Lymphedema: How Do We Diagnose and Reduce the Risk of This Dreaded Complication of Breast Cancer Treatment?

Lymphedema is an under-recognized, progressive, life-long condition estimated to impact 2-3 million people in the United States. The incidence of breast cancer related lymphedema varies greatly in the literature largely due to different measurement techniques, competing thresholds for defining lymphedema, and variation in length of follow-up. Multiple imaging techniques have become useful for diagnosis. Lymphoscintigraphy is one of the most commonly used, as it can identify pathways of lymphatic drainage, quantify extent of dermal backflow, and help determine functional and morphologic changes in the lymphatic system. Early detection and intervention hold the greatest promise of reducing the incidence of lymphedema. Health care providers involved with cancer patients need to become more educated about lymphedema, aware of current risk-reduction practices, and familiar with methods of diagnosis and assessment, so that patients with early swelling can be referred to lymphedema treatment specialists at a time when treatment is more effective.     

The induction of epidermal ornithine decarboxylase following tape stripping is inhibited by a topical vitamin D3 analogue (MC903)

The efficacy of MC903, a vitamin D3 analogue, in reducing hyperproliferation as determined by levels of ornithine decarboxylase (ODC) was investigated in a double-blind study of 15 patients with chronic plaque psoriasis. The lesions of psoriasis were treated for 8 weeks with MC903 in one of two different cream bases or with a placebo cream. Biopsies were taken before and after treatment. In addition an uninvolved area of skin was treated during the last 3 weeks and this as well as control areas were then sellotape stripped and biopsied after 8 h. Clinical improvement was seen in eight out of 11 patients treated with MC903 but there was no reduction in the level of ODC in psoriatic lesions after 8 weeks of treatment. The levels of ODC in the tape-stripped uninvolved skin after 3 weeks of treatment with MC903 averaged 22.5 +/- 4.2 pmol/min/mg protein as compared to 58.6 +/- 12.6 pmol/min/mg protein (P = 0.004). The trauma-induced induction of ODC activity was markedly inhibited by the application of MC903.     

Temporal concordance of anxiety disorders and child sexual abuse: implications for direct versus artifactual effects of sexual abuse.

This study examined the temporal concordance between the onset of childhood anxiety disorders and the points of onset and ending of child sexual abuse (CSA). Sexually abused children (N = 158) were assessed with structured diagnostic interviews. Onset ages for lifetime prevalence anxiety disorders were combined and sequenced with the onset and ending of sexual abuse. Hazard rates were calculated. Departures from the overall linear hazard trajectory for onsets were modeled using piecewise growth curve analyses. Increases from the overall trajectory were found around the point of sexual abuse onset for most childhood anxiety disorders. Decreases were found around the ending of sexual abuse. The risk for developing new anxiety disorders after the onset of sexual abuse showed a positive dose-effect relation with abuse severity. The findings add support to the idea that CSA can have a direct link to childhood anxiety disorders, apart from confounded vulnerability factors, postabuse events, or stable family background factors. The findings are contrasted with those from cross-sectional partial correlation studies that have suggested that there is little direct connection between sexual abuse and mental health outcomes.     

Expression of CD35 (CR1) and CD11b (CR3) on circulating neutrophils and eosinophils from allergic asthmatic children

Complement receptors on neutrophils and eosinophils play a role in activation and adhesion. During asthmatic reactions these receptors have been found elevated on circulating granulocytes. In the present study we compared the expression of CD35 (complement receptor type 1) and CD11b (complement receptor type 3) on neutrophils and eosinophils from asthmatic and non-asthmatic children. This was done in whole blood samples using depolarized light scattering for the discrimination of neutrophils and eosinophils. The non-stimulated expression as well as the upregulated expression of receptors by the chemotactic peptide N-formylmethionyl-leucyl-phenyl-alanine (fMLP) were studied. The results showed that without prior stimulation only the expression of CD35 on neutrophils was significantly elevated in children with asthma (P<0.05). After up-regulation with fMLP, the CD11b expression on neutrophils (P<0.005, fMLP: 0.002 microM) and eosinophils (P<0.05, fMLP: 0.02 microM) was significantly higher in asthmatic children than in the controls. These results indicate that the inducible expression of CD11b on neutrophils and eosinophils from allergic asthmatic children is primed in vivo.     

Drug Education: Supporting Parents to Support Children

Such research evidence as exists on effective drug strategies in prevention and education draws attention to the importance of involving parents along with other community agencies and school governors. Much depends nevertheless on the way in which 'involvement' is interpreted and the assumptions that are made about parents' knowledge of drugs and drug education as well as their attitudes to drug issues. As the age of initial experimentation and contact with drugs continues to fall, the importance of enskilling parents to support drug education programmes for 5 year olds and upwards continues to rise. This paper reports the first wide ranging survey of parents' knowledge of drugs and drug issues across an entire English county embracing younger as well as older children. The need for more coordinated, informed and systematic guidance to parents is established.