Disease clusters in structured environments

This paper discusses the distributions of several cluster statistics and illustrates their utility in the analysis of disease incidence or prevalence data arising in organized or structured environments. Such environments involve primary inhabitant locations in office buildings, manufacturing plants, apartment complexes and communities of homes, for example. The methods, which include some generalizations of some existing methods as well as some new ones, will be used to test for household clustering of Trypanosoma cruzi seropositivity data.     

Cost-effectiveness of transaxillary muscle-sparing same-day operative closure of patent ductus arteriosus

Transaxillary muscle-sparing patent ductus arteriosus closure performed as same-day surgery is described in 10 patients. This approach provides a superb cosmetic result while obviating the need for thoracostomy tube placement.     

Pleomorphic xanthoastrocytoma: DNA flow cytometry and outcome analysis of 12 patients

BACKGROUND: Pleomorphic xanthoastrocytoma (PXA) is an astrocytic tumor occurring primarily in childhood and adolescence with some malignant histologic features but a relatively slow clinical course. However, some tumors progress more rapidly and can undergo malignant degeneration. The authors attempted to determine whether various histologic features or tumor cell proliferative indices might help identify lesions at risk for early progression and distinguish PXAs from malignant gliomas. METHODS: In a retrospective study of 12 patients with PXA, the tumor's histologic features and DNA flow cytometric parameters were compared with their clinical course. DNA flow cytometry values for the S- and G2-phase of the PXAs also were compared with control group samples of malignant and low grade astrocytomas. RESULTS: Of the 12 tumors at initial diagnosis, 5 were considered typical PXAs whereas 7 had some atypical features (4 with paucity of reticulin fibers, 1 with focal necrosis, and 2 with both atypical reticulin and focal necrosis). During the follow-up period (range, 3.75-11 years; mean, 6.8 years), 2 patients had recurrences; 1 atypical reticulin PXA progressed to glioblastoma after 6.5 years and the 1 tumor with focal necrosis recurred at 6 months and again at 2 years with typical histologic features. DNA flow cytometry parameters of the typical PXA group were similar to values for malignant astrocytoma and significantly higher than values for control specimens of low grade astrocytomas. There were no distinctive DNA flow cytometric features that could distinguish this last tumor from others with a more benign clinical course. CONCLUSIONS: Measurements of the S-phase and G2-phase obtained from DNA flow cytometry and atypical histologic features cannot reliably identify PXA patients at risk for early progression and overall are significantly higher than values obtained for low grade gliomas. Therefore, frequent (i.e., two to three times per year) postoperative clinical and radiologic examinations are necessary to judge the appropriateness of adjuvant therapy in patients with PXA. The paradox of slow growth but DNA flow cytometry consistent with aggressive malignant lesions may represent a cell-cycle arrest mechanism in these lesions that could be verified in subsequent studies.     

Measurements of the stiffness map challenge a basic tenet of cochlear theories

The cochlear frequency map is believed to depend on the progressive decrease in partition stiffness from base to apex. Measurements on cochleae from human cadavers by von Békésy (1960) suggested that the elasticity of the partition increases by a factor of 100 from the stapes to the helicotrema. However, conventional models require a factor of nearly 10,000 to support the frequency range of normal hearing if entirely determined by partition stiffness. To test this assumption, we measured point stiffness along the width and length of the partition in the gerbil cochlea. Two major findings result from this study: (1) contrary to von Békésy's results, both cellular and extracellular elements of the sensory epithelium exhibit stiffness gradients; and (2) the stiffness changes by only a factor of 100 over the whole cochlea. Our results imply that present ideas regarding partition vibration need to be significantly revised.