Randomized controlled trial comparing magnetic marker localization (MaMaLoc) with wire-guided localization in the treatment of early-stage breast cancer

Wire-guided localization (WGL) is the standard of care in the surgical treatment of nonpalpable breast tumors. In this study, we compare the use of a new magnetic marker localization (MaMaLoc) technique to WGL in the treatment of early-stage breast cancer patients. Open-label, single-center, randomized controlled trial comparing MaMaLoc (intervention) to WGL (control) in women with early-stage breast cancer. Primary outcome was surgical usability measured using the System Usability Scale (SUS, 0–100 score). Secondary outcomes were patient reported, clinical, and pathological outcomes such as retrieval rate, operative time, resected specimen weight, margin status, and reoperation rate. Thirty-two patients were analyzed in the MaMaLoc group and 35 in the WGL group. Patient and tumor characteristics were comparable between groups. No in situ complications occurred. Retrieval rate was 100% in both groups. Surgical usability was higher for MaMaLoc: 70.2 ± 8.9 vs. 58.1 ± 9.1, p < 0.001. Patients reported higher overall satisfaction with MaMaLoc (median score 5/5) versus WGL (score 4/5), p < 0.001. The use of magnetic marker localization (MaMaLoc) for early-stage breast cancer is effective and has higher surgical usability than standard WGL.     

Vertebral level of the ending of the spinal cord and its relationship to the length of the vertebral column in Northern Turkish neonates

Summary Racial and sex differences in the level of ending of the spinal cord of the adult have been reported. It is lower in Africans and in females. Since such differences may affect even fetuses and newborns we aimed to study in Northern Turkish neonates. The study was made on 40 full-term newborn still-births (23 male, 17 female). In all cases, the length of the vertebral column, the length of the spinal cord and the body weight were measured and the vertebral level of ending of the spinal cord was noted. It was found that the termination of the spinal cord varied from the first lumbar to the second sacral vertebra, with a mean level between L2 and L3. In female neonates, it was observed that the spinal cord ended at a slightly lower level (0.2 vertebra) than in males. Our findings approximately agreed with those of Barson [2] who studied neonates in England and of Jit and Charnalia [5] in North India. However, we found that the spinal cord ended one and half vertebrae lower in Northern Turkish neonates than in South African and South Indian subjects. The correlations between body-weight and length of the spinal cord, weight and length of the vertebral column, length of the spinal cord and length of vertebral column, length of the vertebral column and level of ending of the cord were statistically highly significant for males, females and both sexes together (p<0.001). The longer the vertebral column, the higher the termination of the spinal cord.

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Niveau vertébral de la terminaison de la moelle épinière et sa relation avec la longueur de la colonne vertébrale chez le nouveau-né en Turquie du Nord

Résumé Selon la race et le sexe, les différences de niveau de la terminaison de la moelle épinière ont été rapportées chez l'adulte. Elle est plus basse chez les Africains et chez les femmes. Dès lors il se peut qu'il existe déjà des différences raciales et selon le sexe, chez le foetus et le nouveau-né. Nous nous proposons d'étudier une population de nouveau-nés du Nord de la Turquie. Cette étude est faite à partir de 40 nouveau-nés à terme, décèdes (23 garçons et 17 filles). Chez tous ces nouveau-nés, la longueur de la colonne vertébrale, la longueur de la moelle épinière et le poids ont été mesurés. Le niveau vertébral de la terminaison de la moelle épinière variait entre la première vertèbre lombaire et la deuxième vertèbre sacrée. Le niveau moyen de cette terminaison était situé entre L2 et L3. Chez les filles nouveau-nés, il était observé que la moelle épinière se terminait légèrement plus bas (0,2 vertèbre) que chez les garçons nouveaunés. Nos observations rejoignent celles de Barson [2] qui étudia des nouveaunés d'Angleterre et celles de Jit et Charnalia [5] qui étudièrent des nouveau-nés du Nord de l'Inde. Cependant, nous avons trouvé que la moelle épinière se terminait une vertèbre et demie plus bas chez les nouveau-nés de la Turquie du Nord que chez les nouveau-nés d'Afrique du Sud et d'Inde du Sud. La corrélation entre le poids des spécimens et la longueur de la moelle épinière; le poids et la longueur de la colonne vertébrale, la longueur de la moelle épinière et la longueur de la colonne vertébrale, la longueur de la colonne vertébrale et le niveau vertébral de la terminaison de la moelle épinière parmi les garçons, les filles, et dans les deux sexes, étaient statistiquement très significatifs (p<0.001). Plus la colonne vertébrale était longue, plus haute était située la terminaison de la moelle épinière.

     

Academic education of dentists

The aims of an academic education are phrased on the basis of a report of the Rectors of Dutch Universities, published in 1993. These aims are explicited in more detail for academic dental education. In this respect notable educational forms used in the dental schools in the Netherlands and Flanders (Belgium) are mentioned. A minimum-curriculum for academic education in dentistry is formulated, including theoretical courses, application courses and methods of reinforcement in all parts of the entire dental curriculum.     

Phase II studies of Elsamitrucin in breast cancer, colorectal cancer, non-small cell lung cancer and ovarian cancer

PURPOSE:: To test the antitumor activity of Elsamitrucin in metastaticcancer of the breast, colon and rectum, non-small cell lungand ovary. PATIENTS AND METHODS:: Eligibility required histologically proven cancer. Patientswith colorectal or non-small cell lung cancer could not havereceived prior chemotherapy. Patients were entered if WHO PSwas 2 and organ functions were normal. Treatment consisted ofElsamitrucin 25 mg/m²/week given as a 5–10 min infusionfor at least 3–6 weekly doses. RESULTS:: One hundred and five patients entered the studies, 97 were eligible,94 are evaluable for toxicity and 75 for response. Toxicitymainly consisted of mild nausea/vomiting, and less frequentlyreversible hepatotoxicity and malaise. No objective responseswere seen. CONCLUSION:: Elsamitrucin at this dose and schedule is not an active drugin metastatic breast cancer, colorectal cancer, non-small celllung cancer or ovarian cancer. Elsamitrucin, phase II, breast, colorectum, nonsmall cell lung, ovary     

Clinical researchers and the pharmaceutical industry

The diminished financial support by the government of clinical investigation has led to clinical units that depend for their infrastructure largely on contract research for the pharmaceutical industry. This poses a threat to the independence of scientific research, to the freedom to publish scientific results and to the continuity of the research. Moreover, it is not easy for a researcher to retain a position of integrity and independence in the face of a jungle of conflicting interests and not to let personal interests prevail. The difficult relation between the physician and the pharmaceutical industry is the subject of a forthcoming short series of articles.     

Is leg length discrepancy associated with the side of radiating pain in patients with a lumbar herniated disc?

STUDY DESIGN: The association between leg length discrepancy and the side of the radiating pain in lumbar disc herniation was investigated in a case series. OBJECTIVES: To investigate whether pain tends to radiate into the longer or shorter leg in patients with a lumbar herniated disc. SUMMARY OF BACKGROUND DATA: No previous studies have investigated the association between leg length discrepancy and side of radiating pain in patients with a herniated disc. Results of studies of low back pain with radiation and leg length discrepancy are inconsistent concerning this association. METHODS: Of 132 consecutive patients admitted to a district hospital for surgical management of a lumbar herniated disc, leg length discrepancy was assessed using the indirect method as described by Calliet. RESULTS: Seventy-three patients (55%) were men, and 59 (45%) were women. The mean age was 40 years, and 99% of all herniated discs appeared at L4-L5 (n = 60) or L5-S1 (n = 71). In 64 (62%) of the 104 patients with a leg length discrepancy of 1 mm or more, the pain radiated in the shorter leg (P = 0.02). In subgroups of patients with larger leg length discrepancies, similar results were found but because of smaller sample sizes, these findings did not each statistical significance. In 32 of the 57 men (56.1%), the pain radiated to the shorter leg (P = 0.43); this was observed in 33 of the 47 women (70.2%; P = 0.01). CONCLUSION: The results of this study showed a statistically significant association between leg length discrepancy and the side of radiating pain in a case series of patients with lumbar herniated discs. The relation was more pronounced and statistically significant in women only.     

Desogestrel: using a selective progestogen in a combined oral contraceptive

Desogestrel is the most selective progestogen used in oral contraceptives (OCs). The clinical characteristics of the monophasic combined OC containing 150 g desogestrel and 30 g EE per tablet (Marvelon) are in accordance with the strong progestogenic and minimal androgenic effects of desogestrel: a very high contraceptive efficacy is combined with minimal and, in the case of lipid metabolism, even potentially positive effects on metabolic parameters.Through increasing the plasma levels of sex hormone binding globulin, and thereby decreasing the plasma levels of free testosterone, the desogestrel-containing OC also has substantial beneficial effects on acne.

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Resumen El desogestrel es la progesterona más selectiva empleada en los anticonceptivos orales. Las características clínicas de este anticonceptivo combinado monofásico que contiene 150 g de desogestrel y 30 g EE por comprimido (Marvelon) están de acuerdo con los efectos progestágenos potentes y andrógenos mínimos del desogestrel: su alta eficacia anticonceptiva se combina con efectos minimos sobre los parámetros metabólicos, y hasta potencialmente positivos en el caso del metabolismo de los lípidos.Al aumentar los niveles plasmáticos de la globulina que enlaza las hormonas sexuales, y disminuyendo así los niveles plasmáticos de la testosterona libre, los anticonceptivos orales que contienen desogestrel tienen un considerable efecto benéfico sobre el acné.

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Resumé Le désogestrel est la progestérone sélective la plus utilisée dans les contraceptifs oraux. Les caractéristiques cliniques de ce contraceptif combiné monophasique contenant 150 g de désogestrel et 30 g EE par comprimé (Marvelon) sont conformes aux effets progestatifs puissants et androgènes minimes du désogestrel: sa haute efficacité contraceptive se combine avec des effets sur les paramètres métaboliques qui sont minimes, et même potentiellement positifs dans le cas du métabolisme des lipides.En augmentant les niveaux plasmatiques de la globuline liant les hormones sexuelles, et en diminuant de ce fait les niveaux plasmatiques de la testostérone libre, les contraceptifs oraux contenant du désogestrel ont un effet bénéfique considérable sur l'acné.

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This paper is based on a presentation given at the Seventh International Meeting of the Society for the Advancement of Contraception, which was held in Singapore on 4–11 November, 1990.