Ovarian metastases from cervical carcinomas other than pure adenocarcinomas. A report of 12 cases

Twelve cases of ovarian metastases from cervical carcinomas, most with clinical manifestations of ovarian involvement, are reported. The patients were 23-73 years of age (average, 43 years). The ovarian and cervical tumors were synchronous in eight patients; in three, ovarian tumors were discovered 10 months, 2.5, and 3 years after the detection of a cervical neoplasm. In one patient, the cervical tumor was not discovered until autopsy 7 months after presentation. Four patients had abdominal swelling or distention, three had vaginal bleeding, three had an abnormal Papanicolaou smear, and two had masses discovered during pelvic examination. The ovarian tumors, six of which were bilateral, ranged from 5-17 cm (average, 9.5 cm) in maximal dimension in 11 patients; in the 12th patient, the involved ovary was not enlarged. The cervical tumors were grossly evident in 10 patients. They were usually deeply invasive, often with extracervical extension. Four were squamous cell carcinomas; two, small cell carcinomas; one, a mixed small cell carcinoma and adenocarcinoma; one, a mixed poorly differentiated carcinoid and adenocarcinoma; two, adenosquamous carcinomas; one, a transitional cell carcinoma; and one, an undifferentiated carcinoma. Various features, including bilaterality of the ovarian tumors, the finding that the histologic features of the ovarian tumors typically were unusual for a primary ovarian neoplasm, and the presence of extensive extracervical disease, led to the conclusion that the ovarian tumors were metastatic from the cervix. Although ovarian metastases of cervical carcinoma are uncommon, this series illustrates that, occasionally striking examples with clinical manifestations of ovarian involvement occur.     

Iatrogenic diaphragmatic hernia following abdominal esophagogastrofundoplication: report of a case

The authors describe diagnosis and surgical treatment of a patient with iatrogenic diaphragmatic hernia following esophagogastrofundoduplication by Nissen's operation. The patient had presented a hiatal hernia with esophagitis chronic regurgitation and was submitted to esophagogastrofundoduplication. On the third postoperative day, the patient showed signs of dysphagia and intense dyspnea. The computerized tomography showed the presence of the gastric fundus and it's contents inside the leftpleural cavity. The patient was submitted to a left posterolateral thoractomy and an ischemic peptic ulcer in the gastric fundus, blocked by lung parenchyma was sutured. Then, the stomach was reduced into the abdominal cavity with diaphragmatic suture associated with esophageal and gastric fundus fixation to the right diaphragmatic pilar. The patient presented satisfactory immediate and late postoperative follow-up (1 year). The authors discuss and document aspects of diagnosis as well as surgical indication.     

Pegaspargase: an alternative?

OBJECTIVE: To review the chemistry, pharmacology, pharmacokinetics, clinical activity, adverse effects, dosage, and administration guidelines for pegaspargase. DATA SOURCES: A MEDLINE search (1980-1996), a CANCERLIT search (1983-1996), and a CURRENT CONTENTS search (1980-1996) using the terms pegaspargase, PEG-asparaginase, PEG-L-asparaginase, polyethylene glycol L-asparaginase, polyethylene glycol conjugated L-asparaginase, and Oncaspar were conducted. STUDY SELECTION AND DATA EXTRACTION: All articles were considered for possible inclusion in this review. Abstracts were included only when they were judged to add critical information not otherwise available in the medical literature. DATA SYNTHESIS: L-Asparaginase has been a main component of treatment regimens for acute lymphocytic leukemia. A key limiting factor of L-asparaginase use has been the development of hypersensitivity to the drug. Recently, a polyethylene glycol (PEG) conjugated form of L-asparaginase, pegaspargase, has been made available. PEG modification of L-asparaginase has been shown to alter the tendency of the enzyme to induce an immune response and to extend the half-life of the drug. The majority of patients with hypersensitivity to the native enzyme preparations tolerate pegaspargase without further clinical hypersensitivity. The adverse effect profile of pegaspargase is similar to that of the native forms of L-asparaginase. The recommended dosage of pegaspargase is 2500 IU/m2 administered by intramuscular or intravenous injection every 2 weeks in combination with other chemotherapeutic agents. CONCLUSIONS: Pegaspargase is a safe, effective alternative to L-asparaginase in patients who have had clinical hypersensitivity reactions to both Escherichia coli- and Erwinia carotovora-derived L-asparaginase. However, pegaspargase should not be routinely substituted for L-asparaginase.     

Caregivers and HIV infection. Services and issues

Because of the complexity of their illness, patients infected with HIV may require many services to facilitate the management of the disease. The primary care provider must understand and facilitate the services that are needed and needs to be familiar with the individuals responsible for the care of each patient. There are many stresses that have been identified in HIV caregiving, for informal caregivers and health care workers. These stresses are described, and suggestions for appropriate interventions are outlined.     

The effects of sleep loss on task performance and the electroencephalogram in young and elderly subjects

The effects of 28-h sleep loss on performance, reaction time (RT) distribution functions, and spectral composition of the EEG were evaluated in three choice-RT tasks for young (N = 12, aged 18-24 years) and old (N = 12, aged 62-73 years) subjects. Manipulations of stimulus degradation, stimulus-response compatibility, and interstimulus interval variability were to affect encoding, response selection, and motor adjustment stages, respectively. In order to discriminate between independent variables that were presumed to be computational or energetical in nature, effects on EEG spectra and RT-distributions were studied. Spectra of the EEG indicated higher cortical arousal levels for the elderly than for the young. The most dramatic effect of sleep loss on performance was a marked increase in the number of omitted responses. This effect was smaller for the elderly than for the young. The results suggest that the detrimental effects of sleep loss are smaller in the elderly, which is consistent with an inverted-U relationship between arousal and performance. The age effects on the processing stages were mainly limited to response selection.     

The intrinsic temporal properties of alpha and beta retinal ganglion cells are equivalent

BACKGROUND: Mammalian retinal ganglion cells have been traditionally classified on the basis of morphological and functional criteria, but as yet little is known about the intrinsic membrane properties of these neurons. This study has investigated these properties by making patch-clamp recordings from morphologically identified ganglion cells in the intact retina. RESULTS: The whole-cell configuration of the patch-clamp technique was used to assess the temporal tuning characteristics of alpha and beta cells, the two most extensively studied ganglion cell classes. Fourier analysis was used to examine discharge patterns in response to sinusoidal currents of different frequencies (1-50 Hz). With few exceptions, neurons responded in a stereotypic fashion to changes in temporal modulation, with their output initially increasing and then decreasing as a function of stimulus frequency. Moreover, peak responses in both cell classes were obtained at equivalent temporal frequencies. At high stimulus rates, response probability decreased, but the spikes remained phase-locked to the stimulus cycle, thereby enabling populations of cells to convey temporal information. A small number of ganglion cells did not show an appreciable decrease in output as a function of stimulus frequency, but these cells were not confined to either ganglion cell class. CONCLUSIONS: These findings provide the first evidence that the intrinsic temporal properties of alpha and beta cells are alike. Furthermore, the responses obtained to direct current injections were strikingly similar to those described previously with temporally modulated visual stimuli, suggesting that intrinsic membrane properties may shape the visual responses of alpha and beta cells to a larger degree than has been commonly assumed.     

Tuberculosis control in Bangladesh: success of the DOTS strategy

SETTING: Tuberculosis (TB) has been a major public-health problem in Bangladesh for many decades. National control efforts in the past have not been successful, with less than half of detected cases being cured. In 1993, a project based on the DOTS (directly observed treatment, short-course) strategy was initiated for a population of approximately one million in a rural setting. Following a 78% cure rate in the initial cohort of new smear-positive patients, the project was expanded in phases to cover a rural population of 67 million in 1996. OBJECTIVES: Routine programme data on all new sputum smear-positive patients registered in the TB project since its inception until 1996 were analysed. Case finding results are presented until 1996, as are results of sputum smear conversion after 2 months of treatment in new smear-positive patients for the same cohort of patients. Final treatment outcome results were analysed for new smear-positive patients registered up to 1995. RESULTS: A total of 41,525 patients were registered in the project during the 3-year period. Two-thirds of these were new smear-positive cases and 27% were new smear-negative patients. Sputum smear conversion in 26,151 new smear-positive patients at 2 months was 85%; 5% remained smear-positive, 3% had died and the rest had no sputum examination. Final treatment outcome results in 10,142 new smear-positive patients registered during 1993-1995 showed that 75% were cured, 4% completed treatment but did not have a sputum smear result, 2% remained smear-positive, 6% died, 10% defaulted and 3% were transferred out. CONCLUSION: The DOTS strategy can be successfully implemented in phases in large countries with a high tuberculosis burden. This success is due to decentralizing sputum smear microscopy and treatment delivery services to peripheral health facilities, utilizing the existing primary health care network. High cure rates can be maintained despite rapid expansion of coverage, with proper implementation of the strategy and regular monitoring of reports on case finding, sputum smear conversion and treatment outcome. Case detection needs to be further increased by informing and involving the community in TB control efforts through social mobilization.     

Nicotine nasal spray and vapor inhaler: abuse liability assessment

The differences between shame and guilt are explored, with a focus on experiential and developmental factors and on behavioral reactions to these emotions. The role of shame as a motive for suicidal behavior is illustrated with examples of suicidal behavior in Greek tragedy, Asian cultures, and jails, and among contemporary suicides, such as that in 1996 by Admiral Mike Boorda, Chief of U.S. Naval Operations.