For this cohort, the intratumoral TS/beta-actin ratio had a statistically significant association with response and survival. This relationship for other 5-FU schedules remains unknown. Confirmation of these data in a larger patient population could lead to determination of therapy for disseminated colorectal cancer based on a specific intratumoral molecular parameter.

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Sonographic findings in 497 patients with suspected acute cholecystitis were analyzed prospectively. Combined use of primary and secondary sonographic signs led to excellent positive and negative predictive values. Positive predictive values for stones combined with either a positive sonographic Murphy sign (92.2%) or with gallbladder wall thickening (95.2%) were excellent for acute cholecystitis. Positive predictive value of these signs for patients requiring cholecystectomy was even higher (99.0%). Negative predictive values for combined use of primary and secondary signs to exclude acute cholecystitis were also excellent (95.0% for no stones and negative sonographic Murphy sign). Real-time sonography alone, using both primary and secondary signs, can be definitive in nearly 80% of patients with suspected acute cholecystitis. These patients require no further imaging evaluation. Sonography should be the screening test of choice in acute cholecystitis because it is cost effective, prospectively highly accurate, quick, and better at characterizing and detecting other abdominal lesions than cholescintigraphy. A proposed algorithm is described.

Unsuspected pulmonary emboli adversely impact survival in patients with cancer undergoing routine staging multi-row detector computed tomography scanning. J Thromb Haemost 2011; 9: 305-11.Summary. Background: While symptomatic venous thromboembolism adversely impacts survival among cancer patients, the outcome of cancer patients with unsuspected pulmonary embolism (UPE) found on routine cancer staging multi-row detector computed tomography (MDCT) scans is unknown. Objective: To determine whether UPE detected on routine staging MDCT scans impacts overall survival among cancer patients. Patients and methods: We performed a matched cohort study of cancer patients diagnosed with UPE on routine staging scans between May 2003 and August 2006. Two controls (n = 137) were individually matched by age (± 5 years), cancer type and stage for each UPE patient (n = 70). We used CoxÕs proportional hazard models to compare the mortality between UPE patients and their matched controls. Results: The hazard ratio (HR) for death among UPE patients was 1.51 (95% CI 1.01-2.27, P = 0.048). Compared with their matched controls, patients with UPE more proximal than the subsegmental arterial branches had a HR for death at 6 months of 2.28 (95% CI 1.20-4.33, P = 0.011) and an overall HR of 1.70 (95% CI 1.06-2.74, P = 0.027). Survival among UPE patients with isolated subsegmental PE (ISSPE) was not significantly different than that of matched controls (HR 1.04 95% CI 0.44-2.39, P = 0.92). Conclusions: UPE identified more proximal than the subsegmental arterial branches has a significant negative impact on survival among cancer patients.