Glioma with Leptomeningeal Spread Mimics Chronic Meningoencephalitis in a Young Adult

The most malignant type of intrinsic brain tumor is glioblastoma (WHO grade IV). Primary leptomeningeal spread is rare and leads to a variety of differential considerations, as there is no typical clinical or imaging pattern. Here we present a rare and uncommon case of a primary leptomeningeal glioblastoma in combination with a low-grade glioma in a 21-year-old male, initially presenting with only headache and lower back pain. The presented case illustrates the challenging differential considerations and the severe course of leptomeningeal glioblastomas.

Importance of Transvaginal Elastography in the Diagnosis of Uterine Fibroids and Adenomyosis

PURPOSE

To evaluate normal uterine tissue with special regard to age and the presence of uterine fibroids and adenomyosis with transvaginal elastography.

MATERIALS AND METHODS

In a prospective study elastographic data of the uterus were obtained in 206 unselected women with transvaginal ultrasound. Women who presented without any uterine pathology in ultrasonography were included in a control group, women with uterine fibroids in a uterine fibroid group, and women with adenomyosis in an adenomyosis group. In the control group strain values were measured at two regions of interest (ROIs) placed one upon the other in the anterior inferior uterine segment during a cycle of compression. The maximum strain ratio (ROI1 / ROI2) was stored as the "age index". In all groups strain values were measured at two ROIs placed side by side in a uterine fibroid (uterine fibroid group) or adenomyosis (adenomyosis group) or healthy homogeneous tissue (control group) and adjacent healthy tissue. Maximum strain ratios (ROI3 / ROI4) were stored as the "lesion index".

RESULTS

The "age index" was significantly negatively correlated with the age of the women (r = -0.49, p < 0.001). The median "lesion indices" were significantly (p < 0.001) different between the uterine fibroid, adenomyosis and control groups. Median "lesion indices" were 2.65, 0.44 and 1.19, respectively.

CONCLUSION

The "age index" shows that normal uterine tissue has a certain age-dependent stiffness that increases with age. The "lesion index" allows for the assessment of the presence of a uterine fibroid or adenomyosis and helps to differentiate between both focal findings. Thus the use of elastography in addition to conventional ultrasound could help to diagnose uterine focal lesions and may be useful in preoperative planning.

A qualitative study of perceptions, attitudes, and experiences of long-term levonorgestrel implant users

The present study examined the perceptions, attitudes, and experiences of long-term contraceptive implant users. Group interviews were conducted to obtain qualitative in-depth attitude and opinion data from 31 women who had used the implant for a minimum of four years. Results indicated that many women had experienced side effects with implant use, in particular during the first year. The primary motivations for continuing the use of implant were: women's strong desire for a long-term, reversible, and convenient method that offered effective protection from pregnancy, a strong need for control over one's life, and general dissatisfaction with alternative methods. Exposure to negative media reports, and peer commentaries did not influence implant's continued use. However, intensive educational counseling prior to insertion played a significant role in the long-term use of implant. Findings from this study indicate that women are willing to accept side effects as the price to be paid for an effective and convenient contraceptive method, and for gaining control over their lives. Furthermore, women appear to be less influenced by opposing social climate, in the absence of negative personal experiences. Our findings underscore the importance of educational counseling prior to implant insertion.

Predicting anxiety in competitive sports

The relationship between attitudes toward winning and competitive anxiety was explored in 59 undergraduate students competing on four different New Jersey-based, NCAA Division III sports teams. In a backward multiple regression analysis, cognitive anxiety was predicted significantly only by self-confidence, while somatic anxiety was predicted significantly by self-confidence and the rated importance of the competition.

Factors associated with unintended pregnancy

This research was designed to identify determinants of unintended pregnancy among women attending family practice or family planning clinics. Survey data were collected from 95 women who were categorized according to whether or not they had experienced an unintended pregnancy. Women reporting unintended pregnancy were younger, reported earlier sexual debut and a greater number of sexual partners than those not having experienced an unintended pregnancy. Those who had avoided unintended pregnancy displayed higher levels of preventive sexual self-efficacy, had more confidence in their ability to use contraceptive methods, perceived more negative consequences associated with having children in the near future, and believed pregnancy among unmarried women to be less acceptable than did women who had had unintended pregnancies.

Levonorgestrel subdermal implants. Contraception on trial

When they were introduced to the world market in the 1980s, levonorgestrel subdermal implants offered the promise of an exciting alternative to traditional hormonal contraception. They provide highly effective, long-acting protection from pregnancy, without the need for user compliance. Broad acceptability of the drug has been reported throughout the world. Recently, however, the implants have met with opposition. The drug is associated with a variety of adverse effects, and removal of implants can be problematic. Serious events have been reported in women using levonorgestrel subdermal implants, although causal relationships have not been demonstrated. Additionally, concerns have been raised over the potential for coercive use of the drug. Numerous law suits have been filed alleging serious problems with implants. As a result, the drug has received considerable negative media attention. Before the controversy over levonorgestrel subdermal implants erupted, contraceptive development had declined, resulting from limitations to profits and funding, legal threats, and changes in the insurance industry. The levonorgestrel subdermal implant experience may serve to accelerate this trend. While the introduction of levonorgestrel subdermal implants offered an alternative to the current array of medical contraception, its experience may serve to dampen future contraceptive development efforts. Costly litigation and much controversy involving the implants have acted to create disincentives to further research and development of new methods of medical contraception.

Comparison of spermicides on vulvar, vaginal, and cervical mucosa

The objective of this study was to compare the tolerability of Advantage 24 to two other spermicides containing non-oxynol-9 (N-9). These spermicides were Today Sponge (Sponge) and Conceptrol. In order to examine the incidence of complaints and the clinical observation of vaginal ulceration and irritation of the three spermicides, a randomized, open label, three period cross-over trial was conducted. Thirty-three women, ages 18-45, with a normal vaginal environment based on physical exam, Pap smear, vaginal wet prep, colposcopy, and serum N-9 were randomized into four treatment groups. Each treatment was for seven consecutive days with a 21-day washout. Data obtained were studied by one-way analysis of variance, chi-square, and Kruskal-Wallis test. No vulvar or vaginal abnormality was observed from either spermicide. Subjects had fewer and less severe cervical lesions by colposcopy during treatment with Advantage 24 than with Conceptrol or Sponge (p < 0.01). Comparison of the incidence of abnormal gynecological findings, serum N-9 levels, and the incidence of adverse events before and after treatment with the three study drugs indicate that most subjects had normal examinations pre- and post-treatment. Pap smear and colposcopy changes from normal to abnormal accounted for about 50% of all gynecological findings during the Conceptrol and Sponge treatments, but less than 20% during treatment with Advantage 24. All serum N-9 levels were below the level of detection (< 1.9 microgram/ml). Advantage 24 is better tolerated than Conceptrol or the Sponge. Furthermore, the cervical mucosa appears to be less resilient to spermicides than vulvo-vaginal mucosa.

A cross-sectional survey of condom use in conjunction with other contraceptive methods

A cross-sectional survey of 3,136 women attending family planning clinics in Texas was conducted to examine past use of and future plans for use of condoms by partners during sexual intercourse for disease prevention in conjunction with other contraceptive methods. Following the receipt of clinical services, including counseling about family planning and disease prevention, both contraceptive and planned condom use reporting increased for the majority of subjects. However 22% of the sample indicated that they intended to reduce condom use in the future and instead use a contraceptive which protects from pregnancy but not from disease. Condom use was indicated more frequently for those who reported at least one risk factor for HIV, but 17% of those at risk indicated lower future condom use than past use. This suggests that without changes in risk behavior, these women will be at increased risk of HIV or another sexually transmitted disease.

Characteristics and experiences of American women electing for early removal of contraceptive implants

The study describes the experiences of 430 women who had Norplant(R) contraceptive implants removed prior to the five years of method effectiveness. Each subject was surveyed when the implants were inserted and again at the time of removal. Descriptive data are presented concerning perceptions of the method before insertion and after removal, reactions to the contraceptive and experiences associated with the removal procedure. Subjects' use of Norplant implants ranged from 14 days to 40 months, with a mean of 13.3 and median of 13 months. Over 95% reported changes in menstrual bleeding patterns and 95% experienced other non-bleeding related side effects. Non-bleeding side effects were the most frequently indicated reasons for removal, followed by bleeding changes. The mean removal time was 34 minutes with a median of 25 minutes. Over 48% reported experiencing significant pain during the removal procedure, and 27% stated that the pain was greater than expected. Despite electing for early removal of implants,the majority of women surveyed indicated satisfaction with all aspects of the method save its effect on their overall health. Although method-related side effects were intolerable for most subjects, their overall perception of the method was generally satisfactory.

Characteristics of teens tested for HIV in a metropolitan area

PURPOSE

This article describes the status of HIV infection in an adolescent population attending publicly supported HIV testing clinics in Houston.

METHODS

Records were reviewed of 4017 teenagers receiving HIV counseling and testing services over a period of three years (January 1990 to December 1992). We analyzed demographic characteristics, risk exposure groups, results of HIV antibody testing, and post-test counseling return rates.

RESULTS

An overall seroprevalence rate of 10.2 per 1000 was observed, with the majority of cases seen among black females. Forty-nine percent of teens with the virus failed to acknowledge a risk factor, but of those who did, male-to-male sexual contact was the most frequently reported. None who tested positive reported injected drug use. The majority of teens tested never returned to obtain their test results and post-test counseling.

CONCLUSIONS

In order to reinforce preventive behavior, institutional and other barriers should be examined and priority given to contacting both seropositive and high-risk clients who have sought testing. Interventions that encourage condom use or address sexual behavior may be more beneficial to teens than those that simply focus on drug use.

HIV exposure in the city of Houston

Demographic characteristics and risk factor data for 76,672 clients were studied to characterize the distribution of infection with human immunodeficiency virus (HIV) and the use of counseling and testing facilities in Houston, Tex. The number of clients who received free, voluntary HIV counseling and testing services between January 1990 and December 1992 doubled, while the seroprevalence rate declined from 6.1% to 2.9%. Rates were highest for white males, clients attending freestanding HIV testing sites, and those reporting male-to-male sexual contact. The number of females testing positive had increased by 67% over time and consisted almost entirely of blacks. Only 57% of clients who were tested returned for test results and received posttest counseling. Among those who were HIV negative, high-risk behaviors were frequently reported. Behavioral change must be reinforced, and priority must be given to contacting both seropositive and high-risk clients who seek testing.

The attitudes of clinic staff as factors in women's selection of Norplant implants for their contraception

Medical and counseling staff at 13 family planning clinics in Texas, U.S.A., were surveyed regarding their opinions and level of information about the contraceptive Norplant. These responses were used to assess the relationships between clinicians' information and attitudes about the contraceptive and the use of that method by their patients. No differences were associated with respondents' clinical responsibilities or with their type of professional training. However, significant variations in the numbers of patients receiving Norplant from individual providers, and in the proportion receiving the method from certain clinics, were associated with responses to some attitudinal questions. These findings suggest that the opinions about Norplant held by personnel staffing family planning clinics influence the method selection of their patients.

A risk-based screening approach for prioritizing contaminants and exposure pathways at Superfund sites

Contamination at Superfund sites can involve mixtures of chemicals and radionuclides in a variety of environmental media. Determining priorities for evaluation and remediation of various contaminants is an important part of the initial phases of any site investigation. An effective screening analysis at the beginning of the project can help by identifying both those situations in need of immediate remedial attention and those which require further sampling and evaluation. The screening approach discussed here is made up of two sets of calculations designed to provide upper- and lower-bound estimates of health risk to individuals likely to receive the highest exposures. This approach allows rapid identification of contaminants which pose a negligible risk and can be assigned a low priority for remedial attention or which pose a substantial risk and should be given the highest priority for appropriate remediation efforts. Contaminants designated as neither high- nor low-priority should be investigated in more detail prior to making decisions regarding the need for or method of remediation. The utility of this approach has already been demonstrated in the evaluation of contamination in the Clinch and Tennessee River systems originating from historical operations of atomic weapons and energy research facilities near Oak Ridge, Tennessee.

One-year experience with subdermal contraceptive implants in the United States

Women who received Norplant contraceptive implants from any of fifteen clinical settings in southeast Texas, U.S.A., were followed for one year to determine their reactions to the method. Of 1,385 who enrolled to receive Norplant implants, 1,253 had implants inserted. Side effects were reported by 78% of those receiving implants and 70% described changes in bleeding patterns. Spotting or irregular bleeding, weight gain and headaches were the conditions reported most frequently. Nine pregnancies were reported during the study period. Six of these, however, existed before the implants were inserted. At the one year anniversary, 143 of women receiving implants had had them removed. Those who discontinued method use were less satisfied, reported more side effects and were more likely to have planned to have another child, thus using the method for spacing, or to have had a change in their marital status while they were using the contraceptive. Providers should counsel patients to focus attention on plans for the future in selecting their contraceptive method. In addition, we recommend, as does the product's distributor, that providers confirm that patients are not pregnant prior to inserting implants.

Planned condom use by women with Norplant implants

This research examines the use of condoms to protect from disease women who selected hormonal implants for contraception. After receiving contraceptive implants, subjects were surveyed regarding their past use of condoms and their plans for using them to inhibit the transmission of HIV and other sexually transmitted diseases in the future. Twenty-one percent of women in the sample had used condoms in the past, but did not plan to use them once they have the implants. While decreasing their risk for unplanned pregnancy, they and/or their partners can be expected to experience an increased risk of exposure to sexually transmitted disease. Contraceptive providers must emphasize to their patients the need for protection from disease, in addition to pregnancy, when prescribing contraceptive methods.

Factors associated with the choice of Norplant by women attending subsidized clinics in the US

US women attending family planning clinics in Texas, were surveyed to determine which characteristics, experiences, behavior and specific needs were associated with the selection of the contraceptive Norplant. Race, ethnic origin, age and education were unrelated to choice of method. Increased numbers of previous pregnancies, familiarity with the method, dissatisfaction with previous methods, and sources of information about Norplant were associated with its selection. There was significant variation among the clinics in the proportion of patients to which they dispensed the method. Therefore, clinic selection may have influenced the outcomes of contraceptive decisions.

Risk factors for infection with human immunodeficiency virus among low-income women undergoing voluntary sterilization

Data regarding risk for infection with human immunodeficiency virus (HIV) were collected from 486 women who presented in 1989 for tubal sterilization through a clinic operated by a medical school. This clinic was participating in a blind surveillance project administered by the local health department. The project was designed to estimate the prevalence of seropositivity for HIV among women seeking family planning services within the department's catchment area. The expectation was that the population of women choosing voluntary sterilization would be of relatively low risk for HIV infection. Surprisingly, however, when they were examined, nearly 25% of these women reported at least one identified risk factor for HIV infection. The rates for certain specific risk factors are no lower among these women than among the general population.

Characteristics and attitudes of early contraceptive implant acceptors in Texas

In 1991, shortly after Norplant became available in the United States, 678 women who had received the implant from 17 providers in Texas were surveyed. Forty-five percent of these women were under 21 years old. The majority (56%) had tried the implant because they were dissatisfied with their previous contraceptive method. Forty-four percent of the sample indicated that the implant was one of the first contraceptive methods they had used and that they had only recently decided to prevent unplanned pregnancy. The average number of children per woman was 1.2, and one-third of the sample had had at least one abortion. While 37% of the women said they wanted no more children, 63% said they were using the implant as a spacing method. The reasons for choosing the implant and concerns about it varied according to the user's age, educational level and race or ethnic group.

A randomized, double-blind, placebo-controlled comparison of the impact of low-dose and triphasic oral contraceptives on follicular development

OBJECTIVE

This investigation tests the hypothesis that triphasic oral contraceptives are associated with the development of large, persistent ovarian cysts.

STUDY DESIGN

Weekly vaginal ultrasonography was used in a randomized, double-blind, placebo-controlled, parallel-group, single-center study that compared the incidence, risk, size, and time to resolution of ovarian follicles in healthy women who took Estrostep or Loestrin oral contraceptives (manufactured by Parke-Davis) or a placebo during three consecutive menstrual cycles.

RESULTS

Sixty-three percent of placebo-treated subjects developed follicles greater than 18 mm, compared with 39% and 23% in the Estrostep and Loestrin groups. The risks for each group of developing a large follicle during a single cycle were not different. No dominant follicle persisted for greater than 2 weeks for any subject.

CONCLUSION

These results demonstrate that follicular development continues during treatment with oral contraceptives. In addition, the findings fail to support the hypothesis that triphasic oral contraceptives result in persistent ovarian cysts.

Suicide and homicide away from home

In 1980, suicides in the United States that occurred outside the victim's home state were most often committed by young single or divorced men. Hanging was the most common means of suicide. Homicide victims who were killed outside their home state were usually male, black, divorced, young, and killed by unusual (other) means or by law-enforcement officers.

Underage gambling in Atlantic City casinos

A three-year survey of college students was conducted to ascertain the frequency and preferences of student gambling at nearby casinos in Atlantic City, New Jersey. The data suggest that gambling by underage college students is common and indicates that age control at casino entrances is quite poor. An additional finding of differential memory for wins and losses suggests the need for an information processing analysis of memory for gambling outcomes.

Underage gambling in Atlantic City casinos

A three-year survey of college students was conducted to ascertain the frequency and preferences of student gambling at nearby casinos in Atlantic City, New Jersey. The data suggest that gambling by underage college students is common and indicates that age control at casino entrances is quite poor. An additional finding of differential memory for wins and losses suggests the need for an information processing analysis of memory for gambling outcomes.

Geophysical variables and behavior: LIX. The seasonal variation in suicide rates: three studies

The seasonal variation in suicide in the USA was not more pronounced in 1980 in northern regions but was more clear for married people than for those with other marital statuses. The seasonal variation in suicide was not associated with the gross domestic product of the region.

The use of motor vehicle exhaust for suicide and the availability of cars

A study of the states of the United States showed that suicide rates using car exhaust were lower in states that had lower rates of car ownership, a greater proportion of the population living in non-urban areas and that were further north. The implications of these results for a public health approach to suicide prevention are discussed.

Sex differences in the seasonal distribution of suicides

An attempt was made to replicate in the USA sex differences reported for the seasonal distribution of suicide in the UK, Finland and Australia. No sex differences were found. Spring and late summer peaks were found for suicides by both males and females. The method of suicide was found to be an important factor in the seasonal distribution of the suicides of males and females.

Psychology of the scientist: LVIII: Anxiety about research: an initial examination of a multidimensional concept

24 male and 26 female students in introductory psychology completed questionnaires assessing six dimensions of anxiety: planning, doing a library search, administration of a test or instrument, doing statistical analysis, writing out research results, and presenting the results to an advisor or professor. Six applications of Cole and Oetting's Concept-specific Anxiety Scale were utilized to examine the dimensions of trainee-researchers' anxiety and scores on six subscales were analyzed. Identifiable trainee-researchers' anxiety was found, and scores on the Anxiety About Research Scale discriminated among the various dimensions. Specifically, anxiety about statistics was a significant area of anxiety for men and women, with women indicating more anxiety than men. Presentation of results to an advisor or professor produced identifiable anxiety, as did administration of a test. Implications are discussed.

Bioaccumulation of 95mTc in fish and snails

Concentration factors for technetium recommended in radiological assessment models for freshwater biota are default values based on the behavior of iodine in the environment. In this study a small experimental freshwater pond was spiked with 95mTc to obtain data for calculating concentration factors for fish and snails. A model using the pond data was developed to calculate steady-state body burdens for freshwater biota. The concentration factors based on the calculated body burden for carp (Caprinus carpio), mosquitofish (Gambusia affinis), and snails (Helisoma sp.) were 11, 75 and 121, respectively. The concentration factor for carp was less than the recommended value of 15 listed in the USNRC Regulatory Guide 1.109 for calculating radiation dose to man; however, the concentration factors for mosquitofish and snails exceeded the recommended values by 5 and 24 times, respectively.