p53, c-erbB2, and PCNA status in benign, proliferative and malignant ovarian surface epithelial neoplasms: a study of 75 cases.

Low malignant potential tumors of the ovary are believed to behave in a manner intermediate to their benign and malignant counterparts. However, recent evidence suggests these lesions are in fact benign and better classified as proliferative. Based on our previous work and evaluating p53, c-erbB2, and PCNA status in a full spectrum of ovarian surface epithelial tumors, with emphasis on low malignant potential tumors, we tested this hypothesis. Immunohistochemical stains with monoclonal antibodies were used on 75 archival ovarian neoplasms. The results demonstrated anti-p53 reactivity in 30 carcinomas (40%), 2 of which were proliferative, and no reactivity in the benign tumors. Overexpression of c-erbB2 was seen in 31 malignant neoplasms (64.5%), 4 of which were proliferative (22.1%), and none in benign tumors. The PCNA proliferative index showed means of 42.8%, 22.8%, and 14.9% with benign, low malignant potential, and malignant tumors, respectively. Predicting immunoreactivity in carcinomas for anti-PCNA (Student t test), anti-p53, and anti-c-erbB2 (Pearson chi2 test) versus a lack of immunoreactivity in proliferative tumors indicate P values of .001, <.001, and <.001, respectively. These data show significant differences in the expression of these markers in ovarian tumors and suggest a possible role for these oncogenes as supplemental tools in diagnostic pathology. Further, our findings also support the designation of proliferative as opposed to the current nomenclature of low malignant potential tumors.     

Interrater reliability of the National Institutes of Health Stroke Scale: rating by neurologists and nurses in a community-based stroke incidence study.

The reliability of the National Institutes of Health Stroke Scale (NIHSS) for use by trained neurologists in clinical trials of acute stroke has been established in several hospital-based studies. However, it also has the potential for application in community-based settings and to be used by nonneurologists: issues which have not been explored before. Hence, we aimed to determine the reliability of the NIHSS when administered by research nurses within the existing North Eastern Melbourne Stroke Incidence Study. Using the NIHSS, thirty-one consecutively registered stroke patients were assessed by 2 neurologists and 1 of 2 trained research nurses. The interrater reliability of observations was compared using weighted and unweighted kappa statistics and intraclass correlation coefficients (ICC). There was a high level of agreement for total scores between the 2 neurologists (ICC = 0.95) and between each neurologist and research nurse (ICC = 0.92 and 0.96). While there was moderate to excellent agreement among neurologists and research nurse (weighted kappa > 0.4) for the majority of the NIHSS items, there was poor agreement for the component 'limb ataxia'. Overall, agreement between nurse and neurologist for individual items was not significantly different from agreement between neurologists. It appears that in both hospital and community settings, trained research nurses can administer the NIHSS with a reliability similar to stroke-trained neurologists. This ability could be used to advantage in large community-based trials and epidemiological studies.     

Melatonin treatment of non-epileptic myoclonus in children

Oral melatonin (MLT) has been used by our Vancouver research group in the treatment of paediatric sleep disorders since 1991; slightly over 200 children, mainly with multiple disabilities, who frequently had seizures, have been treated. Three children with markedly delayed sleep onset due to recurring myoclonus were also referred for MLT treatment: two had non-epileptic, and one had epileptic and non-epileptic myoclonus. Low doses of oral MLT (3 to 5 mg) unexpectedly abolished their myoclonus and allowed them to sleep. There were no adverse effects. It appears that certain types of myoclonus, which might be resistant to conventional anticonvulsant medications, may respond to MLT but the mechanism of action is unclear. Further research on this novel treatment is urgently needed.     

Book Reviews

MAKING US CRAZY, DSM: THE PSYCHIATRIC BIBLE AND THE CREATION OF MENTAL DISORDERS by Herb Kutchins and Stuart A. Kirk. New York: The Free Press. 1996. iv + 305 pp.DRUGS AND THE BRAIN by Solomon H. Snyder. New York: Scientific American Library. 1996. 228 pp., 91 illustrations, $19.95 (softcover).DOMESTIC PARTNER ABUSE edited by Kevin Hamberger and Claire M. Renzetti. New York: Springer Publishing Company. 1996. 227 pp.     

Carbon Monoxide and Physical Work Capacity

Submaximal and maximal exercise capacity were compared in 16 subjects while breathing air and a 225-ppm carbon monoxide-air mixture, the latter resulting in a carboxyhemoglobin level of 20%. Maximal oxygen uptake decreased approximately proportional to the reduction in arterial oxygen content (24%) and irrespective of the arterial oxygen tension. The Incremental increases of heart rate and ventilation with exercise were greater in the subjects when breathing CO than air but peak ventilation was reduced with CO. Except for the latter, these responses are similar to that found with hypobaric hypoxia.     

眼内扫描激光视野计用于检测老年黄斑变性

目的：测定眼内扫描激光视野计用于检测老年黄斑变性（ARMD）视功能损害的敏感性和特异性。方法：通过眼内扫描激光视野计测定了患者是否存在视野损害，并在双盲情况下，根据眼底照相的表现评估老年黄斑变性的严重程度。一项前瞻性的双盲实验比较了眼内视野计和眼底照相的结果。91位老年黄斑变性患者和24位非老年黄斑变性患者通过眼科检查后人选了该实验。院内有关审查组批准了此研究。视野暗点是我们测定的主要结果。