Radio-guided occult lesion localization in patients undergoing breast-conserving surgery and sentinel node biopsy

BACKGROUND: The objective of the study was to evaluate the feasibility of radio-guided occult lesion localization (ROLL) in breast-conserving surgery for nonpalpable breast cancer. METHODS: Altogether 215 breast cancer patients were included in a prospective study. Ultrasonographically guided intratumoral injection of radioactive tracer was used for tumor localization in 64 patients with nonpalpable tumors, visible in breast ultrasonography (the ROLL group). Nonpalpable tumors, visible only in mammography, were localized with a help of a guidewire in 14 patients (the WGR group). The remaining 137 patients had palpable tumors. RESULTS: The proportion of specimens with close or involved margins (0 to 3 mm) was the same in the ROLL group (6%) and among cases with palpable tumors (5%). In addition the median length of the closest margin did not differ significantly between the groups. CONCLUSIONS: The results of ROLL for nonpalpable breast cancer are comparable with those for resection of palpable tumors.     

Local complications after cosmetic breast implant surgery in Finland

Concerns regarding potential health effects of silicone breast implants have recently shifted from long-term illnesses to postoperative local complications. In this study, occurrence of local complications and treatment procedures were evaluated in a population of 685 Finnish women who received cosmetic silicone breast implants between 1968 and 2002. Patient records were abstracted, and additional information was gathered using a structured questionnaire that was mailed to 470 of the women in the cohort. Overall, 36% of the women had 1 or more diagnoses of postoperative complications in their medical records. The most common complication was capsular contracture, occurring in 17.7% of women and 15.4% of implantations. Other complications were more rare. The majority of women (74%) needed no postoperative treatment. However, 22% of women required 1 or more surgical procedures after the primary implantation. Most of the women were satisfied with the implantation, but only 40% considered the preoperative information on possible risks related to implantation as sufficient. With respect to the occurrence of local complications following cosmetic breast implantation, the findings of this study are consistent with previous studies. Frequencies of complications were remarkably similar in medical records and self-reports.     

Increased postoperative concentrations of tenascin-C in wound fluid

BACKGROUND: Tenascin-C (Tn-C) is the most studied member of a family comprising large oligomeric glycoproteins in the extracellular matrix. The function of Tn-C still is unclear, and the levels of Tn-C in human wound fluid have not been studied. METHODS: The participants in this study were 24 patients referred for elective major gastrointestinal surgery. Concentrations of Tn-C and procollagen propeptides type 1 and type 3 in serum and wound fluid were measured after surgery. RESULTS: In wound fluid, Tn-C was present on postoperative day 1, and the concentration increased from day 5 up to day 7. CONCLUSIONS: The concentration of Tn-C increases postoperatively in wound fluid. The concentration of Tn-C in wound fluid is markedly higher than that of serum. The differences in expression between Tn-C and the procollagen propeptides may reflect different tasks of these extracellular matrix proteins.     

Testing the individualized care model

BACKGROUND: Although there has been some research to identify the dimensions on which individualized care should be measured, the indicators that constitute individualized care remain unclear. OBJECTIVES: To describe briefly the maintenance of individualized care and to test a hypothetical model of individualized care in a sample of surgical patients. DESIGN AND METHODS: A correlational survey design was used. Data were collected with questionnaires from adult patients (n = 454) discharged from surgical wards in one Finnish hospital district (response rate 91%). Structural equation modelling LISREL SIMPLIS using maximum likelihood estimation was used to estimate and test the parameters of the hypothesized model derived deductively from the previous literature. RESULTS: The goodness-of-fit statistics supported the basic solution of the Individualized Care Model, although two additional paths indicating error covariances between the sub-concepts were identified in the revised model. In this model individualized care is defined in terms of patients' views of nursing activities aimed at supporting individuality in care and in terms of perceptions of individuality in their own care. CONCLUSIONS: The model has been found to capture attributes that characterize individualized care. It can be used as a basis for evaluation in clinical nursing practice from patients' point of view. The study highlights the importance of patients' clinical situation, personal life situation and decisional control as predictors of individualized care. The results also confirm the construct validity of the previously developed Individualized Care Scale.     

No difference in platelet activation or inflammation markers after diets rich or poor in vegetables,berries and apple in healthy subjects

Summary.Background: High intake of vegetables and fruits is associated with decreased risk of coronary heart disease. Part of these cardioprotective effects may be mediated via the antithrombotic effects of compounds found in vegetables and fruits, such as flavonoids.Aim of the study: To study the effects of high and low intake of vegetables, berries and apple on platelet function and inflammatory markers.Methods: The study was a randomised, controlled parallel human dietary intervention with healthy female and male volunteers (n = 77, 19–52 y). Nineteen healthy volunteers served as controls. The volunteers consumed one of four strictly controlled isocaloric 6-week diets containing either 810 or 196 g/10 MJ of vegetables, berries and apple and rich either in linoleic acid (11% of energy, en%) or oleic acid (12 en%). Blood and three 24-hour urine samples were collected at the beginning and at the end of the study period for analyses of various markers of platelet function and inflammation.Results: No differences between the treatment groups were seen in platelet count or volume, markers of platelet activation (ex vivo aggregation to ADP and thrombin receptor activating peptide, protein kinase C activity, urinary 2,3-dinor-thromboxane B₂ excretion, plasma P-selectin), plasma intercellular adhesion molecule-1, sensitive C-reactive protein, or antiphospholipid antibodies.Conclusions: The results indicate that in healthy volunteers 6-week diets differing markedly in the amounts of vegetables, berries and apple do not differ in their effects on platelets or inflammation.     

The effect of <Emphasis Type="Italic">Lactobacillus helveticus</Emphasis> fermented milk on acute changes in calcium metabolism in postmenopausal women

Summary.Background: Milk fermented with Lactobacillus helveticus (L. helveticus) has been shown to lower blood pressure and to increase bone mineral content in spontaneously hypertensive rats. The effect of L.helveticus may be due to better calcium availability. Aim of the study: In the present study the effect of milk fermented with L. helveticus on acute changes in calcium metabolism and bone resorption in postmenopausal women was studied.Methods: The study was performed as a randomised double-blind crossover study of 20 postmenopausal women (mean age 65, range 50–78). The study was carried out in two parts. Firstly, L. helveticus fermented milk was compared to a control milk. Secondly, juice containing peptides formed with L. helveticus bacteria was compared to a control juice. The acute effect on calcium metabolism was measured during the study day by serum ionised calcium (iCa), parathyroid hormone (PTH), calcium (Ca), phosphate (P), and urinary calcium. A direct marker of bone turnover, carboxyterminal telopeptide of type I collagen (ICTP), was measured from the serum.Results: L. helveticus fermented milk reduced serum PTH (405.3 ± 37 ng/l vs. 454.9 ± 37, p = 0.012) and increased serum calcium (19.1 ± 0.2 mmol/l vs. 18.8 ± 0.2, p = 0.031) compared to the control milk. L. helveticus derived peptides had no significant acute effect on calcium metabolism, in fact, ionised calcium was lower and PTH higher after the juice containing peptides compared to the control juice.Conclusions: Fermentation of milk with Lactobacillus helveticus had a positive acute effect on calcium metabolism. This effect was not explained by the small peptides formed by L. helveticus.     

Platelet deposition on stainless steel, spiral, and braided polylactide stents. A comparative study

Platelets play a key role in (sub)acute thrombotic occlusion after stenting. We examined the possible differences between biodegradable polylactide (PLA) and stainless steel (SS) stents in platelet attachment and morphology after whole blood perfusion. PLA stents of different configurations (spiral/braided) and polycaprolactone-polylactide (PCL-PLA)-coatings, or SS stents were implanted into a PVC tube (? 3.2 mm), with or without precoating of the tube with type-I collagen. PPACK (30 microM)-anticoagulated blood with (3)H-serotonin prelabeled platelets was perfused (flow rate: 30 ml/min, 90 s) over the stents. Platelet deposition was assessed by scintillation counting and morphology by scanning electron microscopy (SEM). To examine coagulation activation, plasma prothrombin fragments (F1 + 2) were measured before and after the perfusion. Protein deposition on PLA/SS stents was assessed at augmented shear forces mimicking coronary flow (rate: 60 ml/min, 60 s) under minimal anticoagulation (PPACK 1 microM). More platelets deposited on PLA stents than on SS stents under all study conditions (p < 0.03). Under anticoagulation (PPACK 30 microM) the generation of F1 + 2 remained unaltered. Under higher flow rate and limited anticoagulation SS stents accumulated 3.27 +/- 0.75 microg and PLA stents 5.25 +/- 1.74 microg of protein (Mean +/- SD, p <0.95). Among all biodegradable stents, the braided PLA stent coated with PCL-PLA-heparin accumulated the fewest platelets (p < 0.02). In SEM, signs of platelet activation on braided heparin-coated PLA stents, when compared with uncoated braided PLA/SS stents, appeared modest. In conclusion, PCL-PLAheparin coating of biodegradable stents may enhance their hemocompatibility, expressed by less platelet deposition. Nevertheless, materials, design, and coating techniques of biodegradable stents must be further developed.     

Abnormal imitation-related cortical activation sequences in Asperger's syndrome

Subjects with Asperger's syndrome (AS) are impaired in social interaction and imitation, but the underlying brain mechanisms are poorly understood. Because the mirror-neuron system (MNS) that matches observed and executed actions has been suggested to play an important role in imitation and in reading of other people's intentions, we assessed MNS functions in 8 adult AS subjects and in 10 healthy control subjects during imitation of still pictures of lip forms. In the control subjects, cortical activation progressed in 30 to 80-millisecond steps from the occipital cortex to the superior temporal sulcus, to the inferior parietal lobe, and to the inferior frontal lobe, and finally, 75 to 90 milliseconds later, to the primary motor cortex of both hemispheres. Similar activation sites were found in AS subjects but with slightly larger scatter. Activation of the inferior frontal lobe was delayed by 45 to 60 milliseconds and activations in the inferior frontal lobe and in the primary motor cortex were weaker than in control subjects. The observed abnormal premotor and motor processing could account for a part of imitation and social impairments in subjects with AS.