Reflex sympathetic dystrophy of the face: current treatment recommendations.

Reflex sympathetic dystrophy (RSD) of the face is an infrequently reported clinical pain syndrome characterized by dysesthesia, hyperalgia, hyperpathia, and allodynia. Treatment strategies, extrapolated from RSD and causalgia of the extremities, remain variable and poorly defined. Sympathetic blockade is generally the diagnostic and therapeutic treatment of choice; however, the frequency, timing, and duration of injections; need for neurolytic blocks; and role of sympathectomy are not well understood.

High-dose naltrexone and liver function safety.

Studies have found naltrexone useful in the treatment of diseases other than opiate addiction in which endogenous opioids presumably play a role, such as alcoholism and eating disorders. Some of these studies involve high doses (100-200 mg bid). Because investigational studies with high doses (300 mg/day) reported clinically significant increases in liver enzyme levels, the authors measured a spectrum of liver function parameters in response to high doses of naltrexone in a double-blind, crossover trial (100 mg bid) followed by an open-label period (200 mg bid).

Survival of composite chondrocutaneous grafts by vessel implantation: a study in the rabbit ear model.

Composite chondrocutaneous graft reconstruction or reattachment has limited applicability, is traditionally restricted to small segmental losses, and is dependent on the status of the recipient bed and graft periphery for successful revascularization. Surgical enhancement of composite graft survival was experimentally investigated in the rabbit ear model through transposition and appositional placement of an adjacent vascular pedicle. Fluorescein-derived surface-survival determinations, microangiographic vessel-counting methods, and histologic analysis were used to study the effects of vascular augmentation, pedicle design variations, and angiogenic substance in sixty 8-cm2, full-thickness auricular grafts.

Polyamine levels, ornithine decarboxylase (ODC) activity, and ODC-mRNA expression in normal and cancerous human colonocytes.

Ornithine decarboxylase (ODC) and polyamines (putrescine, spermidine, and spermine) are crucial for cell proliferation. Recently, elevated ODC activity and polyamine levels have been suggested as biological markers for human colon cancer. In this study, we measured ODC activity and the levels of polyamines (putrescine, spermidine, spermine, and cadaverine) and acetyl-putrescine in human colonocytes isolated from cancerous areas compared to the adjacent normal colon tissue.

5-Fluorouracil, etoposide, and cisplatin in the management of metastatic non-small cell lung cancer.

Encouraging response rates have been reported in Stage III non-small cell lung cancer when 5-fluorouracil (5-FU), etoposide (VP-16), and cisplatin (FED) have been combined with radiation therapy (RT) or RT and surgery. The current study evaluated the effectiveness of FED chemotherapy in 32 patients with metastatic non-small cell lung cancer. Treatment consisted of 5-FU (800 mg/m2/d) on days 1 to 4 by continuous infusion, intravenous (IV) VP-16 (60 mg/m2) over 1 hour on days 1 to 4, and IV cisplatin (60 mg/m2) over 1 hour on day 1.

The role of infection in the morbidity and mortality of patients with head and neck cancer undergoing multimodality therapy.

Cancer of the head and neck is a common cancer worldwide. The majority of patients present with locally advanced disease. Recently a great deal of improvement has been made in multimodality therapy of this disease, warranting more careful consideration of factors affecting quality of life, disease course, and treatment.

Phase II study of deoxydoxorubicin in previously untreated metastatic breast cancer.

With the objective of identifying new chemotherapeutic agents active against breast cancer, we administered the phase II agent deoxydoxorubicin (DxDx) to 25 patients who had received no prior chemotherapy for their metastatic breast cancer. A dose of 30-35 mg/M2 given at 3 week intervals resulted in a response rate of 12%. The patients were subsequently treated with a combination of 5-fluorouracil, methotrexate, vincristine, cyclophosphamide, and prednisone.

Polypoid melanoma: a virulent variant of nodular melanoma. Report of three cases and literature review.

We report the cases of three patients with polypoid melanoma. In no case was there microscopic evidence of melanoma cell invasion below the papillary dermis. In the polypoid variant of nodular melanoma, melanoma cells accumulate in large volume above the skin's surface.

Flap reconstruction techniques in conjunctivorhinostomy.

Dacryocystorhinostomy is usually the standard approach to treat epiphora caused by lower lacrimal tract obstruction. When the pathologic condition lies in the upper lacrimal passage, however, alternate bypass or reconstructive options must be considered. Conjunctivodacryocystorhinostomy, using the Jones tube, can effectively bypass the upper tract, but the technique may be complicated by granulation tissue formation, infection from unapposed mucosal flaps, and inefficient passage of tears through scar as a result of healing by secondary intention.

Complete post-traumatic ptosis: a mechanism for recovery?

Traumatic blepharoptosis, although considered relatively rare, is an entity which demands recognition if one is to achieve optimal results. Reports of levator injury following orbital, ocular, and adnexal surgery, as well as in cataract and blepharoplasty procedures, are well described. In most cases eventuating in complete ptosis, levator disinsertion is the anatomic correlate, the ptosis is usually permanent, and surgical intervention is often indicated.

Sexually transmitted papillomaviral infections: V. Prophylactic use of topical 5-fluorouracil in refractory infection in the male.

The topical administration of 5% fluorouracil (Efudex) was used on 60 males afflicted with recurrent papillomaviral infection, all partners of women with proved HPV disease. The overall response to the medication was 84 percent (total plus partial responses) for those patients afflicted with mixed disease of the shaft, compared with the subclinical and exophytic varieties with 70 and 67 percent response, respectively. Because HPV infections tend to be a field phenomenon involving the entire lower genital tract, this simple form of treatment, that is locally applied with few side effects, appears to be ideal for the management, prophylaxis, and treatment of recurrent disease.

Sexually transmitted papillomaviral infections: IV. The white scrotum.

Retrospective review of 353 male patients, partners of women with known HPV infection, revealed a 22 percent (77) incidence of subclinical scrotal involvement histologically characterized by koilocytosis, and clinically diagnosed only by the routine application of 3% acetic acid. Previous viral typing of 20 of these subclinical lesions revealed HPV DNA in 8 cases. Of these 4 contained high-risk HPVs, suggesting that the "white scrotum" is an important reservoir for the transmission of HPV to the female genitourinary tract.

Chemotherapy following surgery for head and neck cancer. A Radiation Therapy Oncology Group Study.

The feasibility of chemotherapy of three courses of cis-platin and 120-h 5-fluorouracil (5-FU) infusion after definitive surgery, followed by standard radiotherapy, in patients with resectable locally advanced head and neck cancer was carried out in Radiation Therapy Oncology Group (RTOG). Seventy-nine percent of the patients had stage IV cancer, 65% of the tumors were moderately differentiated, and primary sites were 38% oropharynx and 28% larynx. Toxicity to chemotherapy was acceptable, with no life-threatening side effects.

Clinical trials with fluorinated pyrimidines in patients with head and neck cancer.

While it is estimated to be one of the most prevalent cancers in the world, cancer of the head and neck is an uncommon malignant tumor in the United States and accounts for only 5% of all malignancies. Head and neck cancer is a term that encompasses heterogeneous groups of patients. The most common histologic type is the squamous cell carcinoma.

ST segment shifts are poor predictors of subsequent Q wave evolution in acute myocardial infarction. A natural history study of early non-Q wave infarction.

Acute ST segment elevation is regarded generally as the sine qua non of evolving Q wave myocardial infarction (MI) because such electrocardiographic (ECG) injury is believed to be a marker of transmural ischemia and a forerunner of transmural necrosis. Alternatively, ST segment depression with or without T wave inversion is viewed as the dominant ECG feature of non-Q wave MI. However, this hypothesis has not been assessed prospectively in an acute MI population.

A cooperative transition theory applied to the kinetics of ionic exchanges in cells.

Manifestations of a cooperative interaction between ion-adsorbing sites in cells include steep, sigmoidal equilibrium adsorption isotherms of K+ and Na+, critical temperature transitions of net exchanges of Na+ for K+, and the allosteric nature of the effects of ligands on cellular K+ and Na+. Cooperative ionic adsorption is described by a one-dimensional Ising model. The experimentally-determined equilibrium parameters permit prediction of the kinetics of exchange of K+ for Na+ (the approach to equilibrium) by stochastic or hydrodynamic solutions of a time-dependent Ising model.

Further clinical experience with CO2 laser in microsurgical vasovasostomy.

Herein are reported the results obtained in 14 patients with the performance of vasovasostomy by carbon dioxide (CO2) laser. Fusion coagulation of the vas wall was successfully accomplished as demonstrated by postoperative sperm counts of over 20 million/mL in 86 per cent of the patients, and a pregnancy rate of 43 per cent in the group of patients operated on within less than ten years of original vasectomy. In contrast, those patients undergoing vasovasostomy ten years after original vasectomy had sperm counts of over 20 million/mL in 43 per cent of the cases, with a zero pregnancy rate.

Sexually transmitted papillomaviral infection in the male: II. The urethral reservoir.

Urethral cytobrushing for hybridization studies was obtained from the anterior urethra of 75 male consorts of known HPV-infected female partners. Our findings revealed a 24 per cent (19 patients) incidence of positive hybridization, identifying HPV-16 or HPV-18 in six instances associated with mixed papillomaviral infection of the shaft and the presence of HPV-6 and HPV-11 in 7 cases clinically related to exophytic disease of the shaft. Although no histologic evidence of virus-tissue interaction could be demonstrated, careful follow-up is recommended to detect early recurrent disease with its potential for partner reinfection.

PCNU: phase II evaluation in advanced colorectal carcinoma.

PCNU, a N-(2-chloroethyl)-N-nitrosourea, was administered to 37 previously treated patients with metastatic adenocarcinoma of the colon and rectum. The drug dose was 100 mg/m2, intravenously, over one hour for good risk patients and 75 mg/m2 for poor risk patients. Poor risk patients were defined as patients over 65 years of age or having liver enzymes greater than twice normal.

Sexually transmitted papillomaviral infections: III. Management of male partner.

The treatment of 199 males afflicted with sexually transmitted papillomaviral infections has shown that to be successful, periodic and prolonged follow-up is necessary to detect recurrent disease. Results of superficial epidermectomy using a battery-powered eye cautery in 49 cases with a few clusters confined to the shaft showed a 40 per cent recurrence rate. The carbon dioxide (CO2) laser was successful in eradicating 75 to 82 per cent of the cases presenting with extensive subclinical and exophytic disease.