Virilisation in a case of transitional cell carcinoma of the ovary

A 52 year old woman presented with a five month history of emotional changes, voice changes, and of abdominal discomfort. Clinical, biochemical, and radiological examinations showed evidence of virilisation, raised testosterone, and a complex ovarian mass. Microscopy of the resection specimen showed the tumour to be a transitional cell carcinoma of the ovary with luteinisation and hyperplasia of the intervening stromal cells. This is a unique case of virilisation caused by transitional cell carcinoma of the ovary. Theories as to the origin of testosterone production in non-functioning ovarian tumours are discussed.

Predominant fatty variant of myofibroblastoma of breast

Myofibroblastoma of the breast is an uncommon but well defined benign stromal tumour. This report describes a case in which the predominant histological component was mature adipose tissue and two further cases with a major adipocytic component. Although small foci of adipose tissue are a recognised feature of this tumour, the dominance of the histological pattern by fat has not been described previously, and the recognition of this variant is important to allow confident diagnosis and avoid confusion with other primary adipocytic or stromal lesions, especially in the setting of potential needle core biopsy of such a lesion.

Effectiveness of clozapine and a social learning program for severely disabled psychiatric inpatients

OBJECTIVE

This study examined the combined effectiveness of clozapine and a comprehensive inpatient psychosocial rehabilitation program on the clinical functioning and aggressive behaviors of patients with chronic schizophrenia.

METHODS

Two groups of 11 subjects each were selected from among patients being treated in the social learning program at Fulton (Mo.) State Hospital. Group 1 subjects were placed on clozapine at various times after the introduction of the program, while group 2 subjects remained on traditional antipsychotics throughout the study period. Group 1 and group 2 subjects were matched on clinical functioning as measured by the Time-Sample Behavioral Checklist (TSBC). For each subject, scores on six TSBC subscales were examined at five time points. Data were analyzed using repeated-measures multiple analysis of variance and univariate analyses of variance. Data on frequency of aggressive behaviors were aggregated into three six-month time periods and were analyzed using Wilcoxon signed-rank tests.

RESULTS

Both groups demonstrated significant improvement on several measures. However, the addition of clozapine resulted in accelerated improvement for group 1 subjects, especially in aggressive behaviors.

CONCLUSIONS

Comprehensive psychosocial treatment programming resulted in significant improvements in clinical functioning for many inpatients. Clozapine may enhance responsiveness to such programming for some patients.

Social-learning procedures for increasing attention and improving basic skills in severely regressed institutionalized patients

Seven severely debilitated and chronically institutionalized forensic psychiatric patients were enrolled in intensive shaping classes as part of a comprehensive social-learning treatment program. Results compiled over 1 year reveal that six of these patients demonstrated marked improvements in their ability to attend to basic academic tasks and five also showed consistently high rates of successful task completion or increased rates over time. Evidence for the generalization of these effects comes from the fact that all four of the residents who went on to regular academic classes demonstrated consistently high rates of successful task completion. Recommendations are made for further applications of intensive shaping procedures for such severely impaired subgroups.

Role of the health care supervisor in management of a therapeutic milieu

The health care supervisor responsible for establishing a therapeutic milieu within a traditional hospital organization will have greater success if these suggested management strategies are employed. Decentralizing, improving organizational communication, and clarifying interdisciplinary role relationships are the strategies that support the integration of differing organizational approaches to management.