The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast

Previous studies of patients with infiltrating ductal breast cancer treated with conservative surgery (ie, limited excision) and radiotherapy have indicated that the presence of an extensive intraductal component (EIC) in the excision specimen is highly associated with subsequent breast recurrence. The reason for this association is not clear, but possible explanations include the presence of more extensive disease in the breast or increased radiation resistance among tumors with an EIC (EIC+) compared with those without (EIC-) tumors. To investigate this association further, we related the presence or absence of an EIC in the primary tumors of 214 women who underwent mastectomy to the likelihood of finding additional foci of cancer in their mastectomy specimens using a correlated pathologic-radiologic mapping technique. Primary tumors that were EIC+ were significantly more likely to have carcinoma in the remainder of the breast than those which were EIC--(74% v 42%; P = .00001). This difference was primarily due to the presence of residual intraductal carcinoma. Seventy-one percent of EIC+ patients had residual intraductal carcinoma compared with 28% of EIC-patients (P less than .00001). In particular, 44% of EIC+ patients had "prominent" residual intraductal carcinoma compared with 3% of EIC-patients (P less than .00001). We conclude that patients whose tumors contain an EIC more frequently have a large subclinical tumor burden in the remainder of the breast compared with patients whose tumors do not contain an EIC. This observation may explain the association between EIC and subsequent breast recurrence when patients are treated with a limited excision before radiotherapy.     

Know your scopes

How much do you know about the endoscopes you buy? If you're anything like most of your colleagues in purchasing, the answer probably is, "Not enough." Endoscopes are incredibly complex instruments. They're also very expensive (but you already knew that). So it makes sense to know something about them when making purchase decisions. Endoscope expert Patricia Holland, R.N., marketing and clinical consultant for FiberTech Medical, often provides education on the structure and operation of endoscopes, as well as criteria for selecting them. The following discussion of flexible endoscopes was adapted from her presentation at a recent conference sponsored by the Society of Gastroenterology Nurses and Associates, of which she is a past president. Material provided by FiberTech, an endoscope repair company based in Baltimore, was also incorporated.     

Board development in two hospitals: lessons from a demonstration

A recently concluded demonstration project examined efforts to improve the effectiveness of nonprofit boards. This article focuses on the interventions at two participating healthcare organizations and examines the outcomes of these efforts. Changes made at the Alpha Health Care system included: reduction in the number of boards, term limits established for board members, election of new board chairs for two of the fewer boards, reduction in the size of those boards, implementation of a consent agenda, and reorganization of the boards' committee structure. Fewer changes were implemented at the Beta Hospital, where several initiatives were started but only some of which were retained by the projects' conclusion. Key factors limiting the extent of changes there were the modest interest in an active board by a new CEO and the limited investment of trustees in change. The article concludes with a discussion of lessons learned about board assessment, the use of retreats to initiate board development, and the importance of time management and CEO support to strengthen board effectiveness.     

Reconstructing the life course: health during early old age in a follow-up study based on the Boyd Orr cohort

A method is described for investigating life course influences on health in early old age. The lives of some 300 individuals at present aged 65-75 y have been reconstructed from the archived records of a pre-WWII survey, in which they took part as children, and from lifegrid interviews with the same individuals 60 y later. Despite loss to study at several points those interviewed are shown to be representative of the British population socio-demographically, in comparison with the 1931 and 1991 decennial censuses, and physically, in comparison with the Health Survey for England. Bias is conservative because the most disadvantaged were disproportionately affected by loss to follow-up through death and because non-responders to interview were more disadvantaged as children than the interviewees. Representativeness and conservative bias, it is argued, justify the use of these data for investigating life course influences on health in early old age.     

Family support and the early years centre: A case study of parent views

Few people would dispute the benefits of early intervention to relieve family stress and promote the needs of children. However, the use of compensatory schemes in pre-school and nursery settings has been the subject of some heated debate over whether such mechanisms effectively tackle disadvantaged or dysfunctional families (see Jary and Jary, 1991; Woodhead and McGrath, 1988:15). Nonetheless there remains strong support for the view that programmes in early childhood can help offset an abusive or neglectful family life through the provision of a consistent and supportive environment and thereby help children in need (Broadhurst et al, 1979; Cannan and Warren, 1997; Durkin, 1986; Maher, 1989; Mirandy, 1976; Pugh, 1994). Similarly, the educational needs of children who are 'looked after' by local authorities have become a topic of some concern provoking fresh thinking about the education / social work interface (see Blyth and Milner, 1997). Such issues inform the current debate over the appropriate distribution of resources and strategy in respect of child and family support services and child protection. The gaze of policy makers and academics has widened in a search for ways to balance these difficult to assimilate objectives. Within this search there has been growing interest in early years services provided by local authorities in order to see if this might offer additional or alternative family support. Such preventive services might allow social services departments greater realignment towards more protection work and other interventions with those families where risk of severe emotional or physical harm has come to light. Such a scenario may not be unlikely given local authority budget limitations, legal and procedural obligations and anxiety over media interest in child abuse and statutory social work (see Parton, 1997, pp. 18-20). We hope therefore that the following case study of an early years centre will make a modest addition to the current debate over children in need and the role of early years provision, particularly in respect of parent experiences and perceptions. We re-iterate the point that this is a case study involving a small number of families and so the usual caveats about reliability and generalisation are declared at the outset.     

Desensitization of guanylyl cyclases in cultured human airway smooth-muscle cells

We previously showed that cultured human airway smooth-muscle cells (HASMC) contain soluble and particulate guanylyl cyclases (GCs). We studied the desensitization of soluble and particulate GCs in HASMC. Homologous desensitization of soluble GC occurred after incubation with S-nitroso-N-acetyl pencillamine (SNAP). SNAP-dependent desensitization was blocked by hemoglobin, a nitric oxide (NO) scavenger, suggesting that it was due to NO release. Cross-desensitization between SNAP and sodium nitroprusside (SNP) and the lack of thiol reduction after SNAP or SNP treatment suggested that thiol depletion was not involved. Assays for soluble GC activity and experiments using protein synthesis inhibitors suggested that SNAP-dependent desensitization was due to reduced soluble GC. Homologous desensitization of particulate GC occurred after pretreatment with atrial natriuretic peptide (ANP) accompanied by reduced particulate GC activity. Recovery required protein synthesis, suggesting that it was due to reduction in particulate GC. Homologous desensitization to either SNAP or ANP was not altered by phosphodiesterase (PDE) inhibitors, suggesting that increased PDE activity was not involved. Cross-desensitization experiments using SNAP and ANP and experiments using zaprinast to elevate cyclic guanosine monophosphate showed no evidence of heterologous desensitization. Our results suggest that pretreatment of HASMC with SNAP or ANP causes homologous, but not heterologous, desensitization of soluble and particulate GCs, respectively.     

An outbreak of Salmonella typhimurium RDNC A045 at a wedding feast in South Australia

In April 1998 an outbreak of salmonellosis amongst guests at a wedding feast was investigated. Of the 58 attendees interviewed 38 (66%) subsequently developed gastrointestinal symptoms. Stool cultures from 7 cases grew Salmonella Typhimurium RDNC A045. Food samples were culture-negative for Salmonella spp. A cohort study implicated spatchcock (RR 2.5, 95% CI 1.09-5.77) and scampi (RR 2.0, 95% CI 1.05-3.89). Temperature abuse and cross-contamination within the kitchen during preparation and cooking are likely to have been the main contributing factors to this outbreak. Control measures included staff education in safe food handling and improvements in poultry processing methods to minimise carcass contamination.