Effectiveness of brief alcohol interventions in primary care populations.

BACKGROUND: Many trials reported that brief interventions are effective in reducing excessive drinking. However, some trials have been criticised for being clinically unrepresentative and unable to inform clinical practice. OBJECTIVES: To assess the effectiveness of brief intervention, delivered in general practice or based primary care, to reduce alcohol consumption SEARCH STRATEGY: We searched the Cochrane Drug and Alcohol Group specialised register (February 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), CINAHL (1982 to February 2006), PsycINFO (1840 to February 2006), Science Citation Index (1970 to February 2006), Social Science Citation Index (1970 to February 2006), Alcohol and Alcohol Problems Science Database (1972 to 2003), reference lists of articles. SELECTION CRITERIA: Randomised controlled trials, patients presenting to primary care not specifically for alcohol treatment; brief intervention of up to four sessions. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, sub-group, sensitivity analyses, and meta-regression were conducted. MAIN RESULTS: The meta-analysis included 21 RCTs (7,286 participants), showing that participants receiving brief intervention reduced their alcohol consumption compared to the control group (mean difference: -41 grams/week, 95% CI: -57 to -25), although there was substantial heterogeneity between trials (I2 = 52%). Sub-group analysis (8 studies, 2307 participants) confirmed the benefit of brief intervention in men (mean difference: -57 grams/week, 95% CI: -89 to -25, I2 = 56%), but not in women (mean difference: -10 grams/week, 95% CI: -48 to 29, I2 = 45%). Meta-regression showed a non-significant trend of an increased reduction in alcohol consumption of 1.1, 95%CI: -0.05 to 2.2 grams/week, p=0.06, for each extra minute of treatment exposure, but no relationship between the reduction in alcohol consumption and the efficacy score of the trial. Extended intervention when compared with brief intervention was associated with a non-significantly greater reduction in alcohol consumption (mean difference = -28, 95%CI: -62 to 6 grams/week, I2 = 0%) AUTHORS' CONCLUSIONS: Brief interventions consistently produced reductions in alcohol consumption. When data were available by gender, the effect was clear in men at one year of follow up, but unproven in women. Longer duration of counselling probably has little additional effect. The lack of differences in outcomes between efficacy and effectiveness trials suggests that the current literature had clear relevance to routine primary care. Future trials should focus on women and on delineating the most effective components of interventions.

Pulmonary metastasis of ameloblastoma: case report and review of the literature.

Ameloblastomas are benign tumors of odontogenic epithelial origin. There is a high incidence of local recurrence associated with these tumors, and distant metastasis is rare. A review of the English literature shows that there have been 41 prior reports of pulmonary metastases from ameloblastomas of the oral cavity. We present another case of ameloblastoma metastatic to the lung and review the histopathology and mechanism of metastatic spread.

Tamoxifen-associated polyps (basalomas) arising in multiple endometriotic foci: A case report and review of the literature.

We present a case of a 62-year-old G0P0 Caucasian woman who developed endometrial adenocarcinoma, FIGO grade 2, endometrioid type, after receiving tamoxifen for 2 years following a diagnosis of invasive carcinoma and ductal carcinoma in situ of the breast. An incidental finding in the hysterectomy specimen was numerous endometriotic foci involving the submucosa, subserosa, and serosa of the cervix; lower uterine segment serosa; and bilateral ovaries. Polypoid structures, similar to the endometrial polyps occurring in tamoxifen-treated patients, were observed to arise from endometriotic foci in the serosa of the cervix and bilateral ovaries. We have found only one similar report in the literature. Since these structures do not fit the definition of "polyp," we suggest "basaloma" as an alternative. We also review all cases of tamoxifen-associated endometriosis reported in the world literature and cases of polypoid endometriosis occurring in non-tamoxifen-treated patients. Of 12 reported cases of tamoxifen-associated endometriosis, 4 occurred in premenopausal women, 1 in a perimenopausal women, and 7 in postmenopausal women, of whom none had a known history of endometriosis. The endometriotic foci gave rise to a spectrum of lesions which included epithelial metaplasias, simple and complex hyperplasias, polypoid lesions, and 2 cases of endometrioid carcinomas.

Endocervical adenocarcinoma in situ of tubal type and its relation to atypical tubal metaplasia.

Endocervical adenocarcinoma in situ (AIS) is currently classified as having endocervical, endometrioid, or intestinal differentiation or admixtures of these patterns. Tubal metaplasia (TM) of endocervical mucosa has been considered a benign lesion that may be confused with AIS but has no malignant potential. In recent years, an increasing number of cases in which TM not only coexists with AIS, but also possesses atypia with transitions between ordinary TM, atypical TM, and AIS with residual tubal morphology have been reviewed by the authors, largely in consultation material. The clinical and pathologic features of 11 cases showing tubal and other types of AIS arising in a background of TM are reported. It cannot be assumed that all ciliated tubal epithelium in the cervix is benign and possesses no premalignant potential. The relationship of atypical TM (dysplasia) to tubal-type AIS must be defined, and the latter pattern should be added to the known types of differentiation of cervical AIS.

Distribution of acetylcholinesterase in the central nervous system of harvestmen (Arachnida: Opilionida).

Enzyme histochemical technique (Gomori and Koelle methods, reaction product development according to Lewis) was applied on 10 microm frozen sections of formalin-fixed material to demonstrate the distribution of acetylcholinesterase in the central nervous system (CNS) of harvestmen (Opilionida: Phalangiidae). Distinctly positive reactions were confined to the neuropil, showing strong staining especially in protocerebral brain centres (optic lobes, cerebral ganglia), the cheliceral ganglia (stomodeal bridge, afferent tracts), and the connective ring systems of the subesophageal nerve mass. The results obtained are discussed with regard to central coordinative functions of the respective brain parts.

Constrictive (obliterative) bronchiolitis: diagnosis, etiology, and a critical review of the literature.

Constrictive bronchiolitis (CB) (or obliterative bronchiolitis) designates inflammation and fibrosis occurring predominantly in the walls and contiguous tissues of membranous and respiratory bronchioles, with resultant narrowing of their lumens. It differs from bronchiolitis obliterans-organizing pneumonia in its histopathology and clinical course. Most cases of CB occur in the setting of organ transplants, particularly lung and heart-lung transplants, but also in bone marrow transplants. Other bona fide cases are rare: infection, particularly viral infection, appears to be a well-documented precursor to CB in children, but not in immunocompetent adults. Constrictive bronchiolitis also has been reported in the course of rheumatoid arthritis, in certain other autoimmune diseases such as pemphigus vulgaris, after inhalation of toxic gases such as nitrogen oxide, after ingestion of certain drugs or medicinal agents such as Sauropus androgynous, and as a cryptogenic illness. Recent reports suggest that CB, as defined by clinical criteria (that is, bronchiolitis obliterans syndrome), is very common in lung allograft recipients who survive more than 5 years and, although it is associated with significant mortality, it also can be clinically stable. Furthermore, with the current practice of close monitoring of these patients, it appears that CB may now be diagnosed at an earlier stage, at which resolution, or at least stabilization of progression, is possible. A histopathologic diagnosis of CB in lung transplant and other patients may be difficult to make due to the patchy distribution of lesions, the technical difficulty in obtaining tissue in late lesions with extensive fibrosis, and the failure to recognize lesions. With regard to the last of these, in early stages of disease, CB may be subtle and easily missed in routine hematoxylin-eosin-stained specimens, while in advanced stages the disease may be equally difficult to diagnose if the patchy scarring in the lung is interpreted as nonspecific. The relative loss of bronchioles and the relationship of the scars to contiguous arteries should signal the need for elastic stains to look for the residual elastica of the bronchioles amidst the foci of fibrosis. Increasingly, clinical grounds, including pulmonary functions studies and high-resolution computed tomography findings, are proving to be relatively sensitive methods of detecting CB. Finally, the progressive airway destruction in chronic transplantation rejection appears to be a T-cell-mediated process. The "active" form of constrictive bronchiolitis, with attendant lymphocytic inflammation of the airways, likely precedes the "inactive" or scarred form of constrictive bronchiolitis.

Endometrial polyps: a comparison study of patients receiving tamoxifen with two control groups.

Many reports describe an increased frequency and unusual features of endometrial polyps and carcinomas in women treated with tamoxifen (TMX) for breast cancer. Postmenopausal women with endometrial polyps were identified by computer search of pathology files from 1990 to 1996. Medical records were reviewed, and patients were divided into three groups: 28 receiving TMX for breast cancer, 23 receiving hormone replacement therapy (HRT), and 28 untreated controls (UC). Cumulative doses (CDs) of TMX were calculated. Histologic slides of polyps were reviewed blindly and evaluated for size, metaplasias, vascularity, fibrosis, and inflammation. Carcinomas were found in 3 TMX, no HRT, and 1 UC patient. Atypical hyperplasias were found in 1 TMX, 0 HRT, and 1 UC patient. Mean polyp size was larger in the TMX group (2.9 cm) than in the HRT (1.05 cm) and UC (1.35 cm) groups, and stromal fibrosis was more prominent in TMX-related and larger polyps. Mucinous metaplasias were observed more frequently in the patients receiving TMX. No other differences were noted. The two TMX patients in whom low-grade carcinomas developed and the one with atypical hyperplasia had independent risk factors. CDs for these patients were 32.9, 36.5, and 17.6 g, respectively. A high-grade carcinoma developed in a TMX patient without constitutional risk factors at a CD of 94.9 g. On the basis of a literature review and these results, low-grade carcinomas developing after relatively low CDs of TMX may be at least partially attributable to other risk factors. The association between poorly differentiated and nonendometrioid tumors with higher TMX CDs is still speculative, but the current study suggests that they may be related to TMX. A statistically significant increase in the frequency of thyroid replacement use by TMX patients is also noted.

Constrictive (obliterative) bronchiolitis.

Constrictive bronchiolitis (CB), also termed in lung transplant patients obliterative bronchiolitis, is inflammation and fibrosis occurring predominantly in the walls and contiguous tissues of membranous and respiratory bronchioles with resultant narrowing of their lumens. CB is found in a variety of settings, most often as a complication of lung and heart-lung transplantation (affecting 34% to 39% of patients, usually in the first 2 years after transplantation) and bone marrow transplantation, but also in rheumatoid arthritis, after inhalation of toxic agents such as nitrogen dioxide, after ingestion of certain drugs such as penicillamine and ingestion of the East Asian vegetable Sauropus androgynous, and as a rare complication of adenovirus, influenza type A, measles, and Mycoplasma pneumoniae infections in children. In lung transplants, CB is the single most important factor leading to death thereafter. In one study, the overall mortality rate was 25%. However, at the same time, 87% of patients who were asymptomatic and diagnosed solely by transbronchial biopsy had resolution or stabilization of disease. Decreases in FEV1 from baseline can be used to clinically support CB in transplant patients; the term bronchiolitis obliterans syndrome is used to denote this clinical dysfunction, and a grading system has been established for it that is now widely used in the literature. Significant risk factors for the development of CB in lung transplants include alloantigen-dependent and -independent mechanisms. In the former group are late acute rejection and HLA mismatches at the A loci; in the latter are ischemia/reperfusion injuries to airways that result from the transplantation surgery and cytomegalovirus infection.

Synovial cyst of dens causing spinal cord compression. Case report.

We report a rare case of synovial cyst of the dens (odontoid process) in a 61 year old women with no previous history of trauma. She had progressive symptoms of 1 year's duration due to spinal cord compression. Magnetic resonance imaging of cervical spine revealed a large mass posterior to the dens which was compressing the spinal cord near the cervicomedullary junction. This lesion was at first considered radiologically to represent an exuberant pannus formation or a meningioma of the foramen magnum, but subsequent surgical intervention and pathological examination revealed that it was a synovial cyst. Similar cases reported in the literature are reviewed and discussed.

Electron microscopical demonstration of thiols and disulphides in the porcine epidermis.

This study describes the electron microscopical distribution of free thiols and disulphides in the epidermis of the domestic pig and the wild boar, as compared to light microscopical histochemistry. With the silver methenamine method, silver labelling of thiols was clearly achieved on the keratohyalin and cytofilament accumulations in the cells of the living epidermis and the plasma membrane of granular cells. To a certain extent, the envelope and cytoplasm of young corneocytes reacted equally intensively. Disulphides were very abundant in the filaments, keratohyalin granules, and cell envelope of granular cells, and, particularly, in the envelope (marginal band) of corneal cells; the latter structure being distinctly delineated from the background. As a specific feature, the viable epidermis of the wild boar stained strongly for disulphides. The results obtained are discussed in view of actual concepts of epidermal keratinization and corneal cell function.

Discordant findings in chorionic villus direct preparation and long term culture--mosaicism in the fetus.

Prenatal cytogenetic study of chorionic villi showed a discrepancy between a normal female karyotype 46,XX in the direct preparation after short-term incubation, and a 45,X karyotype in the long-term culture. The subsequent amniocentesis revealed a normal karyotype in three cultures and a 45,X/46,XX mosaicism in one culture. Cytogenetic analysis of chorionic villi after termination of the pregnancy showed a normal karyotype in the direct preparation and a 45,X/46,XX mosaicism in the long-term culture. Fetal lymphocytes showed normal karyotypes, whereas fibroblast cultures revealed a 45,X/46,XX mosaicism.

Paracentric inversion 14.

A new familial case of paracentric inversion of chromosome 14 inv(14)(q24.1q32.1) ascertained by multiple abortions in a female carrier is presented. A review of the literature revealed 14 cases of paracentric inversion 14 recorded so far. According to the different breakpoints, two major groups of inversions of the long arm of chromosome 14 can be recognized.

Covalent binding to alpha-macroglobulins of a protein with free SH groups produced by activated B cells: blocking by D-penicillamine and gold compounds.

alpha 2-Macroglobulin (alpha 2M) complexed with proteinases or modified by the action of amines has been shown to affect immune responses in vitro, though as yet the mechanisms are poorly understood. Supernates from rabbit lymphoid cells cultured in medium with normal rabbit serum and 35S-methionine (or 14C-leucine) were found to contain intensely radiolabeled alpha-macroglobulins (alpha M) (alpha 1 and alpha 2) on electrophoresis. When human alpha 2 M, instead of rabbit serum, was added to cultures, it also appeared radiolabeled, suggesting that lymphocyte-produced proteins (LyP) formed complexes with serum alpha M. These alpha M-associated LyP were produced in greater quantity when lymphocytes were cultured in the presence of mitogens; they were not produced by cells cultured in the presence of cycloheximide; they were produced primarily by B cells rather than T cells or macrophages. Pretreatment of serum or alpha M with methylamine, enhanced rather than inhibited the formation of LyP-alpha M complexes, a finding which is contrary to that expected if the LyP were a proteinase. Since this methylamine treatment of alpha M also results in the generation of free SH groups from the internal thioester bonds of alpha M, the formation of disulfide bonds between LyP and alpha M was considered. Indeed, (a) the LyP-alpha M complex formation was inhibited by N-ethylmaleimide, aurothiomalate, sodium aurothioglucose or D-penicillamine; (b) blocking the SH groups with NEM, of either culture fluid supernates or serum, had an inhibitory effect on the formation of these complexes; (c) the LyP-alpha M complexes were dissociated by sodium dodecyl sulfate (SDS) only after their reduction with 2-mercaptoethanol (2-ME). Thus, a disulfide bond was formed between alpha M and LyP with free SH groups (SH-LyP). Molecular sieving by high performance liquid chromatography (HPLC) of the serum-free radiolabeled supernates indicated that SH-LyP eluted at a position corresponding to a polypeptide of mol. wt of about 22,000. However, SDS-PAGE of the 22,000 mol. wt HPLC fraction showed that the major protein was approximately mol. wt 11,000 under both reducing and non-reducing conditions. In addition, the SH-LyP reduced by 2-ME from its binding site on alpha 2M had a mol. wt of about 11,000 in SDS-PAGE, suggesting that it was a non-covalent homodimer of mol. wt 11,000 polypeptides. We suggest that alpha 2M as well as SH-LyP may affect the immune system by functioning as SH-reactive agents.

Paracentric inversion 11.

A new familial case of paracentric inversion of chromosome 11 inv(11)(q21q23.3) ascertained by multiple abortions in a female carrier is presented. A review of the literature shows 19 further cases of paracentric inversion 11. According to the different breakpoints, the inversions of the long arm of chromosome 11 may be classified into three types.

A new case of pericentric inversion 20.

A prenatal diagnosis from a chorionic villi biopsy revealed a pericentric inversion of chromosome 20. The child's father also carries the inverted chromosome. The breakpoints p13q11.2 differ for 4 of the 5 published cases of inversion 20.

Chromosomal mosaicism confined to chorionic tissue.

Chorionic villus samples from two healthy pregnant females were obtained for first trimester fetal diagnosis. The karyotypes were 46,XX/47,XX,+3 and 46,XX/47,XX,+15, respectively. In both cases fibroblast cultures after termination of pregnancy were shown to have normal karyotypes.

Structural and histochemical aspects of epidermis development of fetal porcine skin.

Epidermal development of fetal porcine skin was studied in fetuses from 41 days of gestation until birth with scanning and electron microscopy techniques as well as histochemical methods, including immunohistochemistry. The porcine fetus develops a relatively thick and solid multilayered cover of epidermal cells, which is not lost before birth. It consists of tightly packed cells of the periderm and the stratum intermedium. The periderm cells are totally filled with filamentous proteins; in the intermediate cells, the filamentous proteins are concentrated in the cell periphery, forming a thick marginal zone. Immunohistochemically, the cytofilaments could be identified as cytokeratins of lower and higher molecular weights. The first thin stratum corneum lamellae are formed below the stratum intermedium at about 80-85 days of gestation.

Treatment of advanced breast cancer with two doxorubicin-containing regimens.

The Georgetown University Hospital experience in the treatment of advanced breast cancer using either a combination of doxorubicin (adriamycin) and vincristine (AV) or adriamycin and mitomycin-C (AM) is presented. Of 74 previously treated patients with advanced breast cancer, 50 patients were given AV and 24 patients were given AM. Both groups were comparable in regard to number of disease sites, age, prior radiation therapy, disease-free interval after mastectomy, duration of treatment, and estrogen-receptor status. The response rates were 32% and 25% with AV and AM combinations, respectively. Achievement of response was not related to menopausal or estrogen-receptor status. Median time to disease progression was 7.0 and 9.6 months for AV and AM, respectively. Median survivals were not statistically different (9.7 months for AV and 11.1 months for AM). Life-table analysis for responders versus nonresponders within each regimen and between responders in either regimen revealed no statistical differences. Duration of response for each regimen was also equivalent. Toxicity was mild and similar to previous reports using these drugs. However, myelosuppression was significantly greater for premenopausal than postmenopausal patients in the AV group. The possible reasons for this are discussed. Both AM and AV are well-tolerated regimens which provide equivalent but limited response rates, duration of response, and median survival in previously treated women with advanced breast cancer.