Soluble C-erbb-2 (p185) in breast-cancer patients in relation to prognosis

Serum levels of P185-HER-2 were measured in 137 breast cancer patients and in 40 controls. The patients were divided into 4 groups: group A - 40 newly diagnosed patients; group B - 57 patients on long-term follow-up without active disease; group C - 26 patients with metastatic disease and group D - 5 patients with locally advanced inoperable tumors. The median level in controls was 4.8 U/l. The median P185 serum levels in groups C and D were significantly higher compared to groups A and B. In group C 60% and in group D 100% of patients had baseline elevated levels of serum P185 (>5 U/l) compared to 28% in groups A and B. Of the 14 patients in group A with elevated baseline levels of serum P185, 6 (43%) developed metastasis during the 24-month follow-up period. On serial measurements during follow-up in 23 patients of group A, 3 relapsed and the P185 level increased. In group C, serial measurements in patients with elevated baseline levels of P185 correlated with clinical response to therapy. These data suggest that serum levels of P185 are elevated in patients with metastatic disease. High initial P185 serum levels in new patients may have prognostic significance. Serial measurements of P185 in asymptomatic patients may help in monitoring disease state. In metastatic patients, serial P185 determination may be of benefit in assessing response to therapy.     

Exploring the gender gap in healthcare management

A 1990 study by ACHE and the University of Iowa compared the career attainments and attitudes of a group of male and female healthcare executives. The research showed that among men and women who had entered the field at the same time and had achieved similar educational levels, women did not fare as well as men in terms of salary, position level, or job satisfaction. A follow-up to this study, which consisted of two parts, was conducted in 1995 by ACHE, the University of Alabama at Birmingham, and Lamalie Amrop International to learn whether the gender gap had narrowed. The 1990 study divided respondents into groups according to the year they entered healthcare management: 1971-1975, 1976-1980, or 1981-1985. The first part of the 1995 project was a replication study that paralleled the 1990 study, dividing a new pool of respondents into three groups: 1976-1980, 1981-1985, and 1986-1990. The second part of the follow-up project was a panel study, in which respondents from the 1990 study were surveyed again. Following are highlights from the 1995 study.     

How health networks and HMOs could result in public utility regulation

Health networks and HMOs--as strategies to reform the American health system--are considered by many elected officials and providers to be the most effective way to improve the delivery of medical care at a reduced cost. Strongly swaying these proposals are the fiscal pressures that now require us to harness such entitlements as Medicare and Medicaid. As these health networks and capitated payment approaches are being aggressively forged by hospitals, physicians, and insurers, the probable consequences are that one alliance will eventually dominate most geographic regions (except for our nation's largest metropolitan areas) and these oligopolies will tend to behave as a monopoly. More simply stated, this article argues that many healthcare markets will either evolve into monopolies or, at best, oligopolies.     

Parathyroid anatomy in hyperplasia.

Pathologically enlarged parathyroid glands offer the surgeon a vital medium for studying parathyroid anatomy. The advantages include gland magnification, rapid-section diagnosis to aid dissections, and postoperative clinical and laboratory responses to check for "missed" or supernumerary glands. In this series, each of 71 patients had at least four hyperplastic glands. Both mediastinal and intrathyroidal glands occurred in nine instances (13%), supernumerary glands in eight (11%), and ectopic neck glands in seven (10%). In total, anomalous parathyroid glands occurred in almost half (46%) of these patients with parathyroid hyperplasia.