Prognostic relevance of postirradiation lymphocyte reactivity in breast cancer patients

The prognostic relevance of phytohemagglutinin (PHA) and purified protein derivative (PPD) lymphocyte reactivity at diagnosis and after radiotherapy was evaluated in breast cancer patients. The patients were followed up to 13 years and the prognostic value expressed as ratios between observed number of deaths and "estimated" number of deaths under the null hypothesis. There was no significant association between the initial PHA and PPD reactivity and the survival of the patients. On the other hand, mortality up to 8 years after radiotherapy was significantly higher for patients with low PHA and PPD reactivity at completion of treatment. Furthermore, patients who had higher than average PPD reactivity 6 to 10 months after radiotherapy, seemed to have a higher survival rate. The prognostic relevance of postirradiation lymphocyte reactivity was only to some extent explained by clinical stage.     

Pilot study of zatosetron (LY277359) maleate, a 5-hydroxytryptamine-3 antagonist, in the treatment of anxiety

The aim of this study was to make a preliminary investigation of the efficacy and safety of zatosetron maleate, a selective 5-hydroxytryptamine-3 receptor antagonist for patients with a broad range of anxiety symptoms. A double-blind, parallel, placebo-controlled pilot study was conducted in 43 patients, aged 18 to 65 years, scoring >17 on the Hamilton Rating Scale for Anxiety (HAM-A). Patients were randomly assigned to either a fixed oral dose of 0.2, 1, or 5 mg of zatosetron or placebo for 4 weeks, followed by a 2-week placebo phase. Enhanced blinding procedures reduced the influence of side effects on efficacy ratings and obscured phases of the research design to patient and clinician. A change in HAM-A scores from baseline to endpoint was the principal efficacy measure; HAM-A Psychic and Somatic subscales, the Symptom Checklist-90, Montgomery-Asberg Depression Rating Scale, and Clinical Global Impressions Scale subscales provided secondary change indices. Adverse events (AEs) (spontaneously mentioned and elicited with the Udvalg for Kliniske Unders?gelser side effect rating scale), vital signs, electrocardiographic findings, and laboratory analytes were compared among treatment groups. Eighty-eight percent of the patients met the criteria for generalized anxiety disorder. No statistically significant differences in outcome measures differentiated among the four treatment groups. However, a pattern of greater change in the HAM-A scores seemed to favor zatosetron over placebo. Placebo was associated with only modest HAM-A score changes and a 30% response rate. The greatest numeric decrease in the HAM-A score and the highest response rate (45%) occurred in the groups receiving 0.2 and 1 mg of zatosetron. The secondary measures of efficacy demonstrated similar outcomes. There were no deaths or serious AEs reported in this study. This pilot study demonstrated that zatosetron at doses of 0.2 to 5 mg/day was safe. Although statistical significance was not achieved, the results show a greater numeric trend toward reducing anxiety with zatosetron than with placebo.     

Response of human lymphocytes to mitogenic stimuli after irradiation in vitro.

Human lymphocytes were exposed to varying doses of roentgen irradiation in vitro and thereafter tested for reactivity to different polyclonal mitogens and antigens using DNA synthesis as a marker for viability. The dose response profiles obtained indicate that there are two subpopulations of lymphocytes which are responsive to phytohaemagglutinin, poke weed mitogen, concanavalin A and allogeneic cells. One is relatively sensitive to radiation and the other is relatively resistant. However, no "resistant" PPD-tuberculin responsive cell population could be detected. Irradiated lymphocyte populations enriched for T-cells exhibited both a sensitive and a resistant PHA-responsive population, whereas cell populations enriched for B-cells only exhibited a radiation sensitive one.     

Live/Real Time Three‐Dimensional Transesophageal Echocardiographic Assessment of Ventricular Septal Volume and Mass before and after Myectomy in Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is the most common genetically transmitted cardiomyopathy. In patients resistant to medical management, myectomy is the surgical procedure of choice to reduce the symptoms of left ventricular outflow obstruction. Two‐dimensional transesophageal echocardiography (2DTEE) has become part of the operative procedure by decreasing the incidence of postoperative complications. However, because of the three‐dimensional geometry of left ventricular outflow tract, it is unable to comprehensively assess the location and severity of the obstruction and to provide accurate guidance during myectomy. In this study, 10 patients with HCM underwent live/real time three‐dimensional transesophageal echocardiography (3DTEE) intra‐operatively to measure the volume of the resected septum. This volume correlated well with the volume of the resected septal muscle directly obtained using a graduating cylinder containing water (r = 0.9, P < 0.000). 3DTEE may be potentially used as an adjunct to guide the surgeon in performing an adequate myectomy with a lower incidence of residual obstruction and complications such as an iatrogenic ventricular septal defect.     

Orofacial esthetics and dental anxiety: Associations with oral and psychological health

Objective. Severe dental anxiety (DA) is associated with both oral health and psychosocial consequences in what has been described as a vicious circle of DA. The aim of this study was to investigate self-rated orofacial esthetics in patients with DA and its relationship to psychological and oral health. Materials and methods. A consecutive sample of 152 adult patients who were referred or self-referred to a specialized dental anxiety clinic filled out the Orofacial Esthetic Scale (OES) as well as measurements on DA, self-rated oral health and general anxiety and depression. Clinical measures of dental status were also obtained. Results. Compared with the general population, patients with DA had lower ratings of satisfaction on all aspects of their orofacial esthetics, which included the teeth, gingiva, mouth and face, as well as a global orofacial assessment. Furthermore, the perception of the orofacial appearance was related both to dental status and self-rated oral health, as well as to general anxiety and depression. The level of dissatisfaction with the orofacial appearance was similar for both genders, but women reported more regular dental care and better dental status. Conclusions. The results of this study clearly show less satisfaction with dental and facial appearance in patients with DA, and that the self-rating of orofacial esthetics is related to both oral and psychological health. The OES can be used to assess orofacial esthetics in patients with DA.     

Voluntary versus reflex regulation of maximal exercise flow: volume loops

We determined the efficiency with which maximal exercise ventilatory output could be mimicked voluntarily. Five normal subjects exercised to maximal volitional effort and flow:volume and pressure:volume loops, and end-expiratory lung volume (EELV) and breathing pattern were measured. All subjects increased expiratory flow rate and reduced EELV sufficiently so that the forced vital capacity loop was approximated during at least some portion of expiration, but the generation of pleural pressure remained effective, i.e., equal to or only slightly in excess of that required to produce maximal expiratory flow (Pmax). Subsequently, while at rest, subjects used visual feedback and were able to closely mimic the flow:volume, EELV, and breath-timing achieved in maximal exercise; however: (1) expiratory pressures were excessive and usually exceeded average Pmax; (2) abdominal expiratory muscle activity was increased, as indicated by positive shifts in expiratory gastric pressure; and (3) total ventilatory work was increased 15 to 40% greater than that achieved in maximal exercise. Maximal voluntary efforts (MVV) caused EELV to increase and ventilatory work was increased 20 to 300% greater than during maximal exercise. We conclude that accurate determination of maximal effective ventilatory output available for maximal exercise or precise quantitation of the metabolic cost of producing maximal exercise ventilation requires replication of the pressure:volume, breath-timing, and EELV characteristics achieved in maximal exercise.