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Background: Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy., Methods: Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates., Results: There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups., Conclusion: In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy., (© 2021. The Author(s).)

This study investigated prison homicide perpetrators through the lens of the career criminal perspective. Prison homicide, while a rare event, has critical implications for the prison environment. Despite its importance as a form of institutional violence that must be addressed, only four studies in the past five decades have explored the characteristics of homicide perpetrators/victims, the motives, and circumstances of the crime. The goal of the current study was to develop a better understanding of prison homicide by examining 54 perpetrators who committed 37 inmate homicides over 40 years in a mid-Western state prison system. Results showed that prison homicides typically involved a younger male inmate perpetrator, acting independently, murdering an older inmate, in his cell, by stabbing or beating the victim during an altercation. Perpetrators, in comparison with victims and prisoners in general, had a record indicating more prior community homicides, elevated institutional risk scores, and higher rates of serious and assaultive prison misconduct, all indicative of prior community and prison maladjustment. Consistent with career criminal research, prison homicide perpetrators constitute a small but distinct subset of habitually deviant criminals that perpetrate high rates of criminal and violent behavior regardless of context.

Background: The primary objective of this study was to retrospectively compare short-term outcomes of intracorporeal versus extracorporeal anastomosis for minimally invasive laparoscopic and robotic-assisted right colectomies for benign and malignant disease. Recent studies suggest potential short-term outcomes advantages for the intracorporeal anastomosis technique., Methods: This is a multicenter retrospective propensity score-matched comparison of intracorporeal and extracorporeal anastomosis techniques for laparoscopic and robotic-assisted right colectomy between January 11, 2010, and July 21, 2016., Results: After propensity score-matching, there were a total of 1029 minimal invasive surgery cases for analysis-379 right colectomies (335 robotic-assisted and 44 laparoscopic) done with an intracorporeal anastomosis and 650 right colectomies (253 robotic-assisted and 397 laparoscopic) done with an extracorporeal anastomosis. There were no significant differences in any preoperative patient characteristics between groups. The minimally invasive intracorporeal anastomosis group had significantly longer operative times (p<0.0001), lower conversion to open rate (p = 0.01), shorter hospital length of stay (p = 0.02) and lower complication rate from after discharge to 30-days (p = 0.04) than the extracorporeal anastomosis group., Conclusions: This comparison shows several clinical outcomes advantages for the intracorporeal anastomosis technique in minimally invasive right colectomy. These data may guide future refinements in minimally invasive training techniques and help surgeons choose among different minimally invasive options., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Robert K Cleary MD is on the speaker’s bureau for Intuitive Surgical, Inc. Craig S Johnson MD is on the speaker’s bureau for Intuitive Surgical, Inc. and Pacira Pharmaceutical. Amir L Bastawrous MD is on the speaker’s bureau for Intuitive Surgical, Inc. Mark K Soliman MD is on the speaker’s bureau for Intuitive Surgical, Inc. Daryl S Marx MD is a proctor and observation site and is on the speaker’s bureau for Intuitive Surgical, Inc. Luca Giordano MD is a proctor and observation site for Intuitive Surgical, Inc. Eduardo Parra-Davila MD received a KCI research grant, and is a consultant for Medtronic, Inc. Johnson &Johnson, Inc., Titan, Inc., Bard Davol, Inc., Intuitive Surgical, Inc., Levita, Inc., and Storz, Inc. Vincent J Obias MD is a consultant for Intuitive Surgical, Inc. and Medrobotics, Inc. Joseph C Carmichael MD is on the speaker’s bureau for Johnson and Johnson, Inc., Medtronic, Inc., and Novadeq, Inc. He has also received honoraria from Medrobotics, Inc. for product development. Alessio Pigazzi, MD, is a consultant for Intuitive Surgical, Inc., Johnson and Johnson, Inc., and Medtronic, Inc. For the remaining authors, no disclosures were declared. All institutions received financial support from Intuitive Surgical, Inc. for data collection. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no restrictions on sharing data or materials.

Background: Clostridium difficile colitis is an important cause of morbidity and mortality in the surgical patient. In recent years, Clostridium difficile infections have shown marked increases in frequency, severity, and resistance to standard treatment. With urgent operative interventions and novel endoscopic approaches, pseudomembranous colitis is being seen more commonly in surgical practices., Data Sources: In this paper, we will review a number of papers from the literature. We will discuss the epidemiology, evaluation and treatment of Clostridium difficile infection. Fulminant colitis may require emergency operation. For the surgical endoscopist, fecal microbiota transplantation restores the gastrointestinal flora, and has been shown to be effective in more than 80% of patients., Conclusion: Clostridium difficile infection is a major cause of healthcare-related diarrhea leading to increased morbidity and mortality in surgical patients. Increases in failure rates and resistance to current treatments are clinical and economic challenges in the healthcare situation., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The Personality Assessment Inventory (PAI) has been widely employed in correctional settings as a screening tool to assess inmates' risk for committing various types of institutional misconduct. Evaluations have generally found the PAI scales Antisocial Features (ANT), Aggression (AGG), and the Violence Potential Index (VPI) to be modestly related to institutional misbehavior, thus supporting its construct validity. The current study provides the most comprehensive examination of the predictive and incremental validity of the PAI and its subscales among a large sample of imprisoned offenders to date. In particular, the size of the sample (n = 15,546) and follow-up period (mean time at risk of 2.2 years) allowed for the disaggregation of institutional misconduct by levels of seriousness and separate examinations by conviction offense and criminal history variables. The 3 scales most strongly related to general rule infractions were ANT, AGG, and the VPI. After controlling for age at intake, violent conviction history, prior violent arrests, and time at risk, the PAI scales were shown to add incremental validity to the classification of 4 types of disciplinary infractions ranging from 2 to 4 percentage points. The study also explored the relationship of the PAI's response bias scales to institutional misconduct. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Proper inmate assessment is critical to correctional management and institutional security. While many instruments have been developed to assist with this process, most of these tools have not been validated using samples of female inmates although distinct gender differences have been identified in the inmate population in terms of adaptation and misconduct. The Personality Assessment Inventory (PAI) is a multiscale measure of psychopathology that is being increasingly utilized in the correctional setting to assist with the inmate classification process. The current study contributes to the dearth of literature surrounding gender-responsive inmate classification by utilizing a sample of 2,000 female inmates to examine the incremental and predictive validity of the PAI in association with general and assaultive disciplinary infractions. Findings from this study reveal that the PAI scales presenting the strongest relationship to general and assaultive disciplinary infractions among this female sample included Aggression (AGG), Antisocial Features (ANT), Paranoia (PAR), and the Violence Potential Index (VPI). Moreover, findings derived from this study suggest that certain PAI measures, specifically ARD-T, DRU, and more general substance abuse and mental health indicators may be useful in gender-responsive assessments during the female inmate classification process., (PsycINFO Database Record (c) 2016 APA, all rights reserved.)

Recombinant factor VIII Fc (rFVIIIFc) is a fusion protein consisting of a single B-domain-deleted (BDD) FVIII linked recombinantly to the Fc domain of human IgG1 to extend half-life. To determine if rFVIIIFc could be further improved by maintaining the heavy and light chains within a contiguous single chain (SC), we evaluated the activity and function of SC rFVIIIFc, an isoform that is not processed at residue R1648. SC rFVIIIFc showed equivalent activity in a chromogenic assay compared to rFVIIIFc, but approximately 40% activity by the one-stage clotting assay in the presence of von Willebrand Factor (VWF), with full activity in the absence of VWF. Moreover, SC rFVIIIFc demonstrated markedly delayed thrombin-mediated release from VWF, but an activity similar to that of rFVIIIFc upon activation in FXa generation assays. Therefore, the apparent reduction in specific activity in the aPTT assay appears to be primarily due to delayed release of FVIII from VWF. To assess whether stability and activity of SC rFVIIIFc were affected in vivo, a tail vein transection model in Hemophilia A mice was utilized. The results demonstrated similar pharmacokinetic profiles and comparable efficacy for SC rFVIIIFc and rFVIIIFc. Thus, while the single chain configuration did not promote enhanced half-life, it reduced the rate of release of FVIII from VWF required for activation. This impaired release may underlie the observed reduction in the one-stage clotting assay, but does not appear to affect the physiological activity of SC rFVIIIFc.

The ability of capital juries to accurately predict future prison violence at the sentencing phase of aggravated murder trials was examined through retrospective review of the disciplinary records of 115 male inmates sentenced to either life (n = 65) or death (n = 50) in Oregon from 1985 through 2008, with a mean post-conviction time at risk of 15.3 years. Violent prison behavior was completely unrelated to predictions made by capital jurors, with bidirectional accuracy simply reflecting the base rate of assaultive misconduct in the group. Rejection of the special issue predicting future violence enjoyed 90% accuracy. Conversely, predictions that future violence was probable had 90% error rates. More than 90% of the assaultive rule violations committed by these offenders resulted in no harm or only minor injuries., (Copyright © 2013 John Wiley & Sons, Ltd.)

This large-scale study (N = 23,277) investigated the relationship between criminal history in the community and serious or assaultive prison misconduct, while controlling for the effects of inmate characteristics, general criminality, and custody level. Community violence variables included the rate of prior violent crime arrests and the types of prior violent crime, as well as a range of specific violent crimes of conviction. Behavioral continuity from community to prison was neither simple nor intuitively discernible, depending on the type, recency, and pattern of community criminality. Application of logistic regression models revealed that the omnibus measure of the rate of prior violent arrests was not related to either serious or assaultive prison misconduct. Prior arrests for assault and current convictions for robbery and/or assault, but not prior or current homicides, were associated with an increased risk for prison violence. Current conviction for a sexual assault had the strongest inverse relationship to prison violence, while prior arrests for sexual assault showed no relationship to prison violence. A more "nuanced" approach in assigning risk ratings based on prior criminal history and seriousness of offense is recommended., ((PsycINFO Database Record (c) 2012 APA, all rights reserved).)

Atrial natriuretic peptide (ANP) may be a useful molecule for the treatment of cardiovascular diseases due to its potent natriuretic effects. In an effort to prolong the short in vivo half-life of ANP, fusions of the peptide to the Fc domain of IgG were generated using a semisynthetic methodology. Synthetic ANP peptides were synthesized with thioesters at either the N- or C-termini of the peptide and subsequently linked to the N-terminus of recombinantly expressed Fc using native chemical ligation. The linker length between the ANP and Fc moieties was varied among 2, 11, or 16 amino acids. In addition, either one ("monomeric") or two ("dimeric") ANP peptides were linked to Fc to study whether this modification had an effect on in vitro activity and/or in vivo half-life. The various constructs were studied for in vitro activity using a cell-based cGMP assay. The ANP-Fc fusion constructs were between 16- and ∼375-fold weaker than unconjugated ANP in this assay, and a trend was observed where the most potent conjugates were those with longer linkers and in the dimeric configuration. The pharmacokinetics of several constructs were assessed in rats, and the half-life of the ANP-Fc's were found to be approximately 2 orders of magnitude longer than that of the unconjugated peptide. There was no significant difference in terminal half-life between the monomeric and dimeric constructs (2.8-5.5 h), but a trend was observed where the C(max) of the monomeric constructs was approximately 3-fold higher than that of the dimeric constructs, although the origin of this effect is not understood. These novel ANP-Fc fusion constructs hold promise for future therapeutic application in the treatment of cardiovascular diseases.

Treatment of hemophilia B requires frequent infusions of factor IX (FIX) to prophylax against bleeding episodes. Hemophilia B management would benefit from a FIX protein with an extended half-life. A recombinant fusion protein (rFIXFc) containing a single FIX molecule attached to the Fc region of immunoglobulin G was administered intravenously and found to have an extended half-life, compared with recombinant FIX (rFIX) in normal mice, rats, monkeys, and FIX-deficient mice and dogs. Recombinant FIXFc protein concentration was determined in all species, and rFIXFc activity was measured in FIX-deficient animals. The half-life of rFIXFc was approximately 3- to 4-fold longer than that of rFIX in all species. In contrast, in mice in which the neonatal Fc receptor (FcRn) was deleted, the half-life of rFIXFc was similar to rFIX, confirming the increased circulatory time was due to protection of the rFIXFc via the Fc/FcRn interaction. Whole blood clotting time in FIX-deficient mice was corrected through 144 hours for rFIXFc, compared with 72 hours for rFIX; similar results were observed in FIX-deficient dogs. Taken together, these studies show the enhanced pharmacodynamic and pharmacokinetic properties of the rFIXFc fusion protein and provide the basis for evaluating rFIXFc in patients with hemophilia B.

The federal prison disciplinary records of federal capital inmates (n=145) who were sentenced to life without possibility of release (LWOP) by plea bargain, pre-sentencing withdrawal of the death penalty, or jury determination were retrospectively reviewed (M=6.17 years post-admission). Disaggregated prevalence rates were inversely related to infraction severity: serious infraction =0.324, assaultive infraction =0.207, serious assault =0.09, assault with moderate injury =0.007, assault with major injuries or death =0.00. Frequency rates of misconduct were equivalent to other high-security federal inmates (n=18,561), regardless of infraction severity. Government assertions of "future dangerousness" as a nonstatutory aggravating factor were not predictive of prison misconduct. These findings inform federal capital risk assessments and have public policy implications for procedural reliability in death penalty prosecutions.

An experimental scale for the assessment of prison violence risk among maximum security inmates was developed from a logistic regression analysis involving inmates serving parole-eligible terms of varying length (n = 1,503), life-without-parole inmates (n = 960), and death-sentenced inmates who were mainstreamed into the general prison population (n = 132). Records of institutional violent misconduct of these 2,595 inmates were retrospectively examined for an 11-year period (1991 to 2002). Predictors affecting the likelihood of such misconduct included age, type and length of sentence, education, prior prison terms, prior probated sentences, and years served. The scale was modestly successful, as demonstrated by an overall omnibus area under the curve of .719. Double cross-validation demonstrated minimal shrinkage. The authors have termed this experimental scale the Risk Assessment Scale for Prison.

Death-sentenced inmates in Missouri have been integrated or "mainstreamed" into the general population of the Potosi Correctional Center since 1991. By comparing the rate of violent misconduct among these mainstreamed death-sentenced inmates with that of the life-without-parole and parole eligible inmates under fully integrated conditions of confinement, this study provides the first empirical (statistical) evaluation of this innovative alternative to segregated death row confinement. The mainstreamed death-sentenced inmates committed no inmate or staff homicides, or attempted homicides. Comparison of their rates of institutional violence revealed frequencies that were similar to those of life-without-parole inmates, and well below those of fellow inmates who were sentenced to parole eligible terms. These findings cast serious doubt on the security-driven assumptions that have typified the segregation of death-sentenced inmates and have dictated highly restrictive confinement policies for this group. A conclusion that death-sentenced inmates can be safely integrated into a general prison population has significant implications for allocation of scarce fiscal resources and correctional staff, as well as for inmate mental health, particularly given the extended tenure that death-sentenced inmates typically serve between sentencing and relief/execution.

Mental health evaluations at capital sentencing represent a complex and specialized arena of practice. The moral culpability focus of capital sentencing is distinct from guilt-phase considerations of criminal responsibility, and has a specialized literature. Capital violence risk assessment is uniquely oriented to a prison context, relying on past adjustment to incarceration, as well as group statistical data specific to capital offenders and other inmate groups. Personality testing is a more complex consideration in capital sentencing evaluations. The implications of interviewing the defendant, as well as the parameters and documentation of an interview, make full disclosure and informed consent of particular importance. Defense- and prosecution-retained experts are subject to specific ethical vulnerabilities. These are examined in this paper through the lens of current professional standards., (Copyright 2001 John Wiley & Sons, Ltd.)

Prediction of violence in capital sentencing has been controversial. In the absence of a scientific basis for risk assessment, mental health professionals offering opinions in the capital sentencing context are prone to errors. Actuarial or group statistical data, known as base rates, have proven far superior to other methods for reducing predictive errors in many contexts, including risk assessment. Actuarial follow-up data on violent recidivism of capital murderers in prison and post release have been compiled and analyzed to demonstrate available base rates for use by mental health experts conducting risk assessments pertaining to capital sentencing. This paper also reviews various methods for individualizing the application of base rates to specific cases.

Antisocial Personality Disorder (APD) and PCL-R psychopathy are critically examined regarding their application to sentencing determinations. PCL-R psychopathy is emerging in the literature as a more useful forensic diagnostic construct than APD, which appears flawed by multiple weaknesses. These include shifting diagnostic criteria, innumeracy problems, absence of symptom weighting, temporal instability, and the equivalence of some symptoms with substance abuse disorders. Additionally, APD overdiagnosis may result from inattention to issues of social context, trauma history, and symptom pervasiveness. Neither objective nor projective personality testing reliably differentiates APD. Finally, an APD diagnosis does not always indicate criminal, much less incorrigible criminal behavior. By contrast, PCL-R psychopathy results are strongly predictive of criminal behavior and violent recidivism for Caucasian males through mid-life residing in the community. Emerging research with the PCL-R regarding other important populations and contexts is promising but generalization is currently limited.

The neuropsychological functioning of five men suffering alleged physical, cognitive and behavioural changes following exposure to methylene diphenyl diisocyanate (MDI), an industrial chemical, was investigated in the present study. At the time of assessment, four of the five patients remained symptomatic despite having no contact with MDI for periods ranging from 5 to 9 months. All patients reported experiencing subjective symptoms consisting of respiratory distress, headaches, depression, irritability, forgetfulness, decreased calculating ability, word-finding problems and reduced concentration. While the pattern of neuropsychological deficits varied among the patients, common findings for the group included intact psychomotor, psychosensory, visuographic and language functions accompanied by deceased concentration, mental efficiency, rate of information processing, learning ability and abstract reasoning. All five patients also revealed significant emotional distress on an objective personality measure. In general, the neuropsychological test data support the presence of behavioural and cognitive correlates of CNS injury following exposure to MDI.

Methyl bromide (MB) is a pesticide used primarily as a fumigating agent for homes, storage vehicles and soil. Chronic exposure to MB is known to cause damage to the central nervous system and other organs. Previously published post-mortem studies have also revealed significant brain abnormalities in patients whose deaths were attributed to MB. Only one study to date has examined the neuropsychological effects of this potential neurotoxin. The present case report documents the events surrounding an incident of acute and subacute MB exposure following home fumigation and the neuropsychological after-effects associated with that exposure. Behavioural and cognitive correlates of CNS dysfunction revealed by the neuropsychological testing included impairments in concentration, information processing, learning and memory. Emotional sequelae appeared to be a secondary problem associated with fears over physical well-being and impaired cognition. The cognitive symptomatology did not abate after completion of litigation and award of compensation.

This study examined the attribution of blame by mental health professionals in father/daughter incest cases with respect to the influence of professional affiliation, gender, experience in treating victims and perpetrators, and years of clinical experience. A sample of 101 licensed psychologists, psychiatrists, social workers, and counselors completed a demographic questionnaire, the Jackson Incest Blame Scale, and questionnaire assigning blame for father-daughter incest. A factor analysis of the Jackson Incest Blame Scale yielded six factors rather than the four reported in previous research supporting the hypothesis that attribution of blame is a more complex phenomenon than previously thought. The majority of blame was assigned to the father-perpetrator with mothers and societal factors receiving a small percentage, and daughter victims none of the blame. Clinician experience in treating incest victims, gender of respondent, and professional affiliation differentiated attitudes towards family, situational, and societal blame.

The chronic, long-term effects from exposure to many frequently used pesticides have yet to be fully documented. Migrant Hispanic farm workers who are the frequent victims of such exposures are rarely studied. A neuropsychological test battery was administered to 21 migrant farm workers acutely exposed to Phosdrin, Lannate and Maneb on two occasions, and to 11 controls matched for age, sex, education, socioeconomic status, and ethnicity. Results revealed that two years after the pesticide exposures, the exposed group was significantly more impaired than controls on tests of psychomotor speed, dexterity, and visuospatial memory. Disturbing emotional symptoms were reported with significantly greater frequency by the exposed group in comparison to controls. Results are consistent with the previously reported constellation of symptoms and neuropsychological deficits associated with pesticide exposure.

Clinical use of the Millon Adolescent Personality Inventory (MAPI) depends on computerized interpretation of the pattern of scale score elevations in the profile beyond certain cutoff scores rather than the elevations of single scales. There has been no reported work on the stability of the scale scores or the stability of the 2-point codes in a delinquent population. The MAPI was administered to 46 incarcerated male juvenile delinquents and was readministered after a period of 2 to 4 weeks. The test-retest correlations of the base-rate scale scores ranged from .33 to .89 with a mean of .74, which compare favorably to Millon's (1982) standardization sample. However, only 41% of the 2-point codes were judged to be congruent between administrations. The poor congruence of the 2-point codes across administrations raises doubts about interpretive statements based on these codes.

Awareness of child abuse as a serious social problem has risen sharply in recent years, yet there has been only limited and inadequate research on the abused child's growth and development. This study investigated the aggressive characteristics of young abused children with those of nonabused-neglected and normal children, a comparison not previously made. Results indicated that abused children exhibited significantly more aggression than the nonabused-negected and normal children on TAT stories and in a free play environment. Both the abused and the nonabused-neglected groups demonstrated significantly more aggression in a school setting than did normals. The findings lend empirical verification to previous descriptions of abused children as overly aggressive and support the social learning formulation that children exposed to aggressive parental models will demonstrate aggressive characteristics outside the home. The data are also consistent with prior research that links physical punishment in the home with hyperaggressiveness in children. The need for early identification and treatment of abused children is discussed.

The study demonstrates an effective operant conditioning treatment technique to train appropriate eating behavior in a child with brain damage. The child, a 7-year-old boy, received the training during brief hospitalization in a pediatric rehabilitation unit. The principal treatment modality consisted of verbal commands, praise, and manual guidance. During 2 baseline meals the child ate appropriately on the average of 21% of the time. Rapid improvement in correct eating responses occurred during the first week of treatment, reaching a level of 100% in 2 of the last 4 training meals. Following withdrawal of treatment, correct responses decreased to an average of 69%. When treatment was resumed the child reached a correct eating response level of more than 90% on the fifth meal. This level of performance was maintained when hospital staff and the child's mother were introduced into the program. The child's teacher was trained in the technique prior to his discharge from the hospital. School follow-up of more than 15 weeks indicated proper performance had been maintained at more than 90%. High levels of appropriate eating behavior can be learned in the hospital and generalized to the home and school if parents and teachers are actively engaged in rehabilitation efforts.

Thirty-three patients with multiple myeloma were studied with serial skeletal surveys, serum immunoglobulin levels, and postabsorptive urinary hydroxyproline (Spot-HYPRO) determinations. Twenty receiving chemotherapy were also followed with skeletal surveys in order to evaluate bone response to treatment. A close association was found between skeletal findings and changes in immunoglobulin levels with positive correlation in 71% of the patients. A similar association was found between skeletal disease and Spot-HYPRO level changes in 65%. Five of 12 patients (42%) with partial or complete clinical response to chemotherapy, demonstrated improvement in the appearance of skeletal lesions. Positive correlation between the roentgenographic changes and clinical markers of myeloma as well as therapeutic response, indicates that skeletal surveys are useful and effective in monitoring patients with multiple myeloma.