The present study suggests that CRT patients with BMI greater than 25 have improved swallowing outcomes, longer time to disease recurrence, and improved survival when compared with similar patients with lower BMI. BMI at presentation may be an important clinical factor to consider when determining the optimal treatment modality for a head and neck cancer patient. Further investigation is required to determine whether primary surgery should be the preferred treatment in normal or low BMI patients.

Hypothesis: Pancreaticoduodenectomy (PD) is a safe procedure for a variety of periampullary conditions. Design: Retrospective review of a prospectively collected database. Setting: Academic tertiary care hospital. Patients: A total of 516 consecutive patients who underwent PD. Main Outcome Measures: Patient outcomes and survival factors. Results: Pathological examination demonstrated 57% periampullary cancers, 22% chronic pancreatitis, 12% cystic neoplasms, 4% islet cell neoplasms, and 5% other. Fiftyone percent of patients underwent pylorus preservation. Median operating time was 5 hours; blood loss, 1300 mL; and transfusion requirement, 1.5 U. Postoperative complications occurred in 43% of patients, including cardiopulmonary events (15%), fistula (9%), delayed gastric emptying (7%), and sepsis (6%). Additional surgery was required in 3% of patients, most commonly because of bleeding. Perioperative mortality was 3.9% overall but only 1.8% in patients with chronic pancreatitis; 25% of patients who died had preoperative complications associated with their periampullary condition. Three-year survival was 15% after resection for pancreatic cancer, 42% for duodenal cancer, 53% for ampullary cancer, and 62% for bile duct cancer. Univariate predictors of long-term survival in patients with periampullary adenocarcinoma included elevated glucose levels, liver function test results, abnormal tumor markers, blood loss, transfusion requirement, type of operation, and pathologic findings (periampullary adenocarcinoma type, differentiation, and margin and node status). Multivariate predictors were serum total bilirubin level, blood loss, operation type, diagnosis, and lymph node status. Conclusions: Pancreaticoduodenectomy continues to be associated with considerable morbidity. With careful patient selection, PD can be performed safely. Long-term survival in patients with periampullary adenocarcinoma can be predicted by preoperative laboratory values, intraoperative factors, and pathologic findings.

Symptom development from birth to 12 years of age was examined in 18 children who met DSM-III criteria for schizophrenia with onset before 10 years of age. Using a follow-back design, symptom development was rated at each of four age levels using a DSM-III Symptom Rating Scale and the Achenbach Child Behavior Checklist. Results revealed a gradual developmental unfolding of a broad spectrum of symptoms affecting social, cognitive, sensory and motor functioning and beginning many years before the appearance of schizophrenic symptoms--usually in early infancy. Prior to 6 years of age, severe language deficits and motor development problems were each found in 72% of the sample and symptoms of infantile autism were found in 39% of the sample. Onset of schizophrenia occurred at an earlier age for children with a history of autistic symptoms during infancy than for other children in the sample. Schizophrenia as defined by DSM-III was entirely absent before 6 years of age.

This article summarizes a series of cognitive/neuropsychological studies of children with schizophrenia. One set of studies, which surveyed a broad range of neuropsychological functions, revealed no evidence that children with schizophrenia are consistently impaired in sensory, perceptual, or language functions. Rather, the studies showed that children with schizophrenia performed poorly on tasks requiring sensory, perceptual, and language processing that made extensive demands on information-processing capacity. A second series of studies, which examined visual information processing by manipulating the processing demands of span of apprehension tasks, yielded similar findings. The key characteristic of tasks that elicit impaired performance in children with schizophrenia is that the task makes extensive demands on processing resources. This suggests that these children have limited information-processing capacity. Three hypotheses are proposed concerning the cognitive processes that are impaired in children with schizophrenia: (1) the cognitive processes that seem to be impaired in these children are part of a more general, hierarchically organized attention system; (2) the component processes of the system are subserved by different brain structures; and (3) the structures are part of a network that includes the frontal lobe and thalamus in interaction with the reticular activating system.

Reported baseline findings from the neurological assessment component of the Hemophilia Growth and Development Study (HGDS). HIV-positive (HIV+; n = 207) and HIV-negative (HIV-; n = 126) young males with hemophilia ages 6 to 18 years, were enrolled in a prospective study of their growth and development. At baseline, HIV+ and HIV- subjects were not significantly different in test performance. The number of subjects exhibiting below-average performance in three or more areas assessed was about 25% overall. For both groups, mean test scores were within the average range. Academic and adaptive skills were lower than expected based on mean IQ scores, and more behavioral/emotional problems than expected were reported by parents. Absolute CD4 cell counts per mm3 were not related to neuropsychological performance at baseline. Results suggest that the subjects with HIV were relatively free of HIV-related neuropsychological impairment at baseline and that observed differences from a general population reflect effects of hemophilia as a chronic illness.