Tumor eradication and cell survival after localized hyperthermia induced by ultrasound.

This study was designed to test the effect of localized ultrasound-induced hyperthermia on experimental mouse tumors. Transducers operating at 5.17 MHz with relatively uniform output over an area 1 cm in diameter were used to heat EMT6 and KHJJ tumors in 407 BALB/cKa mice. Treatments were at 43, 43.5, 44, and 44.5 degrees. At each temperature level, treatments were applied for 15, 30, or 45 min. Temperature profiles measured in tumors treated by ultrasound hyperthermia indicated that heating was not completely uniform. In general, both rate of tumor eradication and growth delay increased as temperature and/or time of exposure increased. The EMT6 and KHJJ tumors had comparable rates of eradication for the same temperatures and times of exposure. Cell survival studies indicated that there was considerable variation in cell killing between individual EMT6 tumors exposed to the same hyperthermic dose. In addition, cell death appeared to be progressive over a period 2 to 48 hr after hyperthermic exposure. The mechanism of this delayed cell death is not known but may be important in eradicating the tumors. Ultrasound was a relatively safe and effective method of heating tumor volumes up to 44 degrees, and hyperthermia alone resulted in high rates of tumor eradication in the EMT6 and KHJJ systems.

Tumor cure and cell survival after localized radiofrequency heating.

Radiofrequency electromagnetic fields at 13.56 MHz were used to heat locally EMT-6 sarcomas and KHJJ carcinomas in BALB/cKa mice. Temperature profiles obtained in tumors during treatment showed uniform temperature distribution throughout the tumor volume with no systemic hyperthermia. Temperature could be maintained at a stable level throughout treatment by adjustment of power. Tumors were treated at 43 degrees, 43-5 degrees, and 44 degrees, for 5, 10, 20, 30, and 40 min. The EMT-6 tumor was highly sensitive to cure by radiofrequency heating: a 5-min exposure at 44 degrees resulted in cure of almost 50% of the tumors. Cure rate was a function of temperature and of duration of exposure. The KHJJ carcinoma was somewhat more resistant to cure by radiofrequency heating, although most of the animals treated at 43.5 degrees or above were cured of their tumors. In an effort to explain the remarkable effectiveness of radiofrequency heating, tumor cell survival studies were done on EMT-6 tumors treated in situ. Cell inactivation by radiofrequency heating was similar to that for hot water bath heating. However, direct cell killing cannot account for the observed cures, and an additional mechanism must be responsible for tumor eradication.

Psychoanalytic training. Problems and perspectives.

The increasing prolongation of the didactic analysis and supervisory hours that has occurred in most psychoanalytic institutes over the past several decades has not only failed to guarantee a better trained and more scientific group of psychoanalysts, but, because of the unhealthy and authoritarian hegemony of training analysts over their candidates, may be having a contrary effect of fostering rigidity and dogmatism. If psychoanalysis is to remain vital, it must be open to growth and change like any other branch of science and its practitioners must be flexible and open to new vistas of knowledge from whatever source. A suggestion is offered that would enable psychoanalytic candidates, in most instances, to complete their training within a four-year period.

Short-term dynamic psychotherapy.

Short-term dynamic psychotherapy is rooted in psychoanalytic theory. The author traces the historical background of brief psychotherapy, focusing on the contributions of Freud, Ferenczi, Rank, and Alexander and French, and then presents a synthesis of contemporary views. Selection criteria for patients who can benefit from short-term therapy, and the techniques used, are discussed. Similarities to and differences from crisis intervention techniques are pointed out. The trend of the future can be expected to be toward shorter-term therapies, but given the present state of psychiatric knowledge, long-term therapy will still be necessary for many patients.

Systems thinking in psychiatry: some theoretical and clinical implications.

The author discusses the theoretical and pragmatic value of systems thinking in psychiatry. An awareness of the pluralistic, multifactorial origins of psychopathology broadens the psychiatrist's understanding and increases his or her therapeutic potential. The psychiatrist who thinks in systems terms is a true generalist in medicine, and to practice that way is the most effective way of treating people.

Recent trends in psychotherapy.

The author briefly reviews and tentatively categorizes a number of psychotherapeutic techniques that have emerged in recent decades, particularly those which fall under the rubic of the human potential movement. He asks and endeavors to answer four major questions with regard to these therapies: 1) What is the meaning of their rise and popularity? 2) Do they help and, if so, how? 3) Do they present any dangers? 4) What relevance and meaning do they have for more conventional psychotherapists? He also briefly discusses some of the cognitive therapies and the common demoninators in all psychotherapies. The author closes with a plea for a flexible approach to psychotherapy.

Impact of adjuvant chemotherapy on cosmesis and complications in stages I and II carcinoma of the breast treated by biopsy and radiation therapy.

Cosmesis and complication rates were examined in patients with early stage carcinoma of the breast treated by biopsy and radiation therapy with and without adjuvant chemotherapy in an attempt to determine the effect of chemotherapy upon these parameters. Between April 1, 1975 and June 1, 1980, 51 patients were treated with radiation therapy and adjuvant chemotherapy (XRT + ACT) and 83 patients with radiotherapy alone (XRT). Chemotherapy usually consisted of cytoxan, methotrexate and 5-fluorouracil for 6 or 12 cycles. Minimum follow-up was 36 months. Cosmetic results deteriorated with time in both groups but to a greater extent in the XRT + ACT group. At 36 months, excellent cosmetic results were obtained in 73 of the 83 patients (88%) in the XRT group compared to 37 of 51 patients (73%) in the XRT + ACT group (p = less than .05). Comparison of the two treatment groups revealed that complication rates were significantly increased in the XRT + ACT group. Of the 51 patients in the XRT + ACT group, 21 patients (41%) suffered complications compared to 8 (10%) of the 83 patients in the XRT group (p = less than .001). This difference in complication rates resulted primarily from an increased incidence in the XRT + ACT group of wet desquamation in the electron beam portal used to treat the internal mammary lymph nodes and a trend towards a higher incidence of spontaneous nonpathologic rib fractures, myositis and arm edema. An increased incidence of nonbreast primary cancers was not seen. Our preliminary conclusions are that adjuvant chemotherapy has a negative impact upon cosmesis and complication rates in patients being treated with definitive radiotherapy. However, cosmetic results remain satisfactory and complication rates are maintained at an acceptable level. Continued close follow-up will be required before definitive conclusions can be reached as to the overall incidence and severity of the changes noted.

Factors encouraging cohort maintenance in a longitudinal study.

Maintenance of the cohort is one of the primary challenges of a longitudinal study. At the end of 3 years of follow up in the Framingham Children's Study, a longitudinal study of young children and their parents, 100 of the original 106 families (94.3%) have remained in the study. A questionnaire was administered to identify factors contributing to the high rate of follow up to this point in the study. The attitudes of the staff, feedback to the subjects, the staff's handling of questions and problems, and association with the Framingham Heart Study emerged as the most important factors influencing continued participation in the study. In addition, 99% of the subjects stated that they believed the medical research to be important. We conclude that the quality of the communication with study participants and the subjects' perceived importance of the research have been the key factors in maintaining the cohort in this longitudinal epidemiologic study.

Optic nerve head involvement with cytomegalovirus in an adult with lymphoma.

An optic nerve swelling that was thought clinically to represent a lymphomatous infiltrate of the nerve head developed in a 51-year-old man with histiocytic lymphoma. Histologic examination of the eyes showed the presence of cytomegalovirus (CMV) in the nerve head, but no lymphoma cells. Tru lymphomatous invasion of the nerve head in systemic lymphoma is probably very rare. This case points out an unusual manifestation of adult CMV infection, and a new concern in patients with compromised immune systems.

Mother and teacher reports of ADHD symptoms: DSM-IV Questionnaire data.

OBJECTIVE: Diagnosis of attention-deficit/hyperactivity disorder (ADHD) is thought to be best accomplished by a multimodal approach. In many research and clinical settings, such extensive procedures may not be feasible. A screening instrument that could identify children meeting necessary (but not sufficient) criteria would permit selection of subgroups for more resource-intensive diagnostic procedures. METHOD: The Diagnostic Rating Scale (DRS) was completed by the mothers and teachers of 124 children referred to hospital-based clinics and 225 nonreferred children. The authors performed principal components analysis (PCA) on the questionnaire, compared the scores obtained by children from the 2 samples, and examined age and gender effects. Diagnoses derived from the DRS were not validated against structured diagnostic interviews. RESULTS: PCAs replicated the DSM-IV symptom combinations. Children from the referred sample exhibited more symptoms (p < .001) than children from the community sample. Boys were overrepresented among the children who received DRS-derived ADHD diagnoses. Girls were more likely (92%) to receive a diagnosis of ADHD, predominantly inattentive subtype, than other ADHD diagnoses. CONCLUSIONS: The results of this study provide preliminary support for the validity of the parent and teacher DRS as time- and resource-efficient screening instruments for examining symptoms associated with ADHD.