Should We Schedule Breast Surgery Based on a Woman's Menstrual Cycle?

Abstract: The timing of surgery of breast cancer patients has been reported to impact recurrence and survival. It is well known that surgical manipulation of tumor induces micrometastasis. During the menstrual cycle, profound hormonal changes occur affecting the local environment of the breast and breast cancer. A significant amount of scientific research now suggests that estrogen may establish an environment more likely to produce micrometastasis, and an immune system less likely to manage micrometastasis. Progesterone may protect against the effects of estrogen, leading to improved disease-free and overall survival during the luteal phase. The studies examining this association are conflicting, but claim a 30% advantage for those patients undergoing surgery during progesterone predominance. A solid prospective study examining this possible benefit has yet to be performed. Until then, no harm can come from scheduling patients for surgery during the early luteal phase, and these patients may actually have a significant improved survival over those whose tumors are excised during the follicular phase.     

Randomized study of didanosine monotherapy and combination therapy with zidovudine in hemophilic and nonhemophilic subjects with asymptomatic human immunodeficiency virus-1 infection. AIDS Clinical Trial Groups

To evaluate the safety and efficacy of didanosine (ddl) monotherapy and three different combinations of zidovudine (ZDV) and ddl in asymptomatic human immunodeficiency virus-1 (HIV-1) infection, we conducted an open-label, phase I/II study in 126 asymptomatic HIV-1- infected hemophilic and nonhemophilic subjects with a CD4 count of 200 to 500/mm3 stratified for prior zidovudine treatment and baseline CD4 count. Study arms included arm A, low-dose combination (ZDV 150 mg and ddl 134 mg, daily); arm B, moderate-dose combination (ZDV 300 mg and ddI 334 mg, daily); arm C, high-dose combination (ZDV 600 mg and ddl 500 mg, daily), and arm D, ddl monotherapy (ddl 500 mg, daily). Earlier, more frequent hepatotoxicity was experienced by hemophilic subjects (P = .008), but there were no differences in toxicity between treatment arms (P = .51), nor were there any differences in the rate of development of clinical endpoints by treatment (P = .41). Smaller median CD4 increases occurred over the first 12 weeks for arms A and D, 44/mm3 and 42/mm3, than arms B and C, 105/mm3 and 114/mm3, respectively, (P = .015). Hemophilia status (P = .0004) and prior ZDV experience (P = .044) independently predicted weaker CD4 responses during the first 12 weeks of treatment. Using a regression model and adjusting for hemophilia status, prior ZDV treatment, and baseline CD4, there was a significant reduction in quantitative viral load from baseline by week 12 for all treatment arms combined (P = .0001), with significantly lower median percent reduction for arm A (56.3%) than arms B, C, and D (94.6%, 98.5%, and 91.9%, respectively, P = .015). Although greater hepatoxicity and weaker CD4 responses occur in hemophilic subjects, didanosine monotherapy and combination therapy with zidovudine are safe and effective in asymptomatic HIV-1-infected patients.     

Tubo-ovarian abscesses: CT-guided percutaneous drainage

The results of computed tomographic (CT)-guided percutaneous drainage in eight patients with tubo-ovarian abscesses are reported. Seven patients (88%) recovered without surgery and required no further treatment. One patient had marked clinical improvement but still required a posterior colpotomy. No complications occurred. One patient had a recurrence of symptoms 20 months after the procedure that represented a new infection. The role of CT-guided percutaneous drainage in tubo-ovarian abscesses as well as an analysis of the technical aspects associated with a successful procedure are discussed.     

Recognition of verbs,abstract nouns and concrete nouns from the left and right visual half-fields

Visual half-field recognition was evaluated for familiar and unfamiliar verbs, abstract nouns, and concrete nouns. The familiar abstract nouns showed a significantly greater right visual-half-field superiority than did the familiar concrete nouns; however, no difference in asymmetry was found for the unfamiliar abstract and concrete nouns. The greater right visual-half-field superiority for familiar abstract nouns was found under both unilateral and bilateral presentation, with fixation controlled using a center digit. It was suggested that the decreased asymmetry for familiar concrete nouns was due to recognition of these words by both the right and left hemispheres.     

The effects of congenital heart disease on cognitive development, illness causality concepts, and vulnerability.

This study suggests that childhood cardiac illness has a depressive impact on the attainment of conservation tasks, but does not affect illness causality conceptualization. The group of twelve ill children studied appeared to feel somewhat more vulnerable to illness in general, especially when projecting to adult health status, than did a matched group of healthy children.     

Anterior segment ischemia: classification and description in chronic myelogenous leukemia.

A patient with chronic myelogenous leukemia is described who developed anterior segment ischemia after extreme leukocytosis with a resultant increase in the blood viscosity. The patient's signs and symptoms resolved after therapy which normalized the white blood cell count. It is thought that the anterior segment ischemia was a result of sludging of white blood cells in the ciliary arteries. It is important to recognize that anterior segment ischemia can occur as a complication of chronic myelogenous leukemia associated with extreme leukocytosis. A new classification of anterior segment ischemia is given.     

Sedation for Endoscopy

Abstract  In order to examine the investigators' clinical suspicion that Vietnamese patients were more sensitive to the sedative effects of midazolam than were Caucasians, the pharmacokinetics of a single, weight-adjusted intravenous dose of midazolam (0.05 mg/kg) were compared in a group of healthy Caucasian and Vietnamese male volunteers. The Vietnamese group ( n =8) had a significantly lower height, lean body mass and mean weight (59.8±5.5 vs 72.1±8.1 kg, respectively) compared with the Caucasian group ( n =8). No significant differences were found between the Vietnamese and Caucasian groups with regard to distribution half-life of midazolam (8.38±13.1 vs 1.49±0.63 min, respectively), elimination half-life (2.49±1.80 vs 1.48±0.66 h, respectively), clearance (4.93±1.31 vs 5.90±2.12 mL/min per kg, respectively), steady state volume of distribution (0.863±0.497 vs 0.530±0.132 L/kg, respectively) or percentage of unbound drug in plasma (4.89±0.74 vs 4.11±1.08, respectively). This suggests that dosage of midazolam in Vietnamese should be based on total body-weight. Two Vietnamese subjects who were brothers had marked elevation of distribution half-life and initial volume of distribution and lesser elevations in elimination half-life and volume of distribution at steady state. This suggests that the known subgroup of subjects who demonstrate dyshomogeneity in midazolam volume of distribution may be genetically determined.     

Blockade of both L-selectin and alpha4 integrins abrogates naive CD4 cell trafficking and responses in gut-associated lymphoid organs

The recirculation of naive lymphocytes from blood to lymph that is initiated in high endothelial venules (HEV) of secondary lymphoid organs such as lymph nodes and Peyer's patches (PP) is regulated by multiple interactions of adhesion receptor/counter-receptor pairs involving both selectins and integrins. We showed previously that blocking of only L-selectin is sufficient to ablate trafficking of naive CD4 cells and the development of their responses in peripheral lymph nodes but not in PP where alpha4beta7 integrins are thought to primarily regulate entry. However, although antibody to alpha4 integrins partially inhibited homing of naive CD4 cells to PP and not to lymph nodes, there was no effect on the development primary responses in these tissues or spleens. Since previous studies indicate that both alpha4beta7 integrins and L-selectin regulate adhesion of naive cells to PP HEV, we examined the effect a blockade of both adhesion pathways on the recirculation of naive CD4 cells. There was no detectable homing of naive CD4 cells to PP or lymph nodes when interactions with both receptors were inhibited, resulting in a profound depletion of naive CD4 cells and loss of antigen responses in these sites. In contrast, increased numbers of naive CD4 cells and responses of higher magnitude were found in the spleen. The results demonstrate recirculation of naive CD4 cells through tissues where entry is controlled through HEV is essential for the local generation of primary responses.