Sexual activity and functioning in ovarian cancer survivors: an internet-based evaluation.

OBJECTIVES: Sexual dysfunction is a known complication of treatment for many cancers, but there have been relatively few studies investigating outcomes for ovarian cancer survivors. We have previously reported that women treated for ovarian cancer experience persistent psychological and physical problems. Sexual functioning was highlighted as a significant factor and we sought to investigate this further. METHODS: Women were invited to complete a questionnaire using both paper and online response formats. A validated tool, the Sexual Activity Questionnaire, was used to obtain information from women following a diagnosis of ovarian cancer. RESULTS: Across all responders (n = 102, mean age 51.3 years), 63% of women reported their ovarian cancer diagnosis had negatively changed their sex life. The most common reasons given for an absence of sexual activity were a lack of interest in sex, physical problems that prevented sex or no partner. Of the 46% of responders who stated they were sexually active, 77% reported pain or discomfort during intercourse and 87% described vaginal dryness. CONCLUSION: For the majority of women, treatment for ovarian cancer negatively impacts on their sex lives. Many of the symptoms described by participants are potentially reversible and clinicians should be open to raising the issue of sexual functioning with their patients.

Miniature LiF:Mg,Cu,P TLDs to study the effect of applicator material in 192-Ir brachytherapy.

Dose calculations in brachytherapy planning typically don't take into account inhomogeneities and the material of applicators. We evaluated the justification of the latter by investigating the dose delivered in 192-Ir interstitial implants employing plastic catheters and steel needles using miniature LiF:Mg,Cu,P thermoluminescence dosimeters (TLDs) which fit in the applicators. Within the uncertainty of the measurement (+/- 5%) no difference could be found in the dose distribution from 192Ir in steel needles or plastic catheters. Computerized treatment planning (Philips/ADAC Pinnacle) was in good agreement with the measured data.

A morphologic study of long-term retention of fluorocarbon after liquid ventilation.

STUDY OBJECTIVES: To determine how long perfluorinated hydrocarbons remain in the lung after they are used for lung ventilation in dogs, and to determine if residual perfluorinated hydrocarbons cause structural alteration or an inflammatory reaction of the lung. DESIGN: Adult dogs were anesthetized and received ventilation with oxygenated perfluorinated hydrocarbon liquid. Morphologic studies of tissue from the lungs of these dogs were performed at intervals of a few minutes to 10 years after reconversion to breathing gas. SETTING: University College of Medicine. PARTICIPANTS: Adult mongrel and beagle dogs. INTERVENTIONS: Anesthetized adult dogs breathed oxygenated liquid fluorocarbons for 1 h and then were reconverted to breathing air. Three fluorocarbons, FX-80 (C(8)F(16)O; 3M Company; St. Paul, MN), Caroxin-D (C(10)F(22)O(2); P-1D; Allied Chemical Company; Morristown, NJ), and Caroxin-F (C(9)F(20)O; P-12F; Allied Chemical Company), were used. Morphologic studies of the lungs of these animals were performed immediately after restoration of air breathing and at intervals for up to 10 years. Not all animals were studied at each time interval. MEASUREMENTS AND RESULTS: A transient, acute inflammatory reaction was followed by a massive influx of macrophages, which were at first intra-alveolar and later interstitial, especially around vessels and bronchioles. Fluorocarbons remained in the lung in diminishing amounts for at least 5 years, as evidenced by persistent vacuolated macrophages in the alveoli, interstitium, and hilar lymph nodes; fluorocarbon was also detected in these tissues by chemical assays. In no case was there fibrosis or any other structural alteration associated with the residual fluorocarbon, which suggests that it was inert. At 10 years, no evidence of residual fluorocarbon was seen morphologically.

Long-term results of continuous oxygen therapy at sea level.

Twelve patients with hypoxemia associated with severe chronic obstructive pulmonary disease were treated with continuous portable oxygen therapy and have been followed up for a mean period of 25.2 months at sea level. Pulmonary function testing has revealed no further significant deterioration at long-term follow-up (17 months). After oxygen therapy was initiated, arterial carbon dioxide tension increased slightly, but decreased to pretreatment levels when patients were allowed to breathe room air. The electrocardiogram, which was unchanged at one month, has shown some reversal of cor pulmonale in five patients. Six patients have died, yielding a 56 percent survival rate at two-and-one-half years by the life table analysis. Five patients were autopsied, with possible oxygen toxicity being present in only one. The quality of life in our patients was improved and was especially represented by a reduction in hospital admissions for respiratory illness. We believe that continuous oxygen therapy is beneficial and worthwhile economically in certain patients.

Amiodarone pulmonary toxicity presenting as bilateral exudative pleural effusions.

Therapy with the antiarrhythmic drug amiodarone has been associated with drug-related side effects. In addition to pulmonary fibrosing alveolitis, anecdotal reports have alluded to incidental pleural involvement associated with amiodarone. We describe an unusual manifestation of amiodarone-induced pulmonary toxicity in a patient with bilateral exudative pleural effusions and toxic involvement of other organs. We review amiodarone-associated pleural reactions reported in the literature.

Liquid ventilation of primates.

Three adult monkeys were anesthetized with ketamine and ventilated with fluorocarbon liquid [perfluoro bis (1, 4-isopropoxy) butane (Caroxin-D)] at 1 atmosphere on two separate occasions. During five runs, liquid ventilation was continued for 60 minutes. The sixth run was continued for ten minutes. Arterial blood gas levels during and after liquid ventilation were adequate for survival. Three years after the first period of liquid ventilation, the animals were killed. Approximately 0.001 mg of fluorocarbon per gram of tissue was present in the kidney, liver, brain, spleen, muscle, and heart. Fat contained approximately seven to nine times this amount, and the lung and pulmonary lymph nodes contained approximately 1,000 times this amount. In no case was it clinically evident that the monkeys had undergone periods of liquid ventilation. We conclude that primates can be ventilated successfully with liquid fluorocarbon on at least two separate occasions and can return to breathing air without obvious deleterious effects, but fluorocarbon is retained in small amounts for at least three years.

Epithelial downgrowth following penetrating keratoplasty in the aphake.

Four of approximately 1,500 patients receiving corneal grafts developed epithelial downgrowth following penetrating keratoplasty. All were aphakic prior to grafting and had complicated postoperative courses. Epithelial proliferation over the iris and endothelium was demonstrated in three cases at the time of a repeat keratoplasty. While rare, this complication may occur more frequently than has been previously recognized.

Intrastromal noninflammatory bacterial colonization of a corneal graft.

Progressive branching, needlelike stromal opacities were observed within a corneal transplant. Analysis of the corneal button by light microscopy and transmission electron microscopy disclosed a localized epithelial ingrowth into the stroma at a suture tract accompanied by intrastromal pockets of gram-positive cocci extending across the cornea. No inflammatory reaction was found in the areas of bacterial colonization. To our knowledge, noninflammatory bacterial colonization of the stroma of a corneal transplant has not been previously described.

Chromobacterium violaceum infection of the eye. A report of two cases.

We report what we believe to be the first two known cases of Chromobacterium violaceum infection of the eye. One patient had conjunctivitis as the initial manifestation of an ultimately fatal infection. In the second patient, who suffered from chronic granulomatous disease of childhood, orbital cellulitis developed as part of a disseminated C violaceum infection from which he subsequently recovered. Infections caused by C violaceum may involve the eye and orbit. These infections are frequently fatal, but early recognition and aggressive treatment may result in a higher cure rate.

Intracranial spread of squamous carcinoma along the trigeminal nerve.

Two patients with intracranial dissemination of squamous carcinoma along the trigeminal nerve had facial dysesthesias mistakenly diagnosed as tic douloureux. In one case, tumor originated in the skin of the lateral canthus and spread along an orbital nerve to involve the cavernous sinus and Gasserian ganglion. In the other, the primary site was the retromolar trigone, with preponderantly deep intraosseous growth. Perineural spread occurred along the inferior alveolar nerve to eventually involve the facial and the ocular motor nerves. Such neurotropic spread of tumors is unfamiliar to many clinicians, yet early diagnosis may be life-saving. If intracranial foramina have not been transgressed, surgery and radiotherapy have been curative; otherwise, treatment is largely palliative. Adequate initial treatment of the primary lesion would seem to be the best preventive measure. Treatment of recurrent lesions should include consideration of neural invasion.

Physiological effects of corticosteroids in foodstuff aspiration.

Aspiration of gastric contents that contain small food particles has been shown to cause severe pneumonitis, even when the pH of the aspirate is greater than 2.5. The effects of corticosteroids on the hemodynamic and ventilatory consequences of this type of aspiration have not been investigated. Twenty healthy mongrel dogs were anesthetized and 2 mL/kg of gastric contents (pH 5.9) that contained small food particles were injected into their tracheas. Group 1 animals (controls, N = 10) received no therapy. Group 2 animals (steroid-treated, N = 10) were given methylprednisolone intravenously, 30 mg/kg, three times a day beginning one hour after aspiration. The animals were observed for 14 days, during which time there were no statistically significant differences between the groups in mortality, PaCO2, pH, systemic and pulmonary arterial blood pressures, fractional intrapulmonary shunt, or histological findings. Arterial PO2 was lower at 24 hours in group 2 dogs than in group 1 dogs. We conclude that steroids are of no benefit in the treatment of foodstuff-induced aspiration pneumonia.

Effects of cardiopulmonary bypass on pulmonary leukostasis and complement activation.

We measured white blood cell counts and complement component (C3a, C4a, and C5a) and prostacyclin levels, and studied lung biopsy specimens, in 16 patients undergoing cardiopulmonary bypass and compared them with four patients undergoing other pulmonary procedures. Bypass caused no significant elevation in peripheral venous white blood cell counts. Higher counts were present in the right atrium compared with the left atrium. Patients who underwent bypass had elevated complement component and prostacyclin concentrations before operation and these levels increased further during operation. Trapping of polymorphonuclear leukocytes occurred in pulmonary alveolar capillaries and venules after bypass. We conclude that bypass activates complement components primarily of the alternative pathway and leads to increased blood prostacyclin levels. These changes are accompanied by polymorphonuclear leukocyte accumulation in the lungs and may be important in initiation of the adult respiratory distress syndrome in these patients.

Positioning for partnerships. Assessing public health agency readiness.

BACKGROUND: Public health organizations are redefining their roles and aligning their structures with other components of the evolving American health system. Health departments must proactively and strategically plan how to position themselves for the coming years. Prior to implementing changes in functioning, structure, and/or future strategies, an organization should assess its internal readiness to commit to creating these substantial alterations. METHODS: Using a diagnostic tool developed by study investigators, employees of the Cobb and Douglas Counties Boards of Health were surveyed in order to assess their organizational readiness to enter into a strategic partnership with Promina Northwest, a not-for-profit hospital network in the Atlanta, Georgia area. Frequency distributions were conducted for each categorical variable and data were analyzed in aggregate and by job category. RESULTS: The 122 analyzed questionnaires revealed some significant trends. Respondents ranked the six factors having the greatest impact on an organization's ability to change in the following order: leadership, planning, teamwork, mission, information and operations. Interestingly, this rank ordering parallels the perceived strengths and weaknesses of the health departments as determined by the frequency of the most positive responses. CONCLUSION: Cobb and Douglas Counties Boards of Health have taken many key steps to prepare the organizations for significant proactive changes. Survey results emphasized the need for open channels of communication within the organizations and with the external environment so that effective planning can guide the strategic alignment of the health departments with community partners.

Histopathology of meibomian gland dysfunction.

We conducted a histopathologic study of he meibomian glands of seven patients (all men, ranging in age from 58 to 83 years) who had severe or moderately severe meibomian dysfunction and who were undergoing ectropion or entropion repair. Abnormal features included signs of obstruction and dilatation of ducts, enlargement of acini with cystic degeneration and squamous metaplasia, foreign-body reaction and granuloma formation, a mild increase in inflammatory cells, and abnormal keratinization. Demodex organisms were found in both acini and ducts of one patient. These findings were similar to those reported in other entities involving meibomian duct obstruction, probably related to abnormalities of keratinization, plays an important role in the pathogenesis of meibomian gland dysfunction.

Solitary eosinophilic granuloma of the lateral orbital wall.

Two children (aged 18 and 23 months at the initial examinations) were each ultimately found at surgery to have a solitary eosinophilic granuloma of the lateral orbital wall. Both patients had a symptomatic period of six weeks during which time other diagnoses were considered: bacterial preseptal cellulitis and mumps dacryoadenitis in the first case and traumatic recurrent orbital hematoma in the second. Diagnostic difficulties stemmed from confusing features in their histories, as well as the location of the lesion and the deceptively minimal swelling relative to the actual size of the lesion. Follow-up ten and 18 months after curettage of the two lesions showed no recurrence or evidence of systemic involvement. Although most reported cases describe the orbital frontal bone as the site of origin in the orbit, our cases demonstrated that unifocal eosinophilic granuloma may occur in the lateral wall of the orbit.

Mycobacterium avium-intracellulare corneal ulcer.

A healthy 28-year-old man developed a slowly progressive corneal ulcer 21 months after an episode of corneal trauma. Acid-fast bacilli were identified in corneal scrapings, and the causative organism was identified as Mycobacterium avium-intracellulare. Medical treatment with topical amikacin and oral rifampin was ineffective, and a therapeutic penetrating keratoplasty was necessary to cure the infection. To the best of our knowledge, this is only the second reported case of a corneal infection caused by a slow-growing nontuberculous mycobacterium (Runyon groups I, II, and III) and the first caused by M. avium-intracellulare. Slowly growing nontuberculous mycobacteria should be considered among those organisms that cause corneal infection, especially in cases characterized by a protracted course and lack of response to conventional antimicrobial therapy.

Aspergillus panophthalmitis complicating treatment of pterygium.

A 58-year-old woman lost her left eye due to Aspergillus panophthalmitis four months after excision of a pterygium. The patient had received postoperative beta radiation and developed a scleral ulcer in the area of treatment from which no organisms could be cultured on two occasions. Because of the difficulty of diagnosing superficial mycotic infections of the eye, and because the treatment of so-called radiation scleritis may worsen fungal infections, ophthalmologists need to be aware of the potential infectious complications associated with the treatment of pterygia.

A simple method of tumour culture.

We describe a simple explant primary cell culture system which maintains the normal tumour stroma relationship. This technique utilises conventional cell culture methods combined with the skills found in the histopathological laboratory. This produces sections of tumour visible by light microscopy. Using this method we were able to maintain for up to 7 days good morphological preservation and demonstrated continued proliferation. This technique produces histological sections of tumour following in vitro culture that can be utilised for other molecular studies, e.g. immunohistochemistry and in situ PCR. This method should prove invaluable to pathologists enabling direct visualisation and localisation of molecular events involved in tumour growth.

A biochemical hypothesis explaining the response of enhanced biological phosphorus removal biomass to organic substrates.

Anaerobic/aerobic batch experiments were conducted with a variety of volatile fatty (VFAs) and amino acids on two sequencing batch reactor populations displaying enhanced biological phosphorus removal. The batch experiments were consistent between the two systems and with the past literature: acetic and isovaleric acid were the most efficient substrates, and propionic acid was the least efficient of the 2-5 carbon VFAs (lack of acclimation was ruled out). A survey of the engineering and biochemical literature revealed that both acetic and isovaleric acid resulted in a negative reaction redox balance (i.e. it requires reducing equivalents such as NADH2) during their biotransformation to polyhydroxyalkanoates (PHAs). In addition, the survey indicated that acetic and isovaleric acid resulted in 3HB rather than 3HV or 3H2MV formation. Two possible hypotheses were put forward for evaluation: (1) it was hypothesized that a negative intracellular redox balance might result in higher PHA content since PHA biosynthesis could be sustained under anaerobic conditions (no NADH2 build up), and/or (2) it was hypothesized that 3HB resulted in greater P-uptake than other PHA forms such as 3HV.

Nodular pulmonary amyloidosis. Description of a case with ultrastructure.

A 64-year-old man with a suspicious asymptomatic coin lesion received a thoracotomy that showed two foci of isolated nodular pulmonary amyloidosis. Ultrastructural analysis verified the amyloid nature of the lesion and suggested that the fibrils were produced by plasma cells and processed by macrophages. The pathogenesis of this lesion is discussed in light of recent studies.