Leiomyosarcoma of the esophagus: results of surgical treatment

BACKGROUND: This study examined the results of surgical treatment of leiomyosarcoma of the esophagus. METHODS: Between January 1920 and December 1996, 17 patients (9 men and 8 women) with leiomyosarcoma of the esophagus were treated surgically at the Mayo Clinic. Median age was 58 years and ranged from 26 to 76 years. Symptoms included dysphagia in 11 patients (64.7%) and odynophagia in 6 (35.3%). The tumor was located in the middle third of the esophagus in 10 patients (58.8%) and in the cervical esophagus in 7 (41.2%). Procedures performed included esophagogastrectomy in 9 patients (Ivor Lewis in 5, left thoracoabdominal in 3, and transhiatal in 1), enucleation in 3, transgastric excision in 1, and exploration without resection in 4. RESULTS: The procedure was considered curative in 11 patients (64.7%). There was one operative death (mortality, 5.9%). Complications occurred in 3 patients (17.6%) and included anastomotic leak in 2 and bleeding requiring reoperation in 1. Growth pattern was infiltrating in 7, polypoid in 5, and intramural in 5. Histologically, the tumor was grade 1 in 6 patients, grade 2 in 2, grade 3 in 7, and grade 4 in 2. The tumor was postsurgically classified as stage I in 2 patients, stage IIA in 7, stage IIB in 1, stage IIIA in 5, stage IV in 1, and unknown in 1. Six patients (35.3%) received adjuvant treatment. Follow-up was complete in 16 patients (94.1%) and ranged from 1 to 182 months (median, 48 months). Five- and 10-year actuarial survivals were 47.0% and 31.0%, respectively. Seven patients (41.2%) are currently alive (median survival, 72 months); all underwent curative resection. Factors affecting survival included completeness of resection, growth pattern, postsurgical stage, tumor grade, and tumor location (p < 0.05). CONCLUSIONS: We conclude that leiomyosarcoma of the esophagus is rare. Complete resection provides long-term survival.     

Discontinuation of maintenance therapy in patients with quiescent cytomegalovirus retinitis and elevated CD4+ counts

OBJECTIVE: To determine whether maintenance therapy can be discontinued safety in patients with quiescent cytomegalovirus retinitis (CMVR) and increased CD4+ counts after treatment with highly active antiretroviral therapy (HAART). DESIGN: A prospective observational case series. PARTICIPANTS: Eight human immunodeficiency virus (HIV)-positive patients with quiescent CMVR who were taking HAART and had CD4+ counts above 100 cells/microliter elected to discontinue anti-CMV maintenance treatment. INTERVENTION: Biweekly-to-monthly indirect ophthalmoscopy and fundus photographs, monthly-to-quarterly CD4+ counts, and quarterly HIV viral loads were ordered. MAIN OUTCOME MEASURES: Twelve previously affected eyes were examined for evidence of recurrent retinitis, which was defined as any retinal whitening, border opacification, or expansion of areas of retinal pigment epithelial (RPE) atrophy greater than 750 microns. Four previously unaffected fellow eyes were observed for new CMVR. RESULTS: There was no reactivation or progression of retinitis in any patient during the mean follow-up interval of 11.4 months (range, 3-16 months). No previously unaffected eye developed CMVR. CD4+ remained elevated in all patients (range, 70-725; mean, 255). The HIV viral load ranged from undetectable to 139,000 copies. CONCLUSION: Discontinuation of maintenance therapy may be considered in patients with HAART-induced elevated CD4+ counts above 100 cells/microliter, prolonged relapse-free intervals during the reconstitution period before CD4+ counts rise above 100 cells/microliter, and completely quiescent retinitis characterized by RPE scarring only. Reduced risks of drug toxicity and drug-resistant organisms are potential benefits. Close observation for evidence of recurrent retinitis is indicated.     

Fuzzy-trace theory and false memory: new frontiers

We describe the origins of fuzzy-trace theory, including Piagetian, interference, information-processing, and judgment and decision-making influences. The contrasting properties of gist and verbatim memory serve as its foundation and, in recent models of spontaneous and implanted false memories, explain seemingly contradictory developmental trends, such as reverse developmental findings, differential time courses for true and false memories, and conflicting effects of trace strength. However, approaches that integrate fuzzy-trace theory with neurological, social, emotional, and motivational perspectives are needed. A method for accomplishing this integration, using the recent models, is introduced and new research that spans these perspectives is discussed. Relations to other contemporary theories, especially source-monitoring and dual-process theories, are also explained. We conclude by rejecting the notion that spontaneous false memories are actually "true" and distinguish gist and verbatim senses of the term "true" that have different consequences in real life.     

Design and analysis of lateral motion control algorithms for an unmanned aerial vehicle with two control surfaces

This paper considers control of an unmanned aerial vehicle with two horizontal aerodynamic control surfaces in the modes of angular stabilization and coordinated turn. We analyze the linear yaw angle control algorithms based on roll angle variation in terms of their performance. In addition, we suggest an algorithm that ensures a required performance of yaw angle control. Some simulation results are given.     

A high-current plasma generator based on a hollow cathode for high-power electric propulsions

A construction diagram and procedure for independent tests of the new hollow cathode, created at the Keldysh Research Center, being capable of ensuring an emission current of about 100 A, and meeting the main requirements, imposed on thermoemission cathodes of high-power ion thrusters, are considered. Results of the independent tests are given and dependences of the discharge voltage on the discharge current in a discharge-current range of 20–120 A are obtained. The temperatures of the cathode construction elements in stationary operation modes are measured.     

Combustion of titanium plates

The lower combustion limit is determined depending on the pressure of plates made of OT-4 titanium alloy in an O₂-Ar medium. The values of this limit decrease monotonically as the concentration of oxygen in O₂-Ar mixtures grows and increase with the sample thickness. The velocity of combustion propagation over the surface of the samples in a 75% O₂+25% Ar mixture at a pressure of ≦3.1 MPa is found. It is shown that, for titanium, the dependence of the combustion rate on the sample thickness is much weaker and, in contrast, it is much stronger on the pressure compared to similar dependences for cylindrical soft-steel samples known from the literature. Translated fromFizika Goreniya i Vzryva, Vol. 36, No. 4, pp. 60–65, July–August, 2000. This work was supported by the Russian Foundation for Fundamental Research (Grant No. 96-03-32039a).     

Friction and wear of fuel assemblies in water-moderated reactors

Static and dynamic processes that involve frictional forces are experimentally studied. The frictional forces affect the stress of the fuel assembly in all stages of the life cycle.     

Mosaicism in sporadic neurofibromatosis 2 patients

More than half of neurofibromatosis 2 (NF2) patients represent de novo mutations which could have occurred at either pre-zygotic or post-zygotic stages. A post-zygotic mutation can result in mosaicism. In four sporadic NF2 patients, we found NF2 mutations in only a portion of corresponding leukocytes. In two other sporadic patients, no mutations were found in leukocytes but constitutional NF2 mutations were suggested by identical mutations in different tumors from each patient. We screened leukocyte DNA from a total of 16 inherited and 91 sporadic NF2 patients, and found NF2 mutations in 13 (81%) of the former and in 46 (51%) of the latter cases. The 30% difference in the rate of detection of mutations ( P = 0.051) might be partially explained by mosaicism in a portion of sporadic NF2 patients who carry the mutations in such a fashion that their leukocytes are unaffected. Among sporadic cases, we found mutations more frequently in patients with severe phenotypes (59%) than in patients with mild phenotypes (23%) (difference of 36%, P = 0.007). Mosaicism might be more common in the latter patient group since small populations of mutation-bearing cells can in some cases result in mild phenotypes and can also lead to difficulties in identifying mutations. No mutations were found in eight patients suspected of having NF2. Mosaicism with an extremely small population of affected cells may explain the incomplete phenotypes in some of these patients and the lack of mutations in their leukocytes. These findings suggest that mosaicism is relatively common in NF2 and may have important implications for diagnosis, prognosis and genetic counseling.