Limitations of the clonal agar assay for the assessment of primary human ovarian tumour biopsies.

114 biopsy specimens from 70 patients with ovarian carcinoma at all stages of disease were submitted for assessment of clonogenic capacity in agar. A highly significant correlation was found between agar clonogenicity and patient survival after biopsy. However, problems related to inherent tumour heterogeneity, quality of sample and tissue disaggregation indicate that this technique may have limited applicability in the routine assessment of patients. Only 41 biopsy specimens (36%) from 31 patients (44.3%) complied with the prerequisite criteria for agar clonogenic assessment, namely: (a) the confirmed presence of malignant cells in the biopsy, (b) the ability to prepare a single-cell suspension, and (c) adequate viable cell numbers for assay. Furthermore, although the dominant patterns of agar clonogenic growth could be identified and correlated with stage of disease, the heterogeneity in both initial clonogenic capacity and "self-renewal" capacity assessed by the ability of primary clones to propagate in liquid culture and reclone in agar was too inconsistent for the assay to be used as a prognostic index for the individual patient.     

Seasonal changes in cyclists' performance. Part I. The British Olympic road race squad.

British Olympic road squad cyclists were monitored during the 1980 racing season to evaluate training for the Moscow Games. Riders demonstrated reductions in body fat index, % body fat and endomorphy (p greater than .05). Graded exercise, using a "Racermate" wind load simulator/racing cycle ergometer system, showed reduced cardiovascular demands to warm-up exercise, and increased cardiovascular index, VO2 maximum, aerobic/anaerobic threshold shifts during maximal exercise (NS), with no changes in gearing, equivalent road speed, absolute/relative power output and leg power. Compared with "non-select" riders demonstrated lower body fat index, % body fat and endomorphy (p greater than .05), higher Hb and PCV % (p greater than .05) and elevated neuroticism and extraversion (p greater than .05). Furthermore, "select" riders demonstrated lower HR and CV index during warm-up exercise (p greater than .05), and elevated CV index, VO2 maximum, aerobic/anerobic thresholds during maximal exercise (p greater than .05), resulting from higher gearing, equivalent road speed and absolute/relative power output (p greater than .05).     

The identification by physiotherapists of the physical problems resulting from a mild traumatic brain injury

In New Zealand, over 9000 people are diagnosed with a traumatic brain injury (TBI) each year, with at least 80% being classified as mild. The cognitive deficits resulting from mild traumatic brain injury (MTBI) have been well documented, but this is not the case for the physical problems. As a result, the physical problems are not well understood and few people with a MTBI are referred for physiotherapy. The aim of this research was to use a modified Delphi Technique to gain consensus amongst physiotherapists working with TBI clients with regard to: (1) The common motor performance problems associated with MTBI; (2) The importance of assessing these motor performance problem; and (3) Whether these motor performance problems should be used in a formal assessment (FA) or included as a screening measure (SM). Following a pilot study to establish face validity and clarity of instructions, a national sample of 52 physiotherapists with a minimum of 1 year's experience working with TBI clients was recruited. In Round 1, 42 physiotherapists listed 424 physical problems which, in their clinical experience, may occur in people with a recent MTBI. A planning committee developed these listed problems into 33 items. In Round 2, these items were then rated by the physiotherapists as to their importance of being included in an assessment. Using 75% consensus criteria, 31 items were deemed as being at least 'important' for inclusion. In Round 3, the physiotherapists were asked whether these items should be used in a FA or used as a SM. Of the 31 items which were retained, seven reached consensus for FA (balance with unstable, reduced or changing base of support; dynamic standing balance; high level balance activities; quality of movement; ballistic activities; gait; proprioception). Five items reached consensus for being used as a SM (attention; behaviour; sport and leisure activities; vocational activities; quality of movement). Consensus of classification was not reached for the remaining 19 items which had previously been identified in Round 2 as being at least 'important' to be assessed. These results form the foundation for the development of an assessment/management protocol for physiotherapists working with adults with MTBI.     

Alpha-fetoprotein and Sertoli-Leydig cell tumor

Gard GB, Mulvany N, Quinn MA. Alpha-fetoprotein and Sertoli-Leydig cell tumor. Int J Gynecol Cancer 1998; 8 : 499–503.
The association between a Sertoli-Leydig cell tumor and a raised serum alpha-fetoprotein (AFP) is an uncommon occurrence which has only been previously described in 20 patients. We report a 17-year-old patient who presented with a pelvic mass and a raised serum AFP. At laparotomy she had a FIGO stage IA moderately differentiated Sertoli-Leydig cell tumor which required no further treatment. We have reviewed the literature relating to AFP production by Sertoli-Leydig cell tumors. When serum AFP is raised at diagnosis it appears to be a reliable tumor marker, hence a baseline level should be documented on all patients with Sertoli-Leydig cell tumor.     

Sonography of Morton's neuromas

OBJECTIVE: The objective is to evaluate the sonographic characteristics of Morton's neuromas and the usefulness of sonography in detecting them. MATERIALS AND METHODS: Thirty intermetatarsal spaces were evaluated with sonography to diagnose Morton's neuromas. The prospective sonographic reports were correlated with surgical and pathologic findings. Each sonogram was then blindly and retrospectively reviewed to characterize mass echotexture, location, size, and continuity with the plantar digital nerve when present. RESULTS: Surgery revealed 27 Morton's neuromas, one synovial cyst with infarcted tissue, one ganglion cyst, and one giant cell tumor of the tendon sheath. The prospective sonographic reports correctly identified neuromas in 85% of the cases. Retrospectively, 79.2% (19/24) of the neuromas were characterized as hypoechoic compared with muscle, whereas 12.5% (3/24) were of mixed echotexture and 8.3% (2/24) were anechoic. One half (50%) of the neuromas were located dorsal to the plantar aspect of the metatarsal heads, and 50% were both dorsal and plantar to this level. No statistical difference in height and width was found between neuromas and nonneuromas; however, nonneuromas were statistically greater in length than neuromas. All 15 masses in which presumed plantar digital nerve continuity with the mass was identified were neuromas. CONCLUSION: Sonography can reveal a Morton's neuroma in 85% of cases. Identification of the presumed plantar digital nerve in continuity with the mass improves diagnostic confidence. The finding of an interdigital mass greater than 20 mm in length should raise suspicion of an abnormality other than a neuroma.     

Long-term adaptive life functioning in relation to initiation of treatment with antipsychotics over the lifetime trajectory of schizophrenia.

BACKGROUND: There is evidence that the stage of illness at which antipsychotic treatment is initiated in schizophrenia may have consequences for its subsequent course. How this might relate to impaired adaptive life functioning in the long-term is poorly understood. METHODS: Thirty-eight inpatients, many of whom had been admitted in the preneuroleptic era, were assessed using the Social-Adaptive Functioning Evaluation (SAFE); constituent clinical and medication phases of the lifetime trajectory of their illnesses were then analyzed to identify predictors of SAFE score using multiple regression modeling. RESULTS: The primary, independent predictor of SAFE score was duration of initially unmedicated psychosis, which accounted for 22% of variance (p<.001) therein. Conversely, duration of subsequently treated illness, although decades longer, failed to predict SAFE score. CONCLUSIONS: These findings are consistent with some form of "progressive" process, particularly over the first several years following the emergence of psychosis, which is associated with accrual of deficits in adaptive life functioning.     

Neonatal intestinal perforation in Hirschsprung's disease

Over a period of 18 years, 77 of 135 patients treated for Hirschsprung's disease (HD) presented in the neonatal period. Of these 77 patients, 8 had gastrointestinal (GI) perforations. Seven patients were born at full term and 1 at 32 weeks of gestation. Three patients had associated trisomy 21. The site of perforation included rectum in 1 patient, sigmoid in 1, descending colon in 1, transverse colon in 2, caecum in 2, and jejunum in 1. Perforations occurred in ganglionic bowel in 7 patients and in the aganglionic segment in 1. One patient died in the newborn period of overwhelming sepsis secondary to enterocolitis, and histology of the bowel confirmed HD. In 6 patients HD was confirmed on barium enema and suction rectal biopsy, and they subsequently underwent a definitive pull-through operation. The 1 patient in whom the initial barium enema was normal continued to suffer from constipation until the age of 7 years, when the diagnosis of HD was established. He then underwent a pull-through procedure with no further problems. An association between neonatal intestinal perforation and HD must therefore be recognised to avoid delay in the management. Correspondence to: P. Puri