Chemotherapy of advanced prostatic carcinoma

Metastatic prostate cancer remains incurable. Historically, therapy options for patients with nonlocalized disease have been limited to hormonal therapy and palliative radiation therapy. The use of cytotoxic chemotherapy has not been routine, and is still not rigorously demonstrated to alter the natural history of androgen-independent prostate cancer. Nonetheless, there is an established, if not universally accepted, role for chemotherapy in symptom palliation, and several combinations have been described that produce response rates in the range that are associated with alteration of disease progression and improved survival in other cancers. The further refinement of such combination regimens, and their application to patients much earlier in the course of the disease, are the most important immediate challenges for medical oncologists who treat prostate cancer. At present, the curative potential of all local therapies remains disappointing; it is expected that the advent of truly effective systemic therapy will bring much improved prospects for cure by the application of combined modality treatment.     

Angioplasty for long-term treatment of patients with Budd-Chiari syndrome

The goal of radiologic intervention in patients with Budd-Chiari syndrome is to control portal hypertension and prevent further hepatocellular damage until collateral hepatic venous outflow channels can develop. Percutaneous balloon angioplasty was used to treat six patients with this syndrome who were followed up for an average of 43 months (range, 12-92 months). Standard interventional radiologic techniques were used to dilate the hepatic veins (two patients), inferior vena cava (three patients), and proximal anastomosis of a mesoatrial shunt (one patient). Angioplasty was the only invasive treatment in three patients, whereas the remaining three patients had previous portosystemic shunts. Clinical and hemodynamic improvement occurred after each angioplasty. Multiple dilatations were required in all patients (average, 3.2; range, 2-5) because of restenosis at the angioplasty site and ongoing hepatocyte necrosis shown by biopsy. Long-term benefit occurred in five patients despite ultimate caval occlusion in two patients and restenosis in one patient. One patient who was almost free of symptoms for 36 months developed gastrointestinal bleeding caused by portal hypertension. This experience suggests that balloon angioplasty is a safe and effective treatment for patients with Budd-Chiari syndrome. The therapy is not definitive, but serves to moderate the severity of the disease until collateral venous pathways develop. Multiple angioplasties are required for the long-term care of these patients.     

Simian virus 40 small tumor antigen and an amino-terminal domain of large tumor antigen share a common transforming function.

The 82-residue amino-terminal sequences of simian virus 40 large tumor antigen (TAg) and small tumor antigen (tAg) are identical. Genetic analysis of TAg lacking amino acids 1-82 revealed that it was transformation-defective, as revealed by the agar growth assay, except when introduced in the presence of tAg. Since the latter, alone, lacks overt transforming activity, it would appear that the function of the sequence common to TAg and tAg is necessary, but not sufficient, for TAg transforming activity and that tAg can provide that function or its equivalent in trans. Thus, tAg may, in part, be viewed as a "portable" copy of a TAg functional domain.     

Superior mesenteric and portal vein thrombosis following laparoscopic-assisted right hemicolectomy

PURPOSE: This article describes a case of superior mesenteric and portal vein thrombosis following laparoscopic-assisted right hemicolectomy. METHODS: A retrospective case review was performed. RESULTS: Data continue to grow regarding safety and technical feasibility of laparoscopic-assisted colectomy. As this minimally invasive alternative to open colonic resection becomes more popular, it is inevitable that information on benefits and complications associated with it will continue to expand. We report a case of superior mesenteric and portal vein thrombosis following laparoscopic-assisted colon resection. To our knowledge, this represents a complication of laparoscopic colon resection not previously reported in literature. CONCLUSION: Careful patient selection for this procedure is important. Additionally, the incision for extracorporeal resection and anastomosis in laparoscopic-assisted colectomy must be planned appropriately and carefully monitored intraoperatively to avoid potential complication of vascular trauma leading to mesenteric vein thrombosis.     

The association between deployment-related posttraumatic growth among U.S. Army soldiers and negative behavioral health conditions

Objectives: This study assessed posttraumatic growth (PTG) in a sample of U.S. Army Soldiers using the Post‐Traumatic Growth Inventory (PTGI), and the relationship between PTG and negative behavioral health (BH) conditions. Design: A sample of Soldiers with prior combat deployment experience (n = 1,834) completed an anonymous survey including demographics, the PTGI, and negative BH conditions. Results: Among previously deployed Soldiers, those reporting the highest number of combat experiences also reported significantly higher overall PTG. A significant inverse relationship was observed between PTG and recent suicidal ideation, whereby Soldiers reporting recent suicidal ideation reported significantly lower overall PTG. Conclusions: This study quantified PTG resulting from deployment and demonstrated the degree to which combat experiences might result in PTG. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1–10, 2011.     

Evaluation of data obtained from military disability medical administrative databases for service members with schizophrenia or bipolar disorder

OBJECTIVE: We are studying associations between selected biomarkers and schizophrenia or bipolar disorder among military personnel. To assess potential diagnostic misclassification and to estimate the date of illness onset, we reviewed medical records for a subset of cases. METHODS: Two psychiatrists independently reviewed 182 service medical records retrieved from the Department of Veterans Affairs. Data were evaluated for diagnostic concordance between database diagnoses and reviewers. Interreviewer variability was measured by using proportion of agreement and the kappa statistic. Data were abstracted to estimate date of onset. RESULTS: High levels of agreement existed between database diagnoses and reviewers (proportion, 94.7%; kappa = 0.88) and between reviewers (proportion, 92.3%; kappa = 0.87). The median time between illness onset and initiation of medical discharge was 1.6 and 1.1 years for schizophrenia and bipolar disorder, respectively. CONCLUSIONS: High levels of agreement between investigators and database diagnoses indicate that diagnostic misclassification is unlikely. Discharge procedure initiation date provides a suitable surrogate for disease onset.     

Perceptions of the family,personality characteristics,and adolescent internalizing symptoms

OBJECTIVE: To explore the influences of adolescent self-reported and interviewer-rated perceptions of family functioning, parent perceptions of the family, and adolescent personality on internalizing symptoms. METHOD: Two hundred one adolescent twins (mean age = 16.2 +/- 2.0 years; 90% white) completed the Family Assessment Device (FAD), Eysenck Personality Inventory, Children's Depression Inventory, and Multidimensional Anxiety Scale for Children and participated in an interview about their relationships with parents. Parents completed the FAD. Twins were divided into two samples for analysis. RESULTS: Multiple regression analyses in sample A showed that adolescent perceptions of family function accounted for 35% of the variance in depressive symptoms, but did not significantly predict anxiety. Self-reported perceptions were more strongly associated with symptoms than were interviewer-rated perceptions. Parent FAD and adolescent neuroticism accounted for 24% of the variance in adolescent self-reported perceptions. Results were similar in sample B. CONCLUSIONS: Adolescent perceptions of the family are linked to their depressive symptoms and associated with neuroticism. Adolescents who are high in neuroticism may perceive their families more negatively. Clinicians need to carefully discern components of family function that lead to teen depression versus biased cognitions that lead teenagers to perceive family relationships as negative.