Prodromal symptoms vs. early warning signs and clinical action in schizophrenia

The term "prodromal symptoms" has traditionally referred to prepsychotic changes in thought, affect, and cognition that precede the initial onset of schizophrenia. Recently, however, the term has been extended into a clinical action context to refer to the early warning signs (EWS) of impending relapse in patients already diagnosed as having schizophrenia. However, recent reports reviewed by Norman and Malla (1995, this issue) use a narrow definition of prodromal symptoms and question their use in the clinical action context. We argue that the dual use of the term "prodromal symptoms" has led to conceptual confusion and to the impression that EWS cannot be used effectively for clinical action. The ability to base clinical action on EWS is central to schizophrenia therapeutics and is the cornerstone of pharmacological strategies based on early intervention. Our review of the evidence suggests that the effective clinical use of EWS depends on (1) the inclusion of both psychotic and nonpsychotic symptoms as EWS; (2) the use of clinician judgment in combination with predefined symptom changes to define the occurrence of EWS; (3) frequent clinical visits; and (4) the use of family or caregiver informants. We therefore suggest that, in the clinical action context, the terminology "early warning signs of impending relapse" should be used instead.     

Chemotherapy of malignant melanoma

Previous studies have shown the kidney to be an important site for the catabolism of secretin. We have investigated possible sites within the kidney for secretin uptake in four intact anesthetized dogs. The disappearance half-time of an intravenous infusion of secretin, measured by a sensitive and specific ratioimmunoassay in four intact anesthetized dogs was 2.84 minutes. After ureteral ligation (to arrest glomerular filtration), the half-time of a similar intravenous dose of secretin was 2.78 minutes. Finally, the renal vascular pedicles were ligated to totally exclude the kidneys from the circulation and the half-time was found to be 5.43 minutes. These findings demonstrate that the efficient renal mechanisms for secretin degradation are not dependent upon glomerular filtration but upon some other mechanism, presumably located in renal tubular cells.     

Prevention of malignant melanoma

Dermatologists and physicians of other specialties, as well as other health professionals have made tremendous efforts to improve the public education (primary prevention) and early detection (secondary prevention) of cutaneous malignant melanoma (CMM) especially during the last decade. In Australia, the country with the highest incidence of CMM in the world, the first public and effective campaigns were already carried out in the sixties. Through the public campaigns, the knowledge increased about skin cancer, and the attitude and behavior toward sun exposure changed in the population. In the USA and Great Britain too, effective public campaigns were carried out in great numbers and extensive experience was acquired. In Germany, prevention campaigns were first run in regional areas. In 1989, the Commission of Early Detection and Prevention of Melanoma of the German Dermatological Society launched nation-wide campaigns. These activities were complemented by regional campaigns in the 1990s. The analysis of previous campaigns demonstrates that single activities are less effective and repeated campaigns are necessary to increase knowledge about skin and to change attitudes and behavior towards UV-exposure. In addition, the development of sun protective clothing and structural changes, e.g. creation of shady places around open-air swimming pools, should be aimed for. Physicians of other specialties and other health professionals should also be included in prevention campaigns.     

Biochemistry of malignant melanoma

The biochemistry of malignant melanoma is reviewed. The biosynthesis of melanin from tyrosine is described and the role of tyrosinase and other enzymes in melanoma considered. Detailed methods for the assay of free catechols, their metabolites and urinary indole melanogens are included. Normal values for these constituents and their significance in the evaluation of melanoma patients are discussed.     

Immunology of malignant melanoma

Traditionally a homograft valve is used as a pulmonary replacement device for the Ross operation. Right ventricular outflow tract reconstruction during aortic valve replacement with an autograft was performed with stentless xenograft valves in nine patients. Hemodynamic performance is satisfying, but, long term evaluation is needed.     

The changing signs in the relationships among self-efficacy, personal goals, and performance.

The common interpretation of the positive correlation among self-efficacy, personal goals, and performance is questioned. Using self-efficacy theory (A. Bandura, 1977), it was predicted that cross-sectional correlational results were a function of past performance's influence on self-efficacy, and using control theory (W. T. Powers, 1973), it was predicted that self-efficacy could negatively influence subsequent performance. These predictions were supported with 56 undergraduate participants, using a within-person procedure. Personal goals were also positively influenced by self-efficacy and performance but negatively related to subsequent performance. A 2nd study involving 185 undergraduates found that manipulated goal level positively predicted performance and self-efficacy positively predicted performance in the difficult-goal condition. The discussion focuses on conditions likely to affect the sign of the relationship among self-efficacy, goals, and performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The many faces of completely regressed malignant melanoma

The prognostic significance of clinical and histologic regression of malignant melanoma is highly controversial. Although small foci of regression in evolving malignant melanomas seem to have little or no effect on morbidity and mortality, extensive regression in larger, fully evolved lesions may be associated with poor prognosis. This chapter emphasizes the histologic features of regression and the patterns that are responsible for diagnostic pitfalls.     

The current status of somatostatin receptors in malignant melanoma

On the basis that melanomas are of neural crest origin and might contain somatostatin receptors, the authors utilized 111In Pentetreotide (OctreoScan) to image 16 melanoma patients with known sites of disease. Twelve of 16 patients were positive with 38 percent imaging all sites. No lesion less than 1.5 cm imaged nor did one ocular and one amelanotic melanoma. Of the five described somatostatin receptors, OctreoScan binds only 2 and 5 suggesting that not all melanomas contain those receptors. It is concluded that melanomas contain somatostatin receptors and that this property might be used for imaging, tumor suppression with Octreotide, and/or as a target for Octreotide labelled with therapeutic agents such as immune complexes, chemotherapeutic agents or high energy radioisotopes.     

Primary malignant melanoma of the vagina

We report two cases of primary malignant melanoma of the vagina explaining the essential clinical pathological and therapeutic features. They themselves, added those represented in literature, might constitute a further contribution to best definition of the unusual genital pathology, especially as regards prognostic and therapeutic aspects.     

Primary malignant melanoma of the oesophagus

We report the case of a 74-year-old female patient in whom a primary malignant melanoma of the oesophagus was detected at the time of investigation of phlebothrombosis. Therapy of choice for this extremely rare tumour is radical surgical resection of the oesophagus. Even after surgical resection, primary oesophageal melanomas have a very poor prognosis. According to the present state of knowledge, it remains unclear to what extent the prognosis could be improved by adjuvant therapeutic procedures with radiotherapy or chemotherapy and immunostimulation.     

Genetic basis of malignant melanoma]

Visalberghi and Fragaszy [Animal Behaviour 49:1089-1095, 1995] have shown that social influences affect acceptance of novel foods. However, little is known about the temporal course on which such influences act (e.g., for how long they persist and for how many encounters they are effective). To explore this issue, 11 adult tufted capuchins were observed during ten successive encounters with eight unfamiliar foods (phase 1, in which subjects were tested in social or individual condition) and ten more encounters 6 months later (phase 2, in which all subjects were tested in social condition). A total of 680 observational sessions were carried out. Results show that during the first five encounters in phase 1, capuchins ate more when they encountered these foods in the presence of their groupmates than if they encountered them alone. Thereafter, during the second five encounters of phase 1, foods were consumed equivalently whether presented to monkeys socially or individually. In phase 2, the foods were consumed equivalently regardless of the previous circumstance of their presentation (social or alone). In phase 2, consumption was similar to that scored in a previous study for familiar foods [Visalberghi & Fragaszy, Animal Behaviour 49:1089-1095, 1995]. We conclude that 1) foods remain unfamiliar to capuchins only for the first few encounters, 2) social facilitation of consumption of unfamiliar foods is of limited duration, and 3) individuals consumed equivalent amounts of an unfamiliar food when they repeatedly encountered it alone or in the presence of groupmates. These results caution those who interpret similar feeding habits in primate groups as evidence of social influences.     

Markers of melanogenesis in malignant melanoma

Biochemical specifity of malignant melanoma is represented in part by the formation of specific cytoplasmatic particles of the pigment cell--melanosomes--in which the synthesis of pigment eumelanin and pheomelanin takes place and in part by the presence of a specific enzyme--tyrosinase--which catalyzes the formation of pigment eumelanin and pheomelanin and even the formation of specific metabolites (so called melanogens) which are excreted in increased amounts in the course of the disease. Tyrosinase and melanogens are specific for pigment cell and therefore can be used for monitoring of melanogenesis in malignant melanoma. When comparing our results and the results of other authors we can conclude that following of specific markers of melanogenesis in malignant melanoma should serve for the evaluation of prognosis of the disease. The study of melanoma markers is by far not finished. We do hope that nearly future will be able to give a sufficient answer to the question, whether melanogenuria is actually an expression of expected different biochemical or metabolic types of malignant melanoma on the one hand and/or biochemically or immunologically conditioned responses of the host organism on the other.     

Public perception of stroke warning signs and knowledge of potential risk factors

CONTEXT: Decreasing the time from stroke onset to hospital arrival and improving control of stroke risk factors depend on public knowledge of stroke warning signs and risk factors. OBJECTIVE: To assess current public knowledge of stroke warning signs and risk factors. DESIGN: A population-based telephone interview survey using random digit dialing conducted in 1995. SETTING: The Greater Cincinnati, Ohio, metropolitan area, the population of which is similar to that of the United States overall in age, sex, percentage of blacks, and economic status. PARTICIPANTS: Respondents with age, race, and sex that matched the population of patients with acute stroke. MAIN OUTCOME MEASURES: Knowledge of risk factors for stroke and warning signs of stroke as defined by the National Institute of Neurological Disorders and Stroke. RESULTS: Telephone calls were made to 17634 households, which yielded 2642 demographically eligible individuals. Interviews were completed by 1880 respondents (response rate, 71.2%). A total of 1066 respondents (57%) correctly listed at least 1 of the 5 established stroke warning signs, and of all respondents, 1274 (68%) correctly listed at least 1 of the established stroke risk factors. Of the respondents, 469 (57%) of 818 respondents with a history of hypertension listed hypertension, 142 (35%) of 402 respondents who were current smokers listed smoking, and 32 (13%) of 255 respondents with diabetes listed diabetes as a risk factor for stroke. Compared with those younger than 75 years, respondents 75 years or older were less likely to correctly list at least 1 stroke warning sign (60% vs 47%, respectively; P<.001) and were less likely to list at least 1 stroke risk factor (72% vs 56%, respectively; P<.001). CONCLUSION: Considerable education is needed to increase the public's awareness of the warning signs and risk factors for stroke. Respondents with self-reported risk factors for stroke are largely unaware of their increased risk. The population at greatest risk for stroke, the very elderly, are the least knowledgeable about stroke warning signs and risk factors.