Is needle-directed breast biopsy overused?

We undertook this study of needle-localized breast biopsy--a frequently done surgical procedure--to examine current practice patterns and to determine if the technique is overused in any group of patients. From a retrospective review of medical records of all patients who had needle-localized breast biopsy at a teaching hospital between June 1, 1988, and October 31, 1990, we found that a total of 125 were done: 24 biopsy specimens showed malignancy (19%). Mammographic indications for biopsy were microcalcification (n = 62, or 50%), mass or density (n = 60, or 48%) and mass and calcifications (n = 3, or 2%).

Cimetidine-induced myelosuppression after bone marrow transplantation.

A strong temporal correlation was observed between cessation of cimetidine and a sustained increase in blood counts in two marrow transplant recipients. Both were receiving cimetidine from the day of transplantation for prophylaxis of stress ulceration and gastritis. The blood counts of both patients were not increasing satisfactorily 5-6 weeks after marrow transplantation without any obvious cause of marrow suppression.

5-Fluorouracil after primary combined filtration surgery.

We examined the safety and efficacy of 5-fluorouracil in eyes with open-angle glaucoma undergoing combined cataract removal and filtration surgery. We randomly assigned one eye each of 24 patients to receive 5-fluorouracil (five injections of 5 mg during two weeks after surgery) and one eye each of 20 patients to comprise the control group. Preoperatively, the two groups had similar mean intraocular pressure (P = .

Evaluation of a tapered, blunt, bipolar cautery tip for trabeculectomy.

A bipolar cautery instrument with a tapered, blunt tip has been developed for glaucoma filtering surgery. Evaluated in 30 consecutive trabeculectomy procedures, the instrument proved suitable for all aspects of the operation. The narrow, 23-gauge shaft and tapered, blunt tip allowed gentle, pin-point coagulation of individual bleeders, as well as cauterization of tracks of tissue in a continuous motion.

Noncontact transscleral Nd:YAG cyclophotocoagulation: a long-term follow-up of 500 patients.

Long-term experience with transscleral cyclophotocoagulation in 500 patients suggests that this operation is the cyclodestructive procedure of choice. It offers a reasonable surgical option in the high-risk glaucoma population, which includes patients with neovascular glaucoma, glaucomas with active uveitis, glaucomas in aphakia or pseudophakia, and other cases in which filtering surgery has failed or is felt to have a low chance for success. Satisfactory intraocular pressure reduction was achieved in 62% of the patients with one treatment session.

Clinical and histopathologic observations concerning hypotony after trabeculectomy with adjunctive mitomycin C.

Prolonged hypotony-induced maculopathy is a serious complication of trabeculectomy with adjunctive mitomycin C. We performed trabeculectomies with intraoperative mitomycin C on 59 eyes of 52 consecutive patients. Exposure time to mitomycin C was five minutes in the first seven patients, two of whom had prolonged hypotony-induced maculopathy.

Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level.

Fifty-eight healthy, normolipidemic adult men participated in a prospective, masked, randomized crossover study designed to compare the effects of two topical nonselective beta-adrenergic antagonists, carteolol and timolol, on plasma high-density lipoprotein cholesterol levels. Two eight-week treatment periods were separated by an eight-week drug-free period. Carteolol 1.

Feasibility and efficacy of maintenance chemotherapy following autologous bone marrow transplantation for first remission acute lymphoblastic leukaemia.

Thirty-eight patients with poor risk ALL in first remission received maintenance chemotherapy following ABMT. Patients were conditioned for ABMT with high-dose melphalan and single fraction total body irradiation. Maintenance chemotherapy was commenced in a total of 26 patients and was tolerated to a median daily dose of 6-mercaptopurine of 40.

Four-week safety and efficacy study of dorzolamide, a novel, active topical carbonic anhydrase inhibitor.

Objective: To investigate the activity and local and systemic safety of the topical carbonic anhydrase inhibitor, dorzolamide hydrochloride.

Design: Four-week, double-masked, randomized, placebo-controlled, parallel, three-center study.

Setting: Referral centers.

Chronic bullous disease of childhood and ulcerative colitis.

A 12-year-old girl with ulcerative colitis (UC) treated by colectomy with rectal stump preservation, salazopyrin, and systemic steroids developed persistent mouth ulcers, cutaneous targetlike lesions, papulopustules, and bullae. The clinical, histologic, and immunopathologic features were typical of chronic bullous disease of childhood (CBDC). Although resistant to combined immunosuppressive therapy with low-dose prednisolone, cyclosporin, and thalidomide, striking remission of the mucocutaneous symptoms resulted with surgical resection of the diseased rectal stump.

Mutation of the serine 15 phosphorylation site of human p53 reduces the ability of p53 to inhibit cell cycle progression.

Overexpression of wild-type p53 prevents cells from entering the S phase of the cell cycle. The amino-terminal transactivation region of p53 is phosphorylated by several protein kinases, including DNA-PK, a nuclear serine/threonine protein kinase that in vitro requires DNA for activity. DNA-PK was recently shown to phosphorylate serines 15 and 37 of human p53 (Lees-Miller et al.

A comparison of two energy levels for noncontact transscleral neodymium-YAG cyclophotocoagulation.

In a prospective, clinical trial, 89 patients undergoing transscleral neodymium-YAG cyclophotocoagulation for intractable glaucoma were randomized to approximately 4 or 8 J of laser energy per application and followed up for an average of 1 year. The only statistically significant difference between the two groups was early anterior chamber reaction, which was more severe among those receiving 8 J. There was a trend toward better intraocular pressure control in the 8-J group, compared with the 4-J group, with 33 (75%) of 44 patients and 27 (60%) of 45 patients, respectively, requiring no further surgical intervention during the follow-up period.

A hypothesis resolving the apparently disparate activities of native and altered forms of human C-reactive protein.

Although C-reactive protein (CRP) has been studied for over 60 years, the in vivo function of this acute-phase reactant has not been clearly defined. The literature on CRP has been divided here into three categories: the cyclic, pentameric blood-borne form of CRP termed 'native' CRP which has activities mainly associated with the resolution of inflammation, conformationally altered and aggregated forms of CRP which display pro-inflammatory properties, and proteolytic forms of CRP exhibiting mixed activities. Since the activities of certain forms of CRP in some cases contradict others, a hypothesis has been developed which reconciles these differences.

Current concepts in pigmentary glaucoma.

Since its initial description over 50 years ago as a rare clinical entity, pigmentary glaucoma has become recognized as one of the most common forms of secondary open-angle glaucoma. Pigmentary glaucoma affects a much younger patient population than most other forms of open-angle glaucoma, and has a predilection for Caucasian males with myopia. Hallmarks of this disease include midperipheral iris transillumination defects, Krukenberg spindles and a heavily pigmented trabecular meshwork.

Peripheral visual field testing in glaucoma by automated kinetic perimetry with the Humphrey Field Analyzer.

A Humphrey automated perimeter was used to measure the central 24 degrees of vision with static threshold targets and the peripheral field with two automatic kinetic stimuli in 100 eyes of 100 patients with glaucoma or a suspicion of glaucoma and to compare the additional information gained with the peripheral tests. The peripheral visual field supported the diagnosis made with central field testing in approximately one third of the eyes and added additional diagnostic information in another fourth of the cases. In 4% of patients a normal central field was associated with a glaucomatous peripheral defect.

Efficacy of adding nebulized ipratropium bromide to nebulized albuterol therapy in acute bronchiolitis.

Nebulized ipratropium bromide is though to be synergistic with albuterol in therapy for acute childhood asthma. Because the efficacy of ipratropium in bronchiolitis is uncertain and some infants with bronchiolitis do not respond to nebulized albuterol alone, the following study was undertaken. In this double-blind, placebo-controlled trial, 69 infants between 6 weeks and 24 months of age who exhibited the first episode of acute bronchiolitis were randomly assigned to receive either nebulized albuterol (0.

Selection of a Pseudomonas cepacia strain constitutive for the degradation of trichloroethylene.

Tn5 insertion mutants of Pseudomonas cepacia G4 that were unable to degrade trichloroethylene (TCE), toluene, or phenol or to transform m-trifluoromethyl phenol (TFMP) to 7,7,7-trifluoro-2-hydroxy-6-oxo-2,4-heptadienoic acid (TFHA) were produced. Spontaneous reversion to growth on phenol or toluene as the sole source of carbon was observed in one mutant strain, G4 5223, at a frequency of approximately 1 x 10(-4) per generation. One such revertant, G4 5223-PR1, metabolized TFMP to TFHA and degraded TCE.

The influence of exposure duration in transscleral Nd:YAG laser cyclophotocoagulation.

Transscleral cyclophotocoagulation was performed in human autopsy eyes by using three Nd:YAG lasers with different durations of exposure: a pulsed, contact laser with a duration of 0.75 millisecond and a range of one to ten pulses per burst (GLase 106, Sunrise Technologies, Fremont, California); a pulsed, noncontact laser with a duration of 20 milliseconds (Microruptor 2, Lasag Medical Lasers, Thun, Switzerland); and a continuous-wave, contact laser with durations of 700 and 2,000 milliseconds (Microruptor 3, Lasag Medical Lasers, Thun, Switzerland). Tissue responses were observed with a high-magnification videographic recording technique to analyze the immediate, real-time laser effects, and by light microscopy to characterize the laser-induced lesions further.

Cell cycle effects of microinjected antisense oligodeoxynucleotides to p34cdc2 kinase.

In this study the effect of antisense oligomers targeted against the mRNA transcripts of p34cdc2 kinase on G1 progression into S-phase was examined. For this purpose, antisense, sense, or nonsense oligomers were introduced directly into the cytoplasm of T98G cells grown in monolayer cultures by glass-capillary microinjection. The microinjection of antisense oligomers (but not sense or nonsense oligomers) into growth-arrested cells before serum stimulation inhibited G1 progression into S-phase.

Growth arrest induced by wild-type p53 protein blocks cells prior to or near the restriction point in late G1 phase.

Conditional expression of wild-type (wt) p53 protein in a glioblastoma tumor cell line has been shown to be growth inhibitory. We have now more precisely localized the position in the cell cycle where growth arrest occurs. We show that growth arrest occurs prior to or near the restriction point in late G1 phase of the cell cycle.

Inhibition of human subconjunctival fibroblast proliferation by immunotoxin.

The ability to target proliferating cells is important for agents used to modulate wound healing by decreasing the growth of fibroblasts. Proliferating cells are known to express increased numbers of transferrin receptors and have increased receptor turnover. 454A12 Mab-rRA, an immunotoxin containing anti-human transferrin receptor monoclonal antibody conjugated to recombinant ricin A chain, was shown to inhibit the proliferation of human subconjunctival fibroblasts in vitro.