Demographics of breast cancer in a small cohort of women in the Caribbean

OBJECTIVES: To address the prevalence and spectrum of breast cancer (BRCA1 and BRCA2) mutations in the Caribbean population. DESIGN AND METHODS: Demographic and clinical pathologic data was collected from 347 women of Afro-Caribbean decent. The cohort included women with breast cancer from the following countries: the Cayman Islands, Jamaica, Barbados, Dominica, Trinidad & Tobago and Haiti. RESULTS: The mean age of onset in the cohort was 48.1 yrs. with a mean body mass index (BMI) of 27.7. 70% of breast cancer cases were estrogen receptor-positive (ER+) (n=241) and in Jamaica 27% (n=105) of breast cancer cases were human epidermal growth factor receptor 2 positive (Her2+). Total Abdominal Hysterectomy Bilateral Salpingo Oophorectomy (TAH-BSO) delayed invasive breast cancer from 48 to 53 years (p=0.005). Parity was a significant factor (p<0.0001), which delayed age of onset by 8 yrs. Additionally, pregnancy alone delayed age of onset (p<0.005) by 8 yrs. Only three women out of 347 were found to have a mutation. CONCLUSIONS: This population-based study provided an insight into pattern of risk factors – both genetic and environmental of breast cancer incidence and subtype across the Caribbean. In conclusion 1) genetic causes of breast cancer appeared rare outside of the Bahamas, 2) fertility factors appeared important in the development of breast cancer, 3) TAH-BSO was common as both a form of contraception and because of the high incidence of fibroids, it may be protective, 4) BMI may impact on breast cancer development and 5) screening mammography was rare and the vast majority was diagnostic in nature.

Uncertainty in Cost Performance as a Function of the Cusp Catastrophe in the NASA Program Performance Management System.

Cost performance by NASA programs can generate two stable states within the organization system used for program performance management. These states could be stable individually or show multistability with cusp-like behavior. To test this, we constructed a cusp catastrophe model in a multilevel modeling (HLM) procedure on the cost components of an eleven-month period of one NASA program. HLM was used for its ability to estimate random effects as replacements for unknown control parameters. The cusp catastrophe model was a good description of the data and there was some evidence that the overall budget size functioned as a control parameter. Results are presented in terms of three different forms of uncertainty: attractor strength, unistability or multistability, and control parameters. Recommendations and future directions are focused towards understanding the cause of uncertainty in complex management systems.

Post-transplant lymphoproliferative syndrome in the pediatric liver transplant population.

Post-transplant lymphoproliferative disease remains a complication with a high morbidity and mortality. The present study examined 291 pediatric liver transplants performed in 263 children from October 1984 to December 1999. Post-transplant lymphoproliferative disease has an overall incidence of 12%. Tacrolimus and cyclosporine had a similar incidence of post-transplant lymphoproliferative disease. Fifty-six per cent of patients who developed post-transplant lymphoproliferative disease were Epstein-Barr virus negative at the time of transplantation. Mean time of conversion to Epstein-Barr virus positivity was 1.1 years after liver transplantation. Ten per cent of those who developed post-transplant lymphoproliferative disease never had Epstein-Barr virus detected. Mean time from Epstein-Barr virus positivity to detection of post-transplant lymphoproliferative disease was 2.68 years, and 3.13 years from liver transplantation (OLTx) to post-transplant lymphoproliferative disease. There was a 35% incidence of mortality. Deaths occurred a mean of 0.76 years after diagnosis of post-transplant lymphoproliferative disease. Most cases of post-transplant lymphoproliferative disease had extranodal location. There was one recurrence in 10% of patients, and two in 3%. All recurrent cases were seen in recipients who became Epstein-Barr virus positive after transplantation. There has been a decrease in the incidence of post-transplant lymphoproliferative disease from 15% to 9% to 4%. Post-transplant lymphoproliferative disease should be diagnosed promptly and treated aggressively. The best treatment, however, seems to be prevention, starting in the immediate postoperative period. Survivors should be monitored for both recurrence of post-transplant lymphoproliferative disease and acute cellular rejection.

Cerebral arterial diameters during changes in blood pressure and carbon dioxide during craniotomy.

Forty-five measurements of diameters of 12 human cerebral arteries were performed during 10 craniotomies under moderate changes in mean blood pressure and end tidal CO2. The mean change in blood pressure was 30 +/- 16 mm Hg (standard deviation) and that of end tidal CO2 was 14 +/- 6 mm Hg (standard deviation). These changes were induced with nitroprusside, phenylephrine, and adjustment of ventilator rate. Measurements were made through the operating microscope focused at the highest power, with meticulous attention to constant angle and distance from the artery. The mean diameter change in the large cerebral arteries (carotid, middle cerebral artery, vertebral artery) was less than 4%, but the smaller arteries (anterior cerebral artery, M2 segment of middle cerebral artery) showed diameter changes as large as 29% and 21% to end tidal CO2 and blood pressure changes, respectively. These data suggest that at the time of craniotomy, diameters of the large cerebral vessels do not significantly change during moderate variations in blood pressure and CO2, but that larger changes may occur in smaller vessels. This constancy of diameter suggests that the transcranial Doppler velocities obtained during intraoperative monitoring of craniotomies may closely reflect blood flow through the insonated artery.

The relation between stress and disease activity in rheumatoid arthritis.

This study investigated the relation between stress and current disease activity in rheumatoid arthritis (RA). During a routine clinic appointment, subjects were given ratings of global disease status by their physicians and completed self-report measures of major stress and minor stress. In addition, each subject's erythrocyte sedimentation rate was taken. After controlling for disease severity and major stress, minor stress accounted for a significant amount of the variance in inflammation level. These results suggest that minor stress is associated with current disease activity in RA.

The effects of CD-ROM on library services.

This paper presents a wide-ranging overview of compact disc technology in the library environment. It raises important issues currently being debated in the literature and aims to question and stimulate thought on the nature and purpose of CD-ROM provision in health-care libraries.

Microbiology of chronic otitis media with effusion among Australian Aboriginal children: role of Chlamydia trachomatis.

Serum, eye secretions, post-nasal swabs, external ear swabs and middle ear effusions (MEE) were collected from 131 Australian Aboriginal children with chronic otitis media with effusion (COME). The children were all resident in a trachoma endemic region. Chlamydia trachomatis was recovered from the MEE of 2 children. Probable bacterial pathogens were isolated from 34 (12.7%) ears. The remainder were sterile (52.4%) or contained normal skin flora (34.9%). Serum and secretions were examined by the microimmunofluorescent technique for the presence, titre and serotype of anti-chlamydial antibody. Antibody, predominantly of the C serotype, was found in a high percentage of sera (80%) and secretions (approximately 50%). This serotype is associated with ocular trachoma. It is concluded that C. trachomatis is associated with COME among some Aboriginal children in this trachoma endemic area.

Chronic ear disease in Australian Aborigines.

Ear, nose and throat diseases in children living in the Kimberley region of Western Australia have been systematically studied over the last 15 years. A "diagnostic triad" is described; this offers a comprehensive approach to the assessment of middle-ear disease. The aetiology of chronic ear disease in Aboriginal children has been investigated. Management problems of deafness are discussed.

The response to acupuncture therapy in patients with chronic disabling pain.

Twenty-one patients had acupuncture treatment for chronic, disabling pain. Ten (47.5%) thought they had obtained worthwhile relief by the time treatment was completed. Six (30%) had no or negligible benefit and five (25%) had some aggravation of their pain at some stage of the procedure. In this group of patients, with the technique we describe, we were unable to achieve the high degree of short-term success claimed by other workers. Until further scientific studies can confirm the value of acupuncture in medical practice, we urge caution in the use of this procedure.

Naproxen in rheumatoid arthritis. A controlled trial.

The efficacy of naproxen in treating rheumatoid arthritis patients was evaluated in a double-blind clinical trial using aspirin as the control drug. The study was conducted at seven centers and involved 80 patients. After an unequivocal increase in disease activity during a drug-free period, patients were randomly assigned to either drug and continued in the trial for 16 weeks. Some patients took low maintenance doses of corticosteroids, or gold salts, or both throughout the trial. Both test drugs significantly decreased disease activity as measured by a number of ways. By objective measurements, naproxen was as effective as aspirin, although patients in the naproxen-treated group entered the trial with more severe disease. By some subjective evaluations, naproxen was considered more effective than aspirin. Although patients taking naproxen had less frequent gastrointestinal side effects and fewer symptoms VIIIth nerve toxicity, the differences were not statistically significant. We conclude that naproxen is a useful addition to the physician's armamentarium for the treatment of rheumatoid arthritis.

Lactate dehydrogenase isozymes of mouse epidermis.

Five isozymes of LDH are demonstrable in the epidermis of the ear pinnae, hind feet, trunk dorsa, and tails of adult C57BL, C57HR, and C3HB mice by polyacrylamide gel electrophoresis. LDH-5 activity predominates in electropherograms. The ratio of LDH-1 to LDH-K is greater in the epidermis of ear pinna and trunk dorsum than in that of tail and hind foot. The region-specific patterns of epidermal LDH isozymes are not correlated with melanin pigmentation or "hairiness' of the skin.