Terminal Course Research Articles

Autopsy findings in patients with head and neck squamous cell cancer and their therapeutic relevance.

A series of 63 autopsied patients with a history of head and neck squamous cell cancer (HNSCC) is reported with emphasis on the importance of locoregional disease (LRD) versus distant metastasis (DM) in the terminal course of the disease. There were 49 males and 14 females; mean age 64.9 years (range 35-94 years). Locoregional disease was present in 39 patients (62%), in 25 (40%) without tumour at other body sites outside the head and neck region. Distant metastasis was observed in 15 patients (24%); in 12 (19%), it occurred with concomitant LRD. Second primary tumours (SPT) were observed in 20 patients (32%). They occurred in the head and neck region (n = 7; 11%), the lung (n = 9; 14%) and at miscellaneous other sites (n = 4; 6%). Of the 13 patients with SPT outside the head and neck region, 2 had concomitant LRD. 11 patients (17%) died due to other causes, no tumour being found at autopsy. These figures indicate that still a major part of HNSCC patients die with LRD as the single tumour manifestation, which means that improvement of local tumour control will result in a significant therapeutic gain.

A low-tech introduction to operating systems

Operating systems can be taught using DOS as the basis for an introductory course. This approach is both practical and pedagogically sound. It leads to a course which is valuable both as a terminal course on operating systems and as the basis for further theoretical study. It is possible to use DOS as an environment for teaching rudiments of multitasking.

The mortality and pathology of HIV infection in a West African city

HIV disease is epidemic in Africa, but associated mortality, underlying pathology and CD4+ T-lymphocyte counts have not previously been evaluated in a representative study. Such data help to determine the management of HIV-positive people. Both HIV-1 and HIV-2 infections are prevalent in Côte d'Ivoire, and the pathology of HIV-2 infection in Africa is unclear. Consecutive adult medical admissions to a large city hospital in Côte d'Ivoire were studied in 1991, and a sample of HIV-positive deaths autopsied. Of 5401 patients evaluated, 50% were HIV-positive; 38% of these died, with a median survival of 1 week. At autopsy (n = 294, including 24% of HIV-positive deaths in hospital), tuberculosis (TB), bacteraemia (predominantly Gram-negative rods) and cerebral toxoplasmosis caused 53% of deaths. TB was seen in 54% of cadavers with AIDS-defining pathology and Pneumocystis pneumonia in 4%. The median CD4+ T-lymphocyte counts in those who died was < 90 x 10(6)/l. Compared with HIV-1-positives, patients with HIV-2-positivity had a greater frequency of severe cytomegalovirus infection, HIV encephalitis and cholangitis. In this population, HIV-positive adults present to hospital with advanced disease associated with high mortality. The three major underlying pathologies (TB, toxoplasmosis and bacteraemia) are either preventable or treatable. TB is an underestimated cause of the 'slim' syndrome in Africa. The patterns of pathology in HIV-2-positive patients suggest a more prolonged terminal course compared with HIV-1. There is an urgent need for attention towards the issues of therapy and care for HIV disease in developing countries.

Adult T-cell leukaemia-lymphoma in waldeyer's ring: A report of three cases

Adult T-cell leukaemia-lymphoma (ATLL) is a new type of T-cell malignancy which has an adult onset, a rapidly progressive terminal course and a clustering at patients' birthplaces in southeast Japan and the Caribbean. We report the clinical features of three cases of ATLL in Waldeyer's ring, which has been rarely reported in the literature. The patients complained of throat pain and lump in the neck. They received combination chemotherapy, but all died within a year of first noticing the symptoms.

The Status of Laboratory Instruction for Introductory Biology in U.S. Universities

Research Article| March 01 1993 The Status of Laboratory Instruction for Introductory Biology in U.S. Universities Marshall D. Sundberg, Marshall D. Sundberg Search for other works by this author on: This Site PubMed Google Scholar Joseph E. Armstrong Joseph E. Armstrong Search for other works by this author on: This Site PubMed Google Scholar The American Biology Teacher (1993) 55 (3): 144–146. https://doi.org/10.2307/4449610 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Marshall D. Sundberg, Joseph E. Armstrong; The Status of Laboratory Instruction for Introductory Biology in U.S. Universities. The American Biology Teacher 1 March 1993; 55 (3): 144–146. doi: https://doi.org/10.2307/4449610 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentThe American Biology Teacher Search This content is only available via PDF. Copyright 1993 National Association of Biology Teachers Article PDF first page preview Close Modal You do not currently have access to this content.

The portal bifurcation and the termination of the hepatic veins: an anatomical investigation into the projection of the ultrasonographically important hepatic vessels onto the anterior body wall

An investigation was carried out on 50 cadavers, in which the projection onto the anterior abdominal wall of the following vascular points was examined: the portal bifurcation, the direction of the course of the right and left branches of the portal vein and the terminal course of the hepatic veins near their entry into the inferior vena cava (IVC). The results are related to a transverse axis passing through the apex of the xiphoid process and the median plane in the supine position. The average position of the portal bifurcation is projected onto a point between a vertical line passing through the midpoint of the right hemithoracic width and a horizontal line passing through a point on the midclavicular line (MCL) corresponding to 57% of the height of the liver measured upwards from its inferior margin. The axis of the prehepatic course of the portal vein makes an angle of about 50 degrees, open downwards, with a vertical line drawn through the apex of the internal angle of the portal bifurcation. A line parallel to the course of the right and left branches of the portal vein is projected on to a surface line cranial to the right costochondral margin, which runs upwards at an angle of approximately 20 degrees towards the apex of the xiphoid process. The termination of the three great hepatic veins is projected at about the level of the xiphisternal joint, one sternal width to the right of the midline. Close to the IVC, the right hepatic vein runs upwards and medially at an angle of between 20 degrees and 30 degrees with the transverse plane.(ABSTRACT TRUNCATED AT 250 WORDS)

Current Concepts in Childhood Spinal Muscular Atrophy

There has been a surge of interest in neuromuscular disease in the past 2 years, sparked primarily by major genetic discoveries. While initial attention focused appropriately on Duchenne muscular dystrophy, the momentum has now swung to the spinal muscular atrophies, which, the authors note, are equally frequent and no less important in childhood because of their severe handicaps and disabilities. This book covers the clinical picture, research strategies, pathogenesis, genetics, natural history, rehabilitative care, and other clinical management problems. New avenues of therapy are discussed, including attention to nutrition, respiratory care, physical and occupational therapy, and psychological management. Gloria Eng, long a pioneer in the treatment of children with this disorder, notes that the terminal course may be particularly difficult: "Every parent reacts differently when the baby has a protracted course and begins to die. At that point everyone is worn out, including the physician." "No code" status, preference of

Clinical decision making in the care of the aged.

This study examines the decision-making process of health care providers working with older patients. Data were obtained through telephone interviews from a random sample of 251 health care providers at three Veterans Administration medical centers. Responding to a hypothetical clinical vignette, the majority of providers chose to give the one remaining bed in an ICU to a younger versus an older patient. Individuals relied on the patient's expected quality of life as well as the medical risk to the patient as important factors in this decision. In another vignette, less than 15% of the sample strongly supported a life-prolonging intervention for an 85-year-old man whose obstructive pulmonary disease had taken a terminal course. Expected quality of life was the most important determinant of the decision not to intubate. Respondents of different professions consistently ranked DNR orders as the decision with which they were most comfortable and termination of life supports as the decision with which they were least comfortable. A discussion of the different medical, social, and institutional factors that influence decision making is provided.

Leukemia of Non-T Lineage Natural Killer Cells

An unusual case of an aggressive leukemia of natural killer (NK) cells occurred in a 65-year-old male. Clinical characteristics of this case included hepatosplenomegaly, ascites, marrow infiltrate with leukemic cells, and a WBC up to 82.8 X 10(9) before therapy. One year before his presentation he had been noted to have a WBC of 12.1 X 10(9) with 78% lymphocytes, and 6 months before had noted intermittent fever and weight loss. He and his brother had well documented hereditary cold urticaria. The patient was treated with a modification of ProMACE CYTABOM regimen and had prompt regression of the leukemia with associated acute tumor lysis. Renal, hepatic, and marrow failure predominated during a terminal course that ended 22 days after therapy was commenced, and at autopsy there was no evidence for leukemic cell infiltrate in the liver, spleen or marrow. The leukemic cells were large granular lymphocytes by light and electron microscopic criteria, and had the following immunophenotype: CD2+, DR+, Leu7+, NKH1+, CD11+, CD3-, CD5-, CD4-, CD8-, CD16-. The cells displayed high antibody-dependent cell-mediated cytotoxicity (ADCC) and NK activity, and had a high rate of spontaneous proliferation in vitro that was not augmented by phytohemagglutinin (PHA), concanavalin A (Con A), or pokeweed mitogen (PWM). Southern analysis of DNA from leukemic cells revealed normal germline arrangements for the beta and gamma chains of the T cell antigen receptor and immunoglobulin heavy chain genes. The majority of metaphases were clonally abnormal revealing consistent rearrangements involving extra material attached to the long arms of chromosomes 5 and 11.

Leukemia of non-T lineage natural killer cells

An unusual case of an aggressive leukemia of natural killer (NK) cells occurred in a 65-year-old male. Clinical characteristics of this case included hepatosplenomegaly, ascites, marrow infiltrate with leukemic cells, and a WBC up to 82.8 X 10(9) before therapy. One year before his presentation he had been noted to have a WBC of 12.1 X 10(9) with 78% lymphocytes, and 6 months before had noted intermittent fever and weight loss. He and his brother had well documented hereditary cold urticaria. The patient was treated with a modification of ProMACE CYTABOM regimen and had prompt regression of the leukemia with associated acute tumor lysis. Renal, hepatic, and marrow failure predominated during a terminal course that ended 22 days after therapy was commenced, and at autopsy there was no evidence for leukemic cell infiltrate in the liver, spleen or marrow. The leukemic cells were large granular lymphocytes by light and electron microscopic criteria, and had the following immunophenotype: CD2+, DR+, Leu7+, NKH1+, CD11+, CD3-, CD5-, CD4-, CD8-, CD16-. The cells displayed high antibody- dependent cell-mediated cytotoxicity (ADCC) and NK activity, and had a high rate of spontaneous proliferation in vitro that was not augmented by phytohemagglutinin (PHA), concanavalin A (Con A), or pokeweed mitogen (PWM). Southern analysis of DNA from leukemic cells revealed normal germline arrangements for the beta and gamma chains of the T cell antigen receptor and immunoglobulin heavy chain genes. The majority of metaphases were clonally abnormal revealing consistent rearrangements involving extra material attached to the long arms of chromosomes 5 and 11.

Chapter 6 Vagal afferent innervation of the gastrointestinal tract

This chapter describes the thoracic and abdominal distribution of the vagi that are available for a number of species. Several points arise from the observations of the gross anatomy of the vagus. First, apart from the stomach and liver, the remaining abdominal viscera (e.g., pancreas) do not receive macroscopically identifiable discrete branches. This means that their afferent innervation can only be studied, by either using tracer techniques or recording afferent activity at a distant site, where the vagus is “contaminated,” by afferents from the other organs. Even in areas of the gut (e.g., small intestine), where discrete nerve bundles can be identified and activity recorded relatively easily, the question of whether they are vagal remains, as the vagal and the splanchnic nerves often share the same terminal course.

Sensory innervation of the Achilles tendon by group III and IV afferent fibers.

In sympathectomized cats the innervation of the Achilles tendon by fine afferent nerve fibers was studied with semithin and ultrathin sections. Several different types of sensory endings of group III and group IV nerve fibers were identified. Of the five different types of endings in the group III range (T III endings), two are located within vessel walls. One of them ends in the circumference of the venous vessels (T III/VV). Its lanceolate terminals have characteristic receptor areas at their edges. The second type ends in the adventitia of lymphatic vessels (T III/LV). Its receptive areas are scattered along their terminal course. Two further group III endings ramify within the connective tissue compartments of the vessel-nerve-fascicles of the peritenonium externum and internum. One type is tightly surrounded by collagen fibrils (T III/PTic); the other terminates between the collagen fiber bundles (T III/PTgc). The latter arrangement recalls the ultrastructural relation between nerve terminals and collagen tissue in Golgi tendon organs. The fifth type innervates the endoneural connective tissue of small nerve fiber bundles (T III/EN). At least some of them come into close contact with bundles of collagen fibers which penetrate the perineural sheath to terminate within the endoneurium. The endings of group IV afferents (T IV endings) show a striking topographic relationship to the blood and lymphatic vessels of all connective tissue compartments of the Achilles tendon. They form penicillate endings which may contain granulated vesicles. In any event, they can easily be discriminated from the T III endings in the vessel walls. In close neighborhood to Remak bundles, a cell has been regularly found which fulfilled all ultrastructural criteria for mast cells. But this cell is not a mast cell proper because it is surrounded by a basal lamina (pseudo mast cell).

Molluscum Contagiosum and the Acquired Immunodeficiency Syndrome

To the Editor.— Multiple mollusca contagiosa commonly occur in the genital areas of otherwise healthy young adults.1Recurrences are frequent unless all lesions are recognized and destroyed. The following is a report of two patients with acquired immunodeficiency syndrome who presented with large numbers of mollusca that rapidly recurred despite adequate therapy. Case 1.— A 34-year-old homosexual man who was apparently in otherwise good health presented with innumerable mollusca distributed over the entire glabrous skin. Despite weekly curettage of more than 100 lesions, new lesions continued to appear. Within six months of his first visit, the patient developed Kaposi's sarcoma and pneumocystis pneumonia and died. Throughout his terminal course, he continued to develop large numbers of mollusca. Case 2.— A 29-year-old homosexual man, who had had severe herpes zoster of the right leg six months previously, developed recurrent and multiple mollusca on the face. These were treated by curettage

Retention and release of selected major and minor metals by the altamaha river marsh ecosystem

The retention and release of two major metals, K and Mg, and two minor metals, Zn and Mn, bySpartina alterniflora andSpartina cynosuroides salt marsh ecosystems along the terminal course of Altamaha river were investigated. The metal content in plant and soil samples collected from the two sites was measured periodically. A rectangular box-model of the ecosystem (1 m × 1 m × 0.5 m) was used to normalize the metal content of all materials in g m−3. The net annual retention or release of the metals in the ecosystem was computed from the periodic changes in the metal content of the live plant, dead tissues and of the soil (HCI extractable). The system populated byS. alterniflora releases 1.53 g m−3 of Mn while that covered byS. cynosuroides delivers 17.18 g m−3 of Mn to the river. Zinc is retained at the annual rate of 0.17 g m−3 by the former system and 1.21 g m−3 by the latter. The annual retention rate of K and Mg byS. alterniflora system is 71.76 g m−3 and 522.08 g m−3 respectively, whileS. cynosuroides system retains annually 171.0 g m−3 of K and 499.54 g m−3 of Mg.

Electromechanical dissociation: Pathologic explanations in 50 patients

Electromechanical dissociation (EMD), defined as electrocardiographically adequate ventricular systolic complexes in the absence of detectable pulse or blood pressure, may occur in the terminal course of patients and is frequently unexplained. The 50 cases in the autopsy files of The Johns Hopkins Hospital in which the patients had died after documented episodes of EMD were reviewed. Four major categories of patients were identified: In 22 of 50 cases (44 per cent) myocardial ischemia appeared to precipitate EMD; in 14 of these 22 cases (64 per cent) myocardial ischemia was global in extent, while in eight (36 per cent) myocardial ischemia was regional, occurring in the distribution of an occluded coronary artery. A subset of ten patients with ischemia had terminal ventricular tachycardia or fibrillation, which was converted to EMD following resuscitation maneuvers. In 12 of 50 cases (24 per cent) systemic shock preceded the development of EMD; in nine of these 12 (75 per cent) hypotension was due to myocardial or arterial rupture, while in three (25 per cent) hypotension was secondary to sepsis. In ten of 50 cases (20 per cent) pulmonary vascular compromise was the apparent cause of EMD. Of these ten cases, eight (80 per cent) were secondary to pulmonary embolization, and two (20 per cent) were due to pneumothorax. In six of 50 cases (12 per cent) the precise cause of EMD could not be determined. The results of this study indicate that in the dying patient with electromechanical dissociation the differential diagnosis should include myocardial ischemia, systemic shock, and pulmonary vascular compromise.

Adrenoleukodystrophy

Adrenoleukodystrophy is an X-linked disorder characterized by adrenal insufficiency and progressive demyelination of the cerebral white matter. Young boys usually become symptomatic during pre- or primary school years and follow a time-variable, downhill, terminal course. Diagnostic and carrier testing and prenatal diagnosis are available. Several treatments have been used but presently treatment is symptomatic. Nursing in adrenoleukodystrophy involves management of issues including but not limited to diagnosis, genetics, counseling, physical care, emotional care, family care and research.

Drinking by alcoholic cirrhotic patients under medical care: a literature survey.

In order to gain a broader perspective on the natural course of drinking by alcoholic cirrhotic patients receiving medical care, the medical and surgical literature from 1963 through 1982 was surveyed for prospective studies of patients with alcoholic cirrhosis in which follow-up drinking data were reported. Eleven studies with 1,039 patients were summarized. The patients were mostly urban men, averaging about 50 years old, treated in municipal, Veterans Administration, and university hospitals for either decompensated cirrhosis or for portal hypertension and bleeding varices; follow-up periods ranged from less than 1 to 10 years. The clinical investigators in the studies used various means to assess drinking and to categorize drinking behaviors, and expressed caution regarding validity. Between series, from 20 to 53% of the patients were reported to be abstinent from alcohol during the clinical follow-up periods. In five studies (373 patients) where the extent of drinking was determined, from 21 to 35% of the patients were reported to be drinking in a reduced or moderate manner, and from 17 to 42% to have resumed heavier drinking. The rates of improvement in drinking reported for the cirrhotic patients under medical care compare favorably to those for middle-aged male clients after alcoholism treatment, but the variables that predict course and outcome cannot be fairly compared between "medical" and alcoholism treatment populations. The substantial reduction or cessation of drinking reported in these large series of alcoholic cirrhotic patients over long follow-up periods may simple represent the natural, terminal course of alcoholism in the presence of severe liver disease; concomitantly, improvement may reflect the favorable impact of an alcohol-related disease and continued medical care on changing drinking behaviors.

Budd-Chiari syndrome and renal failure in behcet disease: Report of a case and review of the literature

A case of Behcet syndrome associated with three rare complications is presented. The patient initially presented with asymmetric polyarticular arthritis, subcutaneous nodules, conjunctivitis, and episcleritis. Necrotizing vasculltis and renal failure subsequently evolved. Despite immunosuppressive therapy, Budd-Chiari syndrome with high grade hepatic obstruction developed. A Denver shunt procedure failed to alter the terminal course. At postmortem examination, skin lesions, carditis, hepatic vein thrombosis, gastric ulcerations, and focal proliferative glomerulonephritis were found. The immunoglobulins and complement present in skin and renal tissue suggest an immune complex pathogenesis.

General Psychology as a Terminal Review and Integrative Course

(1983). General Psychology as a Terminal Review and Integrative Course. Teaching of Psychology: Vol. 10, No. 1, pp. 50-51.

Dialysis Catheter-Induced Pericardial Tamponade

<h3>To the Editor.</h3> —The article entitled "Dialysis Catheter-Induced Pericardial Tamponade," by Merrill and Raab, published in the SeptemberArchives(1982;142:1751-1753), discussed the practical difficulties associated with confirming the exact location of the tip of a subclavian (hemodialysis) catheter introduced percutaneously. In this case, with a fatal outcome, the tip of the catheter (with end and side-holes) was in the pericardial sac. Resultant tamponade caused by plasmapheresis led to hypotension and cardiac arrest. Neither the abnormal location of the catheter tip nor the subsequent outcome, pericardial infusion with resultant cardiac tamponade, was recognized during the terminal course of this patient. In a critically ill patient, with a rapidly changing stormy course, any procedure to locate exactly the tip of a central venous catheter is cumbersome and time-consuming. As discussed by the authors, attachment of a pressure transducer to the catheter may indicate entrance within the cardiac chambers. Contrast injection within the