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PubMed1978

[Results of the ciliary body exposure (CBE) in secondary angle closure glaucomas. 1. A clinical study (author's transl)].

The authors present their clinical results of the ciliary body exposure following Benedikt and Hiti. This technique has been performed in 23 patients suffering from secondary angle closure glaucoma. As far as the intraocular tension is concerned good results have been obtained in nearly half of the patients. The results are compared with those of other surgical techniques against secondary angle closure glaucomas.

Aged↗
PubMed1978

[Results of the ciliary body exposure (CBE) in secondary angle closure glaucomas. 2. A histological study (author's transl)].

After treatment of secondary angle closure glaucomas by ciliary body exposure with lamellar scleral resection five eyes had to be enucleated. In view of the histological findings taken from these eyes mode of action and therapeutic value of this operation are considered. The effectiveness of scleral resection seems to be doubtful and there is evidence that permanent regulation of intraocular tension depends mainly on direct diathermy of the ciliary body.

Ciliary Body↗
PubMed1999

The rational clinical examination. Does this patient have breast cancer? The screening clinical breast examination: should it be done? How?

CONTEXT: The clinical breast examination (CBE) is widely recommended and practiced as a tool for breast cancer screening; however, its effectiveness is dependent on its precision and accuracy. OBJECTIVE: To collect evidence on the effectiveness of CBE in screening for breast cancer and information on the best technique to use. DATA SOURCES: We searched the English-language literature using the MEDLINE database (1966-1997) and manual review of all reference lists, as well as contacting investigators of several published studies for clarifications and unpublished data. STUDY SELECTION AND DATA EXTRACTION: To study CBE effectiveness, we included all controlled trials and case-control studies in which CBE was at least part of the screening modality; for technique, we included both clinical studies and those that used silicone breast models. All 3 authors reviewed and agreed on the studies selected for inclusion in the pooled analyses. DATA SYNTHESIS: Randomized clinical trials demonstrated reduced breast cancer mortality rates among women screened by both CBE and mammography. Evidence of CBE's independent contribution was less direct; CBE alone detected between 3% and 45% of breast cancers found that screening mammography missed. The precision of CBE was difficult to determine because of the lack of consistent and standardized examination techniques. Studies on CBE precision reported fair agreement (kappa = 0.22-0.59). Pooling trial data, we estimated CBE sensitivity at 54% and specificity at 94%. The likelihood ratio of a positive CBE result is 10.6 (95% confidence interval [CI], 5.8-19.2), while the likelihood ratio of a negative test result is 0.47 (95% CI, 0.40-0.56). Longer duration of CBE and a higher number of specific techniques used were associated with greater accuracy. The preferred technique for CBE includes proper positioning of the patient, thoroughness of search, use of a vertical-strip search pattern, proper position and movement of the fingers, and a CBE duration of at least 3 minutes per breast. The value of inspection is unproved. Professional and lay examiners improved their sensitivity on silicone breast models after being taught this technique. CONCLUSIONS: Indirect evidence supports the effectiveness of CBE in screening for breast cancer. Although the screening clinical examination by itself does not rule out disease, the high specificity of certain abnormal findings greatly increases the probability of breast cancer.

Adult↗
PubMed2000

Factors associated with accurate cancer detection during a clinical breast examination.

PURPOSE: Although most US women who undergo mammography screening also receive a Clinical Breast Examination (CBE), factors that predict cancer detection during a CBE have not been well studied to date.METHODS: We analyzed 752,081 National Breast and Cervical Cancer Early Detection Program (NBCCEDP) screening records for CBEs performed from July 1, 1995 thru June 30, 1998 on low income women across the US. CBE results are reported as "normal" or "abnormal, suspicious for cancer." Other variables include CBE date, age, race, ethnicity, presence of breast symptoms at screening, and whether the woman had received a prior NBCCEDP-funded CBE. Most (74%) records include mammography dates and results. Tumor stage and size are reported for invasive cancers whether detected by CBE or mammography.RESULTS: Breast cancer was reported on 3,780 records. On 2,224 records, the CBE was suspicious for cancer. On 1,556 records, the CBE was normal. Most (93%) cancer records with a normal CBE had abnormal mammography results. Bivariate comparisons between normal and abnormal CBE records with a cancer diagnosis found significant differences (p <.001) in age, race/ethnicity, presence of breast symptoms, history of a prior NBCCEDP CBE, and tumor stage and size. In a logistic model controlling for these variables, women with breast symptoms were more likely to have their cancer detected during CBE (OR = 7.0, 95% CI = 5.9-8.5), while women with a prior NBCCEDP CBE were less likely to have their cancer detected (OR = 0.7, 95% CI = 0.6-0.8). Compared to women aged 50-59 years, women <40 were more likely to have their cancer detected by CBE (OR = 3.2, 95% CI = 1.9-5.4) but women >/=70 were less likely (OR = 0.7, 95% CI = 0.5-0.9). Larger cancers and those at more advanced stages were much more likely to be detected during CBE.CONCLUSIONS: Among low-income women whose cancers were detected through the NBCCEDP, older women and those who had been screened previously in the program were less likely to have their cancer detected during a CBE, even after controlling for tumor size and stage.

Journal Article↗
PubMed2005

Airway responses to the inhalation of cotton dust and cotton bract extracts.

BACKGROUND: Exposure to dust in the cotton industry is associated with respiratory dysfunction. Healthy subjects challenged with cotton bract extract (CBE) develop transient airway hyperresponsiveness. CBE, a major component of cotton dust, is potentially an important agent for studying byssinosis. OBJECTIVES: To compare airway responses to cotton dust extract (CDE) and CBE in healthy subjects. METHODS: In 21 healthy, non-smoking subjects we compared the effects of CBE and CDE in a double-blind random order, following a 10-min aerosol inhalation. The response to methacholine (MCh) 2 h following CBE or CDE was measured. Lung function was recorded using maximal (MEFV) and partial expiratory flow volume (PEFV) curves, measuring MEF at 60% of baseline vital capacity below total lung capacity [MEF40%(P)] on the PEFV curve. Responders were subjects who developed a 20% or greater fall in MEF40%(P) following extract challenge. Endotoxin levels were low for CBE (5.71 EU/mg) and CDE (31.88 EU/mg). RESULTS: There were 18 responders to CBE and 17 responders to CDE. The average maximal falls in MEF40%(P) were 70 +/- 4.9 and 70 +/- 4.4% of baseline (nonsignificant) following CBE and CDE, respectively. All subjects enhanced their MCh response following CBE or CDE. The MCh dose which reduced MEF40%(P) by 40% was identical for CBE and CDE (1.3 microg/ml). CONCLUSIONS: We conclude that CBE and CDE exert similar physiologic effects.

Adult↗
PubMed1998

In vitro bovine ciliary body/epithelium in a small continuously perfused Ussing type chamber.

Our goal is to assess the viability of an in vitro preparation of bovine ciliary body/epithelium (CBE) in a small volume Ussing-type chamber. A new small volume Ussing-type chamber with continuous perfusion was developed for bovine CBE. The trans-CBE electrical parameters were monitored and the electrical responses of the CBE to ouabain (1 and 0.01 mM) were recorded. The trans-CBE fluxes of [14C]-L-ascorbate and [3H]-L-glucose were also studied. The bovine CBE preparation was stable inside the chamber in terms of its potential difference (PD), short circuit current (SCC) and trans-CBE resistance. They were -0.51+/-0.05 mV (aqueous side negative), -5.43+/-0.04 microAcm-2 and 94+/-2 Q.cm2 (mean s.e.m., n=35), respectively. The preparation hyperpolarised when 0.01 mM ouabain was administered to the aqueous side, depolarised when ouabain was applied to the stromal side. [3H]-L-glucose diffusion was about 74 nEq h(-1)cm(-2) in either direction (n=12). Taking the area magnification factor of the CBE into consideration, the diffusional L-glucose flux across the bovine CBE was comparable to other tight epithelia. A significant net ascorbate flux (0.26+/-0.05 nEq h(-1)cm(-2), n=4, p<0.01) was found in the stroma to aqueous direction. We have developed a viable in vitro bovine CBE preparation which was (1) electrically stable, (2) responsive to ouabain, (3) tight to L-glucose diffusion, and (4) capable of actively secreting ascorbate. A net trans-CBE chloride transport (0.81+/-0.30 microEq h(-1)cm(-2), n=12, p=0.01) from stromal to aqueous side was found in the present in vitro model under short-circuited conditions.

Animals↗
PubMed2003

Contribution of clinical breast examination to mammography screening in the early detection of breast cancer.

OBJECTIVES: As the benefit of clinical breast examination (CBE) over that of screening mammography alone in reducing breast cancer mortality is uncertain, it is informative to monitor its contribution to interim measures of effectiveness of a screening programme. Here, the contribution of CBE to screening mammography in the early detection of breast cancer was evaluated. SETTING: Four Canadian organised breast cancer screening programmes. METHODS: Women aged 50-69 receiving dual screening (CBE and mammography) (n = 300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral rate, positive predictive value, pathological features of tumours (size, nodal status, morphology), and cancer detection rates overall and for small cancers (< or = 10 mm or node-negative). Heterogeneity in findings across programmes was also assessed. RESULTS: On first versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of cancers compared with 52.6-60.1% of referrals and 60.0-64.3% of cancers for mammography alone. Among cancers detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected cancers only 31.7-37.2% were also detected by CBE. On average, CBE increased the rate of detection of small invasive cancers by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three cancers for every 10,000 screens and 3-10 small invasive cancers in every 100,000 screens. CONCLUSIONS: Inclusion of CBE in an organised programme contributes minimally to early detection.

Breast Neoplasms↗