Metastatic melanoma to the lung: long-term results of surgical excision

The only long-term survivor of multiple bilateral pulmonary metastases from malignant melanoma after staged thoracotomies has been described, and a series of 18 patients who underwent pulmonary resection for metastatic malignant melanoma at one clinic have been reviewed. Median survival was 16.5 months and the 5 year survival rate was 11.1 percent. Forty-four percent of the patients had multiple metastases and 11.1 percent had bilateral metastases. There was no correlation between length of survival and disease-free interval, number of metastases, or the presence of unilateral versus bilateral tumor nodules. Twenty-seven percent of the patients had more metastases found intraoperatively than suspected preoperatively. Unfavorable results occurred when the extent of the disease required pneumonectomy. The current literature has also been reviewed and arguments have been made to support the surgical approach to carefully selected patients with metastatic melanoma to the lung.     

Characterization of impact-induced tachyarrhythmia utilizing propranolol, quinidine and pacing

Direct impact of the heart on the right ventricle induces transient ventricular tachycardia. Preconditioning the heart with a moderate dose of propranolol (0.4 mg/Kg, IV) did not affect impact-induced tachyarrhthmia although effective beta adrenergic blockage was evident. A high dose of propranolol (1.6 mg/Kg, IV) or a moderate dose of quinidine (3 mg/Kg, IV) prevented impact-induced ventricular tachycardia. High-dose propranolol and quinidine, an agent with no beta blockade properties, share similar local effects on the myocardial cell membrane which was sufficient to prevent the tachyarrhythmia. Pacing of the right ventricular free wall at the impact site resulted in an ECG similar to that observed following impact. Pacing of the subjacent septem, the other possible arrhythmogenic site affected by the impact, resulted in a large aberrant S wave (Lead II) different from the QRS complex during impact-induced tachyarrhythmia. Therefore, impact-induced ventricular tachycardia originates from the impact site by a direct ventricular mechanism.     

Mental status examination: Myth or method

Our clinical experience, as well as literature review, indicate that the MSE may be more myth than method in contemporary psychiatry. Given the current common language available through DSM (III) and the APA Glossary, the MSE may well have enhanced potential as a practical clinical tool because it can be transferable, affordable, portable, and not machine dependent. Having intervened, as noted above, we intend to follow-up via clinical records, interview and questionnaire to determine whether more consistent notation by trainees is present and whether trainees have a shared concept as to form and clinical utility of the MSE.     

Comparative evaluation of povidone-iodine aerosol foam solution and silver sulphadiazine cream as prophylactic topical antibacterial agents for treatment of the burn wound

Nine patients with fresh burns were treated with povidone-iodine aerosol foam solution and matched with 9 patients with fresh burns of similar extent and distribution treated with silver sulphadiazine cream. Severe pain at the time of application of povidoneiodine was a constant complaint. The wounds of 7 patients treated with povidone-iodine had been colonized by bacteria by day 11 post burn, whereas the wounds of only 2 patients treated with silver sulpha-diazine had been colonized at the corresponding time. Gram-negative organisms appeared more frequently, earlier and in higher concentrations in the povidoneiodine treated patients (Pseudomonas aeruginosa, 4 patients), whereas Staphylococcus aureus was more frequent with silver sulphadiazine (4 patients). Five of the povidone-iodine treated patients had developed burn wound sepsis by day 11 post burn, whereas no silver sulphadiazine treated patient developed burn wound sepsis. For this reason, further evaluation of povidone-iodine foam as a prophylactic topical antibacterial for burns was abandoned.     

The CFU-S redistribution in spontaneous AKR leukemia

The number of bone marrow CFU-S decreases at the terminal stage of spontaneous AKR leukemia. This decrease is compensated by an increase of CFU-S in the spleen, lymph nodes, liver and thymus. Thus, the overall CFU-S number is basically equivalent to that found in normal mice. We take this as evidence of a spatial redistribution of CFU-S in AKR leukemia.     

Association of factor V activity with membranous vesicles released from human platelets: requirement for platelet stimulation

The membrane-associated factor V-like activity (platelet factor 1, PF1) and the phospholipid-like catalytic surface activity (platelet factor 3, PF3) were studied in human platelets from normal and two factor V-deficient donors. Collagen stimulation or mechanical disruption of gel-filtered platelets was necessary for the expression of significant amounts of PF1 and PF3. Stimulation was also necessary for the uptake of factor V or Va by PF1-deficient platelets from the factor V-deficient donors. The activity of PF1 was also generated by association of factor V or Va with membrane-rich fractions obtained by gel filtration of the supernatant from collagen-stimulated or frozen-thawed PF1-deficient platelets. The amount of PF1 obtained by such all-or-none binding experiments was directly proportional to the amount of PF3 already expressed in the platelet preparation. These data have been summarized in terms of a hypothesis which views PF1 and PF3 to be activities associated with membranous vesicles released from platelets only after stimulation.     

Shaping relaxation in the unrelaxed client

A procedure called “relaxation programming” is described which has been found useful in helping unrelaxed clients achieve a more comfortable level of relaxation during relaxation training and systematic desensitization.