Long term effects of tamoxifen on blood lipid values in breast cancer.
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Aged↗
Biomedical subjects
R A Wood
Publications and source records attributed to R A Wood.
Modulation of infant formula fat profile alters the low-density lipoprotein/high-density lipoprotein ratio and plasma fatty acid distribution relative to those with breast-feeding.
The effect of breast-feeding was compared with that of two fat-modified milk formulas in 45 infants (15 per group) studied by assessing body weight gain for 4 months and plasma lipids, lipoprotein profiles, fatty acid profiles of plasma and red blood cells, and plasma tocopherol status 3 months after birth. A saturated fat formula with coconut oil/soybean oil (COCO/SOY) had a fatty acid content and polyunsaturated/saturated ratio (P/S, 0.55) comparable with that of human milk fat (P/S, 0.39) and had the same fat energy content (50% kcal). The second formula, with corn oil/soybean oil (CORN/SOY), was highly unsaturated (P/S, 4.6), with only 35% kcal from fat. Energy intake and body weight gain were similar for all groups. Plasma total cholesterol, triglyceride, and phospholipid levels were significantly lower (greater than 20% on average) in infants fed the CORN/SOY formula than in infants fed either the COCO/SOY formula or human milk. Infants fed the CORN/SOY formula also had lower (25% to 35%) plasma low-density lipoprotein cholesterol and apolipoprotein B levels and low-density lipoprotein/high-density lipoprotein and apolipoprotein B/apolipoprotein A-I ratios. Plasma, red blood cell, and cholesteryl ester fatty acids from infants fed COCO/SOY contained less 18:1 and more 18:2; cholesterol esters in plasma from breast-fed infants had the highest 20:4n-6 levels. Plasma tocopherol levels were higher in infants consuming formulas. The presence of cholesterol in human milk appeared to expand the low-density lipoprotein pool and exert an "unfavorable" increase in the low-density lipoprotein/high-density lipoprotein ratio. Thus modulation of infant lipoproteins by changing dietary fat and cholesterol is feasible and in keeping with the known response in adults.
Apolipoproteins↗
Egg hypersensitivity and adverse reactions to measles, mumps, and rubella vaccine.
We evaluated the safety of the measles-mumps-rubella (MMR) combination vaccine in 140 children with egg hypersensitivity. All children, regardless of vaccine skin test results or severity of egg hypersensitivity, were safely immunized with the MMR vaccine. Systemic reactions to MMR vaccine in two nonallergic children were documented, indicating that reactions unrelated to egg protein can occur. With the use of a competitive enzyme-linked immunosorbent assay, the standard MMR injection was found to contain approximately 37 pg of ovalbumin-like material. This study provides 95% confidence that at least 97.5% of egg-allergic children will tolerate MMR vaccine without significant difficulty. Skin testing was not found to be helpful in predicting an adverse reaction. We recommend that the American Academy of Pediatrics consider revising its current policy regarding skin test response to MMR vaccine and administration of MMR vaccine to egg-allergic children.
Anaphylaxis↗
The distribution of cat and dust mite allergens on wall surfaces.
This study was undertaken to determine the distribution of cat and dust mite allergens on wall surfaces and to assess the value of wall-wipe samples as a measure of allergen exposure. Paired samples were collected from 31 homes, 20 homes with cats and 11 homes without, by vacuuming 1 m2 of carpet and by wiping 1 square foot of an adjacent wall. Felis domesticus allergen I (Fel d I) was detected in 30 of 31 settled dust samples (range, not detectable to 832,000 mU/gm; median, 10,250 mU/gm) and in 27 of 31 wall-wipe samples (range, not detectable to 113.7 mU per filter; median, 1.2 mU per filter). There was a significant correlation between Fel d I content in settled dust and wall-wipe samples (rs = 0.73; p less than 0.001). To assess the reproducibility of the wall-wipe method, multiple wipe samples were obtained from 20 homes, revealing a mean coefficient of variation of 110%. In contrast to Fel d I, although Dermatophagoides farinae allergen I was detected in 23 of 25 settled dust samples (range, not detectable to 11,888 ng/gm; median, 1178 ng/gm), it was detected in only four of 25 wall-wipe samples. We conclude that cat allergen, but not dust mite allergen, is widely distributed on wall surfaces and that wipe samples provide a simple and effective means of assessing household exposure to cat allergen.
Allergens↗
Anaesthesia for thoracoscopic pleurectomy and ligation of bullae.
A patient is described who, despite severe pre-operative respiratory disability, had her persistent pneumothorax successfully managed by thoracoscopic pleurectomy. The technique causes considerably less pain and interference with respiratory function postoperatively than does conventional thoracotomy. Potential anaesthetic problems arise because of the necessity of insufflating carbon dioxide at pressures of up to 1 kPa to maintain a pneumothorax during surgery.
Aged↗
Adverse influence of fibrin sealant on the healing of high-risk sutured colonic anastomoses.
The effect of fibrin glue sealing on sutured colonic anastomoses was studied using a 'high-risk' colon anastomosis model in the rat. Animals (n = 104) were randomized to have their sutured anastomosis sealed with fibrin glue or left untreated. They were assessed clinically until they were killed on the fourth day after surgery when contrast radiology, detailed post-mortem examination, anastomotic bursting pressure (ABP) and assessment of adhesion formation were performed. The clinical outcome was worse in the glued group (toxic or death from sepsis: 18 versus seven in the non-glued group; P = 0.0354), which also showed a significantly higher moderate to major leak rate (17 versus two in the non-glued group; P = 0.0009). The median ABP was significantly higher in the glued anastomosis group (96 versus 68 cmH2O in the non-glued group; P = 0.0367). Excessive perianastomotic adhesion formation was significantly greater in the glued group. Microscopic examination showed an extremely intense inflammatory reaction in the glued anastomoses compared with that in the untreated group. These results indicate that sealing of a sutured anastomosis with fibrin glue containing an antiproteinase impairs healing the of anastomotic wound, probably by resisting the ingrowth of vascular granulation tissue during the early stages of repair.
Anastomosis, Surgical↗
Duties of juniors and consultants.
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Clinical Competence↗
Long-term follow-up of elderly patients with locoregional breast cancer treated with tamoxifen only.
One hundred and thirteen women aged 70 years or more with locoregional breast cancer were treated with tamoxifen alone as primary treatment. They were followed for a minimum of 5 years. Complete response occurred in 38 women, partial response in 17, no change in 34 and progressive disease in 24. Where progressive disease occurred, or where patients relapsed after an initial response, the most suitable conventional therapy was given. The actuarial 5-year survival rate was 49.4 per cent for all patients and was much higher (92 per cent) in those showing an initial complete response. Seventy patients (61.9 per cent) were not controlled by tamoxifen alone to death or most recent follow-up. Tamoxifen provides an alternative treatment for operable breast cancer in older women in the short term and may be particularly suitable for those with concurrent disease or who are unwilling to undergo surgery. The low morbidity rate from tamoxifen must be balanced against the need to maintain close follow-up. In the medium to long term, sole primary treatment by tamoxifen delays more definitive therapy.
Age Factors↗
Effect of fibrin glues on the mechanical properties of healing wounds.
Tissue glues are important in clinical practice. Fibrin based glues have many advantages over non-biological adhesives. The optimum formulation of these glues measured by their effect on mechanical properties of healing wounds has not been determined. Using a model involving standard dorsal skin incisions in adult male Wistar rats various glue formulations were compared by varying the fibrinogen, thrombin and factor XIII concentrations. Calcium (40 mumol/ml) and aprotinin (3000 kallidinogenase inactivator units, KIu/ml) concentrations were kept constant. Animals were killed at 8 days and wounds excised. Standard strips of these wounds were mechanically tested using an Instron tensiometer and the stress, strain, elasticity and work required to rupture wounds were calculated. Results indicate that a fibrin glue with a fibrinogen concentration of approximately 39 g/l and a thrombin concentration of 200-600 units/ml with no added factor XIII will result in wounds with significantly increased stress, energy absorption and elasticity values.
Animals↗
Videothoracoscopic ligation of bulla and pleurectomy for spontaneous pneumothorax.
A thoracoscopic technique to ligate pleural bullae and perform parietal pleurectomy is described. The procedure has been performed on 2 patients, allowing definitive treatment of recurrent spontaneous pneumothoraces. Both patients have been cured of their problem and benefited from the decreased trauma of access by reduced postoperative pain, rapid recovery, and decreased scarring of the skin.
Adult↗
Patterns of presentation of breast disease over ten years in a specialised clinic.
A clinic specialising in breast disease has been surveyed over a decade. Detailed information has been collected on 3,500 women with benign breast disorders and 950 with breast cancer. Over this time, the demand for and utilisation of this facility has increased steadily. Over the ten years, there has been a trend for a higher proportion of breast cancers to be smaller in size and for fewer cancers to be locally advanced or metastatic at presentation. Critical appraisal of referral and consultation patterns indicates that the original aims of establishing this clinic have not been maintained. Paradoxically, this is a result of the success of the exercise. Measures which might lead to a higher proportion of patients with breast cancer being managed at the Breast Clinic rather than a General Surgical Outpatient Clinic are discussed.
Adult↗
Potential use of tumour marker CA 15-3 in the staging and prognosis of patients with breast cancer.
The tumour marker CA 15-3 has been assayed in 130 patients with breast cancer and correlated with stage of their disease at presentation. The median value of CA 15-3 (43 kU/l) in 26 patients with stage IV disease was significantly higher than the median for 97 patients classified as stage I or II (17 kU/l). Values were elevated in 18 of 21 (86%) patients with bone metastases at presentation. For the 41 patients with stage I or II disease presenting with levels of CA 15-3 of greater than 20 kU/l, the disease-free interval and survival were significantly less than for 56 patients presenting with levels of less than 20 kU/l. CA 15-3 provides additional information to conventional staging tests for patients presenting with breast cancer and may also have a role as a prognostic indicator. This may be particularly useful in the selection of patients for neoadjuvant therapy.
Adult↗
Value of a multiantigen radioallergosorbent test in diagnosing atopic disease in young children.
The purpose of this study was to investigate the value of a new multiantigen radioallergosorbent test, Phadiatop Paediatric, in the diagnosis of atopy in children less than 7 years of age. The diagnosis of atopic disease was established by history, physical examination, total serum IgE concentration, and the results of prick skin tests or radioallergosorbent tests or both, and then compared with the result of the Phadiatop Paediatric test for each patient. One hundred two patients (62 boys) between the ages of 4 months and 7.3 years were enrolled (median age 3.2 years). After the history and physical examination, 42% of the patients were believed to be atopic and 32% to be nonatopic; the diagnosis was uncertain in 26%. Skin prick test reactions to a variety of foods and inhalants were positive in 41 of 63 children tested; results of radioallergosorbent tests were positive in 35 of 61 children. Overall, atopy was diagnosed in 53 children and 49 were found to be nonatopic. When the clinical diagnosis was used as the gold standard, the Phadiatop test resulted in a correct diagnosis of atopy in 49 of 53 cases and of no atopy in 43 of 49 cases: sensitivity = 92%, specificity = 88%, and efficiency = 90%. Although the Phadiatop Paediatric test does not indicate specific sensitivities, it provides the clinician with a useful screening test for atopic disease in children 7 years of age or less, and the researcher with a means of validating atopic populations.
Child↗
Cytodiagnosis and other methods of biopsy in the modern management of breast cancer.
Since 1970 fine-needle aspiration cytology for breast tumours has grown in popularity and is now routinely used in the initial diagnosis of palpable breast masses in the United States and other parts of the world. Fast staining methods of the aspirate enables reporting within 10 minutes of the aspirate being performed. Training and experience is important in obtaining satisfactory smears for diagnosis, and pitfalls are false-negative and false-positive findings, which may have dire consequences for the patient if cytological diagnosis is the final arbiter. Conditions such as benign mammary dysplasia and sclerosing adenosis are the most common sources of highly cellular smears and often show marked atypia, which makes distinction from carcinoma difficult. Also, atypical papillary formations present a diagnostic problem, and biopsy is indicated to exclude a papillary carcinoma. Fine-needle aspirations very seldom cause traumatic complications, and these are usually of a minor degree. Seeding along the needle track has occurred, but in most cases with a larger-caliber (18 s.e.g.) needle. Aspiration itself has been shown to have no effect on the survival rates in breast carcinoma. Contemporary reports show that around 90% of cases of breast cancer can be detected with confidence by means of this procedure. The reduction in scar formation facilitates future evaluation of the patient as scar tissue often interferes with the interpretation of mammograms. Cost effectiveness is evident in terms of decreased use of anaesthetics and operating time and a reduction in the use of frozen section histology by about 80%.(ABSTRACT TRUNCATED AT 250 WORDS)
Biopsy, Needle↗
Proteinase-like peptidase activities and oestrogen receptor levels in breast cancer tissue.
The relationship between proteinase-like peptidase activities and oestrogen receptor levels and status in breast cancer tissue homogenates from 61 patients with breast cancer has been evaluated. With Spearman's rank-order correlation analysis, significant positive correlations were observed between receptor levels and the activities of cathepsin-(B + L)-like, cathepsin-H-like, trypsin-like, plasminogen-activator-like and elastase-like peptidases. In addition, the activities of all but the latter enzyme were significantly higher in patients with receptor-rich tumours than in receptor-poor tumours, and this may have implications for future treatment regimens for patients with oestrogen-receptor-rich tumours. The findings reported are consistent with the suggestion that in breast cancer there may be an association between steroid receptors and proteolytic enzymes such that the release of these enzymes may be under hormonal control.
Breast Neoplasms↗
The effect of cat removal on allergen content in household-dust samples.
To evaluate the effect of cat removal on cat-allergen content in the home, serial house dust samples were collected from 15 homes during a 9- to 43-week period after cat removal. Samples were obtained with a hand-held vacuum cleaner, and allergen content was quantitated by a radioimmunoassay specific for the major cat allergen, Fe1 d I. Baseline Fe1 d I content ranged from 7.8 Food and Drug Administration units per gram of dust to 436.7 U/gm (median 61.2 U/gm), consistent with levels found in homes with a pet cat. Fe1 d I levels declined gradually in most homes, and by 20 to 24 weeks after cat removal, eight of 15 reached levels consistent with levels found in control homes without cats. In two of those homes, allergen levels fell much more rapidly after aggressive environmental control measures were undertaken. In the other seven homes, however, the decline occurred at a much slower rate, with three homes demonstrating persistent elevations in Fe1 d I content for 20 or more weeks. These data demonstrate that the task of allergen elimination from an indoor environment is extremely difficult, even when the source of a specific allergen can be identified and removed.
Allergens↗
Association of homozygous C4B deficiency with bacterial meningitis.
The fourth component of complement (C4) is encoded by two separate but linked loci (C4A and C4B), each of which produces functionally active C4. Although C4A and C4B share certain antigenic and functional characteristics that identify them as C4, they differ with respect to other structural and functional properties. For example, C4B possesses four times the functional hemolytic activity of C4A. This suggests that homozygous deficiency of C4B might be associated with an increased susceptibility to infection. Forty-six children with bacterial meningitis were examined. Of these, 5 (10.9%) were homozygous deficient for C4B versus 7 (3.1%) of 223 controls (P = 0.038). There was no relation between the prevalence of heterozygous C4B deficiency and meningitis or between the prevalence of either homozygous or heterozygous C4A deficiency and meningitis. These results suggest that homozygous C4B deficiency is a relatively common immunodeficiency disorder that is clinically significant and predisposes children to bacterial meningitis.
Adolescent↗
The child with frequent infections.
In this review, the normal immune system, primary and secondary immunodeficiency diseases, and nonimmunologic causes of recurrent infection have been described. With this information, any child with frequent infections can be evaluated in a sound and logical fashion. The history and physical examination are usually sufficient to rule out a significant immunodeficiency. For those in whom that is not the case, screening laboratory tests, most of which are readily available in hospitals and commercial laboratories, can and should be performed by the primary caretaker. These serve conclusively to rule in or rule out an immunodeficiency disorder in most patients and to establish the need for referral to an immunologist in the rare patient. With a few notable exceptions, the prognosis for children with immunodeficiency diseases has improved dramatically in the past two decades. This progress, fortunately, is certain to continue as the intricacies of the immune system and its genetic basis are gradually unraveled. However, the success of these new technologies depends on the ability of the primary pediatrician to identify these patients early, before permanent structural damage has occurred or a life-threatening viral infection been acquired.
Child↗