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cooper.cpmc.org

BACKGROUND: Understanding sources of physician delay in diagnosis of breast cancer will assist efforts to expedite diagnosis. OBJECTIVE: To test whether increased reliance on screening mammography has affected causes of physician delay in diagnosis of breast cancer. DESIGN: Survey of delays in a case series. SETTING: Practice specializing in breast diseases in a region with high use of screening mammography. PATIENTS: Four hundred thirty-five consecutive patients treated for 454 breast cancers of any stage. INTERVENTION: Customary patient care. MAIN OUTCOME MEASURES: Whether delay was related to how cancer was identified, patient age, individual cancer characteristics (such as tumor type), mammography reports, or physician expertise. RESULTS: Twenty-one women (5%) were inappropriately reassured that a malignant lump was benign without biopsy, 14 women (3%) had a misread mammogram, 4 women (1%) had a misread pathologic finding, and 5 women (1%) had cancer missed by a poorly performed fine-needle aspiration biopsy. Delay was associated with a benign mammography report (relative risk, 10.8; 95% confidence interval, 5.1-22.8), a woman finding her own mass (relative risk, 3.3; 95% confidence interval, 1.8-6.2), and current hormone replacement therapy (relative risk, 3.1; 95% confidence interval, 1.2-8.5). CONCLUSIONS: The leading cause of physician delay in diagnosis of breast cancer continues to be inappropriate reassurance that a mass is benign without biopsy. Reducing delay in diagnosis will require less willingness to rely on clinical examination to decide that a mass is benign, less reliance on benign mammography reports to decide not to biopsy a mass, and a requirement that fine-needle aspiration biopsy be done by persons with demonstrated competence for the procedure.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12076232&dopt=Abstract

Arch Intern Med. 2002 Jun 24;162(12):1388-94.
Rapid down-regulation of thyroid hormones in acute myocardial infarction: is it cardioprotective in patients with angina?

Friberg L, Werner S, Eggertsen G, Ahnve S.

Department of Cardiology, Karolinska Institute at Huddinge University Hospital, S-141 86 Stockholm, Sweden.

BACKGROUND: In severe illness of any cause, down-regulation of the thyroid hormone system may occur. How this affects patients with acute myocardial infarction (AMI) is largely unknown. OBJECTIVE: To investigate changes in serum levels of the thyroid hormones during AMI and their association with cardiac function and outcome. METHODS: Forty-seven consecutive euthyroid patients with AMI were studied prospectively during the first 5 days and again 6 and 12 weeks later. Time from pain onset was used in all analyses. RESULTS: The thyroid hormone system was rapidly down-regulated with maximal changes 24 to 36 hours after onset of symptoms. The mean level of the hormone total triiodothyronine (T3) decreased 19% (P =.02), the inactive metabolite reverse T3 (rT3) levels increased 22% (P =.01), and thyrotropin levels declined 51% (P<.001) between the first 6-hour and the 24- to 36-hour period. The prohormone free thyroxine was largely unchanged. Patients with poor heart function or more intense inflammatory reaction showed more pronounced down-regulation of the thyroid system. No correlation was found with cardiac enzymes. Patients with prior angina pectoris had lower T(3) levels in early samples, smaller infarctions, and higher levels of C-reactive protein and the proinflammatory cytokine interleukin 6 on admittance. Peak levels of interleukin 6 correlated negatively with T3 (P =.005) and positively with rT3 (P<.05), suggesting that down-regulation before AMI may be cardioprotective. However, mortality was high among patients with the most pronounced thyroid level depression, indicating that down-regulation after AMI may be maladaptive. CONCLUSIONS: The thyroid hormone system is rapidly down-regulated in AMI. This may be beneficial during acute ischemia. Patients with angina had higher levels of interleukin 6 and C-reactive protein and more depressed thyroid hormone system in early samples. Thyroid level depression in patients with angina may possibly have been present before the infarction process started. This novel finding needs further evaluation in large studies to sort out cause-and-effect relationships.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12076238&dopt=Abstract

Pharmacol Biochem Behav. 2002 Aug;73(1):53-60.
Prenatal stress produces deficits in socio-sexual behavior of cycling, but not hormone-primed, Long-Evans rats.

Frye CA, Orecki ZA.

Department of Psychology, University at Albany-SUNY, 12222, USA. cafrynsunix.albany.edu

Prenatal stress (PNS) alters behavior of adult offspring in novel environments or in social interactions; variable effects of PNS on female reproductive behavior have been reported. Effects of exposure to restraint and lights for 45 min/day on Gestational Days 14-20 were examined on the motor and socio-sexual behavior of adult female offspring. In a novel arena, proestrous PNS rats displayed greater behavioral inhibition as indicated by significantly fewer beam breaks made in the horizontal crossing task compared to that of proestrous non-PNS rats. In a standard mating test, in which females are exposed to males in a relatively small space for a restricted time or number of sexual contacts, PNS females in proestrus were found to have significant decreases in the intensity of lordosis and in the number of solicitation behaviors that they directed towards the male compared to non-PNS rats. In a seminatural mating test, in which females can control the timing of the sexual contacts from the male, PNS females in proestrus engaged in significantly less pacing of their sexual contacts compared to that of the non-PNS females. When additional PNS and non-PNS rats were ovariectomized (ovx) and tested following hormone priming, behavioral differences were abrogated. PNS decreased motor behavior in a novel arena, lordosis intensity, and solicitation behavior in a standard mating paradigm, as well as adaptive, approach-avoidance behavior in a seminatural mating situation of endogenously cycling proestrous rats but not ovx, hormone-primed rats. Thus, hormone priming may override or mask effects of PNS on some aspects of socio-sexual behavior.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12076724&dopt=Abstract

Pharmacol Biochem Behav. 2002 Aug;73(1):77-85.
Neonatal isolation alters stress hormone and mesolimbic dopamine release in juvenile rats.

McCormick CM, Kehoe P, Mallinson K, Cecchi L, Frye CA.

Neuroscience Program and Department of Psychology, Bates College, Lewiston, ME 04240, USA. cmccormbacus.bates.edu

Rat pups were individually isolated from the mother and nest for 1 h/day from postnatal days (PND) 2 to 9 and tested as juveniles (PND 26-30) compared to nonhandled (NH) controls. In response to 1 h of restraint stress, NH rats increased locomotor activity and dopamine (DA) levels, but neonatally isolated (ISO) rats did not. Both groups had increased plasma corticosterone levels in response to restraint, but corticosterone levels were higher in ISO than in NH. Brain allopregnanolone (3alpha,5alpha-THP) levels also increased in response to stress, but NH and ISO did not differ. Sex of the rats was not a factor for any of the measures except plasma corticosterone levels, where females had higher levels than males. These data indicate that the effects of neonatal isolation persist postweaning and that the effects are most evident in response to stress as opposed to under baseline conditions.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12076726&dopt=Abstract

Epilepsy Res. 2002 May;49(3):181-8.
Castration in female rats modifies the development of the pilocarpine model of epilepsy.

Valente SG, Naffah-Mazzacoratti MG, Pereira M, Silva I, Santos NF, Baracat EC, Cavalheiro EA, Amado D.

Disciplina de Neurologia Experimental, Escola Paulista de Medicina/Universidade Federal de Sao Paulo, Rua Botucatu, 862, Brazil.

Previous studies have shown that the susceptibility to pilocarpine-induced status epilepticus (SE) in female rats changes according to estrous cycle phases. These studies have also shown that following pilocarpine administration changes occur in gonadal, hypophyseal and hypothalamic hormones that could contribute for the sequence of the epileptic events. Accordingly, the present work aimed to investigate the role of sexual hormones withdrawal on the development of the pilocarpine model of epilepsy in female rats. With this purpose, castrated and non-castrated adult female Wistar rats were injected with pilocarpine and some characteristic parameters of the experimental model were observed. The results showed increased mortality after pilocarpine injection in the castrated rats when compared with non-castrated females. The latency period for SE onset and for the first spontaneous seizure was decreased in castrated when compared with non-castrated animals. The mossy fiber sprouting measured by neo-Timm scale during the chronic period, reached grade 3 for castrated epileptic rats while the non-castrated epileptic rats showed grade 2. Our results indicate that castration interferes with the epileptogenesis in the pilocarpine model of epilepsy suggesting that female sexual hormones could have protective effects against pilocarpine-induced SE.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12076839&dopt=Abstract

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