[Adrenal gland lymphoma accompanied by renal cell carcinoma].

A 76-year-old man was admitted with right hypochondralgia. Computed tomography revealed tumors measuring 90 mm and 20 mm in the right adrenal gland and kidney, respectively. Under a diagnosis of renal and adrenal cancer, the patient underwent nephro-adrenectomy, which revealed renal cell carcinoma in the kidney and non-Hodgkin's B-cell lymphoma of the diffuse large cell type in the adrenal grand. The patient has been disease-free for ten months after the operation. To our knowledge, this is the first report of coexisting renal cell carcinoma and adrenal lymphoma. The relationship between these two disorders in our patient is discussed.

Successful therapy of pure red cell aplasia secondary to plasma cell dyscrasia with bolus methylprednisolone.

A 65-year-old man, who is a Jehovah's Witness, was admitted to our hospital due to progressive anemia following a four-year history of biclonal gammopathy of no clinical significance. He was diagnosed with pure red cell aplasia (PRCA) associated with plasma cell dyscrasia. Despite a markedly decreased red blood cell count (hematocrit 5.6%), the patient refused transfusion. He was intravenously administered bolus methylprednisolone. Reticulocytosis and recovery from anemia were observed on day 7 after the start of therapy. Secondary PRCA following plasma cell dyscrasia is a rare disorder; the treatments for this rare condition are discussed.

'Eloquent chaos' in the oral discourse of killing fields survivors: an exploration of atrocity and narrativization.

If "narrative" implies a form of discourse in which sequenced events are meaningfully connected, an "anti-narrative" is a chaotic discourse form "of time without sequence, telling without mediation, and speaking about oneself without being fully able to reflect on oneself" (Frank 1995: 98). This paper examines narratives and anti-narratives in the oral discourses of survivors of the Cambodian killing fields. Through an extended analysis of two cases, we demonstrate the internal logic and "eloquence" of anti-narratives--i.e., the ways in which anti-narrative patterns vividly express and reveal a survivor's complex and continuing experience of atrocity.

Understanding the dynamics of illness and help-seeking: event-structure analysis and a Cambodian-American narrative of "spirit invasion".

Event structure analysis (ESA) and its computer analog, ETHNO, represent a class of relatively new methodological approaches that make it possible to capture the complexity of help-seeking interactions. Using narrative data from a study of Cambodian-American help-seeking interactions within a circumscribed illness episode, this paper demonstrates the feasibility of using ESA/ETHNO to illuminate how event sequence, operant illness beliefs, structural conditions, and human agency interpenetrate and shape the occurrence and timing of pivotal actions and the denouement of a help-seeking episode.

[Angioimmunoblastic T-cell lymphoma presenting with rapidly increasing biclonal gammopathy].

A 59-year-old man was admitted to our hospital with high fever and dysphagia. Physical examination revealed a lingual tumor and swelling of the cervical and inguinal lymph nodes. A lymph node biopsy specimen revealed that the normal nodal architecture had been obliterated by infiltration of small, intermediate, and large pale lymphocytes. Arborous branching of high endothelial venules was also observed. Southern blotting analysis showed rearrangement of the T-cell receptor beta gene. A diagnosis of angioimmunoblastic T-cell lymphoma was made. Serial serum protein fractionation analysis showed rapidly increasing M-protein. Immunofixation electrophoresis indicated specific bands for IgG kappa and IgM lambda, confirming the presence of biclonal gammopathy. Biclonal gammopathy has rarely been reported in patients with angioimmunoblastic T-cell lymphoma. The relationship between the occurrence of biclonal gammopathy and the possible role of HHV-6, HHV-8 and EBV is discussed.

Field test of a tool for level-of-care decisions in community mental health systems.

OBJECTIVE: Tools for supporting decisions about placing clients in different levels of mental health care can facilitate several important functions, such as structuring service allocation, providing standards for quality assurance and concurrent review, designing service and benefit packages, and planning for resource needs. This paper describes a level-of-care decision-support tool and tests its reliability and concurrent validity. METHODS: Panels of clinical managers and administrators of mental health centers developed a decision-support tool with eight levels of care and a computerized decision-tree algorithm for level-of-care placement. A random sample of 1,034 adults from one county mental health system were assessed by their case managers using a package that included variables in the eight-level model, but not the algorithm itself. Other variables were included to assess the tool's concurrent validity. RESULTS: Level-of-care placements based on the decision-support tool showed strong interrater reliability. Concurrent validity was demonstrated by significant relationships in the expected direction between level of care and psychiatric hospitalizations, arrests, residential moves, homeless periods, residential independence, lack of work activity, medication noncompliance, and functioning as measured by the Global Assessment of Functioning Scale. CONCLUSIONS: Preliminary empirical evidence indicates that the level-of-care decision-support tool is reliable and valid. It could be further refined by incorporating the impact of social supports, collateral services, current mental health services, and motivation for services.

Race, gender, and housing inequality: an exploration of the correlates of low-quality housing among clients diagnosed with severe and persistent mental illness.

This paper explores the relationship of race and gender to housing quality among clients diagnosed with severe mental illness. More specifically, it asks: "How do a client's race and gender affect her/his odds of living in a "low-quality" housing arrangement?" A low-quality arrangement is defined as one which is time-limited and/or physically unsafe. The analysis draws upon clinical, demographic, and housing data for 517 African American and White consumers of publicly-funded mental health services in King County, Washington. Multivariate logistic regression is the primary analytic strategy used. Controlling for certain clinical/behavioral and economic/ecological factors, race/gender category is found to affect significantly the odds of experiencing low-quality housing.

Linking resource use to consumer level of need: field test of the level of need-care assessment (LONCA) method.

A team of service system planners in King County, Washington, field-tested the feasibility of the LONCA (level of need-care assessment) method as a strategy to match resources to consumer level of need. LONCA links resources to need by first measuring the incidence and intensity of consumer needs in specific functioning domains. It then preliminarily specifies the type and intensity of services required to minimally but appropriately address specific consumer needs, calculates service costs, and identifies clusters of consumers with similar need and cost profiles. The field test supported the feasibility of performing LONCA tasks. The resulting scheme for clustering consumers appeared to have face validity and was modestly associated with at least 3 independent indicators of resource need: program status, residential status, and hospitalizations. Despite its limitations, the article supports further development of LONCA for use as a resource allocation tool for local service systems.

Effects of combining disparate groups in the analysis of ethnic differences: variations among Asian American mental health service consumers in level of community functioning.

The Asian American population comprises historically, socially, and culturally diverse ethnic groups. Given this diversity, investigators caution that combining disparate ethnic groups together may lead to erroneous conclusions. Whether by choice or necessity, however, mental health studies still typically consider Asian Americans as a single ethnic category rather than as separate ethnic groups. Few investigations have addressed the consequences of this practice. This paper examines the implications of conceptualizing Asian Americans as an ethnic category versus ethnic groups, in an investigation of the community functioning status of clients in publicly funded mental health programs in King County, Washington. When treated as a single ethnic category in a multivariate linear regression model, Asian Americans are found to have a lower level of functioning difficulty than their white counterparts. However, when treated as separate ethnic groups (e.g., Vietnamese, Japanese), only one of five Asian ethnic groups has a significantly lower level of difficulty. In a separate analysis of the Asian American subsample, groups are found to differ significantly from one another with respect to functional status. Several factors, including refugee status, account for this difference.

Assessment of needs of adults with developmental disabilities in skilled nursing and intermediate care facilities in Illinois.

Findings are reported from a statewide assessment of the habilitation, medical, and behavioral training needs of adults with developmental disabilities in Illinois general nursing homes. Only 10% were determined to be appropriately placed in medical settings, and only 27% were enrolled in developmental training programs. A large proportion of those recommended for alternative residential settings had significantly more intense medical, adaptive behavior, self-care, and self-preservation needs than did residents who typically reside in residential facilities for persons with developmental disabilities. Historical barriers to addressing the residential and active treatment needs of the assessed residents were discussed as were recent program developments in Illinois and implications of this study for other states.