Role of PSA testing in multiphasic health screening

BACKGROUND: Although mass screening for prostate cancer does not meet the criteria for an effective screening programme, multiphasic screening which includes PSA testing is still being carried out. AIM: We decided to study and evaluate the usefulness of PSA testing in multiphasic health screening and at the same time establish age-specific ranges of normal PSA values in our local population. RESULTS: Six hundred and ninety five male patients who had their PSA levels tested during a multiphasic health screening from October 1992 to August 1995 were evaluated. Abnormal PSA levels were repeated and subjected to a DRE and TRUS biopsy if they were persistently high using age-specific PSA ranges. Our results showed 14 (4.1%) out of 695 patients who had an abnormal PSA of > 4 ng/mL. compared to 19 who had abnormal PSA levels using the age-specific PSA ranges. Of the patients who were < 40 yrs of age, no further investigations were done. Amongst those 80 years and older, none had abnormal age-specific PSA rates. No prostate cancers were picked up amongst all the patients investigated. Median age specific PSA values at the 95th percentile was calculated for each age group. A rise in the median PSA values with age was also noted. CONCLUSION: We recommend that in patients less than 40 years of age, PSA should not be carried out as the probability of prostate cancer is almost zero. Similarly, in patients who are 80 years and above and asymptomatic, such screening may not be indicated given the limited options available. Age-specific rates are a better way to reduce the negative biopsy rates in the age-groups that are amenable to curative treatment. With a local set of age-specific PSA ranges, we hope to increase the positive predictive value of PSA for prostate cancers in our local population until more specific and equally sensitive tests are made available.     

Indications for psychotherapy

Measurements of urease activity of various cell fractions of U. urealyticum showed that this activity was confined to the soluble fraction of the cytoplasm. It was attempted to devise a method for electron microscopic detection of the sites of urease activity based on precipitation of electron dense MnO2 at the alkaline pH created by hydrolysis of urea. The results obtained by this method supported the previous results indicating a cytoplasmatic localization of the urease activity in the cells. Helical ribosome patterns were observed when glutaraldehyde fixed cells were treated with the cytochemical test solutions.     

Indications for conjunctival transplantation

Long-term follow-up (two to five years) of 12 unilateral chemical burn patients treated by conjunctival transplantation shows permanent stabilization of the ocular surface. The procedure was used in another group of five patients with unilateral recalcitrant epithelial defects. Regardless of the etiology of the epithelial defect, prompt healing of the surface occurs after conjunctival transplantation with no further stromal loss and long-term stabilization of the surface. Such results suggest that epithelial replacement may be a valuable therapeutic approach to a variety of ocular surface disorders.     

Indications for psychosomatically-oriented dermatologic rehabilitation

Dermatological rehabilitation treatment can take different forms: climato-therapy, baths, phototherapy and psychosomatic treatments. Which of these treatments is of most benefit to any one patient depends on his or her illness. Accordingly, a psychosomatic approach to dermatological illness is indicated mainly when a psychological disorder and a dermatological disease coincide. In addition, dermatoses with psychological triggers or overlays, and also depression, pre-existing emotional disorders and special motivation for psychotherapy should be considered for psychosomatic treatment. Finally, patients who are having trouble accepting or confronting malignant skin tumours may also benefit.     

Prostate specific antigen (PSA) value adjusted for transition zone volume and free PSA (gamma-seminoprotein)/PSA ratio in the diagnosis of prostate cancer in patients with intermediate PSA levels

OBJECTIVE: To identify binding proteins of leptin in human plasma. METHODS: Binding was evaluated by electrophoresis, size exclusion chromatography (SEC), Western blotting, and radioisotope labeling. Quantification of leptin and the different forms of alpha2-macroglobulin (alpha2-M) was performed by ELISA. RESULTS: Leptin interacts with the proteinase inhibitor, alpha2-M. 125I-labeled leptin specifically binds to the transformed inhibitor, which arises by reaction with proteinases or with reactive primary amines. No leptin binding was observed to the native alpha2-M, which abundantly occurs in plasma. The complex formation between leptin and alpha2-M was found to proceed within minutes and was stable, as it resisted separation by SEC and electrophoresis. The Kd of the complex was 2.14 +/- 0.78 micromol/l. Complex formation with transformed alpha2-M did not interfere with the immunological determination of leptin in plasma. The leptin-alpha2-M complex was found to be recognized by the alpha2-M receptor/low density lipoprotein receptor-related protein. By computer analysis, a simple model is presented showing that the degree of transformation of alpha2-M may significantly influence the leptin concentration in blood. CONCLUSIONS: The proteinase inhibitor, alpha2-M, may act as a leptin-binding protein in human plasma. Binding of leptin to transformed alpha2-M and its rapid clearance by the alpha2-M receptor may significantly influence the bioavailability of leptin in human plasma.     

Indications for dental-CT. Case reports

In an earlier study we demonstrated that Concanavalin-A stimulated bovine T cell supernatants inhibited the growth of Cowdria ruminantium in bovine endothelial cells in vitro. An investigation was conducted to identify the cytokines which were responsible for this growth inhibition. Addition of antiserum against bovine interferon gamma (IFN gamma) reproducibly neutralized the inhibitory effect of the T cell supernatants, whereas addition of antisera against bovine tumor necrosis factor alpha (TNF alpha) had no effect. The inhibitory effect of IFN gamma on C. ruminantium growth was not mediated by the production of nitric oxide as there was no detectable difference in nitric oxide levels in cultures that were supplemented with T cell supernatants compared with those that were not. The IFN gamma mediated anti-C. ruminantium effect highlights the importance of cell mediated immune responses in control of these infections and in particular incriminates the protective role of T cells, or cells that secrete IFN gamma.     

Indications for clonidine in child psychiatry

We describe here the clinical and pathologic features associated with a specific translocation, t(2;13), in alveolar rhabdomyosarcoma. Tumor specimens from 14 patients with a t(2;13)-positive alveolar rhabdomyosarcoma were studied for cytogenetic-clinicopathologic correlations. Three patients had occult primary tumors; nine patients had primary tumors of the trunk (mediastinal, pelvic, or rectal). The presence of the t(2;13) was ascertained from examination of tumor involved bone marrow in ten patients who had widespread metastatic disease at the time of diagnosis. Marrow involvement was so extensive in three cases that they were initially diagnosed as acute leukemia. Response to therapy was poor, with only five patients achieving a complete response. Twelve patients have died of their disease at a median survival time of 6 months from diagnosis and one is living with recurrent disease; only one patient survives free of disease.     

Indications for laparotomy after hydrostatic reduction for intussusception

A criterion for successful hydrostatic reduction of intussusception is reflux into the terminal ileum. In our practice, absence of reflux into the terminal ileum is not an indication for laparotomy if the radiographic appearances suggest edema of the ileocecal valve. The aim of this study was to validate our approach. We reviewed the case notes of patients with a diagnosis of intussusception (n = 107; age 11.74 +/- 1.48 months; mean +/- SEM) treated from 1987 to 1991. Eleven required primary laparotomy for peritonitis. Ninety-six patients who had a contrast enema were studied. Edema of the ileocecal valve was defined as a persistent filling defect in the cecum after apparently complete hydrostatic reduction, without reflux of contrast into the distal small bowel. In 59 patients hydrostatic reduction was successful: 11 (18.6%) had edema of the ileocecal valve and no reflux contrast into the terminal ileum (group B). All improved clinically after the enema and needed no further treatment. In 37 patients hydrostatic reduction of the intussusception was unsuccessful and an operation was performed: 26 (70.3%) required manual reduction of the intussusception (group C) and 11 (29.7%) underwent bowel resection (group D). None of the patients with edema of ileocecal valve required further treatment or developed recurrent intussusception. In none of the patients who had an operation was the intussusception found to have been reduced by the contrast enema. There were no deaths.(ABSTRACT TRUNCATED AT 250 WORDS)     

Indications for combination of irradiation and surgery

1) The concept "either irradiation or surgery" for all clinical situations should be eliminated. In many clinical situations, one must think of the combined treatment both for the primary lesion and the regional metastases. Conservatism in both disciplines is to be preferred. 2) If irradiation has no place as the sole treatment for a disease, for example soft tissue sarcomas or parotid tumors, it does not mean that it has no place in the management of the disease. 3) The sequence of the modalities of treatment depends upon the structures involved and the extent of the surgical procedure. If one has to choose between a relatively low dose preoperative irradiation, like 3,000 to 4,000 rads or 5,000 to 6,000 rads postoperatively, the theoretical advantages of preoperative irradiation are outweighed by the proven effectiveness of postoperative irradiation in controlling the locoregional disease.