis. The first activity concerns the picking and packing phases and the second one is due to the low efficiency of the random controls of pharmacists. The analysis has also pointed out some medium risk activities in the refill request control, storage temperature control and consignment to delivery service departments. The present analysis has offered the opportunity of quantifying safety within a specific hospital environment and of designing feasible corrective actions. The real effectiveness of the proposed actions will be verified during a subsequent experimental phas

Safety Assessment of Pharmaceutical Distribution in a Hospital Environment

Many of the catastrophic errors in health care are related to inadequate procedures. Robust preventative actions are therefore required to minimize the risks inherent to the prescribing, dispensing and administration of medicines. The redesigning of subsystem processes is a goal that should be undertaken to improve the overall safety of hospitals. Many organizations are beginning to apply traditional aerospace engineering methodologies to the study of patient safety. In a hospital setting, the pharmacy department is responsible for the procurement, distribution, and control of all medicines used within the organization. Pharmacists should ensure that medicines are delivered to patient care areas in a safe and secure manner and that they are available to the administration within a time frame that meets the essential needs of patients. A Failure mode analysis applied to pharmaceutical distribution has been carried out in the S.G.Battista Hospital in Turin (Italy), from the receiving of the goods stage to the delivery to the departments. Two main high risk activities have been identified from risk matrices and risk priority number analysis. The first activity concerns the picking and packing phases and the second one is due to the low efficiency of the random controls of pharmacists. The analysis has also pointed out some medium risk activities in the refill request control, storage temperature control and consignment to delivery service departments. The present analysis has offered the opportunity of quantifying safety within a specific hospital environment and of designing feasible corrective actions. The real effectiveness of the proposed actions will be verified during a subsequent experimental phase

Pulmonary lymphangioleiomyomatosis in postmenopausal women: report of two cases and review of the literature.

Pulmonary lymphangioleiomyomatosis, a disease largely confined to women in their reproductive years, is reported in two postmenopausal patients. Nine similar cases in the literature are reviewed. In older women, the disease appears to be similar to that described in younger women, with the possible exception that the clinical course may be longer and more benign after the menopause. It would appear that hormonal factors play a role in the development of the disease both before and after the menopause, and that hormonal treatment may be beneficial in the older women