Breast Surgery International--breast cancer in developing countries.

Breast Surgery International (BSI) was formed in 1999 as an integrated society within the International Surgical Society ISS/SIC. One goal is to promote breast surgery world wide and focus on the situation in the developing countries. An edited summary of a symposium on locally advanced breast cancer (LABC) and the current situation in two African countries and in Malaysia is reported. Diagnosis, management and treatment options differ from recommendations that prevail due to lack of resources, lack of access to facilities and cultural and socioeconomic barriers. Younger age at onset, more men are affected and locally advanced breast cancer dominates the clinical panorama. A rational treatment plan for LABC should have chemotherapy, surgery, radiotherapy and hormonal therapy as armaments. A unique opportunity exists for international interchange within a professional organization such as BSI, for providing training opportunities, for clinical and experimental studies of the world' s most common female malignancy.

Postradiation sarcomas: 20 cases and a literature review.

PURPOSE: To analyze 20 cases of postradiation sarcoma (PRS) to determine dose levels at which this condition developed, the pathology of the initial and postradiation tumors, latency period, and outcome; and to review the literature and propose modified criteria for diagnosis. METHODS AND MATERIALS: Patient records were reviewed. Previous radiation fields and isodose charts were reconstructed to determine the dose received in the tissue in which the PRS subsequently developed. RESULTS: There were 16 female patients and 4 male patients. Mean age at the time of initial radiotherapy was 28 years. Mean latency was 14 years, with no difference in latency between the adult and pediatric group (t = 0.45, p = 0.37), but shorter latency in the retinoblastoma than in the nonretinoblastoma patients (t = 3.18, p = 0.003). The outcome was poor; 2 patients were alive and disease-free at 2 and 5 years. The 18 patients who died as a result of PRS had a median survival of 1 year. CONCLUSION: PRSs are rare. Unnecessary radiation must be avoided. Cases should be reported with full details so that risk factors can be ascertained. PRSs usually arise in moderate to higher dose areas. Diagnostic criteria should allow soft tissue tumors and short latency.

Pregnancy and abortion in breast cancer patients. Two case reports and a literature review.

Breast cancer in pregnancy is by itself not an indication for abortion. We document the case histories of 2 patients with breast cancer (recurrent or advanced) who elected to carry pregnancies to term. Pregnancy concurrent with or subsequent to breast cancer is not associated with a worse prognosis than would be observed in non-pregnant women. Treatment for breast cancer may be an indication for abortion, but chemotherapy may be administered to pregnant patients, although it should be avoided in the first trimester if possible. Treatment such as radiotherapy may not be aimed at improving survival and this knowledge may affect a patient's decision regarding abortion. Breast cancer patients undergoing abortion must be aware of the exact indications for the procedure and the difference between medical and social indications.

Mastectomy with axillary clearance versus mastectomy without it. Late results of a trial in which patients had no adjuvant chemo-, radio- or endocrine therapy.

OBJECTIVE: Long-term outcome of comparison of mastectomy with axillary clearance to mastectomy without it. DESIGN: Second analysis of a terminated prospective randomised trial. SETTING: The Breast Clinic, Groote Schuur Hospital, Cape Town. PATIENTS: Ninety-five women aged under 76 years with stages 1 and 2 (T1-2 NO-1 MO) breast cancer. INTERVENTIONS: Radical mastectomy (mastectomy and formal axillary dissection with pectoral muscle excision) or simple mastectomy (mastectomy without axillary dissection if nodes were not clinically palpable, or local excision of the nodes if they were). OUTCOME MEASURES: Loco-regional recurrence and survival. RESULTS: Whereas initial analysis at 40 months had showed more axillary recurrences (P = 0.056) in the simple mastectomy group (leading to the termination of the trial), this difference has disappeared at 10 years (P = 0.113). There was no difference in rate of recurrence at all other sites, time to recurrence, or survival rates at 40 months or at 10 or 25 years. CONCLUSIONS: Full axillary clearance offered no better long-term loco-regional control or survival. Early analysis and marginally significant differences in axillary recurrence prompted premature termination of this trial.

Ethics and accountability in nursing people with HIV infection.

This article considers ethical issues in relation to exercising accountability when nursing people with human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS). A range of issues will be explored, some of which may be considered contentious.

Determinants of coronavirus MHV pathogenesis are localized to 3' portions of the genome as determined by ribonucleic acid-ribonucleic acid recombination.

Recombinant viruses derived from coronaviruses mouse hepatitis virus strains JHM and A59, were used to map biologic properties of the virus to viral genes. The 3' portion (about 25%) of the viral genome, including the genes coding for all of the structural proteins, controls biologic properties such as organ tropism of the virus, pattern of the virus-induced central nervous system pathology in mice, plaque morphology, and virus yield in tissue culture.

Induction of MHC class I antigens on glial cells is dependent on persistent mouse hepatitis virus infection.

H-2 class I antigens, but not class II antigens, were detected on the surface of glial cells persistently infected with mouse hepatitis virus strain A59 (MHV-A59) as late as 90 days post-infection. Uninfected glial cells remained negative for H-2 class I and class II surface antigens. We have previously shown that conditioned media from infected glial cell cultures (supernatants) contain a factor unrelated to infectious virus and capable of inducing H-2 class I antigens on uninfected glial cells. The synthesis of this factor appears to be dependent on production of infectious virus since the H-2 inducing activity could not be detected 3 days following the addition of neutralizing antibodies to the cultures. This suggests that H-2 inducing activity contains an unstable component, the synthesis of which is dependent on continual virus production. Persistent MHV infection and H-2 class I antigen expression may play a role in MHV-induced demyelination.

Tumor necrosis factor induces expression of MHC class I antigens on mouse astrocytes.

The effect of tumor necrosis factor (TNF) on expression of major histocompatibility complex (MHC) antigens was examined in mouse glial cells in vitro. TNF induced MHC class I, but not class II, antigen expression on the surface of astrocytes but not on oligodendrocytes. Glial cells do not normally express detectable amounts of MHC antigens. Thus TNF may play a role in the immunopathogenesis of neurologic diseases that involve MHC class I-restricted reactions.