Wednesday's Child: An Adult Survivor of Childhood Sexual Abuse

This paper examines some long-term residues of childhood sexual abuse, drawing on relevant literature and focusing on a case study of a female patient seen three times weekly over a period of two years. I have attempted to explore the particular syndrome that is characteristic of those who have been sexually violated in childhood, by adults who also assume a position of trust. The clinical work provided evidence of the link between early maternal deprivation and vulnerability to abuse and I have illustrated my observations by emphasising the emotional context in which the abuse occurred. Specific difficulties of working with this patient are considered, including problems arising in the transference and the compulsion to repeat the traumatic experience both within and outside the therapeutic situation.     

A modified muscle-splitting approach to the lumbosacral spine.

A modification of a previously reported extraperitoneal approach to the lumbosacral spine is described. The external oblique muscle is split in line with its fibers. The anterior and posterior layers of the rectus sheath are divided vertically medial to the semilunaris without splitting the internal oblique and underlying transversalis abdominus muscles. This allows an extensile retroperitoneal approach suitable for exposure of both the mid-lumbar and lumbosacral spine. There have been no complications of this approach with its use in over 50 patients undergoing anterior lumbar interbody fusion.     

The relationship of proliferating cell density at the invasive tumour front with prognostic and risk factors in human oral squamous cell carcinoma

BACKGROUND: We hypothesise that the density of proliferating cells at the invasive tumour front (ITF) has a positive relationship with prognostic and risk factors in human oral squamous cell carcinoma (SCC). METHODS: Tissues from 47 human oral SCC specimens were collected and stained with a monoclonal antibody directed against the Ki-67 antigen using a horseradish peroxidase based two-step immunostaining method. Counting was performed on two parallel sections at the ITF using an image analyser. The Ki-67 labelling index (LI) was determined by measuring the number of nuclei/mm(2) of epithelium. RESULTS: Our results show that the density of proliferating cells is related to clinical staging, with advanced stage of disease having a significantly higher Ki-67 LI compared with early stage of disease (2111 +/- 905 vs. 1908 +/- 913; P = 0.03). Importantly, this study shows that tumours that have metastasised have a significantly higher Ki-67 LI than tumours where distant metastasis was not detected (3257 +/- 650 vs. 1966 +/- 881; P < 0.0001). CONCLUSIONS: Cell proliferation, as measured by the Ki-67 LI at the ITF, has a positive relationship with clinical staging, tumour thickness, smoking status of the patient and alcohol consumption. Further, we suggest that a multicenter study with a large cohort of patients is indicated to fully elucidate whether cell proliferation at the ITF is directly related to patient survival.     

Cervical esophago-esophageal anastomosis.

We describe our results with cervical esophagoesophageal anastomosis. This approach has been used with success in 4 patients. It has the advantage of avoiding esophagectomy in patients with benign disease and allows restoration of esophageal continuity in patients having limited options for esophageal replacement.     

Oesophageal dissection after thrombolytic treatment for myocardial infarction.

A 62 year old woman admitted with a history suggesting acute myocardial infarction had thrombolytic treatment with anisoylated plasminogen-streptokinase activator complex, which resulted in submucosal haemorrhage in the oesophagus; this caused dissection of the wall of the oesophagus and complete dysphagia. The haematoma resolved spontaneously, leaving behind a diverticulum, with reduced peristalsis and delayed emptying but no obstruction.