Comment on ‘Predicting recurrence in axillary node negative breast cancer patients’, by Rosner and Lane

on behalf of the Nottingham Breast Unit     

Prevalence of behaviour disorders in low birthweight infants

OBJECTIVE--To determine the prevalence of behaviour disorders in low birthweight infants. DESIGN--Children of birth weight < or = 2000 g born to mothers resident in Merseyside in 1980-1 assessed using the Rutter parent and teacher behaviour questionnaires and the Conner modification of the Rutter teacher questionnaire. Children attending normal schools were assessed with controls matched for age, sex, and class in school. Children attending special schools were assessed unmatched. SUBJECTS--233 matched case-control pairs attending normal primary schools and 46 unmatched children attending special schools. SETTING--Primary and special schools. MAIN OUTCOME MEASURES--Emotional, conduct, and undifferentiated behaviour disorders and hyperactivity. RESULTS--On the parental questionnaire screen, 36% of the cases and 22% of the controls had a behaviour disorder and on the teacher questionnaire the proportions were 27% and 12% respectively. Hyperactivity was significantly more common among male cases than their controls (21% v 5.0%) but differed little among female cases and controls (9% v 7%). CONCLUSIONS--Improving neonatal survival of low birthweight infants is accompanied by a higher prevalence of behaviour disorders. The long term implications for psychiatric morbidity and other adult disease must be monitored.     

Pharmacokinetics of Pyrazinamide under Fasting Conditions,with Food,and with Antacids

Study Objectives . To determine intrasubject and intersubject variability in, and the effects of food and antacids on, the pharmacokinetics of pyrazinamide (PZA). Design . Randomized, four-period, crossover phase I study. Subjects . Fourteen healthy men and women volunteers. Interventions . Subjects ingested single doses of PZA 30 mg/kg under fasting conditions twice, without a high-fat meal and with an aluminum-magnesium antacid. They also received standard dosages of isoniazid, rifampin, and ethambutol. Measurements and Main Results . Serum was collected for 48 hours and assayed by gas chromatography with mass selective detector. Data were analyzed by noncompartmental methods and a compartmental analysis using nonparametric expectation maximization. Both fasting conditions produced similar results: mean PZA C_max 53.4 ± 10.4 μg/ml, T_max 1.43 ± 1.06 hours, and AUC_0-∞, 673 ± 79.7 μg·hr/ml. Fasting results are similar to those in previous reports. In the presence of antacids, subjects had a mean C_max of 55.6 ± 9.0 μg/ml, T_max of 1.43 ± 1.23 hours, and AUC_0-∞ of 628 ± 88.4 μg·hr/ml. In the presence of the high-fat meal, mean C_max was 45.6 ± 9.44 μg/ml, T_max 3.09 ± 1.74 hours, and AUC_0-∞ 687 ± 116 μg·hr/ml. Conclusions . These small changes in C_max. T_max, and AUC_0-∞. can be avoided by giving PZA on an empty stomach whenever possible. Conclusion : Serum concentrations in this study were consistent with those described previously. In addition, PZA's kinetic behavior was consistent between fasting treatments. Antacids and food had minimal effects on the agent's absorption. Samples drawn between 0.5 and 3 hours after dosing approached C_max for most subjects, with 1 hour being closest. Samples drawn as early as day 2 of daily PZA therapy will produce serum concentrations that approach steady-state values.     

BENIGN GASTROCOLIC FISTULA ASSOCIATED WITH PERITONITIS

SUMMARY Gastrocolic fistula is most often related to malignancy or previous gastric surgery. It is an uncommon complication of benign gastric ulceration in patients who have not had a previous operation. Benign gastrocolic fistula associated with peritonitis is extremely rare — this case is only the fourth ever reported. The patient presented with an acute abdomen, and subsequent investigations demonstrated a gastrocolic fistula of benign aetiology.