Clivus metastasis of squamous cell carcinoma: a rare location.

Lung cancer is the most frequently encountered cancer in humans and commonly metastasizes to brain and bone. Metastasis to the clivus is very rare and there have been no previous reports. A 51-year-old woman was admitted to our hospital complaining of headache, and left shoulder, arm and back pain. The chest X-ray showed a left paracardiac mass measuring 4x4 cm in diameter and the thorax computed tomographic examination revealed a 4x4 cm mass in the left lower lobe, left hilar and mediastinal lymphadenopathy, and multiple lytic lesions in the thoracic vertebral bodies. Head magnetic resonance imaging showed a mass in the clivus with bony destruction. Bronchoscopic examination revealed an exophytic endobronchial lesion in the left lower bronchus lumen and a biopsy was taken from this lesion. The histopathological diagnosis was "poorly differentiated squamous cell carcinoma". A punch biopsy was taken from the clivus via the transnasal-transphenoidal route. Histopathological findings of this biopsy were similar to the primary site tumor. We report a rare case of clivus metastasis from squamous cell lung cancer.     

Tri-ethnic variations of co-morbid substance and alcohol use disorders in schizophrenia

OBJECTIVES: This study examined the differential prevalence of substance and alcohol use disorders among European Americans, African Americans, and Latinos with schizophrenia (n = 6424) who received public mental health services in San Diego County during fiscal year 2002-2003. METHODS: Data were obtained from the public mental health database used by the San Diego County Mental Health System. Chi-Square analyses and stepwise logistic regression analyses were used to examine differences regarding the prevalence of substance and alcohol use among clients with schizophrenia and schizoaffective disorder, and to analyze the sociodemographic variables associated with this co-morbidity. RESULTS: Significant differences in the prevalence of diagnosed co-morbidity were found across the ethnic groups. Rates of co-morbid diagnosis among African Americans (25%) were significantly higher than those among European Americans (22%) and Latinos (19%). Logistic regression results revealed ethnicity was a significant predictor of co-morbid substance and alcohol use, as was being homeless and male. Among Latinos, language preference was also a significant predictor. Latinos who denoted English as their primary language were 1.7 times more likely to be diagnosed with co-morbid substance or alcohol use disorders than Latinos who denoted Spanish. CONCLUSIONS: Among people with schizophrenia, there were significant differences in prevalence rates and predictors of diagnosed co-morbid substance and alcohol use disorders. Future research is needed to examine the relationship among language preference, level of acculturation, and subsequent diagnosing barriers for Latinos. Among African Americans, the reasons behind increased co-morbidity rates need to be examined, and homelessness should be carefully addressed among all three ethnic groups.     

The effects of alfentanil or remifentanil pretreatment on propofol injection pain

STUDY OBJECTIVE: To compare the efficacy of alfentanil, remifentanil, and saline in minimizing the propofol injection pain. DESIGN: Randomized, double-blind study. SETTING: University hospital. PATIENTS: 175 ASA physical status I and II, adult female patients undergoing minor gynecological procedures with general anesthesia. INTERVENTIONS: Unpremedicated patients were randomly allocated to one of four groups. Patients received 2 mL (1 mg) of alfentanil (n=43), 2 mL of remifentanil 0.01 mg (n = 43), 2 mL of remifentanil 0.02 mg (n=45), or 2 mL of saline (n=44) 30 seconds prior to administration 5 mL of propofol 1%. MEASUREMENTS: Patients were asked whether they had pain due to propofol injection. Their pain scores were evaluated with a Visual Analogue Scale. In the Postanesthesia Care Unit, frequency of postoperative nausea, vomiting, hypotension, and flushing were all determined. MAIN RESULT: The remifentanil and alfentanil groups showed significantly less frequency and severity of pain than the saline group (p <0.05). When the alfentanil group was compared with the remifentanil groups, significant differences in pain relief associated with injection of propofol (p <0.001) were noted. Remifentanil 0.02 mg relieved pain associated with injection of propofol more effectively than remifentanil 0.01 mg (p <0.001). CONCLUSIONS: The remifentanil and alfentanil groups showed significantly less frequency and severity of pain than did the saline group. Remifentanil was effective in preventing propofol injection pain, and should be used at a dose of at least 0.02 mg for this purpose. Remifentanil may be an alternative drug for prevention of propofol injection pain.     

How much might universal health insurance reduce socioeconomic disparities in health?

A strong association between lower socioeconomic status and worse health has been documented within many countries, but little work has been done to compare the strength of this relationship across countries. We compare the strength of the relationship between income and self-reported health in the US and Canada. We find that being below median income raises the likelihood that a middle-aged person is in poor or fair health by about 15 percentage points in the US, compared with less than 8 percentage points in Canada. We also find that this 7 percentage points stronger relationship between low income and poor health in the US compared with Canada is reduced by about 4 percentage points after age 65, the age at which virtually all US citizens receive basic health insurance through the Medicare programme. Income differences in the probability that an individual lacks a usual source of care are also significantly larger in the US than in Canada before the age of 65, but about the same after age 65. Our results are therefore consistent with the theory that the availability of universal health insurance in the US, or at least some other difference that occurs around the age of 65 in one country but not the other, decreases the difference in the strength of the income-health relationship in the US compared with Canada.     

The role of meatal disinfection in preventing catheter-related bacteriuria in an intensive care unit: a pilot study in Turkey

The purpose of this study was to investigate the efficacy of antiseptics meatal care in preventing catheter-related urinary tract infections (UTIs) in patients with an indwelling urinary catheter in the intensive care unit of Osmangazi University Medical School. One hundred patients were divided into four groups (25 per group) and treated with once or twice daily application of chlorhexidine gluconate or povidone-iodine. A control group was also studied (N=30). Urine samples were taken weekly and cultures were evaluated quantitatively. Meatal swabs were obtained on the first, fifth, and 10th day and determinated semiquantitatively. UTI was defined as bacteriuria with 10(5)cfu/L. Cultures showing no growth or mixed growths were stated as negative for UTI. UTI developed in 16 patients on days two, three, four, five and seven (including control group). Dominant micro-organisms in the meatal area were found to be Candida species. In nine cases the causative agents of UTI were Candida species. It was therefore decided that the use of antiseptics to clean the periurethral area provides no benefit in decreasing the rate of bacteriuria.     

Three new and two rare furanoeremophilanes from Senecio asirensis

Three new furanoeremophilanes have been obtained from the aerial parts of Senecio asirensis (N. O. Asteraceae), and characterized as 6-hydroxylmethyl-9-methoxyl-4,11-dimethylnaphtho[2,3-b]furan, designated asirensane-a (1), 6-hydroxyl-1,2-dimethoxyl-4,6,11-trimethyl-6-hydronaphtho[2,3-a]furan-7-one, named asirensane-b (2), and (6,12-dihydroxyl-9-methoxyl-4-methyl-11-acetyl-3,4-dihydronaphtho[2,3-b]furan-3-yl)methyl (2'Z)-2'-methylbut-2'-enoate, designated asirensane-c (3). In addition, two rare furanoeremophilanes have also been isolated and characterized from this source, namely 9-methoxyl-4,11-dimethylnaphtho[2,3-b]furan, named 14-nordehydrocalohastine (4), and 4,11-dimethylnaphtho[2,3-b]furan-6,9-dione, designated as maturinone (5). Their structures have been elucidated on the basis of spectral analysis. The alcoholic extract was also tested for anti-inflammatory activity, which decreased edema by 22% at a dose of 500 mg kg^-1 after 3 h with respect to the control group treated only with carrageenan, while the standard drug phenylbutazone showed a 50% decrease at a dose of 100 mg kg^-1, indicating that the extract has moderate anti-inflammatory activity.