bcl-2 expression in pilomatricoma

Pilomatricoma is a distinctive tumor characterized by a dual population of proliferating basophilic cells and diagnostic shadow cells, believed to arise from the hair matrix. The normal hair matrix undergoes defined cycles of growth (anagen), regression (catagen), and resting (telogen) that are regulated by programmed cell death (apoptosis). bcl-2 is a proto-oncogene that helps to suppress apoptosis in both benign and malignant tumors. In addition, both apoptosis and bel-2 are critical factors in normal hair follicle development. In order to clarify the role of bcl-1, we used immunohistochemical means to study 10 cases of histologically proven pilomatricoma for bcl-2 expression. The study design included both positive and negative controls. All of the pilomatricomas in our series were strongly decorated by bcl-2 immunostaining. Based on our findings of increased bcl-2 staining, we concluded that the faulty suppression of apoptosis contributes to the pathogenesis of pilomatricoma.

Cavernous lymphangioma in the adult parotid

Cavernous lymphangioma is a benign congenital lesion that usually appears in childhood. It rarely presents in the adult but may be diagnosed at this late stage due to the slow growing nature of the tumour. It is rarely found in the salivary glands and when it does occur, the gland is usually incorporated by lymphangioma of surrounding tissue. We present and discuss the case of a cavernous lymphangioma in the parotid gland of an adult male.

Patients' perceptions of changes in their blood pressure

OBJECTIVES

(1) To investigate patients' experience of changes in their blood pressure (BP) in an every day setting and the accuracy of patients' predictions; and (2) to examine what influences patients' belief that they can tell when their BP is up.

SUBJECTS

A total of 102 hypertensive patients were recruited sequentially as they presented for routine BP checks. The setting was an inner city general practice.

DESIGN

Patients attended for BP checks on a weekly basis. Before each check they were asked whether they thought their BP was higher, lower or the same as usual. Subjects were classified as predictors if they thought they could tell when their BP was up. On completing their series of BP checks each subject completed symptom and Hospital Anxiety and Depression questionnaires.

MAIN OUTCOME MEASURES

Accuracy of BP predictions, BP levels and variability, number of symptoms reported and anxiety level.

RESULTS

One hundred and two hypertensive patients entered the study of whom 51 patients were predictors. The majority (86%) of predictors could not accurately predict their BP. There were no significant differences in either BP or variability between predictors and non-predictors. Predictors were significantly more anxious and reported more symptoms than non-predictors.

CONCLUSIONS

For the majority of predictors there is no significant relationship between predictions of BP and clinical measurements. Predictor status is associated with the reporting of more symptoms and higher levels of anxiety. Doctors should counsel patients against using subjective BP assessments to guide their use of antihypertensive medication.

Correlates of change in adolescent alcohol consumption in Ireland: implications for understanding influences and enhancing interventions

Studies of two similar cohorts of students in Ireland in 1984 and 1992 showed a dramatic increase in the consumption of alcohol, especially in the frequency with which students reported being drunk. A comparison of measures obtained at both times showed that there were major changes with regard to beliefs about consequences of alcohol consumption in a direction favorable to consumption as well as increases in the perceived social support for drinking. However, there were no strong indications that changes in problem behavior were associated with the observed increases in drinking patterns. These results are supportive of some explanatory models of initiation to substance use and have associated implications for programs designed to reduce consumption.

Cholinesterase. Its significance in anaesthetic practice

Plasma cholinesterase is an enzyme which has importance to the anaesthetist primarily for its role in the metabolism of suxamethonium, although other anaesthetic related drugs that this enzyme metabolises are also increasingly important. In this article we review current thoughts on the function, profile and chemistry of plasma cholinesterase. Causes of variations in the activity of the enzyme are described and the basis of genetic variations is explained.

Outcomes assessment: a primer

The routine assessment of outcomes, including clinical and functional outcomes, charges, cost and effectiveness data, and complications of treatment, as well as HRQOL and patient satisfaction, are essential to demonstrate and ensure the quality of care. Secondary to patient-related concerns, outcomes data provide a tool for use by the surgeon in proving (and improving) the quality of care rendered. These tools, as well as surgical input into the development of outcomes indicators, will allow surgeons to practice more effectively in a managed care environment.

The impact of chronic urticaria on the quality of life

The impact of chronic urticaria (CU) on the quality of life is undocumented. We assessed quality of life in patients with CU, including patients with associated delayed pressure urticaria (DPU). One hundred and forty-two out-patients completed self-administered questionnaires: a disease-specific, purpose designed questionnaire, and the Nottingham health profile (NHP). Many patients reported problems attributable to their skin condition in facets of everyday life including home management, personal care, recreation and social interaction, mobility, emotional factors, sleep, rest and work. The NHP part I scores showed restriction in the areas of mobility, sleep, energy, and demonstrated pain, social isolation and altered emotional reactions. Part II of the NHP showed that patients experienced difficulties in relation to work, looking after the home, social life, home relationships, sex life, hobbies and holidays. The patients with DPU had significantly more problems with mobility, gardening and choice of clothing than the uncomplicated CU patients. They also suffered more pain, had more problems with work and were more restricted in their hobbies.

Dermatology quality of life scales--a measure of the impact of skin diseases

Patient-generated dermatology quality of life scales (DQOLS) were developed to assess the impact of skin conditions on patients' psychosocial state and everyday activities. The items were derived from the self-reported impacts of their skin condition by 50 dermatology out-patients. The resulting 17 psychosocial items and 12 activities items were assigned five-point scales and self-completed by 118 out-patients. Factor analyses grouped the items into four psychosocial subscales (embarrassment, despair, irritableness, distress) and four activities subscales (everyday, summer, social, sexual). Tests of the psychometric properties indicated that the internal consistency of responses was high, with Cronbach's alpha coefficients of 0.92 for the 17 psychosocial items and 0.83 for the 12 activity items. Assessment of reliability based on 41 psoriasis patients attending phototherapy treatment identified good short-term test-retest reliability, with intraclass correlation coefficients of 0.84 for both the psychosocial and activities scales. Construct validity was confirmed by the ability of the scales to identify clinically expected differences and their greater sensitivity to the impacts of skin problems compared with a widely used generic health status measure. The DQOLS thus form a robust measure of patient-perceived impacts. They were quickly self-completed and provide information that complements traditional clinical indicators. These scales should assist in informing treatment decisions by identifying impacts of different skin conditions and variations in responses among social and cultural groups, as well as guiding priorities for services within the specialty.

Tuberculosis beliefs among recent Vietnamese refugees in New York State

OBJECTIVE

To identify newly arrived Vietnamese refugees' beliefs about tuberculosis (TB) and TB education needs.

METHODS

In 1994, the New York State Health Department and the Centers for Disease Control and Prevention conducted a survey of 51 newly arrived adult Vietnamese refugees in two New York counties. After being trained in interview methods, two bilingual researchers asked 32 open-ended questions on the causes of TB, TB treatment, and the disease's impact on work and social relationships.

RESULTS

Respondents correctly viewed TB as an infectious lung disease with symptoms such as cough, weakness, and weight loss. Hard manual labor, smoking, alcohol consumption, and poor nutrition were believed to be risk factors. Many respondents incorrectly believed that asymptomatic latent infection is not possible and that infection inevitably leads to disease. Nearly all respondents anticipated that having tuberculosis would adversely impact their work, family, and community activities and relationships.

CONCLUSIONS

Targeted patient education is needed to address misconceptions about TB among Vietnamese refugees and to help ensure adherence to prescribed treatment regimens.

Cognitive functioning in premenstrual syndrome

OBJECTIVE

To evaluate cognitive functioning in women with premenstrual syndrome (PMS) and controls during the follicular and luteal phases of the menstrual cycle.

METHODS

Thirty women with PMS and 31 controls were selected on the basis of psychiatric interview and prospective daily diary recordings. Subjects were tested on two occasions, follicular (days 8-10) and luteal (days 24-26), using complex tasks consisting of measures validated previously for the assessment of "executive" frontal-lobe functions. Tests were counterbalanced for order across subjects.

RESULTS

The Beck Depression Inventory scores were significantly different between the groups and across time (P < .001). Women with PMS had a mean luteal phase Beck score of 13.3 consistent with mild-to-moderate premenstrual depression. There were no statistically significant score differences in tests for attention, memory, cognitive flexibility, and overall mental agility. The evaluation of our preliminary data with 30 PMS subjects and 31 controls indicated a very small effect size (.02). To detect an effect size this small (if in fact one exists) with a power of .8 would require a sample of more than 1000 subjects per group.

CONCLUSION

Our sample of women with PMS failed to demonstrate objective evidence of diminished cognitive performance, despite subjective feelings of inadequacy.

Postpartum psychiatric disorder: who should be admitted and to which hospital?

OBJECTIVE

To review the question of whether an infant should be admitted to psychiatric services when a severe psychiatric disorder necessitates admission of the mother.

METHOD

All available literature on mother-infant joint admission was reviewed and arguments for and against are summarised.

RESULTS

Early reports favoured joint admission, then opinions changed, possibly for economic reasons. Recent thinking encompasses research data on (i) longer-term adverse effects of postnatal depression on the children, and (ii) the finding of psychological and psychiatric morbidity in many of the fathers. Joint admission to designated special units is valuable, but such facilities are only cost-efficient and effective if established as part of an appropriate broader plan for managing postpartum, psychiatric disorder.

CONCLUSIONS

(1) Further research is needed to answer this question definitively. (2) Services at primary and secondary level require expansion. (3) All services should target the whole family.

Localization of impalpable breast lesions--a surgical approach

The conventional approach to localization of impalpable breast lesions, i.e. employing a hooked wire with either stereotaxis or a perforated plate, has potential disadvantages for the operating surgeon. Often the entry point of the wire lies some distance from the site of projection of the lesion on the skin. The guide-wire should pierce the skin at, or close to, the site of any proposed surgical incision and proceed along the shortest and most direct course towards the lesion. Ideally, the wire should lie within a radial distance of between 1 and 2 cm from its target. A method is described which achieves these objectives and involves both radiological and clinical measurements. A total of 665 guide-wire localized biopsies have been carried out at the above institutions between 1 November 1987 and 31 March 1995 and between 1 January 1994 and 31 March 1996. In only 4% of cases was re-positioning of the wire required. Excision of the radiological lesion was obtained with a single biopsy in 99% of cases. A second or third biopsy was indicated in 0.7% and 0.3% of cases, respectively. Migration of the wire occurred in two patients and no cases of wire transection or pneumothorax were reported. This method of localization facilitates subsequent excision and permits the most appropriate incision consistent with optimal cosmesis.

Candida peritonitis treated with liposomal amphotericin B

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Brainiac encodes a novel, putative secreted protein that cooperates with Grk TGF alpha in the genesis of the follicular epithelium

brainiac (brn) is involved in a number of developmental events. In addition to being required zygotically for segregation of neuroblasts from epidermoblasts, it is essential for a series of critical steps during oogenesis which also depend upon gurken (grk), a TGF alpha homolog. Animals harboring strong mutations of either grk or EGF receptor tyrosine kinase (Egfr) or doubly mutant for brn and weak grk or Egfr mutations produce ovarian follicles with multiple sets of nurse cell-oocyte complexes. These follicles frequently have discontinuities in the follicular epithelium that uncover nurse cells but not the oocyte. Gaps first appear in the germarium, suggesting that some nurse cells lack affinity for invading prefollicular cells. This is the first evidence that grk, in addition to its involvement in the genesis of anterior-posterior and dorsal-ventral polarity, is also required for Egfr-dependent development of the follicular epithelium that surrounds each nurse cell/oocyte cluster to form an egg chamber. We have used restriction fragment length polymorphisms to localize brn to a 10-kb region within a 300-kb stretch of DNA on the X-chromosome, and we have identified the brn gene by means of RNA rescue. brn codes for a putative secreted protein. brn is expressed in germ cells at the time follicle cells first surround the nurse cell-oocyte complex. Our genetic data suggest that brn acts in a parallel, but partially overlapping pathway to the Grk-Egfr signaling pathway. The brn pathway may help to provide specificity to TGF alpha -Egfr function during oogenesis.

Angioscopically-assisted in situ saphenous vein bypass for infrainguinal revascularisation

OBJECTIVES AND STUDY DESIGN

The diagnostic capability of angioscopy for endoluminal evaluation is established and its superiority over arteriography for completion studies has been confirmed. The therapeutic use of angioscopy in vein graft preparation is more controversial. The aim of this prospective study was to establish whether angioscopic vein preparation confers real benefits over existing techniques.

METHODS

Forty-seven patients were randomised to either full angioscopic (ANG) vein preparation (23 patients) or conventional (CON) in situ grafting (19 patients). All patients underwent completion studies with arteriography and angioscopy and postoperatively, entered a Duplex graft surveillance programme.

RESULTS

There was a significant difference in the incidence of wound morbidity: 26% in the ANG group as against 63% in the CON group (Fisher's exact test: p = 0.043), but no significant differences with respect to duration of operation, duration of vein graft preparation, length of hospital stay and both 30 day and 12 month secondary cumulative patencies (log rank test: p > 0.5). Completion angioscopy detected eight persistent valve cusps in six patients, all missed at arteriography, but failed to detect arteriovenous fistulae.

CONCLUSIONS

Angioscopic preparation reduces wound morbidity and complements arteriography for detecting intraoperative defects. A large, prospective, randomised trial is now warranted to fully evaluate the potential therapeutic role of angioscopy with respect to current vascular practice.

The development of a brief scale to measure outcome expectations of reduced consumption among excessive drinkers

This paper describes the development of a brief scale to measure outcome expectations of reduced consumption among excessive drinkers (low dependence drinkers consuming more than recommended levels). This work, which forms part of a larger matching study of brief intervention, is based on the general proposition that outcome expectations of reduced consumption might be more important than previously thought for understanding and predicting behavior change. Twelve outcomes, derived from interviews with excessive drinkers, formed the basis of a questionnaire, the Excessive Drinker Outcome Expectations Scale (EDOES), which examined not only the valence of each outcome, but a comparison between expectations of reduced consumption versus drinking usual amounts. The questionnaire was administered to 235 hospitalized excessive drinkers. Principal components analysis produced two scales, reflecting the costs and benefits of change. The questionnaire proved to have acceptable levels of test-retest reliability and predictive validity. Analyses of construct validity revealed that outcome expectations of reduced consumption were increasingly positive across stages of change.

No transfer of perceptual learning between similar stimuli in the same retinal position

BACKGROUND

Recent experiments have demonstrated a remarkable amount of specificity in the learning of simple visual tasks in humans, as well as considerable plasticity of receptive fields in the visual cortex of adult monkeys. Here, we tested the specificity of improvement through learning in the performance of human observers on two tasks using almost identical stimuli.

RESULTS

Two groups, of six observers each, were trained in two hyperacuity tasks - three-dot bisection and three-dot vernier discrimination. The groups started with different tasks, and switched tasks after one hour of training. Training improved performance significantly, in spite of considerable variability between observers, but improvement did not generalize from one of these tasks to the other. This result indicates that perceptual learning can be extremely stimulus specific, and that deviations from the same standard but in orthogonal directions require completely new training.

CONCLUSIONS

Learning is not based on the development of a more exact map of positional information, or on training to fixate or accommodate the eye, but on a better discrimination between the stimuli using one specific stimulus dimension. We also demonstrate that observers differ considerably, not only in their speed of learning, but also in their relative level of performance on the two similar tasks.

Vein graft stenosis: incidence and intervention

OBJECTIVES

The incidence of vein graft stenosis ranges from 5%-45%. Reported rates appear to be increasing as technological advances make detection easier. The aim of this study was to review our experiences with regard to the incidence of stenosis in infrainguinal bypass grafts and the outcome of intervention for salvage of failing grafts.

DESIGN

Retrospective review of graft surveillance records.

SETTING

Vascular Studies Unit, Bristol Royal Infirmary.

METHODS

A Duplex-based graft surveillance (GS) programme was used from January 1989 to June 1994 to study 275 primary graft procedures in 250 patients with lower limb ischaemia. Patients were scanned at 1 week, 6 weeks and 3, 6, 9 and 12 months postoperatively.

RESULTS

One year cumulative limb salvage, patient survival and primary, primary assisted and secondary patencies were 91%, 83%, 67%, 77% and 84% respectively. Duplex scanning detected 85 vein graft stenoses in 59 patients: an incidence of 21.5%. In addition, 64 potentially graft-threatening inflow (14) and outflow (50) problems were detected in the native vessels of 52 patients from clamp damage or progression of disease (POD). Of the 85 graft stenoses, 40 were treated by balloon angioplasty (PTA) and 20 by surgical intervention and 1 patient's symptoms were treated by chemical sympathectomy. Twenty-four patients were not actively treated. Of the 64 grafts affected by POD, 20 were treated by PTA, 15 by surgery, one with anti-coagulation and 28 had no treatment. Comparing patients with non-treated and treated lesions, the respective 12 month cumulative patencies for patients with graft stenoses were 75% and 87.5% as against 86% and 83% for patients with POD (log rank test 0.1).

CONCLUSIONS

These results uphold the perceived benefits of a GS programme, although the evidence from the non-treated cases in this series reinforces a need for a large, prospective, randomised trial to confirm the case for GS.