Chyle leak following right axillary lymph node dissection: A case report and review of current literature.

This report discusses the case of a chyle leak following a right axillary lymph node dissection for breast cancer. This presented as a sudden change in drainage character from a right axillary surgical drain from serous to milky white shortly after restarting a diet. The diagnosis of chyle leak was confirmed by laboratory testing of the fluid and managed with closed suction drainage. Chyle leak is a rare, but increasingly recognized complication following axillary clearance for breast cancer and melanoma.

Frequent inactivation of the cyclin-dependent kinase inhibitor p18 by homozygous deletion in multiple myeloma cell lines: ectopic p18 expression inhibits growth and induces apoptosis.

Multiple myeloma (MM) is a clonal neoplasm of plasma cells which offers an excellent model to study multistep molecular oncogenesis. In 20-25% of primary tumors and cell lines examined, cyclin D1 is overexpressed due to the translocation t(11;14)(q13;q32). We have characterized cyclin-dependent kinase inhibitor p15 (CDKN2B), p16 (CDKN2A) and p18 (CDKN2C) deletions in cyclin D1-expressing and non-expressing MM cell lines. p18 was found to be frequently deleted (38%); in some cases p18 deletions coexisted with hemizygous p16 deletion. To examine the function of p18 as a putative tumor suppressor in myeloma cells, a zinc-inducible p18 construct was stably transfected into KMS12, a MM cell line with biallelic p18 and monoallelic p16 deletions as well as cyclin D1 overexpression. Ectopic expression of p18 caused 40-45% growth suppression as determined by trypan blue exclusion and MTS assays. p18 induction also resulted in apoptosis, suggesting that inhibition of the cyclin D1/CDK/pRb pathway in these tumor cells could be a crucial step toward the induction of tumor regression via apoptotic cell death. This cell cycle pathway is thus frequently mutated and provides a potentially novel target for gene therapeutic or pharmacologic approaches to human myeloma.

Nasal Tip Reconstruction Using Integra Bilayer Wound Matrix: An Alternative to the Forehead Flap.

UNLABELLED: Large defects of the nasal tip with exposure of the underlying cartilage pose a significant reconstructive challenge to the plastic surgeon. OBJECTIVE: This article presents a case of a large nasal tip defect following basal cell excision that was successfully treated with Integra bilayer wound matrix and skin grafting. METHODS: Following tumor excision, meshed Integra bilayer wound matrix was placed over the exposed nasal tip cartilage. After 4 weeks, the silicone layer was removed and a full-thickness graft placed on the nasal tip. RESULTS: This reconstruction resulted in the restoration of patient's nasal tip with good contour and color match without the need for a forehead flap. CONCLUSION: This demonstrates the reconstructive potential of this modality in patients who are not candidates for reconstruction with a forehead flap.

Teaching preschool age autistic children to make spontaneous initiations to peers using priming.

Children with autism rarely initiate social interactions with their peers. Currently available interventions have not increased autistic children' spontaneous initiations in natural settings without extensive teacher involvement. A "priming" strategy consisting of a low demand, high reinforcement session prior to the regular school activity was used to increase the spontaneous social initiations of 2 preschool age autistic boys to typically developing peers in a regular preschool classroom. Peers were also trained to independently respond to initiations. Implications for developing practical ways to improve autistic children's social functioning in regular school settings are discussed.

Parents' attitudes about children: associations with parental life histories and child-rearing quality.

This study examined relations among parents' perceptions of their childhood, attitudes about life, expectations for child behavior, attitudes about their child's behavior, and the child-rearing environment parents provide. Eighty mothers of 1- to 5-year-olds were interviewed about perceptions of receiving harsh parenting as children, current attitudes about life, developmental expectations, and views of intentionality and severity of their child's misbehavior. The home environment was measured using the Home Observation for Measurement of the Environment (R. H. Bradley & B. Caldwell, 1979) scale. Mothers who reported harsh parenting as children, negative attitudes about life, and unrealistic developmental expectations had negative attitudes about their own child. These attitudes were related to provision of lower quality home environments. Results support a constructivist approach to understanding parental social cognitions and behavior.

Using rapidly alternating multiple schedules to assess and treat aberrant behavior in natural settings.

The validity of using rapidly alternating multiple schedules (RAMS) as a method for assessing and treating aggression and disruptive behavior was demonstrated by using the naturally occurring reinforces identified in the RAMS to develop treatments that were experimentally tested. The RAMS consists of a series of 2-minute components in which a naturally occurring consequence is applied contingent on the target's behavior, alternated with components in which the consequence is not applied, with no break between components. The aggressive and disruptive behaviors of four 2- to 11-year-old children were analyzed and treated in school and home settings. The RAMS analyses yielded clear results about the reinforcing function of naturally occurring consequences in all cases, and the treatments using the reinforcers identified in the RAMS were all effective. The possible uses of the RAMS as an efficient, ecologically and experimentally valid tool for clinical assessment are discussed.

The effects of reinforcement rate on the spontaneous social initiations of socially withdrawn preschoolers.

Social skills priming was used to increase the spontaneous social initiations of 2 socially withdrawn preschoolers, 1 of whom had been diagnosed with autism. During priming sessions, the teacher prompted and reinforced social behaviors (e.g., smiling, verbal initiations). We varied the rate of reinforcement during priming sessions and measured the effects of this manipulation on the rate of spontaneous social initiations during the subsequent classroom activity. Spontaneous initiations were more frequent after high rates of reinforcement than after low rates of reinforcement.

Preliminary comparison of two negative reinforcement schedules to reduce self-injury.

This study compared the effectiveness of differential negative reinforcement of other behavior (DNRO) and alternative behavior (DNRA) for reducing self-injurious tantrums maintained by escape from demands in a 4-year-old girl with severe retardation. Both DNRA and DNRO reduced self-injury and increased independent performance of two tasks (tooth brushing and bathing); however, improvement on both measures was greater with the DNRA intervention.

Bilateral spontaneous, simultaneous lower extremity hematomas in a patient on dalteparin.

INTRODUCTION: Bleeding related to low-molecular-weight heparins (LMWHs) is typically described as an excess of minor bleeding; however, several reports of spontaneous major bleeding have been noted. PRESENTATION OF CASE: A 58-year-old female presented to the hospital with bilateral spontaneous lower extremity hematomas which rapidly enlarged. CT studies demonstrated active arterial extravasation from small vessels at multiple sites within each leg with no dominant feeding artery identified on either side. She required multiple transfusions, administration of protamine, fresh frozen plasma (FFP), recombinant activated Factor VII and eventual surgery. DISCUSSION: Dalteparin provides an effective and economical method of anticoagulation, however there is a risk of significant, spontaneous arterial hemorrhage even in the absence of risk factors. CONCLUSION: Dalteparin can cause major spontaneous bleeding from multiple arterial sources.

Gene knockout of the alpha6 subunit of the gamma-aminobutyric acid type A receptor: lack of effect on responses to ethanol, pentobarbital, and general anesthetics.

The alpha6 subunit of the gamma-aminobutyric acid type A receptor (GABA(A)-R) has been implicated in mediating the intoxicating effects of ethanol and the motor ataxic effects of general anesthetics. To test this hypothesis, we used gene targeting in embryonic stem cells to create mice lacking a functional alpha6 gene. Homozygous mice are viable and fertile and have grossly normal cerebellar cytoarchitecture. Northern blot and reverse transcriptase-polymerase chain reaction analyses demonstrated that the targeting event disrupted production of functional alpha6 mRNA. Autoradiography of histological sections of adult brains demonstrated that diazepam-insensitive binding of [3H]Ro15-4513 to the cerebellar granule cell layer of wild-type mice was completely absent in homozygous mice. Cerebellar GABA(A)-R density was unchanged in the mutant mice; however, the apparent affinity for muscimol was markedly reduced. Sleep time response to injection of ethanol after pretreatment with vehicle or Ro15-4513 did not differ between genotypes. Sleep time response to injection of pentobarbital and loss of righting reflex and response to tail clamp stimulus in mice anesthetized with volatile anesthetics also did not differ between genotypes. Thus, the alpha6 subunit of the GABA(A)-R is not required for normal development, viability, and fertility and does not seem to be a critical or unique component of the neuronal pathway mediating the hypnotic effect of ethanol and its antagonism by Ro15-4513 in mice. Similarly, the alpha6 subunit does not seem to be involved in the behavioral responses to general anesthetics or pentobarbital.