Symptoms and time to presentation and treatment in ocular melanoma: the Western Canada Melanoma Study

Reports on all ocular melanomas newly diagnosed between Apr. 1, 1979, and Mar. 31, 1981, were obtained from the cancer registries of British Columbia, Alberta, Saskatchewan and Manitoba. Of the 90 cases, 87 were in patients aged 20 to 79 years, 64 of whom were interviewed about their initial symptoms. Three symptoms--loss of part of the visual field (in 33% of patients), photopsia (in 20%) and blurred vision (in 20%)--emerged as the main indicators of disease. In 17% of cases the tumour was discovered as an incidental finding on ocular examination. The length of delay before consulting a physician was generally short in symptomatic patients, with 85% reporting that they saw a physician within 3 months of onset of the first symptom. Of the 30 patients who received definitive treatment 4 months or more after initial presentation, 13 were seen by general practitioners who delayed before referring the patient to an ophthalmologist. Continuing medical education is needed to ensure earlier referral to ophthalmologists by general practitioners of patients with ocular melanoma.     

Mortality among female registered nurses and school teachers in British Columbia

The mortality profile of female nurses and teachers in British Columbia (BC) was examined using age-standardized proportional mortality ratios (PMRs) calculated for the period 1950–1984. Lowered overall mortality among nurses was seen for degenerative heart disease and for cerebrovascular accidents. Significantly elevated PMR values were observed for cancer of the breast and ovary in nurses of age 20–65 years. PMRs were significantly elevated for cancer of the pancreas and leukemia among those age 20 years and older. Elevated values were also observed for motor vehicle accidents and suicide among nurses in both age groups. Lower than expected mortality from degenerative heart disease and cerebrovascular accidents was seen in working age teachers (age 20–65 years). However, elevated PMRs were detected for carcinoma of the colon, breast, endometrium, brain, and melanoma. Among those 20 years and over, significantly elevated PMRs were also observed for cancers of the ovary and other digestive organs. Elevated PMRs were found for motor vehicle and aircraft accidents. Mortality from cirrhosis of the liver was lower than anticipated in both teachers and nurses. A number of significant PMRs declined when deaths of “homemakers” were withdrawn from the comparison group used to generate PMR values, suggesting that risk of death from various causes among women working outside the home differ from those seen in women who are predominantly in the home.     

Evidence for P2-purinoceptors on human osteoblast-like cells.

ATP released from damaged cells or by controlled secretion could be an important factor in the formation or remodeling of bone. In a variety of other tissues ATP has been shown to control cellular processes by acting on P2-purinoceptors and activating the calcium signaling pathway. Here we demonstrate for the first time that extracellular ATP increases the intracellular free calcium [Ca2+]i concentration in normal human osteoblasts and in SaOS-2 cells, a human osteosarcoma-derived cell line, but not in ROS 17/2.8 cells. The ATP-induced increase in [Ca2+]i was dose dependent, and the concentrations of ATP required were similar to those reported to regulate cellular functions in other cell types. Although ATP is metabolized rapidly by bone cells, the effects on [Ca2+]i appeared to be mediated directly by ATP rather than one of its metabolites. Adenosine 3-thiotriphosphate, a nonhydrolyzable analog of ATP, induced similar changes in [Ca2+]i. This indicates that P2-purinoceptors are present on osteoblast-like cells and that extracellular ATP from various sources might be an important factor in the regulation of osteoblast functions.     

Blood pressure and social class in a Jamaican community

A study of social factors and blood pressure was conducted in a Jamaican community among a sample of 199 persons ages 30 to 50. After controlling for obesity, age, and respondent tension (and other covariates), interaction effects of social class x sex for systolic and diastolic blood pressure were found. Blood pressure increased with increasing social class for males and decreased with increasing social class for females.     

Technical considerations in the surgical approach to multiple accessory pathways in the Wolff-Parkinson-White syndrome

Surgical techniques for the approach to and division of atrioventricular accessory pathways have been designed and perfected during the past 18 years. The standard method of exposure of a single left free wall accessory pathway is by a left atriotomy. All other single accessory pathways are exposed through a right atriotomy. Up to twenty percent of patients with Wolff-Parkinson-White (WPW) syndrome harbor multiple atrioventricular accessory pathways. In this subgroup, classic operative techniques, especially the methods of approach, must be combined or modified depending on the specific locations of the accessory pathways encountered. Eighteen of 90 patients operated on for WPW syndrome at Charlotte Memorial Hospital from August, 1983, through September, 1986, had multiple accessory pathways. Thirty-eight of thirty-nine pathways were successfully divided. One posterior septal accessory pathway reappeared 2 months postoperatively and was catheter ablated. The most frequent combination of atrioventricular accessory pathways included a right free wall and a posterior septal accessory pathway (10 patients). This combination is approached by a right atriotomy. The posterior septal space dissection is extended onto the right free wall area. Technically the most difficult combination includes a left free wall and a posterior septal accessory pathway (3 patients in the present series). Our preferred approach is begun with a right atriotomy for the posterior septal space dissection, followed by an atrial septotomy to expose the left free wall area. There are other methods, however, that may be advantageous depending on the exact locations of the accessory pathways encountered.     

A Study of Fluoxetine in Obese Elderly Patients with Type 2 Diabetes

In order to establish the safety and efficacy of fluoxetine in subjects over 60 years of age with Type 2 diabetes, a randomized, double-blind, parallel study of 30 obese subjects was undertaken, comparing the use of fluoxetine 60 mg daily with placebo. Subjects were diet controlled with an HbA₁ < 14% (reference range 6–9%) and BMI > 29 kg m². Those taking fluoxetine had a median weight loss of 2.6 kg at 3 months (p < 0.001) and 3.9 kg at 6 months (p < 0–02), compared with weight loss in the placebo group of 0.1 kg and 0.0 kg at 3 and 6 months, respectively. Improved glycaemic control was also demonstrated in the fluoxetine group compared with placebo, initial HbA₁ levels of 8.0% vs 8.7% (NS) falling at 4 months by 0.9% (p < 0.02) and at six months by 0.9% (p < 0.02). No sustained improvement in fasting blood glucose levels was demonstrated. Reporting of adverse events was similar in both groups. Fluoxetine in the short term aids weight loss and improves glycaemic control without a significant increase in adverse events in elderly Type 2 diabetic subjects.     

Voices from different places: but why a medical school faculty?

Interdisciplinary collaboration between nursing and medicine is a valued goal, but one which is difficult to achieve. Two nurses who are faculty members in medical schools reflect on their unique roles and how these encompass interdisciplinary research, teaching, and practice.     

Are there any successful men from criminogenic backgrounds?

In the Cambridge Study in Delinquent Development, a prospective longitudinal survey of 411 London males, a vulnerable group of 63 boys from criminogenic backgrounds was defined on the basis of the best nonbehavioral predictors of delinquency at age 8-10 (low family income, large family size, convicted parents, low intelligence, and poor parental child-rearing behavior). These males were followed up to age 32, and the more successful men were defined according to criteria such as the absence of convictions and of other deviant behavior, good relationships with wives and children, and good accommodation and employment histories. Hence, "success" here refers to satisfactory social adjustment. The more successful men were those who had been neurotic at age 10, those who had few or no friends at age 8, those without convicted parents or behavior problem siblings, those with mothers who had a high opinion of their sons, and those who did not spend their leisure time with their fathers. At age 8-10 they were already better behaved and less daring than those later judged as the unsuccessful men. There was some tendency for shyness to act as a protective factor against delinquency for non-aggressive boys but as an aggravating factor for aggressive boys.     

Primary venous dissecting aneurysm arising during pregnancy: a case report and review of the literature

This report describes a case of venous dissecting aneurysm presenting as a popliteal mass, in a 33 year old woman. A 1 x 1 x 0.5 cm lump developed early in the course of a second pregnancy. Primary venous aneurysms are rare vascular abnormalities that can affect either the superficial or deep veins, and have been described throughout the venous system. Most commonly found in the neck and central thoracic veins, they have also been found in visceral veins and extremities. There is a tendency for vascular disturbances to occur during pregnancy. The haemodynamic changes and hormonal milieu may be the cause of vascular alterations, which can lead to new aneurysm formation, or weakening of pre-existing aneurysms. This is the first reported case of a dissecting venous aneurysm, and has the added interest that it occurred during pregnancy.