Cancer patients: their desire for information and participation in treatment decisions.

The relationship between cancer patients' desire for information and their preference for participation in decision making has been examined. Approximately 77% of the 52 patients reported that they had participated in decision making to the extent that they wished, while most of the remaining 23% would have preferred an opportunity to have greater input. Although many of the patients actively sought information, a majority preferred the physician to assume the role of the primary decision maker. Ethically, the disclosure of information has been assumed to be necessary for autonomous decision making. Nevertheless, the results of this study indicate that patients may actively seek information to satisfy an as yet unidentified aspect of psychological autonomy that does not necessarily include participation in decision making.     

The relationship of anthropometric measures to radiological features of the breast in premenopausal women.

We studied 273 premenopausal women recruited from mammography units who had different degrees of density of the breast parenchyma on mammography, in whom we measured height, weight and skinfold thicknesses. Mammograms were digitized to high spatial resolution by a scanning densitometer and images analysed to measure the area of dense tissue and the total area of the breast. Per cent density and the area of non-dense tissue were calculated from these measurements. We found that the mammographic measures had different associations with body size. Weight and the Quetelet index of obesity were strongly and positively associated with the area of non-dense tissue and with the total area of the breast, but less strongly and negatively correlated with the area of dense tissue. We also found a strong inverse relationship between the areas of radiologically dense and non-dense breast tissue. Statistical models containing anthropometric variables explained up to 8% of the variance in dense area, but explained up to 49% of the variance in non-dense area and 43% of variance in total area. These results suggest that aetiological studies in breast cancer that use mammographic density should consider dense and non-dense tissues separately. In addition to per cent density, methods should be examined that combine information from these two tissues.     

Congenital absence of the umbilical cord resulting from maldevelopment of embryonic body folding

We report a case of extreme maldevelopment of embryonic body folding that resulted in incomplete fusion of the amnion to the chorion and failure to form an umbilical cord. Massive intra-abdominal and intrathoracic herniation led to rapid neonatal death. The accurate ultrasonic characterization of the defect enabled prudent perinatal management.     

Differential effects of ketamine isomers on neuronal and extraneuronal catecholamine uptake mechanisms

Contractile responses of isolated rabbit aortic strips to epinephrine and norepinephrine were potentiated in a dose-related manner by (+) ketamine but not by (-) ketamine (1.1 X 10(-5) M - 3.7 X 10(-4) M). Potentiation was blocked completely by pretreatment with the extraneuronal uptake inhibitor cortisol (83-138 microM) but was unaffected by the neuronal uptake inhibitor cocaine (29 microM). Responses of the rat anococcygeus muscle to these catecholamines were potentiated by both isomers, with (+) ketamine being more potent than its optical antipode. These effects were blocked completely in tissues from 6-hydroxydopamine sympathectomized animals. Results suggest that inhibition of extraneuronal uptake of catecholamines by racemic ketamine is due solely to an action of the (+) isomer, whereas both isomers appear capable of inhibiting neuronal uptake.     

Cataract formation is prevented by administration of verapamil to diabetic rats

The purpose of the present study was to examine the effects on cataractogenesis of daily sc administration of the Ca2+ antagonist drug verapamil to diabetic rats. Streptozotocin-induced diabetic rats were given verapamil half-way through the 8-week experimental period or during the full 8 weeks of diabetes. Verapamil administration had no effect on the high blood glucose values, low circulating insulin levels, or elevated triglyceride and cholesterol concentrations in the diabetic rats. Untreated diabetic rats had a 90% incidence of cataracts. Four weeks of verapamil administration reduced this incidence to 41%, and a full 8 weeks of drug treatment further lowered the incidence to 20%. Diltiazem, another Ca2+ antagonist, lowered the incidence of cataracts in the diabetic rats to a similar extent. Verapamil administration to the diabetic animals also partially protected against the presence of retinal microangiopathy in the diabetic animals. Lenticular hydration and lipid accumulation were only indirectly related to cataractogenesis in the diabetic rats and its protection by verapamil treatment. Lenticular electrolyte imbalance, particularly Ca2+, in the diabetic animals was closely correlated with cataract formation, and verapamil significantly reduced the alterations in these ion concentrations. The present results demonstrate the efficacy of verapamil as a protective agent against cataractogenesis and some retinal damage in diabetic animals. Most importantly, this occurs in the absence of any change in the glycemic status of the diabetic animals. The findings strongly support a role for lenticular Ca2+ imbalance in cataract development in diabetes and provide initial evidence to suggest its clinical use in the diabetic population at risk for blindness.     

Verapamil prevents cerebral acidosis during moderate hypoxia and hypotension

Carotid ligation and moderate hypoxia in rats causes an increase in the glucose metabolic rate in the caudate-putamen and more widespread reductions in pH. Pretreatment of animals with verapamil did not affect the abnormality of glucose metabolism but abolished the associated acidosis. These data suggest that calcium channel blockade may protect the brain from injury during hypoxic hypoxia by preventing the development of acidosis.