Hormone receptors. An update and application

The introduction of measurements of hormone receptors in breast cancer tumor specimens provides a major advance in selection of patients likely to have hormone-dependent cancers. Endocrine adjuvant treatment for estrogen-positive breast cancers in both pre- and postmenopausal women has been shown to be effective in delaying recurrence. Whenever possible, estrogen and progesterone receptors should be measured in tumor tissue from all patients with breast cancer.     

Quantitative analysis of the acute response to haemorrhage of the renin-angiotensin-vasoconstrictor feedback loop in areflexic dogs.

The importance of the renin-angiotensin-vasoconstrictor system during haemorrhagic hypotension was quantitated in 44 areflexic dogs by determining the ability of the arterial pressure to recover following haemorrhage to 8.8 kPa (66 mm Hg). In 30 animals with intact kidneys, the arterial pressure following haemorrhage rose to a new steady-state level averaging 11.7 kPa (88 mm Hg), which represented 65.3 +/- 1.8 (SE) % compensation. In 18 nephrectomized animals only 24.4 +/- 1.5% compensation occurred. The system exhibited a relatively rapid time course for pressure compensation with the new steady state occurring 19.2 +/- 2.0 min after haemorrhage. Following reinfusion of blood the pressure returned to the pre-haemorrhage in 19.2 +/- 3.0 min. Arterial renin activity was significantly elevated following haemorrhage in the intact kidney group and unchanged in the anephric group. The arterial pressure compensation of two animals with intact kidneys was significantly reduced when the angiotensin-converting enzyme inhibitor (SQ 20881) was infused before the haemorrhage. The results are consistent with a renin-angiotensin-vasoconstrictor mechanism of arterial pressure compensation and indicate that this mechanism possesses sufficient gain and time response characteristics to play a homeostatically significatn role during haemorrhagic hypotension.     

Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone

We have favored treatment of moderate mitral regurgitation and coronary disease with coronary bypass alone because of the high operative mortality of combined mitral valve replacement and coronary bypass. Between 1977 and 1983, coronary bypass alone was performed on 58 patients (mean age 63 +/- 8 years). Preoperatively, 90% had Canadian Cardiovascular Society class III or IV angina, and 10% had class III or IV congestive heart failure. In 72% mitral regurgitation had been caused by coronary disease. Hospital mortality was 3.4% (2/58). At follow-up (100% complete, mean 4.3 years) 66% of survivors were functional classes I and II (compared with 7% preoperatively, p less than 0.0001). Of those patients who worked preoperatively, 84% returned to work. There were no reoperations. The 5-year survival was 77%. In the same period combined mitral valve replacement and coronary bypass was required in 20 unmatched patients with moderate mitral regurgitation and coronary disease. Indications for valve replacement included congestive heart failure (10 cases), high left atrial pressure (three cases), and mitral stenosis (four cases). In these patients with more advanced symptoms the hospital mortality was 25%, and the 5-year survival was 31%. Treatment of moderate mitral regurgitation and coronary disease by coronary bypass alone achieved excellent hospital survival and long-term functional stability without a subsequent valve operation.     

Cataract aspiration with the O'Gawa double-bore cannula

Sixty-eight soft cataracts were removed utilizing the O'Gawa double-bore aspirating-irrigating cannula. The postoperative visual acuity was found to be 20/100 or better in 83% and 20/40 or better in 59% of the 64 cases in which visual acuity was obtainable. In congenital cataracts, associated ocular defects such as strabismus or nystagmus reduced the visual prognosis. All cases of traumatic cataract had associated defects, usually a corneal laceration, however, visual improvement was noted in 81% of the cases. Significant postoperative corneal edema was not seen. Complications attributable to the operation included: rupture of the posterior capsule, insufficient removal of lens cortex, and pupullary block glaucoma. Discission of the posterior capsule was necessary in 26% of the eyes with an intact capsule. Retinal detachment followed the operation in three instances. The O'Gawa double-bore cannula is recommended for the removal of soft cataracts.