Lymph Node Tumor Volumes in Patients Undergoing Sentinel Lymph Node Biopsy for Cutaneous Melanoma

Background: Regional lymph node tumor volumes in patients undergoing sentinel lymph node (SN) biopsy (SNB) for treatment of cutaneous melanoma have not been described. The objectives of this study were to describe the lymph node tumor volumes typically seen in this population and to correlate tumor volumes with tumor thickness and positive SN characteristics.Methods: Review of a consecutive series of patients with clinically localized cutaneous melanoma who underwent SNB of nonpalpable regional lymph node basins followed by complete lymphadenectomy (LND) was performed. Multiple lymph node sections from positive SNs and nonsentinel nodes (NSNs) in LND specimens were examined microscopically. Individual tumor deposit diameters were measured using an ocular micrometer. Aggregate tumor volumes were calculated for SN and LND specimens. Tumor volumes and SN and LND positivity rates were correlated with tumor thickness, the number of positive SNs, and the presence of multiple SN tumor deposits.Results: SNB procedures were performed for 149 melanomas in 189 regional nodal basins. The mean tumor depth was 2.48 mm. The mean number of SNs/basin was 2.1. Thirty-two of 149 SNB procedures (21.5%) revealed a total of 34 nodal basins with at least one positive SN. The median tumor volume in positive SNs was 4.7 mm³ (range, 0.1-3618 mm³; mean, 209 mm³). The median aggregate tumor volume in positive LND specimens was 4.9 mm³ (range, 0.1-3618 mm³; mean, 224 mm³). Six basins (17.6%) contained at least one positive NSN. The regional node aggregate tumor volume correlated weakly with tumor thickness (Pearsons correlation coefficient = .302, P = .0934). NSN positivity was not predicted by tumor thickness, American Joint Committee on Cancer tumor stage, number of positive SNs, or number of metastatic deposits within SNs.Conclusions: Most melanoma-positive SNs contain minute tumor volumes. Tumor thickness and patterns of SN metastases may not be predictive of tumor burden or the presence of positive NSNs.     

Amphetamine disrupts P50 suppression in normal subjects.

BACKGROUND: P50 suppression is viewed as an operational measure of sensory "gating" that is reduced in patients with schizophrenia and their family members. Previous reports have demonstrated that neural gating is regulated by monoaminergic tone in rodent models of P50 suppression. METHODS: In this study, 11 healthy subjects participated in P50 event-related potential recordings at baseline and after either oral administration of dextroamphetamine (.3 mg/kg) or placebo, to determine if the administration of a monoaminergic agonist produces P50 suppression deficits similar to those observed in patients with schizophrenia. RESULTS: As hypothesized, amphetamine disrupted the suppression of the P50 event-related potential. There was a statistically significant decrement in P50 suppression during the amphetamine challenge condition (t10 = 3.15, p < .01, mean difference = -44.1%, d = -2.5) relative to the baseline P50 condition. A comparison of P50 suppression in the placebo and amphetamine conditions (both after a baseline recording session) revealed a significant amphetamine-induced disruption of P50 suppression (t6 = 3.71, p < .01, mean difference = -54.4%, d = -3.14). CONCLUSIONS: The biochemical alterations associated with an amphetamine-induced disruption of P50 suppression in this study may be related to the pathophysiology of P50 suppression deficits in schizophrenia. The findings are consistent with several careful examinations of suppression deficits in rodent models that have identified the monoaminergic regulation of P50 suppression. These data indicate that amphetamine induces a disruption of P50 suppression in normal subjects.     

Effects of religiosity and racial socialization on subjective stigmatization in African-American adolescents

The direct effects of religiosity and racial socialization on subjective stigmatization among 50 African-American adolescents were investigated. A stigma is a characteristic about which others hold negative attitudes and stereotypes. Subjective stigmatization measures the degree to which an individual internalizes such negative attitudes and stereotypes toward a social group of which he or she is a member. Participants who showed strong commitment to the church were more destigmatized than were participants who did not. Further, participants who received racial socialization messages stemming from a single "primary" category were more destigmatized than those who did not. Unexpectedly, the more racial socialization messages participants received, the more self-stigmatized they were. The importance of religiosity and racial socialization in the lives of African-American adolescents are discussed.     

Marketing syringe/needle exchange programs

In an effort to bring the AIDS epidemic under control among the highest risk population of injecting drug users, Syringe/Needle Exchange Programs are being considered, developed and implemented. This paper looks at some of the programs in the United States in various stages of development. Also discussed will be the medical, social and political issues surrounding Needle Exchange Programs.     

The on-eye dehydration of proclear compatibles lenses.

PURPOSE: The purpose of the study was to evaluate the on-eye dehydration over time, of molded omafilcon A lenses (Proclear Compatibles) compared to a range of frequent replacement lenses. METHODS: Ten subjects wore a Proclear Compatibles lens in one eye and a control lens in the other eye for 4-, 8- and 12-hours. The control lenses were Acuvue, Soflens 66 and Optima frequent replacement lenses. Each subject wore three different pairs of lenses for each time period in a masked, randomized fashion. A gravimetric technique was used to determine lens water content. RESULTS: The Proclear Compatibles lenses showed significantly less relative dehydration than the Acuvue and Soflens 66 lenses. The Acuvue and Soflens 66 lenses showed a significant increase in relative dehydration with increasing wearing time. Subjective comfort was graded higher with the Proclear Compatibles than with the Acuvue lenses. There was a significant negative correlation between Acuvue dehydration and subjective ratings of comfort. CONCLUSIONS: The study showed that Proclear Compatibles lenses dehydrate significantly less than the other frequent replacement high-water content lenses. The Acuvue and Soflens 66 lenses showed increasing dehydration during the 4-12 hour wearing period.     

Endoscopic Treatment of Vesicoureteral Reflux with Collagen: Preliminary Report and Cost Analysis

Purpose

We determined therapeutic and operative cost efficacy of endoscopic collagen injection for vesicoureteral reflux.

Materials and Methods

We performed a multicenter study of 10 male and 23 female sequential patients (45 renal units) with vesicoureteral reflux and a surgical indication. Patients were skin tested with collagen and when negative, they underwent endoscopic injection. Renal ultrasound/ cystography was done 3 months after treatment. Cost analysis was performed at 1 institution.

Results

Reflux was grade I in 2 renal units, II in 18, III in 15 and IV in 10. The majority of cases were single systems with primary reflux. We performed 1 treatment in 32 renal units, 2 in 6, 3 in 6 and 4 in 1. Cure was evident in 31 of 38 renal units (81.6 percent) and 21 of 27 patients (78 percent) 3 months after the last injection. Patient morbidity was minimal. Operative cost per renal unit was $1,599.68 for collagen injection and $9,144.47 for reimplantation.

Conclusions

Endoscopic injection of collagen is effective treatment for vesicoureteral reflux. Furthermore, it causes minimal morbidity and may effect cost savings in health care management.     

Seizures and civilian head injuries

Although several studies have reported on the risk of "early seizures" (seizures occurring within 7 days following a head injury), the reported proportions of patients experiencing these seizures vary from 1.4 to 15%. This wide divergence may be due to problems with methodology such as case selection and definitions of head injury and early seizures. In a series of 702 patients admitted with a head injury to Cook County Hospital (CCH), Chicago, Illinois, 29 (4.1%) had early seizures. This proportion is twice as high as one previously reported in a comparable series. This may reflect an actual difference between the two series or a case selection bias serving to elevate the proportion of patients with early seizures at CCH.     

Preoperative and postoperative voice analysis of uvulopalatopharyngoplasty patients.

While clinical studies almost universally report few speech and voice complications from uvulopalatopharyngoplasty, there is a paucity of prospective studies concerned with formal acoustic and perceptual evaluation of these patients. This study compares preoperative and postoperative recordings of 32 uvulopalatopharyngoplasty patients. Fast Fourier Transform analyses were made of both long-term spectra of a reading passage and the resonant characteristics of three vowels. Fundamental frequency and reading time were quantified. Polysomnographic studies of these patients were also compared. Finally, listener judgments of "better voice" were made on preoperative and postoperative pairs of the same patients performing a reading task. While the polysomnographic data demonstrated statistically significant improvement in the physical condition of the patients, no perceptual or acoustic measure of voice or speech was significant when preoperative and postoperative scores were compared.