Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy

Background Our aim was to identify predictors of locoregional recurrence (LRR) in patients with early-stage breast cancer treated with breast-conserving therapy (BCT) and long-term follow-up. Methods From 1970 to 1994, 1153 patients with stage I to II breast cancer underwent BCT and radiotherapy at our institution. Patients with prior breast cancer or other primary malignancies were excluded. Clinical and pathologic characteristics evaluated were age, race, tumor size, stage, pathologic tumor margins, axillary nodal involvement, estrogen and progesterone receptor status, Black's nuclear grade, type of surgery, and use of adjuvant therapy. Results Of 1083 patients, 54% presented with stage I disease and 46% with stage II disease. Median age was 50 years, and median follow-up was 9 years. Axillary nodes were positive in 31% of the patients who underwent axillary dissection. LRR developed in 6%, LRR followed by systemic recurrence in 5%, and systemic recurrence alone in 13%, 76% had no evidence of recurrence at last follow-up. Age, tumor size, positive lymph nodes, and not receiving chemotherapy or hormonal therapy were independent predictors of LRR. Disease-specific survival among patients with LRR was similar to that among patients with no recurrence. Conclusions Multidisciplinary treatment strategies should be used to accomplish durable locoregional control after BCT. Presented at the 54th Annual Cancer Symposium of the Society of Surgical Oncology, Washington, DC, March 15–18, 2001.     

Hemodynamic parameters during normal and hypertensive pregnancy in rats: evaluation of renal salt and water transporters.

OBJECTIVE: To determine whether alterations in extracellular volume expansion observed during normal and hypertensive pregnancy run in parallel to changes in the mRNA expression of renal transporters. METHODS: Wistar rats were divided into four groups: control (C, n = 5); pregnancy (P, n = 5); N(omega)-nitro-l-arginine methyl ester (L-NAME; 50 mg/kg/d)-treated control (H, n = 6); and pregnant rats (HP, n = 6). Hemodynamic studies were performed on day 14 of pregnancy, at which time we also analyzed of the sodium transporters (NHE3, Na/K/2Cl and Na/Cl), potassium channel (ROMK2) and water channel (AQP2). RESULTS: As expected, P rats presented high cardiac output (CO) and normal blood pressure (BP), whereas H rats presented lower CO and elevated BP. A significant (threefold) increase in total vascular resistance and a decrease in stroke volume were observed in the HP group. Hypertension resulting from nitric oxide (NO) synthesis inhibition blunted systemic hemodynamic adaptations during pregnancy. Compared with C rats, mRNA expression of ROMK2 in P rats was lower, whereas that of AQP2 was higher. Expression of AQP2 was significantly higher in H than in C or HP groups. Expression of BSC and NHE3 was lower in the HP than in the P group. The NO inhibition also provoked renal transporter alterations in HP. CONCLUSIONS: Our results suggest that tubule transporter variants may mediate the hemodynamic adaptations seen during pregnancy, although we cannot rule out the hypothesis that other factors are also mediating hemodynamic changes.     

Characterization of NADPH-cytochrome P-450 reductase in a mouse hepatoma cell line

NADPH-cytochrome c reductase in Hepa-1 cells was induced 2-fold by phenobarbital, but was not induced by benz[a]anthracene or 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The apparent K_m of the enzyme for NADPH was 0.57 μM; the activity was inhibitable by NADP; and segregated primarily to the microsomal fraction. Cytoplasm of Hepa-1 cells bound antibody to rabbit cytochrome P-450 reductase. 3T3 cells, which possessed one sixth of the cytochrome c reductase activity of Hepa-1 cells, bound correspondingly less cytochrome P-450 reductase antibody. This supports the notion that cytochrome P-450 reductase was responsible for the cytochrome c reductase activity that was measured.     

Safety, Complications, and Satisfaction of Patients Undergoing Submuscular Breast Augmentation via the Inframammary and Endoscopic Transaxillary Approach

Background Since its introduction, augmentation mammaplasty has gained widespread popularity, as demonstrated by the fact that an estimated 2 million women in the United States have received implants. During recent decades, several surgical approaches have evolved in terms of implant placement or site of access to the surgical plane. Debate has existed concerning the questionable superiority of a particular technique for achievement of optimal results. Thus, the inframammary approach, an established and widely accepted technique for breast augmentation, and endoscopically assisted transaxillary breast augmentation were retrospectively compared in terms of safety and aesthetic outcome, as measured, respectively, by the rate of postoperative complications and patient satisfaction. Methods This study analyzed 78 patients undergoing augmentation mammaplasty between 1997 and 2004. Only patients seeking primary augmentation mammaplasty solely for aesthetic reasons were included in the study. Previously performed breast surgery and simultaneously conducted ipsilateral mastopexy were among the exclusion criteria. Patient satisfaction was assessed using the client satisfaction questionnaire (CSQ-8) because of its easy applicability. Results The complication rate was low in both patient subsets, thus confirming the safety of the transaxillary approach, as compared with the more common submammary technique. However, a higher level of satisfaction was detected in the former patient group, indicating a more favorable aesthetic outcome with the transaxillary augmentation mammaplasty. Conclusion Endoscopically assisted transaxillary augmentation mammaplasty is a safe method with predictable results associated with a high level of patient satisfaction. If applied in the setting of appropriate indications, it is an excellent tool for use with patients who prefer to have an incision at a distant site.     

What is the Role of Magnetic Resonance Imaging in the Evaluation of Total Hip Arthroplasty?

MRI has been shown to be an extremely effective instrument in the management of painful hip arthroplasty. Its superior soft tissue contrast and direct multiplanar acquisition compared to computerized tomography (CT) and radiographs allows for reproducible visualization of periacetabular osteolysis, demonstrating compression of neurovascular bundles by extracapsular synovial deposits. In addition, MRI can often elucidate etiology of neuropathy in the perioperative period and is further helpful in evaluating the soft tissue envelope, including the attachment of the hip abductors, short external rotators and iliopsoas tendon. A further advantage of MRI over CT is its lack of ionizing radiation. Most importantly, MRI can disclose intracapsular synovial deposits that precede osteoclastic resorption of bone.     

Pediatric fractures of the humerus

Humeral shaft fractures constitute only 3% of fractures in children younger than age 16 years. They are most common in children younger than 3 and older than 12 years old. They can be classified according to the fracture pattern, location, and tissues damaged. Fractures resulting from minor trauma may be caused by an occult unicameral bone cyst. Each age group requires different diagnosis, treatment, and prognosis. Fractures at birth are seen mostly with macrosomic and breech presentation. In children younger than 3 years, humeral fractures often are linked to child abuse. In those older than 10 years, fractures are related to direct or indirect trauma. Sports activities have been reported also to cause injuries in skeletally immature patients. Most humeral fractures are controlled nonoperatively; however, potential operative indications include open fractures, multiple trauma, bilateral injuries, compartment syndromes, pathological fracture, significant nerve injuries, and inadequate closed reduction.     

Conjunctival Biopsy as an Aid in the Evaluation of the Patient with Suspected Sarcoidosis

Conjunctival biopsy is an underused but simple technique in the evaluation of the patient with sarcoidosis and occasionally other systemic diseases. In 55% of patients with biopsy-proven sarcoidosis from other sites, a blind conjunctival biopsy was positive. Bilateral conjunctival biopsies and the examination of multiple sections of each biopsy were essential to obtain this high of a yield. There was no relationship between an anterior uveitis and a positive conjunctival biopsy.