Why do some psychiatric patients somatize?

A study was made of a series of 139 outpatients referred by the medical and surgical services of a general hospital for evaluation by the psychiatry unit. In accordance with established criteria, this population was divided into somatizers (56) and non-somatizers (75), and the socio-demographic and clinical characteristics of both groups were comparatively analyzed. The results show that the group of somatizers was younger, had more histrionic personality traits and more stress factors related with alterations in interpersonal relationships or death or disease of relatives. It is emphasized that somatization is poorly known by psychiatrists--whose diagnostic criteria practically omit these aspects--and by other physicians, in spite of its importance and frequency.

Treatment with Norplant subdermal implants inhibits sperm penetration through cervical mucus in vitro

Attempts were made to collect several samples of cervical mucus in each of thirty-three cycles of women using NORPLANT subdermal implants, in seven cycles from NORPLANT-2 rod users, and in 33 control cycles. The attempts to collect a mucus sample were successful on 20 of 77 and 7 of 14 occasions in NORPLANT capsule and rod users, respectively, due to the scanty amount and stickiness found in the majority. All 59 attempts in control subjects were successful. The distance travelled by the fastest sperm and by the bulk of spermatozoa through the cervical mucus in vitro was assessed after 10 min of incubation with a normal semen sample. The best score for each cycle was considered for the comparison between treated and control cases. Sperm penetration was greatly impaired in mucus samples of implant users with penetration by the fastest sperm exceeding 10 mm in only two instances and exceeding 20 mm in none. In 30 of 33 control samples, the fastest sperm travelled 21 mm or more and in 28, the bulk of spermatozoa travelled further than 10 mm. Unsuccessful attempts to collect mucus and poor sperm migration were observed in NORPLANT implant users even when circulating estradiol levels were comparable to those seen in the late follicular phase of the normal menstrual cycle. These results suggest that the principal mechanism by which NORPLANT implants prevent pregnancy is by interference of sperm migration through cervical mucus.

Spongious bone density determination for staging and follow-up of patients with prostatic cancer

Quantitative computerized tomography (QCT) of vertebral bodies could reveal metastatic spread of prostatic cancer before such lesions are seen with standard examinations. Focal increase in the density of the spongious bone in face of normal bone scan and serum acid phosphatase is suggestive of metastasis, but certitude is gained only if further increase in density or structural bone changes are demonstrated on follow-up studies. QCT also may provide an objective measurement of tumor response to therapy.

Influence of Dialysis Membranes on the Convective Transport of Middle Molecules

Ultrafiltrates from 10 patients in chronic maintenance hemodialysis (7 males and 3 females) were obtained simultaneously using three different membranes: cuprophan, polyacrilonitrile and polysulfone. Middle molecules (MM) chromatographic profiles and total MM amount were determined by gel chromatography and high performance liquid chromatography.

The convective transport of MM was similar and not membrane related. Hemofiltration, a predominantly convective solute transfer procedure using high flux membranes such as polyacrilonitrile and polysulfone, in which large amounts of fluids have to be ultrafiltered, is an effective form of MM removal.

Influence of dialysis membranes on the convective transport of middle molecules

Ultrafiltrates from 10 patients in chronic maintenance hemodialysis (7 males and 3 females) were obtained simultaneously using three different membranes: cuprophan, polyacrilonitrile and polysulfone. Middle molecules (MM) chromatographic profiles and total MM amount were determined by gel chromatography and high performance liquid chromatography. The convective transport of MM was similar and not membrane related. Hemofiltration, a predominantly convective solute transfer procedure using high flux membranes such as polyacrilonitrile and polysulfone, in which large amounts of fluids have to be ultrafiltered, is an effective form of MM removal.

Aggressive treatment of metastatic renal cancer

Radical nephrectomy and excision of metastases were performed in 21 patients with metastatic renal cell carcinoma. Followup was 12 years. Eight patients had metastases at the time of diagnosis and survived an average of 54 months, with 50 per cent alive 5 years postoperatively. Metastases developed after nephrectomy for localized disease in 13 patients. After extirpation of the secondary lesions these 13 patients survived an average of 38 months and 25 per cent were alive at 5 years. Survival varied with the length of time free of disease. Patients in whom metastases developed later than 2 years after nephrectomy survived 55 months compared to only 22 months for those in whom metastases developed earlier. Survival also was influenced by tumor aggressiveness (reflected by prognostic index number) and completeness of surgical excision of the secondary lesion.

Renal cell carcinoma: survival and prognostic factors

Three hundred twenty-six patients treated at New York University from 1970 to 1982 were studied for survival in relationship to surgical stage, type of therapy, and pathologic characterization of the primary tumor. At the time of diagnosis 25.5 per cent of tumors were Stage I, 15 per cent Stage II, 28.5 per cent Stage III, and 31 per cent Stage IV. The retrospective study showed that patients with tumor confined within the capsule achieved the highest five- and ten-year survivals of 88 per cent and 66 per cent, respectively. Survivals decreased as tumor invaded perirenal fat (67% and 35%) or regional lymph nodes (17% and 5%). Tumor invasion into the renal vein alone did not significantly change five-year survival (84%) but lowered ten-year survival to 45 per cent. Patients with metastases at the time of nephrectomy did poorly regardless of site of metastases or kind of adjuvant therapy, except for those managed by surgical extirpation of the secondary lesion. Certain tumor characteristics were associated with a better prognosis, e.g., size below 5 cm in diameter, lack of invasion of collecting system, perirenal fat or regional lymph nodes, and predominance of clear or granular cells growing into a recognizable histologic pattern.

Looking for "indicants" in the differential diagnosis of jaundice

The differential diagnosis between intra- and extrahepatic causes of jaundice was studied. At the "20 Noviembre" ISSSTE Hospital in Mexico City, between January 1977 and May 1984, data were collected in 1,263 jaundiced patients. To the clinical data for 1,000 of these 1,263 patients and a new set of 105 jaundiced patients, the COMIC study group algorithm was applied. The differential diagnosis between medical and surgical causes of jaundice was correct in 90% of the cases. In 85% the algorithm could also differentiate between acute and chronic disease, or between benign and malignant causes of jaundice. The COMIC algorithm was then modified and applied to the same 1,000 cases examined previously, with 96% accuracy in distinguishing medical and surgical causes of jaundice and 94% accuracy in discriminating between acute and chronic, or benign and malignant, disease. In a new set of 105 cases of jaundiced patients the modified COMIC algorithm made the correct diagnosis between intra- and extrahepatic causes for 98% of the patients, and for 93% it was also capable of distinguishing benign from malignant and acute from chronic causes of jaundice.

Carcinomatous meningitis from transitional cell carcinoma of bladder

The following case report presents a patient with transitional cell carcinoma of the bladder referred to this medical center after carcinomatous meningitis developed. Previously he had undergone surgical resection of the primary lesion and had received cis-platinum chemotherapy for lung metastasis. This unusual presentation of metastatic disease (carcinomatous meningitis) seems to alert the surgical and medical communities to new complications.

Cancer of nasopharynx in young patients

From 1961 to 1980 17 patients with nasopharyngeal carcinoma who were less than 30 years old at time of diagnosis were treated at the two oncologic hospitals in Puerto Rico. Fourteen of the tumors were lymphoepitheliomas and the remaining three were anaplastic carcinomas. Ninety-four percent of the patients were found to have neck adenopathy at the initial examination and in 65% of them the adenopathy was bilateral. The 5-year actuarial survival was 14. The main cause of failure was the distant metastasis. Seventy-one percent of our patients developed distant metastasis sometime during the course of their disease. Carcinoma of the nasopharynx is uncommon in Puerto Rico as in other western countries. The post-adolescent age incidence peak reported from different countries is also present among Puerto Ricans.

Suprazygomatic SMAS in rhytidectomy

A personal method for the treatment of the suprazygomatic SMAS and its results are presented. By acting on the suprazygomatic fibromuscular layer in the rhytidectomy, the surgeon can avoid tension on the cutaneous layer, and possible consequences thereof, as well as diminish the probabilities of damaging the facial nerve. At the same time, desired effects as a result of pulling on "crow's feet," wrinkles, lateral eyebrows, and wrinkles on the lateral forehead are enhanced.

Artificial urinary Sphincter 800

With the refinements in the Sphincter 800, better patient selection and improved surgical techniques, the artificial urinary sphincter now offers a viable treatment alternative in the management of urinary incontinence arising from sphincteric incompetence.

Anaplastic seminoma

Fourteen patients with anaplastic seminoma were analyzed retrospectively. At the time of presentation anaplastic seminoma has similar prognosis stage for stage as the classic seminoma. However, the distinctive histologic findings and the high rates of local invasion and of elevations of serum beta-subunit human chorionic gonadotropin serve to distinguish anaplastic seminoma from the classic seminoma. These features, suggesting a possibly greater metastatic potential for anaplastic seminoma, warrant its continued identification as a distinct pathologic subtype.

Radiation therapy of carcinoma of the tonsillar region

From 1960 through 1976, 353 consecutive patients with carcinoma of the tonsillar region were primarily treated with radiation therapy. The mean age of patients was 58 years with males predominating (78%). Patients were classified according to a TNM and stage classification. Most of the tumors were large, and the specific site of origin could not be determined in 33% of the patients. The predominant identifiable sites were the soft palate and uvula, 18%, the anterior tonsillar pillar, 18%, and the tonsillar fossa, 13%. Patients were treated with radiation to doses of 6700 rad given in 48 days and 33 fractions using Cobalt 60 radiation. We found a 91.7% control rate for patients with T1 disease and 76.9%, 49.5%, and 25% for T2, T3, and T4 patients, respectively. The overall local control rate was 62.3%. Surgery was used most often in recurrences for Stage III patients. Salvage surgery was carried out in 93 patients. Surgery was more successful in controlling the disease in patients in whom the primary was controlled by irradiation. Overall, the tumors in 43% of the patients who had surgery were subsequently controlled as a result of this treatment. Metastasis occurred rapidly, with 75 of the patients exhibiting metastases by 18 months. Complications were not related to dose but were slightly higher in patients who had surgery (5%). We conclude that radiation therapy is the preferred treatment for Stage I and II squamous cell carcinoma of the tonsillar region. No satisfactory results were obtained in Stage IV; other approaches should be tried.

Role of ovarian and adrenal progesterone in the regulation of ovum transport in pregnant rats

This study was designed to assess the role of postovulatory ovarian and adrenal progesterone secretion in the regulation of ovum transport in pregnant rats. The number and distribution of embryos in the genital tract and the plasma progesterone levels were determined during the first 5 days of pregnancy in ovariectomized (OVX), adrenalectomized (ADX), ovariectomized and adrenalectomized (OVX + ADX), intact control (IC), or sham-operated control (SOC) rats. Some OVX or OVX + ADX rats received subdermal implants of progesterone pellets following surgery. The day of insemination was designated Day 1 of pregnancy. Transport of embryos from the oviduct to the uterus was essentially complete by the morning of Day 5 in IC and SOC. Neither adrenalectomy performed on Day 1, nor ovariectomy done on Day 4 of pregnancy modified the time of passage of ova from the oviduct to the uterus. Retention of some eggs in the oviduct, accompanied by rapid transport of others into the uterus and expulsion through the vagina, was observed when ovariectomy was performed on Days 1, 2 or 3, or when ovariectomy plus adrenalectomy were performed on Day 1. Following ovariectomy plus adrenalectomy or ovariectomy but not adrenalectomy alone, there was a marked and sustained decline in serum progesterone concentration. Subdermal implants of progesterone supplied on Day 1 restored progesterone levels and improved the pattern of ovum transport in OVX or OVX + ADX. It is concluded that postcoital secretion of progesterone by the ovary plays a major role in the physiologic regulation of oviductal embryo transport in the rat. Progesterone secreted by the adrenal is neither essential nor can it substitute for the ovarian source in the regulation of this process.