The American Joint Committee on Cancer Staging and End Results Reporting

Dr. Copeland describes the development of The American Joint Committee on Cancer Staging and End Results Reporting, its objectives, and the steps in the preparation of the clinical classifications. Emphasis is on simplicity, practicability and credibility. The TNM (tumor, nodes, metastasis) system is utilized where possible.     

CONCEPTUALIZING FAMILY MEMBERS OF VIOLENT MENTALLY ILL INDIVIDUALS AS A VULNERABLE POPULATION

A review of literature concerning familial violence and mental illness using the Vulnerable Populations Conceptual Model (VPCM) as an organizing framework is presented. Since family members are most likely to be targets if a person who is mentally ill becomes violent, this review emphasizes the VPCM concepts of resource availability (including capital, stigma, and access to healthcare), risk, and health status of those family members. The population-based VPCM was used in an attempt to move the examination of this phenomenon from a focus on the individual to a conceptualization of it as family violence occurring within a broader, social context.     

Recovery of T cell subsets after autologous bone marrow transplantation is mainly due to proliferation of mature T cells in the graft

In 22 patients with malignancies, treated with high-dose chemoradiotherapy and autologous bone marrow transplantation (BMT), peripheral blood T cell subsets and functions were studied. In ten cytomegalovirus (CMV)-negative patients, CD4+ and CD8+ T cells (representing T cells of the helper/inducer phenotype and T cells of the suppressor/cytotoxic phenotype, respectively), recovered slowly and simultaneously. In 12 CMV-positive patients, however, CD8+ T cells recovered more rapidly than CD4+ T cells and rose to increased counts. No T cells with an immature phenotype (CD1+, OKT6+) were observed. Lymphocyte stimulation by herpes simplex virus infected fibroblasts (and by CMV-infected fibroblasts in CMV-positive patients) in contrast remained high and even increased after BMT in both groups. These data indicate that T cell recovery after autologous BMT is mainly due to proliferation of mature T cells present in the BM graft and not to generation of new T cells from T cell precursors.     

Factors causing malnutrition in patients with chronic uremia

There is abundant evidence that patients with chronic renal failure (CRF), including those treated by hemodialysis or peritoneal dialysis, have evidence of malnutrition with decreased body weight and subnormal values of serum proteins (suggesting a loss of visceral protein stores). Potential causes of an abnormal nutritional status that have been identified include an inadequate intake of protein or calories, an inability to activate the metabolic responses that are needed to achieve nitrogen and protein balance, or the presence of a disease that prevents activation of these metabolic responses or acts to stimulate the breakdown of body protein stores. Three critical metabolic responses to a limited protein intake have been identified: a reduction in the irreversible degradation of amino acids and the degradation of protein breakdown and an increase in protein synthesis in response to a meal. Metabolic acidosis blocks the first two responses and hence contributes to malnutrition in patients with chronic uremia. Other factors that could contribute to malnutrition include an inadequate intake because of anorexia or hormonal imbalances that impair protein turnover. In evaluating CRF patients with malnutrition, the first task is to ensure an adequate intake and to eliminate factors that impair the ability to achieve nitrogen balance.     

Severe obstruction of the left main coronary artery by mycotic aortic psuedoaneurysm following orthotopic heart transplantation.

Mycotic aneurysm of the ascending aorta is a rare complication following orthotopic heart transplantation. This article describes a case of mycotic pseudoaneurysm caused by Candida albicans that developed shortly after orthotopic heart transplantation. The pseudoaneurysm compressed the left main coronary artery, which led to the development of congestive heart failure symptoms mimicking sub-acute transplant rejection. The heart failure signs and symptoms resolved completely with resection of the aneurysm. This case reiterates that early diagnosis and complete resection of the aneurysm is associated with good prognosis.