Assessment of False-negative Ascites Cytology in Epithelial Ovarian Carcinoma: A Study of 313 Patients.

OBJECTIVE: The objective was to determine how often peritoneal cytology is positive for malignancy in women with known ovarian cancer. Knowing this fact would help determine the usefulness of diagnostic paracentesis. METHODS: Records of all women diagnosed with invasive epithelial ovarian cancer from 2004 to 2012 were examined to correlate presence of ascites, cytologic, and pathologic findings. RESULTS: A total of 313 patients were included in analysis. A total of 210 of 313 patients (67.1%) with ascites had cytology positive for malignancy. This left 103 patients with ascites and cancer without malignant cells found in the ascites removed at the time of surgery. CONCLUSIONS: Except in a few cases, paracentesis is not recommended for the diagnosis of ovarian cancer because of the potential spreading of cancer. Furthermore, with only just over two thirds of cases of known cancer and ascites having cytology positive for malignancy, the value of paracentesis for diagnosis of ovarian cancer is minimal.

Factors Associated With Hemostatic Agent Use During Laparoscopic Hysterectomy.

STUDY OBJECTIVE: To evaluate factors associated with the use of hemostatic agents during traditional laparoscopic or robotic hysterectomy. DESIGN: A retrospective cohort trial (Canadian Task Force classification III). SETTING: A single medical center in Cincinnati, OH, from August 1, 2013, to July 31, 2014. PATIENTS: Women undergoing traditional laparoscopic or robotic hysterectomies with and without the use of hemostatic agents. INTERVENTION: The use of a hemostatic agent at the time of hysterectomy. MEASUREMENTS: Patient characteristics and pre- and postoperative metrics were recorded for each subject. Associations between categoric variables were analyzed using chi-square testing, whereas continuous variables were analyzed using analysis of variance. Modeling of study variables to predict hemostatic agent use was performed using chi-square-assisted interaction detection methods. MAIN RESULTS: The study sample included 176 cases performed by 30 surgeons. In our sample, 42% of minimally invasive hysterectomies were performed with the surgical robot (robotic-assisted laparoscopic hysterectomy); the remainder of minimally invasive hysterectomies by approach was as follows: total laparoscopic hysterectomy, 27%; laparoscopic-assisted vaginal hysterectomy, 16%; and laparoscopic supracervical hysterectomy, 15%. Forty-six percent (81/176) of cases recorded the use of a fibrin hemostat, 26% (46/176) involved an alternative hemostat, and 28% (49/176) of cases did not use any hemostat. By surgical approach, no hemostatic agent use was noted most often among laparoscopic-assisted hysterectomy; alternative hemostats were most often used during total laparoscopic hysterectomy. Robotic-assisted laparoscopic hysterectomy and laparoscopic supracervical hysterectomy were most often associated with fibrin-based hemostats. The use of any hemostatic agent did not result in clinical significant blood loss relative to cases in whino product was used. The study variable identified most predictive of hemostat use by the chi-square-assisted interaction detection regression tree model was surgeon identity. CONCLUSION: Hemostatic agent use during traditional laparoscopic and robotic hysterectomy does not appear to be associated with operative bleeding but is related to surgeon identity.

Recurrent Pseudomembranous Colitis in an Ovarian Cancer Patient Undergoing Carboplatin Chemotherapy.

Background. Diarrhea is a common problem in ovarian cancer patients undergoing chemotherapy and Clostridium difficile infection has been identified as a cause. The proper diagnosis and treatment of diarrhea are critical to patient care, especially to prevent the serious complications from a severe Clostridium difficile infection (CDI). Case. We present a heavily pretreated ovarian cancer patient who developed recurrent pseudomembranous colitis while receiving carboplatin chemotherapy. Despite treatment with oral metronidazole for fourteen days, the patient's diarrhea relapsed and colonoscopy revealed extensive pseudomembranous colitis. The infection eventually resolved with the combination of oral vancomycin and metronidazole. Conclusions. Diarrhea is a common problem in patients undergoing chemotherapy for ovarian cancer. Management requires obtaining the proper diagnosis. Clostridium difficile associated pseudomembranous colitis must be part of the differential diagnosis. Treatment must be sufficient to prevent relapses of the Clostridium difficile infection to prevent serious consequences in an already vulnerable patient population.

Educational-entertainment as an intervention with Black adolescents exposed to community violence.

Witnessing violence is one adverse childhood experience (ACE) associated with living in impoverished Black urban communities. Youth with higher violence avoidance self-efficacy and positive coping are more likely to avoid violence. This study evaluates educational entertainment (edutainment) as an intervention with Black adolescents exposed to community violence. Edutainment has shown success in increasing self-efficacy and positive coping skills in other domains. Self-administered scales were used to measure stress, anxiety, violence avoidance self-efficacy, and coping strategies. Data were collected pre- and nine days post-interventions/no intervention from 20 subjects receiving the edutainment intervention, 19 subjects participating in a group discussion about violence, and 21 subjects receiving no intervention (N = 60). Edutainment and no intervention were more effective than group discussion alone in increasing violence avoidance self-efficacy. Violence avoidance self-efficacy was found to have an intervening relationship between edutainment and the outcome of stress. This study indicates limited but positive effects for edutainment.

Differences in motor and cognitive function in patients with Parkinson's disease with and without orthostatic hypotension.

Patients with Parkinson's disease (PD) often present with orthostatic hypotension (OH) as a result of the dysautonomia associated with the disease or as a side effect of the dopaminergic medications used to treat the disease. The purpose of this study was to investigate differences in motor and cognitive function in patients with PD with and without OH. Forty-four patients with a diagnosis of PD were evaluated and stratified by the presence of OH based on orthostatic blood pressure recordings. Both groups underwent assessments of motor and cognitive function. OH was present in 17 of 44 patients (39%) with PD. These patients with OH had significantly lower scores in gross motor, balance, and cognitive function (p < .05). No significant difference between groups was found in the finger tapping scores. These results suggest that patients with PD should be routinely screened for OH as it commonly occurs and may negatively impact gross motor, balance, and cognitive function.

Treating orthostatic hypotension in patients with Parkinson's disease and atypical Parkinsonism improves function.

BACKGROUND: Patients with idiopathic Parkinson's disease (PD) or atypical Parkinsonism (AP) often present with orthostatic hypotension (OH) as a result of the dysautonomia associated with the disease or as a side effect of the dopaminergic medications used to treat it. Our recent study suggested that OH negatively impacts gross motor, balance, and cognitive functions in patients with PD. OBJECTIVE: To determine if correcting the orthostatic hypotension (OH) of patients with PD or AP improves their gross motor, balance, and cognitive functions. METHODS: Forty patients with PD or AP were assessed before and after correcting their OH using a staged approach with a goal of SBP >80 when standing and SBP <180 when laying. Step 1 of treatment included reducing antihypertensive medications, as possible, maintaining hydration with 1500cc/day, decreasing dietary salt, wearing high compression stockings, and keeping the head of bed elevated at 30 degrees when supine. If SBP <80 with standing after step 1, then treatment was started with fludrocortisone and/or midodrine. RESULTS: Patients' OH was managed as part of a rehabilitation program. Tests such as the Motor and Cognitive Functional Independence Measures, Berg Balance Scale, Two Minute Walking test, and the Finger Tapping test showed significant improvements (p < 0.05) in their gross motor, walking, balance and cognitive function with our OH management plan. No significant differences between admission and discharge were found in the Timed Up and Go test. CONCLUSION: Our data suggest that monitoring and correcting the OH of patients with PD or AP improves their gross motor, balance, and cognitive function.

Effectiveness of an inpatient movement disorders program for patients with atypical parkinsonism.

This paper investigated the effectiveness of an inpatient movement disorders program for patients with atypical parkinsonism, who typically respond poorly to pharmacologic intervention and are challenging to rehabilitate as outpatients. Ninety-one patients with atypical parkinsonism participated in an inpatient movement disorders program. Patients received physical, occupational, and speech therapy for 3 hours/day, 5 to 7 days/week, and pharmacologic adjustments based on daily observation and data. Differences between admission and discharge scores were analyzed for the functional independence measure (FIM), timed up and go test (TUG), two-minute walk test (TMW), Berg balance scale (BBS) and finger tapping test (FT), and all showed significant improvement on discharge (P > .001). Clinically significant improvements in total FIM score were evident in 74% of the patients. Results were similar for ten patients whose medications were not adjusted. Patients with atypical parkinsonism benefit from an inpatient interdisciplinary movement disorders program to improve functional status.

Neural substrates of resisting craving during cigarette cue exposure.

BACKGROUND: In cigarette smokers, the most commonly reported areas of brain activation during visual cigarette cue exposure are the prefrontal, anterior cingulate, and visual cortices. We sought to determine changes in brain activity in response to cigarette cues when smokers actively resist craving. METHODS: Forty-two tobacco-dependent smokers underwent functional magnetic resonance imaging, during which they were presented with videotaped cues. Three cue presentation conditions were tested: cigarette cues with subjects allowing themselves to crave (cigarette cue crave), cigarette cues with the instruction to resist craving (cigarette cue resist), and matched neutral cues. RESULTS: Activation was found in the cigarette cue resist (compared with the cigarette cue crave) condition in the left dorsal anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and precuneus. Lower magnetic resonance signal for the cigarette cue resist condition was found in the cuneus bilaterally, left lateral occipital gyrus, and right postcentral gyrus. These relative activations and deactivations were more robust when the cigarette cue resist condition was compared with the neutral cue condition. CONCLUSIONS: Suppressing craving during cigarette cue exposure involves activation of limbic (and related) brain regions and deactivation of primary sensory and motor cortices.

Cigarette smoking saturates brain alpha 4 beta 2 nicotinic acetylcholine receptors.

CONTEXT: 2-[18F]fluoro-3-(2(S)-azetidinylmethoxy) pyridine (2-F-A-85380, abbreviated as 2-FA) is a recently developed radioligand that allows for visualization of brain alpha 4 beta 2* nicotinic acetylcholine receptors (nAChRs) with positron emission tomography (PET) scanning in humans. OBJECTIVE: To determine the effect of cigarette smoking on alpha 4 beta 2* nAChR occupancy in tobacco-dependent smokers. DESIGN: Fourteen 2-FA PET scanning sessions were performed. During the PET scanning sessions, subjects smoked 1 of 5 amounts (none, 1 puff, 3 puffs, 1 full cigarette, or to satiety [2(1/2) to 3 cigarettes]). SETTING: Academic brain imaging center. PARTICIPANTS: Eleven tobacco-dependent smokers (paid volunteers). Main Outcome Measure Dose-dependent effect of smoking on occupancy of alpha 4 beta 2* nAChRs, as measured with 2-FA and PET in nAChR-rich brain regions. RESULTS: Smoking 0.13 (1 to 2 puffs) of a cigarette resulted in 50% occupancy of alpha 4 beta 2* nAChRs for 3.1 hours after smoking. Smoking a full cigarette (or more) resulted in more than 88% receptor occupancy and was accompanied by a reduction in cigarette craving. A venous plasma nicotine concentration of 0.87 ng/mL (roughly 1/25th of the level achieved in typical daily smokers) was associated with 50% occupancy of alpha 4 beta 2* nAChRs. CONCLUSIONS: Cigarette smoking in amounts used by typical daily smokers leads to nearly complete occupancy of alpha 4 beta 2* nAChRs, indicating that tobacco-dependent smokers maintain alpha 4 beta 2* nAChR saturation throughout the day. Because prolonged binding of nicotine to alpha 4 beta 2* nAChRs is associated with desensitization of these receptors, the extent of receptor occupancy found herein suggests that smoking may lead to withdrawal alleviation by maintaining nAChRs in the desensitized state.

Intravitreal triamcinolone for choroidal neovascularization in ocular histoplasmosis syndrome.

PURPOSE: To report the effects of intravitreal triamcinolone acetonide injections for subfoveal and juxtafoveal choroidal neovascularization (CNV) in ocular histoplasmosis syndrome. METHODS: In a retrospective analysis, the proportion of eyes that gained >or=5 or lost >or=5 and >or=15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, best-corrected visual acuity using ETDRS letter score (VA), greatest linear dimension (GLD), and treatment side effects were assessed. RESULTS: Ten patients (five subfoveal, five juxtafoveal CNV; median follow-up: 17 months; range, 6-41 months) were evaluated. Thirty percent gained >or=5 letters, 20% lost 5 to 14 letters, and 50% maintained stable VA. Overall, mean VA and GLD remained stable. Side effects were transient intraocular pressure elevation and mild cataract development. CONCLUSIONS: Intravitreal triamcinolone acetonide for CNV resulting from OHS was found to be relatively safe and showed good visual outcome for both subfoveal and juxtafoveal CNV. Further studies are warranted to evaluate this treatment.

Management of neurotrophic keratopathy.

Neurotrophic keratopathy is an epithelial defect associated with fifth nerve damage, arising from numerous etiologies, which can be difficult to treat. Depending on the location of these defects, they can also prove to be sight threatening if treatment is unsuccessful. Several treatment options are available to assist in the resolution of these defects and, due to the serious potential consequences for sight if not well managed, all treatment options should be considered. This reporting of a patient that developed neurotrophic keratopathy after an intraocular surgical procedure includes details of the early, mid and late stages of the epithelial defect, the treatments that were instituted and the outcomes. The various treatments that are available for management of neurotrophic keratopathy and other persistent epithelial defects are discussed.