Conserving breasts and relationships.

Comments on the article by S. M. Levy et al. (see record 1993-30639-001) which compared mastectomy to breast conservation surgery. Contrary to expectation, Levy et al. found that patients who chose to have breast-conservation surgery rated themselves as having less energy and receiving less emotional support than did women who chose to have modified radical mastectomies. As this research clearly demonstrates, decisions to conserve or remove a breast have complex consequences, which may well have more to do with the disease itself and the patient's and partner's reactions to it than with any intervening surgical and medical procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mammography versus clinical examination of the breasts

Using published data from screening trials, this article compares two-modality (mammography and clinical examination) and single-modality (clinical examination alone) screening by evaluating cancer detection rates, program sensitivities, mode of cancer detection in two-modality screening, nodal status at time of detection, survival 10 years post-diagnosis, and breast cancer mortality 10 years after entry. Consistently, two-modality screening achieved higher cancer detection rates and program sensitivity estimates than either modality alone; mammography alone achieved higher rates than clinical examination alone; interval cancer detection rates between screening examinations were higher following clinical examination alone than mammography alone; single-modality screening with mammography failed to detect breast cancers identified by clinical examination alone; the sensitivity of mammography was lower in younger than older women, while the reverse was true for clinical examination; and mammography identified a higher proportion of node-negative breast cancer than clinical examination. We conclude that combining clinical breast examination with mammography is desirable for women age 40-49 because mammography is less sensitive in younger than older women. Careful training and monitoring are, however, as essential with clinical examiners as with mammographers.     

Epidemiological and clinical aspects relating to the variability of rheumatoid arthritis

OBJECTIVE: To review epidemiological studies dealing with the temporal and geographic variability in the occurrence of rheumatoid arthritis (RA) and clinical studies that address the variability of severity and manifestations among populations. METHODS: An extensive search of the literature, including a Medline search, was completed. Studies addressing the origin, history, and trends in the occurrence of RA were reviewed first. Next, studies of the prevalence and incidence of RA in different populations were reviewed, and occurrence rates compared. Standardization was attempted by tabulating adult prevalence rates of studies using equivalent sets of criteria. Studies comparing RA patients from two populations were sought next. Finally, studies dealing with explanations of the presumed variability were reviewed. RESULTS: Temporal variability is indicated by paleopathological evidence that RA has existed in the New World since 4000 BC, whereas there is no evidence that it occurred in Europe before the 17th century, or in Africa before the 20th century. Epidemiological studies show a possible trend of decreasing incidence of RA in the United States and Western Europe, whereas reports from Africa note a rising incidence. In white populations of Europe and America, prevalence is approximately 1%, and incidence is 0.03%. Significantly higher rates are found in some North American Indians, and significantly lower rates in some Asian and African populations, even when the different population structures are taken into account. In the latter populations, different patterns of occurrence from those observed in whites emerge, such as greater female preponderance and a much younger peak age at onset. Direct standardized comparisons of two diverse populations of RA patients showed some differences in expression, severity, or manifestations of RA between populations. CONCLUSION: The occurrence and manifestations of RA are temporally and geographically variable.     

Factors relating to varying reactions to the 4-day workweek.

Surveyed the reactions of 474 employees of an accounting division of a large multinational corporation to a 4-day, 38-hr workweek. 90% of the employees had been on the 4-day schedule from 6 mo to 1 yr, and nearly 70% were enthusiastic about the schedule. However, more specific questions, especially questions about work, produced negative responses. Fatigue and slowing down at the end of the day were reported, and servicing of customer needs and meeting with co-workers were more difficult. Supervisors perceived that work quality and output in their units were adversely affected by the 4-day workweek, although company productivity records showed no change. Significant age, sex, and salary differences were found in reactions to the 4-day schedule. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eisenmenger syndrome. Factors relating to deterioration and death

AIMS: To assess the natural history, risk factors for death and deterioration of patients with Eisenmenger Syndrome. METHODS: The clinical course of 188 patients from three different cardiac centres specialized in adult congenital heart defects, followed for a median period of 31 years, was retrospectively analysed. According to the diagnosis, 64 males and 124 females, mean age at last follow-up 33.02+/-12.8 years, were divided into two groups: simple (128) and complex (60) congenital heart disease. Events analysed were: time variation of Ability Index, pulmonary and cerebral complications, non-cardiac surgery, urate metabolism and renal function, arrhythmias, pregnancy and contraception, medical therapy and transplantation, death from all causes and sudden death. RESULTS: Eighty-four percent of the overall population showed a satisfactory Ability Index (1 and 2) at the first attendance (median age 25 years). Patients with complex heart disease and Eisenmenger reaction had earlier clinical deterioration (18.6+/-11.3 vs 26.7+/-12.2) and shorter survival (25.8+/-7.9 vs 32.5+/-14.6 years). Thirty-eight (20.2%) patients had at least one episode of haemoptysis between 20 and 40 years of age but it did not modify overall survival; 25 (13.2%) had pulmonary thromboembolism at a mean age of 35.2+/-13.4 years. Fifteen (7.9%) had a stroke and 7 (3.7%) a cerebral abscess at a mean age of 31.4+/-15.7 and 24.1+/-4.9 years, respectively. Cerebral complications influenced the quality of life but did not modify survival. Patients who had venesection showed a 2.04 times greater hazard ratio for haemoptysis. Venesection did not reduce cerebral complications and in 20% caused anaemia and iron deficiency. Other non-cardiac surgery with general anaesthesia carried risks (23.5% of deaths). Significant maternal mortality (27%) in relation to pregnancy occurred with constant deterioration in physical status, high incidence of spontaneous abortions (35.8%) and cardiac abnormalities in offspring (20%). Sixty-one patients died during follow-up, mainly by sudden death (29.5%), heart failure (22.9%) and from haemoptysis (11.4%). Eight patients had heart and lung transplantation and five died 1 week to 4 years after transplant. Deterioration in Ability Index (worsening symptoms), age, complex defects, blood creatinine level, right ventricular dysfunction and non-cardiac surgery were variables which affected the prognosis adversely with uni- and multivariate analysis. CONCLUSIONS: patients with Eisenmenger syndrome can survive to the seventh decade with informed medical care and protection from special risks     

Theories relating mental imagery to perception.

Reviews contemporary theories of relations between mental imagery and perception in terms of structural, functional, and interactive theories. Structural theories propose that mental images exhibit the same spatial and pictorial properties as real physical objects. Functional theories propose that the formation and transformation of mental images contribute to object recognition and comparison. Interactive theories propose that imagery contributes directly to ongoing perceptual processes. The evidence for each type of theory is critically evaluated in view of the following alternative accounts: task-induced demand characteristics, experimenter bias, tacit knowledge, and eye movements. Efforts to rule out these alternatives have had varying degrees of success, with the consequence that the 3 types of imagery theories differ in the extent to which they have been confirmed (i.e., none of the 3 types of imagery theories is universally free from challenges from at least some of the alternative accounts). (4 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex specific issues relating to nuclear cardiology

Coronary heart disease is a major source of morbidity and mortality in women. Despite the importance of this health problem, women in general have not received the same degree of aggressiveness in diagnosis and treatment as men have received. Contributing to underdiagnosis and undertreatment in women include the results of the Framingham study, which showed that women with angina have better prognoses than men, and the results of multicenter percutaneous transluminal coronary angioplasty and coronary artery bypass grafting trials, which showed that women have higher morbidity and mortality rates in the periprocedure periods. These higher morbidity and mortality rates can largely be explained by the older ages of women when they have symptomatic coronary heart disease and the attendant higher incidence of comorbid diseases in an elderly population. Because of the cardiovascular protective effects of estrogen, the incidence of disease of the epicardial coronary arteries in the absence of significant risk factors in premenopausal women is very low despite the fairly high incidence of chest pain syndromes. Some of these women may have endothelial dysfunction, some small vessel disease, and some may have the visceral pain syndrome. When coronary heart disease does present in middle-aged women, it tends to be less severe than in middle-aged men. The recognized limitations of stress perfusion imaging in single vessel disease, as well as resolution limitations in small hearts and limitations due to soft tissue attenuation artifacts, all must be considered when imaging women. Applications of nuclear techniques to some of the unique aspects of chest pain in women such as small vessel disease or endothelial dysfunction represent as yet unmet challenges.     

On resistance to persuasive communications.

3 separate experiments were done at different universities to test the hypothesis that a persuasive communication that argues strongly against an opinion to which the audience is committed will be more effective if the audience is somewhat distracted from the communication so that they cannot adequately counterargue while listening. 2 films were prepared, each containing the same communication arguing strongly against fraternities. One was a normal film of the speaker making a speech. The other film, with the same track, had an utterly irrelevant and highly distracting visual presentation. Fraternity men were more influenced by the distracting presentation of the persuasive communication than by the ordinary version. There was no difference between the 2 for nonfraternity men. In general, the hypothesis concerning the effect of distraction was supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current aspects and problems relating to medical ethics in oncology

A case history of a breast cancer patient is used to exemplify ethical dilemmas in medical oncology: information of a cancer patient and his family, ethical problems with genetic testing, ethical issues with do-not-resuscitate-orders, ethical dilemmas with limited resources, problems with insurance companies, ethical issues in clinical trials and questions in dying patients including physician-assisted suicide and active euthanasia. Medical oncologists have to develop skills in recognizing ethical dilemmas in patient care and must prepare to cope with the many and complex ethical issues in the care of oncology patients.     

Angiogenesis: new aspects relating to its initiation and control

Angiogenesis, the formation of new microvessels from parent microvessels, involves remodeling the basement membrane and interstitial extracellular matrix (ECM) using degrading proteases produced by the endothelial cells (ECs) and other adjacent cells, and the synthesis of ECM molecules by these cells. Degraded ECM releases previously bound heparin-binding cytokines (and growth factors) which are able to act as ligands to high-affinity receptors on various target cells, including ECs. The EC carries receptors for a number of cytokines which are produced by neighboring cells or released from the ECM and which can either induce or suppress the angiogenic phenotype of the EC. ECs are able to synthesize and secrete cytokines with auto- and paracrine effects. Angiogenesis, which virtually never occurs physiologically in adult tissues (except in the ovary, the endometrium and the placenta), is essential in wound healing and inflammation. Angiogenesis is, in fact, strictly controlled by a redundancy of pro- and anti-angiogenic paracrine peptide molecules, some of which have recently been described. The expression and synthesis of two distinct anti-angiogenic factors is, for example, controlled by the p53 tumor suppressor gene. In certain hypoxic conditions, chronic inflammatory diseases and syndromes, angiogenesis is of pathogenic and prognostic significance. Angiogenesis is, moreover, essential for the growth and metastatic spread of solid tumors. This indicates the potential for developing new therapeutic strategies not only for tumors but also in diseases such as rheumatoid arthritis, psoriasis, liver cirrhosis and diabetic retinopathy. Moreover, the therapeutic induction of angiogenesis in ischemic tissues using recombinant cytokines is also promising for clinical application. In fact, the first successful human gene therapy for stimulating angiogenesis has recently been reported.     

Bilateral primary lymphoma of the breasts detected in pregnancy

The authors report a case of bilateral primary malignant lymphoma of the breast presenting during pregnancy in a 24-year-old woman. After delivery of a healthy premature infant by Caesarean section, polychemotherapy was employed. The efficacy of the treatment could not be evaluated since the patient died within a very short period of time. Autopsy and histological examination revealed infiltration of Burkitt-type lymphoma in the breast, ovary, brain, liver, kidney, adrenal gland, pancreas, stomach, bone marrow and myocardium.     

Relationship between patient-doctor compatibility, mutual perception, and outcome of treatment.

An investigation was designed to study the effects of patient-doctor Fundamental Interpersonal Relations Orientation Behavior (FIRO-B) scale compatibility upon outcome of hospital treatment and upon perceptions developed of each other in the dyadic relationship. The latter variable was measured by administration of a Semantic Differential Scale under differing instructonal "sets." A total of 25 voluntarily hospitalized female patients and 3 psychiatric residents participated. The degree of compatibility existing between patient and doctor was found to have been positively correlated with outcome of treatment. This effect upon outcome of treatment appeared to have occurred through the differential effect the compatibility variable had upon the way the resident was perceived by the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the law relating processing to storage in working memory.

Working memory is usually defined in cognitive psychology as a system devoted to the simultaneous processing and maintenance of information. However, although many models of working memory have been put forward during the last decades, they often leave underspecified the dynamic interplay between processing and storage. Moreover, the account of their interaction proposed by the most popular A. D. Baddeley and G. Hitch's (1974) multiple-component model is contradicted by facts, leaving unresolved one of the main issues of cognitive functioning. In this article, the author derive from the time-based resource-sharing model of working memory a mathematical function relating the cognitive load involved by concurrent processing to the amount of information that can be simultaneously maintained active in working memory. A meta-analysis from several experiments testing the effects of processing on storage corroborates the parameters of the predicted function, suggesting that it properly reflects the law relating the 2 functions of working memory. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

New evidence relating to the nature and origin of the hairy cell of leukaemic reticuloendotheliosis

A procedure is presented for the purification of specific mRNAs, which exploits the ability of antibodies prepared against a native protein to bind to the nascent polypeptide on the polysome. Rather than precipitating these soluble antibody-polysome complexes with anti-antibody, which can lead to nonspecific trapping of polysomes, we have linked the anti-antibody to an insoluble matrix. Thus, the antibody-polysome complex binds to the anti-antibody support and nonspecific polysomes can easily be removed by several washes. We have found para-aminobenzyl cellulose (PAB cellulose), to be a suitable matrix for this purpose. This support can bind large quantities of anti-antibody and it displayed no detectable nonspecific affinity for polysomes or RNA. Using this procedure, we have obtained an apparently homogeneous preparation of ovalbumin mRNA.