BACKGROUND & AIMS: This paper presents and discusses selected findings from a study of health-seeking strategies in relation to sexual health among a group of female sex workers in Calcutta, India. Background information on sex work and sexually transmitted disease in Calcutta is followed by the presentation of findings pertaining to women's understandings of (sexual) health, treatment-seeking and service utilisation. In the urban context where health services are readily available, patterns of initial treatment-seeking are shown to be generally (biomedically) appropriate, but subsequent "non-compliant" therapeutic practices give cause for concern. Conventional approaches to the study of "health-seeking behaviour" are reviewed in the light of these findings and questions raised about the appropriateness of approaches that focus on initial choice of treatment type and/or assume processes of health-seeking to be determined primarily by cultural "beliefs" about illness. Inherent biomedical and culturalist biases in the orientation of such research are shown to produce an analytic neglect of the dual influences of material life conditions and people's perceptions of health, rather than illness, upon health-related strategies. Recommendations are made for operational research and policy formulation on the provision of effective sexual health services, and implications are drawn for the scope of interventions and applied research directed at improving sexual health.

背景与目标： 本文介绍并讨论了印度加尔各答一群女性性工作者与性健康有关的寻求健康策略研究的部分发现。关于加尔各答性工作和性传播疾病的背景信息之后，介绍了与妇女对 (性) 健康，寻求治疗和服务利用的理解有关的发现。在容易获得医疗服务的城市环境中，最初寻求治疗的方式通常 (在生物医学上) 是适当的，但是随后的 “不合规” 治疗方法引起了人们的关注。根据这些发现和提出的有关方法的适当性的问题，对 “寻求健康行为” 研究的常规方法进行了审查，这些方法侧重于治疗类型的初始选择和/或假设寻求健康的过程主要由关于疾病的文化 “信仰” 决定。这种研究方向上固有的生物医学和文化主义偏见被证明是对物质生活条件和人们对健康而不是疾病的看法对健康相关策略的双重影响的分析忽略。提出了有关提供有效性健康服务的业务研究和政策制定的建议，并对旨在改善性健康的干预措施和应用研究的范围提出了影响。

BACKGROUND & AIMS: :We report for the first time the possibility of weekly paclitaxel chemotherapy for a patient with advanced, nonresectable gastric cancer undergoing hemodialysis. A 50-year-old man with chronic renal failure due to bilateral polycystic kidneys, who had undergone hemodialysis three times a week for 5 years, presented with hematemesis in December 2004. Based on the diagnosis of gastric cancer with lymph node metastases, surgery was performed. On the 15th postoperative day, the patient was treated with chemotherapy using paclitaxel. Paclitaxel was administered at a dose of 60 mg/m2 as a 1 h iv infusion in 250 mL of saline. Hemodialysis was started 1 h after the completion of the paclitaxel infusion and was performed for 3 h. Paclitaxel was administered weekly on d 1, 8, and 15 on a 28-d cycle. The maximum plasma concentration of paclitaxel was 1390 microg/L. The area under the curve of paclitaxel was 4398.6 microg x h/L. Grade 2 leukopenia was encountered during the first cycle. The plasma concentrations of paclitaxel from 6 to over 24 h after the infusion were 0.01 to 0.1 micromol/L in our patient, and these concentrations have been shown to be effective on inhibiting the growth of gastric cancer cells without producing adverse side effects in the patient. The plasma concentration of paclitaxel was not influenced by hemodialysis. We conclude that the pharmacokinetics of paclitaxel is not altered in a patient with renal failure, and that weekly paclitaxel is a suitable treatment regimen for hemodialysis patients with advanced gastric cancer.

背景与目标： : 我们首次报告了接受血液透析的晚期，不可切除的胃癌患者每周进行紫杉醇化疗的可能性。一名50岁的男子因双侧多囊肾而患有慢性肾功能衰竭，他每周接受3次血液透析，持续5年，2004年12月出现呕血。根据胃癌伴淋巴结转移的诊断，进行了手术治疗。术后第15天，患者接受紫杉醇化疗。紫杉醇以60 mg/m2的剂量在250 mL生理盐水中静脉输注1 h。紫杉醇输注完成后1小时开始血液透析，并进行3小时。紫杉醇每周在第1、8和15天的28天周期给药。紫杉醇的最年夜血浆浓度为1390 μ g/L。紫杉醇曲线下面积为4398.6 μ g × h/L。在第一个周期中遇到2级白细胞减少症。在我们的患者中，输注后6至24小时内紫杉醇的血浆浓度被0.01至0.1 micromol/L，并且这些浓度已被证明可有效抑制胃癌细胞的生长，而不会在患者中产生不良副作用。紫杉醇的血浆浓度不受血液透析的影响。我们得出的结论是，在肾功能衰竭患者中，紫杉醇的药代动力学没有改变，并且每周紫杉醇是晚期胃癌血液透析患者的合适治疗方案。

BACKGROUND & AIMS: :Growth hormone deficiency (GHD) related to standard dose chemotherapy has rarely been described. We report on a case of localized ganglioneuroblastoma treated by carboplatin/etoposide for 2 courses and surgery, which developed a serious GHD after 56 months. At present, the child is growing on by GH replacement therapy. We discuss about the hypothesis that GHD may be related to chemotherapy and we report a review of previous published cases.

背景与目标： : 与标准剂量化疗相关的生长激素缺乏症 (GHD) 很少被描述。我们报告了一例经卡铂/依托泊苷治疗2个疗程和手术的局部神经节神经母细胞瘤，该病例在56个月后发展为严重的GHD。目前，这个孩子正在通过GH替代疗法成长。我们讨论了GHD可能与化疗有关的假设，并报告了以前发表的病例的回顾。

BACKGROUND & AIMS: :Outside the nasopharynx, undifferentiated carcinomas occur only rarely at other head and neck locations. Although the association between undifferentiated nasopharyngeal carcinoma and Epstein-Barr virus (EBV) is consistent, there is conflicting evidence as to the association of EBV with undifferentiated carcinomas outside the nasopharynx. Here, we report on a case of undifferentiated carcinoma of the tongue base. A 71-year-old male, who had been treated with irradiation for primary unknown right neck metastatic EBV-positive undifferentiated carcinoma 9 years previously, was referred to our clinic with masses at the tongue base and right neck. The lesion at the tongue base was revealed to be an EBV-positive undifferentiated carcinoma. He was treated with resection of tongue base tumor and bilateral-neck dissection, and the defect at the tongue base was reconstructed with a free rectus abdominis myocutaneous flap. Re-irradiation was added post-operatively because of a positive surgical margin at the tongue base. The patient is presently alive without recurrence or distant metastasis 20 months after treatment. Although it is unclear whether our case is recurrent or newly developed EBV-latently infected undifferentiated carcinoma, we propose that EBV-associated tumors should be carefully observed after treatment at least for more than 10 years.

背景与目标： : 在鼻咽部以外，未分化癌仅在其他头颈部部位很少发生。尽管未分化鼻咽癌与爱泼斯坦-巴尔病毒 (EBV) 之间的关联是一致的，但关于EBV与鼻咽部以外未分化癌的关联的证据却相互矛盾。在这里，我们报告了一例未分化的舌根癌。一名71岁的男性，9年前曾接受过原发性未知的右颈转移性EBV阳性未分化癌的放射治疗，被转诊到我们的诊所，舌根和右颈有肿块。舌根病变被发现是EBV阳性未分化癌。他接受了舌根肿瘤切除术和双侧颈淋巴结清扫术，并用游离的腹直肌肌皮瓣重建了舌根缺损。由于舌根的手术切缘阳性，术后增加了再照射。治疗后20个月，患者目前还活着，没有复发或远处转移。尽管目前尚不清楚我们的病例是复发还是新开发的EBV潜伏感染的未分化癌，但我们建议在治疗至少10年以上后应仔细观察EBV相关肿瘤。

BACKGROUND & AIMS: :Geriatric depression consists of complex and heterogeneous behaviors unlikely to be caused by a single brain lesion. However, there is evidence that abnormalities in specific brain structures and their interconnections confer vulnerability to the development of late-life depression. Structural magnetic resonance imaging methods can be used to identify and quantify brain abnormalities predisposing to geriatric depression and in prediction of treatment response. This article reviews several techniques, including morphometric approaches, study of white matter hyperintensities, diffusion tensor imaging, magnetization transfer imaging, t2 relaxography, and spectroscopy, that have been used to examine these brain abnormalities with a focus on the type of information obtained by each method as well as each method's limitations. The authors argue that the available methods provide complementary information and that, when combined judiciously, can increase the knowledge gained from neuroimaging findings and conceptually advance the field of geriatric depression.

背景与目标： : 老年抑郁症由复杂和异质的行为组成，不太可能由单个脑部病变引起。然而，有证据表明，特定大脑结构及其相互联系的异常使人们容易患上晚期抑郁症。结构磁共振成像方法可用于识别和量化易患老年抑郁症的脑部异常，并预测治疗反应。本文回顾了几种技术，包括形态计量学方法，白质高强度研究，扩散张量成像，磁化转移成像，t2弛豫成像和光谱学，这些技术已用于检查这些大脑异常，重点是获得的信息类型通过每种方法以及每种方法的局限性。作者认为，可用的方法提供了补充信息，并且如果明智地结合在一起，可以增加从神经影像学发现中获得的知识，并在概念上推进老年抑郁症领域。

BACKGROUND & AIMS: INTRODUCTION:Ethics committees are a necessary resource to guarantee ethical integrity in human research; they must apply international standards in their ethical evaluation of research projects involving human subjects. OBJECTIVE:The ethics committees for human research of Colombia were characterized, and recommendations for strengthening them were formulated. MATERIALS AND METHODS:In 2003, 280 groups with research projects involving human subjects were selected from a list of research groups which form part of the science and technology network of Colciencias. (Colciencias is the Colombian national agency that promotes and funds science and technology.) Eighty percent (224) of the projects were associated with 40 institutions, consisting of universities, hospitals, and public or private research centers. Thirty of these institutions had at least one ethics committee for evaluating use of human subjects. A questionnaire was mailed to each of these Committees, requesting information concerning its their compostition, regulations, multidisciplinarity, plurality, representativity and independence. The World Health Organization's Operational Guidelines for Ethic Committees that Evaluate Biomedical Research (TDR/PRD/ETHICS/2000) was used as reference for the analysis. In 5 of the cities, supplemental information was obtained by direct discussions with members of the ethics committees. RESULTS:Twenty-six committees responded to the questionnaire. The results indicated that 47% of the committee members were physicians, but only 23% of the committees had representatives from the community. In 60% of the Committees, members were not independent from the organization in which it was based. Seventy percent had established operating procedures. Lack of national regulations and limited education in research ethics were mentioned as the main drawbacks in providing effective guidance. CONCLUSIONS:These observations led to the conclusion that national guidelines must be established for ethics committees that correspond to international standards. Committee members must be trained before accepting committee responsibilities. Finally, new committees must be created along with the improvement of the currently existing committees for reinforcing and promoting the importance of ethical integrity in research.

背景与目标：

BACKGROUND & AIMS: :Through an endoscopic transvesico-transurethral approach, we closed a vesicovaginal fistula that occurred after hysterectomy in a patient with uterine leiomyoma. The 3-mm fistula, located in the midportion of retrotrigone, was resected transurethrally and sutured in two layers through two 5-mm suprapubic trocars placed into the bladder and the urethral route under pneumobladder. The patient had no urine leakage from the vagina after surgery.

背景与目标： : 通过内窥镜经膀胱-经尿道入路，我们关闭了子宫平滑肌瘤患者子宫切除术后发生的膀胱阴道瘘。位于后三叉肌中部的3毫米瘘管经尿道切除，并通过放置在膀胱和尿道下的两个5毫米耻骨上套管针缝合两层。患者术后无阴道漏尿。

BACKGROUND & AIMS: :A case of malignant ependymoma with extracranial metastases is reported. A 59-year-old male was admitted to our hospital with vomiting and ataxia. Following computed tomographic (CT) scanning indicating a ring-like enhanced mass in the cerebellum, the tumor was subtotally removed in December, 1985. Histological diagnosis was malignant ependymoma. A second operation was performed in February, 1987, due to recurrence of the tumor in the fourth ventricle. Postoperative radiation therapy at a total dose of 7780 rads was given over 2 years. Eleven months after radiation therapy was completed, he reported cough and multiple skin metastases. Chest x-rays showed metastases at the right hilus. Repeated CT scans revealed separate frontal cerebral metastatic tumors. He died of respiratory insufficiency. Extracranial metastases of infratentorial ependymoma to the skin and lung are rare pathological entities.

背景与目标： : 报告一例恶性室管膜瘤伴颅外转移。一名59岁的男性因呕吐和共济失调入院。在计算机断层扫描 (CT) 扫描显示小脑中有环状增强的肿块后，1985年12月将肿瘤完全切除。组织学诊断为恶性室管膜瘤。由于第四脑室肿瘤复发，1987年2月进行了第二次手术。术后2年给予总剂量为7780 rads的放射治疗。放射治疗完成11个月后，他报告咳嗽和多处皮肤转移。胸部x光显示右肺门转移。反复ct扫描显示单独的额叶脑转移瘤。他死于呼吸衰竭。幕下室管膜瘤向皮肤和肺的颅外转移是罕见的病理实体。

BACKGROUND & AIMS: :Malignant transformation of synovial chondromatosis into chondrosarcoma is unusual. Thirteen cases and one series have been reported; only four of them developed in the hip. The overall survival is about 50%, possibly because of the difficulty of arriving at a correct early diagnosis (radiographically and histologically) and subsequent adequate surgical therapy. We report two patients (ages 30 and 50 years) in whom synovial chondrosarcoma developed in previously excised synovial chondromatosis of the hip. The diagnosis was made with modern imaging techniques (computed tomography and magnetic resonance imaging) and verified by open biopsy. The early recognition allowed a wide limb-saving resection; both patients are disease free 3 and 2 years after surgery.

背景与目标： : 滑膜软骨瘤病向软骨肉瘤的恶性转化是不常见的。已报告了13例和一系列; 其中只有四例在臀部发育。总生存率约为50%，可能是因为难以获得正确的早期诊断 (放射学和组织学) 以及随后的适当手术治疗。我们报告了两名患者 (年龄分别为30岁和50岁)，其中滑膜软骨肉瘤是在先前切除的髋关节滑膜软骨瘤中发展的。诊断是通过现代成像技术 (计算机断层扫描和磁共振成像) 进行的，并通过开放活检进行了验证。早期识别允许广泛的肢体切除; 两名患者在手术后3年和2年均无病。

BACKGROUND & AIMS: :Immune therapy have shown new and exciting perspectives for cancer treatment. Aim of our study was to evaluate toxicity and possible adverse effects from vaccination of patients with advanced colorectal cancer with autologous dendritic cells (DC) pulsed with lysate from a newly developed melanoma cell line, DDM-1.13. Six patients were enrolled in the phase I trial. Autologous DCs were generated in vitro from peripheral blood monocytes in the presence of granulocyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4). DCs were pulsed with melanoma cell lysate from a cloned and selected melanoma cell line enriched in expression of MAGE-A antigens and deficient in expression of melanoma differentiation antigens: tyrosinase, MART-1 and gp100. Vaccinations were administered intradermally on the proximal thigh with a total of five given vaccines at 2 weeks intervals. Each vaccine contained 3-5 x 10(6) DCs. Five of the six patients received all five vaccines. The treatment was well tolerated in all patients without any observed vaccine-correlated adverse effects. Treatment with this DC-based cancer vaccine proved safe and non-toxic.

背景与目标： : 免疫疗法为癌症治疗展示了新的令人兴奋的观点。我们研究的目的是评估用新开发的黑色素瘤细胞系DDM-1.13的裂解液对自体树突状细胞 (DC) 进行疫苗接种的毒性和可能的不良反应。6名患者参加了I期试验。在存在粒细胞-巨噬细胞集落刺激因子 (gm-csf) 和interleukin-4 (IL-4) 的情况下，从外周血单核细胞体外产生自体dc。用来自克隆和选择的黑色素瘤细胞系的黑色素瘤细胞裂解液对dc进行脉冲，该细胞系富含MAGE-a抗原的表达，并且缺乏黑色素瘤分化抗原的表达: 酪氨酸酶，MART-1和gp100。在大腿近端皮内接种疫苗，每隔2周共接种5种疫苗。每种疫苗含有3-5x10(6) dc。六名患者中有五名接受了全部五种疫苗。所有患者的治疗耐受性良好，没有观察到任何与疫苗相关的不良反应。使用这种基于DC的癌症疫苗进行治疗被证明是安全且无毒的。

BACKGROUND & AIMS: BACKGROUND:Cholecystocolocutaneous fistula (CCCF) is a rare complication of gallstone disease resulting from spillage of gallstones from perforation of an empyema of the gallbladder, which can pose diagnostic dilemmas. We describe a patient, who presented initially with a swelling followed by discharging sinuses on her right flank where a diagnosis of CCCF was made and was treated surgically with satisfactory outcome. METHODS:A computed tomography (CT) scan showed an ill-defined soft tissue mass in the right subhepatic space and a fistulogram demonstrated passage of contrast into the gallbladder fossa and hepatic flexure of colon. At laparotomy, a cutaneous fistula containing two pigment stones led to the gallbladder fossa and hepatic flexure of colon. RESULTS:Debridement of infected granulation tissues which had replaced the gallbladder, closure of the cystic duct stump and colonic fistula followed by excision of the fistula tract led to complete resolution. CONCLUSIONS:CCCF is a rare complication of perforated gallbladder with spillage of calculi, and a fistulogram is helpful in establishing the diagnosis. This case highlights the importance of retrieving spilled stones following interventions in the gallbladder to prevent the complication.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Rhinosporidiosis, a fungal infection due to Rhinosporidium seeberi, frequently produces polypoidal lesions in the nose. Sites like the conjunctiva, larynx, trachea, nasopharynx, skin and genitourinary tract are less frequently involved. Generalized rhinosporidiosis with skin and visceral involvement is extremely rare. This report describes the fine needle aspiration cytology (FNAC) of rhinosporidiosis occurring as a solitary lesion with erosion of cortical bone.

CASE REPORT:FNAC of a soft tissue swelling overlying a lytic lesion on the anterior aspect of the tibia was performed in a 40-year-old male. Smears revealed numerous sporangia and spores of R seeberi. There were no mucocutaneous lesions. Histologic examination confirmed the bony involvement.

CONCLUSION:The FNAC diagnosis of rhinosporidiosis is specific. Preoperative diagnosis is possible even in cases with unusual clinical presentations.

背景与目标： 背景 : 鼻孢子虫病是由seeberi鼻孢子虫引起的真菌感染，经常在鼻子中产生息肉样病变。结膜，喉，气管，鼻咽部，皮肤和泌尿生殖道等部位较少受累。皮肤和内脏受累的全身性鼻孢子虫病极为罕见。本报告描述了鼻孢子虫病的细针穿刺细胞学检查 (FNAC)，该检查是孤立的皮质骨侵蚀病变。
病例报告 : 在40岁的男性中，对胫骨前部的溶解性病变进行了软组织肿胀的FNAC。涂片显示出许多孢子囊和R seeberi的孢子。没有皮肤粘膜病变。组织学检查证实了骨受累。
结论 : 鼻孢子虫病的FNAC诊断是特异性的。即使在临床表现异常的情况下，也可以进行术前诊断。

BACKGROUND & AIMS: BACKGROUND:Telephone surveys have been used widely in public health research internationally and are being increasingly used in Ireland and the U.K. METHODS:This study compared three telephone surveys conducted on the island of Ireland from 2000 to 2004, examining study methodology, outcome measures and the per unit cost of each completed survey. We critically examined these population-based surveys which all explored health related attitudes and behaviours. RESULTS:Over the period from 2000 to 2005 the percentage of calls which succeeded in contacting an eligible member of the public fell, from 52.9% to 31.8%. There was a drop in response rates to the surveys (once contact was established) from 58.6% to 17.7%. Costs per completed interview rose from 4.48 euro to 15.65 euro. Respondents were prepared to spend 10-15 minutes being surveyed, but longer surveys yielded poorer completion rates. Respondents were willing to discuss issues of a sensitive nature. Interviews after 9 pm were less successful, with complaints about the lateness of the call. Randomisation from electronic residential telephone directory databases excluded all ex-directory numbers and thus was not as representative of the general population as number generation by the hundred-bank method. However the directory database was more efficient in excluding business and fax numbers. CONCLUSION:Researchers should take cognisance of under-representativeness of land-line telephone surveys, of the increasing difficulties in contacting the public and of mounting personnel costs. We conclude that telephone surveying now requires additional strategies such as a multimode approach, or incentivisation, to be a useful, cost-effective means of acquiring data on public health matters in Ireland and the U.K.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The effects of antipsychotic drug withdrawal have been inadequately studied. Case reports have described dyskinesia occurring in patients with several antipsychotics withdrawn, but studies on amisulpride withdrawal dyskinesia are lacking. CASE PRESENTATION:A 63-year-old man, who was diagnosed with schizophrenia at age 49, received amisulpride treatment since age 62. The dosage of amisulpride was reduced from 200 to 50 mg/day because of occurrence of akathisia during one admission. Severe withdrawal dyskinesia, mixed with dystonia and akathisia, was noted immediately after the dosage reduction. The abnormal involuntary movement showed improvement 2 weeks later when the dosage was increased to 100 mg/day. CONCLUSIONS:Withdrawal dyskinesia and other abnormal involuntary movements could be noted in a patient with reduction of amisulpride dosage or sudden termination. Withdrawal dyskinesia may subsequently lead to persistent tardive dyskinesia. Therefore, withdrawal-emergent dyskinesia should be promptly identified, and appropriate medical interventions should be given early.

背景与目标：

BACKGROUND & AIMS: :Proliferating trichilemmal tumor (PTT) is a rare but morphologically distinct tumor that usually arises on the scalp of elderly women. It is composed of multiple cysts consisting of squamous epithelium with trichilemmal keratinization without granular layer interposition. Vulvar proliferating trichilemmal cyst is very rare, with, to the best of our knowledge, only 3 cases previously reported in the literature. We describe a 39-year-old woman with recurrent PTT on the left labium majus of the vulva, which had been excised from the same side 5 years before. She had a palpable nodule, approximately 2 cm in size, which was firm, mobile, and nontender; without erythema and ulceration; and covered by normal skin on the vulva. There was no inguinal lymphadenopathy. The lesion was removed by wide surgical excision; because of the tissue elasticity, primary closure was possible. The pathology result was reported as proliferating trichilemmal carcinoma with tumor-free margins. Although local recurrence after wide excision is rare, we recommend complete excision for treatment of PTT and long-term follow-up because of the possibility of recurrence.

背景与目标： 增生性毛囊瘤 (PTT) 是一种罕见但形态上不同的肿瘤，通常发生在老年妇女的头皮上。它由多个囊肿组成，由鳞状上皮组成，具有三鞘角化，没有颗粒层插入。外阴增生的毛囊囊肿非常罕见，据我们所知，以前文献中仅报道了3例。我们描述了一名39岁的女性，在外阴的左阴唇上复发性PTT，该女性在5年前从同一侧切除。她有一个可触及的结节，大小约2厘米，坚硬，可移动且不触痛; 没有红斑和溃疡; 外阴被正常皮肤覆盖。无腹股沟淋巴结肿大。通过广泛的手术切除切除病变; 由于组织弹性，可以进行一次闭合。病理结果报告为增殖性毛囊癌，边缘无瘤。尽管广泛切除后的局部复发很少见，但由于复发的可能性，我们建议完全切除治疗PTT并进行长期随访。