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PubMed2000

Aggressive digital papillary adenocarcinoma (aggressive digital papillary adenoma and adenocarcinoma revisited).

In 1987 a clinicopathologic study by the Armed Forces Institute of Pathology (AFIP) of rare sweat gland tumors, termed aggressive digital papillary adenoma and adenocarcinoma, was published. Since that time, the AFIP has continued to collect these tumors for study. Based on additional follow-up data, we think the original classification of these tumors requires revision. Sixty-seven cases of aggressive digital papillary adenoma and adenocarcinoma were studied according to their clinical characteristics and histologic features. Fifty of these were originally diagnosed as adenoma and 17 as adenocarcinoma. Follow up on 45 (67%) of the patients was obtained. None of the clinical or histologic parameters studied were found to be predictive of recurrence or metastasis, indicating that the originally proposed criteria for distinguishing between benign (adenoma) and malignant (adenocarcinoma) do not predict biologic behavior. When primary tumors were treated by subsequent reexcision or amputation, only one recurred (5%), when not so treated, 11 recurred (50%) regardless of the original diagnosis (p <0.05). Metastasis occurred in six (14%) cases and in three cases led to the death of the patient. Three of these metastatic cases had met the earlier criteria for adenoma. Pulmonary metastases were observed in five cases. No effective treatment for widespread metastatic disease has yet been developed. Because histologic features with prognostic significance could not be demonstrated in this retrospective review, we propose that all aggressive digital papillary tumors be designated aggressive digital papillary adenocarcinoma.

Adenocarcinoma, Papillary↗
PubMed2005

Aggressive Lennert's lymphoma: report of three cases in comparison to non-aggressive Lennert's lymphoma.

The present article describes three cases of Lennert's lymphoma exhibiting aggressive clinical courses. These cases were accompanied by disseminated intravascular coagulation (DIC) or hemophagocytic syndrome (HPS). These cases were compared to non-aggressive type of Lennert's lymphoma. Of the three cases, two demonstrated involvement of the liver and the other possessed bone marrow involvement. In one patient, while a lymph node biopsy revealed Lennert's lymphoma histologically, a liver biopsy obtained 2 months later revealed a high-grade large cell cytotoxic T-cell lymphoma. Two of these cases showed HPS and the other exhibited DIC. All patients died within 1 year of diagnosis, with the shortest survival period being 1.5 months. Immunohistochemically, lymphoma cells were CD8+, CD4-, granzyme B+, and T-cell intracellular antigen-1 (TIA-1)+, showing a cytotoxic T-cell phenotype. Two cases demonstrated positive reactivity for Epstein-Barr virus in lymphoma cells by in situ hybridization. These cases were compared with eight cases of non-aggressive Lennert's lymphoma. In comparison to non-aggressive disease, these three cases displayed a higher percentage of Ki-67-positive cells. In conclusion it was found that a subset of Lennert's lymphoma cases share common features with high-grade cytotoxic T-cell lymphoma, indicating that Lennert's lymphoma may be part of the spectrum of cytotoxic T-cell lymphoma.

Aged↗
PubMed1991

Comparison of an aggressive (U.S.) and a less aggressive (Canadian) policy for cholesterol screening and treatment.

OBJECTIVE: To determine the point at which adverse quality-of-life effects engendered by an aggressive cholesterol-lowering strategy dictate the use of a less aggressive approach. DESIGN: Decision analysis was used to compare the effects of the National Cholesterol Education Program (NCEP) guidelines, an aggressive program, with those of the Canadian Task Force on the Periodic Health Examination (CTF) guidelines, a more conservative program. Quality-adjusted life expectancy was calculated for a theoretical cohort of middle-aged men treated according to each program using Markov cohort analysis. MEASUREMENTS: Guidelines were applied to the population of the Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT), under the assumption that cholesterol levels had the distribution of the age- and sex-matched general population. Outcomes were calculated using a three-state (health, coronary heart disease, and death) Markov model. State transition probabilities were calculated using bivariate (age and cholesterol) proportional hazards and logistic regression functions. MAIN RESULTS: The result was a "toss-up"; the number of expected quality-adjusted life years was similar for both programs at all time intervals, although the conservative program was consistently slightly favored. The result was very sensitive to the disutility of dietary therapy (threshold value, 0.0014 compared with the baseline estimate of 0.02) but was also affected by the time frame of the analysis and the rate at which adverse effects of treatment decline. CONCLUSIONS: Even small disutilities associated with treatment may outweight the benefits of aggressive cholesterol-lowering strategies. Research should be directed toward measuring these disutilities and finding ways to reduce their size. Incorporation of the disutility of treatment into policy formulation may result in less interventionist and less costly policies.

Adult↗
PubMed1976

[Amantadine: aggressive effect; effect on apomorphine-induced aggressivity in the rat].

In rats characterized by aggressive behaviour induced by apomorphine, only amantadine in doses of 10 mg/kg i.v. and 50 mg/kg i.p. induces a very slight aggressive effect, but in doses of 30 and 50 mg/kg i.p. it inhibits the aggressive behaviour induced by 1 mg/kg apomorphine. The effect is dose-related and it is more pronounced when amantadine (50 mg/kg i.p.) is injected 30 min rather than 1 h before apomorphine.

Aggression↗
PubMedDate not supplied

The Suicide and Aggression Survey: a semistructured instrument for the measurement of suicidality and aggression.

Despite the rising concern with the increasing rate of violent and suicidal behaviors in this country and others, we remain relatively limited in our ability to rigorously define, classify, and measure these behaviors. In addition to our previous work in developing self-rating scales assessing aspects of aggressive behaviors, we have developed the Suicide and Aggression Survey (SAS), a new, comprehensive, semistructured interview and research tool, for the purpose of comprehensively evaluating and understanding the multiple constituents of these behaviors, and for assisting in predicting which individuals might be at high risk for suicide or violence. The present report describes the need for such an instrument and the theoretical models that have guided us in constructing it; one of these is a sequential description of the major classes of variables related to aggression and the other is a two-stage model of countervailing forces. Preliminary reliability data and a description of the structure of the interview are included.

Adolescent↗
PubMed1988

Defensive aggression and testosterone-dependent intermale social aggression are each elicited by food competition.

Castrated rats with medial hypothalamic lesions or sham lesions and castrated rats with testosterone implants or sham implants were placed on a 23-hr food deprivation schedule, adapted to a highly palatable liquid food, and then housed in pairs. The pairs were observed in competition for the highly palatable food over a 4-min period on each of six days. On the first three days, the food was dispensed in a way that allowed only one animal at a time to drink while during the second three days both animals could drink simultaneously. The pairs of animals were then separated, individually adapted to a bland liquid food, and paired with a different animal for a second series of competition tests. With highly palatable food as the incentive, rats made hyperdefensive by medical hypothalamic lesions were more successful at maintaining access to the food and more aggressive than their sham-lesioned competitors on tests when food access was restricted to a single animal but not on tests when both animals could drink simultaneously. With bland food as the incentive, lesioned animals were not consistently more successful in maintaining access to the food but were significantly more aggressive than their cagemates. With the highly palatable food, castrated males with testosterone implants were neither more successful in maintaining access to the food nor more aggressive than their cagemates with sham implants. However, when paired with an unfamiliar cagemate in preparation for competition tests with the bland food, most rats with testosterone implants attacked the new cagemate using a lateral attack and displaying piloerection.(ABSTRACT TRUNCATED AT 250 WORDS)

Aggression↗
PubMed1977

The effect of testosterone and cyproterone acetate on the concentration of gamma-aminobutyric acid in brain areas of aggressive and non-aggressive mice.

Mice which had been housed in groups were introduced into the home cages of isolated mice and the aggressive defensive behaviour assessed. The grouped mice were chronically treated with testosterone, cyproterone acetate or arachis oil. The concentration of GABA was determined in 10 regions following the last behavioural assessment. The grouped mice which were treated with testosterone or with the anti-androgen, cyproterone acetate, were subjected to fewer aggressive attacks by the isolated mice thatn the grouped controls. The concentration of GABA in particular brain areas appears to depend on the degree of aggressive behaviour exhibited, the type of environment into which the mouse is introduced, the hormone treatment, and the housing conditions.

Aggression↗
PubMed1997

Heritability of aggression and irritability: a twin study of the Buss-Durkee aggression scales in adult male subjects.

To determine the degree of genetic and environmental influences on assessments of aggression and irritability in male subjects, the "Motor Aggression" subscales of the Buss-Durkee Hostility Inventory (BDHI) were mailed to 1208 male twins in the Vietnam Era Twin Registry. Data from monozygotic 182 and 118 dizygotic twin pairs were available and were analyzed using model-fitting procedures. Three of the four BDHI subscales demonstrated significant heritability of a nonadditive nature: 40% for Indirect Assault, 37% for Irritability, and 28% for Verbal Assault. Additive genetic variance accounted for 47% of the individual differences for Direct Assault. Nonshared, but not shared, environmental influences contributed to explaining the variance in the model, with estimates ranging from 53% (Direct Assault) to 72% (Verbal Assault). Because some of these BDHI scales have been shown to correlate with indices of central serotonin function, it is possible that impulsive aggression, as reflected by these scales, is heritable in men.

Adult↗
PubMed1975

The facilitation of aggression by aggression: evidence against the catharsis hypothesis.

Nnety male subjects were either attacked or treated in a more neutral manner by a male confederate. On a subsequent maze-learning task, one third of the subjects shocked the confederate, one third observed as the experimenter shocked the confederate, and one third waited for a period of time during which the confederate was not shocked. Finally, all subjects shocked the confederate as part of a code-learning task. Subjects who had been attacked and had shocked the confederate during the maze task delivered shocks of greater intensity on the code task did subjects in the other two conditions, and the former subjects also experienced a greater reduction in diastolic blood pressure than did the latter. The results contradict the hypothesis of aggression catharsis and are discussed in terms of feelings of restraint against aggressing that a subject experiences after committing an aggressive act.

Abreaction↗
PubMed1979

Components of aggression in chickens and conceptualizations of aggression in general.

A refined analysis of the peck order in chickens was offered as a test of the notion that for this species, different responses such as leaping and various types of pecking need not be interchangeable indexes of aggression. Indeed, tests showed that particular response types of the birds were differentially mediated by organismic or environmental factors. In large cages pecking at the body was most frequent by birds that had a home-cage advantage. Contrarily, rates of aggressive leaping were independent of this environmental influence, with males having an advantage over females. Males showed more head pecking than females, but the profile for this sex difference did not resemble the profile for leaping. Correlational analyses revealed that whereas head pecking between testmates was not matched in frequency, leaping was positively related. Finally, the behavior of birds tested in small cages differed from that of the large-cage subjects. Although there was more head pecking in the small cages, males did not have an edge, and leaping was infrequent. Such results indicate that these responses cannot be viewed as interchangeable indicators of aggression in fowl.

Aggression↗
PubMed1994

Nurses' attitudes towards aggressive behaviour, following attendance at 'The Prevention and Management of Aggressive Behaviour Programme'.

The issue of aggression and violence is current in society. Recent reports indicate that this is not just an issue for society at large, but also for its organizations and institutions. The health care industry is not exception in this regard. Nursing, among other disciplines, has focused an increasing amount of attention on this problem for its members. This is evidenced by the increasing amount of literature on the topic. One feature of this writing is the study of programmes designed to train professionals in techniques to prevent and manage aggression and violence. To date, little attention has been paid to the evaluation of such programmes. In these times of economic difficulty, this position cannot be supported. This paper describes the study of one such educational programme. In this case the evaluation focused on the study of attitude change in participants following attendance at 'The Prevention and Management of Aggressive Behaviour Programme'. Although the indications are that the programme had a positive effect on attitudes, the author concludes that further study is required to illuminate the statistical significance of this positivity.

Adult↗
PubMed2002

Predicting responses to sexually aggressive stories: the role of consent, interest in sexual aggression, and overall sexual interest.

Measures of interest in sexual aggression and overall sexual interest were used to predict men s responses to consensual and nonconsensual stories that contained forceful sexual content. College males (N = 108) listened to these stories and completed questionnaires assessing self-reported sexual arousal and desire, their perceptions of the woman s enjoyment and sexual desire in the stories, their likelihood of acting like the man in the stories, and how likely they would be to read similar stories. Multiple regression analyses revealed that overall sexual interest variables were significant predictors of responses to both consensual and nonconsensual stories, while interest in sexual aggression predicted responses to only the nonconsensual story. The present study highlights the importance of considering overall sexual interest measures in sexual aggression research.

Adult↗
PubMed1989

Relations of moderate physical exercise to scores on hostility, aggression, and aggression, and trait-anxiety.

100 male subjects were selected from a midwestern university and categorized into 5 jogging groups, advanced, intermediate, beginning, drop-out joggers and nonexercisers, who were administered the Commitment to Running Scale, the Buss-Durkee inventory measuring hostility and aggression, and the State-Trait Anxiety Inventory. Analysis of covariance with age as a covariate was performed using a 5 x 2 design with the 5 levels of jogging and status of the jogger (student/nonstudent) as independent variables. Fisher's LSD was used for multiple comparisons. Joggers scored higher than drop-outs or nonexercisers on the Commitment to Running Scale. Nonexercisers had higher mean scores on trait anxiety than advanced, intermediate, and drop-out joggers; advanced joggers had a lower mean trait-anxiety score than any other group. Nonexercisers had higher mean aggression and hostility scores than drop-out or advanced joggers; drop-out and advanced joggers did not differ significantly but their scores were significantly lower than those of other groups of joggers. These findings confirm that jogging affects trait anxiety, hostility, and aggression positively, which supports use of exercise preventively.

Adolescent↗
PubMed1983

Aggression levels in college students after exposure or non-exposure to an aggressive life experience.

Through a secondary analysis of existing data, the authors researched the question of what types of aggressive behaviors are learned from an individual's social environment. The findings included data on three student groups: 1) students who had never been in military service; 2) students who had been in military service and had been to Viet Nam; and 3) students who had been in military service, but who had not been to Viet Nam. The results indicated that assault is clearly one aggressive behavior that appears to increase with exposure to an aggressive life experience.

Adolescent↗
PubMed1993

Cooperative social coordination and aggression: II. Effects of sex and housing among three strains of intact laboratory rats differing in aggressiveness.

Pairs of laboratory rats were rewarded with sugar solution for cooperating by means of synchronized shuttling in a rectangular chamber. Learning and performance were compared in males and females of three strains--S3, Charles River, and Wistar--ordered in terms of decreasing levels of aggressiveness. In addition, same-sex pairs of each strain were housed either together or individually. When housed together, males and females of all strains eventually cooperated at comparable levels, with rates of acquisition across strains inversely related to their aggressiveness. Individual housing, in contrast, was associated with severe deficits in males of the S3 and CR strains linked to violent fighting and prolonged freezing by animals who had previously been defeated. All other individually housed groups, including males of the Wistar strain and females of all strains, were able to cooperate, including S3 females whose violent fighting was not associated with immobility by defeated animals. In general, the majority of groups were able to cooperate despite differences in aggressiveness associated with sex, strain, and housing. Possible processes in this accommodation are discussed.

Aggression↗
PubMed2005

Statin use in a "real-world" clinical setting: aggressive lipid lowering compared with usual care in the Aggressive Lipid-Lowering Initiation Abates New Cardiac Events (ALLIANCE) trial.

Clinical trials that incorporate elements of "real-world" experience are of great value to practicing physicians. Using a trial design adapted to approximate clinical settings, the Aggressive Lipid-Lowering Initiation Abates New Cardiac Events (ALLIANCE) trial compared a focused treatment strategy using atorvastatin with usual medical care. Patients eligible for study participation were predefined based on diagnosis codes for coronary heart disease from US managed care database records; 66% of these patients were taking lipid-lowering medications at study entry. In contrast to standard clinical trials, ALLIANCE maintained a real-world environment by limiting the interactions of investigators with patients after dose titration of aggressive treatment to a low-density lipoprotein (LDL) cholesterol goal < 80 mg/dL (2.1 mmol/L) or maximum atorvastatin dose of 80 mg/day. After 51.5 months of follow-up, the study showed that aggressive treatment with atorvastatin was associated with significantly lower LDL cholesterol levels (147 mg/dL [3.8 mmol/L] to 95 mg/dL [2.5 mmol/L]) over usual care (146 mg/dL [3.8 mmol/L] to 111 mg/dL [2.9 mmol/L]). This greater reduction in LDL cholesterol was accompanied by improved outcomes in the composite primary end point of cardiovascular events (-17% with atorvastatin vs. usual care; P = 0.02) and particularly in the end point of nonfatal myocardial infarction (-47% with atorvastatin vs. usual care; P = 0.0002). No safety difference was noted between the 2 treatment groups. These results indicate that usual-care treatment was not equivalent to targeted statin therapy, even in a trial conducted to minimize potential bias owing to traditional patient selection and trial design methods.

Adolescent↗
PubMed2002

The aggressive nature of the odontogenic keratocyst: is it a benign cystic neoplasm? Part 1. Clinical and early experimental evidence of aggressive behaviour.

In this, the first of three articles on the aggressive nature of the odontogenic keratocyst (OKC), there is a review of clinical and histological observations which indicated that this was an aggressive lesion with a predilection for recurrence unlike the majority of other jaw cysts. This led to the tentative suggestion that the OKC might be a benign neoplasm. Subsequently there were early laboratory investigations that compared proliferation rates of the OKC epithelium with other jaw cysts, comparative enzyme histochemistry to assess aspects of its metabolism and markers that would enable accurate presurgical diagnosis of this cyst. Comparative studies were also pursued on the walls of the OKC and other jaw cysts to identify factors that might influence the capacity of the OKC to resorb the bone surrounding it. The clinical and laboratory studies reviewed in this section provided cogent presumptive evidence of the distinctively aggressive nature of the OKC that led numbers of investigators to pursue immunocytochemical and genetic studies on this cyst. Parts 2 and 3 of this series review this work.

Biomarkers↗
PubMed2001

Are aggressive treatment strategies less cost-effective for older patients? The case of ventilator support and aggressive care for patients with acute respiratory failure.

OBJECTIVES: A common assumption is that life-sustaining treatments are much less cost-effective for older patients than for younger patients. We estimated the incremental cost-effectiveness of providing mechanical ventilation and intensive care for patients of various ages who had acute respiratory failure. DESIGN: Retrospective analysis of data on acute respiratory failure from Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). SETTING: Acute hospital. PARTICIPANTS: 1,005 with acute respiratory failure; 963 received ventilator support and 42 had ventilator support withheld. MEASUREMENTS: We studied 1,005 patients enrolled in a five-center study of seriously ill patients (SUPPORT) with acute respiratory failure (pneumonia or acute respiratory distress syndrome and an Acute Physiology Score > or = 10) requiring ventilator support. For cost-effectiveness analyses, we estimated life expectancy based on long-term follow-up of SUPPORT patients and estimated utilities (quality-of-life weights) using time-tradeoff questions. We used hospital fiscal data and Medicare data to estimate healthcare costs. We divided patients into three age groups (< 65, 65-74, and > or = 75 years); for each age group, we performed separate analyses for patients with a < or = 50% probability of surviving at least 2 months (high-risk group) and those with a > 50% probability of surviving at least 2 months (low-risk group). RESULTS: Of the 963 patients who received ventilator support, 44% were female; 48% survived 6 months; and the median (25th, 75th percentile) age was 63 (46, 75) years. For the 42 patients for whom ventilator support was withheld, the median survival was 3 days. For low-risk patients (> 50% estimated 2-month survival), the incremental cost (1998 dollars) per quality-adjusted life-year (QALY) saved by providing ventilator support and aggressive care increased across the three age groups ($32,000 for patients age < 65, $44,000 for those age 65-74, and $46,000 for those age > or = 75). For high-risk patients, the incremental cost-effectiveness was much less favorable and was least favorable for younger patients ($130,000 for patients age < 65, $100,000 for those age 65-74, and $96,000 for those age > or = 75). When we varied our assumptions from 50% to 200% of our baseline estimates in sensitivity analyses, results were most sensitive to the costs of the index hospitalization. CONCLUSIONS: For patients with relatively good short-term prognoses, we found that ventilator support and aggressive care were economically worthwhile, even for patients 75 years and older. For patients with poor short-term prognoses, ventilator support and aggressive care were much less cost-effective for adults of all ages.

Acute Disease↗