Tamoxifen Therapy for Breast Cancer and Endometrial Pathology

Background

Tamoxifen, used as adjuvant therapy for carcinoma breast in postmenopausal women to prevent relapse has estrogenic effect on the endometrium.

Methods

104 patients on tamoxifen for more than six months were subjected to a clinical examination and transvaginal sonography. Patients with endometrial thickness > 8 mm were further evaluated by hysteroscopy and endometrial biopsy.

Results

35(34%) patients were symptomatic. The average endometrial thickness was 11.2 mm which correlated with duration of tamoxifen use. 27(48%) patients had abnormal hysteroscopic findings. 35 (63%) of endometrial biopsies revealed abnormal endometrium. One case of endometrial carcinoma was diagnosed. The results were statistically analysed. There is a significant association between symptomatic status and endometrial thickness and duration of tamoxifen use.

Conclusion

All patients on long term tamoxifen should be annually screened for endometrial pathology.Key Words: Tamoxifen, Endometrium, Transvaginal sonography     

Histological analysis of rat dental pulp tissue capped with propolis

The aim of the present study was to assess the response of rat dental pulp to direct pulp capping with propolis. Flavonoid and non-flavonoid materials were purified from an ethanol extract of propolis obtained from South Sulawesi, Indonesia. A Class I cavity was prepared on the occlusal surface of the right maxillary first molar in Sprague Dawley rats. The dental pulp was exposed and then capped with a zinc oxide-based filler as a control (group I), or with propolis flavonoids (group II) or non-flavonoids (group III). The animals were sacrificed at week 1, 2 or 4, biopsy samples were obtained, and these were stained and viewed by light microscopy. The results showed that pulp inflammation occurred in groups I and III as early as week 1. No dentin bridge formation was seen in these groups. In contrast, there was no evident inflammatory response in group II at week 1. Mild and moderate pulp inflammation in this group occurred at 2 and 4 weeks after treatment, respectively. Partial dentinal bridge formation was seen in group II at week 4. Therefore, the present results suggest that direct pulp capping with propolis flavonoids in rats may delay dental pulp inflammation and stimulate reparative dentin.     

Placement of Umbilical Artery Catheters High vs. Low

Placement of umbilical artery catheters was retrospectively reviewed in 181 newborns to evaluate random placement of catheter tip in the "high" position between T₇ and T₉ in the thoracic aorta of 127 infants and in the "low" position below 4 in the abdominal aorta of 54 infants. Group differences in gestational age, asphyxia, hypotension, respiratory disease, duration of catheterization, or infusate type were not significant. Cyanosis or blanching in the low extremities occurred in 67% of the "low" group and 21% of the "high" group ( P < .001). Hematuria occurred in 39% of the "low" group and 21% of the "high" group ( P < .05). High placement appears to have fewer complications. Prompt intervention by neonatal nurse practitioners can help reverse complications that occur during umbilical artery catheterizations.     

A23187 inhibits adrenal protein synthesis and the effects of adrenocorticotropin (ACTH) on steroidogenesis and phospholipid metabolism in rat adrenal cells in vitro: further evidence implicating phospholipids in the steroidogenic action of ACTH

We examined the effects of ACTH and the Ca++ ionophore, A23187, on steroidogenesis and phospholipid metabolism during incubation of dispersed rat adrenal cells. Increasing doses of ACTH elicited nearly parallel increases in corticosterone production and adrenal inositide (mono- and di-) concentrations. As reported previously by other investigators in Y1 cells, A23187 inhibited ACTH- and cAMP-stimulated, but not basal or pregnenolone-stimulated, corticosterone production. A23187 also inhibited ACTH-induced increases in phosphatidic acid, phosphatidylinositol, and diphosphoinositide, and this was attended by inhibition of [3H]leucine incorporation into protein. These findings support our previous contentions that: 1) a labile protein is required for ACTH-induced increases in adrenal phospholipids in the phosphatidate-polyphosphoinositide-polyglycerophospholipid pathway; and 2) these phospholipids are involved in the steroidogenic action of ACTH.     

Advantages of focused helical computed tomographic scanning with rectal contrast only vs triple contrast in the diagnosis of clinically uncertain acute appendicitis: a prospective randomized study

HYPOTHESIS: Focused helical computed tomographic (CT) scanning with rectal contrast only is a superior diagnostic modality compared with the traditional triple-contrast CT scan for the diagnosis of acute appendicitis. DESIGN: Prospective randomized analysis of both CT scan modalities. INTERVENTIONS: Only patients with uncertain diagnosis of acute appendicitis were entered in the study. The patients were then randomized to undergo the traditional triple-contrast CT scan or the new focused CT scan with rectal contrast only. Surgical management included operation or observation for 23 hours. RESULTS: Ninety-one patients participated in the study, including 52 in the triple-contrast group and 39 in the rectal-contrast group. The demographics of the triple-contrast vs the rectal-contrast groups were similar. The triple-contrast group had a sensitivity of 97%, specificity of 86%, positive predictive value of 90%, and negative predictive value of 93%. The rectal-contrast group had a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. There were 4 false-positive findings and 1 false-negative finding in the triple-contrast group compared with none in the rectal-contrast group. In the triple-contrast group, there were 13 perforated appendixes compared with 1 in the rectal-contrast group. The cost of a triple-contrast scan was 620 US dollars compared with 305 US dollars for a focused rectal-contrast scan. The negative appendectomy rate for the study was 8.0% (4 of 48 patients in the triple-contrast group vs 3 of 39 in the rectal-contrast group). CONCLUSIONS: The demographics, sensitivity, specificity, and positive and negative predictive values were comparable in both groups. The focused rectal-contrast procedure was better tolerated by patients and demonstrated decreased morbidity, delay to diagnosis, perforation rate, and negative appendectomy rate with no missed diagnosis and decreased cost. Therefore, we believe that focused helical CT scanning with rectal contrast only is a superior diagnostic modality compared with the traditional triple-contrast CT scan for the diagnosis of acute appendicitis.     

Backside wear of modular ultra-high molecular weight polyethylene tibial inserts

BACKGROUND: The capture mechanisms of modular tibial total knee components may allow relative micromotion between the insert and the base-plate, leading to wear at the nonarticulating (backside) surface. Although retrieved components often display laxity in the capture mechanism in the unloaded condition, the magnitude of the relative motion that actually occurs under physiologic conditions has not been determined. This study was performed to assess the impact of different modes of knee-loading on the relative micromotion between the insert and the base-plate and the relationship between the duration that the implant had been in situ and the severity of backside wear. METHODS: Twenty-one posterior-stabilized total knee replacements of one common design (Insall-Burstein II) were retrieved at one to 100 months after implantation. The extent and severity of backside wear was graded with use of stereomicroscopy. All components were soaked in a bath (of physiologic saline solution at 37 degrees C for four days prior to reassembly. The relative micromotion between the insert and the base-plate of each specimen was measured in vitro in two different conditions: with no axial load and with a combination of loads and torques simulating the stance phase of gait. RESULTS: The capture mechanism laxity between the insert and the tibial base-plate in the unloaded condition was approximately eight times larger than the micromotion measured during simulated gait. The capture mechanism laxity allowed a mean (and standard deviation) of 618 +/- 226 micro m of total relative micromotion compared with 103 +/- 54 micro m of relative micromotion during the gait cycle. Under both loading conditions, the predominant direction of interface motion was medial-lateral. No correlation was found between the magnitude of capture mechanism laxity and the relative micromotion measured during simulated gait (p = 0.11). Larger polyethylene protrusions on the backside surface did not correlate with less micromotion (p = 0.48) or with capture mechanism laxity (p = 0.06). CONCLUSIONS: For the implant design that was studied, capture mechanism laxity between the modular insert and the base-plate in the unloaded condition was an order of magnitude larger than and not indicative of the micromotion that occurred during simulated physiologic loading. In addition, polyethylene protrusions into the screw-holes of tibial base-plates did not seat or lock the insert in place and reduce relative motion. CLINICAL RELEVANCE: While some clearance between the insert and the base-plate is required to allow assembly of modular tibial components at the time of surgery, the amount of relative interface motion during a functional activity such as normal gait, which can produce potentially damaging wear debris, is unknown. However, the compressive forces applied to the articular surface during a functional activity may substantially reduce micromotion between the insert and the base-plate relative to the unloaded condition.     

Screening for hepatocellular carcinoma

Liver cancer remains one of the most common causes of cancer death globally, and its cure rate has not improved for the past 20 years. Hepatocellular carcinoma develops in patients with cirrhosis of any etiology. Patients with cirrhosis are thus usually included in screening program aiming to achieve early detection and effective treatment for HCC. Only those patients diagnosed with HCC who would benefit with the available treatment, should undergo the screening procedure. This is based on ultrasonography and alpha-fetoprotein every 3-6 months based on the prevalence and economic status of the community being tested.     

Decontamination of anaesthetic equipment

Awareness that some diseases are transmissible has existed forcenturies. Hippocrates in 450 BC used wine or boiled water toirrigate wounds and, in the second century, Galen was reportedto have boiled his instruments before use. In the middle ages,people suffering with leprosy and the severely ill were isolatedfrom the local population. However, modern infection controlwas only started in the 19th century as a consequence of thework of Pasteur, Lister and other pioneers.