Conservative management of testicular germ-cell tumors.

Cure rates of germ-cell cancer have been greater than 95% for the last decade; therefore, over the past few years there has been a greater focus on 'conservative' approaches to treatment. The increased incidence of late non-germ-cell cancers in the era of radiotherapy and the incidence of subclinical testicular deficiency and metabolic syndrome in cured patients have accelerated this trend. Taking account of the increase in cure rates of primary chemotherapy failures from 5% to 60% with intensification of chemotherapy and surgery, this Review focuses on three areas: lessons from the initial failed trials of less-intensive treatment (i.

Legitimizing the shameful: end-of-life ethics and the political economy of death.

This paper explores one of the most politically sensitive and intellectually neglected issues in bioethics--the interface between the history of contemporary end-of-life ethics and the economics of life and death. It suggests that contrary to general belief, economic impulses have increasingly become part of the conditions in which contemporary end-of-life ethics continues to evolve. Although this conclusion does not refute the philosophical justifications provided by the ethics for itself, it may cast new light upon its social role.

The reproductive significance of human Fallopian tube cilia.

Effective tubal transport of ova, sperm and embryos is a prerequisite for successful spontaneous pregnancy. Although there is much yet to be discovered about the mechanisms involved, it is evident that tubal transit is a far more complicated process than initially thought. Propulsion of gametes and embryos is achieved by complex interaction between muscle contractions, ciliary activity and the flow of tubal secretions.

Selenium in critical illness.

Purpose Of Review: Selenium is a trace element essential to human health. Critical illness is associated with the generation of oxygen free radicals resulting in a condition of oxidative stress. Supplementing critically ill patients with antioxidant nutrients may improve survival.

The effect of ovarian follicular fluid and peritoneal fluid on Fallopian tube ciliary beat frequency.

Background: The Fallopian tube undergoes well-recognized changes during the ovarian cycle. Ciliary beat frequency (CBF) increases during the secretory phase of the cycle. The stimulus is unknown, although CBF is known to be hormone responsive.

The frequency of intratubular embryonal carcinoma: implications for the pathogenesis of germ cell tumours.

Aims: To define the frequency and distribution of intratubular embryonal carcinoma (IEC) in an attempt to shed light on the pathogenesis of non-seminomatous germ cell tumours (NSGCTs). Intratubular germ cell neoplasia of unclassified type (IGCNU) is common in NSGCT; however, IEC is rarely described.

Methods And Results: Sixty-two germ cell tumours were reviewed.

Three-dimensional assessment of treatment outcomes on the face.

Objectives: To investigate the effect on the face of treatment involving extractions.

Design: A prospective study of the effects of extraction and non-extraction treatment on two groups of patients was undertaken.

Setting And Sample Population: Initially there were 16 non-extraction and 18 extraction patients but at the end of treatment there were only 12 in each group.

Airway epithelial inflammatory responses and clinical parameters in COPD.

This study examined inflammatory responses from primary cultured human bronchial epithelial cells in chronic obstructive pulmonary disease (COPD) and the clinical factors modulating them. Epithelial cells from bronchoscopic biopsies from 14 patients with COPD ((mean +/- SD) age 74.6 +/- 5.

Fallopian tube ciliary beat frequency in relation to the stage of menstrual cycle and anatomical site.

Background: The cyclical changes in ciliary structure and motion within the human Fallopian tube are well documented. Previous investigators have studied ciliary beat frequency (CBF) in relation to menstrual cycle and anatomical site, but with conflicting results.

Methods: Using a technique that records variations in light intensity, we have studied the changes in CBF in relation to the menstrual cycle and anatomical site.

An overview of the immune system.

We are continually exposed to organisms that are inhaled, swallowed, or inhabit our skin and mucous membranes. Whether these organisms penetrate and cause disease is a result of both the pathogenicity of the organism (the virulence factors at its disposal) and the integrity of host defence mechanisms. The immune system is an interactive network of lymphoid organs, cells, humoral factors, and cytokines.

Wnt-16a, a novel Wnt-16 isoform, which shows differential expression in adult human tissues.

The WNT genes encode a large family of secreted glycoprotein signalling molecules important from the earliest stages of development through to the adult. We have identified a novel isoform of the recently described WNT family member, Wnt16, following analysis of chromosome 7q31 genomic sequence. We find differential organisation of Wnt16 with the generation of two mRNA isoforms, Wnt16a and Wnt16b.

Receptor pharmacology of neuroleptics.

The term 'neuroleptic' originated from animal experiments--these drugs caused profound sedation and abnormal posturing as if the animal had been 'seized' (Greek 'lepsis', meaning seizure). All early neuroleptic drugs had antipsychotic actions and vice versa. Now there are drugs which are potent antipsychotics without the classic neuroleptic actions known as atypical neuroleptics.

Medical students' concerns about communicating with patients.

Background: Only limited information is available on students' concerns regarding communication with patients. SAMPLE AND DESIGN: A total of 16 concerns regarding communicating with patients were rated by 179 third-year medical students, before the students had any contact with patients and before communication skills teaching had begun. At the end of the term, the ratings were collected again from 139 of the students.

Noise and health in the urban environment.

Noise, including noise from transport, industry, and neighbors, is a prominent feature of the urban environment. This paper reviews the effects of environmental noise on the non-auditory aspects of health in urban settings. Exposure to transport noise disturbs sleep in the laboratory, but generally not in field studies, where adaptation occurs.

'Now please wash your hands': the handwashing behaviour of final MBBS candidates.

The Handwashing Liaison Group has pointed out that "The failure of healthcare workers to decontaminate their hands reflects fundamentals of attitudes, beliefs and behaviours". Doctors are known to be poor at handwashing. This poor compliance may have its roots in a failure to learn this behaviour at medical college, where the influence of consultants and other role models may be critical.

Fetal programming of hepatic lobular architecture in the rat demonstrated ex vivo with magnetic resonance imaging.

We demonstrate that MRI imaging at sub-millimetre resolution can distinguish between periportal and perivenous zones of the rat liver lobule. This made it possible to measure the hepatic lobular radius in ex-vivo perfused fixed livers using MRI. Comparisons of histomorphometric and MRI measurements of lobular radius were in good agreement, although MRI measurements were significantly smaller (P< 0.

Frequency and prognostic impact of microsatellite instability in a large population-based study of endometrial carcinomas.

The replication error repair (RER) phenotype has been reported in 9-43% of sporadic endometrial carcinomas, but there are conflicting data about its effect on prognosis in this disease. This study was performed to establish the frequency of the RER phenotype and to determine its effect on prognosis in a population-based series of 259 endometrial carcinomas with long-term follow-up. Five mononucleotide and dinucleotide microsatellite markers on different chromosomes were analyzed, and tumors exhibiting microsatellite instability at two or more loci were classified as RER+.

Identification of a novel mutation R42P in the gap junction protein beta-3 associated with autosomal dominant erythrokeratoderma variabilis.

We report a missense mutation in the gap junction protein beta-3 (encoding Connexin 31), which was detected in only the affected members of a family in which the autosomal dominant skin disease erythrokeratoderma variabilis was segregating. The nucleotide change results in an arginine to proline substitution in codon 42. This residue is positioned on the first transmembrane/first extracellular domain of the gap junction protein with the mutation replacing a negatively charged residue with a nonpolar residue.

Zonation of gluconeogenesis, ketogenesis and intracellular pH in livers from normal and diabetic ketoacidotic rats: evidence for intralobular redistribution of metabolic events in ketoacidosis.

The intralobular distribution of metabolism was examined in the livers from rats with severe diabetic ketoacidosis (DKA), perfused at pH 6.8, and compared with that in livers from normal starved animals perfused at either pH 7.4 or 6.

Patient case studies.

Three contrasting cases of obese patients with type 2 diabetes mellitus are presented, which illustrate the management difficulties faced by clinicians. The first raises the issue of when to commence an oral hypoglycaemic agent in a newly diagnosed but asymptomatic obese patient; the second case addresses the problem of when to commence insulin in the face of continuing weight gain and poor glycaemic control; the final case is an example of the vicious metabolic spiral which so many patients enter, with increasing body weight, poor diabetic control and associated co-morbidities. The discussion that follows each case presentation recognises the considerable cardiovascular risk faced by such patients and provides guidance about possible management pathways including adjunctive anti-obesity pharmacotherapy.

A double blind, randomised, controlled trial of glutamine supplementation in parenteral nutrition.

Background And Aims: To determine whether the inclusion of 20 g free glutamine as part of the nitrogen source of parenteral feeds reduces length of hospital stay or mortality.

Methods: In a randomised, double blind, controlled trial in 168 patients clinically accepted for parenteral nutrition, standard feeds were compared with feeds in which 3.8 g of the total nitrogen was replaced with the equivalent 20 g glutamine.

The management of residual masses after chemotherapy in metastatic seminoma.

Objective: To review our experience in management of residual masses after chemotherapy for metastatic seminoma.

Patients And Methods: The study comprised a review of 107 patients with metastatic seminoma, treated with initial chemotherapy from 1978 to 1996. Forty-three patients had residual masses detected by computed tomography after chemotherapy, while 64 achieved a complete response.

Germline mutations in the extracellular domains of the 55 kDa TNF receptor, TNFR1, define a family of dominantly inherited autoinflammatory syndromes.

Autosomal dominant periodic fever syndromes are characterized by unexplained episodes of fever and severe localized inflammation. In seven affected families, we found six different missense mutations of the 55 kDa tumor necrosis factor receptor (TNFR1), five of which disrupt conserved extracellular disulfide bonds. Soluble plasma TNFR1 levels in patients were approximately half normal.