Keeping the cat out of the bag: a hazard in continuous ambulatory peritoneal dialysis.
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Adult↗
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Results for “Cartwright Report”
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Cranial CT in the haemolytic uraemic syndrome.
A patient with the haemolytic uraemic syndrome and severe encephalopathy is described. The initial extensive brain hypodensity on CT scan was followed 10 days later by diffuse enhancement of the cerebral gray-white matter interface. A possible explanation for this phenomenon is suggested.
Atrophy↗
Anterior segment ischemia: a complication of retinal detachment repair in a patient with sickle cell trait.
Anterior segment ischemia (ASI) is a dreaded complication of retinal detachment surgery particularly in patients with predisposing factors such as sickle cell disease. We report a case of ASI after scleral buckling in an otherwise healthy black patient with sickle cell trait. Conditions of relative hypoxia intraoperatively from either anesthesia or surgical manipulation may precipitate vasoocclusive phenomena in these normally asymptomatic patients. Since the incidence of sickle cell trait in the black population in the United States is 8.5%, we recommend these patients have a preoperative sickle test followed by hemoglobin electrophoresis with quantification if positive. The presence of sickle cell trait should alert the surgeon to the risk of ASI, and factors predisposing to hypoxia should be minimized when possible.
Anterior Eye Segment↗
Malignant melanoma of the skin and non-Hodgkin's lymphoma in USA: a comparative epidemiological study.
Possible associations of incidence of non-Hodgkin's lymphoma (NHL) with solar UVR have been suggested (Cartwright e.a. 1994, etc.). Also, incidence for both malignant melanoma of the skin (SMM) and NHL has shown a rapid increase over the last 10-15 years worldwide. On the other hand, cyclicity in variations of incidence rates for SMM was reported (Houghton e.a. 1981, Dimitrov 1998, etc.). The present study analysed trends and variations in incidence of SMM and NHL for the USA. Annual age-standardized incidence rates for SMM and NHL (SEER database, 1973-1989) were compared. Linear and non-linear regression modeling, periodogram regression analysis and parametric tests were applied (Dimitrov e.a. 1995). The analysis denoted non-linear trends of increasing incidence for both SMM and NHL. Cyclic variations in incidence rates for SMM in US females were reported previously (Dimitrov 1993) and now were confirmed also for other strata of the population (mainly, cycles with a period T = 8 divided by 9 years, p < 0.05) as well as revealed for NHL (mainly, cycles with a period T = 8 divided by 9 years). This cyclicity was significant at 95% only for black US males (Table 1). After decycling for hypercyclicity of 20-35 years (long-term cyclic trends), however, significant high-frequency infrannual variations of 3 divided by 5 years appeared in NHL (latter cyclic variations, for instance, were observed in the sunspots index, solar UVR and stratospheric ozone). Also, significant cycles of 11-13 years appeared for white US males. Similar cyclicity of 9 divided by 11 years was observed in sunspots number over the same interval. Trends of NHL were very similar to that of SMM, as were the variations. This study might be considered a contribution to the hypothesis on possible associations of incidence for NHL with heliogeophysical phenomena.
Female↗
Screening for cervical cancer: attitudes and policies among Auckland general practitioners.
OBJECTS: to survey Auckland general practitioners and evaluate their attitudes and policies toward screening for cervical cancer. METHODS: an interviewer administered questionnaire asking questions based mainly on the recommendations of the 1985 Working Party on screening for cervical cancer and on some issues resulting from the Cartwright Inquiry. RESULTS: the response rate was 96% of the 100 general practitioners approached. The mean screening interval was 24.1 months. Eighty-eight percent of Auckland general practitioners used a recall system for cervical cancer screening. Doctors more likely to report adherence to the recommendations of the Working Party on screening for cervical cancer were: members and associates of the Royal New Zealand College of General Practitioners; doctors with less than 15 years experience; female doctors; doctors with a diploma of obstetrics and doctors in group practices. CONCLUSIONS: the majority of Auckland general practitioners adhere to the recommendations of the 1985 Working Party on screening for cervical cancer although there is some evidence of overscreening. Areas for improvement include the need for more general practitioners to have a recall system and the need to increase the rate of referral for women with two consecutive smears showing mild dysplasia.
Age Factors↗
Childhood Ki-1 lymphoma: presentation as a buttock mass.
Ki-1 lymphoma is a rare, large-cell anaplastic non-Hodgkin's lymphoma that most commonly affects older children and young adults. Presentation usually occurs as a localized infiltration of the skin and lymph nodes. We report an unusual case of childhood Ki-1 lymphoma that presented as a buttock mass in an eight-year-old girl, Pathologic evaluation revealed the characteristic lymphoma cells expressing Ki-1 antigen (CD-30), HLA-DR, interleukin 2 (CD-25), T-cell gene rearrangement, and the cytogenetic karyotype t(2;5). The patient is in complete remission following treatment with combination chemotherapy. This report broadens the clinical spectrum associated with Ki-1 lymphomas and illustrates the importance of combining routine pathologic examination with other specialized diagnostic techniques in the evaluation of childhood soft-tissue masses.
Aneuploidy↗
SSRIs in the treatment of obsessive-compulsive disorder.
The introduction of the SSRIs (selective serotonin reuptake inhibitors) over the past decade has provided exciting new opportunities for the treatment of obsessive-compulsive disorder (OCD). The serotonin hypothesis, based on the preferential response of OCD to the serotonin reuptake inhibitor, clomipramine, paved the way for research into the efficacy of the SSRIs in the treatment of this disorder. Large, controlled, multicenter studies have found clomipramine and the SSRIs, fluoxetine, fluvoxamine, sertraline, and paroxetine, to be effective and safe in the treatment of OCD. Meta-analytic studies have reported that clomipramine is superior to the SSRIs; however, direct head-to-head comparisons suggest equal efficacy. As SSRIs have a more favorable side-effect profile they may be preferable as first-line treatment of OCD. Improvement following adequate OCD drug treatment is frequently partial whereupon augmentation strategies may become necessary. High rates of relapse have been reported on discontinuation of SRI treatment. Long-term maintenance treatment has been found to be effective in sustaining initial therapeutic gains and bringing about further improvement.
Adolescent↗
Mothers' reports of childhood vaccinations and infections and their concordance with general practitioner records.
Mothers of 294 children aged 3-9 years were interviewed about their child's previous history of vaccinations and infections. The study group comprised healthy children selected at GP surgeries (n = 136) and those hospitalized for both minor and serious conditions (n = 168). The results evaluate the entire study group for the pattern of reporting vaccinations and infectious episodes under three years of age, comparing two different data sources-mothers' reports and GP records. Maternal recall accuracy is formally tested (Kappa statistic) for agreement with GP records. For vaccination history the results indicate that mothers and GPs are inadequate data sources, and suggest use of computerized health district records to improve data accuracy. Major differences on infectious history were evident for two types of questions-closed for specific infections and open-ended for 'other infections'. Specific infections (e.g. measles) were systematically over-reported by mothers compared with GP records, but mothers failed to 'time' the event. Concordance for 'other infections' was also poor, but, by contrast, GPs systematically over-recorded this range of infections, indicating substantial inaccuracy in mothers' recall. The authors suggest that GP records should be the preferred source of data for these 'other' infectious episodes, especially under one year of age. Improved questionnaire design would elicit more accurate maternal reports on specified infections for which a GP may well not be consulted and corroboration would be impossible.
Case-Control Studies↗
Pharmacokinetics of dexamethasone following single-dose intravenous administration to extremely low birth weight infants.
The single-dose pharmacokinetics of dexamethasone were studied in 7 extremely low birth weight infants of mean (+/- SD) gestational age 25.6 +/- 0.5 weeks suffering bronchopulmonary dysplasia. A mean peak dexamethasone concentration of 250.5 +/- 70.7 ng/ml was obtained following an intravenous bolus dose (0.369 +/- 0.04 mg/kg dexamethasone) of dexamethasone sodium phosphate. Dexamethasone was measured in plasma by HPLC. Mean clearance (0.143 +/- 0.028 litres/kg/h) was approximately half that reported previously in children and adults, while the half-life (9.26 +/- 3.34 h) was 2- to 3-fold longer than in these patients. The volume of distribution (1.9 +/- 0.483 litres/kg) was larger than reported in a previous study in adults, but was similar to that determined in pediatric and adult patients in another study.
Bronchopulmonary Dysplasia↗
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Aftercare↗
Identification of human herpesvirus 6-specific DNA sequences in two patients with non-Hodgkin's lymphoma.
Human herpesvirus 6 (HHV-6) is a recently discovered virus which has not been causally linked to any particular disease. In order to investigate the possible role of this virus in the pathogenesis of lymphoid malignancies, we examined tissue samples from 117 patients for the presence of HHV-6-specific DNA sequences. Two cases of non-Hodgkin's lymphoma were found to be positive. One patient had a T cell lymphoma and a preceding history of angioimmunoblastic lymphadenopathy; the other had a B cell lymphoma occurring in the context of Sjögren's syndrome. HHV-6 has been isolated previously from a patient with angioimmunoblastic lymphadenopathy, and viral sequences have been identified in another patient with Sjögren's syndrome and B cell lymphoma. The relationship between HHV-6 and these conditions therefore warrants further investigation.
Aged↗
Congenital abnormalities in children with cancer and their relatives: results from a case-control study (IRESCC).
Several studies have revealed an excess of malformations in children with certain malignancies. A few environmental causes have been identified which may damage the foetus and lead to malformation and cancer. However, most of the numerous recognised cancer/malformation syndromes are genetically determined. This report describes a case-control study of 555 newly diagnosed children with cancer and 1,110 matched controls, chosen from general practitioner lists (GP controls) and hospital admissions (H controls). Their parents were interviewed on topics of possible aetiological significance and medical records were checked to confirm reports at interview. The numbers of congenital malformations in the index and GP control children, and the relatives of the index children, the GP and H controls are described. There were more children with malformations among the cases (60/555) than among the GP controls (27/555), P < 0.001. The abnormalities in the cases included eight with specific chromosomal/genetic conditions (e.g. Down's syndrome, XY gonadal dysgenesis, Von Recklinghausen's neurofibromatosis, Goldenhar's syndrome) whereas only one GP control child had a chromosomal defect (P < 0.05). Five case children but no GP controls had neural tube defects; this is not statistically significant. No excess of malformations was found in the siblings of cases compared with GP and H control siblings. Case mothers had a small excess of malformations (22/555) compared with GP controls (8/555), P < 0.05. Among more distant relatives the results were difficult to interpret because of the relatively small numbers in the diagnostic subgroups and because of apparent under reporting in grandparents, but no striking differences were seen between case and control relatives. The excess of malformations found in children with cancer, compared with controls, without a similar excess of malformations in their close relatives may indicate that in some (perhaps very roughly one in 20) cases antenatal events may lead both to the malformation and the malignancy.
Case-Control Studies↗
Association between Bell's palsy and lymphoid malignancies.
Eight cases of lymphoid malignancy preceded by Bell's palsy are reported. There was a disproportionate number of ALL cases, two of which were of T-cell type. The possible pathogenic association of these conditions is discussed.
Facial Paralysis↗
Skin reflectance results from Holy Island, Northumberland.
The skin reflectance values at three EEL filters: 601, 605, and 609 of 100 inhabitants of Holy Island, Northumberland, are reported. They show no sex differences but a significant age difference and a marked regional difference. A method for examining regional differences in skin colour is introduced.
Adult↗
Factors that correlate with injury sustained by survivors of sexual assault.
A retrospective study of 440 cases of reported sexual assault was undertaken in order to identify factors that correlated with which victims sustained physical injury. Overall, 40% sustained nongenital and 16% genital injury, but most injuries were not severe. Which victim was injured strongly correlated with her age and race, the race of her assailant, and whether he had a weapon. White victims sustained both genital and nongenital injury almost twice as often as black victims. Whether she knew her assailant was less important, unless the victim was a child. Survivors attacked by a single assailant were injured as often as survivors of a "gang rape." Conclusions drawn from these data must take into account that these victims choose to report the event to the authorities, and self-reporting bias might explain some of the findings. Approximately half the victims seen sustained no injury. Apparently, physical injury is not a inevitable consequence of being raped.
Black or African American↗
Lead arthritis and lead poisoning following bullet wounds: a clinicopathologic, ultrastructural, and microanalytic study of two cases.
Bullet wounds causing lead synovitis in the wrist and knee are reported in two patients, one of whom also developed clinical plumbism. Very high lead levels in the synovial fluid are believed to be responsible for toxicity changes that occurred in the synovium and bone. Ultrastructurally, these alterations included the formation of nuclear lead inclusions, dilation, and degranulation of the rough endoplasmic reticulum and deposition of crystalline precipitates in the matrix of the mitochondria in macrophages, osteoclasts, and synoviocytes, as well as the development of cytoplasmic lead inclusions in osteoclasts. Energy-dispersive x-ray elemental analysis (EDXEA) indicated that the nuclear inclusions contained only lead, whereas precipitates within the mitochondria and elsewhere in the cytoplasm were composed of complexes containing lead, calcium, and phosphorus. Similarly constituted extracellular complexes were incorporated into newly formed trabecular bone laid down as a physiologic response to the bullet lodged within the wrist bones. This bone subsequently exhibited defects in bone resorption, which were characterized by depressed osteoclastic function and a unique lesion termed incomplete osteocytic osteolysis. The genesis of this latter lesion is uncertain. The sequestration of the partially degraded bone fragments containing lead complexes into the marrow and eventually into the joint spaces and synovium permitted the recycling of bone lead, and this may have played an important role in inducing clinical plumbism in one of the patients in this study.
Adult↗
Clear cell carcinoma of the sigmoid mesocolon: a tumor of the secondary müllerian system.
Clear cell carcinoma was found in the sigmoid mesocolon of a 54-year-old woman, 6 years after the removal of all ovarian tissue. This tumor is of müllerian origin. In addition to the müllerian structures proper--the fallopian tubes, uterus, cervix, and upper vagina--a "secondary müllerian system" is present diffusely throughout the pelvis and lower abdomen. This case represents a tumor of the secondary müllerian system.
Adenocarcinoma↗
Working with HIV/AIDS sufferers: "when good enough is not enough".
The authors begin by examining the intrapsychic implications that HIV/AIDS presents after knowledge of infection. Using examples drawn from two cases, they explore how knowledge of infection precipitates an insidious traumatizing process that comprises a number of key defensive strategies and dynamic processes. Particular kinds of defensive splitting, projective dynamics, and key identifications, as well as the collapse of the symbolic function, are isolated as being central to understanding the traumatizing process. With this in mind, the role and aim of the insight-oriented therapist is considered. The authors argue that much of the therapeutic work in this area revolves around a central organizing fantasy about the limitations of "good enough" objects in helping them with their diagnosis and its implications. This is linked to a number of technical dilemmas that the therapist will inevitability have to face if he or she chooses to work analytically. Particular technical problems explored include: 1. the management of frame deviations, 2. the therapist's role/s, 3. the use of interpretation, and 4. countertransference experience and enactment.
Acquired Immunodeficiency Syndrome↗