The Nebraska medical journal最新文献

The benefits of adjuvant systemic therapy in the treatment of early breast cancer are well established. However, many questions remain regarding the appropriate selection of patients and regimens, duration of treatment, timing or sequencing of treatment as well as the role of high-dose chemotherapy or new active drugs such as paclitaxel. Future answers will only come through continued participation in carefully designed clinical research.

Data from the Nebraska Cancer Registry indicate that the State's female breast cancer incidence rate did not increase or decrease significantly during the period 1987-1993, although the percentage of in situ diagnoses increased from 8% to 13%. Similarly, breast cancer mortality among Nebraska women has remained relatively constant during the past decade (1985-1994). According to Nebraska's Behavioral Risk Factor Survey, screening mammography rates among Nebraska women have shown striking increases in recent years: in 1994, nearly half (48%) of all women 50 and older reported that they had had a mammogram within the past year, up from 24% in 1988. Nebraska's breast cancer incidence, mortality, and screening rates remain lower than U.S. rates.

A meta-analysis has been performed of available retrospective reports concerning the 5-15 year disease-free survival of 5,353 premenopausal breast cancer patients operated on either during the follicular or luteal phases of the menstrual cycle. Patients with surgery performed during the luteal phase (d14-23+) had an overall mean 5% benefit compared to those operated on the follicular phase determined by date of onset of their last menstrual period p=0.02 by Wilcoxon 2-tailed test. When nodal invasion was reported, node-negative patients had a 5 + 2% SEM benefit. Patients with positive nodes had a 34 + 3% SEM increase in survival (p = .05), including both estrogen and progesterone-receptor negative as well as positive neoplasms. In 3 of 4 reports from major cancer treatment centers, each containing 249-1175 cases, risk of recurrent cancer and/or death increased 5 to 6-fold after 10 years for women receiving surgery during d7-14 of their cycle, compared to those resected during d21-36. Improvement in prognosis was greatest for patients with the highest risk of recurrence due to node-invasive disease and receptor dysfunction. Several cell-mediated immunologic factors inimical to metastasis are maximal in the luteal phase of the menstrual cycle, including natural killer cell activity. A new drug which augments natural killer cell activity may extend any beneficial survival results to post-menopausal breast cancer patients in the future. We conclude that accurate menstrual histories should be included in the medical record from now on for all premenopausal women receiving any surgical procedure upon the breast, preferably using an objective method of determining the date of last ovulation. Prospective randomized clinical trials are necessary to determine the full extent of survival benefits of late luteal surgical timing.

1. A careful history and favorable physical exam is mandatory for consideration of LAUP. 2. Concurrent diseases must be addressed for optimal results. 3. A sleep study should be recommended with any evidence suggestive of sleep apnea. 4. LAUP cures snoring. 5. Primary treatment of severe sleep apnea is nasal continuous positive airway pressure (NCPAP). 6. Mild sleep apnea with appropriate physical exam can be expected to have acceptable results when treated by LAUP. 7. LAUP should be considered for moderate to severe sleep apnea only if NCPAF intolerance is intractible.

Objective: To study portrayals of African Americans in family medicine recruiting literature on a quantitative basis.

Design: Survey.

Setting: Seventy six family medicine residency recruiting brochures, from programs responding to letters requesting "information and an application" for an unrelated study.

Main outcome measures: Numbers of African Americans portrayed as physicians, other health care professionals, patients, and other in recruiting brochures.

Results: Out 2433 individuals portrayed, African Americans accounted for 4.2% of physicians, 10.8% of other health care providers, and 17% of patients. Brochures from twenty three programs, containing photographs of 502 individuals portrayed no African Americans.

Conclusions: About one third of a sample of family practice program brochures sent to resident applicants in 1992 contained no photographs of African Americans. Implications for the recruitment of minorities to family medicine programs are discussed.