Same-gender stalking

Although stalkers most commonly target victims of the opposite gender, the results of larger and less selective studies suggest that same-gender stalking occurs with greater frequency than formerly thought. This study reviews the exiguous literature on same-gender stalking and presents the findings from a clinical study of 29 same-gender stalking cases that were referred to a forensic psychiatry center. The demographic characteristics, behavior, motivations, and psychopathology of same-gender stalkers are compared with a sample of 134 opposite-gender stalkers. The two groups were similar in many respects, with some discrepancies evident in the prior relationship between victim and stalker, harassment methods, and stalking motives. The impact of same-gender stalking on its victims is examined, and the implications of these findings are discussed.     

Problem Drinkers in Medical Wards: consumption patterns and disabilities in newly identified male cases

One hundred and sixty-one male medical inpatients were identified as problem drinkers according to criteria previously defined. This paper describes the pattern of their drinking and the associated medical and psychosocial problems. Over half had been admitted with an illness not typically related to alcohol and a similar proportion reported levels of consumption which have previously been considered safe. Classical symptoms of dependence were uncommon but specific enquiry revealed a broad range of social problems related to alcohol. Recognition of this profile is necessary if problem drinkers are to be identified at an early stage and to benefit from counselling.     

Ultrastructural Observations on Penicillium marneffei in Natural Human Infection

The ultrastructure of Penicillium marneffei and the host response to the infection were studied in two patients. One was immunocompetent and the other an immunosuppressed renal graft recipient. In the immunocompetent patient it was observed that all the yeast cells were phagocytosed and were found either within membrane-bound vacuoles or lying freely within the cytoplasm of the macrophages. It was postulated that continuous lysosomal fusion with the phagolysosomes and multiplication of the fungi within the phagocytic vacuoles might eventually lead to the rupture of the vacuoles with release of the organisms into the cytoplasm of the macrophages. In the second patient, the immunosuppressive effects of corticosteroids might account for the large number of nonphagocytosed fungi in the tissue space, and the failure to form large phagocytic vacuoles.     

Primary Fallopian Tube Adenocarcinoma in Situ Associated with Adjuvant Tamoxifen Therapy for Breast Carcinoma

We report the first case of primary fallopian tube adenocarcinoma in situ in a patient who had received antiestrogen tamoxifen as adjuvant therapy for breast carcinoma. Clinical and in vivo animal model studies, referable to the possible estrogen agonist effect of tamoxifen on the female genital tract, are also reviewed.     

Calcium: a potential central regulator in wound healing in the skin

Calcium has an established role in the normal homeostasis of mammalian skin and serves as a modulator in keratinocyte proliferation and differentiation. Gradients of calcium concentration increasing from 0.5 mM in the basal layer to > 1.4 mM in the stratum granulosum are consistent with migration patterns in response to minor abrasion (normal wear). Dermal fibroblasts require calcium but are approximately 100 times less sensitive than keratinocytes. Normal calcium metabolism in the skin is dependent on cell membrane and cytosolic calcium binding proteins (calmodulin, cadherins, etc.), but their modulation through parathyroid hormone, vitamin D or growth factors in normal or damaged tissue is not well documented. In wound repair, calcium is predominantly involved as Factor IV in the hemostatic phase, but it is expected to be required in epidermal cell migration and regeneration patterns in later stages of healing. Calcium alginate dressings are designed to liberate calcium early in the acute phase to promote hemostasis, but it is presently unclear whether the supplementary calcium influences the intracellular environment at later stages of wound repair, notably during the remodeling phase. Although experimental studies suggest that control of calcium is obligatory in wound management, we know very little as to how calcium in the wound bed is modulated through hormones, vitamin D, or various growth factors. Also, there is limited information as to how calcium released either from dressings, platelets, or from the circulation through the action of parathyroid hormone, growth factors or other modulators influences cell migration and remodeling in skin wounds, although experimental models suggest that management of calcium is essential in wound management.     

Low Complication Rate Associated with Cesarean Section under Spinal Anesthesia for HIV-1-Infected Women on Antiretroviral Therapy

Background: Elective cesarean section decreases the likelihood of vertical human immunodeficiency virus (HIV) transmission from mother to infant. This study aimed to determine whether cesarean section done with spinal anesthesia on HIV-1-infected pregnant women taking antiretroviral therapy is associated with intraoperative hemodynamic instability, postoperative complications, or changes in immune function or HIV-1 viral load.

Methods: A case-controlled study was conducted over a 3-year period in a London academic hospital. Forty-four women infected with HIV-1 and a control group of 45 HIV-negative women undergoing cesarean sections were included. The main outcome measures included intraoperative blood pressure, heart rate, blood loss, and ephedrine requirements, and postoperative infective complications, blood transfusion, changes in blood HIV-1 viral load and lymphocyte subsets, and time to hospital discharge.

Results: There were no differences in hemodynamic stability and postoperative complications between the HIV-infected group and the controls. There was an acute postoperative increase in the CD4T lymphocyte count (P = 0.01), but the CD4T:CD8T ratio and viral load did not change.     

Lymphomatoid Papulosis/Pityriasis Lichenoides in Two Children

Two children developed lymphomatoid papulosis/pityriasis lichenoides at ages 3 and 6 years. Follow-up continued for 13 years in the former patient and for 6 years in the latter. Both children now have continuing low-grade disease activity requiring in the one case topical corticosteroid therapy and in the other low-dose systemic steroid therapy. These children are reported to emphasize to pediatricians, pediatric pathologists, and hematologists that pseudolymphomatous conditions can exist in young children and do not require potent cytotoxic therapy. In both of our patients, the initial diagnosis was thought to be an aggressive lymphoma.     

Comparison of short-term antibiotic cover with a third-generation cephalosporin against conventional five-day therapy using metronidazole with an aminoglycoside in emergency and complicated colorectal surgery

In a prospective, randomized control trial, 152 consecutive patients requiring emergency or complicated colorectal surgery were allocated either to two doses of cefotetan or to five-day cover with gentamicin, and a single dose of metronidazole. Twenty-one patients received 6 gm of cefotetan before prolongation of prothrombin time dictated a change in the dose regimen such that all remaining patients (N = 55) received only 4 gm of cefotetan. The groups were well matched for diagnosis and surgical procedure. Rates of postoperative infection did not differ significantly between the groups, with wound infection rates occurring in 17 of 75 patients receiving gentamicin and metronidazole (22.7 percent) compared with ten of 75 receiving cefotetan (13 percent). Although wound infection rates were lower in the cefotetan group, the incidence of intra-abdominal abscess was similar in both groups. Eight patients receiving cefotetan developed intra-abdominal abscesses (11 percent), compared with seven receiving gentamicin and metronidazole (9 percent). Prolongation of prothrombin time in excess of 13 seconds occurred in six patients receiving cefotetan compared with no patients receiving gentamicin and metronidazole. None of these patients developed clinical bleeding, however.