Breast cancer detection: one versus two views

Mammographic examinations of 169 patients with 172 biopsy-proved carcinomas, and of 194 healthy subjects, were interpreted independently and retrospectively by three experienced mammographers, initially as single-view oblique examinations and 6 months later as two-view oblique-cephalocaudal examinations. For the single-view examinations of the cancer patients, 67% of the cancers were correctly recommended for biopsy, additional views were requested for 23%, and a "negative" interpretation was made for 10%. For the single-view examinations of healthy subjects, biopsy was recommended for 7% and additional views were recommended for 32%. For the two-view examinations of women with cancer, 80% of the cancers were correctly recommended for biopsy, additional views were requested for 4%, and a "negative" interpretation was made for 16%. For two-view examinations of healthy subjects, biopsy was recommended for 7% and additional views were requested for only 5%. The authors conclude that single-view screening should not be performed, because it would lead to an excessive number of "call-back" examinations of healthy patients, producing additional cost and anxiety that would outweigh any theoretical benefit.     

急性有机磷农药中毒120例的救治

0　引言　近年来 ,我科在救治急性有机磷农药 (organophos-phorus,OP)中毒方面 ,积累了一些经验 ,现报告如下 .1　对象和方法1 .1　对象　本组 1 2 0例符合《急诊急救学》中的诊断标准 [1 ](男 2 9例 ,女 91例 ) ,年龄 1 .5～ 70岁 ,平均 2 8.6岁 .经口中毒 99例 ,经皮肤中毒 2 1例 .轻度中毒 1 5例 ,中度中毒 42例 ,重度 (含极重度 )中毒 6 3例 . 1 996年 39例 ,1 997年 43例 ,1 998年 38例 . DDV 79例 ,乐果 2 0例 ,混合性中毒 1 0例 ,水胺磷 3例 ,氧化乐果、 391 1、 1 0 5 9、对硫磷各 2例 ,敌百虫 1例 ,药名不详 1 0例 .服毒量 >2 5 …     

Early stage breast cancer

Breast cancer is the most common malignancy seen in women. Due to the increasing awareness for this disease and the increasing use of screening mammography, more patients are now diagnosed with early stage disease. Over the past few years, the indications for adjuvant treatment have expanded considerably, and more women are now candidates for chemotherapy, hormonal therapy, or both. The role of various prognostic factors and their implications on the design of a multidisciplinary therapeutic approach is discussed in this review. Current recommendations regarding the extent of the surgery, the role of radiation, and its integration to the adjuvant treatment are discussed. Guidelines on adjuvant chemotherapy and adjuvant hormonal therapy are also being presented.     

Type 1/type 2 cytokine modulation of T-cell programmed cell death as a model for human immunodeficiency virus pathogenesis.

In vitro T-cell receptor-induced programmed cell death in both activated T cells from human immunodeficiency virus-seronegative (HIV-) donors and resting T cells from HIV+ donors was substantially influenced by cytokines. Addition of exogenous recombinant "type 1" lymphokines interferon gamma and interleukin 2 (IL-2), as well as the macrophage-produced IL-12, which favor cell-mediated T-cell responses, blocks both systems of T-lymphocyte programmed cell death. In contrast, the "type 2" lymphokines IL-4 and IL-10, which favor antibody responses, either had no effect or enhanced these systems of in vitro T-cell programmed cell death. A role for endogenously produced cytokines was suggested by the inhibition of T-cell receptor-mediated death by antibodies against IL-4 and IL-10 and its enhancement by anti-IL-12 in cultures containing monocytes. These results demonstrate that the functional properties of type 1 and type 2 cytokine classes may be further extended to include their effects on T-cell programmed cell death and their possible role in the pathogenesis of HIV infection.     

Nutrition of women in anticipation of pregnancy

A causal connection between maternal nutrient intake and birth outcome is not universally accepted. In this paper further empirical support is provided, particularly in relation to the impact of maternal nutrition around the time of conception or very early in pregnancy. It is argued that the hypothesis that maternal nutrition has no connection with birthweight is very easily refuted. It is suggested that there should be a new category of recommended dietary allowances; "women in anticipation of pregnancy". The diet of 513 pregnant London women were recorded for 7 days during the first trimester of their pregnancy. Birthweight and nutrient intakes were found to be significantly correlated but only over the lower half of the birthweight range. The optimum birthweight range with the lowest perinatal and infant mortalities is 3,500-4,500 g and it is suggested that the nutrient intake of th 165 women who had babies in this optimum weight range provide tentative values for nutrient intake recommendations in anticipation of pregnancy, but are not claimed to be representative. The need for adjustments of recommendations for the individual, for example for a low body mass index, is discussed. A body mass index of 24 kg/m2 is recommended based on the median of the 165 women.     

Clamp and sew techniques in thoracoabdominal aortic surgery using naloxone and CSF drainage

Surgical repair of thoracoabdominal (TAA) and thoracic aneurysm is challenging, with the potentials for high morbidity and mortality. There is no standardized operative approach. Operative management of TAA consists of simple clamp-and-sew techniques with adjuncts, cerebrospinal fluid (CSF) drainage, naloxone administration, and intraoperative hypothermia, to protect the spinal cord. The use of CSF drainage and naloxone administration has reduced paraplegia to 3.4%, compared with 21% when none of these adjunctive spinal cord measures were used. The authors discuss their operative strategy, surgical technique, and results at the University of Wisconsin Hospital and Clinics.