Clinical challenges presented by three simultaneous solid tumors

BACKGROUND

Simultaneous tumors are rare, and their management can be challenging. The simultaneous presentation of cervical carcinoma, renal cell carcinoma, and appendiceal carcinoma has not been previously described.

CASE

A 57-year-old woman presented with cervical cancer. During her workup, she was diagnosed with mucinous appendiceal carcinoma and clear cell carcinoma of the kidney. One year following surgery, she remains without evidence of disease and with continually improving nutritional status.

CONCLUSION

When simultaneous tumors are diagnosed, optimal care requires the creative expertise of a multidisciplinary team. Standard sequential therapies may be problematic in patients undergoing major surgery to treat another primary tumor, and sequential treatment delays rather than combining therapies can jeopardize cure. Treatment planning should utilize a coordinated multidisciplinary approach.

[Clinical value of induced sputum test in monitoring airway inflammation in asthma]

OBJECTIVE

To explore the clinical value of induced sputum test in monitoring airway inflammation in asthmatic patients.

METHODS

The induced sputum test was done in 12 normal subjects and 21 asthmatic subjects; The levels of interleukin-8 (IL-8), eosinophil cation protein (ECP), malondialdehyde (MDA) in plasma and induced sputum in all subjects were measured.

RESULTS

The levels of IL-8, ECP, MDA in plasma and induced sputum in unstable asthmatic patients were significantly higher than those in stable asthmatic (P < 0.01), in which the levels of IL-8, ECP, MDA in both plasma and induced sputum were significantly higher than those in normal subjects(P < 0.05); In all asthmatic patients, the levels of IL-8, ECP, MDA in induced sputum were significantly higher than those in plasma.

CONCLUSION

The levels of IL-8, ECP, MDA in induced sputum could be used for monitoring airway inflammation in asthmatic patients.

Vaginal hysterectomy as primary treatment of endometrial cancer in medically compromised women

OBJECTIVE

To study the survival, rates and patterns of recurrence, and perioperative morbidity in medically compromised women with endometrial cancer treated by primary vaginal hysterectomy.

METHODS

Fifty-one patients with endometrial cancer treated initially by vaginal hysterectomy between 1977 and 1999 were identified at the University of California, Irvine Medical Center and affiliated hospitals. Data were retrieved from hospital and office records. Statistical analysis, including Kaplan-Meier methods, was performed and the disease-specific survival rates were estimated. This study has 80% power to demonstrate a greater than 20% improvement in 5-year survival over historical controls.

RESULTS

Fifty-one women with uterine carcinoma clinically confined to the uterus underwent primary vaginal hysterectomy with (n = 26) or without (n = 25) salpingo-oophorectomy. Eighty-four percent were obese with a body mass index greater than 27. Additional risk factors for surgical complications included hypertension (57%), diabetes mellitus (27%), and cardiovascular disease (18%). One-third of patients had three or more risk factors. Surgical morbidity included one episode of acute hemorrhage necessitating transfusion and abdominal exploration. Blood transfusions were given to four additional patients. There were no perioperative deaths. Five women recurred and expired at a median of 13 months (range 3--53 months) after surgery. The 3- and 5-year disease-specific survival rates were 91.4% and 88.0%, respectively.

CONCLUSION

Vaginal hysterectomy for the initial treatment of early-stage endometrial cancer is associated with a high rate of cure and minimal morbidity. Thus, it may be considered a reasonable alternative to the abdominal approach in medically compromised women.

Presenilin-1 P264L knock-in mutation: differential effects on abeta production, amyloid deposition, and neuronal vulnerability

The pathogenic mechanism linking presenilin-1 (PS-1) gene mutations to familial Alzheimer's disease (FAD) is uncertain, but has been proposed to include increased neuronal sensitivity to degeneration and enhanced amyloidogenic processing of the beta-amyloid precursor protein (APP). We investigated this issue by using gene targeting with the Cre-lox system to introduce an FAD-linked P264L mutation into the endogenous mouse PS-1 gene, an approach that maintains normal regulatory controls over expression. Primary cortical neurons derived from PS-1 homozygous mutant knock-in mice exhibit basal neurodegeneration similar to their PS-1 wild-type counterparts. Staurosporine and Abeta1-42 induce apoptosis, and neither the dose dependence nor maximal extent of cell death is altered by the PS-1 knock-in mutation. Similarly, glutamate-induced neuronal necrosis is unaffected by the PS-1P264L mutation. The lack of effect of the PS-1P264L mutation is confirmed by measures of basal- and toxin-induced caspase and calpain activation, biochemical indices of apoptotic and necrotic signaling, respectively. To analyze the influence of the PS-1P264L knock-in mutation on APP processing and the development of AD-type neuropathology, we created mouse lines carrying mutations in both PS-1 and APP. In contrast to the lack of effect on neuronal vulnerability, cortical neurons cultured from PS-1P264L homozygous mutant mice secrete Abeta42 at an increased rate, whereas secretion of Abeta40 is reduced. Moreover, the PS-1 knock-in mutation selectively increases Abeta42 levels in the mouse brain and accelerates the onset of amyloid deposition and its attendant reactive gliosis, even as a single mutant allele. We conclude that expression of an FAD-linked mutant PS-1 at normal levels does not generally increase cortical neuronal sensitivity to degeneration. Instead, enhanced amyloidogenic processing of APP likely is critical to the pathogenesis of PS-1-linked FAD.

Outcomes of extremely low-birth-weight infants between 500 and 750 g

OBJECTIVE

The purpose of this study was to describe morbidity, mortality, and developmental outcomes among extremely low-birth-weight infants (500-750 g).

STUDY DESIGN

This retrospective cohort study included 167 live-born infants born at Long Beach Memorial Medical Center between January 1990 and December 1995.

RESULTS

Mortality rates were 86% among infants <600 g and 44% among those > or =600 g, and the rate decreased with increasing gestational age. The absence of chorioamnionitis (P =.01) and the use of antepartum corticosteroids (P <.0001) or neonatal surfactant (P =.0001) were associated with survival. Sixty-four percent of studied infants had respiratory distress syndrome, and 17% had grade III or IV intraventricular hemorrhage. Among the 63 survivors 57% were tested at 30 months of corrected age with the Bayley Scales of Infant Development. Mild or significant delays were seen on the mental development index in 68% of these cases and on the psychomotor development index in 58% of cases.

CONCLUSION

Morbidity and mortality rates and the rate of developmental delay among infants with birth weights between 500 and 750 g were significant.

Elimination of public funding of prenatal care for undocumented immigrants in California: a cost/benefit analysis

OBJECTIVE

We compared the perinatal outcomes and costs of undocumented women with and without prenatal care and inferred the impact of denial of prenatal benefits to undocumented immigrants in California.

STUDY DESIGN

We retrospectively reviewed the delivery records of a cohort of 970 undocumented immigrants. The effects of prenatal care on low birth weight and prematurity were evaluated by means of logistic regression. The difference in the costs of postnatal care between neonates with and without prenatal care was compared with the cost of prenatal care. This ratio was extrapolated to calculate the net cost to the state. Long-term morbidity costs were also considered.

RESULTS

Nearly 10% of undocumented women had no prenatal care. These women were nearly 4 times as likely to be delivered of low birth weight infants (relative risk, 3.8; 95% confidence interval, 2.03-7.05) and >7 times as likely to be delivered of premature infants (relative risk, 7.4; 95% confidence interval, 4.35-12.59) as were undocumented women who had prenatal care. The cost of postnatal care for a neonate without prenatal care was $2341 more initially and $3247 more when incremental long-term morbidity cost was added than that for a neonate with prenatal care. For every dollar cut from prenatal care we expect an increase of $3. 33 in the cost of postnatal care and $4.63 in incremental long-term cost. Elimination of publicly funded prenatal care for undocumented women could save the state $58 million in direct prenatal care costs but could cost taxpayers as much as $194 million more in postnatal care, resulting in a net cost of $136 million initially and $211 million in long-term costs.

CONCLUSIONS

Elimination of public funding of prenatal care for undocumented immigrants in California could substantially increase low birth weight, prematurity, and postnatal costs.

Hindlimb motor neurons require Cu/Zn superoxide dismutase for maintenance of neuromuscular junctions

The role of oxidative damage in neurodegenerative disease was investigated in mice lacking cytoplasmic Cu/Zn superoxide dismutase (SOD), created by deletion of the SOD1 gene (SOD1(-/-)). SOD1(-/-) mice developed a chronic peripheral hindlimb axonopathy. Mild denervation of muscle was detected at 2 months, and behavioral and physiological motor deficits were present at 5-7 months of age. Ventral root axons were shrunken but were normal in number. The somatosensory system in SOD1(-/-) mice was mildly affected. SOD1(-/-) mice expressing Cu/Zn SOD only in brain and spinal cord were generated using transgenic mice expressing mouse SOD1 driven by the neuron-specific synapsin promoter. Neuron-specific expression of Cu/Zn SOD in SOD1(-/-) mice rescued motor neurons from the neuropathy. Therefore, Cu/Zn SOD is not required for normal motor neuron survival, but is necessary for the maintenance of normal neuromuscular junctions by hindlimb motor neurons.

Evaluation of a linked service model of care for HIV-positive, homeless, and at-risk youths

Two instruments were used to evaluate an agency's type and availability of services for HIV-positive and at-risk adolescents, and to assess opinions concerning healthcare referral patterns. These instruments were administered to representatives of 22 agencies from 10 categories of healthcare services. Nonmetric multidimensional scaling was used to model ratings of interagency knowledge, referral patterns, and general satisfaction with services. We found that no agencies offered youth services for inpatient adolescent-specific mental health treatment or short-term residential drug treatment; however, few offered long-term residential substance abuse detoxification services (5%), outpatient drug maintenance (5%), HIV-specific inpatient services (9%), intensive day treatment for substance abusers (9%), HIV home care (14%), HIV hospice care (14%), inpatient medical services (14%), short-term shelters (14%), long-term housing (18%), HIV-specific clinical trials (18%), and dental services (23%). Barriers to expanding care included lack of funding, transportation, and lack of awareness among youths about services. A multidimensional scaling analysis identified a tight service cluster of two community health centers and the largest public hospital serving poor communities of color, as well as a relatively tight cluster of three service agencies located on the Boston Common serving homeless youths. A third service cluster consisted of two university-affiliated medical centers and one community health center. In conclusion, we found that many critical services for HIV-positive youths are relatively scarce. Multidimensional scaling provides a visual presentation of the relationships of network sites. This evaluation of services indicates a need for increased, accessible youth-oriented HIV services and suggests that linkages across the three distinct clusters of service providers should be solidified. These methodologies can be used to develop a generic model describing the stages of linkage formation in HIV care service networks.

Assessment and Modification of Flexibility of Cognitive Structures Created in University Courses

Students' organization of the knowledge that they acquire is an important factor in determining the degree to which it is retained and used. In the past we have used the "fill-in-the-structure" (FITS) task as a direct method of inferring students' cognitive structures of course content (Naveh-Benjamin, Lin & McKeachie, 1995). This study goes one step further by using the FITS task to assess the flexibility of students' cognitive structures of the material learned; that is, whether students are able to relate the same concepts in different ways when the concepts are embedded in two different conceptual frameworks. We assessed the flexibility of students' cognitive structures in three studies by asking students in an ecology course to complete two different structures, each based on a different major dimension in the course. Results of the first study showed that the FITS technique could be used to assess students' ability to use concepts learned in the course appropriately in two different frameworks. The flexibility measures obtained were positively related to academic performance. The second study demonstrated the usefulness of the technique in measuring the development of conceptual flexibility during the course. Finally, the third study employed the technique to show that students' flexible use of concepts can be enhanced by appropriate instruction. Copyright 1998 Academic Press.

The associations of suicide attempts in adolescents

OBJECTIVE

Suicide completion has increased in the United States among 15- to 24-year-olds from 4.5 per 100 000 (1950) to 13.2 per 100 000 (1990). Suicide attempts have been found to be associated with depression, substance use, overall number of life stressors, gender, and impulsive behaviors. We hypothesized that suicide attempt is associated with many other health risk behaviors.

DESIGN

To evaluate this hypothesis, we analyzed the data from the 1993 Massachusetts Youth Risk Behavior Survey from a representative sample of students in grades 9 through 12 in public and private high schools. We examined the relationships between ever attempting suicide and engaging in other health risk or problem behaviors (eg, sexual activity, substance use, violence, and seat belt nonuse).

RESULTS

The 3054 students were distributed among the 9th to 12th grades; 50.7% were female, 77.7% white, 6.7% black, 5.9% Hispanic, 4. 6% Asian, .8% Native American, and 4.4% other; and the mean age was 16 +/- 1.2 years. Based on logistic regression analysis, ever attempting suicide was associated with physical fights in the past 12 months (odds ratio [OR] = 1.3[95% confidence interval (CI), 1. 22-1.44]), regular cigarette use in the past 30 days (2.0[1.41-2. 97]), female gender (3.2[2.21-4.71]), lack of seat belt use (1.3[1. 21-1.34]), gun carrying in the past 30 days (1.4[1.12-1.70]), substance use before last sexual activity (1.4[1.09-1.84]), Native American or other (2.4[1.21-4.71]), and lifetime use of other drugs (1.2[1.04-1.40]). The full model correctly assigned 92% of the youth. There were small differences in models for males, females, and sexually active youth. Same gender sexual experiences for sexually active youth did not significantly improve the model (partial r = .0, OR = .87 [95% CI, .33-2.30]) and fewer (88%) of the youth were correctly assigned by the model.

CONCLUSIONS

Ever attempting suicide is associated with other problem behaviors. This research proposes an empirical model of the relationship between suicide attempts and other health risk behaviors. Identifying which adolescents are at risk for suicide attempts from the presence of accompanying risk behaviors will help clinicians to evaluate suicide risk when other problem behaviors are identified, thus enabling the design of possible prevention strategies.

[Current status of HIV infection in Yunnan Province of China]

In cooperation with the Chinese Academy of Preventive Medicine and Yunnan Province Provincial Office for AIDS Control and Prevention, we studied the current status of HIV infection intravenous drug users (IVDUs) and other high risk groups in Yunnan province of China. As of the end of 1995, 1,807 HIV cases were officially reported (Positive rate was 0.6%), of which 1,278 (77.9%) were IVDUs, and 24 were their spouses. The majority of cases were found among the Dai minority male farmers near Ruili which borders on Myammar, but HIV also appears to be spreading among the Han people. HIV antibody positive rates among commercial sex workers, pregnant women and blood donors were 0.2%, 0.07% and 0.04%, respectively. A system for surveillance of HIV has been developed, but preventive strategies to cope with HIV epidemic are not sufficient. As HIV/AIDS is now a global issue, (1) the integration and coordination of such preventive strategies in cooperation with community health workers, (2) general health education for condom use promotion and (3) care of psychological vulnerable person such as IVDUs, should be developed.

Phase II trial of edatrexate in patients with advanced hepatocellular carcinoma

BACKGROUND

The methotrexate analogue edatrexate (10-ethyl-10-deaza-aminopterin, or 10-EDAM) has demonstrated greater activity than methotrexate has against murine tumors and human tumor xenografts. Phase II trials of edatrexate have already demonstrated its activity against breast, lung, and head and neck carcinomas. A phase II trial of edatrexate was conducted in patients with advanced hepatocellular carcinoma.

PATIENTS AND METHODS

Seventeen patients with previously untreated unresectable hepatocellular carcinoma were enrolled on the study. Edatrexate, 80 mg/m2 weekly for 5 weeks, was administered intravenously. The treatment course was repeated every 6 weeks. Tumor response was evaluated by computerized tomographic scan after 2 courses.

RESULTS

No complete or partial responses were observed in this trial. Two minor responses, each lasting less than 12 weeks, were observed. Twelve patients had elevated serum alpha-fetoprotein (AFP) levels at entry into the study; 4 of the 12 patients experienced a > or = 25% decrease in the level of this tumor marker; 3 of the 4 had a > 50% reduction in AFP level. Grade 3 and 4 toxic effects were granulocytopenia, thrombocytopenia, anemia, oral mucositis, skin reactions, fatigue, anorexia, and diarrhea.

CONCLUSIONS

Edatrexate administered at this dose and schedule appears to have little therapeutic efficacy against advanced hepatocellular carcinoma.

Enhancing effects of interleukin 2-treated peripheral blood mononuclear cells on subsequent B cell differentiation

Despite an extensive literature dealing with IL2-induced cytolytic activity, noncytotoxicity-related effects of IL2 on peripheral blood mononuclear cells (PBMC) or T cell function have received less attention. We have focused on the effects of irradiated, IL2-activated PBMC (PBMC*rIL2) on anti-CD3- and formalin-fixed heat-killed Staphylococcus aureus-induced polyclonal B cell differentiation in secondary cultures. PBMC*rIL2 act directly on B cells and cross major histocompatibility complex barriers to augment polyclonal B cell differentiation as measured by plaque-forming cell (PFC) generation. These effects are preferentially mediated by T (both CD4+ and CD8+) cells, and physical contact between effector PBMC*rIL2 and target B cells is not absolutely required for enhanced PFC generation. PBMC*rIL2 must be present for the initial 24 hr of the secondary cultures, indicating that some soluble B cell differentiation factor rapidly released by PBMC*rIL2 mediates the PFC-enhancing effect. Of IL2, IL4, IL5, IL6, IL10, IFN-gamma, and TNF-alpha, only IFN-gamma mRNA is appreciably and reproducibly increased in irradiated, IL2-activated T cells (T cells*rIL2). Nevertheless, exogenous rIFN-gamma cannot mimic and anti-IFN antibodies cannot block the PFC-enhancing effects of T cells*rIL2, indicating that some unidentified soluble factor(s) apart from or in addition to IFN-gamma is involved. IL2-induced effects on T cell noncytolytic function may help explain certain observed immune anomalies in IL2-treated patients, and a better understanding of the IL2-induced effects on T cell noncytolytic function may have ramifications for autoimmune diseases such as SLE.

[The surgical treatment of partial atrioventricular canal defect]

This paper reports 11 cases of partial atrioventricular canal defect in our hospital. It also discusses the diagnosis of complication prevention and treatment with patient and the disposal during operation term, emphasizes that once definite diagnosis has been made, operation must be taken as soon as possible. Skillfully grasp surgery anatomy and exact suture techniques is the key to avoid conduction damage.

[Surgical treatment of ruptured aneurysm of aortic sinuses and ventricular septal defect. Report of 7 patients]

From Dec. 1985 to Oct. 1988, 7 patients with ruptured aneurysm of the aortic sinus and VSD were treated surgically. The aneurysm of the right coronary sinus of Valsalva was ruptured into the right ventricle in 6 patients and that of the non-coronary sinus into the right atrium in another one. All patients survived and murmurs disappeared. Chest X-ray examination 6-18 months after operation showed a normal cardiac-thoracic ratio. The patients resumed their daily activities.

The effect of a fish oil enriched diet on oxygen toxicity and lipid peroxidation in mice

Mice were fed a chow diet or diets enriched in fish oil, sunflower oil or beef tallow for 3 weeks. Fatty acid analysis was carried out in samples of plasma, brain and lungs from these animals and large changes were found in plasma and lungs with relatively small dietary-induced changes in brain tissue. Bleeding times were increased very significantly in the fish oil group, and slightly increased in the sunflower oil group. Endogenous lipid peroxidation (measured as thiobarbituric acid reactive substances) was unchanged in lung and brain, but lung tissue from fish oil fed mice produced more lipid peroxides in vitro during incubation at 37 degrees than those of other dietary groups. Mice fed the four different diets were exposed to hyperbaric oxygen at 618, 585 and 515 kPa and convulsive activity and lung damage was recorded. No dietary-induced alterations in susceptibility to oxygen toxicity were found.

[Characteristics of endobronchial tuberculosis under fiberbronchoscopy]

Thirty five cases of tuberculosis of bronchial endometrium proved by bronchoscopy and biopsy were reported. More than half of them are young patients below 35 years old. Chief complaints are cough and chest pain. 38.5% of them had atelectasis revealed by x-ray. Granuloma, congestion edema and narrowing of the lumen of the bronchi were characteristic features under the bronchoscopy, 29% of them were misdiagnosed as bronchogenic carcinoma before the bronchoscopy; therefore, the procedure is important in the diagnosis of tuberculosis of endometrium of bronchi.

[Multiple primary bronchial carcinoma. A case report of three separate synchronous primary cancers and a review of literature]

Fibreoptic bronchoscopy was performed in 677 patients with primary bronchial carcinoma during a period from October 1978 to January 1988. In one of them three separate synchronous bronchial carcinomas were found in the lungs. Two of these tumours were radiographically occult. The diagnoses of squamous cell carcinoma of the lung were verified histologically by materials obtained at fibreoptic bronchoscopy. This finding emphasizes the importance of careful bronchoscopic examination of the whole bronchial tree before surgical treatment of lung cancer. The literatures of 41 cases with multiple primary bronchial carcinoma were reviewed.

Cognitive Schemas in Social Perception

This paper explores the cognitive schemas involved in ingroup and outgroup perceptions of three U. S. religious denominations (Baptists, Lutherans, and Catholics) based on a factor analytically derived rating scale. Two principal techniques are used for assessing these perceptions, that is, Similarity Structure Analysis, SSA, and Procrustean Individual Differences Scaling, PINDIS. The first is used to determine what the within-group and between-group perceptual structures are, while the latter is used to determine communalities among the various structures (stereotypy). Results revealed a high communality between denominational self-perceptions as well as some stereotypic misperceptions of Baptists and Catholics, but not of Lutherans.

Markedly enhanced production of gamma interferon in murine T lymphocytes treated with lentil lectin and the diterpene ester, mezerein

Gamma interferon (IFN-gamma) was induced in murine splenocytes first stimulated to grow by concanavalin A (Con A) and subsequently treated for 3 h with the diterpene ester, mezerein (MZN) and then with lectin from Lens culinaris for 24 h. Yields as high as 60,000 u/ml were obtained in cells from either male or female, random-bred, white Swiss mice or inbred C67B1/6 mice. Antibody to Thy 1.2 surface antigen completely obliterated the mouse gamma interferon (MuIFN-gamma) response, whereas anti-Lyt 1.2 and anti-Lyt 2.2 each destroyed a portion of the lymphocyte population responsible for MuIFN-gamma production. Kinetic analysis of production and release showed that IFN was detectable in culture fluids within 4 h after treatment with very little IFN remaining cell-associated (less than 10%). A simple, rapid, and economical two-step purification procedure involving ammonium sulfate fractionation and yeast RNA affinity chromatography resulted in as much as 770-fold purification to achieve specific activities greater than 10(7) u/mg protein. The purified MuIFN-gamma was shown to be predominantly acid-labile, inactivated by sodium dodecyl sulfate (SDS), and neutralized by antiserum to MuIFN-gamma. Approximately 10% of the MuIFN-gamma was acid-stable and SDS-resistant, but was still neutralized by anti-MuIFN-gamma serum. Two molecular weight peaks of about 40 and 20 kD were demonstrated by SDS-polyacrylamide gel electrophoresis. Isoelectric focusing in polyacrylamide slab gels gave a relatively heterogeneous band of activity between pH 5.5 and 6.5. The mechanism by which the combination treatment described enhances MuIFN-gamma production so markedly remains unknown, but the degree of enhancement is greater than additive.

WAIS correlates of the Minnesota Percepto-Diagnostic Test in a sample of epileptic patients: differential patterns for men and women

Intellectual correlates of the total score on the Minnesota Percepto-Diagnostic Test were investigated for a sample of adults with epilepsy. The correlations between the perceptual test score and WAIS IQ and WAIS subtest scores were consistently significant for the men but generally were not for the women. It is recommended that researchers consider separate analyses of data for males and females.