Combined modality treatment of stage III and inflammatory breast cancer. M.D. Anderson Cancer Center experience

Seven hundred fifty-two patients with stage III disease (of those, 178 patients with inflammatory carcinoma) were treated with a combined modality approach at our institute in seven prospective studies. After three to four cycles of chemotherapy, each patient was treated with local therapy. An estimated 54% of patients with stage IIIA disease and 24% of patients with stage IIIB disease were free of disease. An estimated 30% of patients with inflammatory carcinoma of breast were free of disease beyond 10 years with this approach.     

Exocrine pancreatic secretion in man following one week of M1-muscarinic receptor blockade

A double-blind, randomized, placebo-controlled crossover study was performed to assess the influence of one week of selective M1-muscarinic receptor blockade on pancreatic exocrine secretion in man. Ten healthy subjects received telenzepine (3 mg p.o.) and placebo each for 8 days, with a 6-day drug-free washout interval between treatment sequences. On Day 8 of each sequence, pancreatic secretion was stimulated for 2 h by infusion of submaximal secretin (0.2 U.kg/h) followed by maximal stimulation with secretin (1.0 U.kg/h) and ceruletide (120 ng.kg/h). Telenzepine had no significant effect on secretory parameters during submaximal stimulation with secretin. During maximal stimulation, total protein, secretory volume, and output of amylase, trypsin and bicarbonate were unexpectedly increased by telenzepine. These findings might be partially explained by removal of the inhibitory influence of pancreatic polypeptide, which was depressed by telenzepine. Acute studies have shown that M1-receptor antagonists inhibit exocrine secretion. Our results suggest that adaptation of physiological mechanisms governing the exocrine pancreas may occur after one week of receptor blockade by a therapeutic dosage of telenzepine, to the extent that M1-blockade no longer inhibits secretion.     

Imaging findings in patients with-right lower quadrant pain: alternative diagnoses to appendicitis

Patients with right lower quadrant (RLQ) pain referred for imaging studies with a clinical diagnosis of appendicitis may have other pathologic conditions mimicking appendicitis. Appropriate diagnostic imaging may establish other specific diagnoses and thereby play a significant role in determining proper medical or surgical treatment. In this pictorial essay, we present a spectrum of imaging findings in patients whose clinical features were suggestive of appendicitis, but the diagnoses of a broad spectrum of other diseases were established with the imaging studies. The differential diagnoses of diseases mimicking appendicitis are reviewed.     

Effect of helical CT on the frequency of sedation in pediatric patients

OBJECTIVE: We compared the use of sedation for helical CT examination of pediatric patients with that for conventional CT studies. MATERIALS AND METHODS: We retrospectively compared two 4-month periods of CT examinations that differed only in that conventional CT was routinely used in one period and helical CT was exclusively used in the other period. For these two periods, we compared the type and number of CT examinations, the sedation used (if any), and the age of patients who required sedation. RESULTS: We performed 1055 conventional CT examinations in 762 pediatric cancer patients. Of the 264 children who were 8 years old or younger, 107 had been sedated. In comparison, 1195 helical CT examinations were performed on 838 patients: of the 246 children 8 years old or younger, 51 received sedation. For both study groups, the mean and median age of the patients was 4 years old. The mean age of patients requiring sedation was 21 (conventional CT) or 20 months (helical CT); the median age of patients who required sedation was 2 years old for both study groups. Patients who were 8 years old or younger and who underwent helical CT required sedation 49% less frequently than such patients who underwent conventional CT. The most dramatic reduction occurred among patients who were 3 years old or younger (p < or = .004). CONCLUSION: Use of helical CT reduced the need for sedation among our pediatric patients. Fewer sedations may reduce the risk of complications, decrease disruption of the patient's normal daily activities, and improve patient throughout. The associated savings in personnel time and pharmaceutical costs can be redistributed.     

Personal social networks and HIV status among women on methadone

This objective of this study was to examine the association between a women's HIV status and specific (IDUs) characteristics of her social networks with respect to (1) number of injection drug users (2) number of drug partners and (3) number of HIV-positive contacts in her personal networks, after controlling for the respondent's demographic characteristics and drug use. Participants were recruited through posted announcements in three methadone clinics in Harlem, New York City. Individuals were considered eligible if they were enrolled as patients in one of the clinics for at least three months. A social network questionnaire modeled after the General Social Survey network section was developed by the investigators. Face-to-face interviews were conducted by trained interviewers and included demographics, drug use, self-reported HIV status of the woman and her network members, and the social network structures. Univariate analyses found that HIV-positive and HIV-negative women had different network profiles. HIV-positive women were more likely to associate with a higher number of current drug users, injection drug users, injection drug users who were HIV-positive, drug partners, drug partners who used injection drugs, and drug partners who were HIV-positive. Multivariate analyses indicated that HIV-positive respondents were more likely to associate with HIV-positive network members than their HIV-negative counterparts. The findings suggest that to better understand the spread of HIV among female drug users and to design more effective HIV/AIDS prevention programmes, efforts should move beyond focusing on individual attributes to address the contextual dynamics of social networks.     

Gramicidin channel kinetics under tension

We have measured the effect of tension on dimerization kinetics of the channel-forming peptide gramicidin A. By aspirating large unilamellar vesicles into a micropipette electrode, we are able to simultaneously monitor membrane tension and electrical activity. We find that the dimer formation rate increases by a factor of 5 as tension ranges from 0 to 4 dyn/cm. The dimer lifetime also increases with tension. This behavior is well described by a phenomenological model of membrane elasticity in which tension modulates the mismatch in thickness between the gramicidin dimer and membrane.