Bilateral synchronous breast cancer: mode of detection and comparison of histologic features between the 2 breasts

BACKGROUND: Bilateral synchronous breast cancer is uncommon (accounting for 1.0%-2.6% of all patients with breast cancer), and most physicians do not accumulate a large personal experience of patients with this disease. We reviewed our experience with patients with bilateral synchronous breast cancer, focusing on the mode of detection and histologic features in the 2 breasts. METHODS: The charts of patients who were treated at this institution for bilateral synchronous breast cancer during the 15-year period of 1984 through 1999 were reviewed. Information regarding age, mode of detection, histopathologic features, treatment, and overall survival were analyzed. RESULTS: During the study period, 51 patients (all women) were treated at our institution for bilateral synchronous breast cancer. This comprised 2.1% of all patients (n = 2382 patients) treated for breast cancer during the same period of time. The first cancer was detected by palpation in 81% and by mammography in 14%. The corresponding figures for the contralateral cancer were 24% and 54%, respectively. The histologic type of cancer was identical in the 2 breasts in 29 patients (57%) and was different between the 2 breasts in 22 patients (43%). The overall 10-year survival rate was 63%. CONCLUSIONS: Bilateral synchronous breast cancer is often detected by mammography and is frequently of the same histologic type as the index cancer. A better awareness of the risk for this disease may help detect bilateral breast cancer earlier.     

Sicherung der Atemwege des Neugeborenen bei beidseitiger Choanalatresie

Monatsschrift Kinderheilkunde -     

Terminally differentiated CD8 cells in HIV-infected children: HIV-GAG/POL specificity and IFN-γ production

BACKGROUND: CD8 cells are key to antiviral immunity and can be divided by phenotype into early (CD28+ CD27+), intermediate (CD28-CD27+) and terminally differentiated subsets (CD28- CD27-). Despite effective HAART there is an unexplained expansion of CD8+CD28-CD27-T cells in HIV-infected children. The cytokine production and specificity of this terminally differentiated CD8 T cell subset in chronic virus infection is unclear. PATIENTS, METHODS & RESULTS: In a cohort of 26 HIV-infected children the cytokine production of terminally differentiated CD8 cells was analyzed by intracellular staining and FACS analysis and was compared to children with chronic hepatitis B infection and to healthy children. The specificity of CD8 subsets was analyzed by staining with Gag/Pol tetramers in a cohort of 13 patients. We show that an increased production of interferon-γ in terminally and early/intermediate differentiated CD8 cell subsets after stimulation is specific for HIV-infection. The expanded population of terminally differentiated CD8+CD28-CD27- T cells does include HIV Gag/Pol specific T cells in adults but not in children. CONCLUSION: The expansion of terminally differentiated CD8 cells might be important for immunomodulation but in children it does not appear to play a role in HIV Gag and Pol specific immunity.     

Parathyroid surgery and methylene blue: A review with guidelines for safe intraoperative use

Methylene blue has been used to help facilitate parathyroid surgery for over 30 years. Its use has been widely considered both safe and cost effective. Twenty‐six cases of a toxic metabolic encephalopathy, however, have been reported with its use. As a result, some surgeons have stopped using this technique altogether. It is now known that methylene blue is a monoamine oxidase inhibitor. When combined with drugs that increase central serotonin neurotransmission, serotonin toxicity results. This is the cause of the encephalopathy described in the literature. A case report, review of the literature, and guidelines as to its proper use are presented so as to allow for safe parathyroid surgery. Laryngoscope, 2009     

The evolution of early fibromuscular lesions hemodynamically induced in the dog renal artery. I. Light and transmission electron microscopy.

In view of the important roles of arterial intimal fibromuscular lesions as precursors of atherosclerotic plaque and occlusive lesions in arterial reconstructions, a model has been developed for the rapid hemodynamic induction of these lesions by anastomosis of the dog right renal artery to the inferior vena cava. Light and transmission electron microscopic observations were made on the arterial shunt after periods of rapid flow ranging form 10 minutes to 2 hours to identify initial factor(s) and evolutionary mechanisms in the etiology of the lesions. The sequence of events included aberrations in ruthenium red staining of the endothelial luminal membrane at 10 minutes, multilayered thickening of the subendothelial basement membrane (BM) at 15 minutes, and initial reorientation and migration of smooth muscle cells (SMC) into the intima along with the appearance of areas of degeneration of the internal elastic lamina (IEL) at 30 minutes. The endothelial cells were still intact in some areas overlying the SMC migration and IEL degeneration, but they were separating from the surface in other such areas. As subendothelium became exposed, some platelet adherence was noted. By 2 hours, the entire wall reaction was fully developed. Initial observations indicate that in the evolution of this hemodynamically induced lesion visible alteration in the endothelial cells is not prerequisite to degeneration of the underlying IEL and reorientation and migration of medial SMC.     

THE OCCURRENCE OF ANTIGOITROUS SUBSTANCES IN PLANTS

The development of simple goiter in rabbits, which results when they are fed on a diet consisting chiefly of cabbage (or other Brassica) can be prevented by the feeding of certain fresh plants. Lawn grass, fresh alfalfa, skunk cabbage and steamed cabbage press juice have been found effective. Washing Brassicae with water improves their goiter-producing action, probably by the removal of goiter-preventing substances. The antigoitrous effect of plant juices was found to vary with the amount of reducing substance other than glutathione present. Skunk cabbage press juice, obtained from growing plants during the spring months, contained a large amount of iodine-absorbing material, and was very effective in involuting hyperplastic glands while juice obtained from mature plants in July when the iodine-absorbing material had nearly all disappeared, was quite ineffective. Certain extracts from cabbage administered parenterally, containing the reducing material, also had a marked involuting action on the thyroid. These extracts were practically iodine-free. The substance or substances believed to be responsible are easily soluble in water, ethyl alcohol, aqueous ethyl alcohol and are precipitable by lead acetate at a pH of 0.68–0.70. They are partially destroyed by exposure to air and by steam at 100°. Hexuronic acid isolated by Szent-Györgyi from cabbage, orange juice and suprarenal glands could be the antigoitrous agent. It cannot be glutathione.