Psychological correlates of differential infertility diagnosis in an in vitro fertilization program

We describe a study designed to assess the role of infertility diagnosis in differentiating participants in an in vitro fertilization program on psychological variables. Three hundred forty-eight in vitro fertilization candidates representative of five diagnostic categories (tubal problems, endometriosis, male factor, multiple factors, and idiopathic) underwent psychological assessment before entering the in vitro fertilization program. Measures of personality functioning, depression, anxiety, social support, coping ability, and marital adjustment were obtained. Analyses revealed significant differences among diagnostic groups on several psychological measures. As well, candidates were categorized as having either organic or functional (idiopathic) infertility, and analyses revealed several differences between these two groups. Results suggest ways of providing individualized psychological support in vitro fertilization participants.     

The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit

As a means of assessing the effects of natural inhibition of cyclooxygenase enzymes on arachidonic acid metabolism in vivo, the authors supplemented the diet of 38 New Zealand white rabbits with fish oil containing eicosapentaenoic acid and docosahexaenoic acid (EPA/DHA) or olive oil (control). Endometriosis was surgically induced 10 days later using a previously described experimental technique. Peritoneal fluid PGE2 and PGF2-alpha concentrations were significantly lower in the EPA/DHA group versus controls (P less than 0.05, P = 0.05, respectively). Total endometrial implant diameter 8 weeks after induction of endometriosis was significantly smaller in the experimental group (3.1 +/- 0.2 cm) compared with the controls (4.0 +/- 0.3 cm) (P less than 0.03). The authors conclude that dietary supplementation with fish oil, containing the n-3 polyunsaturated fatty acids EPA and DHA, can decrease intraperitoneal PGE2 and PGF2-alpha production and retard endometriotic implant growth in this animal model of endometriosis.     

Cause of kinematic differences during centrifugal and centripetal saccades

Measurements of eye movements have shown that centrifugal movements (i.e. away from the primary position) have a lower maximum velocity and a longer duration than centripetal movements (i.e. toward the primary position) of the same size. In 1988 Pelisson proposed that these kinematic differences might be caused by differences in the neural command signals, oculomotor mechanics or a combination of the two. By using the result of muscle force measurements that were made in recent years (Orbit 1.8 Gaze mechanics simulation, Eidactics, San Francisco, 1999) we simulated the muscle forces during centrifugal and centripetal saccades. Based on these simulations we show that the cause of the kinematic differences between the centrifugal and centripetal saccades is the non-linear force-velocity relationship (i.e. muscle viscosity) of the muscles.     

Measuring practitioners' beliefs, goals, and practices in psychiatric rehabilitation

This article reports on a scale to measure the psychiatric rehabilitation beliefs, goals, and practices of staff who provide services to consumers. The scale's reliability, validity, and factor structure are presented based upon 469 staff members and 191 people in rehabilitation. The scale appears to be a stable measure of staff members' knowledge of modern psychiatric rehabilitation beliefs, goals, and practices as elaborated by the field's leadership. It also appears to provide a valid measure of staff members' actual practice patterns as they relate to the consumer outcomes of empowerment, quality of life, independent living, and competitive employment. Consumers, program administrators, educators, researchers, and practitioners may find the scale useful as a measure of some of the beliefs, goals, and practices that currently define modern psychiatric rehabilitation.     

Job satisfaction and job success as moderators of the self-esteem of people with mental illnesses

This study investigated job satisfaction and job success as moderators of the self-esteem of people with mental illnesses. Prior studies and models had produced contradictory findings so that the appropriateness of self-esteem as an outcome variable for psychiatric rehabilitation employment services was in doubt. Job satisfaction and success measures for 65 employed and 170 unemployed individuals with mental illnesses along with their work status and work status duration measures were combined in a single multiple regression analysis with self-esteem as the criterion. The job satisfaction and success measures were found to be significant and moderate level moderators of self-esteem for the combined sample and separately for the employed and unemployed samples. It appears that self-esteem varies with satisfaction and success with the work status and not with work status alone. These findings suggested that self-esteem was an appropriate and modifiable outcome measure for psychiatric rehabilitation services. Some practical, theoretical, and policy implications of these results were also discussed.     

Absence of neurotoxic effects in leopard sharks, Triakis semifasciata, following domoic acid exposure.

Domoic acid (DA), a potent neurotoxin produced by select species of algae and diatoms, kills neurons bearing kainic acid-type glutamate receptors. Studies have shown that DA bioaccumulates in invertebrates and fish that consume the diatoms. In every vertebrate species tested or observed in the wild, dietary or systemic DA causes neuronal damage or clinical signs of neurotoxicity. Sharks, like marine birds and mammals, are exposed to DA through their diet; however, no research has demonstrated the effect of DA on shark behavior or physiology. In this study, juvenile leopard sharks (Triakis semifasciata) were given DA by intracoelomic injection at doses of 0, 1, 3, 9, and 27 mg/kg and observed for 7 days. The sharks failed to demonstrate behavioral or histological changes in response to the toxin. We identified putative brain glutamate receptors by probing western blots with an antibody specific for kainic acid-type glutamate receptors and demonstrated receptor localization in the cerebellum with immunohistochemistry. Blood levels of DA in three sharks dosed at 9 mg/kg fell rapidly within 1.5h of injection. We show that leopard sharks possess the molecular target for DA but are resistant to doses of DA known to be toxic to other vertebrates.     

Obstetrical management following incontinence surgery

OBJECTIVE: To analyze in a retrospective fashion our experiences with obstetrical management following previous incontinence surgery. METHODS: Between 1990 and 1997 4 women presented to our institution in the third trimester of pregnancy with a history of colposuspension performed 3 months to 4 years before onset of pregnancy for second degree stress incontinence. Three of 4 patients experienced recurrent incontinence during the third trimester. RESULTS: A cesarean section was performed before the onset of labor in all 4 patients. Postpartal pelvic floor exercises were prescribed and a follow-up ensued after 6 and 11 months in the form of a questionnaire. While incontinence persisted in 2 patients for 6 months, all 4 patients demonstrated complete continence after one year. CONCLUSIONS: We consider an elective cesarean section to be the optimal mode of delivery in women with a history of incontinence surgery.     

Gastrointestinal stromal tumors

Opinion statement The nonepithelial, nonlymphoid tumors of the gastrointestinal tract are heterogeneous in terms of clinical presentation, behavior, pathology, and genetic features. Concepts regarding these tumors have changed rapidly over the past decade as nomenclature has evolved. Many of these tumors have no muscle differentiation, and designations such as leiomyoma or leiomyosarcoma are inappropriate for many of these neoplasms. With an improved understanding of the biology of these tumors, gastrointestinal stromal tumor (GIST) is used as a specific term for tumors of the gastrointestinal tract that lack markers of myogenic differentiation, but stain positive for vimentin, and express CD34 and CD117, the product of the c-kit oncogene. Both benign and malignant types are recognized. In addition to myogenic tumors and GIST, gastrointestinal autonomic nerve tumors (GANT) are also recognized. Complete en bloc surgical resection, when possible, is the cornerstone of therapy. Metastasis tends to occur to the liver and within the peritoneal cavity, especially in patients whose tumors have ruptured spontaneously or been violated by the surgeon. Incomplete surgical resection and metastatic disease indicate a dismal prognosis in the majority of patients. Recurrent or metastatic disease is often resected, but this has an uncertain impact on outcome. Operation may palliate patients with intestinal obstruction or other symptoms. For patients with unresectable disease, the results with systemic chemotherapy have been dismal. Treatment with doxorubicin/ifosfamide combinations is of dubious value. Hepatic arterial embolization, with and without intra-arterial chemotherapy, results in regression of liver metastases in selected patients. Regression has also been seen using intrahepatic arterial infusion of doxorubicin without embolization. The impact of such treatment on outcome, however, is poorly studied. Aggressive surgical resection of peritoneal metastases with intraperitoneal chemotherapy has been advocated, but requires formal study in large trials.     

Chemotherapy of non-small cell lung cancer: Clinical trials at the Memorial Sloan-Kettering Cancer Center

Bronchogenic carcinoma is one of the most difficult and pressing problems in cancer therapy. Overall survival of 799 primary cases at Memorial Sloan-Kettering Cancer Center was 7.8%, reflecting the advanced nature of most lung cancer at the time of presentation and the inadequacy of current local therapies as potential cures. The need for effective systemic therapy having acceptable toxicity is obvious. From 1972 to 1975, four combination drug regimens were tested at the Center: MAV, MFC, CAMF, and VAB. Despite the lack of significant responses, the median survival was 2.5 to 6 months. A subsequent study of the effect of high doses of cyclophosphamide, followed by high doses of methotrexate with leukovorin rescue, produced significant toxicity; partial responses were seen in 5/20 patients. Other agents tested have included pyrazofurin, vindesine, chlorozotocin, PCNU, PALA, m-AMSA, and interferon. Only vindesine has shown promise. Recent trials of cisplatin (DDP) in combination with vindesine have been encouraging. Eighty-one patients with measurable inoperable non-small cell lung cancer have been treated with this combination. Toxicity has been easily managed. Complete or partial responses have been demonstrated in 43 percent of 35 patients. Duration of response has been significantly greater for patients receiving high-dose DDP as compared to low-dose DDP. Addition of cyclophosphamide to the regimen appeared to offer no obvious advantages. Future studies include a clinical trial of the DDP-vindesine combination in the adjuvant setting.

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Résumé Le cancer bronchogénique représente un des cancers les plus difficiles à traiter. Le taux de survie sur 779 cas de cancers primitifs au Memorial fut de 7,8% reflétant le caractère avancé du cancer du poumon lorsqu'il fut découvert l'inefficacité du traitement local habituel. Ainsi s'impose la nécessité d'un traitement général, de faible toxicité. De 1972 à 1975, 4 combinaisons de drogues ont été traitées au Centre: MAV, MFC, CAMF, VAB. Malgré le défaut de réponse significative la survie médiane fut de 2,5 à 6 mois. Une étude ultérieure à propos de hautes doses de cyclophosphamide suivies par de hautes doses de méthotrexate avec leukovirine se traduisit par une toxicité significative cependant qu'une réponse favorable partielle fut constatée chez 5 malades sur 20. D'autres agents furent testés pyrazofurin, vindesine, chlorozotocin, PCNU, PALA, m-AMSA et Interferon. Seule la Vindesine fut prometteuse. De nouveaux essais de D.D.P. combiné avec la Vindesine ont également été encourageants. Quatre-vingt-et-un malades présentant des cancers inopérables ont été traités par cette combinaison d'agents chimiques. La toxicité fut aisément contrôlée. Des réponses complètes ou partielles ont été enregistrées chez 35 malades. Ces réponses favorables ont une durée plus longue chez les malades recevants de fortes de doses D.D.P. L'adjonction de cyclophosphamides ne semble présenter aucun avantage. De futures études portant sur la combinaison de D.D.P. et de vindesine sont à envisager pour juger d'une meilleure efficacité.

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Supported in part by NIH Contract NO-1CM57043 and Grant CA-05826

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Drs. Gralla, Casper, and Krown are recipients of American Cancer Society Junior Faculty Fellowship Awards. Dr. Kelsen is a Landrum/Karnofsky Scholar.     

Icodextrin reduces postoperative adhesion formation in rats without affecting peritoneal metastasis

BACKGROUND: Peroperative peritoneal trauma activates a cascade of peritoneal defense mechanisms responsible for postoperative adhesion formation. The same cascade seems to play a role in the process of intra-abdominal tumor recurrence. Icodextrin is a glucose polymer solution that is absorbed slowly from the peritoneal cavity, allowing prolonged "hydroflotation" of the viscera, thereby decreasing adhesion formation. This study evaluated the adhesion-preventing properties of icodextrin and its effect on peritoneal metastasis. METHODS: Reproducible rat models of peritoneal trauma were used, allowing semiquantitative scoring of adhesion formation or tumor load. In one experiment, peritoneal trauma was inflicted; one group was treated by peroperative intra-abdominal instillation of 7.5% icodextrin, one by instillation of RPMI (placebo), and one had no instillate (controls). In another experiment involving a different model of peritoneal trauma, the coloncarcinoma cell line CC531 was injected intraperitoneally to induce tumor load, again using these three groups. RESULTS: Treatment of peritoneally traumatized rats with icodextrin caused a 51% reduction in postoperative adhesion formation ( P < .001). However, peroperative intra-abdominal treatment with icodextrin did not affect intraperitoneal tumor cell adhesion and growth of free intra-abdominal tumor cells in rats with this model of severe peritoneal trauma. CONCLUSION: A 7.5% icodextrin solution is effective in reducing postoperative adhesions without promoting tumor recurrence and therefore may prove useful and safe in oncologic surgery.