Effect of tamoxifen on sexual functioning in patients with breast cancer.

Purpose: To define the incidence of sexual dysfunction in a population of women with breast cancer treated with tamoxifen.

Patients And Methods: Breast cancer patients with a performance status of 0 to 2 who had been treated with tamoxifen for 2 to 24 months completed the following measures: the Center for Epidemiologic Studies-Depression Scale, the Sexual History Form, and the Breast Cancer Prevention Trial Symptom Checklist. Forty-nine of the participants underwent gynecologic examinations with vaginal smears for determination of estrogen effect.

Positron emission tomographic assessment of "metabolic flare" to predict response of metastatic breast cancer to antiestrogen therapy.

We have investigated whether increased tumor uptake of fluorine-18 fluorodeoxyglucose (FDG) detected with positron emission tomography (PET) early after initiating tamoxifen therapy ("metabolic flare") predicts a hormonally responsive breast cancer. Eleven postmenopausal women with biopsy-proved estrogen receptor-positive (ER+) metastatic breast cancer were studied by PET with FDG and 16alpha[18F]fluoro-17beta-estradiol (FES) before and 7-10 days after initiation of tamoxifen therapy. FDG and FES uptake was evaluated semiquantitatively in 21 lesions.

Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer.

Background: We performed a multi-institutional randomized trial comparing preoperative chemotherapy followed by surgery with surgery alone for patients with local and operable esophageal cancer.

Methods: Preoperative chemotherapy for patients randomly assigned to the chemotherapy group included three cycles of cisplatin and fluorouracil. Surgery was performed two to four weeks after the completion of the third cycle; patients also received two additional cycles of chemotherapy after the operation.

Laparoscopic placement of electrodes for diaphragm pacing using stimulation to locate the phrenic nerve motor points.

Laparoscopic mapping of the phrenic nerve motor points using test stimulation was conducted for the implant of epimysial electrodes for diaphragm pacing in dogs. Both visual assessment of muscle activation and measurements of recruitment were useful for identifying an implant location resulting in a mean electrode placement approximately 14 mm from the phrenic nerve motor points in 16 dogs. Postmortem analysis of the stimulus test site locations and corresponding recruitment curves suggested that the phrenic nerve motor points could be predicted during the laparoscopic procedure to within 4.

Stability of the input-output properties of chronically implanted multiple contact nerve cuff stimulating electrodes.

The objective of this investigation was to measure the input-output (I-O) properties of chronically implanted nerve cuff electrodes. Silicone rubber spiral nerve cuff electrodes, containing 12 individual platinum electrode contacts, were implanted on the sciatic nerve of seven adult cats for 28-34 weeks. Measurements of the torque generated at the ankle joint by electrical stimulation of the sciatic nerve were made every 1-2 weeks for the first 6 weeks post-implant and every 3-5 weeks between 6 weeks and 32 weeks post-implant.

Occupational exposures to solvents and aluminium and estimated risk of Alzheimer's disease.

Objectives: To study the role of occupational exposures to solvents and aluminium in the aetiology of Alzheimer's disease (AD). An industrial hygienist rated exposure.

Methods: 89 subjects diagnosed with probable AD were matched by age, sex, and type of informant to 89 controls.

Functional conditions of micturition induced by selective sacral anterior root stimulation: experimental results in a canine animal model.

Electrical stimulation of the sacral anterior roots using conventional rectangular current pulses results in a simultaneous contraction of the urinary bladder and the striated urethral sphincter. Using a tripolar nerve cuff electrode with quasitrapezoidal current pulses and appropriate stimulation parameters, hyperpolarization of the nerve-fiber cell membrane under the anode of the stimulating electrode can reversibly arrest action potential propagation in large myelinated nerve fibers, innervating the striated urethral sphincter, while leaving action potential propagation unaffected in small nonmyelinated nerve fibers innervating the urinary bladder smooth muscle (anodal arrest). Using this technique in 19 female mongrel dogs, we studied the effect of bladder filling, level of anesthesia, and sacral deafferentation on bladder pressure, urethral pressure, and urinary flow.

Visual sensations produced by optic nerve stimulation using an implanted self-sizing spiral cuff electrode.

A blind volunteer with retinitis pigmentosa was chronically implanted with a self-sizing spiral cuff electrode around an optic nerve. Electrical stimuli applied to the nerve produced localized visual sensations that were broadly distributed throughout the visual field and could be varied by changing the stimulating conditions. These results demonstrate the potential for constructing a visual prosthesis, based on electrical stimulation of the optic nerve, for blind subjects who have intact retinal ganglion cells.

Unusual HIV transmissions through blood contact: analysis of cases reported in the United Kingdom to December 1997.

It is important to establish the likely route of infection for all reported HIV infected individuals if the HIV epidemic is to be understood. Investigating routes of infection may bring unusual infection routes to light. Steps have been taken in the United Kingdom (UK) to establish the likely mode of HIV acquisition for everyone reported as infected.

Pre-AIDS mortality in HIV-infected individuals in England, Wales and Northern Ireland, 1982-1996.

Objective: To assess pre-AIDS mortality in HIV-infected patients in England, Wales and Northern Ireland during the period 1982-1996.

Design: Surveillance data on pre-AIDS and AIDS deaths reported to the PHLS-AIDS Centre were analysed.

Methods: Pre-AIDS mortality was estimated as the proportion of pre-AIDS deaths among all deaths in HIV-infected people.

Correlates of cognitive function in middle-aged adults. Atherosclerosis Risk in Communities (ARIC) Study Investigators.

The Atherosclerosis Risk in Communities Study administered cognitive function tests to more than 14,000 middle-aged adults in 1990-1992. The battery included the Delayed Word Recall test, the Digit Symbol Subtest of the Wechsler Adult Intelligence Scale-Revised, and the Controlled Oral Word Association (Word Fluency) test. Test performance was correlated positively with education level, negatively with age, was better in women than in men, and better in managers/professionals compared with other occupations.

Epidemiology and detection of HIV-1 among pregnant women in the United Kingdom: results from national surveillance 1988-96.

Objective: To describe the epidemiology of HIV-1 infection in pregnant women in the United Kingdom.

Design: Serial unlinked serosurveillance for HIV-1 in neonatal specimens and surveillance through registers of diagnosed maternal and paediatric infections from reporting by obstetricians, paediatricians, and microbiologists.

Setting: United Kingdom, 1988-96.

Extraction forces and tissue changes during explant of CWRU-type intramuscular electrodes from rat gastrocnemius.

Intramuscular electrodes are currently in use for clinically implementing several electrotherapeutic and neuroprosthetic protocols. A decrease in motor recruitment is often reported in these systems due to movement of the electrode tip from the initial implant site. In the study reported here, multistrand intramuscular electrodes of the CWRU design were implanted aseptically in the gastrocnemii of adult rats under anesthesia.

The tissue response to epimysial electrodes for diaphragm pacing in dogs.

Epimysial electrodes stapled to the abdominal surface of the diaphragm produced a chronic inflammatory response that appeared to be mediated by mechanical stresses placed on the encapsulation tissue by periodic diaphragm contraction. The tissue response surrounding 34 epimysial electrodes implanted in 11 dogs was studied three months post implant. The tissue response was characterized by a capsule having a mean thickness of 1.

Brain reserve and the clinical expression of Alzheimer's disease.

Prospective clinicopathologic studies show that a large proportion of older, nondemented individuals have sufficient numbers of plaques and tangles to meet neuropathologic criteria for Alzheimer's disease (AD). One explanation for this finding is that these individuals had greater brain reserve, which buffered clinical expression of the disease. Three types of brain reserve are discussed: (1) the number of neurons and/or the density of their interconnections in youth, (2) the collection of cognitive strategies for solving problems and taking neuropsychological tests, and (3) the amount of functional brain tissue remaining at any age.

Assessment of knowledge about cancer pain management by physicians in training.

This survey assessed the knowledge of physicians in training about the pharmacology of opioid analgesics and the benefits of palliative radiation therapy in the management of cancer pain. Eighty-one trainees at the Washington University Medical Center completed a questionnaire that addressed the palliative care of a hypothetical patient with metastatic non-small cell lung cancer. The questions addressed were 1) opioid selection, 2) conversion of parenteral to oral morphine, 3) management of opioid toxicities, 4) opioid addiction, and 5) efficacy of radiation therapy.

Brain infarction and the clinical expression of Alzheimer disease. The Nun Study.

Objective: To determine the relationship of brain infarction to the clinical expression of Alzheimer disease (AD).

Design: Cognitive function and the prevalence of dementia were determined for participants in the Nun Study who later died. At autopsy, lacunar and larger brain infarcts were identified, and senile plaques and neurofibrillary tangles in the neocortex were quantitated.

Heritability for Alzheimer's disease: the study of dementia in Swedish twins.

Background: Alzheimer's disease has been thought to have familial and sporadic forms, and several genetic defects have been identified that chiefly explain early-onset familial cases. In this study, our purpose was to detect all cases of dementia in an established twin registry and to estimate total extent of genetic contribution to liability to Alzheimer's disease.

Methods: At the first stage, members of the registry were screened for dementia, using in-person or telephone mental status testing.

Intersecting pools and their potential application in testing donated blood for viral genomes.

Amplification assays for viral genomes are at present too expensive and cumbersome to be applied to individual blood donations. Through constructing interesting pools of specimens, however, it may be possible to screen as a single process large numbers of units for several low prevalence viruses using relatively few tests. The preparation of the intersecting pools that would be required is explained in this paper.

Inversion of the current-distance relationship by transient depolarization.

The objective of this research was to develop a technique to excite selectively nerve fibers distant from an electrode without exciting nerve fibers close to the electrode. The shape of the stimulus current waveform was designed based on the nonlinear conductance properties of neuronal sodium channel. Models of mammalian peripheral myelinated axons and experimental measurements on cat sciatic nerve were used to determine the effects of subthreshold polarization on neural excitability and recruitment.

Staple penetration and staple histological response for attaching an epimysial electrode onto the abdominal surface of the diaphragm using a laparoscopic approach.

Background: Laparoscopic stapling was found to be a viable option for attaching epimysial electrodes onto the abdominal surface of the diaphragm. Stapling was preferable to suturing due to its simplicity and speed.

Methods: Of the two staplers tested in this study, the Ethicon Endopath was preferred over the Autosuture Endo Hernia because the staples did not penetrate the diaphragm when an electrode tab thickness greater than 0.