Population demographics of American eels Anguilla rostrata in two Arkansas, U.S.A., catchments that drain into the Gulf of Mexico.

The goal of this study was to compare American eel Anguilla rostrata life history in two inland river systems in Arkansas, U.S.A., that ultimately discharge into the Gulf of Mexico via the Mississippi River and the Red-Atchafalaya catchments. From 21 June 2011 to 24 April 2014, 238 yellow-phase A. rostrata were captured in the middle Ouachita River and tributaries using boat electrofishing and 39 in the lower White River using multiple sampling gears. Most of them were caught downstream of dams in both basins (61%). Medium-sized A. rostrata ranging from 225 to 350 mm total length (LT ) were the most abundant size group in the Ouachita River basin, but they were absent from the White River. Mean LT at age 4 years (i.e. youngest shared age) was 150 mm greater for the White River than the Ouachita River basin. Anguilla rostrata appeared to have a greater initial LT (i.e. minimum size upon arrival) in the White River that allowed them to reach a gonado-somatic index (IG ) of 1·5 up to 4 years earlier, and downstream migration appeared to occur 5 years earlier at 100 mm greater LT ; these differences may be related to increased river fragmentation by dams in the Ouachita River basin. Growth and maturation of A. rostrata in this study were more similar to southern populations along the Atlantic coast than other inland populations. Adult swimbladder nematodes Anguillicoloides crassus were not present in any of the 214 swimbladders inspected. Gulf of Mexico catchments may be valuable production areas for A. rostrata and data from these systems should be considered as range-wide protection and management plans are being developed.

Effects of pool isolation on trophic ecology of fishes in a highland stream.

The objective of this study was to examine the effects of pool isolation on fish diet and to answer three questions: Were food resources different or reduced in isolated compared with connected pools? Were fishes more selective and did they increase resource partitioning in isolated pools? Would individuals exhibit increased gastrointestinal tract (GIT) length in isolation to aid nutrient absorption? Benthic macroinvertebrate density and richness were significantly lower in isolated pools compared with connected pools; fishes became more selective and partitioned resources more in isolated pools and all three species showed an increase in GIT length in isolated pools compared with connected pools. With a changing climate predicted to increase intermittency within headwater streams, the results show that these fishes have the adaptive ability to respond and continue to survive.

Phase III comparison of high-dose paclitaxel + cisplatin + granulocyte colony-stimulating factor versus low-dose paclitaxel + cisplatin in advanced head and neck cancer: Eastern Cooperative Oncology Group Study E1393.

PURPOSE: To determine dose-response effects and the activity of paclitaxel combined with cisplatin in patients with incurable squamous cell carcinoma of the head and neck. PATIENTS AND METHODS: Two hundred ten patients with locally advanced, recurrent, or metastatic disease were randomly placed in either Arm A, paclitaxel 200 mg/m(2) (24-hour infusion) + cisplatin 75mg/m(2) + granulocyte colony-stimulating factor, or Arm B, paclitaxel 135 mg/m(2) (24-hour infusion) + cisplatin 75 mg/m(2). Cycles were repeated every 3 weeks until progression or a total of 12 cycles for complete responses. Primary outcomes were event-free and overall survival. RESULTS: No significant differences in outcomes were observed between the high- and low-dose paclitaxel regimens. The estimated median survival was 7.3 months (95% confidence interval, 6.0 to 8.6). The 1-year survival rate was 29%, and event-free survival was 4.0 months. The objective response rate (complete response plus partial response) was 35% for the high-dose patients and 36% for the low-dose patients. Myelosuppression was the most frequent toxicity: grade 3 or 4 granulocytopenia, 70% of patients in Arm A and 78% in Arm B; febrile neutropenia, 27% of patients in Arm A and 39% in Arm B. Grade 5 toxicities occurred in 22 patients (10.5%). Treatment was terminated early in 31% because of excessive toxicity or patient refusal. CONCLUSION: This phase III multicenter trial showed (1) no advantage for high-dose paclitaxel and (2) excessive hematologic toxicity associated with both regimens. Therefore, neither of the paclitaxel regimens evaluated in this trial can be recommended.

Concurrent radiation therapy and chemotherapy for locally unresectable squamous cell head and neck cancer: an Eastern Cooperative Oncology Group pilot study.

PURPOSE: The feasibility and success of an intensive chemoradiotherapeutic protocol for patients with locally advanced, unresectable squamous cell head and neck cancer was tested in this limited-institution, Eastern Cooperative Oncology Group phase II pilot study. MATERIALS AND METHODS: Between December 1987 and September 1989, 57 patients were entered onto this trial. The treatment protocol consisted of three courses of a 4-day continuous fluorouracil infusion, a single cisplatin bolus injection, and concurrent split-course radiotherapy. After 30 Gy of radiation and two chemotherapy courses, patients were evaluated for response and for the possibility of surgical resection. RESULTS: Fifty-five of 57 registered patients are assessable for toxicity and 52 are assessable for response and survival. Toxicity was significant, but tolerable, although there were three toxic deaths. A complete response to this treatment was ultimately achieved by 77% of patients. Twenty-four patients remain relapse-free. The projected Kaplan-Meier 4-year relapse-free survival rate is 45% and the overall survival rate is 49%. Median relapse-free and overall survival durations are 26 and 37 months, respectively. Of the 28 treatment failures, 79% were locoregional. Fourteen patients underwent surgery. Six remain relapse-free. CONCLUSION: This aggressive concurrent chemoradiotherapy protocol appears feasible within a cooperative group. Treatment results are promising and appear durable. A randomized phase III clinical trial is currently underway.

Subcellular immunolocalization of protein kinase CK2 in normal and carcinoma cells.

CK2 is a messenger-independent protein serine/threonine kinase that has been implicated in cell growth and proliferation. Our recent analysis of squamous cell carcinomas of the head and neck (SCCHN) revealed a significant elevation in CK2 activity in these tumor cells relative to normal mucosa of the upper aerodigestive tract and suggested a correlation with aggressive tumor behavior and poor clinical outcome. In order to further define the distribution of CK2 in these tissues, we have examined the immunohistochemical staining pattern of surgical specimens of both SCCHN tumors and normal upper aerodigestive tract mucosa using a monoclonal antibody directed against the catalytic subunit CK2-alpha of the kinase, and have compared these data with the subcellular distribution of CK2 activity in these same tissues. These measurements showed that CK2 is predominantly localized to the nuclei of the tumor cells, which agreed closely with the immunohistochemical staining pattern of CK2-alpha in tumor cells. The chiefly nuclear distribution of CK2-alpha immunostaining found consistently in SCCHN tumor cells and tumor-infiltrating lymphocytes contrasted with a relatively more predominant cytosolic staining pattern exhibited by various cellular constituents of normal oropharyngeal mucosa. The immunostaining pattern of CK2-alpha revealed that staining was observed in the cells stained for the proliferation-marker Ki-67; however, strong distinct immunostaining for CK2-alpha was also observed in large numbers of other cells in these same tumors, suggesting that CK2 elevation in these tumors is not a reflection of proliferative activity alone, but may also relate to the pathobiological behavior of the tumor.

Diagnosis and pharmacotherapy issues in the care of Hispanics in the public sector.

Clinical data from 1,752 ambulatory patients treated at five public mental health clinics were used to test hypotheses concerning the diagnoses and psychopharmacotherapy of Hispanic patients compared with Anglos and blacks. Hispanics were less likely than the other two groups to be labeled schizophrenic but more likely to be diagnosed as having other mental illnesses. Hispanics were less likely to receive medication than the other two groups. However, when pharmacotherapy was used there were no significant differences among groups in the number of medications prescribed. There were no differences among the groups in the doses prescribed.

Elevated protein kinase CK2 activity in chromatin of head and neck tumors: association with malignant transformation.

We hypothesized that malignant transformation of normal mucosa of the upper aerodigestive tract to squamous cell carcinoma of the head and neck (SCCHN) might be associated with altered CK2 activity in the chromatin compartment of these tumors. We measured CK2 activity in the cytosol and chromatin of 7 surgical specimens of SCCHN, and 5 specimens of normal oropharyngeal mucosa from non-smokers/non-drinkers. CK2 activity in SCCHN tumors was significantly elevated in both the nuclear chromatin (P < 0.0005) and cytosolic (P <0.04) compartments relative to normal mucosa. These data suggest that activation of dysregulation of the chromatin-associated CK2 signal may play a role in the pathobiology od SCCHN.

The prevalence of tardive dyskinesia in geropsychiatric outpatients.

The prevalence of tardive dyskinesia was studied in a geropsychiatric outpatient clinic. All currently active patients were examined using the Abnormal Involuntary Movement Scale (AIMS) and a standardized procedure. Data were collected on a number of previously reported risk factors. A higher prevalence was noted in both tardive dyskinesia and spontaneous involuntary movement disorders in this patient population. Only sex and duration of exposure to antipsychotic drugs were noted to be significant risk factors.

Treatment of head and neck cancer with combined modalities.

Patients with advanced epidermoid carcinoma of the head and neck are often treated with combinations of radiation therapy and surgery. Patients with more advanced malignancies may also receive adjuvant chemotherapy. Prospective randomized protocols provide the most effective means of determining the value of combined modalities versus a single modality only. Preoperative assessment includes direct visualization, palpation, endoscopy and, in selected incidents, CT or MRI scanning. CT scan may provide objective evidence of tumor response when preoperative adjuvant treatment, either as radiation or chemotherapy, is given.

Reliability in evaluating letters of recommendation.

To measure the interobserver reliability in evaluating letters of recommendation for residency applicants, three letters were collected from each of the application files of 58 residents at one program. The letters were rated by six faculty. Interobserver reliability, calculated using the kappa statistic, was slight. These preliminary results show significant variability in the interpretation of letters of recommendation.

Long-term survival in rhinocerebral mucormycosis. Case report.

Mucormycosis refers to a group of rapidly progressive infections caused by fungi belonging to the order Mucorales. Infection most often develops in individuals with immunological or metabolic compromise, although patients without underlying abnormalities have been affected. Specific clinical manifestations are associated with various predisposing factors. Rhinocerebral mucormycosis is the most common form and most frequently develops in individuals with poorly controlled diabetes mellitus. The extent of anatomical involvement and clinical course are unpredictable, depending on the intrinsic factors of the host. Over the past 20 years the prognosis for patients with rhinocerebral mucormycosis, once considered to be a uniformly fatal disease, has improved. Coordinated medical and surgical treatment, including rapid diagnosis, the advent of systemic antifungal agents, aggressive surgical debridement, and control of the underlying disease process, have been credited with its successful management. The range of survival rates recorded with the regimen of combined therapies is wide because the number of patients reported is limited and anatomical involvement is diverse. Survival with intracerebral abscess is rare. The authors describe the successful management of a patient who developed a bifrontal fungal abscess during treatment for rhinocerebral mucormycosis associated with ketoacidosis and diabetes mellitus. The patient remains without radiographic or clinical evidence of infection more than 2 years after treatment. The authors review the characteristic clinical, radiographic, and pathological features of previously reported infections and emphasize the importance of early detection and aggressive treatment in the management of this frequently fulminant and fatal disease.

Respiratory papillomas: presentation before six months.

The prognosis of respiratory papillomatosis (RP) in newborns appears to be less favorable than in infants and older children. In this series of four patients who developed symptoms of the disease within the first 6 months of life, the mortality was 100%. In these premature and term newborn infants, endoscopic laser surgery and medical and immunologic therapy were unable to control the growth of RP. Meticulous local removal of the airway lesions is the most reliable form of management.

Carcinoma of the lip.

A retrospective analysis of 206 patients with lip cancer is presented. Poorly differentiated primary lesions have a high rate of metastases. The metastatic potential of well differentiated lesions, when classified by size in the TNM staging system, is the same as that of intraoral carcinoma. A therapeutic approach is proposed.

Cues of disability and treatment continuation of chronic schizophrenics.

Serious questions have arisen concerning the retention of the chronically ill in outpatient community mental health clinics (CMHC). This study tests a model based upon sociological theories of disability and the sick role to explain differential continuation in treatment among schizophrenics. We hypothesized that economic, social and medical cues facilitate a patient's self-definition of disability and contribute to continuation in treatment. Data were collected from the clinical charts of 879 chronic schizophrenic patients at five CMHC's. Hypotheses were tested using OLS multiple regression and logistic regression. Findings indicated level of functioning may be an important explanatory variable. Analysis strongly indicated the efficacy of the medical model in the area of treatment continuation.

"Emergency" laryngectomy and stomal recurrence.

The data on 281 patients who underwent surgical therapy for laryngeal carcinoma from 1976 through 1984 were reviewed, revealing 16 patients who presented with an impending obstruction of the airway that was treated by an "emergency" laryngectomy. A review of the patients in our series did not reveal any serious complications from the procedure and it has allowed effective management of these advanced neoplasms. In addition, 10 patients who developed peristomal recurrences were reviewed. Preoperative factors such as location of lesion, antecedent surgery, and previous radiation therapy were assessed and compared to the patients who underwent "emergency" laryngectomy in an attempt to further define risk factors involved in peristomal recurrence. A strong association with subglottic extension was noted. Also associated in this review was antecedent full-course radiation therapy.

Complications of pectoralis myocutaneous flaps.

The myocutaneous pectoralis major flap has recently caught the attention of head and neck surgeons. Over the last 12 months, our service has used this flap in 14 patients. Reconstruction in the oral cavity and larynx as well as closure of large areas of skin necrosis of the neck have been the indications. Our complications occurred in 4 of the 14 patients and included neck abscess and fistula, flap necrosis, and chest wall hematoma or abscess. The flap is an eminently useful and successful flap when designed and performed as indicated in the body of the paper.

Inhibition of head and neck tumor cell growth with arachidonic acid metabolism inhibition.

Head and neck tumors are known to synthesize arachidonic acid metabolites. The authors have postulated that these substances may confer growth advantage to cancer cells, and by interfering with arachidonic acid metabolism squamous cancer growth may be altered. The tongue derived squamous carcinoma cell line, SCC-25, was treated with three leukotriene synthesis inhibitors and indomethacin. A dose-dependent decrease in DNA synthesis occurred with leukotriene inhibition, but not prostaglandin inhibition. All leukotriene synthesis inhibitors produced a dramatic and immediate effect ( > 70% inhibition by 4 hours) without cytotoxicity ( > 90% trypan blue exclusion). Cell populations at 96 hours were decreased when compared to control populations. In conclusion, leukotrienes or other lipoxygenase products may play a role as growth factors for squamous cell carcinoma, and arachidonic acid inhibition may be a novel target for chemotherapeutic intervention.

Oncocytic lesions of the larynx.

True laryngeal adenomas are considered extremely rare and some doubt their existence. Laryngeal lesions having oncocytes as the predominant cell type have been described in the literature under a variety of different names: oncocytoma, oncocytic papillary cystadenoma, papillary cystadenoma, oxyphilic granular cells adenoma, etc. The oncocytes originate from changes in normal acinic and ductal cells. The significance of these changes is controversial. Whether the oncocytic laryngeal lesions represent true neoplasms or are degenerative in nature remains to be determined. We present clinical and histopathological details of four cases of oncocytic lesions of the larynx and compare their histology with microscopic findings in 30 cases filed as laryngeal cysts at the Minneapolis V.A. and University of Minnesota Hospitals. While the controversy regarding the neoplastic versus degenerative etiology of these lesions could not be resolved from a histopathological standpoint, their clinical behavior is that of a benign neoplasm. We review the literature on the subject and suggest a course of treatment for these lesions.

Preoperative permanent balloon occlusion of internal carotid artery in patients with advanced head and neck squamous cell carcinoma.

OBJECTIVE/HYPOTHESIS: To determine the value of preoperative balloon occlusion in predicting the safety of carotid artery resection in advanced recurrent head and neck squamous cell carcinoma. STUDY DESIGN: Retrospective chart review of all cases undergoing planned carotid artery resection for recurrent disease at a major university hospital. METHODS: If the carotid artery was encased, a nonemergent carotid artery balloon test occlusion was performed for 30 minutes. If the patient tolerated this, he or she underwent permanent carotid artery occlusion. RESULTS: Twenty-three patients were prospectively evaluated for resection. Three underwent emergent carotid artery ligation. Twenty others underwent nonemergent carotid artery test occlusion. Of these, 5 patients failed preoperative carotid artery balloon occlusion and 15 patients successfully underwent permanent carotid balloon occlusion. Although eight of these patients died of recurrent disease in less than 1 year, seven patients survived more than 1 year with two patients surviving more than 2 years. CONCLUSIONS: Preoperative carotid balloon occlusion predicted patients who could tolerate permanent occlusion. All patients eventually developed recurrent disease, but in 14 of the 15 patients, no hemorrhages occurred.

Reconstruction of the mandible.

Forty-five patients were evaluated for reconstruction of the mandible. Thirty-four patients had a particulate cancellous bone and marrow (PCM) crib graft placed. Thirty of 34 were successful at the primary operation producing a success rate of 88%. By using secondary procedures all 33 patients repaired to date have been rehabilitated. A dynamic bendable defect bridging plate with cancellous cortical graft (DBDB plate with CCG) was used in 7 patients, 4 of whom had tumor surgery and 3 of whom were operated on after trauma to the anterior mandible. All 7 cases were successfully rehabilitated in achieving a stable, functioning mandibular arch. An osteomyocutaneous flap was planned to reconstruct the anterior mandible in 4 cases; 1 in this group was not reconstructed. The PCM graft has been our first line approach to the mandibular non-union but with experience we are beginning to rely on the DBDB plate with CCG for large bony defects after both trauma and secondarily after tumor surgery. When indicated, the osteomyocutaneous flap has been eminently successful in restoring function and form in the tumor patient.