The 1-year survival rate was similar among candidates and non-candidates for cardiac catheterization and is comparable to that reported for PTCA4–9 and CABG.8,10–14 The age of octogenarians inherently limits the capacity of any treatment modality to substantially prolong survival. Accordingly, palliation of symptoms and improvement in quality of life may be more appropriate end points in this age group. It is important therefore that half of the catheterization candidates experienced a recurrent cardiac event during follow-up. Although most elderly patients have coronary anatomy suitable for PTCA or CABG,15 the use of these procedures to prevent recurrent cardiac events would be expected to produce a higher in-hospital mortality and a similar long-term mortality than that observed in the current study. This underscores the need to develop improved means of identifying octogenarians who will have an unsatisfactory outcome with medical therapy, and to define more specific indications for cardiac catheterization and revascularization in this age group.

Despite widespread concern that emergency ultrasound services are not widely available after regular business hours, data supporting or refuting this concern have not been reported. To determine the availability of emergency ultrasound services as perceived by directors of emergency departments (EDs) and radiology departments, direct mail survey was sent to both ED Directors and Directors of Radiology at 100 large teaching hospitals (more than 300 beds) and 100 smaller nonteaching hospitals (fewer than 300 beds) chosen at random from the American Heart Association Guide. Questions elicited the directors' perceptions of availability of emergency ultrasound services in their own institutions as well as their attitudes toward performance of ultrasound examinations by emergency physicians. The overall response rate was 53%. It was found that 24-hour in-house ultrasound services are rarely available even in large teaching hospitals, even as reported by Directors of Radiology. ED Directors and Directors of Radiology differ significantly in perceptions of ultrasound availability, clinical importance of emergency ultrasound, and desirability of ultrasound performance by ED physicians.

PURPOSE:This Phase II study was designed to test the tolerance and effectiveness of concurrent cisplatin-radiotherapy in the treatment of invasive bladder cancer. Objectives were to determine toxicity, complete response rate, bladder preservation rate, and survival.METHODS AND MATERIALS:Patients with invasive bladder cancer, clinical Stages T2-4, NO-2 or NX, MO were treated with pelvic radiotherapy 40 Gy in 4 weeks and cisplatin 100 mg/m2 on days 1 and 22. Complete responders were given an additional 24 Gy bladder boost plus a third dose of cisplatin; patients with residual tumor after 40 Gy were assigned radical cystectomy.RESULTS:The complete remission rate following cisplatin and 40 Gy for evaluable cases was 31/47 (66%). Acute toxicity was acceptable with only two patients not completing induction therapy. Patients with poorly differentiated tumors were more likely to achieve complete remission. Of fully evaluable patients, 28/42 (67%) achieved complete remission with induction therapy, 11 remain continuously in remission, and eight have relapsed with bladder as the only site of failure. Five of these eight cases relapsed with noninvasive tumor. Of the 14 patients who failed to achieve complete remission, only three remain disease-free. Median survival is not reached, with 17/42 (19/48) deaths reported. Actuarial survival is 64% at 3 years.CONCLUSION:This combined cisplatin-radiotherapy regimen was moderately well-tolerated and associated with tumor clearance in 66% of patients treated. Isolated bladder recurrences with invasive carcinoma are infrequent. Better definition of pretreatment selection criteria is needed if combined modality treatment is to achieve disease control and organ preservation for patients with bladder cancer.