The role of cooking practices in the transmission of the foodborne parasite Taenia solium: A qualitative study in an endemic area of Southern Tanzania.

The pork tapeworm Taenia solium is a zoonotic food-borne parasite endemic in many developing countries causing human cysticercosis and taeniosis as well as porcine cysticercosis. It mainly affects the health of rural smallholder pig farmers and their communities, resulting in lower health status, reduced pork quality, and economic loss due to condemnation of pigs or low pricing of pork. This qualitative study aimed to identify key food related practices linked to consumption of pork at village level, of importance for transmission of taeniosis. We used an interpretivist-constructivist paradigm in a multiple case study of exploratory qualitative research design. Data was acquired through guided and probing interviews with 64 pork cooks, and 14 direct observations in four villages in a T. solium endemic area of Mbeya Region in the Southern Highlands of Tanzania. The study showed that the informants were members of communities of practice through their pork cooking practices, one community of practice for the restaurant cooks and one for the home cooks, learning, sharing, and distributing their cooking skills. Furthermore, the analysis showed that the pork cooks generally had some awareness of there being something undesirable in raw pork, but they had very diverse understandings of what it was, or of its potential harm. Major potential transmission points were identified in restaurants and in home kitchens. It appears that the pork cooks act according to socio-cultural and economic factors guiding them in their actions, including pressure from customers in restaurants, the family values of tradition in the home kitchens, and the culturally guided risk perception and appraisal. These practices might generate potential transmission points. Future research on interventions aimed at preventing the spread of T. solium taeniosis should recognise the importance of tradition and culture in risky food practices.

Trial Design of a Prospective Multicenter Diagnostic Accuracy Study of a Point-of-Care Test for the Detection of Taenia solium Taeniosis and Neurocysticercosis in Hospital-Based Settings in Tanzania.

Taenia solium diagnosis is challenging as trained personnel, good diagnostic tools, and infrastructure is lacking in resource-poor areas. This paper aims to describe the study trial design adopted to evaluate a newly developed rapid point-of-care test that simultaneously detects taeniosis and neurocysticercosis (TS POC) in three district hospitals in Tanzania. The two-stage design included three types of patients: patients with specific neurological signs and symptoms (group 1); patients with complaints compatible with intestinal worm infections (group 2); patients with other symptom(s) (group 3). For group 1, all patients were tested using the TS POC test (stage 1), after which all positive, and a subset of negative, patients were selected for laboratory reference tests, clinical examination, and a brain computed tomography (CT) scan (stage 2). For groups 2 and 3, a similar design was adopted, but clinical examination and a brain CT scan (stage 2) were only performed in patients who were TS POC test-positive for cysticercosis. Due to the lack of a gold standard, a Bayesian approach was used to determine test accuracy for taeniosis and cysticercosis. For neurocysticercosis, a composite case definition was used as the reference standard. If successful, this study will help the future developments (commercialization and implementation) of the rapid test and improve patient management and disease prevention.

The effect of temperature and time on the viability of Taenia solium metacestodes in pork.

OBJECTIVE: Taenia solium taeniosis is a growing health problem in large parts of the world including Sub-Saharan Africa. Humans are infected by eating undercooked pork with T. solium metacestodes, which cause taeniosis. The aim of the present study was to assess the effect of increasing temperatures on T. solium metacestode viability in pork. METHODS: Heavily T. solium infected pieces of pork were cooked in a water-bath at five different temperatures (40 °C, 50 °C, 60 °C, 70 °C and 80 °C) for 10-60 min. At each temperature/time point, five 5x5x5 cm pieces of pork fitted with thermometers at the core were placed in the water-bath. Controls were kept at 5 °C throughout exposure. After exposure, approximately 100 intact metacestodes were harvested and after a maximum of 6 h incubation at 37 °C in a culture media consisting of 50% porcine bile and 50% saline, the metacestodes were evaluated for viability. RESULTS: The metacestodes were fully viable after cooking at a core temperature of 40 °C for up to an hour. The metacestodes were non-viable after cooking for >40 min at a core temperature over 50 °C. All metacestodes were dead after cooking for 30 min at a core temperature of 60 °C; at 70 °C, non-viability was found after 20 min and all metacestodes were dead after 10 min cooking at 80 °C. CONCLUSION: Findings showed that pork pieces cooked at >80 °C for >10 min proved safe for human consumption. This means that dishes consisting of pork pieces in sizes not greater than a 5 cm cube which are immersed in continuously boiling water for at least 10 min would be safe to eat. However, pork deep-fried in oil may entail a risk due to generally shorter cooking time. More research on the cooking practises is needed in order to produce safe guidelines for risk-free pork consumption.

Vascular "pseudo invasion" in laparoscopic hysterectomy specimens: a diagnostic pitfall.

Total laparoscopic hysterectomy has been shown to be an equally effective and safe technique when compared with conventional abdominal surgery for endometrial carcinoma. The procedure, as performed at our institution, involves the use of a uterine balloon manipulator (RUMI manipulator and Koh Colpotomizer system) for optimal surgical control. The fallopian tubes are cauterized to prevent transtubal spread of the tumor. The balloon manipulator thus creates a positive closed pressure system within the uterine cavity. After observing extensive displacement of tumor into small and large blood vessels in 1 case of grade 1, stage 1b endometrial carcinoma, we reviewed slides from 37 hysterectomy specimens (7 for endometrial carcinoma or atypical hyperplasia and 30 for benign conditions) performed laparoscopically between August 2004 and March 2006 at Emory University and Crawford Long Hospitals. We reviewed all slides for the presence or absence of endometrial tumor/tissue in vascular spaces. Patients with endometrial carcinoma/atypical complex hyperplasia included 6 FIGO grade I endometrioid carcinomas (3 stages 1A; 3 stages 1B) and 1 patient with atypical complex hyperplasia. Tumor within blood vessels was noted in 5 of 7 (71%) cases. In 3 cases, including the case of atypical complex hyperplasia, the number of vessels containing tumor were too numerous to count small and large caliber blood vessels. In the remainder, 1 case had 2 small vessels involved and in the other 7 small vessels showed tumor within vascular lumina. Benign endometrial glands and stromal tissue were noted within vascular spaces in 4 of 30 (13%) hysterectomy specimens removed for benign conditions. We describe a hitherto unreported artifact of vascular pseudo invasion in hysterectomy specimens obtained using the technique of total laparoscopic abdominal hysterectomy. We postulate that the creation of a closed pressure system generated as part of the operative technique is likely responsible for this phenomenon. Pathologists need to be aware of this artifact to avoid misinterpretation of vascular invasion in these cases with its associated therapeutic and prognostic implications.

Molecular analysis of an immature ovarian teratoma with gliomatosis peritonei and recurrence suggests genetic independence of multiple tumors.

Immature ovarian teratoma is a common germ cell tumor of young women. Patients with immature teratoma often exhibit multiple neoplasms, including tumors outside the ovaries, and occasionally a rare benign condition termed gliomatosis peritonei (GP). These multiple neoplasms are generally believed genetically-linked progeny of the ovarian tumor resulting from local recurrence/spread. In this study, we performed a molecular analysis of a single patient clinically diagnosed with immature ovarian teratoma, GP, and recurrent pelvic mucinous teratoma. Microsatellite PCR and amplicon analysis was performed to genetically characterize tissue samples from omental glial implants and multiple peritoneal tumors. PCR-based amplification of microsatellite markers identifies unique genetic differences (allelic variation) between tumors resulting from divergent natural histories among multiple tumor nodules in a single patient. A total of 21 different microsatellite markers were employed, and seven provided informative results (D3S1744, D6S1056, D7S2846, D14S306, D16S764, D18S858, D22S420). These markers demonstrated mutually exclusive genetic differences among the tumors from this patient, establishing the neoplasms as genetically distinct from each other (non-identical), and that no lineage relationship exists among them. This observation suggests that the multiple tumors arising in this patient with immature ovarian teratoma, GP, and recurrent pelvic mucinous neoplasm represent multiple independent tumors rather than true tumor recurrence/spread. The results of this study suggest strongly that patients with recurrent teratoma may be afflicted with a tumor-prone syndrome where one or more peritoneal cell types or populations are predisposed to neoplastic conversion and formation of tumors as a result of an endogenous or exogenous neoplastic stimuli.

Endometrial adenocarcinoma associated with elevated serum concentrations of the free beta subunit of human chorionic gonadotropin.

We report a case of a histologic grade II endometrial adenocarcinoma without trophoblastic differentiation in a 24-year-old woman with an elevated serum concentration of human chorionic gonadotropin (hCG) and with no evidence of pregnancy. Serum and urine specimens were used to study the hCG immunoreactivity. Qualitative tests performed on serum and urine using 5 different assays produced conflicting results. The hCG concentration in serum and urine was quantified using assays designed to detect different molecular forms of the molecule; analysis revealed that serum hCG immunoreactivity was due entirely to the presence of the free beta subunit. Immunohistochemical analysis performed on tissue samples showed strong cytoplasmic staining for hCG. While hCG is a well-recognized tumor marker in gynecologic malignant neoplasms, immunoreactivity most often is due to the presence of both intact molecule and the free beta subunit. To our knowledge, this is the first report of an endometrial adenocarcinoma producing only the free beta subunit of hCG.

[Subjective quality of life of children and adolescents with psychiatric disorders: development and validation of a new assessment scale]. / Zur subjektiven Lebensqualität von Kindern und Jugendlichen mit psychischen Störungen: Entwicklung und Validierung eines neuen Erhebungsinstruments.

Within paediatric disciplines and in particular in child and adolescent psychiatry very little work is available regarding the quality of life (QoL) of patients. After using literature search and interviews for identifying the relevant QoL domains, a set of self report questionnaires (for the parents: proxy rating) was developed (C-version: children 10 to 14 years, A-version: adolescents 14 to 18 years, P-version: parental proxy rating about child/adolescent). It was aimed at an almost identical wording within each questionnaire version in regard to the different QoL domains. The questionnaires should not primarily address symptomatology (like e.g. the Child Behaviour Checklist by Achenbach and Edelbrock 1983). After a pilot phase ensuring adequacy and appropriateness of the forms, the questionnaires were field tested in a consecutive series of nearly 700 patients which were referred to the Cologne university department of child and adolescent psychiatry for diagnosis and treatment between 1996 and 2000. The intended structure of the questionnaire system with symptom and functioning scales concerning the domains: "physical performance, fatigue, anxiety, depression, peer group, school, family, beliefs, general QoL" and some further single questions was confirmed by psychometric testing (validity and reliability). Interscale correlations were in general moderate, exhibiting the expected pattern. Analyses of variances using the method of "known groups comparisons" showed e.g. age, sex, and diagnosis related effects hinting towards clinically meaningful differences. The questionnaire forms were well accepted and understood by patients and parents and the wording of the addressed topics was reported to be adequate. Further work will include the psychopathological findings and will focus on specific subgroups of patients (e.g. different diagnoses) as well as on the longitudinal observation of special patient groups, e.g. patients with eating disorders. It can be concluded that the new QoL instruments were successfully employed in a consecutive series of patients and showed very sufficient psychometric properties.

Invasive squamous cell carcinoma of the vagina in the setting of true hermaphroditism.

BACKGROUND: Primary vaginal cancer constitutes less than 2% of all malignancies of the female genital tract and is even rarer in true hermaphrodites. A unique case report of the occurrence of both of these developments in the same patient is presented. CASE: A 31-year-old 46,XX hermaphrodite presented with a history of vague abdominal symptoms and weight loss. Surgery was performed, and pathology revealed invasive squamous cell cancer arising in an epithelial-lined tissue consistent with vagina. The patient subsequently completed whole pelvic external-beam radiation therapy with cisplatin chemosensitization. CONCLUSION: This is a case of primary vaginal cancer in a patient with true hermaphroditism, which is exceedingly rare. It is a reminder that malignant changes in residual mullerian tissue should be considered in these patients.

Primary leiomyosarcoma of the vagina: a case report involving a TVT allograft.

INTRODUCTION: Primary malignant lesions of the vagina represent less than 2% of all gynecologic malignancies. Primary vaginal sarcomas account for about 2% of all malignant vaginal lesions, with leiomyosarcoma being the most common vaginal sarcoma found in adult women. CASE: We report a case of primary vaginal leiomyosarcoma occurring in the field of a prior tension-free vaginal tape (TVT) procedure using a Bard Duraderm allograft. CONCLUSION: This report represents the first report, to our knowledge, of a vaginal sarcoma arising in the field of a Bard Duraderm TVT allograft. Although the product is no longer available for this use, the ongoing studies of the TVT procedure and outcomes should include this potential complication in their review.

The role of optimal debulking in advanced stage serous carcinoma of the uterus.

OBJECTIVE: To evaluate the role of optimal surgical cytoreduction and postoperative therapy in women with advanced uterine serous carcinoma (USC). METHODS: A multi-institutional, retrospective review identified 52 women with stage IV USC. Patient factors, surgical findings, and follow-up data were collected. Differences in demographics, surgical treatments, and adjuvant therapies administered were assessed with Fisher's exact test. Analysis of survival was performed using Kaplan-Meier and comparisons of survival were made using the log-rank test. RESULTS: Twenty-six women were optimally debulked ( 0.05). Median survival was longer in the optimal group (15 vs. 8 m), however, this did not reach statistical significance (P > 0.05). Women who received adjuvant platinum-based chemotherapy had a longer median survival than those who did not receive platinum chemotherapy (21 vs. 2 m) (P < 0.0001). Optimal cytoreduction combined with adjuvant therapy demonstrated a trend toward prolonged survival when compared to suboptimal cytoreduction combined with adjuvant therapy. However, the results did not achieve statistical significance (P > 0.05). CONCLUSION: Although no clear survival advantage is shown in the women who underwent optimal versus suboptimal debulking, there was a trend towards longer median survival in those who were maximally cytoreduced. Adjuvant platinum-based chemotherapy is associated with significantly longer survival in all women, regardless of amount of residual disease.