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PubMed2002

Is there a role for axillary dissection for patients with operable breast cancer in this era of conservatism?

BACKGROUND: The trend in breast cancer surgery is toward more conservative operative procedures. The new staging technique of sentinel node biopsy facilitates the identification of pathological node-negative patients in whom axillary dissection may be avoided. However, patients with a positive sentinel node biopsy would require a thorough examination of their nodal status. An axillary -dissection provides good local control, and accurate staging and prognostic information to inform decisions about adjuvant therapy. In addition, the survival benefit of axillary treatment is still debated. The objectives of the present study were to examine the pattern of lymph node metastases in the axilla, and evaluate the merits of a level III axillary dissection. METHODS: Between June 1997 and May 2000, 308 patients underwent a total of 320 level III dissections as part of their treatment for operable invasive breast cancer. The three axillary levels were marked intraoperatively, and the contents in each level were submitted and examined separately. The patterns of axillary lymph node (ALN) metastases were examined, and factors associated with > or =4 positive nodes, and level III ALN metastases were evaluated by univariate and multivariate analyses. RESULTS: An average of 25 lymph nodes were examined per case (range: 8-54), and using strict anatomical criteria, the mean numbers of ALN found in levels I, II and III were 18 (range: 2-43), 4 (range: 0-19), and 3 (range: 0-11), respectively. Axillary lymph node involvement was found in 45% of the cases (143/320). Of the 143 cases, 78% (n = 111) had involvement of level I nodes only, and 21% (n = 30) had positive ALN in levels II and, or, III, in addition to level I. Involvement of lymph nodes in level II or III without a level I metastasis was found in two cases only (0.6%). By including level II, in addition to level I, in the dissection, four cases (1%) were converted from one to three positive nodes to > or =4 positive nodes (P = 0.64). By the inclusion of level III to a level I and II dissection, three cases (1%) were converted from one to three positive nodes to > or =4 positive nodes (P = 0.74). Involvement of lymph nodes in level III was found in 22 cases (7%), and 51 cases (16%) had > or =4 positive nodes. Palpability of ALN, pathological tumour size, and lymphovascular invasion (LVI), were sig-nificantly associated with level III involvement and > or =4 positive nodes by univariate and multivariate analyses. The frequencies of level III involvement and > or =4 positive nodes in patients with palpable ALN were 22% and 42%, respectively. The corresponding frequencies in patients with a clinically negative axilla, and a primary tumour which was >20 mm and LVI positive, were over 14% and 31%, respectively. CONCLUSION: Level III axillary dissection is appropriate for patients with palpable ALN, and in those with a tumour which is >20 mm and LVI positive, principally to reduce the risk of axillary recurrence. Staging accuracy is achieved with a level II dissection, or even a level I dissection alone based on strict anatomical criteria. Sentinel node biopsy is a promising technique in identifying pathological node-positive patients in whom an axillary clearance provides optimal local control and staging information.

Adult↗
PubMed1975

Pituitary growth hormones: further evidence for evolutionary conservatism based on immunochemical studies.

Immunochemical relatedness of preparations of purified somatotropins (growth hormones) of somatotropins in pituitary extracts from various vertebrate species was investigated by applying an antiserum to a purified somatotropin from a submammalian species, the snapping turtle. With the exception of monkey somatotropin, all mammalian, reptilian, and avian preparations tested showed reactions of identity or near identity by immunodiffusion studies in agar gel. Radioimmunoassay employing labeled rat somatotropin as a tracer and for standards, revealed that these same pituitary preparations gave steep inhibition slopes that were parallel or nearly parallel to each other. Purified somatotropins or somatotropins in pituitary extracts of subreptilian species, including an amphibian and existing primitive fishes, showed partial yet substantial relatedness to mammalian (ray) or reptilian (turtle) somatotropins by both immunodiffusion and radioimmunoassay. Our evidence indicates that the immunochemical relatedness of somatotropins from various vertebrate species appears to be even closer than has been suggested previously, and that a high degree of conservation of structure occurs during evolution.

Animals↗
PubMed1994

Use of probabilistic methods to understand the conservatism in California's approach to assessing health risks posed by air contaminants.

Many state and federal agencies have prepared risk assessment guidelines, which describe methods for quantifying health risks associated with exposure to vapors and particulates emitted from point and area sources (e.g., California Air Pollution Control Officers Association [CAPCOA] under the Air Toxics "Hot Spots" Act [Assembly Bill 2588] and the U.S. Environmental Protection Agency [EPA] under the Clean Air Act). In general, these guidelines recommend or require the use of upperbound "point" estimates for numerous exposure parameters. This methodology yields a single risk estimate, which is intended not to underestimate the true risk and may significantly overstate it. This paper describes a risk assessment of a facility's airborne emissions using a probabilistic approach, which presents a range and distribution of risk estimates rather than a single point estimate. The health risks to residents living near a food processing facility, as estimated using techniques recommended by California AB2588, are compared to the results of a probabilistic analysis. Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) were identified as the emitted chemicals of concern. The point estimate method recommended by CAPCOA resulted in estimates that were greater than the 99.99th percentile risk predicted by the probabilistic analysis. As shown in other assessments of persistent airborne chemicals, secondary or indirect exposure pathways (i.e., ingestion of beef, ingestion of cow's milk, and ingestion of mother's milk) rather than inhalation, were the greatest contributors to risk. In this analysis, the probability distributions for the cancer potency factor and ingestion of cow's milk had the largest impact on the results of the 33 exposure factors considered.

Air Pollutants↗
PubMed2004

Adaptation, niche conservatism, and convergence: comparative studies of leaf evolution in the California chaparral.

Small leaves and low specific leaf area (SLA) have long been viewed as adaptations to Mediterranean-type climates in many species of evergreen woody plants. However, paleobotanical and floristic evidence suggests that in many cases these traits originated prior to the advent of the summer-drought climate regime. In this study, molecular phylogenies and ancestral state reconstructions were used to test the hypothesis of adaptive leaf evolution in 12 lineages of evergreen shrubs in the California chaparral. Across all lineages there was a small but significant shift toward lower SLA, but there were no trends in leaf size evolution. For individual lineages, adaptive changes were detected in only three cases for SLA and in one case for leaf size. Three of these cases of evolutionary change were observed in taxa derived from cool temperate ancestors (e.g., Heteromeles). In contrast, most lineages originating from subtropical ancestors exhibited relative stasis in leaf trait evolution (e.g., Ceanothus). The absence of change suggests that ancestors of chaparral taxa had already acquired appropriate traits that contributed to their success under Mediterranean-type climates. These results illustrate how biogeographic history may influence patterns of trait evolution and adaptation and highlight the contribution of ecological sorting processes to the assembly and functional ecology of regional biotas.

Adaptation, Physiological↗