Primary ovarian leiomyosarcoma in an adolescent following radiation for medulloblastoma

Primary ovarian leiomyosarcomas are rare neoplasms of the ovary, particularly in the pediatric population. Their occurrence following radiation therapy for previous malignancy has important implications. We present a case of primary ovarian leiomyosarcoma in an adolescent following therapy for medulloblastoma. Received: 6 August 1997 Accepted: 22 December 1997     

Prognostic use of ultrasonography in acute non-hemorrhagic carotid stroke

In order to evaluate whether the results of ultrasound examination may be associated with 30-day outcome, 76 consecutive patients (43 men and 33 women; mean age 68.1±8.9 years) underwent duplex scanning of the carotid bifurcations and transcranial doppler investigation of the basal skull arteries within the first few hours of the onset of an acute carotid stroke. Forty-three patients (56.6%) had appropriate arterial occlusion at ultrasounds examination. On day 30, 22 patients (28.9%) were self-sufficient, 41 (53.9%) were disabled and 13 (17.1%) were dead. The chisquared test showed that the ultrasound results were significantly related to 30-day outcome (p=.0003).After logistic regression analysis, the ultrasound results remained independent predictors of 30-days outcome (p=.0129), together with neurological impairment 24 hours after stroke onset and lesion size at control computed tomography.Our study suggests that the results of ultrasound examination may be useful in the management of acute carotid stroke as an early indicator of patients with a worse prognosis.

---

Sommario Abbiamo sottoposto 76 pazienti consecutivi, di età media di 68.1±8.9 anni, ricoverati per un primo ictus ischemico nei territori carotidei, a studio ecodoppler delle biforcazioni carotidee e a doppler transcraniale delle arterie del basicranio, per valutare se le informazioni ricavate dagli studi ultrasonori potessero essere di aiuto a fini prognostici, 43 pazienti (56.6%) presentavano occlusione di una appropriata arteria agli ultrasuoni. A 30 giorni dall'ictus, 22 pazienti (28.9%) erano autosufficienti, 41 pazienti (53.9%) erano dipendenti e 13 pazienti (17.1%) erano morti.Al test del Chi quadrato, i risultati degli ultrasuoni erano significativamente correlati alla prognosi a 30 giorni (p=.0003). Dopo analisi di regressione logistica multipla, i risultati degli ultrasuoni rimanevano indicatori prognostici indipendenti (p=.0129) insieme alle dimensioni della lesione ischemica alla TAC encefalo ripetuta tra il 4° e il 7° giorno dallo stroke e alla gravità neurologica a 24 ore dall'esordio dei sintomi. Il nostro studio suggerisce che gli ultrasuoni potrebbero essere utili nelle decisioni cliniche dei pazienti con stroke ischemico carotideo quali indicatori precoci di prognosi.

     

Decreased Interleukin-7 and transforming growth factor-beta1 levels in blister fluids as compared to the respective serum levels in patients with bullous pemphigoid: Opposite behavior of TNF-alpha, Interleukin-4 and Interleukin-10

Abstract: This study analyzes both the blister fluid (BF) and serum levels of IL-7 and TGF-beta₁ in samples from 18 patients affected with bullous pemphigoid (BP). These cytokines clearly present lower concentrations ( P <0.001) in BFs than in the sera (1/20 and 1/2, respectively). In contrast, TNF-alpha, IL-10 and IL-4 present increased amounts in BFs that were 12, 12 and 17-fold, respectively. Eighteen sera (and 10 suction BF) from normal individuals were also employed as control. Normal sera presented significantly lower serum IL-7 concentrations than BP, while no significant TGF-beta₁ variations were observed between normal and pathologic serum samples. In addition, the serum levels detected in BP patients were significantly correlated with disease intensity ( r =0.64, P =0.003, evaluated as the number of blisters/erosions for each patient) as well as with the peripheral B-lymphocyte counts ( r =0.80, P <0.001) and antibodies directed against the basement membrane zone ( r =0.65, P <0.005). Although a clear explanation of this phenomenon is lacking, the data presented in this report agree with a strong decrease of IL-7 production at the local level (keratinocyte is known to produce IL-7 and the latter is known to be down-regulated by IL-10, and in other models also by TGF-beta₁ and IL-4, whose levels are elevated in BP BFs) as opposed to an increased peripheral release of the same modulator. The IL-7 reduction may have a biological relevance in controlling a chronic, progressive disease.     

Gabapentin does not reduce post-thoracotomy shoulder pain: a randomized, double-blind placebo-controlled study

PURPOSE: Despite adequate epidural analgesia, up to 97% of patients undergoing thoracotomy experience ipsilateral shoulder pain. In this setting, this study evaluated the safety and the efficacy of pre-emptive gabapentin. METHODS: A double-blind, placebo-controlled study was undertaken in 51 patients randomized into two groups. Two hours before surgery, 23 patients received gabapentin 1200 mg po (Group G), and 28 patients received placebo (Group P). Shoulder pain and postoperative pain, at the surgical site, were monitored every four hours for 24 hr, using a numerical rating scale. Subcutaneous hydromorphone was administered for rescue analgesia against shoulder pain. RESULTS: Forty-four patients complained of shoulder pain (prevalence of 86%). Demographic and surgical data were similar between the two groups. There were no significant differences in the total cumulative doses of hydromorphone administered at eight, 16, and 24 hr, nor were there differences in individual numerical rating scale scores for shoulder pain. The groups were similar with respect to the degree of pain at the surgical site. The frequency of side effects between groups at corresponding time intervals was also similar, with the exception of sedation. At four hours, the incidence of sedation scores > 1 was greater in Group G (21/23 patients), compared to Group P (18/28 patients; P = 0.025). In contrast, by 24 hr, 5/18 patients in Group P had sedation scores > 1, compared to 0/28 patients in Group G (P = 0.05). CONCLUSION: Pre-emptively administered gabapentin, 1200 mg, does not reduce the incidence, or the severity, of post-thoracotomy shoulder pain in patients receiving thoracic epidural analgesia.     

Experience with a questionnaire administered by emergency medical service for pre-hospital identification of patients with acute stroke

We prospectively verified whether an ad-hoc questionnaire administered by phone supports pre-hospital suspicion of stroke in the order to reduce the time before care is given. Form June 1996 to May 1997, physicians of the Emergency Medical Service in the area of Bergamo, Italy asked all people calling for a patient with symptoms and signs suggesting a cerebral vascular injury to immediately answer some questions on common symptoms and signs of stroke. The medical records of the patients hospitalized at Ospedali Riuniti of Bergamo were reviewed at the end of the study by a single neurologist, skilled in stroke management and blinded to the questionnaires. Sensitivity and specificity, in addition to positive and negative predictive values, of single questions versus final diagnosis were assessed. Logistic regression analysis was also performed to identify those questions useful to suspect strokes. We collected 143 valid questionnaires, related to 63 men and 80 women, aged 34–99 years (mean, 71.8 years). The question concerning headache had the lowest sensitivity and specificity, respectively 57.1% and 36.5%, and teh question concerning leg palsy had the highest sensitivity and specificity, respectively 82.0% and 52.4%. Multivariate analysis identified questions on facial and leg palsy as independent predictors of a final diagnosis of stroke. A few questions on motor deficits proposed by emergency medical service operators may be useful in the pre-hospital identification of stroke patients. Concordance of any questions versus final diagnosis of stroke was, however, far to be satisfying. Thus, our experience supports the need for an educational program to improve the efficiency of a pre-hospital diagnosis of stroke. Received: 12 April 2001 / Accepted in revised form: 23 October 2001     

Self-rated health and mortality among black and white adults: examining the dynamic evaluation thesis.

OBJECTIVES: Many studies of self-rated health show that it is a reliable predictor of mortality even when controlling for health-related variables and status characteristics. According to previous research, one reason for the consistent finding is that self-ratings of health represent judgments of health trajectories. Although self-ratings of health may be dynamic perceptions of health, relatively few studies have systematically examined this possibility. METHODS: This study reexamines the prognostic value of self-ratings of health on mortality with data from 20 years of the National Health and Nutrition Examination Survey-I Epidemiologic Follow-up Study (N = 6,833). Special attention is given to differences between White and African Americans. RESULTS: Results indicate that event history models of mortality with self-rated health treated as a time-dependent covariate are superior to those treating it as a baseline predictor only-the latter are likely to underestimate the effect. Moreover, self-ratings of health predict mortality for African Americans only when treated as a time-dependent covariate. DISCUSSION: The results suggest that self-ratings of health are sensitive to declines in physical health, especially those associated with terminal drop. The analysis also demonstrates the importance of using dynamic models for studying the link between self-rated health and mortality if data from multiple observation points are available.     

Distribution of VP7 serotypes and VP4 genotypes among rotavirus strains recovered from Italian children with diarrhea

Summary.  108 rotavirus strains obtained from children with diarrhea hospitalized in Palermo, Italy, in the years 1990–1994, were examined by seminested PCR to study the relative frequency and distribution of the four most common alleles of the gene 4. Such strains were selected from 344 human rotavirus strains recovered in Palermo during those years after characterization by electropherotyping, subgrouping and G serotyping. One hundred and seven of the 108 strains could be classified into P types, the P[8], G1 (38.3%) and the P[8], G4 (52.3%) types being predominant. The unique strain whose P genotype could not be identified showed an unusual combination of long migration electrophoretic pattern and subgroup I specificity. Received January 13, 1997 Accepted June 11, 1997     

HIV-1 seroprevalence in the general population of Salvador, Bahia State, Northeast Brazil

To estimate HIV-1 seroprevalence in the general population of Salvador, Bahia, Brazil, we conducted a cross-sectional survey of 3,437 residents from 1998 to 2000. Subjects were drawn from 30 sentinel areas representing a wide range of living conditions. Plasma samples were screened for HIV-1 antibodies by ELISA and confirmed by immunofluorescent assay. Subtype determination by HMA was performed after proviral DNA amplification. Phylogenetic analysis using parsimony was performed with the neighbor-joining method. Overall HIV-1 seroprevalence was 0.55% (19/3,446): 0.8% for men and 0.36% for women. Seroprevalence was higher in the 31-45-year age group (1%) and among persons with family income less than twice the minimum wage (0.78%) as compared to 0.33% for the higher income group. Syphilis was detected in 37% of HIV seropositive individuals. Phylogenetic inferences identified 10 samples as subtype B in the env region and 2 samples with Benv/Fgag/Fpol and Fenv/Bgag. Age > or = 30 years, male gender, and income < or = 2 times the minimum wage were identified as risk factors for HIV-1 infection. Extrapolating the proportion of seropositive individuals to Salvador, the number of HIV-1 infected individuals was estimated at 13,750.