Cardiotoxicity evaluation in patients treated with a mitoxantrone combination as adjuvant chemotherapy for breast cancer.

Indices of cardiac function were measured in 49 women who received adjuvant treatment for stage II breast cancer. The combination chemotherapy consisted of six monthly courses of cyclophosphamide, 500 mg/m2, mitoxantrone, 10 mg/m2 and fluorouracil, 500 mg/m2 (CNF). Left ventricular function was assessed by echocardiography, systolic time intervals and nuclear angiography. The values of the echocardiographic left ventricular end diastolic diameter (Dd) and end systolic diameter (Ds), and those of the index of preejection period (PEPI) and the ratio of the preejection period to left ventricular ejection time (PEP/LVET), determined in 41 patients before chemotherapy, at midcourse and after chemotherapy by echocardiography and systolic time intervals (STI), showed a slight but significant increase. All these values remained within normal limits. Resting nuclear angiography, performed before and after treatment, showed a decrease in LVEF by 10% or more in four patients; the postchemotherapy values remained within the normal range in all cases. In conclusion, adjuvant treatment of breast cancer patients with 6 cycles of the CNF combination, as judged by its effect on the measured indices, does not appear to be cardiotoxic.     

Pre-clinical Study of <Superscript>213</Superscript>Bi Labeled PAI2 for the Control of Micrometastatic Pancreatic Cancer

Purpose: The urokinase plasminogen activator (uPA) and its receptor (uPAR) are expressed by pancreatic cancer cells and can be targeted by the plasminogen activator inhibitor type 2 (PAI2). We have labeled PAI2 with ²¹³Bi to form the alpha conjugate (AC), and have studied its in vitro cytotoxicity and in vivo efficacy. Methods and Materials: The expression of uPA/uPAR on pancreatic cell lines, human pancreatic cancer tissues, lymph node metastases, and mouse xenografts were detected by immunohistochemistry, confocal microscopy, and flow cytometry. Cytotoxicity was assessed by the MTS and TUNEL assay. At 2 days post-cancer cell subcutaneous inoculation, mice were injected with AC by local or systemic injection. Results: uPA/uPAR is strongly expressed on pancreatic cancer cell lines and cancer tissues. The AC can target and kill cancer cells in vitro in a concentration-dependent fashion. Some 90% of TUNEL positive cells were found after incubation with 1.2 MBq/ml of AC. A single local injection of ~222 MBq/kg 2 days post-cell inoculation can completely inhibit tumor growth over 12 weeks, and an intraperitoneal injection of 111 MBq/kg causes significant tumor growth delay. Conclusions: ²¹³Bi-PAI2 can specifically target pancreatic cancer cells in vitro and inhibit tumor growth in vivo. ²¹³Bi-PAI2 may be a useful agent for the treatment of post-surgical pancreatic cancer patients with minimum residual disease.     

The relationship between rates of hospitalization for ambulatory care sensitive conditions and local access to primary healthcare in Manitoba First Nations communities: Results from the Innovation in Community-based Primary Healthcare Supporting Transformation in the Health of First Nations in Manitoba (iPHIT) study

ObjectivesThe objective of this study was to assess the performance of models of primary healthcare (PHC) delivered in First Nation and adjacent communities in Manitoba, using hospitalization rates for ambulatory care sensitive conditions (ACSC) as the primary outcome.MethodsWe used generalized estimating equation logistic regression on administrative claims data for 63 First Nations communities from Manitoba (1986–2016) comprising 140,111 people, housed at the Manitoba Centre for Health Policy. We controlled for age, sex, and socio-economic status to describe the relationship between hospitalization rates for ACSC and models of PHC in First Nation communities.ResultsHospitalization rates for acute, chronic, vaccine-preventable, and mental health-related ACSCs have decreased over time in First Nation communities, yet remain significantly higher in First Nations and remote non-First Nations communities as compared with other Manitobans. When comparing different models of care, hospitalization rates were historically higher in communities served by health centres/offices, whether or not supplemented by itinerant medical services. These rates have significantly declined over the past two decades.ConclusionLocal access to a broader complement of PHC services is associated with lower rates of avoidable hospitalization in First Nation communities. The lack of these services in many First Nation communities demonstrates the failure of the current Canadian healthcare system to meet the need of First Nation peoples. Improving access to PHC in all 63 First Nation communities can be expected to result in a reduction in ACSC hospitalization rates and reduce healthcare cost.     

Pediatricians' recommendations for complementary and alternative medical (CAM) therapies.

OBJECTIVES: Increasing numbers of children use complementary and alternative medicine (CAM). The purpose of this project was to assess pediatricians' attitudes and recommendations regarding CAM. METHODS: This was a national survey sent to a random sample of active members of the American Academy of Pediatrics (AAP). The survey was 8 pages long and included questions on demographic and practice characteristics, attitudes about CAM, and 3 clinical vignettes asking what therapies physicians recommended in these situations. RESULTS: The 745 eligible respondents were demographically similar to the national AAP membership. Most (87%) had been asked about CAM by a patient/parent in the 3 months prior to the survey and 34% said they or an immediate family member had used CAM in the past year. Most (66%) believed that CAM therapies could enhance recovery or relieve symptoms, but even more were concerned about possible side effects (75%) or that CAM use might delay mainstream care (74%). Only 20% routinely asked patients/parents about their use of herbs, and fewer asked about other CAM therapies. Fewer than 5% felt very knowledgeable about individual CAM therapies. For the clinical vignettes, pediatricians were far more likely to recommend medications than any CAM therapy. Over 80% of pediatricians desired additional information on CAM; the highest priorities were information about herbs, dietary supplements, nutritional therapies, and therapeutic exercise. CONCLUSIONS: Pediatricians recognize that many patients are interested in using CAM therapies, but do not feel comfortable discussing or recommending CAM therapies. Pediatricians are very interested in learning more about CAM.     

The Evaluation of Suspected Pediatric Sexual Abuse

Children with suspected sexual abuse often present to the ED, not infrequently like those in the 2 cases described. Most children who are sexually abused have normal genital examinations, which should be explained in discussions with caretakers and investigators. Interviewing of the child should be avoided by the physician, except to establish current symptoms that may impact examination or testing. Exams should not be forced on children. The hymen is extremely sensitive in the unestrogenized female and should not be touched. Speculum examination is never performed in the prepubertal child, except under anesthesia by a practitioner experienced in child sexual abuse evaluation or gynecology. Examination under anesthesia by a physician experienced in surgical repair is indicated with active vaginal or rectal bleeding. In cases in which the examination is abnormal or inadequate, the subspecialist should be consulted. Patients with contact less than 72 hours before presentation may need forensic evidence collection, which should be coordinated with the subspecialist. Prepubertal females with vaginal discharge seen on examination should have testing sent not only for STDs, but also for non-STD etiologies including group A streptococcus and enterics. Postexposure prophylaxis (pregnancy, STD, HIV) should be considered when appropriate. There are many conditions that may be mistaken for sexual abuse. Detailed documentation of the history and the physical examination (written, drawings, and ideally photographs) is essential.     

Aktuelle Entwicklungen und Einsatzgebiete von Schulterorthesen

The use of shoulder braces has become more important recently. Although the effectiveness and actual need of different shoulder braces have not yet undergone an evidence-based evaluation, empirical data shows differentiated use of shoulder braces not only in postoperative care but also for non-surgical treatment. For this, not only biological factors (lengths of immobilisation and tissue healing), but also biomechanical factors (pathology-adapted immobilisation) need to be considered.Apart from simple slings, physicians can choose between two different types of braces: soft shoulder braces and rigid shoulder braces. Future studies should evaluate commercially available shoulder braces on their functionality and comfort as well as for potential problems related to different pathologies of the shoulder joint and its clinical outcome.     

Amplitude Integrated EEG in the Preterm Population: A “Trend” in the Right Direction

There are several uses for aEEG in the preterm population today. Many studies have shown that cEEG patterns and aEEG patterns change with increasing gestational and postnatal age. As the understanding the typical aEEG patterns for premature infants has grown, the potential day-to-day practical bedside uses of aEEG in this population are becoming more apparent. Sufficient evidence exists to use aEEG in preterm infants but several questions remain: when to monitor, how long, what will it tell us, and what should I do with the information?