Incidence and Patterns of Distant Metastases for Patients With Early-Stage Breast Cancer After Breast Conservation Treatment

BackgroundBreast conservation treatment (BCT), consisting of breast conservation surgery followed by definitive radiation therapy (RT), has been shown to be effective for early-stage breast cancer. Patterns of metastatic failure by specific anatomic site are not well described in the literature.MethodsA total of 1754 patients with stage I or II invasive carcinoma of the breast treated with BCT between 1977 and 2003 were identified. Patients were scored based on first site of metastasis: bone, brain, lung, liver, or other. Non–breast cancer deaths, contralateral breast cancer, and second malignancies were treated as competing risks events. Cumulative incidence functions for each competing event were calculated using competing risk methodology. Univariate analysis was performed to determine the hazard ratio (HR) associated with patient and tumor characteristics.ResultsThe most common event was non–breast cancer death (16.5% at 15 years; 95% confidence interval [CI], 13.9%-19.4%). The most common exclusive first site of metastasis was bone (5.9% at 15 years). The 4 most common anatomic sites of distant metastases as the first exclusive event were bone (41.1%), lung (22.4%), liver (7.3%), and brain (7.3%).ConclusionThe present study has demonstrated the site-specific risks of metastases. These data support current clinical practice of screening for site-specific metastatic disease after BCT based on concerning patient-specific signs or symptoms.     

Prevalence of dental anxiety in an adult population in a major urban area in Sweden

The aims of the study were to describe the level of dental anxiety in a representative sample of an adult population, to evaluate different demographic variables in relation to dental anxiety, and to compare two measurement scales of dental anxiety. A random sample of residents (n = 830) of the city of Gothenburg (population 432,000) was selected for a telephone survey. The survey comprised different questions concerning demographic variables, dental care habits, and the level of dental anxiety. The methods of measurement of dental anxiety were a 10-point dental Fear Scale (FS) and the Corah Dental Anxiety Scale (DAS). A total of 620 interviews were completed giving a response rate of 74.7%. 41.4% of the respondents were males, 58.6% females. Females were significantly more likely to report a high dental anxiety compared with males. The prevalence of high dental anxiety in the sample as measured by the FS and DAS was 6.7% and 5.4% respectively. The correlation between the FS and DAS was 0.81. The distribution of high dental anxiety and age showed a clearly and significantly higher portion of dental anxiety in the age group 20-39 yr compared to both younger and older groups. The effect of dental anxiety on regularity of dental visits revealed a significant difference as measured by the FS. No significant correlation was found between dental anxiety and educational level or income. A majority of the respondents (82-95%) expressed a desire for establishment of a special dental fear treatment clinic without need for referral.     

Maxillary and mandibular displacement in hemifacial microsomia: a longitudinal Roentgen stereometric study of 21 patients with the aid of metallic implants.

OBJECTIVE: To record maxillary and mandibular displacement with articular growth and in response to bimaxillary surgical repositioning in patients with hemifacial microsomia (HFM) and to observe ipsilateral corpus/ramus growth in severely affected children. DESIGN: Prospective roentgen stereometric analysis (mean age 7 years 10 months to 18 years 0 months) and retrospective profile and panoramic roentgenograms. Mean total observation period was 9 years 1 month. SETTING: Department of Plastic and Reconstructive Surgery, Malm? University Hospital (Malm?, Sweden). PATIENTS: Twenty-one patients consecutively diagnosed from 1976 through 1988 with HMF, five of whom had bimaxillary surgery. INTERVENTIONS: Surgery was performed at the Department of Plastic and Reconstructive Surgery. Implants were inserted at the initial reconstructive surgical procedure under general anesthesia. Roentgen examinations were performed in connection with continued clinical evaluations and treatment. MAIN OUTCOME MEASURES: Stereo roentgenograms were digitized at the Department of Orthopedic Surgery, Malm? University Hospital (Malm?, Sweden). RESULTS: Displacement of the jaws with articular growth and in response to bimaxillary surgical repositioning varied interindividually with no apparent common pattern. Relapse displacement occurred several years after bimaxillary surgery. Mandibular growth changes were found in the corpus/ramus area and alveolar process on the affected side. CONCLUSIONS: A marked interindividual variability of maxillary and mandibular displacement indicates that the relevance of statistical analysis of HFM growth data may be questioned. We would suggest that precise and accurate longitudinal recordings of growth and response to surgery in individual HFM patients be more appropriate.     

High frequency of contact allergy to gold sodium thiosulfate

When gold sodium thiosulfate was added to the patch test standard series, positive reactions were obtained in 8.6% of 823 consecutive patients with suspect contact allergy. The test reactions were clinically of an allergic type and, in several cases, long-lasting. There was no correlation with other allergens in the standard series. In a special study on 38 patients with contact allergy to gold sodium thiosulfate, the following principal findings were obtained: positive patch tests to the compound itself in dilute concentration; positive patch tests to potassium dicyanoaurate; negative patch tests to gold sodium thiomalate, sodium thiosulfate, and metallic gold; positive intradermal tests to gold sodium thiomalate. Our findings make gold sodium thiosulfate the 2nd most common contact allergen after nickel sulfate. It is suggested that a positive skin test to gold sodium thiosulfate represents gold allergy.     

Allergic contact dermatitis from diphenylthiourea in Vulkan heat retainers

11 cases of contact dermatitis from Vulkan heat retainers are reported. The skin eruptions started on days 1-11 after the 1st day of exposure. The clinical picture varied from eczema through urticaria to purpura. In some cases, the symptoms were severe. Patch testing was performed in 10 individuals and all reacted positively to the heat retainer and/or the rubber glue used in the heat retainer. A series of rubber chemicals was patch tested in 7 patients and all showed positive reactions to diphenylthiourea (DPTU), and all but one to ethylene thiourea (ETU). TLC examination revealed a spot with the same RF-value as DPTU in extracts of the adhesive, but no spot corresponding to ETU. There were no indications of impurities in the test preparations of DPTU and ETU. By HPLC, the content of DPTU in the adhesive was determined as 0.6% w/w.     

Demonstration of Kathon® CG in some commercial products

The preservative Kathon CG has become one of the most common sensitizers. It has, however, been difficult to explain the sensitization and to assess the clinical relevance of the contact allergy, partly due to lack of specification of the preservative in products. A high-performance liquid chromatography method was used to demonstrate Kathon CG in 123 commercial products of both "leave on" and "rinse off" types. 38 of these contained Kathon CG in the range of 1-15 ppm of active ingredients. There were no differences between "leave on" and "rinse off" products concerning the relative number of products containing Kathon CG and the concentrations of the preservative.     

Severe reactions after the intake of soy drink in birch pollen-allergic children sensitized to Gly m 4

Aim: To study the connection between reaction to soy milk and IgE sensitization to Gly m 4. Methods: Four subjects who experienced unforeseen and severe symptoms after the ingestion of soymilk were studied. Results: All children were birch pollen allergic, had high IgE responses to the PR‐10 proteins from birch and soybean, Bet v 1 and Gly m 4. All reactions took place after the ingestion of soymilk during the peak pollen season. Conclusion: This is the first time soybean‐dependant pollen‐food cross‐reaction has been reported in children experiencing reactions during the birch pollen season. These findings may well be helpful to doctors in identifying individuals at risk of severe reactions upon the ingestion of soymilk, and we foresee an increase in the number of similar cases as soy drinks are promoted for health purposes.