Necessity of Axillary Dissection in Elderly Women with Early Breast Cancer

The need for axillary dissection forstaging and treating early breast cancer has been questioned recently.Can a patient forego axillary dissection, with its associated costs,risks, and morbidity, if it does not affect survival? The studyattempted to find a subset of patients with early breast cancer in whomdisease-free survival was independent of axillary lymph node status. Ifsurvival does not depend on lymph node status, axillary dissectioncould be omitted in the care of these patients. This study included 378women over age 70 with T1 breast cancer diagnosed and treated duringJanuary 1992 to December 1999 at both of our institutions: a largetertiary teaching hospital in Columbus, Ohio and a breast cancertreatment center in West Columbia, South Carolina. We compared thedisease-free survival, using the Kaplan-Meier estimate, in 334node-negative patients and 44 node-positive patients with T1 breastcancer. The 3- and 5-year survival rates of patients with T1N0 tumorswere 86% and 77%, respectively; and the 3- and 5-year survival ratesfor T1 node-positive tumors were 81% and 69%, respectively(p = 0.0673). There was no statistical difference between thenode-negative and node-positive groups. Axillary dissection in womenover 70 years of age with early breast cancer may be unnecessary, asthe presence of lymph node metastases does not appear to affectdisease-free survival rates significantly in this patient group.     

Poly-victimization,Trauma, and Resilience: Exploring Strengths That Promote Thriving After Adversity

ABSTRACT

Although it is well known that victimization is associated with higher trauma symptoms, there is still limited information on the protective factors that can help people thrive after adversity. Using the Resilience Portfolio Model as a framework, this study explores a range of psychological and social strengths in a community sample of youth from the southern U.S.

A sample of 440 youth aged 10 to 21 (average age 16.38, SD = 3.04) was recruited from youth-serving organizations. They completed a survey on trauma symptoms, victimization, other adversities, and 16 psychological and social strengths.

Almost 9 in 10 (89.3%) youth reported one or more victimizations, with peer victimizations most common. Adult-perpetrated offenses were reported by almost half of youth (47.1%). Although several psychological and social strengths were inversely correlated with trauma symptoms at the bivariate level, hierarchical regressions indicated that a sense of purpose was the only strength that uniquely contributed to more resilient mental health in a model with all strengths and controlling for victimization, other adversities, poverty, age, and gender (total R² = .33). The variance explained by strengths (17%) was similar to the variance explained by adversities (15%).

In this highly victimized sample of youth, many strengths were associated with lower trauma symptoms for youth, with a sense of purpose showing the most promise. Prevention and intervention programs may benefit from efforts to increase a sense of purpose or other meaning making activities, in addition to efforts that specifically target incidents of trauma.     

Season of birth and substance abuse: findings from a large national sample

BACKGROUND: Season of birth is a putative etiological factor for several psychiatric illnesses. An excess of late winter and early spring births has been demonstrated repeatedly for schizophrenia, which has usually been interpreted as the result of prenatal or infant exposure to seasonally mediated "harmful effects," such as infectious diseases. This study determined whether the seasonal birth rates of substance abusers differed from those of unaffected control groups. METHODS: The 1992 National Longitudinal Alcohol Epidemiologic Survey, an interview-based study of 42,862 men and women, provided data to assess the association between quarter year of birth and lifetime diagnoses of substance abuse. RESULTS: Logistic regression revealed decreases in winter births in men with histories of alcohol dependence. The significant interaction of sex with season of birth reflected an excess of fall births among male but not female alcoholics. In contrast, there was no evidence of seasonality of birth among alcohol abusers. Men and women with histories of illicit drug use had excesses of fall birth. DISCUSSION: Birth rates of men with past or present alcohol dependence, and of men and women with histories of illicit drug use, implicated seasonal factors in the pathogenesis of substance abuse. The similar birth patterns of illicit drug users and male alcoholics suggest that they may share some common etiological factor, such as seasonal effects on environmental temperature, hormonal function, or susceptibility to viral infection during pregnancy or early infancy.     

Neuropathic changes associated with insulin treatment of diabetic rats: Electron microscopic and morphometric analysis

Tibial nerves from control, untreated alloxan diabetic, and 4-week insulin treated alloxan diabetic rats were examined with light microscopy and computerized morphometric analysis of axons. Teased fiber preparations and electron microscopy were utilized to evaluate nerve degeneration. The insulin treatment regimens included daily injections of protamine zinc insulin (PZI), daily injections of ultralente insulin, and continuously delivered insulin through osmotic minipumps. Evaluation of axon:myelin ratios, teased fiber profiles, and electron microscopic cross sections of nerves demonstrated different degrees of neuropathic changes within the treated groups. The control group and untreated diabetic group showed little or no degeneration, while all insulin-treated groups showed evidence of Wallerian degeneration. Among these insulin treated groups, the PZI-treated group showed the greatest number of degenerating profiles while the minipump group showed the least. These data suggest that insulin treatment of alloxan diabetes results in axonal degeneration which closely resembles findings in human diabetic neuropathies. The substantially diminished number of degenerating axons seen in the osmotic minipump insulin-treated rats suggests that continuous delivery of insulin may decrease the neuropathic changes seen with single injection insulin therapy. Since virtually all insulin-dependent diabetic patients receive daily administration of insulin, the possibility that peripheral neuropathies may in part result from the insulin treatment requires more extensive investigation in a variety of animal models to separate the neuropathic effects of diabetes from the neuropathic effects of insulin therapy.     

Initial experience with the four-arm computer-enhanced telesurgery device in foregut surgery

BACKGROUND: The da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA) has been used effectively and with good results. Previously, the surgeon could manipulate three arms on the robot: one camera port and two working ports. This configuration required a second surgeon for most general surgical procedures. Recently, the robotic device has been modified to include a fourth arm, adding another computer-assisted instrument that the surgeon can manipulate. In this report, we describe our experience with the da Vinci robot with a fourth arm modification for the performance of selected surgical procedures. MATERIALS AND METHODS: A total of six patients were prospectively enrolled and underwent surgery using the modified da Vinci robot. Their average age was 56 years. Five patients underwent Nissen fundoplication, and one patient underwent Heller myotomy. Operative time, defined as the time from skin incision to completed skin closure, as well as robotic time, defined as the time during which the robot was being used, were recorded. Intra-operative and perioperative complications were also recorded. RESULTS: Average operative and robotic times for Nissen fundoplication were 134 and 80 minutes, respectively. Operative and robotic times for the Heller myotomy were 118 and 70 minutes. All patients tolerated the procedure well and experienced no perioperative complications. CONCLUSIONS: The da Vinci robot with the addition of the fourth arm results in a efficient and safe operation and allows the surgeon to perform additional maneuvers without the use of a surgical assistant.     

Non-mosaic tetrasomy 9p in a liveborn infant with multiple congenital anomalies: Case report and comparison with trisomy 9p

Tetrasomy of the short(p) arm of chromosome 9 has been reported in few cases. Most of these children present with microbrachycephaly, wide forehead, hypertelorism, lowset, malformed ears, beaked noses, and micrognathia. Additional anomalies include short neck, congenital heart disease, genital abnormalities, multiple limb defects, hypotonia, and early death. © 1996 Wiley-Liss, Inc.