Birth defects risk associated with maternal sport fish consumption: potential effect modification by sex of offspring

Contaminated sport fish consumption may result in exposure to various reproductive and developmental toxicants, including pesticides and other suspected endocrine disruptors. We investigated the relation between maternal sport fish meals and risk of major birth defects among infants born to members of the New York State (NYS) Angler Cohort between 1986 and 1991 (n=2237 births). Birth defects (n=125 cases) were ascertained from both newborn medical records and the NYS Congenital Malformations Registry. For sport fish meals eaten during pregnancy, the odds ratio (OR) for all major malformations combined was slightly elevated for < or =1 meal/month (OR=1.26, 95% confidence interval (CI): 0.84, 1.89) and > or =2 meals/month (OR=1.51, CI=0.74, 3.09), with no meals during pregnancy as the reference category. Higher ORs were consistently observed among male offspring compared with females. For > or =2 meals/month, the risk for males was significantly elevated (males: OR=3.01, CI: 1.2, 7.5; females: OR=0.73, CI: 0.2, 2.4). Exposure during pregnancy and effect modification by infants sex could be important considerations for future studies of birth outcomes associated with endocrine disruptors.     

Audit of local recurrence rates following 'ultra'-conservative surgery for invasive breast cancer--a boost to the breast?

BACKGROUND: Conservative breast surgery with postoperative radiotherapy and appropriate systemic therapy is associated with similar outcomes when compared with mastectomy. The reported 5 year local recurrence rate varies between 3% and 15%. We prefer a more conservative 'complete' local excision rather than 'wide' local excision combined with post-operative radical radiotherapy and tumour bed boost with the aim of achieving optimal cosmesis. AIMS: Our review was undertaken to assess whether or not this 'ultra' conservative approach was compromising long-term local control. METHODS: Case notes and pathology reports of patients who underwent conservative surgery for breast cancer from January 1983 to February 2001 were accessed for this audit. Patient demographic data and tumour characteristics were noted. The primary outcome data were the number of local recurrences following invasive breast cancer at 5 and 10 years and the distance from the tumour to the closest margin of excision. RESULTS: At 5 and 10 years there were 16/451 and 5/124 local recurrences, with a local recurrence rate of 3.5% (95% CI, 1.7-4.7%) and 4.1% (95% CI, 0.47-6.5%), respectively. Complete data with regards to the closest histological margin of excision were available in 423 patients. One hundred and sixty-five patients (39%) had their tumours excised with a distance of less than 1 mm to the closest margin. Nearly, all tumours (97.8%) were excised with the distance to the closest margin less than 1 cm and 81% with 5 mm or less. CONCLUSION: It is possible to achieve low local recurrence rates after very conservative surgery for breast cancer when this is combined with radical radiotherapy and an additional tumour bed boost.     

Radiopaque coil insertion into breast cancers prior to neoadjuvant chemotherapy

Between May 1998 and December 2002, neoadjuvant chemotherapy was given to 81 women aiming to reduce tumour size and avoid mastectomy. A coil was inserted under ultrasound guidance into the tumour before treatment started. The impact of coil placement on subsequent surgery was assessed prospectively. Clinical response was seen in 69 patients and breast conservation was achieved in 60 cases. In 19 cases (23%) mammography and ultrasound were normal and localization was achieved exclusively by use of the coil. Eight of these 19 (10% of the total) had a complete pathological response; however in the remaining 11 cases (13%) there was residual invasive cancer. This study suggests that in patients undergoing neoadjuvant chemotherapy surgery is still appropriate even when clinical response appears complete. The use of the coil identifies 13% of patients with otherwise undetectable residual disease and is a valuable guide in identifying the site for further surgery.     

PAM cell assay as a tests for multiple-sclerosis associated agent.

Contrary to previous reports, no evidence for a multiple sclerosis-associated agent (MSAA) was obtained when coded brain samples from multiple sclerosis patients and controls were tested in PAM cells.