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16 slice multidetector CT provides virtual endoscopic views of the inside of arteries, or any other hollow structures. This is performed non-invasively using post-processing of three-dimensional isotropic image data sets, acquired during standard CT examinations. These virtual endoscopic views are simultaneously correlated with the standard multiplanar reconstructions, with the ability to navigate a virtual camera through the hollow structure under study. Normal and abnormal volume rendered images of the pulmonary arteries are presented in correlation with the multiplanar reformats. The abnormal images show the volume rendered appearances of acute and chronic pulmonary embolic disease. It is also postulated that this technique has a problem solving role in the differential diagnosis of chronic mural emboli from extravascular structures such as adjacent lymph nodes or bronchiolar impaction. This technique may also have a role in medical education, providing clinicians and medical students with interactive three-dimensional representations of disease processes.

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A case of phaeochromocytoma which presented post partum is reported. Uneventful pregnancy and delivery of a healthy infant were followed by acute respiratory and cardiovascular deterioration of the mother. Despite intervention our patient died 36 h after first presentation. Diagnosis of phaeochromocytoma was confirmed post mortem.

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The feasibility of a randomized clinical trial to implement and compare the effectiveness of three components of an intervention for women with breast cancer and their partners was tested. The intervention components, standardized education by videotape (SE), telephone counseling (TC), and education with telephone counseling (SE+TC), were designed with a complementary approach to disease management of breast cancer at each of four phases of the breast cancer experience: diagnostic, postsurgery, adjuvant therapy, and ongoing recovery. A standardized Telephone Counseling Training Manual was developed. A nonprobability sample of 12 patient-partner pairs was accrued. Four pairs were randomly assigned to each of the three intervention components. A set of questionnaires was completed by each patient and partner at baseline and following each intervention for assessment of emotional, physical, and social adjustment, and perceived support. Attrition was minimal and return rate for the completed questionnaires at all five data-collection points was high. Validation of the SE and the TC, one of the objectives, was by data from the preliminary descriptive study (Hoskins, 1990-1994), pretests and posttests for standardized education, audiotapes for each phase-specific telephone counseling session, and evaluation forms for each intervention session. The positive findings included significant changes from pre- to postmeasurement in patients' and partners' scores for the standardized education in each of the four phases. Even with the limited statistical power, the effects were marked, lending support for a full-scale randomized clinical trial, to understand better the relative treatment efficacy and differential benefit of one or some interventions over others.

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A three-phase program of research consisted of: (1) data collection at eight data points across one year on predictors and outcomes of adjustment among 128 women diagnosed with breast cancer and 121 partners; (2) development of phase-specific interventions: standardized education by videotape (SE), and telephone counseling (TC); and (3) a pilot study among 12 patient-partner pairs. Four phases were identified: diagnostic, post-surgical, adjuvant therapy, and ongoing recovery. Needs were categorized as those related to: (1) physical well-being, (2) emotional well-being; (3) support; and (4) the healthcare system. In the pilot study, each group consisted of 4 patient-partner pairs, randomly assigned to one of four groups. At each of the four phases, all groups received the currently accepted disease management (DM). Group 1: DM * Group 2: DM+SE * Group 3: DM+TC * Group 4: DM+SE+TC. Measures of outcomes validated in the longitudinal study were administered. The feasibility of a confirmatory randomized clinical trial was demonstrated. Preliminary evidence indicates the importance of research-based, phase-specific educational and counseling interventions that have a positive effect on adjustment among both patients and their families.

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Using data from a longitudinal study of Hoskins' 'Patterns of Adjustment to Breast Cancer among Women and their Partners', a conceptually derived multidimensional formulation of psychosocial adjustment was empirically tested. The Psychosocial Adjustment to Illness Scale was administered to both patients and partners at six times post-definitive surgery, i.e., 7-10 days, 30 days, 60 days, 90 days, 180 days, and one year. Extensive factor analytic studies were performed on data from the Psychosocial Adjustment to Illness Scale at four of the collection times when complete data sets were available for 128 patients and 121 partners. Results of the principal components analysis with varimax rotation were compared to factor analyses reported by the developers of the scale. The seven-factor matrix reported by Derogatis was not reproduced; instead, one factor was consistently identified at each of the four time periods as the best solution. Although items from all seven domains of the scale loaded on the single factor, items pertaining to psychological distress and role performance in the domestic and social environments were most prominent. These data support the need to validate empirically hypothesized separate dimensions of psychosocial adjustment to breast cancer in both patients and partners as proposed in a number of widely used tests.

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PURPOSE/OBJECTIVES: To describe variations in side effects of treatment of breast cancer and concurrent variations in psychological distress and perceived health status. DESIGN: Data were collected at six collection points: 7-10 days, one month, two months, three months, six months, and one year postsurgery. Standardized inventories, including subscales from the Psychosocial Adjustment to illness Scale, the Multilevel Assessment Inventory, and the investigator-developed Treatment Recovery Inventory, were completed by subjects in their homes at the six data-collection points. SETTING: Self-report measures completed in subjects' homes. Private practices of breast surgeons at medical centers in the New York City metropolitan area SAMPLE: Convenience sample of 93 women from a main longitudinal study (x = 51.4 years of age). MAIN RESEARCH VARIABLES: Psychological distress, perceived health status, and side effects of treatment for breast cancer. FINDINGS: Fatigue and emotional distress were persistent issues. Psychological distress and perceived health status improved with no significant differences between breast-conserving and mastectomy groups. Significant differences existed between patients receiving chemotherapy versus no therapy between three and six months. Significant changes also existed in perceived health status and psychological distress in both the positive and negative node groups with no differences between groups. CONCLUSIONS: Adjustment, a multidimensional and complex process, occurs over time. IMPLICATIONS FOR NURSING PRACTICE: Patterns in side effects should enable clinicians to anticipate needs for planning methods of control over time. Nurses must assess side effects from a multidimensional perspective at all phases.

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The effect of marital support and support from other adults on the emotional and physical adjustment of 128 women with breast cancer was examined. Role function and satisfaction with health care also were evaluated as predictors of adjustment. Intact data series were obtained at 7-10 days, at 1, 2, 3, and 6 months, and 1 year postsurgery. Emotional adjustment could be predicted by satisfaction with a spouse's response to interactional and emotional needs and by support from other adults. The relationships were significant at concurrent times, across contiguous times, and predicting from the 7-10 day postsurgical period to both the 6-month and 1-year end points. Physical adjustment was not predicted by support but satisfaction with health care was predictive of perceived overall health status. Functional status in vocational, domestic, and social roles was significantly related to emotional and physical adjustment at all phases with few exceptions.

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Four inventories were completed by 128 women and 121 partners evaluating predictors of emotional and physical adjustment at six phases of experience with breast cancer. Emotional adjustment could be predicted by marital support, support from other adults, and role function. The relationships were significant at concurrent times, across contiguous times, and predicting from the 7- to 10-day postsurgical phase to both the 6-mo. and 1-yr. end points.

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Present aims were to examine differences in fulfillment of emotional and interactional needs between 128 breast cancer patients and 121 partners and to examine differences in emotional and physical adjustment outcomes using a multivariate model of family adjustment to illness. Intact data series were obtained at 7 to 10 days, at 1, 2, 3, and 6 months, and 1 year postsurgery. The effect of cancer accentuated a complementary pattern for both emotional and interactional needs. The t tests of differences between means were significant at all phases. The main effect of time was statistically significant for scores on Negative Emotions, Psychological Distress, and Psychological Well-being for both partners. Performance of life roles in the vocational, domestic, and social environments also improved significantly over time. Although perceived Health Status remained stable for partners, patients' perceptions improved across phases of illness.

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The authors review the entity of traumatic intermetatarsal neuroma. A thorough evaluation with the aid of magnetic resonance imaging is illustrated. This can be a beneficial modality in the initial identification, or differentiation of recurrent, pathologic lesions.

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Circadian periodicities in activation were studied in relation to married partners' interactional-emotional need fulfillment. Activation was defined as the phenomenological awareness of general bodily energy state or readiness to respond. It was hypothesized that differences in activation would be related to dissatisfaction with need fulfillment. Activation was measured at four designated times of day by alternate forms of the Activation Checklist (Thayer, 1967) and need fulfillment by parallel forms of the Partner Relationship Inventory (Hoskins, 1988). Five couples completed data series that ranged between 27 and 29 days, providing 67 to 106 pairs of data. Cosine curves were fitted to the data for each subject to test for significant circadian periodicities in each variable. A desynchrony score in activation was calculated for the couple at each measurement time and correlated with the interactional-emotional need scores. The data supported the hypothesis for three subjects. Theoretical interpretations and methodological issues are presented.

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The purpose of this study was to investigate differences in scores of 59 mentally retarded adults (mild, moderate, severe, or profound), 133 advantaged, and 130 disadvantaged (low income) children in Grades 1, 2, 3 on the Primary Measures of Music Audiation. Test-retest reliabilities for the Tonal and Rhythm subtests were .81 and .86, respectively, for the retarded group. Analysis of variance indicated that the mildly retarded children performed significantly better than other groups of retarded children on these two tests. 2 x 3 analyses of variance indicated that third graders from both advantaged and disadvantaged groups performed significantly better than the first or second graders on both subtests and that advantaged children performed significantly better than the disadvantaged. However, disadvantaged children made greater gains, especially for third graders, than the advantaged.

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Lupus anticoagulants are associated with venous and arterial thrombosis and with recurrent spontaneous abortion resulting from placental infarction. Treatment with high-dose prednisone and aspirin has been reported to reduce the otherwise very high frequency of spontaneous abortion in affected women. We report the case of a young woman with an idiopathic lupus anticoagulant who had a history of arterial and venous thrombosis and of previous spontaneous abortion; anticoagulation throughout pregnancy was associated with normal fetal growth and with an absence of placental infarction. We conclude that anticoagulation without concurrent prednisone or aspirin may provide an alternative approach to prevention of habitual abortion in some women with lupus anticoagulants.

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Three strains of Clostridium perfringens were inoculated into different food products and their recovery rates on tryptose sulfite cycloserine (TSC) agar, with and without an oxygen-reducing membrane fraction (ORMF), were compared. Organisms were generally recovered in greater numbers using TSC+ORMF and aerobic incubation than with TSC and anaerobic incubation. Organisms inoculated into beef stew were subjected to heat and cold stress for various periods. In all instances, presence of ORMF in TSC and aerobic incubation resulted in greater recovery of viable C. perfringens than did TSC and anaerobic incubation. Of 35 uninoculated raw meat samples evaluated, C. perfringens was recovered from 22 using TSC+ORMF compared to 18 using TSC alone.

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This study investigated the relationship between expressive language ability and rhythm perception, pitch perception, vocal range, and vocal midpoint for 28 mentally retarded adults. A standardized speech test determined language scores, a standardized music test assessed rhythm and pitch perception, and vocalization determined vocal range and midpoint. Multiple correlation and multiple linear regression analyses indicated a significant correlation between expressive language ability and rhythm perception. Further research with music tests more appropriate for mentally retarded adults is recommended.

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