Isolated primary squamous cell carcinoma of the tympanic membrane

INTRODUCTIONPrimary squamous cell carcinoma (SCC) of the tympanic membrane is exceptionally rare. We describe the history, investigation and management of this disease.PRESENTATION OF CASEA 68-year-old woman presented with a three month history of intermittent otorrhoea and external ear canal (EAC) pruritus. Otoscopy revealed a polypoidal granular nodule, confined to the posterior aspect of the tympanic membrane. Examination under anaesthesia (EUA) confirmed that the lesion was confined to the tympanic membrane, with a surrounding rim of normal drum. Biopsies were consistent with well differentiated SCC.DISCUSSIONFollowing discussion at multi-disciplinary team meeting for treatment planning, the patient underwent lateral temporal bone resection with ipsilateral superficial parotidectomy and selective neck dissection. Post-operative histology confirmed an SCC confined to the tympanic membrane.CONCLUSIONSCC of the tympanic membrane is an extremely rare condition. As with early temporal bone SCC, surgical resection with adjacent structure clearance remains the primary treatment modality.     

Social Adjustment of Women With and Without a Substance-Abusing Partner

Little normative information is available about the psychosocial functioning of women who have a substance-abusing intimate partner. This study examined whether the social adjustment of women who indicate that they have a substance-abusing partner (n=69) is compromised relative to that of women who indicate that their partner does not abuse substances (n=68). Women with a substance-abusing partner reported compromised social adjustment relative to a comparison sample both overall and in five of six life domains (work, social/leisure, primary relationship, parental, family). Results suggest the potential benefit of expanding the focus of research and treatment to include effects and outcomes for these women and to influence treatment-related policy.     

Racquetball Injuries

It doesn't take a lot of skill to play racquetball and benefit from the excellent exercise it provides. Most of the injuries can be prevented if safety precautions are observed.     

The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial

OBJECTIVE: Osteoarthritis (OA) of the knee causes significant morbidity and current medical treatment is limited to symptom relief, while therapies able to slow structural damage remain elusive. This study was undertaken to evaluate the effect of glucosamine and chondroitin sulfate (CS), alone or in combination, as well as celecoxib and placebo on progressive loss of joint space width (JSW) in patients with knee OA. METHODS: A 24-month, double-blind, placebo-controlled study, conducted at 9 sites in the United States as part of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), enrolled 572 patients with knee OA who satisfied radiographic criteria (Kellgren/Lawrence [K/L] grade 2 or grade 3 changes and JSW of at least 2 mm at baseline). Patients with primarily lateral compartment narrowing at any time point were excluded. Patients who had been randomized to 1 of the 5 groups in the GAIT continued to receive glucosamine 500 mg 3 times daily, CS 400 mg 3 times daily, the combination of glucosamine and CS, celecoxib 200 mg daily, or placebo over 24 months. The minimum medial tibiofemoral JSW was measured at baseline, 12 months, and 24 months. The primary outcome measure was the mean change in JSW from baseline. RESULTS: The mean JSW loss at 2 years in knees with OA in the placebo group, adjusted for design and clinical factors, was 0.166 mm. No statistically significant difference in mean JSW loss was observed in any treatment group compared with the placebo group. Treatment effects on K/L grade 2 knees, but not on K/L grade 3 knees, showed a trend toward improvement relative to the placebo group. The power of the study was diminished by the limited sample size, variance of JSW measurement, and a smaller than expected loss in JSW. CONCLUSION: At 2 years, no treatment achieved a predefined threshold of clinically important difference in JSW loss as compared with placebo. However, knees with K/L grade 2 radiographic OA appeared to have the greatest potential for modification by these treatments.     

A breaker of advanced glycation end products attenuates diabetes-induced myocardial structural changes

The formation of advanced glycation end products (AGEs) on extracellular matrix components leads to accelerated increases in collagen cross linking that contributes to myocardial stiffness in diabetes. This study determined the effect of the crosslink breaker, ALT-711 on diabetes-induced cardiac disease. Streptozotocin diabetes was induced in Sprague-Dawley rats for 32 weeks. Treatment with ALT-711 (10 mg/kg) was initiated at week 16. Diabetic hearts were characterized by increased left ventricular (LV) mass and brain natriuretic peptide (BNP) expression, decreased LV collagen solubility, and increased collagen III gene and protein expression. Diabetic hearts had significant increases in AGEs and increased expression of the AGE receptors, RAGE and AGE-R3, in association with increases in gene and protein expression of connective tissue growth factor (CTGF). ALT-711 treatment restored LV collagen solubility and cardiac BNP in association with reduced cardiac AGE levels and abrogated the increase in RAGE, AGE-R3, CTGF, and collagen III expression. The present study suggests that AGEs play a central role in many of the alterations observed in the diabetic heart and that cleavage of preformed AGE crosslinks with ALT-711 leads to attenuation of diabetes-associated cardiac abnormalities in rats. This provides a potential new therapeutic approach for cardiovascular disease in human diabetes.     

Growth hormone-releasing hormone messenger ribonucleic acid in the hypothalamus of the adult male rat is increased by testosterone

Since intact adult male rats have higher GH pulse amplitude than do castrated animals and since GH-releasing hormone (GHRH) secretion is predominantly responsible for the production of these GH pulses, we hypothesized that testosterone stimulates GHRH synthesis in neurons of the hypothalamus. To test this hypothesis, we compared GHRH mRNA content in individual neurons of the arcuate (ARC) and ventromedial (VMH) nuclei among groups of intact (n = 3), castrated (n = 5), and castrated testosterone-replaced (n = 5) adult male rats. Cellular GHRH mRNA content was measured by using semiquantitative in situ hybridization with an 35S-labeled cRNA probe complementary to the coding sequence of rat GHRH mRNA. Castration resulted in an approximately 35% decline in GHRH mRNA signal relative to that in intact animals in both the ARC (P less than 0.005) and VMH (P less than 0.005). Replacement with testosterone at the time of castration completely prevented the decline in both areas. Testosterone can exert effects either through activation of the androgen receptor directly or through aromatization to estradiol; therefore, we also examined the effects on GHRH mRNA of replacement with 17 beta-estradiol (n = 5) or dihydrotestosterone (DHT), a nonaromatizable androgen (n = 4). Estradiol had no effect on the castration-induced decline in GHRH mRNA in either the ARC or VMH. In contrast, DHT partially prevented the postcastration decline in GHRH in the ARC (P less than 0.005), while having no statistically significant effect on GHRH mRNA in the VMH. These results clearly indicate that testosterone stimulates expression of GHRH mRNA in neurons of the hypothalamus. Furthermore, the failure of estradiol to substitute for testosterone and the ability of DHT to substantially support GHRH mRNA suggest that testosterone exerts its effects on GHRH gene expression predominantly through direct activation of the androgen receptor.     

Alcohol consumption and mortality in men with preexisting cerebrovascular disease

BACKGROUND: In counseling patients with a history of stroke, clinicians have limited information regarding the risks and benefits of alcohol consumption. OBJECTIVE: To examine the relationship between alcohol intake and risks of total and cardiovascular mortality in men with a history of stroke. METHODS: The study population consisted of 112 528 men from the enrollment cohort of the Physicians' Health Study, 1320 of whom reported a baseline history of stroke. Men provided self-reported data on alcohol consumption, which was classified into 1 of 4 categories: rarely or never drink, very light (<1 drink per week), light (1-6 drinks per week), or moderate (> or =1 drink per day). Cox proportional hazards models were used to assess the relative risks of mortality associated with alcohol consumption, after adjustment for major coronary risk factors. RESULTS: During a mean follow-up of 4(1/2) years, 369 men died, 267 of whom died of cardiovascular disease. Compared with men with a history of stroke who drank rarely or never, those with a very light to moderate alcohol intake had multivariate relative risks for total mortality of 0.88 (95% confidence interval [CI], 0.60-1.28), 0.64 (95% CI, 0.48-0.85), and 0.71 (95% CI, 0.54-0.94), respectively (P =.03 for trend); and relative risks for cardiovascular mortality of 0.89 (95% CI, 0.58-1.36), 0.56 (95% CI, 0.40-0.79), and 0.64 (95% CI, 0.46-0.88) P =.008 for trend). Compared with age-adjusted models, adjustment for major coronary risk factors did not significantly change risk estimates for total or cardiovascular mortality. CONCLUSIONS: These data indicate a possible inverse association between light to moderate alcohol intake and risks of total and cardiovascular mortality in men with a history of stroke. More data are needed to confirm or refute these results.     

Annual Medicare Wellness Visit: Advanced Nurse Practitioner Perceptions and Practices

Advanced Practice Nurses (APNs) can contribute to health prevention efforts with older adults by utilizing a health risk appraisal (HRA) during the Medicare Annual Wellness Visit. This study examined APN perceptions and practices concerning use of HRAs during Annual Wellness Visits (N = 51). Results indicate that respondents agree it is important to collaboratively identify risks and develop a personalized prevention plan, but only a small percentage (7.8%) use HRA data to do so. Reported concerns include reimbursement and time; further work on how to best integrate HRAs into APN practice to enhance prevention efforts with older adults is critical.