Malignant Peritoneal Mesothelioma in the setting of a Ventriculo-Peritoneal Shunt: A novel clinical presentation.

We report a case of malignant peritoneal mesothelioma (MPM) in a 31-year-old male with history of cerebral palsy, hydrocephalus, and ventriculoperitoneal shunt (VPS) placed since infancy. He presented with fever, abdominal pain and distension. Computed tomography scan revealed a thick-walled rim-enhancing fluid collection, interpreted as pseudocyst. Intraoperatively, diffuse nodular peritoneal thickening with adhesions was demonstrated. The resection specimen consisted of multiple membranous fragments displaying firm nodules. Microscopic examination revealed a tumefactive malignant-appearing epithelioid proliferation involving the peritoneum, focally invading the underlying fat. Immunohistochemically, the tumor cells expressed keratin AE1/AE3, CK7, CK5/6, Calretinin, WT1 and D2-40, and were negative for CEA and MOC31. The findings were consistent with MPM, epithelioid type. The patient's condition continued to decline with increasing abdominal distension during the month following the original diagnosis. While atypical mesothelial hyperplasia has been described in association with long standing VPS, well-documented cases of MPM have not been previously reported in such context.

The body remembers: somatic symptoms in traumatized Khmer.

UNLABELLED: Cambodians experienced genocide from 1975 to 1979 and ensuing civil war until 1993. PURPOSE: Are Khmer with a history of trauma who present to a general medical clinic with unexplained physical symptoms more likely than the general population to harbor psychiatric symptoms? METHODS: Subjects were drawn from a Phnom Penh clinic and the surrounding neighborhood. All subjects completed the Stressful Life Events Screening Questionnaire (SLESQ) and the PRIMEMD. Clinic patients with unexplained physical complaints were compared with neighborhood nonpatients. All individuals reporting trauma during the Pol Pot regime were compared to those reporting no such trauma; and those reporting exposure to domestic violence were compared to those without such exposure. FINDINGS: There is an increased incidence of traumatic events, depressive symptoms, general anxiety symptoms, and panic symptoms in the clinical group as compared to the control group. Survivors of genocide-associated trauma reported more somatic complaints and panic symptoms, while survivors of domestic violence had an increased incidence of depressive symptoms, general anxiety symptoms, and panic symptoms. CONCLUSION: Clinicians should consider the possibility of trauma-related psychological distress in patients who present with undiagnosable physical complaints.

The functional value of Caribbean coral reef, seagrass and mangrove habitats to ecosystem processes.

Caribbean coral reef habitats, seagrass beds and mangroves provide important goods and services both individually and through functional linkages. A range of anthropogenic factors are threatening the ecological and economic importance of these habitats and it is vital to understand how ecosystem processes vary across seascapes. A greater understanding of processes will facilitate further insight into the effects of disturbances and assist with assessing management options. Despite the need to study processes across whole seascapes, few spatially explicit ecosystem-scale assessments exist. We review the empirical literature to examine the role of different habitat types for a range of processes. The importance of each of 10 generic habitats to each process is defined as its "functional value" (none, low, medium or high), quantitatively derived from published data wherever possible and summarised in a single figure. This summary represents the first time the importance of habitats across an entire Caribbean seascape has been assessed for a range of processes. Furthermore, we review the susceptibility of each habitat to disturbances to investigate spatial patterns that might affect functional values. Habitat types are considered at the scale discriminated by remotely-sensed imagery and we envisage that functional values can be combined with habitat maps to provide spatially explicit information on processes across ecosystems. We provide examples of mapping the functional values of habitats for populations of three commercially important species. The resulting data layers were then used to generate seascape-scale assessments of "hot spots" of functional value that might be considered priorities for conservation. We also provide an example of how the literature reviewed here can be used to parameterise a habitat-specific model investigating reef resilience under different scenarios of herbivory. Finally, we use multidimensional scaling to provide a basic analysis of the overall functional roles of different habitats. The resulting ordination suggests that each habitat has a unique suite of functional values and, potentially, a distinct role within the ecosystem. This review shows that further data are required for many habitat types and processes, particularly forereef and escarpment habitats on reefs and for seagrass beds and mangroves. Furthermore, many data were collected prior to the regional mass mortality of Diadema and Acropora, and subsequent changes to benthic communities have, in many cases, altered a habitat's functional value, hindering the use of these data for parameterising maps and models. Similarly, few data exist on how functional values change when environmental parameters, such as water clarity, are altered by natural or anthropogenic influences or the effects of a habitat's spatial context within the seascape. Despite these limitations, sufficient data are available to construct maps and models to better understand tropical marine ecosystem processes and assist more effective mitigation of threats that alter habitats and their functional values.

Reef development at Inhaca Island, Mozambique: coral communities and impacts of the 1999/2000 Southern African floods.

Inhaca Island, southern Mozambique, is located towards the southerly latitudinal limits of coral reef growth. Reef development is restricted to the margins of channels which dissect intertidal flats on the Maputo Bay side of the island, and to depths of around 6 m. In contrast to lower latitude reefs, reef development is therefore both spatially and bathymetrically restricted (largely due to high turbidity levels). These natural stress levels were exacerbated, via increased freshwater and sediment discharge, during the severe floods of late 1999/early 2000. Flood impacts varied but were most significant on reefs on the inner (western) side of the island where live coral cover (LCC) decreased from 60.5% (1999) to 24.0% (2001). This is attributed to freshwater-induced bleaching. Dead in situ coral cover increased from 18.6% (1999) to 51.3% (2001). Reefs on the southern tip of the island, by contrast, were relatively unaffected. It is suggested that this largely reflects a closer proximity to the open Indian Ocean which mitigated the effects of freshwater dilution.