MP offers a testimonial: “I've had superb care,and I'm alive today because of it”

When Beryl Gaffney, a Liberal member of Parliament, was told she had a brain tumour, she decided to take control of her own life. Instead of allowing the first doctor she saw to rush her to hospital, she travelled to Montreal and London, Ont., to get a second and third opinion. Then she showed neurologists in Atlanta her test results and asked which of the three options for treatment she had received coincided with their treatment recommendation. Today, she is back in the House of Commons, where she spends much of her time debating health care issues.     

Histological evidence of carcinoma in a hepatic tumour associated with oral contraceptives.

A primary hepatic tumour occurred in a 21-year-old woman who had been taking oral contraceptives for two years; she was treated by partial hepatectomy. Part of the neoplasm showed features suggestive of focal nodular hyperplasia, while the remainder had the histological characteristics of a well-differentiated hepatocellular carcinoma. This is the first report of malignant transformation of a tumour in a patient taking oral contraceptives.     

Multifocal fibromatosis: a case report

We present of rare case of multifocal fibromatosis in a 52 year-old women. In 1996, she was first evaluated for a tumour of the right breast and on the basis of the surgical specimen the extra-abdominal fibromatosis was diagnosed. Four years later, she was reevaluated for the tumor of the right lung, and then in 2001 for the lesion of the right parietal pleura. Microscopic examination of pulmonary and pleural lesions revealed histological pattern almost identical with the breast tumor. The recurrent lesions were located proximally to the primary one.     

Growth hormone hypersecretion in a girl with neurofibromatosis type 1 and an optic nerve glioma: resolution following chemotherapy

Growth hormone hypersecretion is extremely rare in childhood. We report a girl with neurofibromatosis type 1, an extensive optic nerve glioma and growth hormone hypersecretion. She was treated with chemotherapy to prevent further extension of her sight-threatening tumour. Three years after chemotherapy her growth hormone hypersecretion has resolved although she has gone on to develop precocious puberty.     

Carcinosarcoma of the gallbladder

The case of a 60-year-old woman with a five-year history of abdominal pain, jaundice, and weight loss is presented. On physical examination a hard mass on her right flank was evident. She died under unknown circumstances while she was waiting to be examined. At post-mortem examination the gallbladder was replaced by a neoplasm and there were gallstones within its lumen. Histologically, the tumour was constituted by a mixture of adenocarcinoma, squamous cell carcinoma and undifferentiated sarcoma. The diagnosis of carcinosarcoma of the gallbladder was established. A review of previously reported cases is presented too.     

A woman with thyrotoxicosis- and hyperemesis gravidarum-associated Wernicke's encephalopathy

Although hyperthyroidism arising from primary thyroid disease is rare in pregnancy, transient gestational hyperthyroidism is not uncommon. This condition can be associated with hyperemesis gravidarum (HG), and Wernicke's encephalopathy. We present the case of a woman with toxic nodular goiter complicating HG-associated Wernicke's encephalopathy. A 38-year-old Caucasian woman, who had received a diagnosis of hyperthyroidism and HG early in her pregnancy, had intrauterine fetal death at Week 16 of gestation. One day after undergoing therapeutic abortion, she was admitted to our clinic with persistent thyrotoxicosis, nausea, and vomiting. A toxic thyroid nodule was detected. She was given antithyroid medication, total parenteral nutrition. On Day 10 of hospitalization, she developed ataxia, aphasia, and somnolence. Cranial magnetic resonance imaging showed increased bilateral thalamic signalization. She was given a diagnosis of Wernicke's metabolic encephalopathy, for which she received thiamine and multivitamin preparations. She responded dramatically on the second day of thiamine therapy. Her consciousness improved rapidly and she began to speak. Her muscle tone was slightly weak and she had paresthesias in both legs. Absorption of thiamine may be particularly impaired in pregnant women with hyperemesis and hyperthyroid disease. Wernicke's encephalopathy should be considered in hyperthyroid women with HG who develop neurological abnormalities.     

Self-induced water intoxication in a schizophrenic patient.

Water intoxication occurred in a 53-year-old woman with chronic simple schizophrenia and poorly controlled diabetes. For several years she had had a compulsive habit of drinking excessive amounts of water. Coma, fever, convulsions and other neurologic signs appeared suddenly, and she had severe hyponatremia. Her condition improved rapidly when the electrolyte abnormality was corrected.     

Measuring driver impairments: sleepiness, distraction, and workload

Snow was falling heavily when Sarah was driving on a slippery road to her cousin's country cottage. It was dark outside, and the visibility was poor. She had planned to arrive before sunset, but the rental service had made a mistake, and it took hours before she got her rental car at the airport. It was past midnight now, and after a long day of traveling, Sarah was starting to get sleepy. Fortunately, there were only 15 km to go, but her eyelids were starting to feel heavy. To stay awake, she put her favorite CD on, turned up the volume, and started to sing along. This seemed to help a little-good-only 10 km to go. This was when Sarah's phone started ringing, and she awkwardly tried to find the mute button for the car stereo while answering the phone. As she looked up again, she barely caught a glimpse of the red brake lights of the car in front of her as she smashed into it.     

Partial 7q Isochromosome in Bone Marrow Following Treatment of Hodgkin's Disease

We report on a 29-year-old female followed for relapsed Hodgkin's disease. She had been diagnosed with Hodgkin's disease at 20 years of age and had been treated with chemotherapy. She had been in remission for six years when she relapsed, at which time she received chemotherapy for bone marrow transplant (BMT). After failure of BMT, she received additional chemotherapies with growth factors and radiation treatment. A bone marrow biopsy showed moderate hypercellularity with erythroid hyperplasia, but the karyotype had an abnormal clone containing an isochromosome derived from a 7q22 deletion.     

A case of 'contagious delusional parasitosis' in an adult pair of twin sisters

In July 1992, a 50-year-old married woman, who was a hospital administrative clerk with an adult daughter, stated that, for over 5 years, she had been parasitised by 'small animals coming out from her skin'. While physical and microscopical examinations did not show either lesions or parasites on the skin, both the patient's medical history and the conviction with which she reported the phenomenon, led to a diagnosis of Delusory Parasitosis, a condition which has been well-defined for over 50 years and considered of prevailingly psychiatric competence. The patient was examined several times during the course of 6 years. She exhibited varying levels of anxiety, and brought with her different species of insects which she had captured 'when she saw them coming out of her skin'. In July 1998 the patient returned with her twin sister, who 'had been infected by her'. Indeed, she too 'had discharged various insects from her skin' for more than a year. The authors provide information on the response of this hallucinatory syndrome to therapy which, as in this case, appears to be resistant to treatment, unless appropriate psychoactive drugs are used.     

Anna Fraentzel Celli (1878-1958)

This paper provides a short history of Anna Fraentzel Celli life, from her arrival in Italy in 1898 to her death in 1958, reviewing available documents and written testimonies. Anna Fraentzel was born in Berlin in 1878, third of four daughters from a bourgeois family; her maternal grandfather, Luigi Traube, was a very well known physician, as well as her father Oscar, and she developed an early interest in medicine that she couldn't fulfill: actually after her father's death she was forced to shorten her education, she couldn't enter the medical school, as she would have liked to, and she attended the nursing school, instead, displaying a lot of good practical sense. As a nurse in Hamburg in 1896 she met Prof. Angelo Celli, who was there on a professional visit, and who assisted the young nurse in finding a job at the city hospital. She was much younger than him, who was already a middle aged respected scientist; anyhow, even after his departure, they kept in touch and eventually fell in love. They married in 1899 and she moved to Rome to work at the S. Spirito Hospital joining a brilliant group of physicians and researchers as Tommasi-Crudeli, Marchiafava, Bignami, Bastianelli, Dionisi, Grassi, and her husband Angelo. They had long been studying the mode of transmission of the malaria infection and in 1898 they had identified the mosquito Anopheles as the vector of the malaria parasite. She got enthusiastically involved both in the scientific work and in the antimalarial campaign which Celli promoted in the Agro Romano. The strong personality of Anna Celli, her active involvement in social problems, her passionate dedication to her work, her peculiar way of being feminist, expressed fully her commitment to the struggle against malaria and illiteracy in the Agro Romano and in the Paludi Pontine at the beginning of the twentieth century. She must be credited as a major force in the creation and functioning of the Peasant Schools, as well as in the organisation of the experimental antimalarial health clinics. After her husband's death in 1914 she continued as a promoter of the antimalarial campaign, co-operating with the Red Cross and other institutions. Moreover, she edited the scientific and historical papers which Angelo Celli had collected and written during his life. She was also a prolific writer and lecturer on these issues and gained widespread appreciation both in Italy and in Germany. Toward the end of her life she retired to a nursing home in Rome where she died almost alone in 1958.     

The case of asymptomatic primary actinomycosis of the greater omentum in the patient with intrauterine contraceptive device

This paper describes a case of asymptomatic multifocal actinomycosis of the greater omentum which was detected accidentally in a patient who was suspected of uterus myoma. The patient was a 40 year old woman who had a copper intrauterine contraceptive device (IUCD) for three years. After the gynecological examination and pelvic ultrasound she was diagnosed with sub serous myoma of uterus. Since she did not give a birth it was suggested to have myoma enucleating. However during the surgery a dermoid teratoma of the right ovary was detected so it was removed together with tumor and there were two thickenings on the greater omentum, suspicious of inflammation, whereas one grew together with the front abdominal wall. Due to these conditions, she had partial omentectomy done and omentum was sent for path histological examination. The path histological examination confirmed it to be actinomycosis. The patient had an intensive antibiotic therapy prescribed (Penicillin) in order to prevent a disease relapse because we could not be sure whether the remaining part of omentum was affected by microscopic actinomycosis.     

Brittle diabetes: long-term control with a portable,continuous, intravenous insulin infusion system.

A young woman had severe brittle diabetes mellitus that was critically unmanageable with all conventional insulin treatment. Continuous subcutaneous and intramuscular infusions of insulin also failed to control her metabolic instability. Use of a continuous intravenous infusion, however, whereby a portable, variable-rate, battery-operated syringe pump delivered insulin through a subcutaneously tunnelled central venous catheter, resulted in good control. When she was receiving hourly intramuscular insulin injections (a mean of 778 IU daily) mean blood glucose concentrations had been 22.1 +/- 1.4 mmol/l (398 +/- 25 mg/100 microliters). After she had received the intravenous infusion for one month as an outpatient mean blood glucose concentration was 8.2 +/- 0.46 mmol/l (148 +/- 8 mg/100 microliters) and only 80 IU insulin daily was required. Follow-up after over five months of use showed that few complications had occurred. The system is simple to use and safe, and the diabetes had been stabilised such that she could enjoy a near-normal life style.     

Of sad and wished-for years: Elizabeth Barrett Browning's lifelong illness

The Victorian poet Elizabeth Barrett Browning suffered for most of her life from an illness that her physicians were never able to diagnose, and that Barrett Browning scholars and others have tried to diagnose since her death in 1861. Many suggestions have been offered, but none has been convincing. By happenstance, my daughter was reading the correspondence of Elizabeth and Robert Browning not long ago, and she recognized the symptoms described as those of the rare muscle-weakening disorder she herself has, hypokalemic periodic paralysis (HKPP). The evidence from Barrett Browning's letters and the diary she kept when she was 25 strongly suggest she too had HKPP.     

Malice's wonderland: Research funding and peer review

The players all played at once, without waiting for turns, quarreling all the while and fighting for the hedgehogs; and in a very short time the queen was in a furious passion and went stamping about, and shouting “off with his head” or “off with her head,” about once a minute. Alice began to feel very uneasy: to be sure she had not as yet had any dispute with the queen, but she knew that it might happen any minute, “and then” thought she, “what would become of me? They're dreadfully fond of beheading people here: the great wonder is, that there's any one left alive”.     

Pregnancy in a woman with treated bladder extrophy, split pelvis and hypoplasia of ischial bones. Case report

We present a case of a pregnancy in a 24 year old woman who was born with ectopia vesicae, split pelvis and hypoplasia of ischial bones. From childhood to adulthood she had undergone reconstructive surgeries of the abdomen and perineum, as well as urine diversion surgery. During pregnancy she experienced recurrent urinary tract infections which were treated with antibiotics. In spite of tocolysis, she delivered by cesarean section a premature baby boy at 35th week of gestation due to premature uterine contractions. The postoperative period was uneventful and they were discharged from the hospital in a good general condition.     

Memoirs of an amnesiac--two years with brain cancer,or the outer space of living with brain tumors.

Alexandra Dane Dor-Ner ("Ali" to friends) was a photographer, writer, and a producer of programs on child development. In February 1989, at the age of 41, she was diagnosed with malignant brain cancer. During the following months she underwent brain surgery, radiation, and implant radiation. Throughout her treatment, she continued to work on a novel and write stores and literary criticism. A volunteer in hospitals before her illness, she now became very active in a support group of brain tumor patients and often served as a first resource and contact for others diagnosed with brain cancer. All was very accomplished; her award-winning photographs have been exhibited in the Smithsonian Institution in Washington, and her articles and pictures were published in books, periodicals, and newspapers around the world. A native of Boston, Ali lived for 17 years in Israel, where she joined a group of photographers documenting disappearing neighborhoods in Jerusalem. She was awarded first prize in the "Israel Through the Camera''s Eye" competition in 1977. She also taught English and photography in Israeli high schools. Ali traveled extensively on photographic assignments. Early in their 22-year marriage, she and her husband circumnavigated the globe on a freighter, producing a documentary film of the voyage. "Memoirs of an Amnesiac" was written while Ali was a student at the Warren Wilson College Writers'' Program in North Carolina; she intended to explore the compensatory aspects of her disease. In February 1991, within days of completing the piece, Ali had a third brain operation to remove a regrowth of cancerous tumor cells, as well as necrotic tissue. Two days later, she was again operated on to remove blood clots resulting from the previous surgery. For the next 12 weeks she fought to regain her ability to walk, talk, and write. In May, she underwent a fifth operation to relieve pressure in the brain. She was still in the hospital when she learned, to her great pleasure, that she would be awarded a master of fine arts degree from Warren Wilson College. She died on June 19, 1991.     

Growth hormone and tumour recurrence.

OBJECTIVE--To determine whether using growth hormone to treat radiation induced growth hormone deficiency causes tumour recurrence. DESIGN--Comparison of tumour recurrence rates in children treated with growth hormone for radiation induced deficiency and an untreated population. Computed tomograms from children with brain tumours were reviewed when starting growth hormone and subsequently. SETTING--North West region. PATIENTS--207 children treated for brain tumour, 47 of whom received growth hormone and 161 children with acute lymphoblastic leukaemia 15 of whom received growth hormone. MAIN OUTCOME MEASURES--Tumour recurrence and changes in appearances on computed tomography. RESULTS--Among children with brain tumour, five (11%) who received growth hormone had recurrences compared with 42 (26%) who did not receive growth hormone. Also adjusting for other variables that might affect tumour recurrence the estimated relative risk of recurrence was 0.82 (95% confidence interval 0.28 to 2.37). The only child with acute lymphoblastic leukaemia who relapsed while taking growth hormone had relapsed previously before starting treatment. Two of the five children with brain tumours who relapsed had abnormal appearances on computed tomography when growth hormone was started. 14 other children who remained relapse free and had follow up computed tomography showed no deterioration in radiological appearance during treatment. CONCLUSIONS--In this population growth hormone did not increase the risk of tumour recurrence but continued surveillance is essential. Abnormal results on computed tomography are not a contraindication to treatment with growth hormone.     

A great adventure: from quantitative metabolism to the revelation of Chinese science

By the end of the 1930s, Frederick Gowland Hopkins had built his Cambridge laboratory into the pre-eminent institute of biochemistry that was a magnet for scientists from all over the world. Even so, it was an exceptional event that saw a young Chinese student leave a homeland at that time relatively isolated from the West and embark on a research career in his department. Within 2?years, she had published a highly influential set of papers on metabolism in the Biochemical Journal, a field that some 70?years on has once again become a major focus as its role in cancer is dissected. From the outset, however, she had come under the spell of the legendary polymath Joseph Needham to whom she would dedicate the rest of her life in a partnership that would unveil the astounding history of Chinese science to the world.