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PubMed1990

Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature.

One hundred cases of mullerian adenosarcoma of the uterus were encountered in patients 14 to 89 years of age (median, 58 years), who usually had the symptom of abnormal vaginal bleeding. An enlarged uterus and tissue protruding from the external os were the most common findings on pelvic examination. Five patients presented on multiple occasions with "recurrent polyps" that were interpreted retrospectively as adenosarcomas. Primary treatment, known in 97 cases, included some form of hysterectomy in 93 of them, and conservative resection in four cases. Gross examination of the excised uteri disclosed polypoid masses, some of which had spongy cut surfaces, usually filling the endometrial cavity; less commonly, the tumors were confined to the endocervix or the myometrium or involved more than one site. Histologic examination revealed benign or atypical neoplastic glands within a sarcomatous stroma, which typically formed periglandular cuffs of increased cellularity, intraglandular polypoid projections, or both. The sarcomatous stroma was homologous in 78% of the cases and contained heterologous elements in the remainder. The stromal mitotic rate varied from 1 to 40 mitotic figures (MFs) (mean 9) per 10 high-power fields (HPFs). Extensive areas of stromal fibrosis that focally imparted a deceptively benign appearance to the tumor were common. Myometrial invasion was present in 15 cases, but was deep in only four. Recurrent tumor developed in 23 cases at postoperative intervals of 0.5 to 9.5 years (mean 3.4); in one third of such cases, the interval was 5 years or longer. Recurrent tumor was almost always confined to the vagina, pelvis, or abdomen; hematogenous spread occurred in only two cases. The only feature associated with an increased risk for recurrence was the presence of myometrial invasion. Criteria found useful in separating mullerian adenosarcomas from mullerian adenofibromas included, alone or in combination: two or more stromal MFs per 10 HPFs, marked stromal cellularity, and significant stromal cell atypia.

Adolescent↗
PubMed1992

B-zone small lymphocytic lymphoma: a morphologic, immunophenotypic, and clinical study with comparison to "well-differentiated" lymphocytic disorders.

The pathologic, immunologic, and clinical features of five cases of B-zone small lymphocytic lymphoma (BZSLL), characterized by a nondestructive growth pattern with a selective and complete replacement of the B-zone areas of lymph nodes, were examined. These findings were compared with those of 13 cases of intermediate differentiated lymphoma/mantle zone lymphoma (ILL/MZL) and 20 cases of typical small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL). B-zone SLL was characterized histologically by a deceptively benign pattern at a low magnification, the lymph node architecture being substantially preserved, in contrast to the ILL/MZL and SLL/CLL cases, in which complete effacement of the normal architecture usually could be observed. Moreover, in BZSLL the cellular population was rather uniform and lacked either a prolymphocytic component or the small-cleaved lymphoid cells often seen in SLL/CLL and ILL/MZL cases, respectively. The phenotypic profile of the BZSLL clonal cell population studied by the immunoperoxidase method and by single- and double-labeling flow cytometric analyses (SIg+, CD19+, CD20+, CD21+, CD22+, CD24+, CD35+, CD37+, CD74+, CD45+, CD45R+, MB2+, HLA-DR+, Leu-8+, CD9+/-, CDw75+/-, CD5-/+, CD23-/+, CD10-, FMC7-, PCA-1-, CD25-, CD38-, CD43-, CD3-) appeared to be fairly homogeneous and sufficiently distinct from that of ILL/MZL, based on the absence of FMC7 and CD38 molecules, and from that of SLL/CLL due to significantly stronger expression of SIgs (P less than .05), the higher reactivity with anti-CD9 and -CD22 antibodies (P less than .05), the lower reactivity with anti-CD5 and -CD23 antibodies (P less than .05), and the absence of CD25 determinants. Several clinical features of patients with BZSLL, including age group, advanced stage disease, and high frequency of bone marrow and peripheral blood involvement, were similar to those found in the other patients with ILL/MZL and SLL/CLL, but none of the BZSLL patients had an absolute lymphocyte count higher than 15.0 x 10(9)/L at presentation. Based on the architectural pattern, cytologic features, immunophenotypes, and hematologic findings, we conclude that BZSLL is an unusual variant of SLL that is primary in the lymph nodes and should be distinguished from ILL/MZL and CLL.

Adult↗
PubMed1995

Nevoid melanoma: a clinicopathological study of seven cases of malignant melanoma mimicking spindle and epithelioid cell nevus and verrucous dermal nevus.

We report seven cases of a distinctive type of malignant melanoma characterized by a deceptively benign histological appearance with an architecture resembling that of benign melanocytic nevi on scanning magnification. Two predominant architectural patterns were observed: a dome-shaped pattern (two specimens) and a verrucoid pattern (five specimens). The specimens with a dome-shaped pattern of growth were characterized by a smooth epidermal surface and a proliferation of epithelioid melanoma cells with an inconspicuous intraepidermal component resembling spindle and epithelioid cell nevi (Spitz nevi). Gradual diminution in the size of dermal nests toward the bases of the lesions simulating the maturation phenomenon of benign nevi was observed; however, the dermal organization in cords and strands of melanoma cells and the persistence of cellular atypia extending to the bases of the tumors allowed their recognition as malignant melanomas. On the other hand, the specimens with a verrucoid growth pattern consisted of broad, exophytic tumors with a verrucous epidermal surface resembling that of papillomatous dermal nevi but distinguished from them by the presence of a continuous proliferation of melanocytes along the dermal-epidermal junction and by confluent sheets of melanoma cells in the dermis without evidence of true maturation. Clinical follow-up showed local recurrence in three patients after intervals ranging from 5 months to 5 years and regional metastasis in one patient after 2 years. The lesions described here may constitute a serious pitfall for diagnosis because of their innocent silhouette on scanning magnification and their superficial resemblance to spindle and/or epithelioid cell nevi and benign verrucous melanocytic nevi. Proper attention to cytological detail and subtle architectural features will aid in recognizing this unusual variant of malignant melanoma.

Adult↗
PubMed1995

Inflammatory sarcomatoid carcinoma of the lung: report of three cases and clinicopathologic comparison with inflammatory pseudotumors in adult patients.

Although the capacity for some pulmonary carcinomas to mimic sarcomas is well recognized, their potential resemblance to selected benign lesions of the lung is currently underappreciated. The authors herein report three examples of sarcomatoid bronchogenic carcinoma with a deceptively bland appearance and an investment of reactive inflammation, such that they resembled pseudotumors histologically. These lesions occurred in two men and one woman who were 44, 61, and 63 years old, respectively, at diagnosis. All patients presented with a productive cough, hemoptysis, or chest pain. Their pulmonary masses were irregularly marginated radiographically, and ranged in size from 2.5 to 5.5 cm. Two were treated with lobectomy, and one underwent a wedge excision, followed by radiotherapy to the thorax. Despite these measures, each patient with inflammatory sarcomatoid carcinoma (ISC) died of disease or is likely to do so. Microscopically, ISCs were composed of uniform spindle cell proliferations with only modest nuclear pleomorphism, limited mitotic activity, and an arrangement in fascicles, storiform configurations, or haphazard arrays. Lymphocytes and plasma cells were interspersed throughout each of them, and keloidal stromal collagen was apparent internally in two examples. Two of the neoplasms also invaded pulmonary blood vessels or bronchi. A comparison group of 10 adults with pulmonary inflammatory pseudotumors (IPs) of the fibrous histiocytoma type shared several clinical attributes with ISC and showed closely similar histological features, except that the IPs lacked mitoses and invasiveness, and contained xanthoma cells or multinucleated elements in some cases in this series. Immunohistochemical analyses showed consistent dissimilarities between ISC and IP; keratin and epithelial membrane antigen were present in ISC but not IP, whereas actin was observed only in the proliferating spindle cells of IP. In summary, the potential clinicopathologic overlap between ISC and IP suggests that caution should be exercised in the separation of these two lesions. In particular, it is unwise to attempt to make this distinction in an intraoperative frozen section setting.

Adult↗
PubMed1995

Munchausen by proxy victims in adulthood: a first look.

Very little is known about the long-term impact of Munchausen by Proxy abuse on children, as many victims probably are never identified and most have been lost to follow-up soon after termination of protective services supervision. This exploratory study examined the childhood experiences and long-term psychological outcomes for 10 adults, ranging from 33 to 71 years of age, who were self-identified victims of illness fabrication by a parent. Subjects completed a 33-item questionnaire including demographic and open-ended questions and a checklist of PTSD symptoms, supplemented by telephone interviews. Subjects described a range of experiences from poisonings and induced bone fractures to symptom exaggeration. Subjects generally felt unloved and unsafe in childhood; a few were directly aware of their parent's deceptions. They made limited attempts to alert others, with little success. Subjects reported significant emotional and physical problems in childhood, and problems in adulthood including insecurity, reality-testing issues, avoidance of medical treatment and posttraumatic stress symptoms. Most of their siblings were also abused, physically or medically. Some subjects express considerable residual anger towards the abusing mothers, but a surprising degree of sympathy for the fathers who passively colluded or failed to protect. Some of the MBPS parents have continued fabricating their own medical illnesses or harassing their adult children with fabricated dramas even decades later.

Adaptation, Psychological↗
PubMed1992

Cardiovascular disease in the elderly.

The current worldwide explosive increase in the numbers of older persons is unprecedented in history. In the 1990s and beyond, the preponderance of patients with cardiovascular illness will be elderly, with a substantial subset among the frail elderly, 85 years old and older. Cardiovascular disease remains the leading cause of death and disability in this population, and cardiovascular risk increases steadily with age. Pascal defined old age as "just a time that is farther from the beginning and nearer to the end." Elderly persons, with and without cardiovascular disease, vary widely in their physical, behavioral, cognitive, and emotional functioning; severity of illness; and expectations from medical care. The challenge to the clinical and research communities alike is to delineate the appropriate components of preventive, diagnostic, and therapeutic care for elderly cardiac patients in our society, interventions that are likely to relieve suffering, restore function so as to limit disability and dependency, and maintain a dignified and meaningful life-style for the end years of life. Major societal strides have been made in redefining both the onset of old age and its limitations. The eighteenth century poet, Robert Burns, wrote of his fears that he would be 45 years old at a time when life expectancy was 40 years; he saw himself as being weary, wrinkled, creeping, and joyless. For, ance that five-and-forty's speel'd, See crasy, weary, joyless Eild, Wi' wrinkled face, Comes hostin', hirplin', owre the field, Wi' creepin' pace. Burns died at the age of 37 years. A more attractive option is offered by Abraham Joshua Heschel, 1907-1972. According to all the standards we employ ... the aged person is condemned as inferior. ... Conditioned to operating as a machine for making and spending money, with all other relationships dependent upon its efficiency, the moment the machine is out of order and beyond repair, one begins to feel like a ghost without a sense of reality. ... Regarding himself as a person who has outlived his usefulness, he feels as if he has to apologize for being alive. May I suggest that ... old age be regarded not as the age of stagnation but as the age of opportunities for inner growth. ... The years of old age ... are indeed formative years, rich in possibilities to unlearn the follies of a lifetime, to see through inbred deceptions, to deepen understanding and compassion, to widen the horizon of honesty, to refine the sense of fairness.

Aged↗
PubMed1979

The Munchausen spectrum: borderline character features.

In this paper the author presents a continuum of disease simulation that ranges from hysteria to malingering, with a range of relative unawareness to awareness of producing such deception. Focus is on the particular group of patients who consciously and repeatedly simulate disease. The frequency and form of such disease mimicry vary within such a group. A continuum in terms of frequency ranges from occasional adventures to the simulation of disease as the center of a person's life. Two groups of patients designated as exhibiting Munchausen Syndrome are defined within this continuum: (a) those who work (mostly as nurses or in other medical professions) and (b) those called "hospital hobos" --the more prototypical Munchausen patient. The author takes a somewhat different approach to Munchausen Syndrome in that it is viewed as a subgroup of the borderline character. Further, the often found exhortation for psychiatric treatment of Munchausen patients is reexamined, and caution regarding such zeal and its potential negative effects is registered.

Adult↗
PubMed1991

Effects of mental countermeasures on psychophysiological detection in the guilty knowledge test.

This study focused on the effects of mental countermeasures on psychophysiological detection in a guilty knowledge paradigm. Two experiments which utilized a 3 x 2 between subjects factorial design were conducted. Two types of mental countermeasures (specific dissociations from the relevant stimulus and continuous dissociation throughout the entire test, as well as a control-no countermeasure condition were used). Each group was further subdivided into two conditions--a high attention condition created by motivational instructions and a deceptive verbal response to the relevant question; and a low attention condition in which no motivational instructions were provided and no verbal response was required. The results of both experiments (one was conducted in a field set up, and the other utilized more standard experimental equipment and measurement procedures) revealed the following pattern: the item-specific countermeasures tended to increase psychophysiological detection, whereas the continuous dissociations tended to decrease detection efficiencies. The pattern was consistent across attention conditions and experiments but it was stronger in the field experiment where overall detection efficiency was relatively high. In other respects the present results replicated previous findings and revealed a significant effect for the attention factor.

Adult↗
PubMed1995

Polygrapher's dilemma or psychologist's chimaera: a reply to Furedy's logico-ethical considerations for psychophysiological practitioners and researchers.

We respond to Furedy's article in this journal where he raised an issue he referred to as the "Polygrapher's dilemma" (Furedy, J.J. (1993) Int. J. Psychophysiol., 15: 263-267). Furedy claimed that the control question test, the most commonly applied psychophysiological detection of deception test, is inherently subjective and harmful to subjects in both the field and the laboratory. Fortunately, Furedy's arguments were based on inaccurate representations of the control question test and on flawed logic. To correct Furedy's misrepresentations, we present an accurate description of how the control question test is used and evaluated. We then examine the results of empirical research that address Furedy's concerns. Furedy's concerns are found to be lacking on almost all counts. Finally, we discuss the findings from several studies that Furedy failed to mention but are directly relevant to the issues he raised.

Ethics, Professional↗
PubMedDate not supplied

Some elementary distinctions among, and comments concerning, the 'control' question 'test' (CQT) polygrapher's many problems: a reply to Honts, Kircher and Raskin.

Although the title of Honts et al.'s paper suggests that it will be a reply to the specific, logico-ethical problem of the CQT polygraph (the Polygrapher's Dilemma), the text deals only tangentially with this logico-ethical problem, and engages, instead, in a diffuse discussion of related, but different, ethical, methodological, and empirical problems of the CQT polygraph. This paper seeks to restore some clarity to the discussion by reminding us of certain basic distinctions among logico-ethical, ethical, methodological, and empirical problems. In the light of these distinctions, the relevant literature, and the essential characteristics of the CQT (which continue to be obscured by the use of systematically misleading terminology), I stand by my claim that, on the ethico-logical grounds (i.e. the CQT Polygrapher's Dilemma formulated in my 1993 paper [1]), as well as ethical, methodological, and evidential grounds (which have been detailed elsewhere), the CQT should be abandoned as a serious method of detecting deception, no matter how useful it may be to practitioners as an interrogatory prop.

Ethics, Professional↗
PubMed1996

Pattern formation in the immortal Hydra.

Well-documented experimental studies with Hydra, done 10-20 years before Mozart was born, marked the dawn of modern developmental biology. Since those days, the immortal and perpetually embryonic hydra has been a classic model system, but despite its deceptively simple appearance, hydra has not yielded its secrets readily. Recent evidence points to a pivotal role of PI-PKC-type signal transduction pathways in morphogenesis: interference with these pathways results in polyps with multiple heads or feet. While molecular techniques are revealing genes involved in pattern realization, a new model of pattern regulation, based on competition for hormonal factors by autoregulatory receptors, emphasizes epigenetic interactions.

Animals↗
PubMed1982

Curable cancers and fatal ulcers. Attitudes toward cancer in Japan.

Japanese patients having terminal cancer are generally not told their true diagnosis. Japanese physicians deem it unethical to reveal a 'death sentence' and the patient's family provides support by reassuring the patient that he will recover. This behavior, strange to many Americans, seems best explained by a symbolic interactionist approach. The Japanese public views cancer as a polluting force leading to death. Family members express their concern in this stressful situation, not by open verbal communication, but by immersing themselves in proper role behavior. The patient also has a specific role in the deception, although he may suspect the true diagnosis. An ironic situation results in that an 'independent' American patient has wider opportunities for support as death approaches, but a 'dependent' Japanese patient faces death alone. As cancer technology changes public images, we suspect that cancer will be more openly discussed. Yet the symbolic behavior that surrounds cancer in Japan today will continue whenever death is seen as prolonged, deforming, and uncontrollable.

Attitude to Death↗
PubMed1988

The drum is the shaman, the spear guides his voice.

Kodi rituals of curing use anthropomorphized objects--the drum and the spear--as intermediaries to communicate with the spirits causing the affliction. The spear 'cuts through' to the cause of the illness at the divination, by guiding the arm and voice of the human diviner. The drum beaten during an all night ceremony has a more important role: a myth at the opening of the ceremony tells the drum's personal story or biography, which is identified with the suffering patient. In the course of the ceremony it travels on a shamanistic journey to the upperworld to seek the blessings of health and well-being. The myth of the drum's origin provides a narrative structure for the whole ritual, and defines the basis for its efficacy. The percussive sounds of the drum and gongs are said to make the patient feel better. A case study shows how 'ordered sound' is used to dissolve social tensions into a culturally structured pattern, so that consensus can be achieved in implicit accommodations in which neither party loses face. An older man's illness awakens guilty feelings among his younger relatives, whose thieving is believed to be responsible. The healing ritual creates the context for them to express contrition without confessing. Thus, although the rite re-establishes communication between persons and between the human and spirit worlds, it involves deception and silences as well as revelations. Through an analytic comment on social tensions, artistic illusions are used to overcome the airing of social differences. The healing rite is intended to restore a social consensus, produced by a combination of music, speech and actions, which allow signs to triumph over substance.

Ceremonial Behavior↗
PubMed1996

Meanings of community.

Community participation in health promotion is one of the central tenets of the WHO's Health For All strategy. Throughout the United Kingdom, 'Health For All' projects have been established and efforts dedicated to the pursuit of community participation in health promotion. Despite this zeal, the deceptively simple notion of 'community' is one of the most contested in the social sciences. Taking this as its point of departure, this paper reviews the meanings of 'community' in social sciences and health literatures. Based on empirical data, it then explores meanings of 'community' for people who are involved in generating community participation in health promotion in the context of four U.K. Health For All projects. A wide variety of different meanings are found; what they share in common is that they are each constructed by people who regard themselves as 'non-members' of these 'communities' and that the views of the putative 'members' are not taken into account in their construction. This substantially differs from meanings of community constructed by their 'members', as represented by Anthony Cohen, where community members' perceptions of sharing are central to the delineation of boundaries. This paper argues that there is a fundamental difference between the construction of communities by 'members' and 'non-members'. In the former case notions are sharing are integral to the construction, in the latter case they are assumed. In the final part of the paper we examine informants daily experiences of operationalising the 'communities' which they construct and argue that commonly their assumptions of sharing prove unfounded. We conclude by arguing that recognition of the differences in the construction of communities by members and non-members is essential, not least because it demands a fundamental rethinking of the notion of community participation in health.

Community Health Services↗
PubMed1996

Maternal and child health in Albania.

Women in Albania today live in a world very different from that of their parents and grandparents. In an increasingly "westernized" nation, women initially appear to have more autonomy within their families and greater power within society than their traditional ancestors had. From the reports of aid agencies and the former government, it appears that Albanian women's health has also greatly improved in the last half century. However, these reports are based largely on questionable statistics. At the same time, initial impressions based on women's public images can be deceptive. According to Albanian physicians, most of the data produced during the socialist era was falsified to improve the government's image. Furthermore, no comprehensive research projects have examined the multi-faceted nature of pregnancy including both social and physical factors. Albanian clinicians and international aid organizations need accurate indicators of maternal and child health to either corroborate or disprove the reports under discrepancy. The study reported here documents current health conditions for pregnant women and their offspring in Albania. Data for the study were collected in 1993 and 1994 from field sites throughout Albania. A total of 3250 medical charts from 1993 were abstracted from five maternity houses. Interviews were conducted during 1993-1994 with 1199 pregnant women who were followed through their pregnancies. Of these women, 938 were located at delivery. Their infants were weighed and assessed. The data show that infant birth weights, gestational ages and mortality rates are now comparable to the rest of Europe. Maternal disease rates and spontaneous and therapeutic abortion rates are also surprisingly low considering the previous reports. However, fertility rates remain relatively high compared to Western Europe. The results show that despite the degeneration of health services, maternal and child health in Albania is much better than expected and vastly improved over the pre-communist era.

Adolescent↗
PubMed1995

Chemical mixtures from a public health perspective: the importance of research for informed decision making.

When considered from a public health perspective, the central question regarding chemical mixtures is deceptively simple: Are current approaches to risk assessment for chemical mixtures affording effective (adequate) and efficient (cost-effective) protection for members of our society? Answering this question realistically depends on an understanding of the hierarchical goals of public health (i.e. prevention, intervention, treatment) and an accurate evaluation of the extent to which these goals are being achieved. To allow decision makers to make informed judgments about the health risks of chemical mixtures, adequate scientific knowledge and understanding must be available to support risk assessment activities, which are an integral part of the regulatory decision making process. Designing and implementing relevant research depends on the existence of a feedback loop between researchers and regulators, where the information needs of regulators influence the nature and direction of research and the information and understanding generated by researchers improves the scientific basis for public health decisions. A clear, consistent, commonly accepted taxonomy for describing important mixture-related phenomena is a key factor in creating and maintaining the necessary feedback loop. Ultimately, both researchers and regulators share a common goal with regard to chemical mixtures; improving the state-of-the-science so that we can make informed decisions about protecting public health. A survey of research issues and needs that are crucial to attaining this goal is presented.

Decision Making↗
PubMedDate not supplied

A comparison of two techniques for analyzing neuronal interspike intervals: autocorrelation and relative interval coding.

Only two theoretical approaches for serial order analysis of spike trains seem to be practical and to preserve a degree of the sequential ordering of the intervals. We herein compared these approaches, employing the two common techniques for autocorrelation and a group of relative interval coding techniques, using 4 short, idealized trains of spike intervals. The relative interval coding approach seemed to be more sensitive for accurately specifying and analyzing serial order. The autocorrelation methods create ambiguity because of inherent "partitioning" effects in the computation and because the interrelations among peaks in the correlogram can be deceptive.

Evoked Potentials↗
PubMed1984

Some personality characteristics of imprisoned heroin addicts.

A group of 20 imprisoned heroin addicts was compared on 4 personality dimensions with a group of non-addict fellow prisoners and a group of normal controls. The 4 personality measures examined were level of self-esteem, perceived locus of control, tendency to self-deception and tendency to project a flattering self-image. The addict group was significantly lower in self-esteem and significantly less inclined to project a flattering self-image than the normal controls. However the addicts were similar to their fellow prisoners on all the psychological measures. The addict and non-addict prisoners were also similar in respect of various socioeconomic indices and criminal history. The belief that one could give up use of heroin without outside help was found to distinguish a subgroup of addicts who were at an earlier stage in the addiction process. However this subgroup did not differ from the more experienced addicts on the 4 psychological measures.

Adolescent↗