The current state of affairs for disaster planning for a nuclear terrorist attack.

The author presents current thinking on the effects of an atomic bomb blast from a medical point of view and will argue that current US Federal plans for a nuclear disaster are simply crude, insufficient, disarticulated, and principally relies on martial law as a means of crowd control. The simple physics of a fusion reaction bomb is discussed along with the plans of other countries, apparently "secret"American plans, which show a poor knowledge of the physics of nuclear bombs as well as poor insight into what will be needed to help the maximum number of citizens. An alternative plan involving computer modeling and educating the public to the effects of a fission explosion are presented.

Bioterrorism versus radiological terrorism: notes from a bio/nuclear epidemiologist.

The antiterrorism and disaster planning communities often speak of the high potential for bioterrorism and possible potential for radioterrorism, specifically the explosion of a fission device on US soil. Information gained from an epidemiologist's work in the national and international scene, which inevitably involves Intel regarding the cultures and subcultures being studied, suggest that bioterrorism is far less likely to be a major threat, that has been over-emphasized at the state level due to warnings from Homeland Security, and that Homeland Security itself appears biased toward bioterrorism of late with very little available rational basis.

Nuclear disasters: current plans and future directions for oncologists.

Objective: To show that there is a significant role for oncologists in the event of a terrorist nuclear disaster. Professionals need data on current political issues regarding a nuclear attack already put in place by the administration and the military.

Design: Review of what actually occurs during a fission bomb's explosion helps to point out what medical care will be most needed.

Impact of race on breast cancer in lower socioeconomic status women.

Lower socioeconomic status and lack of access to care are often implicated as plausible causes for African American women to present with later stage breast cancer than Caucasian women. Our objective is to determine if racial differences are present in newly diagnosed breast cancer in women of equivalent socioeconomic status. A retrospective review of prospectively gathered data from women with newly diagnosed breast cancer was performed.

Cosmesis with bilateral mammoreduction for conservative breast cancer treatment.

Over 7 years, 57 women with breast cancer underwent lumpectomy and bilateral mammoreduction. Physical complaints about large or lax breast shape were the predominate rationale. Two patients were immediately lost to follow-up, 55 patients remained and were followed every 3 months for an average of 1.

Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery.

The purpose of this study was to assess risk for lymphedema of the breast and arm in radiotherapy patients in an era of less extensive axillary surgery. Breast cancer patients treated for cure were reviewed, with a minimum follow-up of 1.5 years from the end of treatment.

Shielding of the contralateral breast during tangential irradiation.

The purpose of this study was to investigate both optimal and practical contralateral breast shielding during tangential irradiation in young patients. A shaped sheet of variable thickness of lead was tested on a phantom with rubber breasts, and an optimized shield was created. Testing on 18 consecutive patients 50 years or younger showed shielding consistently reduced contralateral breast dose to at least half, with small additional reduction after removal of the medial wedge.

Quality of life with well-differentiated thyroid cancer: treatment toxicities and their reduction.

Introduction: Patients with well-differentiated thyroid cancer have a good prognosis but a significant chance for local recurrence. In the past, limited surgery with postoperative 131I only for extremely high-risk cases or recurrence was not uncommon. As more aggressive surgical and postoperative treatments appear to gain wider acceptance, toxicity and long-term morbidity become more important issues.

Obesity and lymphatic mapping with sentinel lymph node biopsy in breast cancer.

Background: With increasing sentinel lymph node experience, patient subsets associated with lower success rates are being identified. Obesity may be one such subset.

Methods: A retrospective review was conducted of breast cancer patients who underwent sentinel lymph node biopsy from March 1997 to September 2002.

Near-lethal respiratory failure after recombinant human thyroid-stimulating hormone use in a patient with metastatic thyroid carcinoma.

A patient with widely metastatic differentiated thyroid cancer who had been heavily pretreated with (131)I was given recombinant human thyroid stimulating hormone (rhTSH) prior to (131)I treatment. Clinical and physical data from both this case and the literature suggest that the recombinant hormone, not the (131)I, may have caused a significant portion of the tumor swelling, which in turn was the most likely cause of the patient's symptoms. The potential effect of (131)I-induced tumor swelling and direct radiation effect on the lung is also analyzed.

Induction of glioblastoma multiforme in nonhuman primates after therapeutic doses of fractionated whole-brain radiation therapy.

Object: To determine the acute and long-term effects of a therapeutic dose of brain radiation in a primate model, the authors studied the clinical, laboratory, neuroimaging, molecular, and histological outcomes in rhesus monkeys that had received fractionated whole-brain radiation therapy (WBRT).

Methods: Twelve 3-year-old male primates (Macaca mulatta) underwent fractionated WBRT (350 cGy for 5 days/week for 2 weeks, total dose 3500 cGy). Animals were followed clinically and with laboratory studies and serial magnetic resonance (MR) imaging.

Intensity-modulated radiation therapy.

Intensity-modulated radiation therapy (IMRT) is an increasingly popular technical means of tightly focusing the radiation dose around a cancer. As with stereotactic radiotherapy, IMRT uses multiple fields and angles to converge on the target. The potential for total dose escalation and for escalation of daily fraction size to the gross cancer is exciting.