Quantitation of peripheral vascular versus direct cardiac effects of isoproterenol (0.002 mg/kg) was attempted in a new pharmacologic animal model, the unanesthetized calf, before and after replacement of its natural heart with a pneumatically driven artificial heart (AH). Isoproterenol significantly increased (rho less then 0.01) cardiac output and pulmonary shunt and decreased aortic blood pressure before and after AH replacment. Elevation of cardiac output and pulmonary shunt was greater (rho less than 0.05) and depression of aortic pressure less (rho less than 0.05) before AH replacement than after. Isoproterenol did not change pulmonary artery (PA) or right atrial (RA) blood pressures before AH implantation but did reduce (rho less than 0.05) PA diastolic and mean pressures and increase mean RA pressures after. Systemic vascular resistance was significantly (rho less than 0.01) reduced by isoproterenol before and after AH implantation. Heart rate, 02 uptake, respiratory rate, tidal volume, and minute volume were all markedly increased before AH implantation but unchanged after. These findings demonstrate that approximately half the increase in output and pulmonary shunt and all changes in 02 uptake and respiratory dynamics after administration of isoproterenol are related to cardiac effects of the drug. Our data also suggest that the unanesthetized bovine before and after AH replacement is a unique model for study of the differential pharmacology of drugs with respiratory, cardiac, and peripheral vascular effects.

Animals↗

PubMedDate not supplied

The hospital's role in educating the public.

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California↗

PubMedDate not supplied

Patients with inflammatory bowel disease: their response to information leaflets about medical therapy in particular azathioprine.

Thirty-eight patients with inflammatory bowel disease who had been treated with azathioprine were asked to complete an anonymous questionnaire about information they had received on the drug. Twenty responded of which 16 recalled having had information on azathioprine. Recall of the content on an information leaflet was poor with up to 25% of patients failing to recall warnings about side effects. Documentation of this advice on the clinical notes was also poor with this happening in only one case. This failure to both recall and record information must increase the chances of successful litigation.

Azathioprine↗

PubMedDate not supplied

[The possible relation between hepatitis B vaccination and chronic fatigue syndrome].

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Fatigue Syndrome, Chronic↗

PubMedDate not supplied

Prognostic significance of mammographic detection in a cohort of conservatively treated breast cancer patients.

PURPOSE: This study aimed to evaluate the prognostic significance of nonpalpable mammographically detected breast cancer in a cohort of conservatively treated breast cancer patients. METHODS AND MATERIALS: The records of 953 patients with invasive stage I and II breast cancer treated with conservative surgery and radiation therapy prior to January 1990 were reviewed. Mode of presentation with reference to clinical and mammographic findings was recorded. For statistical analysis, patients were divided into two groups: 748 patients presented with clinically palpable masses with or without mammographic abnormalities (PALP), and 205 presented with nonpalpable mammographically detected tumors (MGDET). RESULTS: Patients in the MGDET group presented with cancers at earlier stages of disease, had tumors of smaller pathological size, were more often hormone-receptor positive, and less frequently required adjuvant systemic therapy. As of December 1995, with a median follow-up of 11.6 years, the MGDET group had a higher 10-year overall survival rate (82% vs 68%) and a superior 10-year distant-metastasis-free rate (87% vs 75%). The ipsilateral breast tumor relapse rate was similar between the PALP and MGDET groups. When broken down by age (< 50 years vs > or = 50 years), the benefits of early detection remained apparent with a statistically significant superior distant-metastasis-free rate in women under age 50 in the MGDET group compared with women under age 50 in the PALP group. In a multivariate analysis, mammographic detection remained an independent prognostic factor for distant-metastasis-free survival. CONCLUSION: Patients presenting with nonpalpable mammographically detected invasive breast cancer have a favorable prognosis compared with their counterparts presenting with clinically palpable masses. Although the issue of lead-time bias cannot be addressed adequately in this retrospective review, the favorable prognosis with respect to disease-free survival and breast conservation is quite evident. The high probability of disease-free survival and breast preservation in these patients should further encourage the widespread using of screening mammography and the increased use of breast-conserving surgery with radiation therapy.

Breast Neoplasms↗