Patterns of failure in patients with stage I, grade 3 carcinoma of the endometrium

Patients with high grade, early stage endometrial carcinoma are reported to have worse survival and local control rates than those with low grade carcinomas. To define failure patterns further in patients with FIGO Stage I, grade 3 endometrial carcinomas, the patients from three institutions who received adjuvant or definitive radiation (RT) were analyzed. Of 119 patients meeting the criteria of Stage I, grade 3 endometrial carcinoma, 57 patients received preoperative radiation, 49 patients received postoperative radiation, and 10 patients received definitive radiation with 5-year actuarial survival rates of 64%, 73%, and 65%, respectively. Three additional patients received both preoperative and postoperative treatment. The overall local control rate was 88% with a median follow-up of 70 months. Of 36 patients who failed, 14 had a component of local failure, and 31 had a component of distant failure. Eighteen of 31 distant failures involved metastatic spread to the abdominal cavity. Recurrence patterns by method of treatment are documented. Patients with high grade tumors do have a propensity for distant metastasis. Clinical investigation into the value of systemic therapy is necessary.

An increase in in vitro fertilization ability of low-density human sperm capacitated by multiple-tube swim-up

Comparison was made of the efficacy of multiple-tube swim-up (MT-SU) and single-tube swim-up (ST-SU) preparations on inducing human sperm fertilization ability in semen samples of less than 60 million motile sperm/ml. Two parallel groups of in vitro fertilization (IVF) patients possessing sperm density of this category had their sperm capacitated by MT-SU or ST-SU. The MT-SU patients' sperm fertilized 71 +/- 6.0% of eggs retrieved in comparison to 39 +/- 7.9% in the parallel ST-SU patients (P less than 0.001). Similarly, MT-SU increased the rate of human sperm penetration into zona-free hamster eggs. The increased fertilization rate of MT-SU sperm was not from acceleration of the acrosome reaction, but may be attributed to the higher efficiency of MT-SU in removing antifertility factors present in the seminal plasma from sperm.

Brain-tumor cell kinetics correlated with survival

In a review of 38 glioblastoma patients for whom fresh tissue kinetic data were available before any therapy was instituted, no correlation between the labeling index and survival time could be statistically determined. This relationship seems entirely consistent with the published theoretical determinants of tumor behavior: that is, altered ability for growth arrest and differentiation, constantly evolving mutant sublines, genetic instability, and an ever-changing metabolic and vascular environment.

Marital separation and health: stress and intervention

Marital separation is a stressful life event implicated in much current thinking and practice in mental health, health psychology and psychosomatic medicine. This study examines marital separation in a controlled, prospective design. The participants were 314 Health Maintenance Organization (HMO) subscribers followed over a two year period. Marital separation was experienced by 127 of these participants early in the two-year study period. A stratified random half of these separated individuals participated in a short-term psychoeducational group intervention, "Seminars for the Separated." Measures of psychosocial adjustment and medical utilization were analyzed to describe correlates of marital separation and to evaluate the intervention. Statistically significant increases in medical utilization by people experiencing marital separation were observed in comparisons with married control subjects. Much of this increased utilization occurred in the year surrounding the actual separation and may be accounted for by mental health visits as well as nonmental health contacts with the health plan. The effects of the intervention were not evident until controls for baseline levels of medical utilization were introduced into the multivariate analysis. Even then, intervention effects were slight. Methodological problems and implications for further study are presented.

Locating Rehabilitation Product Information Through ABLEDATA

The ABLEDATA System, a program of the National Rehabilitation Information Center, is a computerized listing of commercially available aids and equipment for disabled persons. Anyone can obtain information from ABLEDATA by calling (202)635-6090 or writing to 4407 Eighth St., NE, Washington, DC 20017. The following article outlines the development and organization of ABLEDATA and includes an expansion of the Information Broker Network. It describes the information available from ABLEDATA and illustrates a typical product search. It also discusses the use of the system by occupational therapists. Costs involved with using the system are discussed in the article.

The stress of marital separation: intervention in a Health Maintenance Organization

Relationships between life stress and illness form the basis of much current thinking and practice in psychosomatic medicine. This study examines a particular life stress, marital separation, in a controlled, prospective design. Participants are 237 Health Maintenance Organization [HMO] subscribers followed over a two-year period. Marital separation was experienced by 117 of these participants early in the two-year study period. A stratified random half of these separated individuals participated in a short-term psychoeducational group intervention, "Seminars for the Separated." Measures of psychosocial adjustment and medical utilization were analyzed to describe correlates of experiencing marital separation and to evaluate the intervention. Statistically significant increases in medical utilization by people experiencing marital separation were observed in comparisons with married control subjects. Much of this increased utilization is in the year surrounding the actual separation and is accounted for by mental health visits. Effects of the intervention were not evident until controls for baseline levels of medical utilization were introduced. Even then, intervention effects were slight. Methodological problems and implications for further study are presented.

Opiates, catecholamines, behavior, and mood

Indirect evidence has linked opioid reinforcement with changes in noradrenergic metabolism secondary to drug administration. Methodological precedents for biobehavioral correlations in depressive illness have suggested an important association between changes in mood and biogenic amine excretion patterns in the urines of patients during depression and recovery. This paper presents preliminary data on the possible relationship between changes in catecholamine excretion that were observed and the changes in behavior, mood, psychiatric status, and cardiorespiratory physiology secondary to heroin administration and methadone-assisted withdrawal. This study focuses on the urinary excretion of MHPG, since an appreciable fraction of this metabolite is probably derived from norepinephrine originating in the brain. The subjective changes in mood associated with heroin use, the decrease in respiratory rate, and the behavioral and mental status effects associated with opiate intoxication were observed only in the individuals whose MHPG excretion increased during the period of opiate administration.

Aftercare on narcotic antagonists: prospects and problems

This study examines the problems and prospects of aftercare of the multiple treatment failure opiate addict who is being treated with narcotic antagonists (primarily naltrexone). At the time of this paper, 21 patients had been admitted to the Drug Addiction Research Project at McLean Hospital, with a retention rate of 42%. "Completers," "noncompleters," and "dropouts" could not be differentiated on the basis of demographic or psychiatric variables, thus making it impossible to define the population most suited for antagonist treatment. The degree of carry-over into the first month in the community, for those who successfully completed the inpatient segment of the program, disappeared over time. The nonreinforcing (lack of euphoric effect) properties of the antagonists and the resultant high level of motivation necessary for the continuation of its use by the patient make this form of treatment suitable for only a small percentage of the "hard core" addict population.

Ovarian Dermoid with Secondary Cysts connected with the Omentum: With Pathological Report and Remarks

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