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The NCCN Guidelines for Central Nervous System Cancers provide multidisciplinary recommendations for the clinical management of patients with cancers of the central nervous system. These NCCN Guidelines Insights highlight recent updates regarding the management of metastatic brain tumors using radiation therapy. Use of stereotactic radiosurgery (SRS) is no longer limited to patients with 3 or fewer lesions, because data suggest that total disease burden, rather than number of lesions, is predictive of survival benefits associated with the technique. SRS is increasingly becoming an integral part of management of patients with controlled, low-volume brain metastases.

Primary and metastatic tumors of the central nervous system are a heterogeneous group of neoplasms with varied outcomes and management strategies. Recently, improved survival observed in 2 randomized clinical trials established combined chemotherapy and radiation as the new standard for treating patients with pure or mixed anaplastic oligodendroglioma harboring the 1p/19q codeletion. For metastatic disease, increasing evidence supports the efficacy of stereotactic radiosurgery in treating patients with multiple metastatic lesions but low overall tumor volume. These guidelines provide recommendations on the diagnosis and management of this group of diseases based on clinical evidence and panel consensus. This version includes expert advice on the management of low-grade infiltrative astrocytomas, oligodendrogliomas, anaplastic gliomas, glioblastomas, medulloblastomas, supratentorial primitive neuroectodermal tumors, and brain metastases. The full online version, available at NCCN. org, contains recommendations on additional subtypes.

A study of 1,207 male veterans admitted to a substance-abuse program found a history of sexual abuse was related to spiritual injury and low stability of spiritual behaviors, but not to overall rate of current religious behavior. Abuse was related to increased frequency of prayer and of spiritual experience. (Author/CR)

Seventh-day Adventist missionaries entered Kenya in 1906. Because they were relatively late on the scene and the British colonial government policy discouraged direct competition between missions, they concentrated their efforts [...]

by PAULA D. NESBITT. New York: Oxford, 1997, 283 pp. $45.00. The influx of women to seminaries since 1980 has caused male leaders to express concern that the feminization of [...]

Explores the dynamics of evolution of church-state relations in the Adventist context and the transformation of the pattern of relationship between the Adventist church and the government. Role of the Adventist church in the espousal of religious liberty and in the separation of church and state; Chronological discussion of the tension between the state and the Adventist Church.

Ceftizoxime was used as initial antibiotic therapy in 38 neutropenic cancer patients with 53 febrile episodes. Patients with infections were found in 21 of the febrile episodes and responded in 71% of instances. Sites of infection included soft tissue, blood, urinary tract, lung, and multiple sites. Gram-negative bacilli and Gram-positive cocci comprised 62% and 38% of organisms, respectively, and responded in 69% and 80% of instances, respectively. Patients with a high initial neutrophil count or a neutrophil count that rose during therapy tended to respond to therapy better than those with an initial lower neutrophil count. Response was higher when organisms were sensitive in vitro. Pseudomonas aeruginosa was the only organism not showing in-vitro susceptibility, and patients with infections caused by Ps. aeruginosa responded infrequently (33%). Most patients showed excellent response to ceftizoxime used alone; however, patients with Ps. aeruginosa infection (because of its in-vitro resistance) may require another antibiotic in conjunction with ceftizoxime as initial therapy. [ABSTRACT FROM PUBLISHER]