Pseudomyxoma peritonei arising from colonic polyps.

AIMS: Pseudomyxoma peritonei may have as its primary site a mucinous gastrointestinal adenoma or carcinoma that gains access to the peritoneal cavity. This manuscript describes this disease arising from a benign or malignant colonic polyp. METHODS: From a database of over 1000 pseudomyxoma peritonei patients and colorectal carcinomatosis patients, three cases were identified in which the primary tumor site was a colonic polyp. The clinical history and course of these patients were studied. RESULTS: In a review of the clinical management of these patients, all three had an event whereby neoplastic cells from the surface of the colonic polyp could have gained access to the free peritoneal cavity. The patients developed the characteristic pseudomyxoma peritonei syndrome. All three patients were treated with cytoreductive surgery plus perioperative hyperthermic intraperitoneal chemotherapy. CONCLUSIONS: Colonic polyps can serve as a source of dysplastic cells whereby pseudomyxoma peritonei can result. Caution to prevent seeding to the free peritoneal cavity during surgery for colonic polyps should be observed. If pseudomyxoma peritonei develops, cytoreductive surgery and perioperative intraperitoneal chemotherapy should be considered for treatment.

Endocrine parameters and alpha-tocopherol therapy of patients with mammary dysplasia.

Patients with mammary dysplasia (17 patients) and controls (6 patients) were treated in a double-blind study with alpha-tocopherol acetate (600 units/day). Determination of serum alpha-tocopherol, estradiol, estriol., and progesterone were made from blood samples collected on Day 21 of the menstrual cycle before and during therapy. Eight-eight % of patients showed clinical response to therapy. Serum alpha-tocopherol concentrations rose after therapy in patients and controls. Serum estradiol and progesterone concentration were not statistically different in patients or controls after therapy, although patients showed a trend toward increased serum progesterone concentration. However, the ratio of progesterone to estradiol, which is abnormal in mammary dysplasia patients, rose from 30 +/- 7 (S.E.) to 53 +/- 11 in patients after alpha-tocopherol therapy (p less than 0.05). Control patients showed no significant change in progesterone/estradiol ratio. Results of this study indicate that alpha-tocopherol therapy may correct an abnormal progesterone/estradiol ratio in patients with mammary dysplasia, with implications on reducing future risk for malignant breast disease.

Hearing screening of high-risk newborns with brainstem auditory evoked potentials: a follow-up study.

Numerous techniques have been used in attempts to find a reliable and efficient screening method for determining auditory function in the newborn. The brainstem auditory evoked potential (BAEP) is the latest method advocated for that purpose. The BAEP was evaluated as a hearing screening test in 168 high-risk newborns between 35 and 45 weeks of conceptual age. Follow-up data were obtained after 1 year (mean 17.3 months) on 134 of the infants (80%). Normal hearing was defined as a reproducible response in both ears to a 25 dB normal hearing level (nHL) click stimulus; 21 infants (12.5%) failed the initial screening test. Follow-up on 19/21 infants revealed 18 infants with normal hearing and one infant with an 80 dB nHL bilateral hearing loss substantiated. One infant with an abnormal screening test died before retesting, and the other infant was lost to follow-up but had only a unilaterally abnormal BAEP. None of the infants with a normal BAEP screening study had evidence of hearing loss on retesting. Sensitivity of the BAEP was 100%, specificity was 86%, predictive value of a positive test was 5.26%, and the predictive value of a negative test was 100%. The incidence of significant hearing loss in our population was between 0.75% (1/134 infants) confirmed, and 2.24% (3/134 infants) including infants who failed screening but were lost to follow-up. The BAEP is a sensitive procedure for the early identification of hearing-impaired newborns. However, the yield of significant hearing abnormalities was less than predicted in other studies using BAEP for newborn hearing screening.

Therapeutic abortion in California. Effects of septic abortion and maternal mortality.

PIP: The impact of the reformed California abortion law, passed in November 1967, is investigated. The law allows interruption of pregnancy in the presence of substantial risk of grave impairment to the mental or physical health of the mother. Septic abortions (complete or incomplete abortion in a patient whose gestation is less than 20 weeks; duration and whose temperature is greater than 100.4 degrees F for more than 4 hours) per 1000 deliveries at San Francisco General Hospital fell from 69 in 1967 to 22 in 1969. The total number of abortions rose from less than 100 per 1000 births in 1968 to more than 250 in 1969. Maternal deaths due to abortion decreased in California per 100,000 live births from 8 to 5 to 3 in 1967, 1968, and 1969. Maternal deaths due to other causes remained relatively fixed in incidence. Maternal deaths have decreased much more markedly in the San Francisco Bay area, where many more therapeutic abortions have been performed, than in the Los Angeles Area, where relatively few therapeutic abortions have been performed. The decrease in septic abortion seems to represent a trend toward decrease in the number of illegal abortions.^ieng

Medical management of mammary dysplasia.

As a primary care physician for women, the gynecologist frequently is faced with management of patients who have benign breast disease. Mammary dysplasia, or fibrocystic disease, clinically presents a difficult management problem, both in terms of relieving the patients' symptomatology and of detecting occult malignancy. Traditionally, diuretics, salt restriction, and hormone therapies have been recommended. Recently, data concerning nutritional impact on this disease process, including methylxanthine restriction and tocopherol therapy, have been reported. New, effective pharmacologic agents also are now available. This article reviews the efficacy of these therapeutic regimens and recommends a rational approach for the management of patients with mammary dysplasia.

Myasthenia gravis and preeclampsia.

Myasthenia gravis in pregnancy is rare, and its occurence in conjunction with preeclampsia has not been previously described. A case report of preeclampsia in a myasthenic patient is described with recommendations for management. The authors conclude that magnesium is a contraindicated pharmacologic agent in a myasthenic patient.

The effect of vitamin E on mammary dysplasia: a double-blind study.

Alpha-tocopherol (vitamin E) has been used to treat patients with benign breast disease. To evaluate the efficacy of this treatment, a randomized, double-blind placebo-controlled study was performed on 128 women with confirmed mammary dysplasia. Patients were treated with placebo or 150, 300, or 600 IU of d, 1 alpha-tocopherol per day for two months; breast examinations, sonography, and thermography were performed in the midluteal phase of the menstrual cycle before and after treatment. No significant objective effects to treatment were noted in any of the parameters monitored. In addition, serum concentrations of estradiol, progesterone, dehydroepiandrosterone sulfate, and testosterone were measured before and after treatment. There were no significant effects on concentrations of these hormones. From this study, d, 1 alpha-tocopherol does not seem to be beneficial in the treatment of patients with mammary dysplasia.

Prevention of pregnancy in rabbits using vaginal application of prostaglandin f2alpha.

Seventy-two rabbits were artificially inseminated at the time of ovulation induced by intravenous human chorionic gonadotropin. Twenty-four hours later vaginal suppositories containing graded amounts of prostaglandin F2alpha (PGF2alpha) (5 to 25 mg) were inserted into test rabbits in each group. A control group received plain vaginal suppositories. Ten days later the rabbits were killed and examined for numbers of corpora lutea and implantation sites. The results indicate that 5 to 15 mg of PGF2alpha had no effect or a minimal effect on the number of implantation sites, that 20 mg of PGF2alpha reduced the number of implantation sites, and that 25 mg of PGF2alpha was the most effective dose. Fifteen of twenty treated rabbits were not pregnant, despite the presence of ovarian corpora lutea. Four remaining rabbits were pregnant but had markedly reduced implantation sites (four, two, three, and two fetuses, respectively. PGF2alpha is known to increase tubal motility markedly. These data are consistent with such a mechanism's inhibiting pregnancy when used postcoitally in rabbits.

Sequence of drug use among serious drug users: typical vs atypical progression.

Sequence of drug use was examined in a secondary analysis of two samples of serious drug users: one of 152 men and one of 133 women. The proportions of drug users following specified patterns of drug use onset were compared to proportions obtained in previous research in samples of high school youth, and serious drug users. The serious drug users were substantially different from high school samples in their progression of drug use. The serious drug users were less likely to follow the typical sequence identified in previous studies (alcohol, then marijuana, followed by other illicit drugs). They were more likely to have used marijuana before using alcohol, and more likely to have used other illicit drugs before using marijuana. We also found that atypical sequencing was associated with earlier initiation of the use of illicit drugs other than marijuana and greater lifetime drug involvement. These findings suggest that for a large number of serious drug users, marijuana does not play the role of a 'gateway drug'. We conclude that prevention efforts which focus on alcohol and marijuana may be of limited effectiveness for youth who are at risk for serious drug abuse.

alpha-fetoprotein and screening markers of congenital disease.

Alpha-fetoprotein (AFP) is produced in the gut and liver during fetal life and appears to act like albumin in the adult. Because AFP appears in the maternal circulation during pregnancy, interest has been focused on its measurement in maternal serum to predict fetal abnormality. In addition, AFP, as an embryonic product, is elevated in certain malignant states. This article provides a summary of current clinical knowledge of AFP and its applications.

Reliability of contact-thermogram reading services.

Contact thermography has been advocated by some as a rapid, noninvasive diagnostic modality in evaluating patients at risk for breast cancer. In order to study the value of different criteria for interpreting thermograms, two sets of contact thermograms from 34 patients with benign breast disease were submitted to two different reading services. The results suggest that interrater agreement is enhanced when thermograms are classified as "normal" and "abnormal" rather than as class I-V.

Evaluation and treatment of breast symptoms in patients with the premenstrual syndrome.

Breast symptoms are a common finding in women with the premenstrual syndrome (PMS). The underlying endocrine pathophysiology of PMS and benign breast disease may be similar and possibly related. Endocrine theories concerning both disorders have been developed, and nutritional intervention can be of aid. In a double-blind study, breast symptoms of PMS were recorded before and after vitamin E or placebo was administered. A significant decrease (p less than 0.05) in some of the symptoms was noted.

From bag brides to skeezers: a historical perspective on sex-for-drugs behavior.

There are many ways that women support their use of crack cocaine, including sex-for-crack bartering and other forms of prostitution. Empirical studies conducted in the mid-1970s and in the mid-1980s in New York City, and in Chicago in the late 1980s to early 1990s are compared, analyzing similarities and differences between the contemporary crack-prostitution scene and previous prostitution scenes. Findings suggest that the arrival of crack cocaine has directly and indirectly affected the drugs-prostitution nexus by lowering the price of sex for street prostitutes, altering the social status of cocaine, and increasing the level of social disorganization in illicit street activities, including prostitution. Barterers are shown to be the heaviest drug users, using the greatest variety of drugs, using larger amounts of drugs, and using more frequently.

Race/ethnicity and gender differences in the drugs-violence relationship.

This article examines the drug relatedness of violent events reported by White, Black, and Hispanic male and female street drug users from New York City. The primary purpose is to determine if the drugs-violence relationship varies for these different populations of drug abusers. Drug relatedness is assessed according to a tripartite conceptual model of the general relationship between drugs and violence. Significant race/ethnicity and gender differences were found in regard to the number of violent events manifesting specific drug-related dimensions of violence, the drugs associated with these violent events, and the primary reasons for the occurrence of these events. The implications of these findings are discussed.

Drugs, violence, and federal funding: a research odyssey.

Two decades of research activity focusing on drugs/violence relationships are described. Initial interest in this area was kindled by field experiences. Literature review revealed a dearth of concepts and data. A tripartite conceptual framework was formulated to define drug-related violence. A series of empirical studies were undertaken to verify and elaborate the conceptual framework. Findings from these studies debunked prevailing mythology about drugs/violence relationships. Findings also demonstrated the usefulness of a public health perspective and the critical importance of collecting qualitative data in order to achieve a deeper understanding of these phenomena.