Behavior of reticular,vestibular and prepositus neurons terminating in the abducens nucleus of the alert cat

Summary The activity of pontomedullary reticular, vestibular, and prepositus neurons has been recorded in the alert cat during spontaneous and vestibular-induced eye movements. Neurons were identified by their antidromic activation from the abducens nucleus. Spikes of these neurons were used to trigger the recording of field potentials in the abducens nucleus. The analysis by post-spike averaging of the field potentials showed the presence of a trifold system of reciprocal (excitatory and inhibitory) direct projections that originated in the above nuclei and terminated in the abducens nucleus with a distinctly graded effectiveness. This trifold afferent system is involved in the generation of fast eye movements, slow compensatory movements of vestibular origin, and eye fixation, respectively.     

Does the false-negative rate for 1 or 2 negative sentinel nodes after neo-adjuvant chemotherapy translate into a high local recurrence rate?

Prospective trials demonstrate that sentinel node (SN) biopsy after neo-adjuvant chemotherapy (NACT) has a significant false-negative rate (FNR) when only 1 or 2 SNs are removed. It is unknown whether this increased FNR correlates with an elevated risk of recurrence. Tumor Registry data at an NCI-Designated Comprehensive Cancer Center were reviewed from 2004 to 2018 for patients having a negative SN biopsy after NACT. Among 190 patients with histologically negative nodes after NACT having 1 (n = 42), 2 (n = 46), and ≥3 (n = 102) SNs, axillary recurrences occurred in 7.14%, 0%, and 1.96% (p = 0.09), breast recurrences occurred in 2.38%, 6.52%, and 0.98% (p = 0.12), and distance recurrences occurred in 16.67%, 8.70%, and 7.84% (p = 0.27), respectively. Time to first recurrence did not differ by SN count (p = 0.41). After adjustment for age, race, clinical stage, and receptor status, there were no differences in the rates of axillary (p = 0.26), breast (p = 0.44), or distance recurrence (p = 0.24) by numbers of SNs harvested. Median follow-up was 46.8 months. Despite higher post-NACT FNRs reported in randomized trials for patients having <3 sentinel nodes, recurrence rates were not significantly different for 1 versus 2 versus ≥3 SNs. This suggests that patients having 1 or 2 post-NACT SNs identified may not necessitate axillary dissection.     

Breast cancer in young women: Imaging and clinical course

The purpose of this study was to characterize presenting imaging findings in women younger than 40 diagnosed with invasive breast cancer in the context of pathology and clinical course. Retrospective chart and imaging reviews were performed in patients under 40 diagnosed with breast cancer between July 1, 2004, and December 31, 2013. Patient demographic, imaging, pathology, and clinical data were collected. Overall and recurrence-free survival were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were performed to identify factors associated with recurrence-free survival. Our study cohort consisted of 110 patients with invasive mammary carcinoma. One hundred one (91.8%) presented with a palpable mass. The mean size of all lesions on imaging was 3.5 cm ± 2.9 cm. Malignant calcifications were present in 54 (49.1%) cases. Imaging demonstrated multifocal or multicentric disease in 45 (40.9%) cases. Seventy four (67.3%) cancers were high grade. Luminal genomic subtypes were the most common (n = 61, 55.5%). At presentation, 4 (3.6%) patients had bilateral malignancy and 8 (7.3%) patients had distant metastatic disease. Ninety seven (88.2%) underwent neoadjuvant chemotherapy and 67 (60.9%) underwent radiation therapy. Seventy five (68.2%) of the patients underwent mastectomy. The restricted mean time to recurrence was 9.01 years (standard error 3.162 months). ER positivity was associated with compromised recurrence-free survival. The overall survival rate was 0.962 at 10 years. Young patients diagnosed with breast cancer typically present with advanced breast imaging findings and undergo aggressive treatment. Recurrence often occurs >5 years from diagnosis, and ER positive subtypes are at increased risk for recurrence.     

High tension electrical burns

Summary In this study, 85 patients with high-tension electrical burns who were seen in an 11 year period were reviewed. Only victims with documented passage of high-tension electrical current (more than 1000 volts) through the body were included. A total of 210 operations were performed for exploration, debridement and closures of the injuries; 44 cases underwent a total of 65 amputations. Acute renal failure developed in two cases (2.3%) and both died. No cases of clostridial infection occurred. Four patients (4.7%) died in this series. We came to the conclusion that the primary treatment of these burns must include aggressive fluid resuscitation and early aggressive debridement.Presented at the IV European Burns Congress in Barcelona, Spain, September 23–26, 1991     

Primary and preventive care in a university obstetrics and gynecology group practice

Objective: Our purpose was to determine whether primary and preventive care is practiced by a university obstetrician-gynecologist group practice.Study design: A retrospective chart review spanning 2 years of four academic physicians' private practices was performed. A total of 335 patients were reviewed with 739 patient encounters and 1032 patient problems identified. The definition of a primary care physician according to The American College of Obstetricians and Gynecologists was used to standardize data collection and evaluation.Results: Obstetric complaints accounted for 27.7% of all visits, whereas 65.4% were for gynecologic problems. Almost 7% of all complaints were neither obstetric nor gynecologic, and of those 74.6% were primary care problems completely managed by the obstetrician-gynecologist. Only 19.7% of these were referred for management. More than 89% of all encounters () involved some element of primary care.Conclusion: This study provides evidence that the majority of health care provided by the obstetrician-gynecologists is primary care.     

Specific prognostic factors for secondary pancreatic infection in severe acute pancreatitis

BACKGROUND/AIMS: The aim of the present study was to investigate whether there are specific prognostic factors to predict the development of secondary pancreatic infection (SPI) in severe acute pancreatitis in order to perform a computed tomography-fine needle aspiration with bacteriological sampling at the right moment and confirm the diagnosis. METHODS: Twenty-five clinical and laboratory parameters were determined sequentially in 150 patients with severe acute pancreatitis (SAP) and univariate, and multivariate regression analyses were done looking for correlation with the development of SPI. RESULTS: Only APACHE II score and C-reactive protein levels were related to the development of SPI in the multivariate analysis. A regression equation was designed using these two parameters, and empiric cut-off points defined the subgroup of patients at high risk of developing secondary pancreatic infection. CONCLUSION: The results showed that it is possible to predict SPI during SAP allowing bacteriological confirmation and early treatment of this severe condition.     

The magnitude of malnutrition in Latin America

Malnutrition, an illness which can easily be prevented and cured with existing resources and technology, is perhaps the most widespread disease in Latin America. However, it is unrecognized as such, and those population groups that suffer most from it are most prone to have their sufferings unrecorded. Two factors contribute to this: (a) the inaccuracy and incomplete coverage of vital statistics, as reflected by underregistration of deaths, insufficient medical certification of registered deaths, and biases both among certifying physicians and in the International Classification of Diseases; and (b) low population coverage by the health care systems and thus by the statistics which they generate. These factors are related to the ideological bias of those statistical systems and to the concepts of causality which they use. Through a review and analysis of "ad hoc" studies on the frequency of malnutrition in Latin America and its incidence in relation to morbidity and mortality, an estimation is made of malnutrition-caused deaths, which would amount to almost one-fifth of deaths from all causes. As overall availability of food in Latin America is adequate, it is held that this continent ultimately has the level of malnutrition that it wishes to have.     

Multiple myeloma in an adolescent

The radiographic findings of a 15-year-old Brazilian male with diagnosis of multiple myeloma are described. He presented with claudication and recent onset of tender painful swelling of the right mid leg. Radiographs showed wide spread soap bubble lesions of the skull, long bones, spine, pelvis, ribs, shoulders, and clavicles. The diagnosis was confirmed by the presence of a plasmacytoma on tissue biopsy (femur), serum IgG gammopathy and Bence-Jones proteinuria.Supported by grants (CA-20180 and CA-21765) from the National Cancer Institute and the American Lebanese Syrian Associated Charities (ALSAC)