In order to test the effect of a psychological intervention on survival from cancer, 66 women with metastatic breast cancer, all receiving standard medical care, were randomly assigned into two groups; one group (n = 30) attended the psychological intervention, consisting of 35 weekly, 2 h sessions of supportive plus cognitive behavioral therapy; the control group (n = 36) received only a home study cognitive behavioral package. No significant difference was found in survival post-randomization between the groups as assessed by a log rank test 5 years after the commencement of the study. As expected, several prognostic factors were significant predictors of survival: metastatic site, hormonal receptor status, and chemotherapy prior to randomization. While many personal and demographic variables did not influence survival, there was a significant effect of self-reported exercise (possibly due to better health). A small subgroup of intervention subjects who attended outside support groups also survived significantly longer than those who did not. The strengths and limitations of the present study are discussed, and the results contrasted with those of a well known study by Spiegel et al. (Spiegel, D., Bloom, J.R., Kraemer, H.C. and Gottheil, E. (1989) Lancet ii, 888-891). We propose that a different experimental design (correlative) may be needed to show any effect of self-help behaviors and psychological attributes in a small minority of patients.

Adult↗

PubMedDate not supplied

Acute renal allograft rejection: difficulty in diagnosis of histologically mild cases by MR imaging.

To determine the ability of magnetic resonance (MR) imaging to diagnose various degrees of acute allograft rejection (AR), 33 MR examinations in 28 patients were obtained. Surface coils were used in 21 examinations. Seventeen examinations were correlated with biopsy results, which were graded as absent (n = 7), mild (n = 6), or severe (n = 4) AR. Corticomedullary differentiation (CMD) on T1 weighted images was graded as absent/poor versus distinct, and images were also evaluated for visibility of intrarenal vessels. For serial examinations, renal volume was measured and compared. The MR results were correlated with radionuclide interpretations in 22 cases. Diminished CMD was most common with AR (7 of 12) but was also seen with acute tubular necrosis (2 of 6) and cyclosporin toxicity (2 of 3). All four cases of severe AR had diminished CMD. In contrast, only one of six cases of mild AR had diminished CMD (p less than 0.05). Four of five cases of mild AR by radionuclide scan were correctly diagnosed. Visualization of intrarenal vessels was best with surface coils, but this did not contribute to differential diagnosis. Renal volume was increased in rejecting allografts. Magnetic resonance is a promising modality for investigation of renal allografts but is not a sensitive or specific modality for the diagnosis of mild AR.

Graft Rejection↗