The youngest victims of child maltreatment: what happens to infants in a court sample?

Current data show that infants represent an increasing proportion of cases of child maltreatment. To learn more about how infants fare in the current system and to provide baseline data against which to compare outcomes following recent legislative reforms, this study examined a subsample of infants in a sample of 200 care and protection cases brought before the Boston Juvenile Court in 1994. Child, parent, and case characteristics of infants 0 to 3 months of age (n = 46) were compared with characteristics of older children in the sample. All cases were followed prospectively for 4 years, and data were abstracted from court records. Results revealed that the infants were primarily children of substance abusers who had extensive prior histories of child protective service system involvement. Although the majority of the infants were eventually permanently removed from parental custody and adopted, many experienced time delays and multiple placements before achieving permanent homes.

Cisplatin and radiation therapy for locally advanced squamous cell carcinoma of the lung.

A pilot study was initiated to test the safety and efficacy of the simultaneous administration of high-dose cisplatin and irradiation in patients with locally advanced squamous cell carcinoma of the lung. Cisplatin was administered at 100 mg/m2 on Days 1 and 21 and was continued at 20 mg/m2 once a week to the completion of radiation therapy. Irradiation was begun on Day 22 and was administered 5 days a week for 6 weeks at a rate of 200 cGy per day to a total of 6000 cGy to the primary site, using a shrinking field technique. Of the 13 patients so treated, all but one showed objective evidence of tumor regression according to chest x-ray. Six patients are still alive from 12 to 37 months after the start of treatment, including four who are asymptomatic and without apparent tumor and two with persistent local disease. Of the seven patients who died, four had metastatic disease (including one with local recurrence as well), one (who had been resistant to therapy) had persistent local disease, and two died too early to allow comment on efficacy (although autopsy in one case showed no evidence of locoregional tumor). This program is both active and tolerable, and deserves further study.

Keratin expression in normal esophageal epithelium and squamous cell carcinoma of the esophagus.

The 8-nm keratin filament is a major component of the cytoskeleton of epithelial cells and epithelial-derived cancers (carcinomas). Recently, it has been shown that the pattern of keratins produced by an esophageal epithelial cell undergoes change upon malignant transformation. In order to evaluate the potential importance of these differences in providing improved diagnostic techniques for pathology, we have investigated the consistency of the patterns of keratins expressed in normal esophageal epithelium, squamous cell carcinoma (SQCC) of the esophagus, and cultured esophageal epithelial cells. In six patients, the keratin pattern expressed by SQCC of the esophagus and corresponding normal esophageal epithelium was consistently different as judged by immunoblot analysis of electrophoretically separated protein extracts. Whereas the SQCCs typically expressed major keratins with molecular weights of 58,000, 56,000, 50,000, and 46,000, the normal esophageal epithelium produced two major keratins with molecular weights of 58,000 and 52,000 and a minor keratin with a molecular weight of 56,000. When normal esophageal epithelial cells were grown in tissue culture, their keratin pattern changed, and keratins with molecular weights of 58,000, 56,000, 52,000, 50,000, 46,000, and 40,000 were expressed. Although some minor variations in keratin patterns were seen, the major differences in keratin pattern expressed by normal esophageal epithelial tissue, SQCC of the esophagus, and cultured esophageal cells were consistent and reproducible.

Cardiac performance in response to PEEP in patients with cardiac dysfunction.

The effect of PEEP on cardiac performance was evaluated in 21 patients with left ventricular (LV) dysfunction. Twenty-three data sets were divided into three groups according to pulmonary arterial wedge pressure (PAWP). In three of four group A data sets (PAWP = 12 mm Hg), cardiac output (CO) decreased when PEEP was added. In four of six group B data sets (PAWP = 14-18 mm Hg) and in 12 of 13 group C data sets (PAWP less than or equal to 19 mm Hg), CO increased with addition of PEEP. In group C, the mean increase in CO was 500 ml/min, and the mean level of best PEEP was 3.9 cm H2O. When PAWP exceeded 18 mm Hg, PEEP was safe and in many instances augmented CO.

Aorticopulmonary paraganglioma and gastric leiomyoblastoma in a young woman.

The 16th report of a patient with "Carney's triad" is presented. The triad consists of an extra-adrenal paraganglioma, gastric leiomyoblastomas and a pulmonary chondroma. The diagnosis is made by discovery of the presence of at least two of these individually rare tumors. The patient described as 15 year old girl who presented with a pericardial effusion caused by an invasive mediastinal paraganglioma. She was subsequently found to have multiple gastric leiomyoblastomas. The leiomyoblastomas have been resected. The paraganglioma was unresectable, and the patient underwent sequential radiation therapy and chemotherapy without response. Concomitant 5-fluorouracil chemotherapy with radiation resulted in an objective regression of tumor mass.