Reduction of fear-related dental management problems with use of filmed modeling.

In this study of the modification of anxiety-related disruptive behavior in dental treatment, matched groups of inner-city children attending a pedodontic clinic were shown a videotaped demonstration of a 4-year-old black child undergoing a dental restorative procedure or were given an unrelated drawing task before dental treatment. Children who viewed the videotape demonstration of a peer model coping with dental procedures showed significantly fewer fear-related disruptive behaviors during restoration of lesions. Observations of children's anxiety levels made by dentists and independent observers validated the effectiveness of viewing the videotaped demonstration. No significant correlation was found between the children's reports of their anxiety and their behavior during dental treatment.     

Repetitive milrinone therapy in ambulatory advanced heart failure patients

BackgroundAdvanced heart failure (HF) patients usually poorly tolerate guideline‐directed HF medical therapy (GDMT) and suffer high rates of morbidity and mortality. The use of continuous inotropes in the outpatient settings is hampered by previous data showing excess morbidity. We aimed to assess the safety and efficacy of repetitive, intermittent, short‐term intravenous milrinone therapy in advanced HF patients with an intention to introduce and up‐titrate GDMT and improve functional class.HypothesisRepetitive, intermittent milrinone therapy may assist with the stabilization of advanced HF patients.MethodsAdvanced HF patients treated with beta‐blockers and implanted with defibrillators were initiated with repetitive, intermittent short‐term intravenous milrinone therapy at our HF outpatient unit. Patients were prospectively followed with defibrillator interrogation, functional class assessment, B‐natriuretic peptide (BNP) levels, and echocardiography parameters.ResultsThe cohort included 24 patients with a mean 330 ± 240 days of milrinone therapy exposure. Mean age was 73 ± 6 years with male predominance (96%). Following milrinone therapy, median BNP levels decreased significantly (882 [286−3768] to 631 [278−1378] pg/ml, p = .017) with a significant reduction in the number of patients with New York Heart Association (NYHA) Class III and IV (p = .012, 0.013) and an increase in number of patients on GDMT. Importantly, the number of total sustained ventricular tachycardia events and HF hospitalizations did not change.ConclusionsIn this small cohort of advanced HF, repetitive, intermittent, short‐term milrinone therapy was found to be safe and potentially efficacious.     

Subareolar and peritumoral injection identify similar sentinel nodes for breast cancer

Background Sentinel lymph node (SLN) mapping with radioisotope and blue dye is rapidly becoming the standard of care for breast cancer. The optimal location for injection of radioisotope and blue dye is still being investigated. The goal of this study was to determine whether blue dye injection into the subareolar (SA) location localized the same sentinel nodes as the peritumoral (PT) location for patients with breast cancer. Methods Three hundred thirty-two patients with biopsy-proven operable breast cancer or ductal carcinoma in situ at two institutions underwent SLN mapping. Eighty-three patients had PT injection of blue dye (group 1), and 249 patients had SA injection of blue dye (group 2). All patients underwent PT injection of^99mTc-labeled sulfur colloid. Results The two groups were similar in age, previous biopsy type, and tumor size, location, and histology. The mean number of SLNs identified was 2.4 (range, 0–9) in group 1 and 2.5 (range, 0–11) in group 2. The SLN identification rate was 95% for group 1 and 97% for group 2. The isotope success rate was 94% for both groups. The blue dye success rate was 84% for group 1 and 90% for group 2. The isotope/blue dye concordance rate was 87% for group 1 and 90% for group 2. At a median follow-up of 28 months (range, 14 to 40), there were no axillary recurrences in any of the 332 patients. Conclusions These data suggest that delivery of mapping reagents in the SA and PT locations identifies similar lymph nodes. Because of simplicity and the similarity in node identification between SA and PT injection, further investigation of the SA site for delivery of SLN mapping reagents for breast cancer is warranted. Presented at the 54th Annual Cancer Symposium, Society of Surgical Oncology. Washington, DC, March 15–18, 2001.     

Ethical Considerations in Air Pollution Research

The acceleration of tumor production in mice by repeated application of polycyclic aromatic hydrocarbon carcinogens of high and low potency in the presence of cocarcinogenic compounds is described. Experiments exploring the concentration levels of carcinogen and cocarcinogen necessary to produce tumors demonstrate that there is a 1,000-fold increase in the enhancement of potency of low concentrations of benzo[a]pyrene and benz[a]anthracene when n-dodecane is the diluent. The effect of cocarcinogens is most obvious during exposure to low concentrations of carcinogen. The implications of this observation in the environment is discussed.     

Book Received

There exist numerous difficulties in the recruitment of patients to drug trials for Alzheimer's disease. This article describes a successful community-based case-finding strategy. The success is largely attributed to effective liaison between the co-ordinating psychiatrist, GPs, community psychiatric nurses and practice nurses.     

Klatskin tumors of the bile ducts: sonographic appearance

The authors present 3 cases of surgically proved Klatskin tumor diagnosed by ultrasound alone. Sonographic features of these tumors include (a) dilatation of the intrahepatic biliary ducts but not the extrahepatic duct, (b) non-union of the right and left hepatic ducts, and (c) small, solid masses at the hepatic hilus. Local spread to the liver may also be seen. If the pancreas appears normal and no primary tumor can be found, Klatskin tumor can be diagnosed with a high degree of accuracy.     

Posterior spinal cord block: a dosimetric study

To determine the optimal width of a midline posterior spinal block (MPSB) (to avoid delivering too great a dose to the cord and too small a dose to adjacent tissue), the authors determined with magnetic resonance (MR) imaging normal ranges of cord depth and width and correlated them with film dosimetric data. In 59 randomly selected patients there was a wide range for both depth and width. The average depths of the anterior and posterior surfaces of the cord were 6.7 cm +/- 1.4 and 5.4 cm +/- 1.3, respectively. The average cord width was 1.6 cm +/- 0.4. Optimal cord block width as a function of cord width was determined for a 6-MV photon beam. The optimal cord block width at the surface (half-value layer [HVL] thickness = 6) varied from 1.5 to 3.0 cm for cord widths of 0.8-2.4 cm, which correspond to two standard deviations from the average. There was no significant dependence on depth of the cord. For optimal treatment outcome, the MPSB width may have to be determined for each patient individually.     

Bone marrow transplantation for constitutional pure red cell aplasia

Constitutional pure red cell aplasia (CPRCA) is a syndrome of failed erythropoiesis usually diagnosed within the first year of life. Four patients with CPRCA received transplants with marrow from their HLA- identical, mixed lymphocyte culture-nonreactive siblings. All patients were resistant to corticosteroid therapy and were dependent on regular red cell transfusions for at least 5 years. Three patients were conditioned with procarbazine, antithymocyte globulin, cyclophosphamide, and busulfan, and one was conditioned with antithymocyte serum, cyclophosphamide, and busulfan. Three patients promptly had successful engraftments with establishment of donor hematopoiesis. One patient initially rejected his graft but received a successful retransplant. All patients are currently alive with Karnofsky performance scores of 100 and normal erythropoiesis of donor origin. Despite a history of multiple transfusions, bone marrow transplantation is a potentially curative therapy for patients with CPRCA.     

Acceptance of HIV Testing by Substance-Abusing Individuals

Routine HIV (human immunodeficiency virus) testing of high-risk groups (i.e., substance-abusing individuals) could help decrease the spread of AIDS (acquired immune deficiency syndrome). Such a policy, however, could deter individuals from entering treatment, paradoxically increasing the likelihood of the disease being spread. The authors examined the willingness of substance-abusing individuals to consent to HIV testing by randomly assigning patients entering either a drug-free outpatient program or a methadone maintenance program to one of three informed consent conditions differing in degree of perceived coerciveness. Overall, 69% of the patients agreed to testing. As hypothesized, the proportion of agreement was highest under the most coercive informed consent condition. Although the results tend to support continuation of voluntary testing programs, only 5.5% of patients asked indicated that mandatory testing would have deterred them from entering treatment.