Psychological and Aesthetic Outcomes in Breast Cancer Patients.

BACKGROUND: Patients who undergo breast cancer treatment require psychosocial and aesthetic rehabilitation. Advantages of breast reconstruction in-patient rehabilitation are well known. Oncoplastic organ-preserving surgery offers aesthetically better results, yet is often considered less safe than more radical procedures. We compared the aesthetic and psychological outcomes in patients undergoing breast reconstruction and oncoplastic breast cancer treatment. METHODS: In total, 1130 patients who received either breast reconstruction or oncoplastic breast cancer surgery were included in the study. Patients were classified into two groups. Group 1 included 510 patients who received breast reconstruction surgery. Group 2 included 620 patients who received oncoplastic surgery. The following aspects were compared between the two groups: demographics, tumor progression, and immunohistochemical aspects, complications, hospitalization stay, and psychological and aesthetic outcomes. RESULTS: Patients in the oncoplastic group showed statistically significant higher psychosocial and aesthetic outcomes, as well as lower incidence of complications, revision rate, disease progression, and recurrence. The majority of oncoplastic patients were treated in early stages of breast cancer. CONCLUSION: Offering superior treatment results, oncoplastic organ-preserving surgery should be favored in patients with earlier stages of cancer progression.

Botulinum Toxin Type A as a Tool for Correcting Capsular Contracture after Reconstructive Breast Surgery.

Capsular contracture is one of the most common complications after breast reconstruction. Surgical treatment is the main option for capsular contracture correction and includes capsulotomy, capsulectomy, and removal/replacement of the affected implant. However, the surgical trauma from reoperation, along with reduced quality of life, in patients with clinically significant capsular contracture has prompted a search for alternative treatment options. The use of the botulinum toxin type A in the treatment of neurological diseases and of keloid scars in aesthetic practice nudged the idea of using the same toxin for the correction of capsular contractures in breast cancer patients. Botulinum toxin type A injection is an easy procedure requiring no anesthesia or inpatient care. The treatment has few side effects. In addition, the injection does not cause sensory loss or dysesthesia. We described a clinical case of the capsular contracture correction using incobotulinumtoxin A. Capsular contracture IV developed 4 months post surgery after long-term lymphorrhea. Radiation therapy was not performed. According to the internal protocol, the patient was advised to undergo incobotulinumtoxin A treatment instead of surgery. Within 1 week after the second injection, all symptoms decreased-specifically, the general shape of the reconstructed breast. Also, the pain syndrome disappeared.

Spectrum of infections in splenectomised thalassaemia patients.

Splenectomised thalassaemia patients are at risk of developing sepsis. As the infection may be life-threatening, treatment should be sought and given promptly. A retrospective study was performed amongst our thalassaemia major patients who were splenectomised. The vaccination status of each patient and the types of infections seen were reviewed to obtain a local perspective. In our cohort of 49 splenectomised patients, 25 patients required hospitalization for the treatment of infection. There were a total of 40 febrile episodes within this hospitalised group of which 27.5% were microbiologically documented infection with bacteraemia. The predominant causative organisms were gram negative rods and three patients succumbed to overwhelming septicaemic shock as a result of delayed presentation. Sixty percent of the febrile episodes were clinically documented infection and comprised mainly upper respiratory tract infections. Based on the spectrum of infections seen, there is a need to improve the patients' awareness level so that early treatment is sought. There is also a need to re-address the approach towards vaccination in this immunocompromised group of patients by administering a booster pneumococcal and influenza vaccination in an attempt to reduce morbidity.

Laparoscopic ovariectomy in standing donkeys by using a new instrument.

Bilateral laparoscopic ovariectomy was performed in six female donkeys. Laparoscopic ovariectomy was performed in standing position by using a new laparoscopic instrument which was developed by the authors. We used the instrument for isolation, coagulation and cutting of mesovarium. One laparoscope portal and two instrument portals were located in each paralumbar fossa. The ovary was removed through an enlarged second portal. The contralateral ovary was removed through the opposite paralumbar fossa. Hemostasis, coagulation and cutting of the mesovarium were achieved successfully using the new laparoscopic instrument. The time required for removal of each ovary was between 2 and 4 min (average 2.8 min). While the total time of unilateral ovariectomy was between 10 and 15 min (average 12 min). No additional ligature was required in all operations. There was no complication, hemorrhage or oozing of blood from the mesovarium during or after the operations. In conclusion, laparoscopic ovariectomy in donkeys by using this new instrument was safe and effective. The new instrument reduced the time of operation and provided a viable hemostasis and coagulation for blood vessels within the mesovarium. Also cutting of the mesovarium was very easy.

Assessment of bovine sperm viability by MTT reduction assay.

The MTT reduction assay depends on the ability of metabolically active cells to reduce the tetrazolium salt (3[4,5-dimethylthiazol-2-y1]-2,5-diphenyltetrazolium bromide) to formazan. This study was conducted to examine and validate a simple and less costly MTT test to determine bovine sperm viability and compare the efficiency of this test with a flow cytometer. Fresh ejaculates from eight bulls were included in this study. Semen sample was diluted to 30x10(6) sperms/ml in a Hepes 0.1% BSA. The rates of MTT reduction were measured in microtiter plates after incubation for 1h at 37 degrees C using spectrophotometer (MS2 Reader) at wave length 550nm. Simultaneously split samples of the same semen were tested, using a flow cytometer for sperm viability, mitochondrial activity, and acrosomal integrity using SYBR-14, Rhodamine 123 and LysoTracker Green DNA-26, respectively. The correlation between the results of these tests was calculated using the Pearson correlation coefficients. The results revealed a strong correlation (P<0.001) between the results of MTT reduction rate and the results that simultaneously determined by flow cytometer, yielding correlation coefficients of r=0.950 for sperm viability, of r=0.926 for mitochondrial activity and of r=0.959 for acrosomal integrity. The same correlation coefficient was observed between the values of sperm viability calculated on the basis of MTT reduction rates and the results of flow cytometer. In conclusion, the MTT reduction test was found to be a reliable method in evaluating bovine semen viability and can be used successfully, especially in routine analysis, where practical aspects such as time, costs and practicability are important.

Application of MTT reduction assay to evaluate equine sperm viability.

The assay of MTT reduction depends on the ability of metabolically active cells to reduce the tetrazolium salt (3[4,5-dimethylthiazol-2-y1]-2,5-diphenyltetrazolium bromide) to formazan. This study was conducted to examine and validate of a simple and less costly MTT test in determining equine sperm viability and compare the efficiency of this test with a flow cytometer. Fresh ejaculates from 11 stallions (warm blood) were included in this study. Semen was diluted to 100 million cells/ml in a Hepes 0.1% BSA. The rates of MTT reduction were measured in microtiter plates after incubation for 1 and 4h at 37 degrees C using spectrophotometer (MS2 Reader) at wavelength 550 nm. Simultaneously split samples of the same semen were tested, using a flow cytometer for mitochondrial activity, sperm viability, and acrosomal integrity using Rhodamine 123, SYBR-14 and LysoTracker Green DNA-26, respectively. The results revealed a strong correlation (P < 0.001) between the results of MTT test at 1 and 4 h of incubation time and the result of mitochondrial activity (r = 0.978, 0.977), sperm viability (r = 0.954, 0.977) and acrosomal integrity (r = 0.867, 0.886). In conclusion, the MTT test was found to be a reliable method in evaluating semen viability and can be used successfully, especially in routine analysis, where practical aspects such as time, costs and practicability are important.

Dose to superficial node for patients with head and neck cancer treated with 6 MV and 60Co photons.

The superficial neck nodes in only 1 out of 7 patients with head and neck cancer studied received more than 90% of the prescribed dose when treated with opposed 6 MV photons. Beam spoilers placed upstream from the patient enhanced the dose to the superficial node at the expense of higher dose to the skin.

Quantitation of estrogen and progesterone receptors by immunocytochemical and image analyses.

Compared to other techniques, the ability to detect estrogen and progesterone receptors by immunocytochemical analysis in formalin-fixed, paraffin-embedded sections has clear advantages, including the ability to assay small biopsy specimens, fine-needle aspirate samples, and archival material. Twenty-two cases of breast carcinoma were evaluated for estrogen and progesterone receptors by immunocytochemical analysis and enzyme immunoassay. Using a true color-based image analysis system, histograms of area versus the optical density of the positive staining nuclei were generated. A binary decision algorithm was derived from these histogram parameters by the CART computer program. Estimates generated by the algorithm for image analysis/immunocytochemical analysis had a 90% concordance with the enzyme immunoassay values. It is concluded that quantitative immunocytochemical results for estrogen and progesterone receptor content in formalin-fixed, paraffin-embedded tissue can be generated using image analysis.

Protease inhibitor drug levels in the management of human immunodeficiency virus-1 antiretroviral therapy.

In order to evaluate the relationship between protease inhibitor (PI) plasma concentrations and viral suppression in individuals receiving highly active antiretroviral therapy (HAART), plasma concentrations and area under the time concentration curve (AUC(0.5-4)) for 35 HIV-infected adults receiving their initial (or first salvage) nelfinavir- (NFV) or indinavir (IDV)-based HAART were studied. Two groups were evaluated: those who had achieved HIV-RNA suppression (HIV-RNA <500 copies/mL, group 1, n=21) and those who had achieved incomplete HIV-RNA suppression (HIV-RNA>500 copies/mL, group 2, n=14) at the time of study entry. NFV one-hour pre-dose concentrations were significantly higher in group 1 compared to group 2 (P=0.023). The NFV AUC(0.5-4) for group 1 approached significance (P=0.068). No significant differences in IDV concentrations or AUC(0.5-4) were found between group 1 and group 2. It is feasible to use PI drug level monitoring in the outpatient setting.

Effect of dystocia on serum haptoglobin in Awassi ewes.

Serum haptoglobin concentration was determined in 102 Iraqi Awassi ewes. Blood samples were collected from 82 ewes before the correction of dystocia, 10 ewes with eutocia 2 to 4 h after parturition and 10 nonpregnant ewes during the seasonal anestrus phase. The mean serum haptoglobin concentration was significantly higher (P < 0.01) in ewes with dystocia than in ewes with normal births and in the nonpregnant ewes. No significant difference was found between serum haptoglobin concentrations of ewes with ringwomb and ewes with dystocia due to other causes. There was a significant elevation (P < 0.01) of serum haptoglobin in cases treated 24 h after labor compared with those treated during the first 24 h. Significant (P < 0.05) differences were found between serum haptoglobin concentrations in ewes treated surgically and those treated manually.

Effect of interferon therapy on fatty acid saturation index in hepatitis C virus infection.

The ratio of stearic to oleic acids, i.e. the fatty acid saturation index, in red blood cell membranes was assayed in 60 patients with chronic hepatitis C virus infection before and after interferon-alpha therapy. Results were compared with 20 healthy controls. Hepatitis C virus titre was also assayed before and after interferon-alpha therapy. Within 2-5 months following interferon-alpha therapy, a significant inverse correlation was observed between saturation index and hepatitis C virus load. We conclude that hepatitis C virus infection enhances the degree of desaturation of 18-carbon fatty acids and that interferon-alpha is involved in their metabolism by increasing the degree of saturation and subsequent decrease in membrane fluidity.

Human papillomavirus testing in the clinical laboratory. Part I: squamous lesions of the cervix.

The aim of this study was twofold: (1) to evaluate the contribution of viral (HPV) testing for improving the sensitivity of cervical cytology and (2) to correlate HPV types with the histology of the detected cervical cancer precursors, particularly the low-grade, CIN I variant. We used the dot blot hybridization technique (ViraPap) and polymerase chain reaction (PCR) in 63 women referred to our colposcopy clinic for evaluation of an abnormal Pap test. Histopathologic samples obtained by multiple colposcope-directed punch biopsies were used for a diagnostic gold standard. Among the 53 women with histologically proven CIN, precolposcopy cytology was positive in 38 (72%) compared to 53% and 60% HPV positivity by ViraPap and PCR, respectively (p less than 0.01). When the yields of ViraPap/PCR and cytology were combined, however, the detection rate of CIN was 91%, a significant improvement over cytology alone (p less than 0.02). HPV DNA was found either by ViraPap or PCR in 45 of 63 (71%) biopsy specimens, and 37 of 38 (97%) HPV-positive CIN, including the low-grade CIN I variant, contained oncogenic HPV types. HPV type 16 was present in 22 of 38 (58%) CIN lesions and mixed with HPV 6/11, 18, or the 30s group in 6 of 38 (16%) of the cases. HPV 6/11 alone was found only in 1 case of CIN I (2.7%). HPV testing by molecular technology increases the sensitivity of cytology.(ABSTRACT TRUNCATED AT 250 WORDS)

Human papillomavirus testing in the clinical laboratory. Part II: vaginal, vulvar, perineal, and penile squamous lesions.

The accurate diagnosis of HPV-related diseases of the lower genital tract requires expertise, and sometimes even the expert may face a dilemma as to the precise nature of the biopsies submitted from colposcopically suspicious HPV-related lesions. We have evaluated the role of viral testing using dot blot hybridization (ViraType) and PCR in the diagnosis of histologically typical (42 cases) and equivocal (30 cases) squamous intraepithelial lesions of the vagina (7), vulva (30), perianal epithelium (3), penis (31), and scrotum (1). The viral kits were used according to the manufacturer's instructions in a routine laboratory setting, and the probes available were HPV 6/11, 16, 18, and 31, 33, 35 (the 30s group). HPV DNA was found in 45 of 72 (62%) of all lesions. PCR was more sensitive (58%) than ViraType (39%) for detecting HPV DNA sequences (p less than 0.02), particularly in equivocal lesions (EQHPV), 14 of 30 (47%) by PCR vs 4 of 30 (13%) by ViraType (p less than 0.004). The majority of lesions contained oncogenic type viruses irrespective of their histologic presentation, namely, type 16. Only condylomata acuminata were predominantly HPV 6 or 11 positive. Viral testing may play a role in the quality control of the diagnostic expertise of routine laboratories as well as ascertaining the HPV-relatedness of histologically equivocal lesions of the anogenital tract. In view of the relatively high false-negative rates for detecting HPV DNA by ViraType and PCR, only a positive test may be meaningful unless other HPV types are added.

Stimulation of bovine sperm mitochondrial activity by homeopathic dilutions of monensin.

Mitochondrial activity is an important viability parameter of spermatozoa and is linked to sperm motility. Monensin is commonly used as an inhibitor for sperm mitochondrial activity in the laboratory. This study was conducted to evaluate the influence of some homeopathic dilutions of monensin on sperm mitochondrial activity. Fresh ejaculates from 6 mature bulls were used in the study. Samples of the semen were tested using a flow cytometer for mitochondrial activity and sperm viability using Rhodamine 123 and SYBR-14, respectively. The 9x dilution of monensin resulted in very highly significant (P<0.001) stimulation of mitochondrial activity. Monensin 5x, 7x, 8x and 13x caused highly significant (P<0.01) stimulation of the sperm mitochondrial activity. Other homeopathic dilutions of monensin (6x, 10x, 11x, 12x and 14x) also had a significant (P<0.05) stimulatory effect. The use of monensin did not have any negative effect on sperm viability. We conclude that some homeopathic dilutions of monensin increase mitochondrial activity of bovine spermatozoa without negative effect on sperm viability, the 9x dilution was the most effective. Further in vivo studies are required to estimate the effect of homeopathic dilutions of monensin on semen quality.

Quantitation and morphometric analysis of tumors by image analysis.

Digital image analysis provides objective measurements of tissue and cell analytes previously interpreted subjectively. Both analyte concentration determination and morphometric analyses are possible. Calibration of the instrument and the use of standards and controls are essential for precise and reproducible quantitation of the analyte. Multi-tissue blocks ensure reproducible staining of the batch in quantitative immunohistochemical assays such as breast cancer estrogen and progesterone receptors. These multi-tissue blocks can be shared among laboratories to reduce interlaboratory variation and to objectively quantitate estrogen and progesterone receptors in clinical trials. In colon carcinoma, p53 can be quantitated objectively by image analysis. In prostate carcinoma, morphometric analysis of nuclear shape, nuclear roundness factor, and variations in nuclear size are objective measurements which constitute the pathologist's nuclear grade. Developments in instrumentation have now made it possible to combine analyte determination (such as DNA ploidy) and morphologic analysis of tumors, a diagnostic improvement over either method alone. A study employing image analysis to detect and quantitate androgen receptors and p53 in formalin-fixed, paraffin-embedded prostate cancer biopsies is underway to determine the utility of androgen receptors in predicting response to hormonal therapy. Histopathological features such as nuclear size, shape, and pleomorphism must be converted to image features such as area, shape factor, and variance of the area; this feature vector must be correlated with the pathologist's expert opinion or diagnosis. Other applications of image analysis include quantitation of immunofluorescent assays such as anti-nuclear antigen or anti-cytoplasmic nuclear antigen. Fluorescent image analysis provides more precision and greater reproducibility, as well as reduced test costs.(ABSTRACT TRUNCATED AT 250 WORDS)

Prostate-specific antigen and prostate volume: a meta-analysis of prostate cancer screening criteria.

OBJECTIVE: To establish the value of serum prostate-specific antigen (PSA) and prostate-specific antigen per unit volume of prostate gland (PSAD) in detecting prostate carcinoma (CaP) in a hypothetical screening algorithm, a meta-analysis of the sensitivities, specificities, predictive values and likelihood ratios were combined from the published data. DATA SOURCES: Journal articles identified by a MEDLINE database search from 1988 to October 1992, using prostate-specific antigen as a key word were used to calculate the distribution of PSA in healthy men, men with benign prostatic hyperplasia (BPH) and men with prostate carcinoma (CaP). STUDY SELECTION: Only studies that contained the specified serum PSA values and patient outcomes were included. DATA EXTRACTION: The distributions of the serum PSA were plotted versus serum PSA for healthy men (2567), men with BPH (798) and men with CaP (835) from the abstracted data. Prostate volume distributions were estimated from the published transrectal ultrasound (TRUS) calculations. DATA SYNTHESIS: Hypothetical cohorts of 1,000 men between the ages of 60 and 70 years were screened using three different screening decision algorithms. Using a serum PSA cutoff of 3.0 ng/ml for referral for transrectal biopsy, 59 of 80 (74%) CaP would be detected and 21 (26%) would be missed. 209 transrectal biopsies would be performed, and 150 (72%) of them would be negative for CaP. Using a serum PSA cutoff of 4.0 ng/ml, 52 of 80 (65%) CaP would be detected and 28 (35%) would be missed. 146 transrectal biopsies would be performed, and 94 (64%) of them would be unnecessary. Using a cutoff of 2.0 ng/ml for serum PSA and 0.1 ng/ml/cc for PSAD, 55 of 80 (69%) of the cancers would be detected and 25 (31%) would be missed. Only 84 transrectal biopsies would be performed, and 29 (35%) of them would be negative for cancer. CONCLUSION: This algorithm maximizes the number of cancers detected (true-positive cases) and at the same time reduces the number of false-positive cases, minimizing the number of patients who would have to receive an unnecessary transrectal biopsy, compared to using a serum PSA cutoff of 3.0 or 4.0 ng/ml.