Solitary bronchioloalveolar carcinoma: CT criteria

The computed tomographic (CT) scans of 30 patients with solitary bronchioloalveolar carcinoma were reviewed. Common features at CT included the peripheral or subpleural location of a pulmonary mass (25 cases), pseudocavitation (18 cases), heterogeneous attenuation (17 cases), irregular margins forming a star pattern (22 cases), and pleural tags (21 cases). Using these CT criteria, four independent observers attempted to identify cases of bronchioloalveolar carcinoma from a larger sample of lung cancers and benign lesions by categorizing a series of test cases into four probability categories. Although the bronchioloalveolar carcinomas were correctly ranked in the two highest probability categories 75% of the time (in 45 of 60 cases), there was considerable overlap with other lung lesions, particularly with adenocarcinoma and large cell undifferentiated carcinoma. However, even though the typical features of bronchioloalveolar carcinoma are not invariable or highly specific, they are characteristic enough to suggest the diagnosis.     

Conservative extirpative treatment of cancer of the penis.

Carcinoma in situ, erythroplasia of Queyrat, and Bowen's disease have been managed successfully with a variety of conservative techniques. The management of invasive carcinoma remains controversial. The goal of surgical treatment in these patients is complete excision of the tumor with adequate tumor-free margins. While partial or total penile amputation is necessary for complete eradication of some primary penile tumors, many patients can be managed adequately with optimal preservation of function. Young and reliable patients with well-differentiated tumors are the most suitable candidates for conservative surgical extirpation.     

Characterization of melanocyte stimulating hormone receptor variant alleles in twins with red hair

The association between MSHR coding region variation and hair colour in humans has been examined by genotyping 25 red haired and 62 non-red Caucasians, all of whom were 12 years of age and members of a twin pair study. Twelve amino acid substitutions were seen at 11 different sites, nine of these being newly described MSHR variants. The previously reported Val92Met allele shows no association with hair colour, but the three alleles Arg151Cys, Arg160Trp and Asp294His were associated with red hair and one Val60Leu variant was most frequent in fair/blonde and light brown hair colours. Variant MSHR genotypes are associated with lighter skin types and red hair (P < 0.001). However, comparison of the MSHR genotypes in dizygotic twin pairs discordant for red hair colour indicates that the MSHR gene cannot be solely responsible for the red hair phenotype, since five of 13 pairs tested had both haplotypes identical by state (with three of the five having both identical by descent). Rather, it is likely that additional modifier genes exist, making variance in the MSHR gene necessary but not always sufficient, for red hair production.      

Significance of the width of keratinized gingiva on the periodontal status of teeth with submarginal restorations

The purpose of this clinical study was to evaluate the periodontal condition of teeth having submarginal restorations associated with either narrow or wide zones of keratinized gingiva. Fifty-eight teeth in 26 individuals were selected and then divided into two groups according to the width of the keratinized gingiva at the midfacial aspect of the tested tooth. Group I consisted of 30 teeth with greater than or equal to 2.0 mm, and Group II consisted of 28 teeth with less than 2.0 mm of keratinized gingiva. Each group was equally subdivided into subgroup "A" having teeth with a full coverage, subgingival type of restoration for at least 2 years, and subgroup "B" representing contralateral homologous teeth, in the same individual, with no subgingival restoration. Clinical examination of individual teeth included determination of plaque and gingival indices, gingival fluid, probing depth, bleeding tendency and bone level. Data were subjected to statistical analysis using the Student t test and a two-way analysis of variance to determine any significant differences in variables between teeth with and without subgingival restorations, in narrow and wide zones of keratinized gingiva. The findings were: (1) teeth with subgingival restorations and narrow zones of keratinized gingiva showed statistically significant higher gingival scores than teeth having submarginal restorations with wide zones of keratinized gingiva. (2) Teeth without subgingival restorations showed no statistical difference between narrow and wide zones of keratinized gingiva (P greater than 0.05).     

Failure of recombinant human interleukin-3 therapy to induce erythropoiesis in patients with refractory Diamond-Blackfan anemia [see comments]

In two previous studies, we observed that recombinant human interleukin- 3 (IL-3) induced an increase in marrow burst-forming unit-erythroid- derived colonies in vitro in some patients with Diamond-Blackfan anemia (DBA). To determine whether a similar erythropoietic response could be induced in vivo, we treated 13 patients with DBA (aged 4 to 19 years) with two preparations of IL-3. All patients had absent absolute reticulocyte counts and markedly reduced to absent recognizable bone marrow erythroid elements; patients with circulating reticulocytes in the previous 12 months were excluded from study. All patients except 1 had failed steroid therapy and had been transfusion-dependent since infancy; 1 patient was maintained on high-dose prednisone at the time of enrollment. On the first arm of the study, IL-3 (Immunex Corp, Seattle, WA) was administered subcutaneously using a dose escalation regimen of 125 to 500 micrograms/m2/day in divided dosage at 12-hour intervals, coadministered with 1.5 mg/kg/d of oral ferrous sulphate. Of the 13 patients that entered the trial, 4 stopped prematurely because of adverse side effects. In the other 9 evaluable cases, reticulocytes increased transiently in 1 patient from 0 to 65 x 10(9)/L after 35 days of IL-3 therapy at 250 micrograms/m2, but transfusion dependency persisted. One transient peak in absolute reticulocyte count was noted in 6 other patients, but no erythroid response was observed after completion of a full course of IL-3. Oral prednisone at 0.5 mg/kg/d was then coadministered with IL-3 at 500 micrograms/m2 to 5 of the patients without effect, and treatment was stopped. In 2 patients, a second preparation of IL-3 (Sandoz Canada Inc, Dorval, Quebec, Canada) was initiated in a dose escalation regimen of 2.5 to 10 micrograms/kg and was coadministered with ferrous sulphate. No erythroid response was observed in either patient, and in one of the two, alternate-day subcutaneous recombinant erythropoietin at 300 U/kg was administered for 3 weeks in combination with daily IL-3 at 10 micrograms/kg, but no increased erythropoiesis was seen. Significant increases in white blood cell and eosinophil counts during administration of both preparations of IL-3 were observed in all patients. These data show that the response of DBA patients to IL-3 in vivo is heterogeneous and cannot be predicted from in vitro studies. The absence of a corrective effect of IL-3 in these patients with DBA indicates that a deficiency of the cytokine is not central in the pathogenesis of the disorder.     

Developmental changes in group climate in two types of group therapy for binge-eating disorder: A growth curve analysis

Abstract

The development of group climate across 16 sessions of group psychodynamic–interpersonal psychotherapy (GPIP) and group cognitive–behavioral therapy (GCBT) for 65 female treatment completers with binge-eating disorder (BED) was assessed. Engaged scale growth for GPIP patients varied across sessions and was best represented by a cubic growth curve. This suggested that GPIP progressed in definable phases that reflected a rupture and repair sequence of engaged group climate. For patients receiving GCBT, engaged, avoiding, and conflict scale growth was gradual and consistent (i.e., linear), indicating an increase in positive group climate across sessions. This likely reflected patients taking greater responsibility for treatment as suggested by the CBT model. Linear growth in engaged climate mediated the relationship between attachment anxiety and outcome in GPIP. A consistent increase in engaged group climate through the rupture and repair phase may be a necessary condition for successful treatment of BED patients with high attachment anxiety who receive GPIP.

Zusammenfassung

Entwicklung von Veränderungen im Gruppenklima bei zwei Arten von Gruppentherapie für Essstörungen: Eine Wachstumskurven-Analyse

Es wurde die Entwicklung des Gruppenklimaklimas über 16 Sitzungen bei psychodynamisch - interpersoneller Gruppentherapie (psychodynamic-interpersonal psychotherapy [GPIP]) und kognitiv-verhaltensmässiger Gruppentherapie (group cognitive-behavioral therapy [GCBT]) eingeschätzt. An der Untersuchung nahmen 65 Frauen mit Essanfallstörungen, die die Behandlung auch zu Ende geführt haben, teil. Der Zuwachs der Engagement-Skala variierte für GPIP-Patienten und ließ sich am besten mit Hilfe einer kubischen Wachstumskurve wiedergeben. Das legt für das engagierte Gruppenklima das Fortschreiten vom GPIP-Patienten mit einer Phasensequenz von Einbrüchen und ihrer Wiederherstellung nahe. Für GCBT-Patienten war der Anstieg der Skalen für engagiertes, vermeidendes und konflikthaftes Gruppenklima graduell und konsistent (d. h. linear) und wies insgesamt auf einen kontinuierlichen Anstieg des positiven Gruppenklimas über die Sitzungen hin. Das spiegelt wahrscheinlich die größere Verantwortung der Patienten für die Behandlung, wie sie nach dem CBT-Modell angenommen wird, wider. Ein linearer Anstieg des engagierten Gruppenklimas, über die Phasen von Einbrüchen und Wiederherstellung hinweg, könnte eine notwendige Bedingung für eine erfolgreiche Behandlung von Essanfallstörungs-Patienten mit hoher Bindungsangst unter der GPIP Bedingung sein.

Résumé

Changements du climat dans le groupe dans deux types de thérapies de groupe pour le binge-eating?: une analyse par courbe de croissance

Le développement du climat dans le groupe était évalué à travers 16 séances de psychothérapie de groupe psychodynamique–interpersonnelle (GCBT) et de thérapie de groupe cognitivo–comportementale (GCBT) pour 65 femmes avec un trouble de binge–eating (BED) ayant terminé le traitement. La croissance sur l’échelle d'engagement des patients en GPIP variait à travers les séances et était le mieux représentée par une courbe de croissance cubique. Ceci suggère que la GPIP progressait par phases définies reflétant une séquence de rupture et de réparation du climat d'engagement du groupe. Pour les patients en GCBT, la croissance des échelles d'engagement, d’évitement et de conflit était graduel et consistant (linéaire), indiquant une augmentation du climat de groupe positif à travers les séances. Ceci pourrait refléter une plus grande prise de responsabilité par les patients pour leur traitement, comme suggéré par le modèle CBT. La croissance linéaire du climat engagé était médiatrice de la relation entre l'anxiété d'attachement et l'issue en GPIP. Une augmentation consistante du climat d'engagement dans le groupe dans la phase de rupture et de réparation pourrait être une condition nécessaire pour un traitement réussi de patients BED avec une haute anxiété d'attachement qui bénéficient d'une GPIP.

Resumen

Cambios en el clima grupal en dos tipos de terapia para la bulimia: análisis de la curva de crecimiento

Se evaluó el desarrollo del clima grupal a lo largo de 16 sesiones de una psicoterapia grupal psicodinámica-interpersonal (GPIP) y de otra grupal cognitivo-comportamental (GCBT) de sesenta y cinco mujeres que completaron su tratamiento para desorden bulímico (BED). El crecimiento de la escala comprometida para pacientes GPIP varió a través de las sesiones y se lo representó mejor por medio de una curva de crecimiento cúbico. Esto sugiere que la GPIP progresó en fases definibles que reflejaron una secuencia de ruptura y reparación del clima comprometido grupal. Para los pacientes que recibieron GCBT, el crecimiento en las escalas comprometida, evitativa y conflictiva fue gradual y consistente (esto es, lineal), lo que indica un aumento en el clima positivo grupal a lo largo de las sesiones. Probablemente, esto fue reflejo de que los pacientes tomaron su tratamiento con mayor responsabilidad, según lo sugiere el modelo CBT. Un crecimiento lineal en el clima comprometido medió entre la ansiedad de apego y el resultado en GPIP. Un aumento consistente en el clima grupal comprometido a través de las fases de ruptura y reparación puede ser una condición necesaria para un tratamiento exitoso con GPIP de pacientes BED con gran ansiedad de apego.

Resumo

Mudanças no ambiente de grupo em dois tipos de terapia de grupo para a perturbação de ingestão alimentar compulsiva: uma análise da curva de crescimento

Foi avaliado o desenvolvimento de atmosfera de grupo durante 16 sessões de psicoterapia interpessoal psicodinâmica de grupo (PIPG) e terapia cognitivo-comportamental de grupo (TCCG) no tratamento de 65 mulheres que completaram o tratamento para a perturbação de ingestão alimentar compulsiva (PIAC). O aumento na escala do envolvimento em pacientes com PIPG variou ao longo das sessões e era melhor descrito por uma curva de crescimento cúbica. Isto sugere que a PIPG progrediu em fases definidas que reflectem a ruptura e restauram a sequência da atmosfera de envolvimento do grupo. Para os pacientes que receberam TCCG, a elevação nas escalas de envolvimento, evitamento e conflito foi gradual e consistente (i.e. linear), indicando um aumento positivo no ambiente do grupo ao longo das sessões. Isto parece reflectir que os pacientes tomam maiores responsabilidades no tratamento tal como é sugerido no modelo cognitivo-comportamental. O crescimento linear no envolvimento mediava a relação entre a vinculação ansiosa e o resultado da PIPG. Um aumento consistente no envolvimento do ambiente de grupo ao longo da ruptura e fase de reconciliação poderá ser necessário para o sucesso no tratamento de pacientes com BED, com elevada vinculação ansiosa, que recebem PIPG.

Sommario

Cambiamenti nel clima di gruppo in due tipi di terapia di gruppo per il binge-eating disorder: un'analisi della curva crescente

E’ stato valutato lo sviluppo del clima di gruppo mediante 16 sedute di psicoterapia di gruppo psicodinamico-interpersonale (GPIP) e di terapia di gruppo cognitivo-comportamentale (GCBT) per 65 donne con binge-eating disorder (BED) che hanno terminato il trattamento.

La crescita nelle scale impiegate per i pazienti GPIP è variata tra le sedute ed è stata al meglio rappresentata da una curva di crescita cubica. Ciò ha suggerito che il GPIP è progredito in fasi determinabili che hanno riflettuto una sequenza di rottura e riparazione del clima di gruppo instaurato.

Per i pazienti che hanno ricevuto la GCBT, la crescita nelle scale di adesione, evitamento e conflitto è stata graduale e consistente (lineare), indicando un incremento nel positivo clima di gruppo attraverso le sedute. Ciò probabilmente ha rispecchiato i pazienti che hanno assunto la maggiore responsabilità per il trattamento, come suggerito dal modello CBT.

La crescita lineare nel clima instaurato ha mediato la relazione tra ansia d'attaccamento ed esito nel GPIP. Un incremento consistente nel clima di gruppo instaurato attraverso la fase di rottura e riparazione potrebbe essere una condizione necessaria per un trattamento di successo dei pazienti con BED con alta ansia d'attaccamento che ricevono GPIP.

     

Urologic manifestations of drug therapy

Numerous drugs used for a variety of medical conditions may be involved in urologic disease or dysfunction. Manifestations include sexual dysfunction, voiding disturbances, incontinence, renal impairment, urolithiasis, obstructive uropathy, urothelial tumors, and others. The office urologist thus must be aware of the possibilities, which are listed and discussed briefly.     

Factors influencing periodontal therapy for the geriatric patient

Anatomic changes in the periodontium occur with aging. There is no indication that these changes predispose to periodontal breakdown. In the United States, there is evidence that older individuals are retaining more teeth and that these teeth have less periodontal disease than previous generations of seniors. Studies comparing the healing of older and younger patients have clearly demonstrated that both groups of patients respond equally well to therapy. Proven methods of periodontal therapy include modified Widman surgery, pocket elimination surgery, or nonsurgical scaling and root planing. Surgical treatment may be used with confidence unless there are medical contraindications. In these cases, nonsurgical therapy may be preferred. If there are physical or mental disabilities that make effective home care difficult, antimicrobial agents, such as the extensively tested chlorhexidine rinse, may be valuable adjuncts. In the future, senior adults can look forward to the benefits of regenerative periodontal procedures that seek to regain lost periodontal support. Age alone should not diminish an individual's right to care because the practitioner has qualms about his or her longevity. Successful treatment of periodontitis by surgical and nonsurgical methods has been extensively documented. Senior patients can benefit from these treatments as much as younger patients, and age is not a barrier to effective periodontal therapy.