Post-treatment sarcoma in breast cancer patients

Background: Many patients treated for breast cancer with radiotherapy will survive their disease and be at risk for treatment-related sarcoma for many years. Methods: In order to identify patients with post-treatment sarcoma and define this disease, we examined the records of 99 patients treated for sarcoma with a history of antecedent breast carcinoma. Of these patients, 51 were felt to have a sarcoma unrelated to breast cancer treatment and 48 were felt to have a treatment-related sarcoma (secondary to lymphedema and/or radiation). Results: Lymphangiosarcoma of the extremity was the most common histologic subtype of post-treatment sarcoma, accounting for 22 of 48 cases (46%). Twenty-six patients (54%) developed nonlymphangiosarcoma post-treatment sarcoma; all of these were radiation-associated sarcomas. The median latency interval between the diagnosis of breast cancer and the development of sarcoma was 11 years (range 4–44) and was not different between the two groups. However, patients with nonlymphangiosarcoma were significantly younger when diagnosed with breast cancer than were those with lymphangiosarcoma of the extremity (median 43 vs. 51 years, p<0.001). The survival of all 48 patients was poor: 5-year survival was 29%. Five-year survival of patients with other types of post-treatment sarcoma was just as poor as those with lymphangiosarcoma of the extremity (30% vs. 28%, p=0.98). Conclusions: Patients who develop sarcoma after treatment for breast cancer have a poor prognosis whether it occurs as Stewart-Treves syndrome or other types of post-treatment sarcoma. Younger patients may be at higher risk than are older patients for the development of nonlymphangiosarcoma post-treatment sarcoma.Presented at the 46th Annual Cancer Symposium of the Society of Surgical Oncology, Los Angeles, March 18–21, 1993.     

Adolescent obesity: guidelines for the management.]

The increasing prevalence of adolescent obesity justifies widespread effort and attention of the paediatrician. In order to manage, following points are to be documented: (I) weight status assessed on the basis of body mass index (BMI)split in two levels: obesity grade I: >or=97 ème centile, obesity grade 2: level IOTFC 30; (2) complete anamnesis including age at adiposity rebound and existence of overweight in family; (3) research of associated morbidity and medical risks;(4) assessment of food intake and feeding practice; (5) assessment of physical activity; (6) talk with the adolescent to assess the psychological status, looking after depressive symptoms, anxiety, loss of self esteem. Once the items are documented, it allowed making a plan to manage the obesity in alliance with the adolescent and his family.     

Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Process, format, and clinimetric testing plan.

This article presents the revision process, major innovations, and clinimetric testing program for the Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson's Disease Rating Scale (UPDRS), known as the MDS-UPDRS. The UPDRS is the most widely used scale for the clinical study of Parkinson's disease (PD). The MDS previously organized a critique of the UPDRS, which cited many strengths, but recommended revision of the scale to accommodate new advances and to resolve problematic areas. An MDS-UPDRS committee prepared the revision using the recommendations of the published critique of the scale. Subcommittees developed new material that was reviewed by the entire committee. A 1-day face-to-face committee meeting was organized to resolve areas of debate and to arrive at a working draft ready for clinimetric testing. The MDS-UPDRS retains the UPDRS structure of four parts with a total summed score, but the parts have been modified to provide a section that integrates nonmotor elements of PD: I, Nonmotor Experiences of Daily Living; II, Motor Experiences of Daily Living; III, Motor Examination; and IV, Motor Complications. All items have five response options with uniform anchors of 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. Several questions in Part I and all of Part II are written as a patient/caregiver questionnaire, so that the total rater time should remain approximately 30 minutes. Detailed instructions for testing and data acquisition accompany the MDS-UPDRS in order to increase uniform usage. Multiple language editions are planned. A three-part clinimetric program will provide testing of reliability, validity, and responsiveness to interventions. Although the MDS-UPDRS will not be published until it has successfully passed clinimetric testing, explanation of the process, key changes, and clinimetric programs allow clinicians and researchers to understand and participate in the revision process.     

Nutrition and Health Communication: The Message and the Media Over Half a Century

The diet-health message for the 1990s has become complex, changing from the simple directives of previous decades as scientific evidence has evolved. If today's consumers are more knowledgeable, they are also more confused. The confusion stems not only from the complexity of the message, but also from the fact that the various groups and organizations developing it respond to the challenge from their own perspectives. Added to this are the constraints of the various media (print, radio, and television) that deliver the message. For consumers, the result has been not only confusion but, at times, outright rejection of resonable recommendations. The more that health professionals in academia, government, and voluntary organizations, food producers, and health reporters can agree on a set of clear, consistent, focused, and positive messages based on current scientific knowledge, the sooner recommendations for a healthful diet will be accepted and followed.     

Mood Matters: Negative Mood Induction Activates Dysfunctional Attitudes in Women Vulnerable to Depression

Cognitive theory holds that dysfunctionalattitudes are important risk factors for depression.Critics have questioned this view, noting that, althoughdysfunctional attitudes are elevated in depression, they are not evident in vulnerable individualswho are asymptomatic. To deal with this criticism,Miranda and Persons (1988) have advanced the mood-statedependent hypothesis, which suggests that cognitive vulnerability factors are indeed present invulnerable individuals, but remain dormant untilactivated by negative mood. To test this hypothesis, 33women with and 67 women without histories of depression reported dysfunctional attitudes before andafter a film negative mood induction. As predicted,vulnerable subjects who reported increased negative moodreported increased dysfunctional attitudes.Unexpectedly, nonvulnerable subjects who reported increasednegative mood reported decreased dysfunctionalattitudes. These findings support the mood-statedependent hypothesis, and suggest that a deficit in theability to regulate negative emotions may be animportant feature of vulnerability todepression.     

Angiotensin-converting enzyme (ACE) gene polymorphism in type II diabetic patients with increased albumin excretion rate

Approximately one in three patients with diabetes is at risk of developing kidney disease, despite current methods of treatment. It has long been suspected that diabetic kidney disease has a genetic basis, but this has been difficult to prove. Polymorphisms of the angiotensin-converting enzyme (ACE) gene have been shown to be related to the occurrence of nephropathy in type I diabetic patients. This study showed that there was no association in the ACE genotype frequency and increased albumin excretion rate in type II diabetic patients.