T Lymphocyte Subsets in Parenteral and Non-parenteral Heroin Abusers in Britain

Parenteral drug abusers comprise the second largest group of patients with the acquired immune deficiency syndrome (AIDS). To determine whether heroin abusers in Britain had immunologic abnormalities similar to those seen in AIDS, we determined T lymphocyte subsets in 14 parenteral heroin abusers and 10 non-parenteral heroin abusers. No significant differences were found in T4/T8 ratios or in the absolute numbers of T3, T4, or T8-positive cells. These results suggest that neither narcotic drugs nor repeated exposure to unsterile injectable substances are responsible for low T4/T8 ratios in parenteral drug abusers with AIDS.     

Male Breast Cancer: A Population-Based Comparison with Female Breast Cancer in Hong Kong,Southern China: 1997–2006

Background

Male breast cancer (MBC) is uncommon. As a result, there is limited availability of studies and reviews and even fewer reports from Asia. This is the largest population-based study to compare Chinese MBC patients with female patients during a 10-year period in Hong Kong, Southern China.

Methods

A retrospective review of medical records of 132 male and 8,118 female breast cancer patients between year 1997 and 2006 in Hong Kong was performed. Each MBC patient was matched with three female breast cancer patients for further analysis. Different characteristics, overall, breast-cancer specific, and disease-free survivals (DFS) were compared.

Results

Mean age at diagnosis of male and female patients was 64.5 and 52.7 years respectively. Male patients showed lower histological grade, overall stage, smaller tumor size, and more positive sensitivity in hormone receptors. They were more likely to die of causes other than breast cancer. Matched analysis found that the 5-year overall survival (OS), breast-cancer–specific mortality, and DFS for male and female patients were 78.7, 90.5, 90.5, and 77.9, 86.4, and 81.4 % respectively. Male patients had poorer OS at early overall stage but better breast-cancer—specific mortality rates at any age (p < 0.01). Male patients had a significant risk of dying due to any cause in the presence of distant relapse and had less risk of dying when tumor was ER-positive and HER2-positive.

Conclusions

Chinese male breast cancer patients tend to have poorer OS but better breast-cancer—specific survival compared with their female counterparts.     

AN INTEGRATED HAEMATURIA CLINIC

The prognosis of bladder cancer is worsened by delay in its management. To reduce such delay we have organised a clinic where intravenous urography and cystoscopy, using a flexible cystoscope, are carried out at the patient's first visit. In a two-year period 321 patients attended this clinic. The results of investigation in 305 patients are reported. A total of 6% of patients with microscopic haematuria (n = 52) and 15% of patients with macroscopic haematuria (n = 253) had transitional cell carcinomata. This difference was not significant (P=0.08, chi-squared). The delay between referral and trans-urethral resection of tumour for patients with bladder tumours was reduced from a mean of 60 days to a mean of 33 days by the institution of the clinic (P<0.01, Mann-Whitney). We recommend that all patients referred to a urological service with haematuria, whether macroscopic or microscopic, should be investigated. The integration of that investigation in a single day decreases delays in diagnosis and management.     

Epidural anaesthesia and Familial Dysautonomia (the Riley Day syndrome). Three case reports

Epidural anaesthesia in Familial Dysautonomia (FD) or the Riley Day syndrome has not previously been reported. Three children with FD presenting for redo Nissen fundoplication were managed with epidural anaesthesia. Cases 1 and 2 had had their original Nissen fundoplication without epidural anaesthesia. In Case 3, FD had not yet been diagnosed when she had her first operation, and it was performed with epidural anaesthesia. The anaesthetic management of these cases with and without epidural anaesthesia is described and discussed.     

Dementia praecox to schizophrenia: The first 100 years

The historical roots of dementia praecox and schizophrenia are described in the context of current nosology and continuing controversies surrounding this nosology. Relevant books and journal articles were reviewed. The information was obtained through computer searches and cross-references from previously published papers. If English translations of foreign language articles were available, they were used; if not, the cross-references were consulted. The psychoses have existed as diagnostic categories from ancient times although their names have changed. Initially, these disorders were considered diseases of the brain, a concept that was swept aside in the United States, influenced by European-derived psychodynamic theories. American clinicians and investigators simply accepted these theories, showing little interest in testing their underlying principles. In contrast, a narrower Kraepelinian approach was adopted outside the United States, and attempts were made to refine its nosology. Because current data supports a central nervous system aetiology for schizophrenia, the concept of dementia praecox warrants resurrection. The authors suggest abandoning the term schizophrenia in favour of the more broad and generic term dementia praecox. Replacing 'schizophrenia' with 'dementia praecox' in the 21st century will facilitate further research and help clarify the nosology of various brain disorders currently included in the schizophrenias.     

Ventricular fibrillation in an ex‐premature neonate following reperfusion of ischemic gut incarcerated within an inguinal hernia

We describe the case of a neonate who underwent surgery for bowel obstruction. The child was born at 25 weeks postconception, and at the time of surgery, he had a postconceptual age of 44 weeks. He had undergone two previous laparotomy procedures for necrotizing enterocolitis. At laparotomy, there was unexpected extensive compromise to gut perfusion. The child developed ventricular fibrillation following the reperfusion of a segment of ischemic gut found incarcerated in an inguinal hernial orifice. We discuss the pathophysiology of intestinal ischemia–reperfusion (I‐R) injury. We have reviewed the interventions that may be employed to minimize the systemic impact of I‐R.