Introducing this Special Issue on the "Mental Health of Asian Americans and Pacific Islanders"

There are approximately 1.4 million Asian American and Pacific Islanders who are suffering from some form of psychiatric disorder. Given the extent of this problem, I wish that we could provide specific epidemiological estimates of psychiatric disorders among Asian Americans. Unfortunately, there are few, if any, reliable and valid community-based epidemiological data on Asian Americans at this point. Given this state of affairs, it is quite important that we continue to do research on the mental needs and problems among Asian Americans so that we can provide the much needed mental health services.     

Mothers of Vietnamese Amerasians: Psychological Distress and High-Risk Factors

PURPOSE: The goal of the present article is to provide information useful to clinical caseworkers and mental health professionals on the nature and correlates of psychological distress as well as high­risk factors related to the adaptation of mothers of Vietnamese Amerasians (MVAs) in the United States. METHODOLOGY: By using a series of psychological distress instruments, the psychological distress levels of MVAs were compared to that of Amerasian adolescents. PRINCIPAL FINDINGS: The data enabled us to identify possible high­risk factors related to the adaptation and adjustment of MVAs in the United States. The MVAs as a group were experienceing about equal levels of distress as the Amerasian adolescents. However, differences began to emerge when we used the clinical cutoff method and found that there were differences between the two groups in two of the measures. The MVAs had a significantly higher proportion who were in the clinical range as compared to the Amerasian adolescent group. The conditions that were found to put the MVAs at higher risk for psychological distress include: Feeling distant from Amerasian child, feeling close to Vietnamese child, having no relatives in the United States, higher number of years of schooling, lower income, higher number of times with serious illness, missing work due to serious illness, higher number of months at the resettlement camp, greater amount of knowledge about American husband, not being officially married to American husband, and lack of support from American husband. CONCLUSIONS: The psychological instruments used in this study were not refined enough to be used for diagnosis of specific psychological disorders. Differences between Amerasian adolescents and MVAs pointed out the importance of examining both the groups' level of distress and the propotions in each grouop who were experiencing clinical levels of distress. The high risk factors identified in the current study may be used to examine potential sources of psychological distress for MVAs. RELEVANCE TO ASIAN AMERICAN AND PACIFIC ISLANDER POPULATIONS: This article is particularly relevant to Vietnamese and Amerasian. KEY WORDS: Psychological distress, high risk factors, MVAs, Ameriasian adolescents.     

A case-controlled MRI/MRA study of neurovascular contact in hemifacial spasm

BACKGROUND: Neurovascular contact (NVC) with the root exit zone (REZ) of the ipsilateral facial nerve is associated with hemifacial spasm (HFS), but unresolved issues remain. OBJECTIVES: To 1) determine the frequency of symptomatic and nonsymptomatic NVC, 2) determine the features of NVC associated with HFS, and 3) correlate severity of HFS to these features. METHODS: Two independent, blinded, prospective assessments of high-resolution MR and MR angiography (MRA) images were performed on Chinese cases (HFS: n = 44; age-matched control subjects: n = 20). RESULTS: Over 88% of 44 symptomatic sides in patients with HFS had NVC of the ipsilateral facial nerve. At least 80% of symptomatic sides involved NVC at the anterior aspect of the REZ [REZ(ant.)]. Although NVC was observed in approximately half of nonsymptomatic sides, at least 70% of them were not at REZ(ant.). NVC at the cisternal and intracanalicular portions of the facial nerve were not associated with HFS. Half of our patients with HFS had bilateral NVC, but none had bilateral symptoms. Most of our MR/MRA images showed that the size and position of the arterial branches of the vertebrobasilar system were markedly asymmetric. Of patients with bilateral NVC, over 83% had asymmetric NVC sites. The anterior inferior cerebellar artery was the most common vessel involved in NVC, but was not significantly associated with HFS. Most of the NVC involved one vessel at one contact point with no indentation. The development of HFS was significantly associated with nerve indentation in NVC. The development and severity of HFS were not associated with multiple contact points in NVC. No significant interobserver variability existed between the blinded assessments. CONCLUSIONS: MRI/MR angiography are accurate, fast, and safe in characterizing neurovascular contact (NVC) at the brainstem. The site of NVC and ipsilateral facial nerve indentation in NVC are significant determinants for the development of hemifacial spasm (HFS). The lack of bilateral NVC at the anterior aspect of the root exit zone of the facial nerve could explain in part the lack of bilateral symptoms. The development and severity of HFS are not associated with a specific blood vessel or multiple contact points in NVC.     

Classical transplantation tolerance in the adult: the interaction between myeloablation and immunosuppression.

Allogeneic bone marrow transplantation in the neonate is an effective way of inducing permanent tolerance to donor tissue. To do the same in the immunocompetent adult requires immunosuppression to counter host-versus-graft alloreactivity. Conditioning with monoclonal antibodies (mAb) to CD4 and CD8 has been sufficient where donor and recipient are mismatched at only multiple "minor" histocompatibility loci, or at major histocompatibility complex (MHC) class I plus "minor" loci, but not where the mismatch involves the entire MHC. Tolerance across the MHC barrier requires extra conditioning with agents that happen to be both immunosuppressive and myeloablative, so obscuring the assessment of which effect is important. By using dimethylmyleran as a selective "space"-creating myeloablative agent, and CD4 plus CD8 mAb as sole immunosuppressive agents, we have been able to dissect the relative requirements for immunosuppression and myeloablation. We show here that transplantation tolerance could only be achieved when both types of agent were combined together so as to guarantee sufficient donor-type hemopoietic chimerism. We argue that the donor marrow, given sufficient space, will engraft and provide a sustained source of tolerogen overriding any host resistance that antibodies cannot control.     

A retrospective analysis of immunohistochemical staining in identification of poorly differentiated round cell and spindle cell tumors--results, reagents and costs.

Immunohistochemistry has rapidly established a significant role in diagnostic pathology. We use immunohistochemistry as an adjunct to morphological diagnosis and employ a "panel approach" to the classification of poorly differentiated tumors. This retrospective analysis was conducted to examine the efficacy of such an approach, using, as an example, the two most common categories of poorly differentiated tumors, namely, the poorly differentiated round cell tumors and spindle cell tumors. Five hundred and fifty-seven consecutive cases of such tumors, collected over a two-yr period, had been subjected to immunohistochemical staining because specific or definitive categorization of the tumor was not possible on the basis of the examination of hematoxylin and eosin stained sections. The clinical history, gross and microscopic findings, as well as the results of immunohistochemical stains were analyzed. Immunohistochemistry allowed a definitive diagnosis to be assigned in 420 cases (75.4%). It was particularly useful in identifying malignant melanoma of both epithelioid and spindle types and distinguished between melanoma, lymphoma and poorly differentiated carcinoma in 126 cases of such lesions occurring in adult lymph nodes. It was also useful in identifying tumors in small biopsies where poor cytomorphological preservation or small size precluded accurate categorization. The application of appropriately chosen panels of antibodies tailored to a narrow list of differential diagnoses helped to identify myogenous, vascular, nerve sheath and fibrocystic lesions among the group of spindle cell tumors. Immunohistochemistry provided definitive diagnoses in 70% of round cell tumors and 92% of spindle cell tumors.(ABSTRACT TRUNCATED AT 250 WORDS)     

Should patients with asymmetrical noise‐induced hearing loss be screened for vestibular schwannomas?

Should patients with asymmetrical noise‐induced hearing loss be screened for vestibular schwannomas? The Peterborough ENT department receives many referrals for MoD personnel who have suffered hearing loss from occupational noise exposure. Those patients with asymmetrical sensorineural hearing loss are routinely screened for vestibular schwannomas by MRI scanning. Scan reports from the past 5 years have been reviewed and out of 152 scans, four revealed vestibular schwannomas giving a pick‐up rate of 2.5%, which compares favourably with other published pick‐up rates. Review of the audiograms in these cases suggests that they can be misleading in this context. The conclusion is that patients with noise‐induced asymmetrical hearing loss should be screened for acoustic neuromas.     

Chiari osteotomy and shelf augmentation in the treatment of hip dysplasia

The clinical and radiographic results of Chiari osteotomy and shelf augmentation for acetabular dysplasia in 30 hips were reported. The average age at operation was 17 years for Chiari osteotomy and 13.8 years for shelf augmentation. The mean follow-up was 7.1 years for Chiari osteotomy and 4.1 years for shelf augmentation. Of the 14 Chiari osteotomies, 12 had good results by Tonnis clinical grading and 2 had poor results. There were significant improvements in the radiographic parameters measured (p < 0.01). They included center-edge angle of Wiberg, the acetabular angle of Sharp, the percentage of femoral head coverage, and the "c/b" ratio. For the 16 shelf augmentations, there were 8 good, 2 fair, and 6 poor results. The radiographic parameters measured were also all significantly improved (p < 0.01). The final Severin grading of the hips were improved by both Chiari osteotomy and shelf augmentation.     

Computer databases for the sentinel lymph node program

At the University of California San Francisco Comprehensive Cancer Center, a computer database system was created using the FileMaker Pro database program. The system allows the clinical team to bring together data from all aspects of a multidisciplinary effort toward improving daily clinical management, for research, and ultimately, for the clinical standard of care for melanoma patients. With modest objectives during the initiation of the database, its adaptability has allowed it to become an integral link in all the efforts of the melanoma program. For the future, tapping into the immense potential of the Internet has begun to organize multicenter efforts. Through nationwide collaboration, the Sentinel Lymph Node Working Group will be able to follow, on a larger scale, the successes of the FileMaker pro database at the UCSF Comprehensive Cancer Center.