Breast-conserving therapy for macroscopically multiple cancers.

Of 586 unilateral stage I-II breast cancers treated with conservative surgery and radiotherapy, 61 patients were found to have two or more macroscopic tumor nodules, diagnosed either clinically (n = 20), mammographically (n = 2), or on gross pathologic examination (n = 39). After a median follow-up of 71 months, 15 of 61 (25%) of the patients with multiple tumors developed recurrence in the treated breast, compared to 56 of 525 (11%) of patients with single cancers (p less than 0.005). Local failure occurred in 6 of 37 (16%) of bifocal tumors and in 9 of 24 (35%) of patients with 3 or more tumor foci. Recurrence was more frequent for multiplicity diagnosed clinically or mammographically (8 of 22 patients, 36%) than when it was apparent only to the pathologist (7 of 39 patients, 18%). Only 1 of 21 bifocal tumors diagnosed on gross examination recurred. Local failure occurred in only 1 of 22 cases with clearly negative resection margins; the remaining recurrences were associated with positive (n = 3) or indeterminate margins (n = 11). In contrast with recurrences of unifocal breast cancers, local failures in these patients tended to be located at a distance from the original foci, to be multifocal, or to be diffuse, including skin involvement. Only four recurrences presented as a single focus in the vicinity of the original primary tumors. This study indicates that macroscopically multiple breast cancers are at higher local failure risk, especially if multiplicity is clinically apparent, or if three or more gross nodules are seen on pathologic examination. Negative resection margins appear to be essential for satisfactory results.     

Recording ventilation during sleep using pneumotachography: drawbacks and disadvantages

Pneumotachographic recording of ventilation requires an air-tight nasobuccal face-mask which might disturb the subjects' sleep and thereby modify their breathing pattern. In a cross-over randomised study we compared recordings obtained with and without a face-mask in 20 healthy normal volunteers (10 males, 10 females, mean age = 21.7 +/- S.E.M. = 0.5). The sleep modifications that resulted from the presence of the face-mask were a lengthening of the REM-sleep latency (+ 38%; P less than 0.01), an increase in intra-sleep waking-time (+ 65%, P less than 0.05), an increase in stage I duration (+ 40%, P less than 0.02), and a decrease in REM-sleep duration (- 20%, P less than 0.01), resulting in a decrease in total sleep duration (- 9%, P less than 0.05). The sleep latency, the number of awakenings, the stage II duration, the deep slow-wave sleep duration, the sleep stability, and the number of sleep cycles were not significantly modified.     

Laboratory identification of erythroblastosis fetalis

The clinical laboratory assumes the paramount role of supplying accurate data to the attending physician for the diagnosis, treatment and prevention of HDN. Maternal prenatal testing identifies patients at risk for Rh-HDN. The antibody titer is of primary value in assessing patients as candidates for amniocentesis. Amniotic fluid analyses provide an assessment of fetal prognosis in HDN and also an assessment of gestational age, lung maturity, and placental function. In severe HDN, amniotic fluid analysis can indicate the need for intrauterine transfusion. Postnatal laboratory studies can confirm the suspected diagnosis of HDN, identify those neonates at risk of developing kernicturus, and provide the physician with information pertaining to the treatment of HDN. Finally, prenatal and postnatal laboratory testing identifies those females eligible for Rh-immune globulin therapy to prevent HDN in subsequent pregnancies.     

Pleural-based changes on chest X ray after irradiation for primary breast cancer: correlation with findings on computerized tomography

In treating breast cancer with excisional biopsy and irradiation, a volume of lung underlying the breast and chest wall receives significant doses of irradiation. This irradiation can produce pleural and pulmonary changes that can be seen on routine chest radiographs. In five such cases, we have examined pre and post-treatment computerized tomograms of the chest and show that these radiographic changes are pleural-based and lie within the high dose radiation volume. Failure to correct radiation treatment plans for the influence of lung density results in an increased dose to lung and pleura that could, in theory, exacerbate pulmonary and pleural radiation effects.     

Clinical considerations in the treatment of dens invaginatus

Abstract Dens invaginatus is a developmental malformation of teeth which results from abnormal morphodiflerentiation. Such a condition is often associated with pulpal and periapical pathosis, which require treatment. Due to their abnormal anatomical configurations, invaginated teeth present technical difficulties in their clinical management. The treatment modalities available to the clinician include: endodontic therapy, endodontic surgery, combined treatment, or extraction. The treatment of choice should be selected according to specific clinical considerations. This article discusses these clinical considerations and establishes criteria for case selection and treatment planning.     

Legionella pneumophila in cooling water systems. Report of a survey of cooling towers in London and a pilot trial of selected biocides.

Fourteen recirculating cooling water systems were surveyed during the summer, 1981, to see what factors might influence the prevalence of Legionella pneumophila. The effect on the organism of three anti-microbials was studied, each in two systems, by intermittent treatment at two week intervals. L. pneumophila was isolated from six of the 14 cooling systems at the beginning of the trial but by the end was present in ten. An association was found between the presence of the organism and the concentration of dissolved solids, and chlorides and the pH. There also appeared to be associations with exclusion of light and higher water temperatures. Repeated tests on eight untreated systems showed that two were consistently infected, three became and remained infected, one was infected on a single occasion and two were never infected with L. pneumophila. Treatment of a contaminated system, either with a 10 p.p.m mixture of a quaternary ammonium compound and tributyltinoxide or slow release chlorine briquettes (maximum recorded free chlorine level 1.2 p.p.m.), did not eliminated legionellae. Treatment of two infected towers with a chlorinated phenol (100 p.p.m.) eliminated legionellae for at least three days, but after 14 days the organism was again found.