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PubMed1993

Reduction of blood loss from diagnostic sampling in critically ill patients using a blood-conserving arterial line system.

STUDY OBJECTIVE: To demonstrate the utility of a new blood-conserving arterial line system in reducing blood loss associated with blood drawing in the critical care setting. DESIGN: Prospective, randomized, crossover comparison between two arterial line systems. SETTING: Medical intensive care unit (ICU); tertiary care teaching institution. PATIENTS: Thirty-one patients who required invasive arterial blood pressure monitoring throughout their ICU course. INTERVENTIONS: For ICU days 1 to 2, patients were randomized to receive either a conventional arterial line system or a new blood-conserving arterial line system. On ICU days 3 to 7, patients with a conventional arterial line were crossed over to the blood-conserving arterial line, and vice versa. Laboratory blood volumes, mixed discard volumes, and blood discard volumes were then recorded to document how much blood loss is associated with each aspect of the blood sampling process. RESULTS: The mean total volume of blood sent to the laboratory for testing was 257.4 ml. As a result of "clearing the line" over the 7-day period, patients with the conventional arterial line system lost a mean volume of 340.2 ml of blood mixed with heparinized saline solution more than patients with the blood-conserving arterial line. In terms of the blood component of the blood-heparinized saline solution mixture, use of the conventional arterial line was associated with an average of 156.8 ml more blood discarded than with the blood-conserving arterial line. CONCLUSION: The new blood-conserving arterial line system provides a simple and effective method for reducing blood loss related to diagnostic sampling in the critical care setting.

Blood Specimen Collection↗
PubMed2004

Comparison of conservative and aggressive smoking cessation treatment strategies following coronary artery bypass graft surgery.

PURPOSE: Patients who continue to smoke following coronary artery bypass graft surgery (CABG) have substantially poorer outcomes than patients able to stop smoking after CABG. This study evaluated the effectiveness of two smoking cessation treatment strategies in patients undergoing CABG. METHODS: Two smoking cessation treatment strategies were compared in smokers who underwent CABG. In the conservative treatment strategy, smokers undergoing CABG were followed up prospectively at monthly intervals. Patients who started smoking again at any time in the year following CABG were asked to enroll in an 8-week smoking cessation program. In the aggressive treatment strategy, smokers undergoing CABG were asked to enroll in an 8-week smoking cessation program starting immediately after hospital discharge. The structure and makeup of the smoking cessation program used in the conservative and aggressive treatment strategies were identical. The primary study outcome was smoking status assessed by self-report and confirmed by expired carbon monoxide at 1.5 months, 3 months, 6 months, and 12 months after surgery. RESULTS: Nineteen patients were enrolled in the conservative treatment strategy, with 2 patients unavailable for follow-up prior to the first follow-up visit. Of the remaining 17 patients, 14 patients (82%) resumed smoking at an average of 10.3 weeks after CABG. Eleven of these 14 patients (79%) agreed to participate in the smoking cessation program. Based on evaluable patients, 10 of the 17 patients (59%) in the conservative strategy group were not smoking at the 12-month follow-up. Twenty patients were enrolled in the aggressive treatment strategy. All patients agreed to participate in the smoking cessation program. All patients were available for follow-up. At the 12-month follow-up, 17 of 29 patients (85%) in this treatment strategy were not smoking. Point prevalence and continuous abstinence cessation rates were significantly greater in the aggressive treatment strategy compared to the conservative treatment strategy at all follow-up intervals after CABG. CONCLUSION: Based on our findings in a small number of patients, an aggressive smoking cessation intervention is associated with a superior smoking cessation rate compared to a conservative treatment strategy in smokers undergoing CABG. A larger study will be needed to confirm that an early aggressive smoking cessation intervention should be provided to all smokers undergoing CABG.

Aged↗
PubMed2004

Elucidation and structural analysis of conserved pools for genome-scale metabolic reconstructions.

In this article, we introduce metabolite concentration coupling analysis (MCCA) to study conservation relationships for metabolite concentrations in genome-scale metabolic networks. The analysis allows the global identification of subsets of metabolites whose concentrations are always coupled within common conserved pools. Also, the minimal conserved pool identification (MCPI) procedure is developed for elucidating conserved pools for targeted metabolites without computing the entire basis conservation relationships. The approaches are demonstrated on genome-scale metabolic reconstructions of Helicobacter pylori, Escherichia coli, and Saccharomyces cerevisiae. Despite significant differences in the size and complexity of the examined organism's models, we find that the concentrations of nearly all metabolites are coupled within a relatively small number of subsets. These correspond to the overall exchange of carbon molecules into and out of the networks, interconversion of energy and redox cofactors, and the transfer of nitrogen, sulfur, phosphate, coenzyme A, and acyl carrier protein moieties among metabolites. The presence of large conserved pools can be viewed as global biophysical barriers protecting cellular systems from stresses, maintaining coordinated interconversions between key metabolites, and providing an additional mode of global metabolic regulation. The developed approaches thus provide novel and versatile tools for elucidating coupling relationships between metabolite concentrations with implications in biotechnological and medical applications.

Algorithms↗
PubMed2005

Value of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment: a prospective evaluation.

AIM: Gastrografin is a hyperosmolar water-soluble contrast medium. Besides its predictive value for the need for operative treatment, a potential therapeutic role of this agent in adhesive small bowel obstruction has been suggested. This study aimed at evaluating the effectiveness of gastrografin in adhesive small bowel obstruction when conservative treatment failed. METHODS: Patients with adhesive small bowel obstruction were given trial conservative treatment unless there was fear of bowel strangulation. Those responded in the initial 48 h had conservative treatment continued. Patients who showed no improvement in the initial 48 h were given 100 mL of gastrografin through nasogastric tube followed by serial abdominal radiographs. Patients with the contrast appeared in large bowel within 24 h were regarded as having partial obstruction and conservative treatment was continued. Patients in which the contrast failed to reach large bowel within 24 h were considered to have complete obstruction and laparotomy was performed. RESULTS: Two hundred and twelve patients with 245 episodes of adhesive obstruction were included. Fifteen patients were operated on soon after admission due to fear of strangulation. One hundred and eighty-six episodes of obstruction showed improvement in the initial 48 h and conservative treatment was continued. Two patients had subsequent operations because of persistent obstruction. Forty-four episodes of obstruction showed no improvement within 48 h and gastrografin was administered. Seven patients underwent complete obstruction surgery. Partial obstruction was demonstrated in 37 other cases, obstruction resolved subsequently in all of them except one patient who required laparotomy because of persistent obstruction. The overall operative rate in this study was 10%. There was no complication that could be attributed to the use of gastrografin. CONCLUSION: The use of gastrografin in adhesive small bowel obstruction after unsuccessful conservative treatment is safe and reduces the need for surgical intervention.

Adolescent↗
PubMed2005

[Comparison of health conservation for elders in assisted living facilities and nursing homes].

PURPOSE: This study was performed to evaluate and compare health conservation and its related factors of elders in assisted living facilities or nursing homes. METHOD: Data for health conservation was collected from 316 elders in 10 institutions in Daegu city and Kyungpook province from February 1st to February 22nd, 2005. Data was collected by a structured questionnaire that included general characteristics, general health status, health conservation, functional health status (ADL, IADL) and depression (GDS-K) scales. The collected data was analyzed by the SPSS (version 11.5) program including descriptive statistics, t-test, chi2-test, Pearson's correlation and stepwise method regression analysis. RESULT: The elders in assisted living facilities revealed lower scores in health conservation, ADL and IADL than the elders in nursing homes. Predictable variables influencing health conservation of the elders in assisted living facilities were depression and MAC (Mid-Arm Circumference) that is equal to .270, and the the elders in nursing home were depression, IADL, degree of sleep, and TSF (Triceps Skin Fold) that is equal to .409. CONCLUSION: The development of a health conservation program and long-term health care service system for elders in assisted living facilities are needed than for the elders in nursing homes.

Aged↗
PubMed2000

[Conservative surgical treatment of osteogenic sarcoma of the limb in children and adolescents].

PURPOSE OF THE STUDY: Advances in chemotherapy protocols over the last 20 years have considerably improved the prognosis and functional outcome in patients with osteogenic sarcoma. We report here the results of a cooperative study conducted under the auspices of the French Society of Pediatric Oncology (SFOP). Twenty-nine oncology centers participated in this retrospective national multicentric study. MATERIALS AND METHODS: The study included 153 patients with osteogenic sarcoma of the limb who were treated by the OS87 protocol with conservative surgery between 1987 and 1994. The OS87 protocol consisted in conservative or non-conservative surgery combined with pre- and postoperative chemotherapy. The following inclusion criteria were used: age under 20 years, tumor localization in a limb (pelvis and spine excluded), no metastasis at diagnosis, biopsy proven osteogenic sarcoma. RESULTS: Mean age at diagnosis was 13 years. The knee localization predominated (80 p. 100). 82.5 p. 100 of the patients had grade IIB disease (Enneking classification). For the 187 patients included in the protocol surgery was non-conservative in 20 p. 100 of the cases and conservative in 80 p. 100. The choice of the surgical technique (arthroplasty, allograft, autograft, resection without reconstruction) depended on the patient's age and school situation. Data analyzed here concerned only those patients who had conservative treatment. Mean follow-up was 64 months. The actuarial survival curve plateaued at 71 p. 100 at more than 6 years. Early and late complications were numerous and variable (mechanical, infectious, local recurrence). Secondary amputation was required in 10 p. 100 of the patients. The overall functional outcome of the preserved limbs was nevertheless good with rapid restoration of self-sufficiency despite major surgery and a high number of reoperations (about 65 p. 100 of cases). DISCUSSION: In light of the frequency and the seriousness of the complications, these results are modest. Patients and family should be advised of the risk, particularly the risk of secondary amputation which may be required early due to contaminated excision or at mid term due to major non-cancerological complications. As survival has been improved, functional capacity must be preserved for several years. This orients surgery towards more "biological" reconstruction which can provide greater longevity than arthroplasty.

Adolescent↗
PubMed2001

[Functional outcome of primary pontine hemorrhage: conservative treatment or stereotaxic surgery].

In this study we compared the outcome of patients with primary pontine hemorrhage (PPH) in those who underwent stereotaxic aspiration and those treated non-surgically. Out of 75 PPHs, 37 patients were selected. Their consciousness on admission was somnolent to semicoma (alert and deeply comatose cases were excluded). Patients admitted between 1988 and 1990, and between 1995 and 1996 underwent CT guided stereotaxic aspiration (18 cases: Surgical Group), and those admitted between 1991 and 1994 were treated conservatively (19 cases: Conservative Group). The outcome was analyzed three months after the onset from the viewpoint of level of consciousness and severity of paresis, according to the location of the hemorrhage. With regard to consciousness, 13 of 18 cases in the Surgical Group showed remarkable improvement, while only 8 of 19 cases in the Conservative Group did. The severity of paresis was evaluated only among the patients who could obey commands three months after the onset. Paresis improved in 7 of 13 patients in the Surgical Group, vs. in 3 of 8 patients in the Conservative Group (p < 0.05). According to the location of hemorrhage (CT classification), in the Unilateral tegmental type and the Massive type, the Surgical Group and the Conservative Group showed no difference. On the other hand, in the Bilateral tegmental type and the Basal tegmental type, surgery seemed to be more effective than conservative treatment. In conclusion, CT guided stereotaxic aspiration may improve not only the consciousness level but also the functional outcome.

Adult↗
PubMedDate not supplied

[Comparative radiographic analysis of surgical and conservative treatment of unstable injuries of the thoracic and lumbar spine].

INTRODUCTION: Treatment of fractures and dislocations of the thoracolumbar spine is aimed at achieving a stable and painless spine. Concerning mode of treatment therapists are divided into two groups--those for conservative approach and those who advocate operative stabilization of spinal column. The objective of this paper was to compare radiological findings of both modes of treatment on the basis of our clinical material. MATERIALS AND METHODS: The examination included radiographs of 96 patients with radiolographic signs of unstable spine, treated at Clinic of Orthopaedic Surgery and Traumatology of the Institute of Surgery of the Clinical Center in Novi Sad from 1984 to 1998. Among 48 operated patients (average age of 40.7), there were more females--25, and among nonoperated, there were more males--33. The average age of conservatively treated patients was 52. Dynamic radiographs evaluated the angle of local kyphosis on the spot of injury (Cobb's angle), reduction of dimensions of the body of injured vertebra and sagittal movement of the body on affected level. Measured values were corrected by values of sagittal index. RESULTS: Initially the average angle of local kyphosis among operated was 26.9, among conservatively treated it was 19.7. Control values for operated were 14.7 and for conservatively treated 25.6. Initially, a wedge-shaped deformity larger than half of the front part of the injured vertebra body had 42 nonoperated and 32 operated patients. Initially, the average sagittal movement of the injured vertebra body among operated patients was 6.97 mm, and at control 1.34 mm. Among nonoperated, the average movement of the body was 1.71 mm initially and 3.23 mm at control. DISCUSSION: Similar results of angular deformity were found by other examiners. Their results are also in favor of operative treatment of unstable injuries of Th-L spine. The number of those proclaiming good results of conservative treatment of injures of thoracolumbar spine in patients with initially high values of angular deformity is much less. Willen, Mumford, Andreycik and others using wedge-shaped deformity and sagittal movement of the body as parameters in their studies had similar results as those in this study, and they conclude that the stability of segment is much higher among operated patients and that operative treatment finally ends in better radiological results. CONCLUSION: Radiological results of operative treatment of unstable injuries of thoracolumbar and lumbar spine are better than those of conservative treatment. In order to obtain a stable spine, which is the aim of treatment of unstable spine injuries, operative stabilization is necessary.

Adult↗
PubMed2002

Prognosis of central retinal artery occlusion: local intraarterial fibrinolysis versus conservative treatment.

BACKGROUND AND PURPOSE: Local intraarterial fibrinolysis (LIF) is one of several methods used in treating central retinal artery occlusion (CRAO). We investigated whether LIF is more effective than conservative methods in the treatment of CRAO. METHODS: In this retrospective study, a total of 178 patients (125 men and 53 women) with CRAO were treated at the Eye Hospital of the University of Freiburg from 1980 to 2000. The average age of the patients was 66.8 years (SD, 12 years). In group I, 116 patients were treated conservatively by anterior chamber paracentesis, massage of the globe, isovolemic hemodilution, acetazolamide, Pentoxifyllin, acetylsalicylic acid, and reduction of arterial hypertension. Some combination but not all of the mentioned conservative methods were used in the conservatively treated patients. In group II, 62 patients receiving LIF received local injection of urokinase or recombinant tissue plasminogen activator into the proximal part of the ophthalmic artery. In case of ipsilateral carotid artery occlusion or high grade stenosis (14 of 62 patients), the thrombolytic agent was administered into the internal maxillary artery. RESULTS: Among 178 patients, the CRAO was subtotal in 130 (73.0%), incomplete in 39 (21.9%), and total in nine (5.1%). Statistical calculations showed a significantly better visual acuity in group II patients, who were treated with LIF, in comparison with group I patients, who were treated conservatively (P =.0022). CONCLUSION: For patients with CRAO, LIF is superior to conservative treatment.

Acetazolamide↗
PubMed2003

Optimization of antisense drug design against conservative local motif in simulant secondary structures of HER-2 mRNA and QSAR analysis.

AIM: To study the role of mRNA secondary structure stability in antisense drug design and obtain better antisense candidates against neu/HER-2/erbB-2 mRNA than previous report. METHODS: Program RNAstructure was utilized to simulate the secondary structures of HER-2 mRNA. Then 21 antisense phosphorothioate oligodeoxynucleotides (S-ODN) targeting different parts of secondary structural motif were designed. HA4 was set as positive control. Mean 50 % inhibitory effects (IC(50)) of S-ODN on proliferations of SK-BR-3 breast cancer cells were evaluated. The expression of target mRNA was detected by RT-PCR. The multiple regression and quantitative structure-activity relationship (QSAR) analysis was preformed by SPSS software. RESULTS: One optimal and two suboptimal secondary structures of target mRNA were obtained. Nine out of 11 S-ODN against completely conservative local motif (LM) (conservative among all simulant secondary structures) got lower or similar IC(50) values compared with HA4. On the other hand, 2 out of 3 S-ODN against relatively conservative LM (conservative between any two simulant secondary structures) got lower or similar IC(50) values compared with HA4. Only 2 out of 5 S-ODN targeting variable LM (variable among different predicted secondary structures) had acceptable activities. Average IC(50) of S-ODN against completely conservative LM was significantly lower than that of S-ODN against diverse LM. QSAR analysis suggested that stability, base number of bulge loops, and target free energies Delta GoT were statistically significant. In the multiple regression, R was 0.967, P=0.005. CONCLUSION: Antisense drug design against conservative LM was helpful for improving the positive rate. Several S-ODN candidates better than positive control were screened.

Antineoplastic Agents↗
PubMed1992

A novel, highly conserved structural motif is present in all members of the steroid receptor superfamily.

Steroid and thyroid hormone receptor superfamily members are ligand potentiated transcription factors. Recent evidence indicates that one aspect of steroid receptor action is an interaction with other trans-acting factors, such as the glucocorticoid receptor with the AP1 transcription factor, for example. Using a structural approach to identify domains of the glucocorticoid receptor responsible for interactions with affiliated transacting factors and DNA, we have identified a putative helix-turn-zipper motif that is conserved in all steroid, thyroid hormone, retinoic acid, and vitamin-D3 receptors. This structural motif is also conserved among new members of the family, the peroxisome proliferator-activated receptors and the retinoid-X receptors. This structural domain is characterized by a pair of amino acids (I,L,V)P that is conserved in all superfamily members. Additional characteristics include six heptad repeats of hydrophobic amino acids, four of which form a canonical leucine zipper in the rat glucocorticoid receptor. Although this leucine repeat is not absolutely conserved among superfamily members, the periodicity of hydrophobic residues is conserved throughout. Based on sequence analyses from the GenEMBL and SwissProt databases using the Genetics Computer Group and MacVector sequence analysis software packages, and the Brookhaven structural database, we present evidence for a novel structural domain, a helix-turn-zipper that is conserved in all superfamily members, and may function in transactivation of cognate genes.

Amino Acid Sequence↗
PubMed1992

Examination of the functional roles of 5 highly conserved residues in the cytochrome b subunit of the bc1 complex of Rhodobacter sphaeroides.

The cytochrome b subunit of the bc1 complexes contains two cytochrome components (bL and bH) and is the locus of both a quinol-oxidizing site (Qo or Qz) and a quinone-reducing site (Qi or Qc). Sequence alignments of this subunit from over 20 eukaryotic and prokaryotic species have revealed a remarkable degree of conservation, including approximately 20 totally conserved residues. In this paper, site-directed mutagenesis has been used to examine the structural or functional roles of 5 of these highly conserved residues, Gly48, Gln58, Ser102, Phe104, and Pro202, all predicted to be within transmembrane alpha-helical segments. The mutants were made in the bc1 complex of Rhodobacter sphaeroides, a photosynthetic bacterium. The ability to use spectroscopic, electrochemical, and flash-induced kinetic methods allows the mutants to be analyzed for influences both on cytochrome spectra and thermodynamic properties and on the kinetics of specific electron transfer reactions. The results show that none of the 5 residues is absolutely essential. Substitution of aspartate or valine for Gly48 results in the loss of photosynthetic growth. The G48V mutant assembles a bc1 complex, but with modified cytochromes bH and bL, and a dysfunctional quinone reductase (Qc) site; an alanine is tolerated at this position. Possibly, a small residue is important here for heme packing. Gln58 and Ser102 are the only highly conserved polar residues predicted to be within the transmembrane spans, apart from the histidines which are heme axial ligands. Neither Gln58 nor Ser102 is essential for assembly or function of the bc1 complex, although substitution of other amino acids in these positions does cause subtle, but measurable changes. Phe104 lies midway between the axial ligands to cytochromes bL and bH and can be modeled to project in the space separating the two hemes. Replacement of this highly conserved aromatic residue by isoleucine has no measurable influence on the rate of electron transfer through the cytochrome b chain containing the two hemes. Finally, Pro202 is a totally conserved proline which is in the middle of transmembrane helix D, in between the 2 histidines which provide ligands to the hemes. No major inhibition of electron transfer resulted from replacing this proline by a leucine, although subtle changes in spectra of the b cytochromes and their electrochemical properties were noted.

Amino Acid Sequence↗
PubMed2004

[Controversies in breast conservation treatment for breast cancer].

Breast conservation treatment has become the standard treatment for early breast cancer patients, after the equivalence of mastectomy and breast conservation treatment was demonstrated in prospective, randomized trials and large retrospective studies. New questions, such as the feasibility of neoadjuvant chemotherapy in improving breast conserving rate, the appropriateness of breast conservation treatment in ductal carcinoma in situ, the effectiveness of radiation therapy in patients treated by breast conservation, and patient selection for breast conservation without radiation, are now being raised. Future work that needs to be done to answer these questions is discussed in this review.

Breast Neoplasms↗
PubMedDate not supplied

[Breast conserving surgery --7 years of experience].

The breast cancer treatment is based nowadays on a new surgical option: breast-conserving surgery, which is reliable at least for the first and second stage of cancer, with radical intention, obviously. We have started to practice the breast-conserving surgery in our surgical clinic (at CFR Hospital, from Craiova) for 7 years; until now we have performed 159 breast-conserving operation and, as results, we have recorded 3 local recurrences (2.12%) and 1 death due to cancer evolution. Our protocol includes removal of the primary tumor with enough surrounding tissue to ensure negative margins of resectable specimen, associated with total axillary lymph-node dissection and postoperative breast irradiation. Our oncologist on different postoperative conditions indicated the chemotherapy: tumor size, axillary lymph node involvement, patient age, etc. The purpose of this paper is to emphasize our unassuming experience but especially to draw attention on important results, obtained by long-term monitoring the patient who underwent breast-conserving surgery, in a two prospective protocols, which demonstrate the importance and applicability of breast-conserving therapy. The conclusion of this study is that breast-conserving surgery followed by breast irradiation is reliable, as the results are similar with the radical mastectomies; the main objective is to obtain a good cosmetic result, which depends on tumor size/size of the breast ratio.

Adult↗
PubMed2004

[Is interval appendectomy necessary after conservative treatment of appendiceal masses?].

BACKGROUND: This prospective study was conducted to investigate whether interval appendectomy was necessary after successful conservative treatment of appendiceal masses. METHODS: Thirty-seven patients with a diagnosis of appendiceal mass by physical examination and ultrasonography were initially treated conservatively with broad-spectrum antibiotics, anti-inflammatory drugs, and, if required, intravenous fluid treatment. Interval appendectomy was ruled out in 28 patients who responded well to conservative treatment, three of whom were then lost to follow-up. The remaining 25 patients (9 females, 16 males; mean age 25 years; range 17 to 54 years) were monitored for recurrent appendicitis and other causes of appendiceal mass. The mean follow-up period was 35 months (range 6 to 66 months). RESULTS: The mean duration of abdominal symptoms was nine days (range 3 to 20 days). The mean length of hospital stay was 14 days (range 10 to 21 days) in patients who responded to conservative treatment. Recurrent appendicitis developed in three patients (12%; 2 males, 1 female). Two patients who presented with acute appendicitis within six months after discharge and one patient who developed chronic abdominal right lower quadrant pain unresponsive to medical treatment a year after discharge underwent appendectomy. No other complications were seen with conservative treatment. CONCLUSION: We do not recommend routine interval appendectomy in patients who benefit from conservative treatment for an appendiceal mass unless recurrent appendicitis develops.

Adolescent↗
PubMed2004

[Fertility of women after conservative operation for borderline ovarian tumors].

OBJECTIVES: The aim of the study was to assess procreation in group of patients who were treated by conservative operation for borderline tumors of the ovary. DESIGN: The analysis included 42 patients conservatively operated for ovarian tumor of borderline malignancy in Department of Gynecology Medical University of Gdansk between 1978-2000. The incidence of pregnancy, age of patients, tumor pathology, type of conservative surgery and the course of pregnancy and labour were evaluated in this study. RESULTS: In the analysis group were 36 (85.7%) stage IA, 2 (4.8%) stage IB, 3 (7.1%) stage IC and 1 (2.4%) stage III C patients. Unilateral adnexectomy was performed in 36 (85.7%) patients, 4 (9.5%) unilateral cystectomy, 2 (4.8%) bilateral cystectomy with omentectomy in one case. After conservative operation 10 (23.8%) patients were pregnant and delivered healthy children but 2 patients delivered twice and 1 third. Recurrence was observed in 2 patients in period of 27 and 50 months after operation. 5 years survival was 97.6%. CONCLUSIONS: Percentage of pregnancy after conservative treatment for borderline ovarian tumors was high (23,8%) and number of recurrences was low so conservative surgery allows young women to retain procreational potential without increasing risk of recurrence.

Adult↗
PubMedDate not supplied

Local control by breast-conserving surgery with nipple resection.

Local control was compared between patients who had undergone breast-conserving therapy with and without nipple resection. We explored whether there was any difference in local control between the two treatment methods for patients with early breast cancer. A total of 333 women with breast cancer, who had undergone breast-conserving therapy between 1991 and 2002, were included in this study. Surgery consisted of a wide local excision of the primary tumor with a 2-cm free margin as the minimum distance. When the tumor was located under the nipple or close to the nipple, breast-conserving surgery with nipple resection was selected. A total of 320 patients received breast-conserving surgery without nipple resection and radiation therapy (BCT) and 13 patients breast-conserving surgery with nipple resection and radiation therapy (BCT-NR). There were no significant differences in age, tumor size, nodal status, clinical stage, ER status, histological type or surgical margin status between the two groups. The surgical margin was positive in 55 (17.2%) out of 320 patients in the BCT group and in one (7.7%) out of 13 patients in the BCT-NR group. There was no significant difference in the breast-free survival between the two groups. In conclusion, breast-conserving surgery with nipple resection and radiation therapy may be the treatment of choice for early breast cancer patients with the tumor located under the nipple or very close to the areola.

Breast Neoplasms↗
PubMed2005

Conserved structure and spatiotemporal function of the compact rhodopsin kinase (GRK1) enhancer/promoter.

PURPOSE: To demonstrate that the crucial elements responsible for the spatial and temporal expression patterns of rhodopsin kinase (Rk) are contained within a narrow conserved segment immediately flanking the Rk transcription start sites. METHODS: Sequences upstream of the mouse Rk gene were compared to the human sequence to identify areas of conservation. Transgenic mice carrying a segment of the conserved human DNA sequence linked upstream of the green fluorescent protein (GFP) gene were examined by fluorescence microscopy and RT-PCR to localize GFP expression in retina and pineal gland. Rk and GFP temporal expression patterns were further compared by immunostaining and real-time RT-PCR in transgenic eyes during development. RESULTS: Comparison of the mouse and human 5' flanking sequence revealed only a small island of conserved sequence upstream of the respective Rk start sites. Uniform GFP expression was supported by a 0.2 kb fragment of the conserved human sequence in the transgenic mouse rods, cones, and pinealocytes. Developmental studies revealed an exponential rise in Rk and GFP transcripts in the first ten day postnatal period followed by a plateau later extending to adulthood. Rk and GFP proteins were first detected after postnatal day 10 and rose in parallel afterwards, overlapping in time with the maturation of photoreceptor outer segments and eye opening. CONCLUSIONS: The conserved short enhancer/promoter immediately upstream of the Rk gene contains the key elements required for appropriate response to spatial and temporal cues during photoreceptor cell differentiation and fate determination. The above studies narrow the core sequences that govern gene expression in photoreceptors in vivo.

Animals↗