The relationship between borderline personality disorder and anxiety disorders

Eleven "pure" borderlines, ten borderlines with depression, 16 "pure" depressives, and 31 normal subjects were compared on a number of standardized inventories of anxiety. While patient groups experienced more anxiety of all types than did normals, borderlines did not emerge as more anxious than other patient groups. Qualitative differences in the anxiety experienced by borderlines and nonborderlines are discussed.     

Optimal debulking following chemotherapy of advanced-stage epithelial ovarian carcinoma

We reviewed the records of 110 consecutive patients with advanced-stage epithelial ovarian carcinoma treated at the Soroka Medical Center, Beer-Sheva, Israel, from 1961-1987. Twenty patients (18.1%) had optimal debulking at initial laparotomy, 30 patients (27.2%) had nonoptimal debulking at initial laparotomy, 20 patients (18.1%) had an "inoperable" disease at initial laparotomy, and 40 patients (36.3%) had such poorly written records that no information about the degree of resectability at initial laparotomy could be obtained. Four patients, in whom the residual tumor left at initial laparotomy had responded to chemotherapy, had a second laparotomy. In all four patients optimal debulking surgery at second laparotomy was easy to perform and was successful. The value of a second laparotomy after a few cycles of chemotherapy in order to optimally debulk the residual tumor left at initial laparotomy is discussed. It is concluded that a second attempt of debulking surgery after chemotherapy has a respectable place in the management of patients with advanced-state epithelial ovarian carcinoma, but further research is needed.     

Mosaic ring 12p and total anomalous pulmonary venous return

An infant born with total anomalous pulmonary venous return (TAPVR) was found to have an extra chromosome present as a small ring. Spectral karyotyping and FISH analysis identified the material as a duplication involving the short arm of chromosome 12. Previous cases describing a variety of cytogenetic abnormalities that have been associated with TAPVR are reviewed along with prior cases of duplication 12p with their associated findings. We believe ours is the first case to report the occurrence of mosaic ring 12p and its association with TAPVR.     

Developmental Progression in Children's Knowledge of AIDS: Implications for Education and Attitudinal Change

The effectiveness of curricula designed to enhance a child'sunderstanding of AIDS may hinge partially upon incorporatinginformation adjusted to the child's developmental status. Accordingly,we examined the developmental progression of children's understandingof illness transmission in general and AIDS in particular, aswell as explored the relation between a child's knowledge ofAIDS and his/her attitudes toward persons with AIDS. Knowledgeof AIDS was manipulated through use of a brief educational intervention.Results support a developmental progression in knowledge aboutAIDS that is consistent with progressions related to illnessesin general. Knowledge enhancement was associated with positivechanges in attitude.     

Managing pain: The Challenge in Underserved Populations: Appropriate Use Versus Abuse and Diversion

ISSUE: Inadequate pain management is a serious public health problem that affects a wide cross-section of Americans. Patients are often denied sufficient medication, because physicians lack training and fear scrutiny from federal and state regulatory agencies. In addition, even the state-financed system of care, Medicaid, has been increasingly denying payment for the best treatment for pain management. These factors are complicated by physician bias about various subgroups and poor physician-patient communication. Comprehensive patient assessment plays a crucial role in determining appropriate treatment and identifying potential abuse problems. Physicians must routinely document medications analgesic effects and screen for potential ill effects and drug abuse. OBJECTIVE: To examine the prevalence of the undertreatment of pain, particularly among African Americans, and to recommend relevant proactive policy and practice changes to aid in eliminating this health problem. CONSENSUS PROCESS: In July 2002, the NMA convened the "Managing Pain: The Challenge in Underserved Populations: Appropriate Use versus Abuse and Diversion" Consensus Meeting in Washington, DC. The country's most renowned experts in the area of pain management and substance abuse reviewed substantial information regarding pain management and substance abuse including the following: --A draft summary paper on pain management and substance abuse that served as briefing material for consensus members; --Annotated bibliographies; --Articles on pain management and substance abuse; and --Key presentations on pain management and substance abuse.     

Expression microdissection: operator-independent retrieval of cells for molecular profiling.

Tissue microdissection is an important method for the study of disease states. However, it is difficult to perform high-throughput molecular analysis with current techniques. We describe here a prototype version of a novel technique (expression microdissection) that allows for the procurement of desired cells via molecular targeting. Expression microdissection (xMD) offers significant advantages over available methods, including an increase in dissection speed of several orders of magnitude. xMD may become a valuable tool for investigators studying cancer or other disease states in patient specimens and animal models.     

No evidence for involvement of the calpain-10 gene 'high-risk' haplotype combination for non-insulin-dependent diabetes mellitus in early onset obesity

In light of evidence of linkage of obesity to chromosome 2q31-q37, we hypothesized that the calpain-10 gene 'high-risk' haplotype combination for non-insulin-dependent diabetes mellitus (NIDDM) is involved in early onset obesity. We screened the NIDDM 'high-risk'-haplotype combination formed by the alleles 112 and 121 of the polymorphisms UCSNP-43, -19, and -63 in 166 families consisting of an extremely obese child or adolescent (mean BMI percentile: 99.3+/-1.38), one or more obese sibs (mean BMI percentile: 97.42+/-2.88), and both of their parents. Genotyping for three calpain-10 gene polymorphisms was performed by polymerase chain reaction (PCR) with (a) length polymorphism detection (UCSNP-19) or (b) allele-specific PCR (UCSNP-43 and -63). To allow for correct haplotype assignment all individuals were additionally genotyped for two microsatellite markers (D2S125 and D2S2338). We followed a hierarchical test procedure. As the first step, model-free linkage analysis was performed using maximum likelihood binomial statistics. The second stage consisted of a one-sided asymptotic pedigree disequilibrium test for the UCSNP-43 and on an exploratory level for the other SNP-markers and all haplotypes formed by the three SNPs. The final stage investigated the reported haplotype combination. We failed to detect an initial linkage of obesity to this region (LOD score <0.4). All subsequent exploratory analyses were negative. Our analysis of the relationship between the NIDDM 'high-risk' haplotype combination and extreme early onset obesity revealed no evidence for linkage and association.     

Comparison of antireflux surgery among ethnicity

African Americans appear less likely than caucasians to undergo surgery for gastroesophageal reflux disease (GERD). When they do, they appear to have higher conversion and complication rates. Nevertheless, satisfaction with surgery is similar to caucasians. BACKGROUND: There is little information comparing the prevalence and treatment of GERD in various ethnic populations. The purpose of this study was to examine the variations in outcomes between caucasians and African Americans undergoing antireflux surgery. METHODS: The records of all patients who underwent antireflux surgery for GERD or paraesophageal hernia by a single surgeon from January 1997 through December 2001 were reviewed for preoperative and postoperative symptoms, complications, and postoperative satisfaction with surgery. RESULTS: Of the 204 procedures performed, 198 patients were either African American (24) or caucasian (174). Of the 18 African Americans undergoing laparoscopic antireflux surgery (LARS), five were converted to open and four had grade-1 or -2 complications. Of the 160 caucasians undergoing LARS, 27 were converted, and 17 had grade-1, -2, or -3 complications. African-American females had a heavier weight (222 lbs. versus 175 lbs., p<0.05) and conversion rate (55% versus 18%, p<0.05), compared to caucasian females. Satisfaction rates for African Americans were 88%, compared to 82% for caucasians. CONCLUSION: This study demonstrated significant differences between conversion rates in African Americans and caucasians with respects to frequency of surgery for GERD and conversion rates for LARS. Nevertheless, African Americans appear more satisfied with their surgical outcome. Further research is needed to determine whether African Americans truly have a lower incidence of GERD or if bias exists in referral patterns or cultural attitudes.