Carcinoma coexisting with Manson's schistosomiasis

Summary The coexistence of extensive infestation bySchistosoma mansoni and adenocarcinoma of the rectum in a young native of Puerto Rico is described. No claim for causal relationship can be made on this isolated experience. Nevertheless, it is suggested that the link between inflammation and neoplasia, if such a link exists, is in the nature of hyperplastic polypoid granulomas resulting from an undefined stimulus acting in a susceptible tissue.Acknowledgment is made of the preparation of the photomicrographs at the direction of Dr. Robert C. Horn, Jr.     

Ectopic ACTH production in disseminated prostatic adenocarcinoma

The second fully documented case of ACTH-producing prostatic adenocarcinoma with elevated plasma and tissue levels of ACTH is presented. The distinguishing characteristics of ACTH-producing extrapituitary neoplasms and the various modes of therapy are discussed.     

How accurate are faculty evaluations of clinical competence?

Objective:To determine the degree and sources of variability in faculty evaluations of residents for the American Board of Internal Medicine (ABIM) Clinical Evaluation Exercise (CEX). Design:Videotaped simulated CEX containing programmed resident strengths and weaknesses shown to faculty evaluators, with responses elicited using the openended form recommended by the ABIM followed by detailed questionnaires. Setting:University hospital. Participants:Thirty-two full-time faculty internists. Intervention:After the open-ended form was completed and collected, faculty members rated the resident’s performance on a five-point scale and rated the importance of various aspects of the history and physical examination for the patient shown. Measurements and Main Results:Very few of the resident’s strengths and weaknesses were mentioned on the openended form, although responses to specific questions revealed that faculty members actually had observed many errors and some strengths that they had failed to document. Faculty members also displayed wide variance in the global assessment of the resident: 50% rated him marginal, 25% failed him, and 25% rated him satisfactory. Only for performance areas not directly related to the patient’s problems could substantial variability be explained by disagreement on standards. Conclusions:Faculty internists vary markedly in their observations of a resident and document little. To be useful for resident feedback and evaluation, exercises such as the CEX may need to use more specific and detailed forms to document strengths and weaknesses, and faculty evaluators probably need to be trained as observers. Received from the Fellowship Program in General Internal Medicine, Departments of Medicine, Walter Reed Army Medical Center, Washington, D.C., and the Uniformed Services University of the Health Sciences, Bethesda, Maryland. Presented at the Tenth Annual Meeting of the Society of General Internal Medicine, April 30, 1987, San Diego, California. Supported in part by the Department of Clinical Investigation, Walter Reed Army Medical Center. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

Quality of life and everyday activities in patients with primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is generally a slowly progressive disease that may lead to cirrhosis and liver failure. However, patients with PBC often suffer from a variety of symptoms long before the development of cirrhosis that include issues of daily living that have an impact on their work environment and their individual quality of life. We therefore examined multiple parameters by taking advantage of the database of our cohort of 1032 patients with PBC and 1041 matched controls. The data were obtained from patients from 23 tertiary referral centers throughout the United States and from rigorously matched controls by age, sex, ethnicity, and random-digit dialing. The data showed that patients with PBC were more likely than controls to have significant articular symptoms, a reduced ability to perform household chores, and the need for help with routine activities. Patients with PBC rated their overall activity similar or superior to that of controls; however, more of them reported limitations in their ability to carry out activities at work or at home and difficulties in everyday activities. PBC cases also more frequently reported limitations in participating in certain sports or exercises and pursuing various hobbies; however, they did not report significant limitations in social activities. In a multivariable analysis, household income, a diagnosis of systemic lupus erythematosus, limitations in work activities, a reduction in work secondary to disability, and church attendance were independently increased in PBC cases with respect to controls. CONCLUSION: Our data indicate that the quality of life of patients with PBC in the United States is generally well preserved. Nevertheless, patients with PBC suffer significantly more than controls from a variety of symptoms that are beyond the immediate impact of liver failure and affect their lifestyle, personal relationships, and work activities.     

Hyperpolarization-activated Cyclic nucleotide-gated Channel and Cardiac Biological Pacemaker:Part Ⅰ

Hyperpolarization-activated cyclic-nucleotide-gated (HCN) channels in the heart modulate cardiac automaticity via the hyperpolarization-activated cation current ( named Ⅰf, Ⅰh, or Ⅰq). Recent studies have unveiled the molecular identity of HCN (HCN1-4) channels. HCN isoforms are unevenly expressed in the heart, even in the sinoatrial node. Features of HCN currents have been characterized in cardiac and other types of cells or in cell lines transfected with the HCN isoforms. The factors modulating Ih and the physiological significance of HCN channels in the heart have been extensively investigated in recent years. The hypothesis for transplanting and/or creating biological pacemakers to replace diseased sinoatrial and/or atrioventricular nodes has been postulated and tested in animal models. Local overexpression of HCN2 channels in the left atrium or in the left conductive bundle branch of the left ventricle via gene delivery induced significant Ⅰh and escape rhythms during vagal stimulation in canines. In addition, implantation of human mesenchymal stem cells with overexpression of HCN2 channels to the canine left ventricular wall was associated with formation of spontaneous escape rhythms of left-sided origin during vagal-stimulation-induced sinus arrest. This preliminary data suggest that the use of HCN channels may hold great promise in,the development of biological pacemakers.     

Paget's disease of the patella

Five patients with Paget's disease involving the patella were evaluated for the following radiographic features: trabecular pattern, cortical integrity, density, and size of the affected patella. Radiographic appearances consisted of minimal trabecular coarsening in the patella of nearly normal size and progressed to considerable cortical thickening and osteoblastic remodeling in a dramatically enlarged patella. The radiologic features of Paget's disease of the patella are distinctive and should obviate biopsy.The opinions and assertions contained herein are the private views of the authors and do not reflect the views of the Department of the Army or of the Department of Defense     

近视药物治疗研究进展

本研究复习本世纪以来 (2 0 0 0年～ 2 0 0 4年 )有关近视药物治疗问题的文献。方法是主要通过PubMed ,对“myopia”进行检索 ,同时也参考一些重要会议最新资料。