Mammographic Screening Downstages Breast Carcinomas at Time of Diagnosis: A Community-Based Experience

Abstract: To determine the effectiveness of screening mammography in a community medical setting, data from a population-based, retrospective study was analyzed. Medical records of 827 patients with newly diagnosed breast cancer in California between October 1994 and March 1996 were reviewed. The primary care physician's record was abstracted for clinical history, including recommendation of screening mammography. The facility records where final diagnosis was made were abstracted for stage and treatment data. Among the patients who did not have previous screening mammography, 65.7% were diagnosed with "advanced" breast cancer (stages II, III, IV), while only 39.9% who had previous screening mammography were diagnosed with advanced breast cancer (p < 0.001). This study has reaffirmed that screening mammography of adult females generates downstaging at the time of diagnosis of breast cancer. Despite possession of a health insurance program and receiving educational materials, only 65% of patients over 50 years of age had screening mammography. As opposed to the once-a-year mailing of general reminders to all women 40 years old and older, developing a longitudinal electronic medical record in the managed care setting will support a more coordinated and individualized intervention based on age, date of last mammogram, and relative risk, among other factors. Continuing education efforts must also be directed to referring physicians, who may not yet recognize the value of screening mammography.     

Core beliefs in anorexic and bulimic women

There is research evidence to suggest the presence of dysfunctional cognitions in anorexia nervosa and bulimia nervosa that are not related to food, weight, or shape. These maladaptive cognitions have not been addressed by the conventional cognitive behavioral models of etiology or therapy. This study aimed to assess the impact of unhealthy core beliefs on eating disorders and their symptoms. Twenty restricting anorexics, 10 bulimic anorexics, 27 bulimics, and 23 normal controls completed Young's Schema Questionnaire. Eating behaviors and attitudes were also measured. The results indicate that both anorexic and bulimic women had significantly higher levels of unhealthy core beliefs than comparison women, but the clinical groups only differed on one individual core belief (entitlement). However, there were different patterns of association between core beliefs and eating psychopathology in anorexic and bulimic women. It is suggested that future clinical practice should incorporate core beliefs as a potential element in the assessment and treatment of eating disorders.     

Isolated pedunculated congenital corneal dermoid

PURPOSE: To investigate a case of isolated pedunculated congenital corneal dermoid. METHODS: Case report. RESULTS: In a 14-day-old infant, the pedunculated portion of the dermoid was removed and confirmed by histopathologic examination. No surgical complication or recurrence was encountered, and the patient is waiting for a rotational autokeratoplasty. CONCLUSIONS: Prompt treatment of such an unusual tumor is important to allow for visual rehabilitation and development.     

Progression of myopia in Hong Kong Chinese schoolchildren is slowed by wearing progressive lenses.

PURPOSE: In Chinese societies, primary and secondary schoolchildren perform large amounts of reading and homework and thus spend long periods performing near work during their growth years. Progressive lenses, which can permit a focused retinal image at distance, intermediate, and near, without accommodation, may slow the development of myopia. This paper reports results of a 2-year longitudinal study to examine the effects of progressive lenses on myopia progression in myopic Chinese children; these children were aged between 9 and 12 years at the beginning of the study. METHODS: Prestudy vision screening tests and five examinations, which included noncycloplegic refraction, were conducted at half-yearly intervals. Of those who completed the study, 32 children wore single vision (SV) lenses (the SV group) and 36 wore progressive lenses; of the latter, 22 wore a +1.50 D addition (the P1 group) and 14 wore a +2.00 D addition (the P2 group). Refractive error, corneal curvature, axial length, vitreous depth, and intraocular pressure were measured at every examination. Height was measured as an index of general growth. RESULTS: Progressive lenses significantly retarded the progression of the myopia in these children. Initially, the mean refractive error of the SV group was -3.67 D, of the P1 group was -3.73 D, and of the P2 group was -3.67 D. The mean myopic progressions over the 2 years of the study were -1.23, -0.76, and -0.66 D for the SV, P1, and P2 groups, respectively. CONCLUSION: Progressive lenses reduce the progression of myopia. It may be that the interaction of the progressive lenses with the accommodation system is the cause of this reduction in myopia progression because the +2.00 D addition appeared more effective than the +1.50 D addition in slowing the progression.     

Primary bone tumors. MR morphologic appearance correlated with pathologic examinations.

Eighty-three MR studies for primary bone tumors, performed with both spin echo and short time inversion recovery (STIR) sequences, were reviewed. Twenty-six patients underwent surgery within 10 days after MR imaging. Specimens were cut and directly compared with MR images. In the remainder, pathologic slides were compared in order to obtain a better understanding of MR pattern. All MR images were examined with a traditional morphologic approach and, upon comparison with surgical macroslides and with pathology samples, some MR distinctive patterns were identified: the bulky appearance of osteosarcoma surrounded by muscle edema, the multilobular high signal intensity (SI) chondroid lesions, the subtle infiltration of Ewing's sarcoma, rarely accompanied by muscle edema and prone to MR underestimation, the well defined "multiple shells" pattern of giant cell tumor, and the ill defined "storiform" appearance of malignant fibrous histocytoma are all typical MR features strictly corresponding to pathologic findings. The chondroid origin tumors may be identified based on the lobular high SI pattern whereas a benign fibrous lesion was the only one in this series to be distinguished relying on the SI. Peritumoral soft tissue edema was found by the STIR sequence only in malignant tumors (69%) of this series, and particularly in osteosarcoma (96%), chondrosarcoma (83%), and giant cell tumor (100%): this associate finding may further contribute to the diagnosis.     

The "throbbing sign"--an indication of early venous congestion in replantation surgery.

Venous congestion in a replanted or transplanted digit can be detected, even before any obvious color changes, by the "throbbing" elicited by pinching the digit between the thumb and finger of the examiner until the skin blanches. Releasing the pressure slowly, a sensation of throbbing will be felt synchronous with the patient's pulse rate. The sign disappears when venous congestion is relieved or when swelling persists and increases enough to lessen the arterial inflow.     

Autobiographical memory in diabetes mellitus patients

Objective: Although current theorizing proposes that adjustment to insulin-dependent diabetes mellitus (IDDM) is influenced by appraisals of past health, there is little research into the role of autobiographical recall in patients with this condition. Autobiographical memory patterns were investigated in patients with IDDM and controls. Method: Fifteen patients with IDDM and 15 control participants were administered the Autobiographical Memory Test, the Beck Depression Inventory (BDI), and the Multidimensional Health Locus of Control Survey (MHLCS). Results: Patients with IDDM displayed impaired access to specific positive memories and took longer to retrieve memories than controls. Impaired retrieval in patients with IDDM was associated with higher scores on the MHLCS-Powerful Others scale. Conclusions: Findings suggest that impaired recall of positive experiences is associated with poor adjustment to IDDM.     

Polymeric micellar paclitaxel phosphorylates Bcl-2 and induces apoptotic regression of androgen-independent LNCaP prostate tumors

BACKGROUND: Paclitaxel has been difficult to evaluate in preclinical tumor model systems because its poor solubility requires a Cremophor EL formulation, which results in lethal anaphylaxis. We tested the effectiveness of a novel polymeric micellar paclitaxel on androgen-independent tumor growth in the LNCaP tumor model. METHODS: Athymic male mice bearing LNCaP tumors were castrated and allowed to grow until their PSA levels increased to three times above precastration levels. The animals were then treated with 0.5 mg intravenous polymeric micellar paclitaxel once daily for the first 5 days of a 3-week cycle. In total, three cycles were given. Tumor volume and serum PSA levels were measured weekly to monitor tumor progression. RESULTS: In vitro mitogenic assays demonstrated that polymeric micellar paclitaxel was effective in inhibiting LNCaP cell growth with an IC(50) of 5 nM. Paclitaxel precipitated apoptosis in vitro at a concentration of 1 nm and higher, confirmed by DNA laddering. Western blotting demonstrated that paclitaxel treatment phosphorylated and inactivated Bcl-2. In mice bearing LNCaP tumors treated with micellar paclitaxel, tumors regressed rapidly with the commencement of micellar paclitaxel treatment. Tumor size decreased 91% and PSA level decreased 96% after three cycles of treatment. TUNEL immunostaining of the tumor treated with micellar paclitaxel showed marked apoptosis when compared with the control. No significant side effects or mortality was observed in the micellar paclitaxel group (n = 7). In contrast, all (n = 7) mice treated with conventional Cremophor EL paclitaxel died within 1 day of injection. CONCLUSIONS: The polymeric micellar paclitaxel formulation is water-soluble and capable of inducing complete response in mice bearing androgen-independent LNCaP tumors. The lack of toxicity of polymeric micellar paclitaxel permits in vivo preclinical testing of paclitaxel-based combination regimens.