The changing role of amputation for soft tissue sarcoma of the extremity in adults.

The role of amputation in soft tissue sarcoma of the extremity has decreased at Memorial Sloan-Kettering Cancer Center during the last 20 years. In an attempt to determine the reasons for this change in therapy, an analysis of two separate databases involving 1,057 patients compiled during the periods of 1968 to 1978 and 1982 to 1990 was performed. The patients requiring amputation for soft tissue sarcoma of the extremity in the two databases (n = 233) were compared in an attempt to determine any significant differences between the two time periods. The groups were specifically compared for differences in risk factors, indications for amputations and the effect a decreasing incidence of amputation in the 1982 to 1990 group had on local recurrence and overall survival between the two groups. Despite similarity of risk factors and indications for amputation, the decreased incidence of amputation during the 1982 to 1990 period was associated with a significant decrease in local recurrence after amputation and no significant change in overall survival compared with the 1968 to 1978 group. Absence of local recurrence was associated with significant improvement in survival. Possible reasons for the shift in therapy, as well as the present and future role of amputation in soft tissue sarcoma of the extremity, are discussed.     

Dysphonia in the aging: physiology versus disease.

A chart review from 151 dysphonic patients over the age of 60 was done to define aging related voice disorders. Overwhelmingly, patients suffered from dysphonia due to disease processes associated with aging rather than to physiologic aging alone. These include: 1. central neurological disorders affecting laryngeal function (e.g., stroke, Parkinson's disease, essential tremor, Alzheimer's disease); 2. benign vocal fold lesions (e.g., Reinke's edema, benign and dysplastic epithelial lesions); 3. inflammatory disorders (e.g., laryngitis sicca, medication effect); 4. laryngeal neoplasia; and 5. laryngeal paralysis. Typical laryngeal findings of vocal fold bowing and breathiness consistent with presbylarynges were present in only six patients. Presbylarynges is not a common disorder and should be a diagnosis of exclusion made only after careful medical and speech evaluation.     

Pregnancy outcome following cerclage. 2. Multiple pregnancy

In a retrospective study pregnancy and labour after cerclage had been studied in comparison to 160 patients with singleton pregnancies and a matched pair control group of multiple pregnancies without operative cervix closure. Cervical incompetence in multiple pregnancy observed more frequently than in singleton ones is not correlated to obstetric history, but has a bad prognosis because of necessity of tocolysis during pregnancy, marked shortening of duration of pregnancy, lowering of length and weight of newborns. An increase in frequency of amniotic infections had to be calculated following cerclage in multiple pregnancies, too. Our results especially in multiple pregnancies are not so optimistic. This statement is valid also for the indication to its prophylactic use.     

Bone marrow transplantation for severe aplastic anemia in children

For young adults and children who have a bone marrow donor who is a genotypic or phenotypic sibling match, bone marrow transplantation is now the preferred treatment for severe aplastic anemia. For those who lack such a matched donor, use of matched unrelated donors and family member donors who are mismatched for a single HLA antigen have been successful and appear to be the treatment of choice. Patients lacking either of these alternatives should receive antilymphocyte globulin, either alone or combined with cyclosporine as a first step. Although the success rate of marrow transplants in our series using mismatched family donors is similar to that following treatment with antilymphocyte globulin, several caveats must be kept in mind. First, the results reported with use of alternative donors must be confirmed with study of larger numbers of patients and longer follow-up. Second, the preparative regimen given prior to bone marrow transplantation destroys the patient's residual bone marrow, whereas antilymphocyte globulin cyclosporine A and androgens do not. The sequence of immunosuppression followed by transplantation with alternative donor marrow should produce greater long-term hematopoietic improvement. Unfortunately, when marrow transplant follows one or more courses of immunosuppressive therapy, nonengraftment is then a problem because of sensitization to blood cell antigens. It should also be kept in mind that studies done in children, especially in those younger than 6 years old, show that these patients respond better to transplantation than to treatment regimens not including marrow transplantation. Therefore, for the child with severe aplastic anemia, every effort should be made to identify a suitable bone marrow donor. Finally, we need to determine the specific components of the conditioning regimen and the constitution of the donor marrow necessary for engraftment and to minimize potential long-term complications, and there should be only a tolerable degree of graft-versus-host disease. Many of the transplant-related problems that plagued us in the 1970s have still not been fully resolved, but many have shown improvement. As we enter the 1990s, increasing the pool of marrow donors for patients with severe aplastic anemia who lack an HLA-matched sibling will continue to be a top priority for research.     

Psychological correlates of differential infertility diagnosis in an in vitro fertilization program

We describe a study designed to assess the role of infertility diagnosis in differentiating participants in an in vitro fertilization program on psychological variables. Three hundred forty-eight in vitro fertilization candidates representative of five diagnostic categories (tubal problems, endometriosis, male factor, multiple factors, and idiopathic) underwent psychological assessment before entering the in vitro fertilization program. Measures of personality functioning, depression, anxiety, social support, coping ability, and marital adjustment were obtained. Analyses revealed significant differences among diagnostic groups on several psychological measures. As well, candidates were categorized as having either organic or functional (idiopathic) infertility, and analyses revealed several differences between these two groups. Results suggest ways of providing individualized psychological support in vitro fertilization participants.     

The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit

As a means of assessing the effects of natural inhibition of cyclooxygenase enzymes on arachidonic acid metabolism in vivo, the authors supplemented the diet of 38 New Zealand white rabbits with fish oil containing eicosapentaenoic acid and docosahexaenoic acid (EPA/DHA) or olive oil (control). Endometriosis was surgically induced 10 days later using a previously described experimental technique. Peritoneal fluid PGE2 and PGF2-alpha concentrations were significantly lower in the EPA/DHA group versus controls (P less than 0.05, P = 0.05, respectively). Total endometrial implant diameter 8 weeks after induction of endometriosis was significantly smaller in the experimental group (3.1 +/- 0.2 cm) compared with the controls (4.0 +/- 0.3 cm) (P less than 0.03). The authors conclude that dietary supplementation with fish oil, containing the n-3 polyunsaturated fatty acids EPA and DHA, can decrease intraperitoneal PGE2 and PGF2-alpha production and retard endometriotic implant growth in this animal model of endometriosis.     

Cause of kinematic differences during centrifugal and centripetal saccades

Measurements of eye movements have shown that centrifugal movements (i.e. away from the primary position) have a lower maximum velocity and a longer duration than centripetal movements (i.e. toward the primary position) of the same size. In 1988 Pelisson proposed that these kinematic differences might be caused by differences in the neural command signals, oculomotor mechanics or a combination of the two. By using the result of muscle force measurements that were made in recent years (Orbit 1.8 Gaze mechanics simulation, Eidactics, San Francisco, 1999) we simulated the muscle forces during centrifugal and centripetal saccades. Based on these simulations we show that the cause of the kinematic differences between the centrifugal and centripetal saccades is the non-linear force-velocity relationship (i.e. muscle viscosity) of the muscles.     

Measuring practitioners' beliefs, goals, and practices in psychiatric rehabilitation

This article reports on a scale to measure the psychiatric rehabilitation beliefs, goals, and practices of staff who provide services to consumers. The scale's reliability, validity, and factor structure are presented based upon 469 staff members and 191 people in rehabilitation. The scale appears to be a stable measure of staff members' knowledge of modern psychiatric rehabilitation beliefs, goals, and practices as elaborated by the field's leadership. It also appears to provide a valid measure of staff members' actual practice patterns as they relate to the consumer outcomes of empowerment, quality of life, independent living, and competitive employment. Consumers, program administrators, educators, researchers, and practitioners may find the scale useful as a measure of some of the beliefs, goals, and practices that currently define modern psychiatric rehabilitation.     

Job satisfaction and job success as moderators of the self-esteem of people with mental illnesses

This study investigated job satisfaction and job success as moderators of the self-esteem of people with mental illnesses. Prior studies and models had produced contradictory findings so that the appropriateness of self-esteem as an outcome variable for psychiatric rehabilitation employment services was in doubt. Job satisfaction and success measures for 65 employed and 170 unemployed individuals with mental illnesses along with their work status and work status duration measures were combined in a single multiple regression analysis with self-esteem as the criterion. The job satisfaction and success measures were found to be significant and moderate level moderators of self-esteem for the combined sample and separately for the employed and unemployed samples. It appears that self-esteem varies with satisfaction and success with the work status and not with work status alone. These findings suggested that self-esteem was an appropriate and modifiable outcome measure for psychiatric rehabilitation services. Some practical, theoretical, and policy implications of these results were also discussed.