The clinical, histologic, and ultrastructural presentation of polyvinyl sponge (Ivalon) breast prostheses removed for massive fluid accumulation

The current study describes what we believe is the first report of bilateral massive seromas associated with open-cell Ivalon sponges. Additionally, the gross, histologic, and ultrastructural features consistent with previous reports of polyvinyl alcohol prostheses are presented. Despite the reported chemical inertness of polyvinyl alcohol, this material may incite a biologic response in some patients, leading to dense fibrosis and occasional foreign-body giant-cell reaction. It is postulated that the molecular breakdown products of the polyvinyl alcohol polymer may create an osmotic gradient across the periprosthetic capsule, which may lead to intracapsular fluid accumulation, as presented in this case.

Laparoscopic colposuspension

Laparoscopic Burch colposuspension has entered the surgical armory for the treatment of genuine stress incontinence. The limited data available of the outcomes of the procedure currently suggest that success rates are lower than for the open colposuspension in the short term. Data is lacking on long-term effectiveness. This and the longer operating times documented may reflect inexperience of surgeons. There seem to be advantages in terms of sooner return to normal voiding, earlier discharge from hospital, perioperative morbidity, and a lower incidence of voiding problems when compared with the open procedure. No reduction in the incidence of de novo detrusor instability postoperatively has emerged. A large randomized controlled trial of the two procedures is required to provide higher quality data on outcomes.

The suspiciousness factor: critical care nursing and forensics

This conceptual article provides a guide for understanding the place of forensic nursing within the discipline of nursing. Ways of knowing in nursing and expert nursing practice are described to identify the role of intuition in nursing practice. The relationship between suspicion and intuition is explored. Strategies for developing forensic nursing expertise and increasing suspicion are described. Suspicion (intuition) is presented as a rapid, acquired, patient oriented perception that leads to decisive action.

The effect of ethylene and cytokinin on guanosine 5'-triphosphate binding and protein phosphorylation in leaves of Arabidopsis thaliana

Binding of [alpha-32P]guanosine 5'-triphosphate ([alpha-32P]GTP) has been demonstrated in a Triton X-100-solubilised membrane fraction from leaves of Arabidopsis thaliana (L.) Heynh. Binding was stimulated by 1 h pre-treatment of leaves with ethylene and this effect was antagonised by the inclusion of N6-benzyladenine in the medium used for homogenisation. The ethylene-insensitive mutants eti 5 and etr showed contrasting responses. In eti 5 the constitutive level of GTP binding was higher than in the wild type whereas in etr the level was much lower. Neither ethylene nor cytokinin affected GTP binding in the mutants. The GTP-binding activity was localised in two bands at 22 and 25 kDa, both of which were immunoprecipitated by anti-pan-Ras antibodies, indicating that the activity is due to small GTP-binding proteins. In a similar membrane fraction, ethylene was shown to increase protein phosphorylation and benzyladenine antagonised this effect. In eti 5 the constitutive level of protein phosphorylation was higher than in the wild type, but benzyladenine increased activity substantially while ethylene was without effect. In etr, protein phosphorylation was lower than in the wild type, ethylene was without effect, but cytokinin increased activity. A protein of M(r) 17 kDa was detected on gels using antibodies to nucleoside diphosphate kinase. Phosphorylation of this protein was upregulated by ethylene but nucleoside diphosphate kinase activity was unaffected. The results are compared with the effect of the two hormones on the senescence of detached leaves and discussed in relation to pathways proposed for ethylene signal transduction.

Intraoperative cytologic diagnosis of suprasellar and sellar cystic lesions

The intraoperative distinction of craniopharyngiomas (CP) and cystic pituitary adenomas (PA) from other intracranial parasellar cystic lesions can significantly modify the extent of surgery and reduce postoperative morbidity. Frozen-section diagnosis may be limited by the scant tissue available for examination. The imprint cytology of six parasellar cystic lesions is examined, along with their radiologic and histologic findings. These include two Rathke's cleft cysts (RCC), three CP, and one cystic PA. RCC showed scattered clusters of cuboidal cells with prominent cilia. Cystic PA demonstrated clusters of monomorphic round cells with minimal cytoplasm. CP displayed "wet" keratin and clusters of squamous cells with a palisaded border. In all six cases, cytology supported the final histologic diagnosis. In one case, the intraoperative diagnosis was based solely on cytologic examination. Cytology can contribute significantly to an accurate intraoperative diagnosis of parasellar cystic lesions and potentially modify surgical management.

Fine needle aspiration cytology of a mediastinal granular cell tumor with histologic confirmation and ancillary studies. A case report

BACKGROUND

Mediastinal granular cell tumors (GCT) are extraordinarily rare and have not been previously reported in the cytology literature. Fine needle aspiration (FNA) cytology of GCT resembles the cytologic features of several other lesions that are more common in the mediastinum.

CASE

A middle-aged female with a recent onset of nonproductive cough and otherwise unremarkable medical history presented with a mediastinal mass. Imaging studies confirmed the presence of a large mass in the superior, posterior mediastinum closely apposed to the apex of the left lung. FNA revealed scattered large, polygonal to spindle cells with granular cytoplasm and indistinct cell borders. The cytologic differential diagnosis included a benign neural tumor with granular cell features versus GCT. Histologic examination of the surgically resected mass along with supportive immunohistochemical and electron microscopic studies confirmed GCT.

CONCLUSION

This is the first reported case of FNA cytology of a mediastinal GCT. A reliable diagnosis can be made with aspirated material from these lesions based upon the characteristic cytologic, immunocytochemical and ultrastructural features of the tumors.

Teaching pathophysiology from a multicultural perspective

Pathophysiology is the study of deviation from normal physiology and the 70-kilogram white male that remains the standard by which all else is compared. As United States demographics shift, a new perspective is necessary to meet the needs of multicultural patients. This article describes how a multicultural perspective provides a new framework for teaching that both transforms course content and stimulates new teaching methodologies.

Nursing model of hospitalization events

PURPOSE

To provide a model of hospitalization events from a nursing perspective. Hospitalization has become an event of highly technical care coupled with intense nursing care requirements. This proposed model is needed to support clinical nursing research among hospitalized patients.

SCOPE

Hospitalization occupying space and time as a discrete event on the health-illness continuum. First developed to provide a framework for a descriptive study, the model shows the factors involved in hospitalization and provides a framework for understanding the nursing care that occurs. Selected results from descriptive research that used patients hospitalized with AIDS as subjects are reported as an example of use of the model.

CONCLUSIONS

Research about hospitalization events continues to be critical for the advancement of clinical nursing. This model is presented to provide a conceptual framework for future research.

Temporal lobe (TL) damage following surgery and high-dose photon and proton irradiation in 96 patients affected by chordomas and chondrosarcomas of the base of the skull

PURPOSE

To determine the temporal lobe (TL) damage rate in 96 patients treated with high-dose proton and photon irradiation for chordomas and chondrosarcomas of the base of the skull.

METHODS AND MATERIALS

The records of 96 consecutive patients treated at Massachusetts General Hospital (MGH) and Harvard Cyclotron Laboratory (HCL) between June 1984 and 1993, for chordomas and chondrosarcomas of the base of the skull were reviewed. All the patients had undergone some degree of resection of the tumor prior to radiation therapy. Seventy-five patients were classified as "primary tumors" and 21 as recurrent or regrowing tumors after one or more surgical procedures. All the patients were randomized to receive 66.6 or 72 cobalt Gray equivalent (CGE) on a prospective dose-searching study by proton and photon irradiation (Radiation Therapy Oncology Group #85-26) with conventional fractionation (1.8 CGE/day, 5 fractions/week). All treatments were planned using the three-dimensional (3D) planning system developed at the Massachusetts General Hospital, and the dose was delivered using opposed lateral fields for the photon component and a noncoplanar isocentric technique for the proton component. Clinical symptoms of TL damage were classified into 4 grades. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans were evaluated for white matter changes. Abnormalities associated with persistent or recurrent tumor were distinguished from radiation-induced changes. TLs were delineated on the original scans of the 10 patients with damage and those of a group of 33 patients with no clinical or MRI evidence of injury. Dose distributions were calculated and dose-volume histograms were obtained for these patients.

RESULTS

Of the patients, 10 developed TL damage, with bilateral injury in 2 and unilateral injury in 8. The cumulative TL damage incidence at 2 and 5 years was 7.6 and 13.2%, respectively. The MRI areas suggestive of TL damage were always separated from the tumor bed. Symptoms were severe to moderate in 8 patients. Several baseline factors, tumor- or host-related, were analyzed to evaluate their predictivity for TL damage: age, gender, tumor site, histology, type of presentation, type and number of surgical procedures, primary tumor volume, prescribed dose, normal tissue involvement, and volume of TL receiving doses ranging between 10 and 50 CGE or more. Only gender, in a univariate analysis (log rank) was a significant predictor of damage (0.0155), with male patients being at significantly higher risk of TL injury. In a stepwise Cox regression that included gender as a variable, no other baseline variable improved the prediction of damage.

CONCLUSIONS

The 2- and 5-year cumulative TL damage rates were 7.6 and 13.2%, respectively. Despite the different TL damage rates related to age, tumor volume, number of surgical procedures prior to radiation therapy, and prescribed doses to the tumor, only gender was a significant predictor of damage (p = 0.0155) using a univariate (log rank) test. Chordomas and chondrosarcomas of the base of the skull may represent an interesting model to evaluate the TL damage rates because of their extradural origin, displacing the white matter instead of infiltrating it as gliomas do, because of their longer local recurrence-free survival other than gliomas and other brain tumors and because of the high doses of irradiation delivered to the target volume to obtain local control.

A novel plasmid pIJB1 possessing a putative 2,4-dichlorophenoxyacetate degradative transposon Tn5530 in Burkholderia cepacia strain 2a

A 102-kb plasmid, pIJB1, was isolated from Burkholderia cepacia strain 2a, which is able to use 2,4-dichlorophenoxyacetate (2,4-D) as a sole carbon source, and a physical map of the plasmid has been established. It was observed that spontaneous loss of a 37-kb fragment of the plasmid after growth in nonselective medium occurred, generating a plasmid of diminished size, pIJB2. The deletion event is concomitant with the loss of the 2,4-D dissimilatory phenotype, indicating that at least some of the 2,4-D degradative genes are on the missing fragment. The missing fragment is flanked by two identical 4.3-kb insertion sequences (IS) and shows a typical composite transposon structure of 41-kb in size, designated Tn5530. The mutant plasmid pIJB2 possesses a single copy of the IS element.

The potential role of proton beams in radiation oncology

Historically, major gains in the local control of large, deep-seated tumors treated with radiation have occurred whenever dose distributions have become more localized to the tumor. Better dose localization permits the delivery of higher tumor doses while delivering less dose to dose-limiting normal tissues. High-energy protons, because they stop abruptly in tissue at the end of their range and deposit most of their energy there, provide dose distributions that are superior to x-rays when used in comparable beam configurations. The installation of a hospital-based proton therapy facility at the Massachusetts General Hospital in Boston, MA, and the existing facility at Loma Linda University Medical Center, Loma Linda, CA, provide a potential for achieving higher rates of local control in tumors throughout the body.

Spatial disorientation blocks reliable goal location on a plus maze but does not prevent goal location in the Morris maze

Cue control in spatial learning was investigated in a plus maze and a Morris maze. Rats transported in opaque containers with prior rotation to a plus maze, but not a Morris maze, could not find a goal defined by external cues. Rats transported in clear containers without rotation found the goal in both mazes. In the Morris maze, goal location was readily relearned following cue removal by rats in clear containers but not by rats in the opaque/rotation group. B. L. McNaughton et al.'s (1996) theory that during spatial learning sensory information is bound to preconfigured internal maps in the hippocampus, whose metric is self-motion and whose orientation depends on input from an inertial based head direction system, may explain this study's findings.

Spatial disorientation blocks reliable goal location on a plus maze but does not prevent goal location in the Morris maze

Cue control in spatial learning was investigated in a plus maze and a Morris maze. Rats transported in opaque containers with prior rotation to a plus maze, but not a Morris maze, could not find a goal defined by external cues. Rats transported in clear containers without rotation found the goal in both mazes. In the Morris maze, goal location was readily relearned following cue removal by rats in clear containers but not by rats in the opaque/rotation group. B. L. McNaughton et al.'s (1996) theory that during spatial learning sensory information is bound to preconfigured internal maps in the hippocampus, whose metric is self-motion and whose orientation depends on input from an inertial based head direction system, may explain this study's findings.

Comparison of the cellular fatty acid composition of a bacterium isolated from a human and alleged to be Bacillus sphaericus with that of Bacillus sphaericus isolated from a mosquito larvicide

The cellular fatty acid (CFA) composition of the cytoplasmic membrane of a bacillus isolated from a human lung and deposited in the National Collection of Type Cultures as Bacillus sphaericus NCTC 11025 was determined by gas-liquid chromatography. The CFA composition of B. sphaericus 2362, isolated from a microbial larvicide, and those of B. sphaericus reference strains obtained from public collections were also determined. Samples were grouped by hierarchical cluster analysis based on the unpaired-group method using arithmetic averages. Samples that linked at a Euclidean distance of < or = 2.0 U were considered to belong to the same strain. NCTC 11025 and the type strain of B. sphaericus, ATCC 14577, were mixed; all other isolates were monotypic. The predominant fatty acid in NCTC 11025 was 12-methyltetradecanoic acid, while the predominant fatty acid in the remaining isolates was 13-methyltetradecanoic acid. NCTC 11025 linked to the other isolates at a Euclidean distance of 83.8 U, and we concluded that it belongs to a different species that we could not identify. We could distinguish among six DNA homology groups of B. sphaericus by using fatty acids. Within DNA homology group IIA, strain 2362 could be distinguished from other strains belonging to serotype H5a, 5b. We concluded that CFA analysis is a useful technique to determine if future human isolates identified as B. sphaericus in fact belong to other species of bacteria or whether the isolates originated from commercial products.

Urodynamic services, personnel and training in the United Kingdom

OBJECTIVE

To audit the provision of urodynamic services in the UK, with particular emphasis on the personnel involved and the training they received.

METHODS

A questionnaire was sent to 163 centres carrying out urodynamics in the UK asking for information on the department providing the service, the frequency of use, the number of patients investigated, professional training of the personnel and whether the personnel thought that the training was adequate.

RESULTS

Most urodynamic facilities in the UK function on a part-time basis. Urodynamics are carried out by a variety of healthcare professionals but most are performed by doctors and nurses. Half the respondents considered the training to be inadequate.

CONCLUSION

Consideration should be given to requiring a minimum standard of training for personnel carrying out urodynamics in the UK to ensure that a quality service is provided.

Treatment planning for adenocarcinoma of the rectum and sigmoid: a patterns of care study. PCS Committee

PURPOSE

To conduct a study of the process of treatment planning and treatment of adenocarcinoma of the rectum and sigmoid in the United States, and to compare survey results to consensus guidelines.

METHODS AND MATERIALS

A consensus committee developed guidelines for the radiotherapeutic management of adenocarcinoma of the rectum and sigmoid, and also developed a survey form that was used to gather data to evaluate the practice patterns for patients treated in 1989 and 1990 against the consensus guidelines. Seventy-three facilities were randomly selected for site visits from the 1321 radiation therapy facilities in the US: 21 academic, 26 hospital based, and 26 free standing. During the site visits, the radiotherapy records were examined by the surveyor physicist and radiation oncologist to extract and record the required data. Data collected included items related to treatment specific parameters, including treatment planning considerations. Analyses included stratification as to the types of institutions, academic, hospital based, or free standing.

RESULTS

For many treatment parameters there are discrepancies between the patterns of practice determined by the surveys and the consensus guidelines for radiotherapy treatment of adenocarcinoma of the rectum and sigmoid. Significant differences in practice among the stratified institution types were found in only a few parameters.

Identification and sequencing of a novel insertion sequence, IS1471, in Burkholderia cepacia strain 2a

A novel insertion sequence (IS), IS1471, has been identified which is inserted into IS element IS1071 possessed by plasmid pIJB1 in Burkholderia cepacia strain 2a. Nucleotide sequencing has revealed that IS1471 is 1112 bp in length and is flanked by 22/21-bp imperfect inverted repeats with a 3-bp duplication of the target sequence IS1471 contains a single open reading frame encoding a putative polypeptide of 345 amino acids with molecular mass of 39406 Da. Searches of DNA and protein sequence databases did not result in the detection of any homologous IS elements, suggesting that IS1471 is novel and may not belong to any known IS groups.

Induced radioactivity of LDEF materials and structural components

We present an overview of the Long Duration Exposure Facility (LDEF) induced activation measurements. The LDEF, which was gravity-gradient stabilized, was exposed to the low Earth orbit (LEO) radiation environment over a 5.8 year period. Retrieved activation samples and structural components from the spacecraft were analyzed with low and ultra-low background HPGe gamma spectrometry at several national facilities. This allowed a very sensitive measurement of long-lived radionuclides produced by proton- and neutron-induced reactions in the time-dependent, non-isotropic LEO environment. A summary of major findings from this study is given that consists of directionally dependent activation, depth profiles, thermal neutron activation, and surface beryllium-7 deposition from the upper atmosphere. We also describe a database of these measurements that has been prepared for use in testing radiation environmental models and spacecraft design.

Treatment planning for primary breast cancer: a patterns of care study

PURPOSE

The 1989 Patterns of Care Study included treatment planning for early breast cancer. A Consensus Committee of radiation physicists and oncologists determined current guidelines and developed questionnaires to determine treatment planning and delivery processes used by the participating institutions (e.g., use of portal films). This article presents and analyzes the results of that survey.

METHODS AND MATERIALS

The survey included 449 respondents, distributed as follows: 136 (30%) from Strata I (academic facilities); 169 (38%) from Strata II (hospital based facilities); and 144 (32%) from Strata III (freestanding facilities). The treatment planning procedures surveyed included: whether individualized tissue compensators are used, whether inhomogeneity corrections are used in dose calculations, the use of computerized tomography, whether isodose distributions for external beam tangents and interstitial implants are generated, the use of lymphoscintigraphy, immobilization devices, simulations, portal films, etc.

RESULTS

The survey results demonstrated that out of 305 patients from Strata I and II institutions, 237 (78%) had simulated tangential fields. Consistent with this finding is that 76% of patients from Strata I and II institutions were immobilized, while only 51% of Strata III patients were. Moreover, only 18 out of the 449 (4%) of cases did not have any type of external beam dose distribution calculated--presumably, in these cases missing tissue compensation would be unlikely. On the other hand, 41% of the Strata II, 27% of Strata III, but only 19% of Strata I (p < 0.0002) cases received CT. Surprisingly, 19% of the Strata I, 35% of the Strata II, and 25% of the Strata III (p = 0.0011) patients received lymphoscintigraphy, perhaps reflecting the use of wide tangents to encompass the internal mammary nodes in these patients. In terms of optimizing treatments, 74% of Strata I, 70% of Strata II, and 78% of Strata III patients had wedges used on both tangential fields, although in 5, 12, and 14%, respectively, no beam modification of any sort was used. Furthermore, it should be noted that in 7% of the Strata I, 23% of Strata II, and 37% of Strata III cases there was no attempt to reduce the divergence of the tangential fields into the lung. On the other hand, if one considers the 135 (of 449) patients where matching of the tangential and supraclavicular fields was applicable, 41% of Strata I, 22% of Strata II and 46% of Strata III patients had those fields matched in a vertical plane, which would involve sophisticated alignment procedures. Quality control of treatment delivery was high: 97% of all surveyed received portal films at least once. The use of thermoluminescent dosimetry (TLD) to measure the dose to the contralateral breast was of little interest: only 4 of the 305 Strata I and II patients received in vivo measurements.

CONCLUSIONS

This national survey has established the patterns of treatment planning for early breast cancer. It shows a generally consistent approach-although a number of statistically significant variations have been identified.

Effects of fumonisin-containing culture material on pulmonary clearance in swine

OBJECTIVE

To determine the potential effects of feeding tumonisin-containing culture material on the pulmonary clearance of blood-borne particulates and bacteria in swine.

ANIMALS

21 healthy male pigs randomly assigned to control and treated groups.

PROCEDURE

Control pigs were fed a standard grower ration while culture material containing fumonisins (20 mg of hydrolyzed fumonisin B1/kg of body weight/d) was added to the feed of treated pigs for 7 days. On day 8, pigs were anesthetized with halothane and catheterized, using a sterile cut-down procedure. 18 hours after recovery from anesthesia, Monastral Blue or Pseudomonas aeruginosa was infused into the right atrium of treated and control pigs for 30 minutes and pulmonary clearance was determined.

RESULTS

Pigs that were fed fumonisin-containing culture material had a significantly (P < 0.05) decreased ability to clear Monastral Blue and P aeruginosa. Ultrastructural examination of the lung indicated that uptake of copper pigment by pulmonary intravascular macrophages was decreased in treated pigs.

CONCLUSIONS AND CLINICAL RELEVANCE

Fumonisins, even when fed to pigs at sub-lethal concentrations, can inhibit pulmonary intravascular macrophages from removing particulate matter and bacteria from the circulation, thus potentially predisposing swine to infectious disease.

Formation of Atomically Flat Silver Films on GaAs with a "Silver Mean" Quasi Periodicity

A flat epitaxial silver film on a gallium arsenide [GaAs(110)] surface was synthesized in a two-step process. Deposition of a critical thickness of silver at low temperature led to the formation of a dense nanocluster film. Upon annealing, all atoms rearranged themselves into an atomically flat film. This silver film has a close-packed (111) structure modulated by a "silver mean" quasi-periodic sequence. The ability to grow such epitaxial overlayers of metals on semiconductors enables the testing of theoretical models and provides a connection between metal and semiconductor technologies.

The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction

This article presents a standard system of terminology recently approved by the International Continence Society, the American Urogynecologic Society, and the Society of Gynecologic Surgeons for the description of female pelvic organ prolapse and pelvic floor dysfunction. An objective site-specific system for describing, quantitating, and staging pelvic support in women is included. It has been developed to enhance both clinical and academic communication regarding individual patients and populations of patients. Clinicians and researchers caring for women with pelvic organ prolapse and pelvic floor dysfunction are encouraged to learn and use the system.