Stress Management,Depression, and Immune Status in Lower‐Income Racial/Ethnic Minority Women Co‐infected with HIV and HPV

The stress of co‐infection with human immunodeficiency virus (HIV) and human papillomavirus (HPV), in race/ethnic minority women, may increase depression and immune decrements. Compromised immunity in HIV+ HPV+ women may increase the odds of cervical dysplasia. Thus, we tested the efficacy of a 10‐week cognitive behavioral stress management (CBSM) group intervention and hypothesized that CBSM would decrease depression and improve immune status (CD4+ T‐cells, natural killer [NK] cells). HIV+ HPV+ women (n = 71) completed the Beck Depression Inventory and provided blood samples, were randomized to CBSM or a control condition, and were re‐assessed post‐intervention. Women in CBSM revealed less depression, greater NK cells, and marginally greater CD4+ T‐cells post‐intervention vs. controls. Stress management may improve mood and immunity in HIV+ HPV+ lower‐income minority women.     

Clinical experiences at St. Mark’s Hospital with multiple synchronous cancers of the colon and rectum

Summary We have reviewed the experience of St. Mark’s Hospital with double synchronous cancers of the large intestine. This occurs in 3.5 per cent of cancer resections, and in 75 per cent there are associated benign neoplasms. Patients with double or treble cancers fare much the same as those with single cancers, and the prognosis appears to be surprisingly favorable, even when the second growth is comparatively advanced. The second lesion, however, is usually not palpable at operation, and full clinical and radiologic investigation is therefore essential before any resection is undertaken for cancer of the colon or rectum. Read at the meeting of the American Proctologic Society, Detroit, Michigan, June 10 to 14, 1973.     

Infrared coagulation: A new treatment for hemorrhoids

Many methods, which have effectively reduced the number of patients requiring hospital admisssion, have been described for the outpatient treatment of hemorrhoids. However, complications have been reported, and the methods are often associated with unpleasant side effects. In 1977 Neigeret al. described a new method that used infrared coagulation, which plroduced minimal side effects. The authors have conducted a prospective, randomized trial to evaluate infrared coagulatioin compared with more traditional methods of treatment. The authors' results show that it may be more effective than injection selerotherapy in treating nonprolapsing hemorrhoids and that it compares favorably with rubber band ligation in most prolapsing hemorrhoids. No complications occurred, and significantly fewer pattents experience pain after infrared coagulation (P=<0.001).     

Colonic metaplasia with colonic-type polyps on an ileostomy stoma in polyposis coli

A unique case is reported in which chronic physical and chemical irritation of an ileostomy stoma (after proctocolectomy for polyposis coli) was associated with colonic metaplasia and formation of colonic-type tubular adenomas on the external surface of the ileostomy. The remainder of the terminal ileum and the upper gastrointestinal tract were normal, with no evidence of Gardner's syndrome. This case demonstrates that even metaplastic colonic epithelium is susceptible to the formation of adenomas in polyposis coli patients.     

Intranasal amphotericin B reduces the frequency of invasive aspergillosis in neutropenic patients

PURPOSE: To retrospectively study the prophylaxis of invasive aspergillosis in neutropenic patients and to relate the frequency of this fungal disease to any causal or modifying factors that could be identified. PATIENTS AND METHODS: Between 1977 and 1988, 130 patients underwent 158 intensive treatment episodes to control acute leukemia, lymphoma, and aplastic anemia, and the frequency of complicating aspergillus infection was determined. RESULTS: Proven invasive aspergillus infections occurred in 22 cases, 12 of which were fatal. Invasive aspergillosis was suspected in a further 16 cases and all these patients recovered with amphotericin B treatment. Colonization by Aspergillus in the absence of clinically significant infection was seen in 31 treatment episodes. Invasive aspergillosis involved mainly the upper and lower respiratory tract and skin. Control of the infection was closely related to the control of the underlying disease, with subsequent return of normal marrow function and resolution of neutropenia. The incidence of aspergillus infection has decreased dramatically since 1985, most probably due to the introduction of intranasal amphotericin B. This occurred despite the persistence of aspergillus spores in the hematology ward air during the 1986 to 1988 period. CONCLUSION: Intranasal aerosolized amphotericin B may protect against invasive aspergillosis, even when neutropenic patients are cared for in conventional wards without HEPA filtration.     

Primary Relationships, HIV Treatment Adherence, and Virologic Control

To identify factors associated with antiretroviral therapy (ART) adherence and virologic control among HIV-positive men on ART in primary relationships, data were collected from 210 male couples (420 men). Dyadic actor-partner analyses investigated associations with three levels of adherence-related dependent variables: self-efficacy (ASE), self-reported adherence, and virologic control. Results indicated that higher patient ASE was related to his own positive beliefs about medications, higher relationship autonomy and intimacy, and fewer depressive symptoms. Fewer depressive symptoms and less relationship satisfaction in the partner were linked to higher ASE in the patient. Better self-reported adherence was related to the patient's positive appraisal of the relationship and the partner's positive treatment efficacy beliefs. Greater medication concerns of both patient and partner were associated with less adherence. The partner's higher relationship commitment was associated with lower viral load in the patient. Findings suggest that depressive symptoms, treatment beliefs, and relationship quality factors of both partners may influence adherence-related outcomes.     

Recurrent adhesive small bowel obstruction

Adhesive obstruction of the small bowel complicates about 5% of laparotomies; of these, 5–10% have recurrent attacks. The etiology of adhesions is incompletely understood and attempts to prevent their formation are of unproven value. Patients with recurrent acute obstruction that threatens strangulation, or that fails to subside, require laparotomy. If numerous adhesions have to be divided, it is worth considering a procedure to encourage fresh adhesions to form in a favorable pattern. Suture plication of the bowel by Noble's technique has a high incidence of complications and recurrent obstruction, and transmesenteric plication cannot be used in the presence of sepsis. Splinting of the entire small bowel by intraoperative passage of a long tube, which is left indwelling for 2–3 weeks, appears to be effective and safe. We have used this method in 140 patients without associated complications; of these, 17 had recurrent intestinal obstruction after 1–5 previous laparotomies for adhesions. A meticulous adhesiolysis followed by transluminal splinting through a jejunostomy has been followed by freedom from recurrence during 103 patient-years of follow-up.

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Resumen La obstrucción por adherencias es una complicación que ocurre en alrededor del 5% de las laparotomías, y de los pacientes que la desarrollan 5–10% sufren episodios recurrentes. La etiología de las adherencia no es totalmente conocida, y los intentos orientados a prevenir su formación han probado ser de utilidad no comprobada. Los pacientes con obstrucción aguda que presagia estrangulación o que no cede con un manejo de unos días de reposo intestinal y líquidos parenterales, requieren laparotomía. Cuando es necesario dividir numerosas adherencias, es Útil considerar la realización de un procedimiento que promueva la formación de adherencias frescas en un patrón ordenado y favorable. La plicación mediante suturas segÚn la técnica de Noble se acompaña de una elevada tasa de complicaciones y de obstrucción recurrente, y la plicación transmesentérica está contraindicada en presencia de sepsis. La fijación de la totalidad del intestino delgado mediante la colocación intraoperatoria de un tubo intestinal largo, el cual es dejado por 2–3 semanas, parece ser un método efectivo y seguro. Hemos utilizado tal método en 140 pacientes sin complicaciones; de éstos, 17 presentaban obstrucción recurrente después de 1–5 laparotomías previas por adherencias. La meticulosa lisis de las adherencias seguida de la fijación transluminal mediante tubo colocado a través de una yeyunostomía a 10–15 cm del ángulo duodenoyeyunal ha resultado en ausencia de recurrencia en 103 pacientes-año de seguimiento.

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Résumé L'occlusion de l'intestin grÊle secondaire à des adhérences complique environ 5% des laparotomies et récidive dans 5–10% des cas. L'étiologie précise des adhérences n'est pas parfaitement connue et toutes les méthodes de prévention qui ont été tentées n'ont pas fait leur preuve. Tous les malades qui présentent des attaques répétées et des menaces d'étranglement intestinal doivent Être opérés. Si les adhérences à lever sont très nombreuses il est nécessaire d'avoir recours à une méthode thérapeutique qui favorise la reconstitution en bon ordre de nouvelles adhérences. La plicature ordonnée des anses intestinales selon la technique de Noble est suivie de nombreuses complications et de récidive, la plicature transmésentérique selon la technique de Child ne peut Être employée en cas d'infection. C'est la raison pour laquelle il convient de substituer à ces modes de plicature, celle qui fait appel à un long tube intradigestif qui est laissé en place 2–3 semaines. La méthode est dénuée de danger et efficace. Elle a été employée chez 140 malades sans aucune complication alors mÊme que 17 d'entre eux présentaient des occlusions à répétition, et avaient subi de l à 5 laparotomies. Cette technique de libération des adhérences suivie de la plicature ordonnée des anses intestinales sur un tube introduit dans le grÊle par la voie d'une petite jéjunostomie a permis d'enregistrer l'absence de récidives de l'occlusion chez 103 malades qui ont été attentivement suivis.