Prognostic significance of oestrogen and progestogen receptor activities in breast cancer

The prognostic significance of the tumour activities of 2 steroid receptors, those for oestrogen (ER) and for progestogen (PgR), has been studied in 372 patients with breast cancer, in whom follow-up was available for 2-6 years (median 41 months). Of 252 patients with operable disease, 75.8 per cent had ER-positive tumours and 46.4 per cent had PgR-positive tumours, though a small additional fraction (6.3 per cent) had an equivocal PgR assay result. For the 236 patients with unequivocal receptor status, the relationships between disease-free interval or overall survival and receptor activity and other factors were evaluated by univariate and multivariate analyses. The latter revealed that only tumour size, node status, menstrual status and ER status related significantly to both disease-free interval and survival, though adjuvant therapy also related to disease-free interval, and tumour grade related to survival. It is concluded that measurements of PgR activity do not add to the prognostic significance of ER status.     

Cutaneous allergy to mustard in a salad maker

A case of allergic contact dermatitis to mustard (Brassica nigra) in a salad maker is reported. The sources of skin contact included a commercial salad cream, a vinegrette, and various members of the mustard family, Cruciferae. The Cruciferae family includes many salad vegetables and condiments which contain allergenic isothiocyanates. The extent of skin contact among salad makers and other food handlers may be significant, and sensitization to isothiocyanates from this large family of vegetables may be an important cause of food contact allergy in these individuals.     

Tensor fascia lata myocutaneous flap in lower abdominal wall reconstruction

The tensor fascia lata myocutaneous flap provides a reliable autogenous building block for anatomical lower abdominal wall reconstruction. Preservation of innervation allows maintenance of voluntary motor control and protective sensation. The excellent blood supply of this flap is particularly helpful in reconstructing previously irradiated areas. A one-stage repair is possible, leaving minimal secondary defect. We describe 4 patients illustrating the uses and versatilty of this flap. Anatomy, operative procedures, and indications for delay are also discussed.     

Influence of a calcium dependent protease inhibitor on platelet activation and secretion

Continuous proteolysis resulting in consumption of major cytoskeletal proteins may be essential for platelet activation and aggregation. In this study we evaluated the effect of a known protease inhibitor, Leupeptin, on agonist induced platelet aggregation and secretion. Platelets exposed to 10 ugs/ml of Leupeptin did not aggregate in response to the action of thrombin (0.2u/ml). However, a concentration of Leupeptin as high as 250 ugs/ml did not prevent arachidonate induced aggregation and secretion. Leupeptin (100 ugs/ml) effectively blocked thrombin (0.2 u/ml) induced elevation of cytosolic calcium, but did not affect arachidonate induced elevation of platelet intracellular calcium levels. At a concentration of 100 ug/ml, Leupeptin effectively blocked thrombin (0.5u/ml) induced clot formation of platelet poor plasma, suggesting that it can exert its effect on thrombin by preventing fibrinogen degradation. Effective K_i for the competitive inhibition of thrombin induced hydrolysis of a chromogenic substrate, S2238, by Leupeptin was 2.4 uM. Leupeptin inhibition of platelet function was reversible by washing platelets free of the polypeptide. Results of our study demonstrate that Leupeptin inhibits thrombin induced platelet activation, probably by interfering with its proteolytic activity on the platelet surface membrane. However, inhibition of platelet surface membrane associated proteases did not prevent activation of platelets by other agonists.     

Cardiac arrhythmogenic action of benzo(a)pyrene in the rabbit

Rabbits treated with benzo(a)pyrene developed cardiac arrhythmias when exposed by inhalation to 8100 ppm trichloroethylene or 15000 ppm halothane to a greater extent and at lower doses of epinephrine challenge than did controls. Benzo(a)pyrene and 3-methylcholanthrene both increased the metabolism of trichloroethylene, but 3-methylcholanthrene did not increase its cardiotoxic effect. The basis of the arrythmogenic action of benzo(a)pyrene appears to be unrelated to its ability to induce xenobiotic metabolism.     

The ora serrata and the spiral of Tillaux. Anatomic relationship and clinical correlation

Conventional teaching states that the spiral of Tillaux marks the location of the ora serrata. On literature review, no source for this was found. This study explores this anatomic relationship. In 20 cadaver eyes, narrow-gauge needles were placed penetrating the center of each rectus muscle insertion, and distance to the ora was measured. Insertions ranged from 2.25 mm posterior to 2.25 mm anterior to the ora, with 90% within 1 mm of it. In ten eyes, distance from the edge of insertion also was measured. Results indicate that the centers of rectus insertions, especially the lateral rectus, approximately overlie the ora, with the edges of the insertions more posterior and variable.     

Midazolam in combination with propofol for sedation during local anesthesia.

STUDY OBJECTIVE: To compare the sedative, anxiolytic, and amnestic effects, as well as the recovery characteristics, when midazolam (vs. a placebo) is administered to patients receiving a propofol infusion for sedation during local anesthesia. DESIGN: Randomized, double-blind, placebo-controlled study to evaluate the perioperative effects of intravenous (IV) midazolam. SETTING: Outpatient surgery center of a university-affiliated medical center. PATIENTS: One hundred thirty-nine consenting, ASA physical status I, II, and III outpatients undergoing elective surgical procedures under local anesthesia. INTERVENTIONS: Patients were randomly assigned to receive either midazolam 2 mg IV or saline 2 ml IV prior to injection of local anesthesia. Intraoperative sedation was maintained using a variable-rate propofol infusion. MEASUREMENTS AND MAIN RESULTS: Preoperative assessment of sedation, anxiety, and amnesia was performed before and after IV midazolam. Intraoperative evaluations included level of sedation, as well as cardiovascular and respiratory measurements, at 1- to 5-minute intervals during the operation. Postoperatively, recovery of psychomotor function and patients' subjective feelings were assessed using the visual analog scale and questionnaires. Amnesia was assessed using picture recall during the perioperative period. In the operating room, midazolam 2 mg IV, compared with the placebo, produced a significantly greater increase in patients' level of sedation (7 +/- 13 mm to 49 +/- 21 mm for midazolam vs. 8 +/- 11 mm to 19 +/- 21 mm for the placebo; p less than 0.01) and a greater decrease in anxiety level (62 +/- 25 mm to 21 +/- 21 mm for midazolam vs. 54 +/- 27 mm to 53 +/- 22 mm for the placebo; p less than 0.01). Although the propofol dosage requirements to maintain comparable levels of sedation were similar in both groups, midazolam decreased patients' recall of intraoperative events (e.g., propofol-induced pain on injection and discomfort with local anesthetic injection) without significantly altering cardiorespiratory parameters or prolonging times to ambulation and discharge from the outpatient facility. CONCLUSIONS: Premedication with midazolam 2 mg IV produced increased sedation, amnesia, and anxiolysis when administered immediately prior to the propofol infusion as part of a sedation technique for outpatient surgery. This combination did not prolong the recovery room stay when compared with propofol alone.