Long‐term results after excision of breast mass using a vacuum‐assisted biopsy device

Background: The excision of breast lesions using an ultrasound‐guided vacuum‐assisted biopsy device (VABD) is a widely used technique for the diagnosis and treatment of breast disease, but the results of long‐term follow‐up after VABD excision of benign breast tumours have not been reported. The purpose of this study was to evaluate the results of long‐term follow‐up after complete excision of benign breast tumours using an ultrasound‐guided VABD. Methods: This is a retrospective clinical study. Between January 2001 and December 2004, patients who had undergone VABD excision of benign breast tumours and been followed up by clinical examination and ultrasonography for 2 years or more were included. Results: One hundred eighty‐four cases representing 153 patients were studied. The median follow‐up period was 33 months (range, 24–67 months). All lesions were histologically benign. The mean size of the lesions was 1.09 ± 0.57 cm (range, 0.3–3.03 cm). Within 2 years after VABD excision, residual lesions were detected in 10% of patients sonographically, but after 2 years or more, residual masses were found in 6.5% of patients. Scar changes also decreased from 36.0% to 15.8% during the period of follow‐up. Finally, the benign breast tumours were completely excised without residual masses in 93.5% of the participant patients. Residual masses developed in two fibroadenoma cases (1.08%); one was re‐excised and the other was followed serially. Conclusion: Ultrasound‐guided VABD excision is a minimally invasive technique for the complete removal of benign breast tumours. The results of this long‐term follow‐up of VABD excisions are comparable to conventional methods.     

The rapid‐eye‐movement sleep behavior disorder in Chinese‐Taiwanese patients

Aims: While the features of rapid‐eye‐movement sleep behavior disorder (RBD) have been reported in Caucasian patients, the characteristics of Chinese‐Taiwanese patients with RBD have never been examined. Methods: Subjects were retrospectively recruited between April 2005 and February 2008 from the neurological clinic and sleep laboratory in the Department of Neurology of Kaohsiung Medical University Hospital. A total of 70 consecutive subjects fulfilling the criteria for RBD were recruited. Results: The records of standard overnight polysomnography in patients with RBD were analyzed retrospectively. Twenty‐five (35.7%) of the patients were female; the mean age of diagnosis was 67 years and the mean age of symptom onset was 60 years. Among patients with idiopathic RBD, there were 28 men (61%) and 18 women (39%). Nocturnal wandering in the bedroom was reported in 11 cases and out of the bedroom in seven cases. Nineteen patients (27.1%) had accidental falling from bed and 27 patients (38.6%) had sleep‐related injury that resulted in ecchymosis and laceration of the head, face or limbs. Conclusions: We found that some features in Chinese‐Taiwanese patients with RBD were different from Caucasian patients, such as a greater female ratio, lower injury episodes during sleep and more sleep wandering.     

John Bryant Curtis: Neurosurgeon, leader and mentor

In every generation of neurosurgeons, there are those whose judgment and professional accomplishments gain distinction among their peers. Such exceptional leaders often exhibit unique talent and inevitably, they exert a lasting influence on their field of endeavour. John Bryant Curtis was one of these.Rising from humble roots, Curtis made his impact in neurosurgery starting at the age of 36. A legendary and a master neurosurgeon for his period, he became the second director of Neurosurgery at The Royal Melbourne Hospital, succeeding R. S. Hooper in 1967. Like Hooper, Curtis had undertaken a three years Fellowship in Oxford at the Radcliffe Infirmary to train under Sir Hugh Cairns in 1947. On his return to Australia in 1950, he was among the pioneers in introducing percutaneous angiography into the country, which earned him the honourable Hunterian Professorship at the Royal College of Surgeons of England in 1958. This was in recognition for his contribution to the investigation of intracranial aneurysms.Among the many neurosurgeons whom John Bryant Curtis trained at the Royal Melbourne Hospital and at the Prince Henry Hospital, he was considered, by a few, a controversial figure. Others found the experience very positive. He was a distinguished neurosurgeon with expert clinical judgment, but simultaneously a stern and formidable character who demanded only the best from his staff and trainees. He was contrastingly thoughtful and gentle to his patients.Behind every great leader, there is a personal side, often more gentle and vulnerable than the public persona. Curtis was a generous, loving, funny, although at times eccentric human being. Although he died in 1989, ironically from metastatic brain tumours, his dynamic personality and work ethic imprinted a lasting impression on those who had met him.     

A review of effects of particulate matter-associated nickel and vanadium species on cardiovascular and respiratory systems

Many epidemiological investigations indicate that excess risks of mortality and morbidity may vary among specific PM_2.5 components. Nickel (Ni) and vanadium (V) particulate metal species may potentially be related to increasing respiratory and cardiovascular mortality and morbidity. This review focuses on exposure concentrations of these two species in various settings, their health effects based on epidemiological and toxicological studies and the underlying mechanisms. The evidence shows that environmental exposure concentrations of Ni and V in general setting are lower than the World Health Organization standard (V, 1 μg/m³/day) in 2000, or the European Environment Agency standard (Ni, 1 μg/m³/day) in 2003, but their associations with cardiopulmonary diseases can still be found. The toxicological mechanism can be explained by laboratory-based studies. Updated safe guidelines on environmental and human exposure of Ni and V are necessary in order to clarify the associations between them and cardiopulmonary diseases and provide environmental intervention policies.     

Chronic Pharmacological and Safety Evaluation of Hematide™, a PEGylated Peptidic Erythropoiesis‐Stimulating Agent,in Rodents

Abstract: Hematide? is a synthetic peptide‐based, PEGylated erythropoiesis‐stimulating agent, which is being developed for the chronic treatment of anaemia associated with chronic renal failure. To support the safety of long‐term dosing of chronic renal failure patients, a comprehensive toxicology programme was implemented including rat subchronic and chronic studies. Rats were administered 0, 0.1, 1 and 10 mg/kg of Hematide every 3 weeks for 3 months via subcutaneous injection or for 6 months via intravenous injection. The dosing period was followed by a 6‐week follow‐up period. The primary pharmacology of Hematide resulted in erythroid polycythemia as measured by elevated haemoglobin levels that were time‐ and dose‐dependent. The pharmacology profiles were similar regardless of administration route. For example, for male rats at Day 90, subcutaneous dosing resulted in haemoglobin increases of 2.7, 4.5 and 6.9 g/dl for 0.1, 1 and 10 mg Hematide/kg respectively, compared to 2.8, 5.7 and 7.4 g/dl increases for intravenous dosing. Histopathological changes were related to the prolonged severe polycythemia induced in normocythemic animals administered an erythropoiesis‐stimulating agent. The findings included extramedullary haematopoiesis in the spleen and liver, bone marrow hypercellularity and organ congestion. Microscopic findings were reversible, demonstrating a return towards control findings within 6 weeks following cessation of dosing. Systemic exposures, based on both area under the curve (AUC) and maximum concentration (C_max), were substantially greater for intravenous than subcutaneous administration. No Hematide‐specific antibodies were detected. In conclusion, Hematide is a potent erythropoiesis‐stimulating agent, and the studies provide support for the safety of clinical development, including chronic dosing, for the treatment of anaemia associated with chronic renal failure.