LONG‐TERM FOLLOW UP OF PATIENTS WITH SMALL GASTROINTESTINAL STROMAL TUMORS IN THE STOMACH USING ENDOSCOPIC ULTRASONOGRAPHY‐GUIDED FINE‐NEEDLE ASPIRATION BIOPSY

Background: Gastrointestinal stromal tumors (GIST) are one of the most common mesenchymal tumors of the gastrointestinal tract. GIST are defined by positive immunohistochemical staining for KIT or CD34 and thus are generally diagnosed after surgery. Because small GIST are rarely diagnosed before surgery, the clinical course of these small tumors is not clear. The aim of the present study was to follow changes in size and configuration of small GIST that were pathologically confirmed using endoscopic ultrasonography‐guided fine‐needle aspiration biopsy (EUS‐FNAB). Methods: Between July 1997 and December 2003, 16 tumors in 16 patients (10 men and 6 women) with an immunohistochemical diagnosis of GIST were regularly followed in our hospital. The median patient age when EUS‐FNAB was performed was 62 years (range 26–82 years) and the median follow‐up period was 4.9 years (range 0.5–9.6 years). Results: Fourteen tumors showed no remarkable changes in size and shape during follow up compared with the initial diagnosis. Two tumors enlarged: one tumor approximately doubled its diameter in 8 years and the other tumor increased from 1.8 cm at diagnosis to up to 10 cm after only 2 years. Doubling time of the latter tumor was calculated as 3.1 months. Conclusions: We conclude that EUS‐FNAB might be a good modality for final diagnosis of GIST without surgery, and that GIST without rapid growth on follow up can be endoscopically followed.     

Ocular side effects of isotretinoin therapy

Isotretinoin (Accutane Capsules) is a synthetic vitamin A compound used for treatment of recalcitrant cystic acne. It has numerous ocular toxic side effects which include anterior segment inflammation, dry eye syndrome, contact lens intolerance, altered refraction, photosensitivity, and reduced night vision. Eye care practitioners should be aware of these potential side effects and be prepared to communicate with the prescribing physician if side effects present.     

Cognitive-behavioral therapy for panic: an open study

This paper reports results of an open prospective study of 26 patients who met DSM-III criteria for panic disorder or agoraphobia with panic attacks. Cognitive-behavioral treatment alone produced clinically and statistically significant improvement in panic symptoms, including both full-blown and limited symptom episodes. In addition, the treatment produced improvement in associated symptoms of phobic avoidance and generalized anxiety. This work provides further preliminary indication of the usefulness of cognitive-behavioral strategies as an alternative to medication in symptom-oriented treatments.     

Programmed stimulation in the evaluation of life-threatening or potentially life-threatening ventricular arrhythmias

Conclusion In conclusion, programmed stimulation is an excellent and appropriate method to guide thrapy for life-threatening and potentially life-threatening arrhythmias that occur infrequently and with unpredictable timing.The sensitivity and specificity of programmed stimulation is excellent in patients whose clinical presentation is by sustained uniform ventricular tachycardia and cardiac arrest. In contrast, such parameters are substantially less in patients with nonsustained ventricular tachycardia and in those who present wit syncope. The predictive accuracy of therapy guided by programmed electrical stimulation in cohorts with cardiac artest and sustained uniform ventricular tachycardia cohorts is reasonably well established and appears to be very good. Although no large randomized controlled comparative study of noninvasive versus PES-guided therapy has yet been completed, preliminary evidence suggests that there is a decreased incidence of arrhythmia recurrence and sudden cardiac death when therapy is guided by PES. In the minority of patients with syncope in whom sustained uniform ventricular tachycardia is induced during PES, therapy may be effectively guided by this modality. PES appears to be of benefit in managing patients with coronary artery disease who present with nonsustained ventricular tachycardia and depressed ejection fraction thereby defining a high risk subset for a subsequent arrhythmic event. However, we have not found electrophysiologic testing postmyocardial infarction to be prognostically useful.Dr. Josephson is the Robinette Foundation Professor of Medicine (Cardiovascular Diseases)Supported in part by grants from the American Heart Association, Southeastern Pennsylvania Chapter, Philadelphia, PA; and National Heart, Lung, and Blood Institute, Bethesda, MD (HL28093, HL07346, HL24278).     

Monovision vs. aspheric bifocal contact lenses: a crossover study

Twenty selected presbyopic patients were fitted with both monovision correction and Hydrocurve bifocal contact lens correction in a crossover study. Eighty percent of the population preferred bifocal correction and 20% preferred monovision. The results suggest that bifocal contact lens correction should be explored prior to considering monovision correction.