BACKGROUND & AIMS: OBJECTIVE:To assess and compare immediate effects of chest physiotherapy with positive expiratory pressure (PEP) versus oscillating PEP on transcutaneously measured blood-gas tensions in patients with cystic fibrosis. METHODS:Fifteen patients (mean age 12.5 y, range 6.9-21.5 y) participated. The treatments were randomized and performed on 2 separate occasions, 8 weeks apart. Spirometry was conducted before and after each treatment. We transcutaneously measured oxygen tension (P(tO2). RESULTS:There were no changes in spirometry values. During PEP, different trends in blood-gas tension were seen, and there were no consistent changes. During oscillating PEP, P(tO2) increased and P(tCO2) decreased. During oscillating PEP, P(tCO2) was lower and the intra-individual change in P(tCO2) was more pronounced than during PEP. The results obtained immediately after oscillating PEP showed a higher P(tO2) and a lower P(tCO2) than with PEP. CONCLUSION:PEP and oscillating PEP can both cause transitory effects on blood gases in patients with cystic fibrosis. However, oscillating PEP alters blood-gas tensions more than does PEP, and hyperventilation during oscillating PEP may reduce treatment time.

背景与目标： 目的：评估和比较呼气正压（PEP）和振荡PEP对胸部物理治疗对囊性纤维化患者经皮测量的血气张力的即时效果。
方法：15例患者（平均年龄12.5岁，范围6.9-21.5岁）参加了研究。治疗是随机的，分别在两个不同的场合进行，相隔8周。在每次治疗之前和之后进行肺活量测定。我们经皮测量了氧气张力（P（tO2）。
结果：肺活量测定值没有变化。在PEP期间，观察到了血气紧张的不同趋势，并且没有一致的变化。在振荡PEP期间，P（tO2）增加而P（tCO2）减少。在振荡PEP期间，P（tCO2）较低，并且P（tCO2）的内部个体变化比PEP期间更为明显。振荡PEP后立即获得的结果显示，与PEP相比，P（tO2）更高，P（tCO2）更低。
结论：PEP和振荡PEP均可对囊性纤维化患者的血气产生短暂影响。但是，与PEP相比，振荡PEP对血气压力的改变更大，并且在振荡PEP期间过度换气可能会减少治疗时间。

BACKGROUND & AIMS: :Construction of tissue microarrays (TMAs) to efficiently characterize large sets of noninvasive epithelial lesions in the breast by immunohistochemistry is an appealing investigative approach, but presents technical challenges. We report methodologic studies performed to optimize methods for building TMAs from noninvasive breast tissues collected in a large case-control study of breast cancer. Using a manual arraying technique with 2.0-mm diameter needles, we constructed TMAs from specimens obtained from 32 women with breast cancer containing the following targets: (1) 28 terminal duct lobular units (TDLUs); (2) 28 ductal carcinomas in situ, and (3) 23 invasive carcinomas. Using careful target selection, we achieved representation of approximately 80% of noninvasive targets with sustained preservation through section 30 of the TMAs. Immunohistochemical staining of TDLU targets demonstrated positive staining for estrogen receptor (ER) in 30.8% of tubules and for progesterone receptor (PR) in 50.0%. To establish an efficient method to evaluate staining results in TDLUs, we created a categorical scoring system to approximate the percentage of tubules containing positive stained cells (<10%, 10% to 50%, >or=50%), and compared the results with those obtained by tubule counting. Comparison between the two methods demonstrated exact agreement for 70.8% of ER and 79.2% of PR stains without two-category discrepancies. ER/PR expression levels in multiple (up to 4) noninvasive targets of the same tissue type (TDLU or DCIS) from a single block showed good correlation. These data suggest that it is feasible to produce TMAs of noninvasive breast structures, albeit with careful selection of targets, and that immunostains of such cores may permit efficient immunohistochemical characterization of peritumoral tissues. Additional exploration of this approach is needed.

背景与目标： ：通过免疫组织化学法构建组织微阵列（TMA）以有效表征乳腺中大量非侵袭性上皮病变的方法是一种有吸引力的研究方法，但也带来了技术挑战。我们报告进行的方法学研究，以优化从大型乳腺癌病例对照研究中收集的无创乳腺组织中构建TMA的方法。我们使用直径为2.0毫米针头的手动排列技术，从32位乳腺癌女性的标本中构建了TMA，这些标本包括以下目标：（1）28个末梢小叶单位（TDLU）； （2）28例原位导管癌，（3）23例浸润性癌。通过精心选择目标，我们通过TMA第30节实现了约80％的非侵入性目标的代表，并得到了持续的保护。 TDLU靶标的免疫组织化学染色显示，在30.8％的肾小管中，雌激素受体（ER）和50.0％的孕酮受体（PR）都呈阳性染色。为了建立一种有效的方法来评估TDLU中的染色结果，我们创建了一个分类评分系统，以估计含有阳性染色细胞的小管的百分比（<10％，10％至5​​0％，>或= 50％），并比较结果与那些通过肾小管计数获得的。两种方法之间的比较表明，ER染色的70.8％和PR染色的79.2％完全吻合，没有两类差异。单个区域中相同组织类型（TDLU或DCIS）的多个（多达4个）非侵入性靶标中的ER / PR表达水平显示出良好的相关性。这些数据表明，尽管精心选择了靶标，但生产无创性乳房结构的TMA是可行的，并且此类核心的免疫染色可允许对肿瘤周围组织进行有效的免疫组织化学表征。需要对该方法进行其他探索。

BACKGROUND & AIMS: :Extensive literatures have shown significant trend of progressive electrical changes according to the proliferative characteristics of breast epithelial cells. Physiologists also further postulated that malignant transformation resulted from sustained depolarization and a failure of the cell to repolarize after cell division, making the area where cancer develops relatively depolarized when compared to their non-dividing or resting counterparts. In this paper, we present a new approach, the Biofield Diagnostic System (BDS), which might have the potential to augment the process of diagnosing breast cancer. This technique was based on the efficacy of analysing skin surface electrical potentials for the differential diagnosis of breast abnormalities. We developed a female breast model, which was close to the actual, by considering the breast as a hemisphere in supine condition with various layers of unequal thickness. Isotropic homogeneous conductivity was assigned to each of these compartments and the volume conductor problem was solved using finite element method to determine the potential distribution developed due to a dipole source. Furthermore, four important parameters were identified and analysis of variance (ANOVA, Yates' method) was performed using design (n = number of parameters, 4). The effect and importance of these parameters were analysed. The Taguchi method was further used to optimise the parameters in order to ensure that the signal from the tumour is maximum as compared to the noise from other factors. The Taguchi method used proved that probes' source strength, tumour size and location of tumours have great effect on the surface potential field. For best results on the breast surface, while having the biggest possible tumour size, low amplitudes of current should be applied nearest to the breast surface.

背景与目标： ：大量文献显示，根据乳腺上皮细胞的增殖特性，进行性电变化的显着趋势。生理学家还进一步假设，恶性转化是由于持续的去极化和细胞分裂后细胞无法重新极化所致，因此与非分裂或静止状态的癌症相比，癌症发展的区域相对去极化了。在本文中，我们提出了一种新的方法，即Biofield Diagnostic System（BDS），它可能具有增强乳腺癌诊断过程的潜力。该技术基于分析皮肤表面电势以鉴别诊断乳房异常的功效。通过将乳房视为仰卧状态下的半球，各层厚度不相等，我们开发了一个接近实际的女性乳房模型。各向同性的各向同性电导率分配给这些隔室，并使用有限元方法解决了体积导体问题，以确定由于偶极子源而产生的电势分布。此外，确定了四个重要参数，并使用设计进行了方差分析（ANOVA，Yates方法）（n =参数数量4）。分析了这些参数的作用和重要性。 Taguchi方法进一步用于优化参数，以确保与其他因素产生的噪声相比，来自肿瘤的信号最大。使用的Taguchi方法证明了探针的源强度，肿瘤大小和肿瘤位置对表面电势场有很大的影响。为了在乳腺表面获得最佳效果，同时应尽可能增大肿瘤的大小，应在最靠近乳腺表面的地方施加较小的电流。

BACKGROUND & AIMS: OBJECTIVE:The purpose of our study was to evaluate the effects of 0.3-second high-resolution CT (HRCT) of the lung using partial reconstruction on cardiac motion artifacts and image noise. SUBJECTS AND METHODS:Thirty-seven pairs of 0.3-second (partial reconstruction) and 0.75-second (full reconstruction) HRCT images were obtained for the lower lung zone during full-inspiration breath-holding. Imaging parameters other than temporal resolution were identical for each patient. Two radiologists visually graded motion artifacts of the cardiac border, bronchi, pulmonary vessels, and fissure in the left lung on a 4-point scale (with 4 indicating no artifacts). The maximum width of motion along the left cardiac border and the area percentage of motion artifacts in the left lung were calculated. Image noise in the air and lung was also determined. Cardiac motion artifacts and image noises were compared between the two sets of CT images. RESULTS:Visual grades for the cardiac border (4 +/- 0), bronchi (3.8 +/- 0.7), pulmonary vessels (3.6 +/- 0.8), and fissure (3.9 +/- 0.5) were higher for 0.3-second images than for 0.75-second images (1.7 +/- 0.7, 2.0 +/- 1.0, 1.6 +/- 0.7, and 2.4 +/- 0.9, respectively) (p < 0.001). The maximum width of motion along the left cardiac border (0.1 +/- 0.5 mm) and the area percentage of motion artifacts in the left lung (6.7% +/- 18.4%) were smaller for 0.3-second images than for 0.75-second images (4.5 +/- 1.7 mm and 36.2% +/- 20.9%, respectively) (p < 0.001). Image noises in the air (38.0 +/- 9.2) and the lung (86.0 +/- 23.1) were greater for 0.3-second images than for 0.75-second images (35.6 +/- 9.6 and 76.0 +/- 20.3, respectively) (p < 0.01). CONCLUSION:Compared with 0.75-second HRCT using full reconstruction, 0.3-second HRCT using partial reconstruction substantially reduces cardiac motion artifacts in the lung at the expense of increasing image noise.

背景与目标： 目的：本研究的目的是通过部分重建对心脏运动伪影和图像噪声的效果，评估0.3秒高分辨率肺部CT（HRCT）的影响。
研究对象和方法：在全屏吸气时，获得了37对0.3秒（部分重建）和0.75秒（完全重建）的HRCT图像，用于下肺区。对于每个患者，除时间分辨率以外的成像参数均相同。两位放射科医生对心脏边界，支气管，肺血管和左肺裂的运动伪影进行了4分制的视觉分级（其中4表示没有伪影）。计算沿左心脏边界的最大运动宽度和左肺中运动伪影的面积百分比。还确定了空气和肺中的图像噪声。比较两组CT图像之间的心脏运动伪影和图像噪声。
结果：0.3秒图像的心脏边界（4 /-0），支气管（3.8 /-0.7），肺血管（3.6 /-0.8）和裂痕（3.9 /-0.5）的视觉等级高于0.75秒图像（分别为1.7 /-0.7、2.0 /-1.0、1.6 /-0.7和2.4 /-0.9）（p <0.001）。对于0.3秒的图像，沿左心脏边界的最大运动宽度（0.1 /-0.5 mm）和左肺中的运动伪影的面积百分比（6.7％/-18.4％）小于0.75秒的图像（分别为4.5±1.7毫米和36.2％±20.9％（p <0.001）。对于0.3秒的图像，空气（38.0 /-9.2）和肺（86.0 /-23.1）的图像噪声大于0.75秒的图像噪声（分别为35.6 /-9.6和76.0 /-20.3）（p <0.01 ）。
结论：与使用完全重建的0.75秒HRCT相比，使用部分重建的0.3秒HRCT可以显着减少肺部的心脏运动伪影，但会增加图像噪声。

BACKGROUND & AIMS: Prostate-specific antigen (PSA), a glycoprotein initially thought to be produced only by the epithelial cells of the prostate, has recently been found in 30% of female breast tumours using immunofluorometry. Our aim was to localize PSA immunohistochemically in a selected group of 27 paraffin-embedded breast tissues. A scoring system was developed for the histological assessment of PSA positivity within the breast tissue. One pathologist (DH) scored, classified and graded all tumours. Site-specific PSA staining was noted in the histology slides. Intense staining was identified in apocrine metaplasia and within the lining ductal epithelium of cystically dilated ducts. The epithelium in lesions of sclerosing adenosis was also frequently positive for PSA staining. Hyperplastic ductal epithelium (especially of mild degree) occasionally stained positive, as did normal breast ducts. Better differentiated tumours showed PSA staining [e.g. mucinous carcinoma (colloid)]. If an infiltrating duct carcinoma showed staining for PSA, adjacent intraductal carcinoma was also noted to stain positively, if present.

背景与目标： 前列腺特异性抗原（PSA）是一种最初被认为仅由前列腺上皮细胞产生的糖蛋白，最近在30％的女性乳腺肿瘤中使用免疫荧光法发现了这种蛋白。我们的目标是通过免疫组化将PSA定位在27个石蜡包埋的乳腺组织的选定组中。开发了评分系统用于乳腺组织内PSA阳性的组织学评估。一名病理学家（DH）对所有肿瘤进行了评分，分类和分级。组织学幻灯片中记录了位点特异性PSA染色。在顶泌化生和囊性扩张管的衬里导管上皮中鉴定到强染色。硬化性腺病病灶中的上皮也常对PSA染色呈阳性。增生性导管上皮（尤其是轻度导管）偶尔染色为阳性，正常乳腺导管也是如此。分化更好的肿瘤表现出PSA染色[例如粘液癌（胶体）]。如果浸润性导管癌显示PSA染色，则也可以发现邻近的导管内癌也呈阳性染色。

BACKGROUND & AIMS: :A retrospective study of male breast cancer was undertaken at Ouagadougou University Teaching Hospital over a 3 year period (1993-1996). Authors report 5 cases representing 4.16% of all breast cancers. The patients' mean age was 61 years. The average duration of signs and symptoms before the diagnosis was 13 months. Clinically all the 5 cases presented advanced cancers (4 T4N2M0, 1 T4N2M1 according to UICC TNM System) with size ranging from 5.5, to 11.5 cm. Histology found: 2 medullary infiltrating carcinoma, 1 canalar infiltrating carcinoma, 1 colloid mucous carcinoma and 1 lobular infiltrating carcinoma. All patients had mastectomy associated with axillary clearance in 4 cases. Radiotherapy, chemotherapy and hormonotherapy were not associated because unavailable in Burkina Faso. Three patients died: the first, 10 days after surgical treatment and the 2 others respectively after 14 and 17 months. We have lost sight 1 patients. The last one is still alive. Authors find that to get better prognosis, it is important to improve medical and technical means, to increase information and to promote early detection.

背景与目标： ：在瓦加杜古大学教学医院进行了为期3年（1993年至1996年）的男性乳腺癌回顾性研究。作者报告了5例病例，占所有乳腺癌的4.16％。患者的平均年龄为61岁。诊断前平均体征和症状持续时间为13个月。临床上所有5例患者均出现晚期癌症（根据UICC TNM System，为4个T4N2M0、1个T4N2M1），大小在5.5至11.5厘米之间。组织学发现：2个髓样浸润癌，1个管状浸润癌，1个胶体粘​​液癌和1个小叶浸润癌。所有患者均进行了伴有腋窝清除术的乳房切除术4例。放疗，化学疗法和激素疗法没有联系，因为布基纳法索无法使用。 3例患者死亡：第一例，手术治疗10天后死亡，另外2例分别在14个月和17个月后死亡。我们失去了视力1例患者。最后一个还活着。作者发现，要获得更好的预后，重要的是改善医学和技术手段，增加信息并促进早期发现。

BACKGROUND & AIMS: BACKGROUND:The appendix vermiformis can provide an excellent urinary conduit or a catheterizable outlet in continent urinary reservoirs in selected cases. We report our clinical experience using the appendix in urinary reconstruction in adult patients. METHODS:A total of 12 patients underwent urinary reconstruction using the appendix. The indications were pelvic malignancies except for 1 patient with neurogenic bladder and difficulty in self-catheterization via urethra. The appendix was used as a catheterizable conduit in 8 patients, and as a urinary conduit in 4 patients. The in situ submucosally embedded method was used in 6 patients and the Mitrofanoff method was used in 2 patients. Follow-up ranged from 3 to 41 months (mean, 22). RESULTS:Early complications occurred in 3 patients (wound infection, false passage and intestinal anasotomotic leak). Late complications occurred in 3 (slight hydronephrosis, ileus, stomal stenosis). Emergent colostomy and pouchstomy with resection of the appendix was performed in the patient with anastomotic leak. The isoperistaltic Kock nipple valve was reconstructed for continence in this case. Prolonged ileus in 1 patient was treated by open surgery. Other complications were managed conservatively. End results were excellent in 8 patients, good in 3, and poor in 1. CONCLUSIONS:The appendix can be used advantageously as an outlet of continent urinary reservoirs or for a urinary conduit when the ureter is too short to reach the skin. Complete continence and easy catheterization can be obtained, and the appendix construction can be used as a urinary conduit instead of the ileal conduit in poor risk patients.

背景与目标： 背景：在某些情况下，阑尾可在大陆性尿液储库中提供出色的导尿管或可导管插入的出口。我们报告了在成人患者尿路重建中使用阑尾的临床经验。
方法：共有12例患者使用阑尾进行了尿路再造。适应症为盆腔恶性肿瘤，除了1例神经源性膀胱并且难以通过尿道自行导尿的患者。附录在8例患者中用作导管插入导管，在4例患者中用作导尿管导管。 6例采用原位黏膜下埋入法，2例采用Mitrofanoff法。随访时间为3到41个月（平均22个月）。
结果：3例患者发生了早期并发症（伤口感染，假传代和肠吻合口漏）。晚期并发症发生3例（轻度肾积水，肠梗阻，造口狭窄）。发生吻合口漏的患者进行了紧急结肠造口和袋切开术，并切除了阑尾。在这种情况下，重建了手术性的科克乳头瓣膜以用于节制。 1例患者的肠梗阻经开放手术治疗。其他并发症均保守治疗。最终结果好8例，好3例，差1例。
结论：阑尾可以方便地用作大陆性泌尿系统的出口，或者当输尿管太短而无法到达皮肤时，可以用作导尿管。可以获得完全的尿失禁和容易的导管插入术，并且在低危患者中，阑尾结构可以用作导尿管，而不是回肠导尿管。

BACKGROUND & AIMS: PURPOSE:The subareolar and periareolar injection techniques result in higher detection rates and do not require tumor localization in impalpable lesions when compared with the peritumoral technique. One of the main criticisms, however, is the widely reported inability to detect internal mammary nodes. This contrasts with our clinical experience using Tc-99m antimony sulfur colloid, in which internal mammary nodes are commonly seen. METHODS:A retrospective analysis of 241 patients over 38 months was performed to investigate the ability of our periareolar injection technique to detect internal mammary lymph node drainage in breast cancer sentinel node lymphoscintigraphy. Four injections of 5 to 10 MBq (0.14-0.27 mCi) Tc-99m antimony sulfur colloid were administered on the day of surgery followed by massage and imaging. The radioisotope was suspended in 0.1 mL with a 0.5-mL air lock. Each injection was performed over 2 seconds with a 25-gauge needle at a depth of 1.1 to 1.3 cm. Patients whose records could not be retrieved or who underwent an injection technique apart from periareolar or peritumoral were removed from the analysis. RESULTS:One hundred thirty-three patients underwent the periareolar technique, 72 patients underwent the peritumoral technique, and 36 patients were excluded from the analysis. Internal mammary drainage was seen in 24 of 133 (18.0%) patients, of which 12 (9%) were seen only in the internal mammary chain. This is much higher than previous studies quoting 0.0% to 4.3% and is similar to previously reported rates using the peritumoral technique. CONCLUSIONS:Our periareolar injection technique using Tc-99m antimony sulfur colloid is able to detect internal mammary lymph nodes in at least 18.0% of patients.

背景与目标： 目的：乳晕下和乳晕周围注射技术与肿瘤周围技术相比，具有更高的检出率，并且不需要将肿瘤定位在无法触及的病变中。然而，主要的批评之一是被广泛报道的无法检测内部乳腺淋巴结。这与我们使用Tc-99m锑硫胶体的临床经验形成了鲜明对比，在该经验中，内部乳腺淋巴结很常见。
方法：回顾性分析了241例患者，历时38个月，以探讨我们乳晕周围注射技术在乳腺癌前哨淋巴结显像术中检测内部乳腺淋巴结引流的能力。在手术当天进行四次5至10 MBq（0.14-0.27 mCi）Tc-99m锑硫胶体注射，然后进行按摩和成像。将放射性同位素悬浮在0.5 mL气闸中的0.1 mL中。每次注射都是用25号针在1.1至1.3厘米深度下进行2秒钟。无法检索记录或除了乳晕周围或肿瘤周围进行了注射技术的患者均从分析中剔除。
结果：133例患者接受了乳晕治疗，72例患者接受了肿瘤周围治疗，36例患者被排除在分析之外。 133例患者中有24例（18.0％）出现了内部乳腺引流，其中12例（9％）仅见于内部乳腺链。这比以前的研究（引用0.0％至4.3％）要高得多，并且与先前报道的使用肿瘤周围技术的比率相似。
结论：我们使用Tc-99m锑硫胶体的乳晕周围注射技术能够检测至少18.0％的患者的内部乳腺淋巴结。

BACKGROUND & AIMS: :Following surgery, the hormone dependence of breast tumors is exploited for therapy using antagonists such as tamoxifen, although occasional hormone-resistant clones do appear. Another chemotherapeutic strategy uses microtubule inhibitors such as taxanes. Unfortunately, these agents elicit toxicities such as leukocytopenia, diarrhea, alopecia, and peripheral neuropathies and are also associated with the emergence of drug resistance. We have previously described a tubulin-binding, natural compound, noscapine, that was nontoxic and triggered apoptosis in many cancer types albeit at 10 mumol/L or higher concentrations depending on the cell type. We now show that a synthetic analogue of noscapine, 9-bromonoscapine, is approximately 10-fold to 15-fold more potent than noscapine in inhibiting cell proliferation and induces apoptosis following G2-M arrest in hormone-insensitive human breast cancers (MDA-MB-231). Furthermore, a clear loss of mitochondrial membrane potential, release of cytochrome c, activation of the terminal caspase-3, and the cleavage of its substrates such as poly(ADP-ribose) polymerase, suggest an intrinsic apoptotic mechanism. Taken together, these data point to a mitochondrially mediated apoptosis of hormone-insensitive breast cancer cells. Human tumor xenografts in nude mice showed significant tumor volume reduction and a surprising increase in longevity without signs of obvious toxicity. Thus, our data provide compelling evidence that 9-bromonoscapine can be useful for the therapy of hormone-refractory breast cancer.

背景与目标： ：手术后，尽管偶尔出现激素抵抗性克隆，但利用他莫昔芬等拮抗剂开发了乳腺肿瘤的激素依赖性疗法。另一种化学治疗策略是使用微管抑制剂，例如紫杉烷类。不幸的是，这些药物引起毒性，例如白细胞减少，腹泻，脱发和周围神经病，并且还与耐药性的出现有关。先前我们已经描述了微管蛋白结合的天然化合物Noscapine，尽管在10μmol/ L或更高的浓度（取决于细胞类型）下，但在许多类型的癌症中均无毒并引发细胞凋亡。我们现在显示，Noscapine的合成类似物9-bromonoscapine在抑制细胞增殖方面比Noscapine效力高约10倍至15倍，并在激素不敏感的人类乳腺癌（MDA-MB）中引起G2-M阻滞后诱导凋亡-231）。此外，线粒体膜电位的明显损失，细胞色素c的释放，末端caspase-3的活化以及其底物（如聚（ADP-核糖）聚合酶）的裂解表明了内在的凋亡机制。综上所述，这些数据表明了激素不敏感的乳腺癌细胞由线粒体介导的凋亡。裸鼠中的人类肿瘤异种移植物显示出明显的肿瘤体积减少和寿命的惊人增加，而没有明显的毒性迹象。因此，我们的数据提供了令人信服的证据，表明9-溴莫可可碱可用于治疗激素难治性乳腺癌。

BACKGROUND & AIMS: BACKGROUND:This study aimed at analyzing different treatments of breast cancer (BC) prevalent in the region, their effect on patients' survival, and discusses the most suitable method within available resources. METHODS:The study was set up at a tertiary care hospital in north India. We retrospectively reviewed data of 473 female BC patients who attended the departments of Surgical Oncology and Radiotherapy from January 1997 to December 1999. Patients with cTNM stage IV and inoperable stage III were included; those who defaulted or were lost to follow-up were excluded. Out of 473 patients, 372 were selected. The selected patients were divided into groups on the basis of place and type of local treatment they received: (1) local excision only, (2) standard breast conservation therapy (BCT), (3) total mastectomy (TM) + axillary lymph node dissection + radiotherapy (RT), and (4) modified radical mastectomy (MRM) + RT. Data regarding recurrence and survival were analyzed in December 2005. Minimum follow-up was 6 years. RESULTS:Overall recurrence rates were significantly higher in patients operated elsewhere (P <0.0001). Of 194 operated at our Breast Unit, 25 (14.6%) of 171 MRM patients and none of 23 BCT had recurrence. Of 178 patients operated elsewhere, 44 (100%), 6 (42.9%), 41 (41%), and 8 (40%) developed recurrence in groups 1, 2, 3, and 4 respectively. Overall survival was significantly better in patients with MRM at our unit versus TM outside (93.6% vs. 80%). CONCLUSIONS:Several types of treatment from improper local excision alone, BCT, TM, to a carefully done MRM are prevalent here. Properly done, MRM yields significant local control with survival benefit and appears to remain the gold standard in management of our BC patients.

背景与目标： 背景：本研究旨在分析该地区流行的乳腺癌（BC）的不同治疗方法，它们对患者生存的影响，并在可用资源范围内讨论最合适的方法。
方法：该研究是在印度北部的一家三级保健医院进行的。我们回顾性回顾了1997年1月至1999年12月就诊于外科肿瘤和放射治疗科的473例女性BC患者的数据。那些违约或失去随访的人被排除在外。在473名患者中，选择了372名。根据所接受的局部治疗的位置和类型将选定的患者分为几类：（1）仅局部切除，（2）标准乳房保留疗法（BCT），（3）全乳房切除术（TM）腋窝淋巴结清扫术放射疗法（RT）和（4）改良根治性乳房切除术（MRM）RT。有关复发和生存的数据于2005年12月进行了分析。最低随访时间为6年。
结果：在其他地方手术的患者的总体复发率显着更高（P <0.0001）。在我们的乳房科进行的194例手术中，171例MRM患者中有25例（占14.6％），而23例BCT均未复发。在178例在其他地方手术的患者中，分别在第1、2、3和4组中复发了44例（100％），6例（42.9％），41例（41％）和8例（40％）复发。我们单位的MRM患者的总生存期明显优于室外TM（93.6％vs. 80％）。
结论：从单独的不当局部切除，BCT，TM到精心制作的MRM的几种治疗方法在这里很普遍。正确完成后，MRM可以产生明显的局部控制并具有生存获益，并且似乎仍然是我们BC患者治疗的金标准。

BACKGROUND & AIMS: :Women of African descent have a lower incidence of breast cancer than their white counterparts; however, the overall age-adjusted breast cancer mortality rates are higher. They also present at a younger age, and have more advanced disease that exhibits poor prognostic features including significantly larger tumors of higher grade, higher rates of estrogen receptor and progesterone receptor negativity and a higher rate of p53 mutations and HRAS1 proto-oncogene expression, all of which confer a poor prognosis. While there are many possible contributory factors to the discrepancies in outcome in women of African descent, there is no satisfactory explanation as to why women of African origin tend to present at a younger age with hormone receptor-negative tumors and more adverse prognostic features.

背景与目标： ：非洲裔女性的乳腺癌发病率低于白人女性；但是，按年龄调整的总体乳腺癌死亡率更高。它们也以较年轻的年龄出现，并具有较晚期的疾病，表现出不良的预后特征，包括更高级别的明显更大的肿瘤，更高的雌激素受体和孕激素受体阴性率以及更高的p53突变和HRAS1原癌基因表达率，所有其中预后不良。尽管有许多可能的因素导致非洲人后裔的结果差异，但对于为什么非洲裔妇女倾向于在年轻时出现荷尔蒙受体阴性肿瘤和更不利的预后特征尚无令人满意的解释。

BACKGROUND & AIMS: BACKGROUND:Little is known about the impact of the recent varicella vaccine shortage. To assess the temporal trend in varicella vaccine administration before 18 and 24 months of age in a community cohort of children prior to, during and after the recent varicella vaccine shortage. And to compare the temporal trends in varicella vaccinations to trends of an older, more widely accepted vaccine, the MMR. METHODS:Community population-based birth cohorts were identified who were eligible for the varicella vaccination before, during and after the 2001 to 2002 varicella vaccine shortage. Only children (84% of all) who remained in the community through their second birthday were included. For each child in the cohort, the medical records and immunization registry records from both medical facilities in the county were reviewed to identify the dates and sites for all varicella immunizations given. In addition to varicella immunizations, the dates of all MMR vaccinations were recorded. Additional data abstracted included the child's birth date, gender and dates of any recognized cases of chickenpox up through age 24 months. RESULTS:Of the 2,512 children in the birth cohorts, 50.8% were boys. In the three cohorts combined, 81.1% of the boys and 79.3% of the girls (p = 0.30) received the varicella vaccine by age 24 months. The pre-shortage community rate of varicella immunization was 79.7% by 24 months of age. During the varicella vaccine shortage, the rate of varicella immunization by 24 months fell to 77.2%. Only 6 additional children received a "catch-up" immunization by 36 months of age. In the post shortage period the community 24-month immunization rate rebounded to a level higher than the pre-shortage rate 84.0%. During the almost three years of observation, the MMR immunization rate by age 24 months was constant (87%). CONCLUSION:The varicella shortage was associated with an immediate drop in the 24-month varicella immunizations rate but rebounded quickly to above pre-shortage rates. In this community the only long term impact of the varicella vaccine shortage may be on the small number of children who still had not received catch-up varicella immunizations by 36 months of age.

背景与目标： 背景：对最近水痘疫苗短缺的影响知之甚少。在最近的水痘疫苗短缺之前，期间和之后，评估社区队列中儿童在18和24个月大之前接种水痘疫苗的时间趋势。并将水痘疫苗接种的时间趋势与较旧的，被更广泛接受的疫苗MMR的趋势进行比较。
方法：确定2001年至2002年水痘疫苗短缺之前，之中和之后有水痘疫苗接种资格的以社区人群为基础的出生队列。仅包括直到第二个生日仍留在社区中的儿童（占总数的84％）。对于该队列中的每个孩子，都检查了县内两个医疗机构的病历和免疫登记记录，以确定所有水痘疫苗接种的日期和地点。除水痘疫苗接种外，还记录了所有MMR疫苗接种的日期。提取的其他数据包括孩子的出生日期，性别以及直到24个月大的任何公认的水痘病例的日期。
结果：在出生队列的2,512名儿童中，男孩占50.8％。在这三个队列中，到24个月大时，有81.1％的男孩和79.3％的女孩（p = 0.30）接受了水痘疫苗。到24个月大时，水痘疫苗的短缺前社区接种率为79.7％。在水痘疫苗短缺期间，水痘疫苗的免疫率在24个月内下降到77.2％。到36个月大时，仅再有6名儿童接受了“追赶”免疫。在短缺后时期，社区24个月的免疫接种率反弹到高于短缺前84.0％的水平。在将近三年的观察中，到24个月大时的MMR免疫率是恒定的（87％）。
结论：水痘短缺与24个月水痘疫苗接种率立即下降有关，但迅速反弹至短缺前水平。在这个社区中，水痘疫苗短缺的唯一长期影响可能是对仍在36个月大时仍未接受追赶水痘免疫接种的少数儿童。

BACKGROUND & AIMS: The sonographic features of 22 patients with histologically benign intraductal papillomas are presented, with clinical, mammographic, galactographic, and histopathologic correlation. The most common presenting feature in this series is a palpable central breast mass in an elderly woman. Sonography was abnormal in all 22 patients. The typical sonographic features include a well-defined, smooth-walled, solid, hypoechoic nodule or a lobulated, smooth-walled, cystic lesion with solid components. Dilated ducts are a common feature, often with visible solid intraluminal echoes. These findings suggest the diagnosis of an intraductal papilloma. The differential diagnosis includes fibroadenoma and phyllodes tumor (for large solid lesions) and intracystic carcinoma (for complex cystic lesions). Mammograms are frequently normal (36% of patients). When abnormal, the mammographic features are of a smooth-walled, well-defined mass or increased retroareolar opacity. Contrary to the reported literature, calcification was seen infrequently. We conclude that ultrasonography is useful in the detection and delineation of intraductal papillomas.

背景与目标： 介绍了22例组织学上良性导管内乳头状瘤患者的超声特征，并与临床，乳房X线照片，乳腺摄影和组织病理学相关。该系列最常见的表现是一名老年妇女的中央乳腺肿块。所有22例患者的超声检查均异常。典型的超声特征包括界限分明，光滑的壁，实体的低回声结节或具有固体成分的小叶的光滑壁的囊性病变。扩张的导管是常见特征，通常伴有可见的固体腔内回声。这些发现提示导管内乳头状瘤的诊断。鉴别诊断包括纤维腺瘤和叶状肿瘤（对于大的实体病变）和囊内癌（对于复杂的囊性病变）。乳房X线照片通常是正常的（36％的患者）。异常时，乳房X光检查的特征是壁光滑，边界清晰或乳晕后不透明性增加。与报道的文献相反，很少见到钙化。我们得出的结论是，超声检查可用于导管内乳头状瘤的检测和勾画。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: :Immediate placement refers to the placement of an implant into a tooth socket at the time of extraction; early placement refers to the placement of an implant after substantial gingival healing, but before any clinically significant bone fill occurs within the socket. This study evaluated the success and survival rates of implants following immediate and early placement. 50 implants were placed in 36 patients. 26 immediate (group I) and 24 early placements (group II) were performed. Pain or tenderness with function, mobility, radiographic bone loss from initial surgery and exudate history were evaluated. Mean vertical bone loss in the immediate placement group was 0.55 mm and 0.80 mm in the early placement group. The survival rate for the immediate placement group was 96.16% with 51.6 months follow-up and in the early placement group was 100% with 61.9 months follow-up. The results of this study suggest that although the success and survival rates of early placed implants were a little higher and the follow up period was longer than immediately placed implants, the difference was not remarkable. In conclusion, both implant insertion techniques are safe and reliable procedures with considerably high survival rates.

背景与目标： ：立即放置是指拔出时将植入物放置在牙槽中；早期放置是指在基本的牙龈愈合之后但在窝内发生任何临床上显着的骨填充之前的植入物放置。这项研究评估了立即和早期放置后植入物的成功率和存活率。在36例患者中放置了50个植入物。进行了26例即刻（I组）和24例早期放置（II组）。评估疼痛或压痛以及功能，活动性，初次手术的影像学骨丢失和渗出液病史。立即放置组的平均垂直骨丢失为0.55 mm，早期放置组为0.80 mm。立即安置组的生存率为96.16％，随访时间为51.6个月，早期安置组的生存率为100％，随访时间为61.9个月。这项研究的结果表明，尽管早期放置的植入物的成功率和存活率比立即放置的植入物更高，并且随访时间更长，但差异并不明显。总之，两种植入物插入技术都是安全可靠的方法，具有很高的生存率。