Recent advances in the management of primary breast cancers.

The current concept of breast cancer treatment arises from Fisher's theory that operable breast cancer has distant micrometastasis at its very early stages. Since it is the presence of systemic diseases or micrometastasis that determines the final outcome, variation in local treatment would not affect survival. Fisher's theory led to a change in local treatment, from Halsted's radical mastectomy to breast-conserving therapy (BCT), and the introduction of adjuvant systemic treatment. As part of the job of surgery is replaced by radiation therapy in local control, the efficacy and side effects of radiation should be carefully monitored. The recently published results of 20-year follow-up in 2 important studies confirm that BCT achieves equal survival compared to mastectomy in women with early breast cancers, even after all causes of mortality have been considered. The introduction of sentinel lymph node biopsy has further decreased the adverse impact of breast cancer treatment on women. As variation in local control does not affect survival, more efforts are being put into developing adjuvant systemic treatment with curative intent. Adjuvant chemotherapy has been demonstrated to substantially affect the survival of women with early breast cancers. It is now apparent from numerous studies that adjuvant therapy improves survival in all subgroups of women with early breast cancer, although the absolute benefit varies depending on axillary lymph node status, tumor size, and other prognostic factors. This article reviews recent advances in the management of primary breast cancer, including: long-term follow-up after BCT; side effects of radiation therapy in BCT; post-mastectomy radiotherapy; sentinel node biopsy; adjuvant hormone therapy; and chemotherapy, including new strategies such as the incorporation of taxanes, dose-dense chemotherapy schedules, and the use of aromatase inhibitors in place of, or in addition to, tamoxifen.     

见于湖南的一例血红蛋白G-台中家系

见于湖南江华县的一例慢泳血红蛋白α链变种,其先证者为汉族青年,属杂合子。家系调查发现其父、大姐和弟均携有同样的异常Hb。血液学常规检查一般正常。除先证者肝在肋缘下0.5cm扪及外,无任何临床症状。经一级结构分析,确证此例为HbG一台中[α74(EF3)Asp→His]。功能观测其氧平衡特征与HbA无差异。这是见于湖南的首例。     

Identification of Leishmania donovani isolates from different kala-azar foci in China by kDNA hybridization.

kDNA sequence homology of Leishmania donovani isolates from three types of kala-azar foci in China were analyzed by using dot and Southern hybridization with biotin- and 32P-labelled probes. The results revealed kDNA sequence heterogeneity among Leishmania donovani isolates from the three kala-azar foci: sequence homology between isolates of hill and desert foci was higher than that between hill and plain foci isolates. The kDNA hybridization technique was also found to be specific and sensitive for direct identification of Leishmania in animal tissues. In a preliminary survey, kDNA hybridization of cutaneous tissue blots of 71 dogs from endemic regions showed a positive rate of 40.8%, and the rate of double positive cases (touch blot hybridization and bone marrow smear) reached 91.3%. The direct identification of Leishmania in tissues by kDNA hybridization seems to be a useful and convenient method for epidemiological study and clinical diagnosis, especially for species/strain characterization.     

Pituitary function before, during, and after chronic gonadotropin-releasing hormone agonist therapy.

OBJECTIVE: To examine possible adverse effects on pituitary function of long-term administration of gonadotropin-releasing hormone agonist (GnRH-a). DESIGN: Prospective analysis of blood sampling before, during, and after GnRH-a therapy. SETTING: Tertiary institutional outpatient care. PATIENTS: Twelve normally ovulatory women with a diagnosis of endometriosis. INTERVENTIONS: Six-month suppression with GnRH-a. MAIN OUTCOME MEASURES: Serum levels of follicle-stimulating hormone, luteinizing hormone, free thyroxin index, cortisol (F), growth hormone (GH), prolactin (PRL), and thyroid-stimulating hormone (TSH). RESULTS: Basal and stimulated values of gonadotropins, PRL, F, TSH, and GH were normal and unchanged by 6 months of GnRH-a after resumption of menses. CONCLUSIONS: Utilizing dynamic pituitary function tests, we were unable to demonstrate an adverse effect of long-term GnRH-a therapy on pituitary function.     

围套式显微血管减压术治疗面肌痉挛

使用围套式显微血管减压术治疗面肌痉挛５０例。采用耳后斜行小切口，分离压迫血管后，用涤沦片包绕面神经根起始部并用银夹固定，术后４９例痉挛停止。本法并发症少，无死亡。术后随访３个月至１０年均无复发。根据术中发现将“责任血管”分为４型：接触型、压迫型、粘连包绕型和贯穿型。讨论了手术适应证、要求及并发症的预防等。     

Tumor cell-enhanced sensitivity of vascular endothelial cells to photodynamic therapy

Effective antitumor photodynamic therapy (PDT) may be related to damage of vasculature within the tumor. The purpose of this study was to determine if tumor cells secrete factors that stimulate proliferation of human umbilical vein endothelial cells (HUVEC) and result in enhanced sensitivity of HUVEC to aluminum-sulfonated phthalocyanine (AISPc)-PDT. Three human tumor cell lines—pharyngeal squamous carcinoma, colonic carcinoma, and mammary carcinoma—were used in this study. Co-culture of HUVEC and either squamous carcinoma or colonic carcinoma, but not mammary carcinoma, significantly increased HUVEC proliferation and AlSPc-PDT mediated cell damage. In addition, supernatant from squamous carcinoma and colonic carcinoma cultures also stimulated HUVEC proliferation and sensitivity to AISPc-PDT. Both supernatant and cell lysate from squamous carcinoma cells contained angiogenic factors consistent with basic and acidic fibroblast growth factors, as evidenced by Western blot analysis and BALB/c 3T3 fibroblast cell proliferation assays. Collectively, these results suggest that selected tumor cell lines produce angiogenic factors that induce HUVEC proliferation and subsequently enhance sensitivity to AISPc-PDT. © 1994 Wiley-Liss, Inc.     

The effects of radiofrequency catheter ablation on the metabolic enzymes and Ca++-ATPase of myocytes

Summary Using histochemical technique, the effects of radiofrequency catheter ablation (RFCA) on the activities of LDH, SDH, CCO, and Ca⁺⁺-ATPase of guinea-pig ventricular myocytes were examined. The histological changes were observed for comparison. Radiofrequency energy (500 kHz) delivered was 20 WX 10 s. The results were as follows: RFCA resulted in significant impairments in all the four kinds of enzymes but without statistical differences in the areas involved in this energy level. No statistically significant difference was found between the ranges of enzymatic damages and areas of pathological lesions. These findings showed a consistency in areas of the histological and histochemical lesions resulted from RFCA.     

Parametric phase-delay estimation of sound transmitted through intact human lung

Sonic noise between 300 and 1600 Hz is introduced into the mouths of 11 healthy adult male subjects at resting lung volume and is detected over the anterior extrathoracic trachea and at three sites on the right posterior chest wall. To overcome the difficulties associated with non-parametric phase unwrapping due to thoracic anti-resonances, the pahse delay τ(f) of propagation between the trachea and the chest wall is estimated using a linear parametric ARX-type statistical model with the non-parametric magnitude spectra as a guide. The resulting τ(f) estimates are unambiguous and reliable, and show a clear trend of decreasing τ(f) with increasing frequency, indicating that sound at higher frequencies reaches the chest wall faster than that at lower frequencies. This finding indicates that respiratory sound transmission is highly dispersive, most probably owing to frequencydependent airway and parenchymal wavespeeds.     

Maternal corneal thickness during pregnancy

We measured central corneal thickness in 89 pregnant women. It was increased 16 micron (P = .01) compared to the control eyes of 18 nongravid and 17 postpartum women. There was no significant difference (P = .79) in corneal thickness between the nongravid and postpartum groups. When comparing subjects by week of gestation, there was no trend over time in corneal thickness (analysis by linear regression). Intraocular pressure was lowered during pregnancy, but it did not correlate with corneal thickness for either the pregnant or nonpregnant group.