Pseudomyxoma peritonei arising from colonic polyps.

AIMS: Pseudomyxoma peritonei may have as its primary site a mucinous gastrointestinal adenoma or carcinoma that gains access to the peritoneal cavity. This manuscript describes this disease arising from a benign or malignant colonic polyp. METHODS: From a database of over 1000 pseudomyxoma peritonei patients and colorectal carcinomatosis patients, three cases were identified in which the primary tumor site was a colonic polyp. The clinical history and course of these patients were studied. RESULTS: In a review of the clinical management of these patients, all three had an event whereby neoplastic cells from the surface of the colonic polyp could have gained access to the free peritoneal cavity. The patients developed the characteristic pseudomyxoma peritonei syndrome. All three patients were treated with cytoreductive surgery plus perioperative hyperthermic intraperitoneal chemotherapy. CONCLUSIONS: Colonic polyps can serve as a source of dysplastic cells whereby pseudomyxoma peritonei can result. Caution to prevent seeding to the free peritoneal cavity during surgery for colonic polyps should be observed. If pseudomyxoma peritonei develops, cytoreductive surgery and perioperative intraperitoneal chemotherapy should be considered for treatment.

Association between HIV in pregnancy and antiretroviral therapy, including protease inhibitors and low birth weight infants.

OBJECTIVE: To determine the incidence of low birth weight infants born to HIV seropositive women and to demonstrate any effects of antiretroviral therapy on birth weight. METHODS: Retrospective review of all obstetrical medical records from January 1, 1995 through June 30, 1998 to identify HIV seropositive women. We evaluated their antiretroviral therapy, CD4 counts, and birth weights of their newborns. We conducted detailed review of the clinical and laboratory findings for the HIV-infected untreated patients, women who received ZDV antepartum alone, and those who received PIs as part of antiretroviral treatment. RESULTS: The frequency of low birth weight infants was significantly increased in HIV seropositive compared to HIV seronegative parturients. Low birth weight infants were more frequent among HIV infected women with lower CD4 counts but the association was not statistically significant. Women who received no antepartum treatment, antepartum only ZDV, and those treated with PIs had significantly more low birth weight infants than did comparison groups. HIV seropositive women also had high frequencies of several obstetrical risk factors for low birth weight infants. CONCLUSION: The present study showed a significantly increased frequency of low birth weight infants among HIV infected women and especially the subgroups of infected women who received no antepartum treatment, antepartum ZDV only, and those treated with PIs. This association, however, may be related to the presence of many other preterm obstetrical risk factors noted in this study. Increasing numbers of HIV seropositive women are being treated with PIs according to the Centers for Disease Control (CDC) guidelines. If PIs are a cause of low birth weight infants, women taking these drugs may have incremental risk of low birth weight.

Drugs, violence, and federal funding: a research odyssey.

Two decades of research activity focusing on drugs/violence relationships are described. Initial interest in this area was kindled by field experiences. Literature review revealed a dearth of concepts and data. A tripartite conceptual framework was formulated to define drug-related violence. A series of empirical studies were undertaken to verify and elaborate the conceptual framework. Findings from these studies debunked prevailing mythology about drugs/violence relationships. Findings also demonstrated the usefulness of a public health perspective and the critical importance of collecting qualitative data in order to achieve a deeper understanding of these phenomena.

Postmortem cesarean section with infant survival: a case report of an HIV-infected patient.

Postmortem cesarean sections are rare events, but modern technology is forcing society to explore the definition of viability and the legal rights of both mother and fetus that ultimately will affect the frequency and use of this rare operation. Since the Human Immunodeficiency Virus (HIV) prevalence rate and the number of critically ill obstetrical patients with Acquired Immunodeficiency Syndrome (AIDS) continues to rise, it is reasonable to assume more patients and physicians may be confronted by issues concerning fetal and maternal rights and other considerations in perimortem delivery. A 33-year-old woman, at 27 weeks' gestation, with fulminant AIDS was admitted to the intensive care unit (ICU) in respiratory distress. As her condition deteriorated the complex problem of caring for both mother and fetus emerged. A patient advisory panel explored the issues with the patient, her family, and her health care team. Eventually a peri/postmortem cesarean section was performed on the mother when she suffered an acute fatal cardiorespiratory arrest. With the prevalence of AIDS increasing and with most women not being tested prior to pregnancy, many obstetricians will be confronted with new medical and legal challenges. Establishing comprehensive medical management for the critically ill obstetrical patient and understanding the legal rights of both patients (mother and fetus) will help avoid conflicts and potentially improve survival.

Sequence of drug use among serious drug users: typical vs atypical progression.

Sequence of drug use was examined in a secondary analysis of two samples of serious drug users: one of 152 men and one of 133 women. The proportions of drug users following specified patterns of drug use onset were compared to proportions obtained in previous research in samples of high school youth, and serious drug users. The serious drug users were substantially different from high school samples in their progression of drug use. The serious drug users were less likely to follow the typical sequence identified in previous studies (alcohol, then marijuana, followed by other illicit drugs). They were more likely to have used marijuana before using alcohol, and more likely to have used other illicit drugs before using marijuana. We also found that atypical sequencing was associated with earlier initiation of the use of illicit drugs other than marijuana and greater lifetime drug involvement. These findings suggest that for a large number of serious drug users, marijuana does not play the role of a 'gateway drug'. We conclude that prevention efforts which focus on alcohol and marijuana may be of limited effectiveness for youth who are at risk for serious drug abuse.

Childhood abuse and the use of inhalants: differences by degree of use.

OBJECTIVES: Using two existing ethnographic studies of drug-involved adults, this study evaluates the association between child-abuse victimization and levels of involvement in inhalant use. METHODS: Historical accounts of childhood exposure to physical or sexual abuse were compared among nonusers of inhalants (n = 197), light inhalant users (n = 64), and heavy inhalant users (n = 24). Crude and adjusted odds ratios were used to compare informants with no history of inhalant use with those having a history of light inhalant use and those having a history of heavy inhalant use. RESULTS: Heavy inhalant use was associated with history of any child abuse (adjusted odds ratio [OR] = 4.6) and physical abuse (adjusted OR = 3.8). Light inhalant use showed no association with child-abuse history. CONCLUSIONS: Child abuse may be an important correlate of extensive involvement in inhalant use. The findings invite speculation with respect to a hypothetical causal role for child abuse in the etiology of inhalant use. The lack of support for causality in this study underscores the need for replication and more carefully designed longitudinal research.

From bag brides to skeezers: a historical perspective on sex-for-drugs behavior.

There are many ways that women support their use of crack cocaine, including sex-for-crack bartering and other forms of prostitution. Empirical studies conducted in the mid-1970s and in the mid-1980s in New York City, and in Chicago in the late 1980s to early 1990s are compared, analyzing similarities and differences between the contemporary crack-prostitution scene and previous prostitution scenes. Findings suggest that the arrival of crack cocaine has directly and indirectly affected the drugs-prostitution nexus by lowering the price of sex for street prostitutes, altering the social status of cocaine, and increasing the level of social disorganization in illicit street activities, including prostitution. Barterers are shown to be the heaviest drug users, using the greatest variety of drugs, using larger amounts of drugs, and using more frequently.

alpha-fetoprotein and screening markers of congenital disease.

Alpha-fetoprotein (AFP) is produced in the gut and liver during fetal life and appears to act like albumin in the adult. Because AFP appears in the maternal circulation during pregnancy, interest has been focused on its measurement in maternal serum to predict fetal abnormality. In addition, AFP, as an embryonic product, is elevated in certain malignant states. This article provides a summary of current clinical knowledge of AFP and its applications.

Race/ethnicity and gender differences in the drugs-violence relationship.

This article examines the drug relatedness of violent events reported by White, Black, and Hispanic male and female street drug users from New York City. The primary purpose is to determine if the drugs-violence relationship varies for these different populations of drug abusers. Drug relatedness is assessed according to a tripartite conceptual model of the general relationship between drugs and violence. Significant race/ethnicity and gender differences were found in regard to the number of violent events manifesting specific drug-related dimensions of violence, the drugs associated with these violent events, and the primary reasons for the occurrence of these events. The implications of these findings are discussed.

Ethnographic field stations.

Ethnographic field stations are not a substitute for traditional ethnography, because they provide an "unnatural" setting for research interaction and observation to take place. However, they do provide perhaps the optimal setting for qualitative and quantitative methodologies to be undertaken in a single research effort. In this sense, they are critically important for advancing our knowledge about drug abusers and their behaviors.

Drug relationships in violence among methadone maintenance treatment clients.

In this paper the nature, scope, and drug relatedness of violent events reported by a sample of methadone maintenance treatment clients is examined and compared with events reported by a sample of drug abusers not in treatment. The drug relatedness of events is ascertained according to a tripartite model of the drugs-violence relationship. Data derive from a study of the drugs-violence nexus among male drug users and distributors who lived in or frequented the lower east side of Manhattan. Among the major findings were that while events reported by the treatment group were less likely than those reported by the not-in-treatment group to be related to heroin, total alcohol and cocaine related dimensions of violence were similar for the two groups. There was no difference between these groups in terms of the proportion of events that were drug related or the proportion of drug related events that could be attributed to each of the three posited models of drug relatedness. The implications of our findings are discussed.

Patient-staff governance in methadone maintenance treatment: a study in participative decision making.

To help counteract some methadone patients' unfavorable attitudes to treatment and consequent antitherapeutic behaviors, a participative decision-making model was implemented in two methadone maintenance programs. Team building was used to initiate collaboration between patients and staff, resulting in the establishment of joint patient-staff governance committees. Outcomes as measured by the Client Attitudes Toward Methadone Programs (CAMP) Scale (a new instrument developed for the study) and by patients' supplementary drug use showed no statistically significant changes. The process evaluation, however, indicated that the committees had positive results in increasing communication and understanding between patients and staff, and in improving the efficiency of certain clinic procedures. The study analyzes the organizational dilemmas encountered in implementing participative decision making in drug treatment programs and gives recommendations for promoting future work in this area.

The validity of methadone clients' self-reported drug use.

Drug use self-reports were compared with urinalysis for 248 clients in four methadone treatment programs. The validity of self-reporting based on urinalysis as a criterion depended on the type of drug examined. Opiate reporting was least valid, while benzodiazepine and cocaine reporting were moderately and highly valid, respectively. EMIT urinalysis was far more useful as a criterion of validity than TLC urinalysis. Self-reports helped identify drug users who were missed by urinalysis because of the latter's limited detection period, but urinalysis in turn detected an equal number of drug users missed by the interviews. The age of clients and the type of interviewer directly affected the rate of underreporting. Some respondents systematically denied disvalued behaviors (i.e., drug use and criminality), leading to a spurious correlation between these behaviors. This has important implications for future research.