Long-term results of simple and radical nephrectomy for renal cell carcinoma

From 1974 to 1983, simple and radical nephrectomies were performed at the Chaim Sheba Medical Center (Tel Hashomer, Israel) for renal cell carcinoma. The authors reviewed 109 cases that were followed for a period ranging from 5 to 14 years. Simple nephrectomy was performed in 55 patients, and 54 patients underwent radical nephrectomy. The selection of the surgical procedure was based on the surgeon's preference and not on the basis of clinical stage, age, or sex. The surgical results and survival rates were assessed according to the pathologic stage of the tumors. Among patients with Stage I tumor, radical nephrectomy produced better survival rates at 5 and 10 years (P = 0.03); however, when the non-cancer deaths were excluded, the difference in survival was not statistically significant. For Stage I tumors the survival free of disease at 5 years was better for the radical nephrectomy group, but this difference was not statistically significant. No difference was noticed in the local recurrence rate between the two groups. Nephrectomy in patients with Stage IV disease did not alter survival regardless of the type of operation.     

Effect of educational programs, rigid sharps containers, and universal precautions on reported needlestick injuries in healthcare workers

OBJECTIVE: To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital. DESIGN: Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially. SETTING: A 700-bed general hospital that serves as the main teaching hospital of the University of Cincinnati. PARTICIPANTS: All employees of University Hospital who reported to personnel health for management of needlestick injuries. INTERVENTIONS: In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice. RESULTS: Surveillance identified 1,602 needlestick injuries (320/year) or 104/1,000/year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers. CONCLUSIONS: The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.     

Using structured discourse as a language intervention technique with autistic children

A structured discourse strategy, employing child echoic imitations and adult expansion, was used to teach 5 autistic children two-term semantic relations. The 5 male preschoolers in late Stage I of linguistic development were exposed systematically to two-term semantic relations in a structured dialogue with a clinician. A combined multiple baseline and AB(A) design was used to examine the relationship between the clinician expansions and the children's subsequent spontaneous imitations and spontaneous productions. The results showed that an increase in modeling and expansion was related to an increase in the children's initial spontaneous imitations of two-term relations. Further, following the increase in spontaneous imitations, spontaneous productions of the two-term relations increased and were maintained, whereas spontaneous imitations subsequently decreased.     

Induced hypoglycemia. A unusual case of child battering

We describe a case of Munchausen's syndrome by proxy in a 12 years old child. The administration of glibenclamide by the mother led to severe hypoglycemias in the child, who underwent various instrumental researches and a subtotal pancreatectomy before the final diagnosis could be reached. The diagnosis also was possible with the substantial help of an accurate psychological survey. The case solution, with disappearance of hypoglycemias, was made possible by the removal of the maternal presence settled by the juvenile court.     

123I-amphetamine-SPECT in classical migraine and migraine accompagnée

Migraine is considered to be a functional neurological disorder. In classical migraine (headache associated with prodromal visual field disturbances) and migraine accompagnée (headache associated with transient neurological symptoms), disturbances of cerebral blood flow and amine metabolism are thought to be pathogenetic factors. However, conventional methods of neuroimaging (CAT, NMR) usually do not yield any pathological findings in patients. Since 123I-iodoamphetamine (123I-IMP) crosses the intact blood brain barrier, 123I-IMP-SPECT is used for the assessment of cerebral perfusion in various neurological diseases, including functional disorders. 123I-IMP-SPECT was performed on 5 patients with classical migraine and 18 patients with migraine accompagnée. At the time of investigation, all patients were symptom-free. Cerebral blood flow was decreased in all patients with migraine accompagnée, and often corresponded to the site of headache as well as to the topography of transient neurological symptoms. This reduction was most obvious in a patient with persisting neurological symptoms. Most patients with classical migraine, however, did not show any alteration of cerebral perfusion. It appears that migraine--and in particular migraine accompagnée--is characterized by a permanent alteration not only of cerebral blood flow but also of neuronal activity. Migraine attacks may occur in connection with exacerbations of preexisting metabolic alterations.