A rat model of syngeneic bone marrow transplantation during breast cancer therapy.

The purpose of this study was to develop a breast cancer model in rats, in which myeloablative chemotherapy and syngeneic bone marrow transplantation (SBMT) could be evaluated systematically for therapeutic effect. The Wistar-Furth (WF) DMBA-4 breast cancer cell line transplanted into naive WF rats produced rapidly growing tumors that were lethal within 2 months. SBMT was performed following preparation with a regimen (Bu-Cy), consisting of busulfan 16 mg/kg by gastric gavage on days -3 and -2 followed by 250 mg/kg of cyclophosphamide i.p. on day -1. Marrow was prepared from the femurs of donors and infused i.v. into the recipient on day 0. In all, 15 rats treated with Bu-Cy without marrow died, while 22 of 25 transplanted rats survived. In total, 16 rats with measurable tumors showed tumor responses following transplantation, but tumors recurred and survival was minimally prolonged. Of nine rats transplanted before clinical tumors were detected, five became long-term survivors that resisted further tumor challenge. It was concluded that the DMBA-4 breast cancer in WF rats could serve to evaluate SBMT following myeloablative doses of chemotherapy at various tumor loads. At large tumor loads therapy was not curative, but at low tumor burdens cures were possible and resistance to subsequent tumor challenge was demonstrated. The model may be useful for further studies of stem cell infusion in rodent tumor systems.

Psychological impact of screening for familial ovarian cancer: reactions to initial assessment.

OBJECTIVES: To assess the psychological impact on women attending a familial ovarian cancer screening clinic. STUDY METHODS: 157 women referred for screening completed an investigator designed questionnaire, the Spielberger State Trait Anxiety Scale and the Centre for Epidemiological Studies Depression Scale prior to the screening interview and an eight-item questionnaire post-assessment. RESULTS: 95.4% saw the screening as valuable. Thirty-one point four percent of all patients scored about the cutoff point for depression. Sixteen percent exhibited high levels of anxiety. Fifty-six point four percent of patients accurately perceived their risk. Twenty-one point five percent of those who accurately perceived themselves as being at high risk had high anxiety and 40.6% reported significant depressive symptoms. Of the 26.5% of patients who overestimated their risks, 40.0% reported significant depressive symptoms and 22.6% were anxious. Of the 17.1% who minimized their risk, none were anxious (0.0%), and only 15.8% were depressed. CONCLUSION: Attendees at a familial ovarian cancer screening clinic may have high levels of depression and anxiety.

A survey of Canadian psychiatric residents regarding resident-educator sexual contact.

BACKGROUND AND METHOD: A survey of all Canadian psychiatric residents was undertaken to ascertain the prevalence of resident-educator sexual contact in training programs, the residents' feelings about this contact, their knowledge of the ethical standards of the profession, and the extent of the information they had been given about this subject. An investigator-designed questionnaire was circulated to all psychiatric residents in Canada through the directors of postgraduate training programs. To ensure confidentiality, the residents returned their questionnaires directly to the investigators. RESULTS: Of the 314 respondents, 4.1% (N = 6) of the female residents and 1.2% (N = 2) of the male residents reported sexual involvements with their educators. Although the majority of these eight residents had positive or neutral feelings about the contact, 37.5% (N = 3) of the involved residents had mixed feelings. The residents' education concerning resident-educator sexual contact was strikingly sparse. CONCLUSIONS: This study highlights the need for inclusion of this tissue in residency programs.

Newer emergency reperfusion techniques in acute myocardial infarction.

We have given an overview of the management of the acute myocardial infarction patient utilizing the aggressive reperfusion techniques available today. Anatomic reperfusion rates have been over 95% with the combined methods described. The remaining problems technically are those of earlier reperfusion, methods to enhance myocardial recovery after ischemia, and prevention of restenosis or reocclusion. The use of laser methodology, coronary sinus retroperfusion, partial left heart bypass, and other innovative strategies may improve these results. The introduction of tissue plasminogen activator will affect our approach and will profoundly alter society's expectations of therapeutic success. Still, patients will die from acute myocardial infarction and its complications. The search for a prevention must, therefore, not be overshadowed by our current enthusiasm for reperfusion techniques. Hopefully, our current approach will become a historical footnote as breakthroughs in preventive strategies occur.

The use of the guiding catheter in coronary angioplasty: the technique of manipulating catheters to obtain the necessary power to cross tight coronary stenoses.

We have examined a small selection of helpful maneuvers to facilitate passage of a balloon through tight stenoses. Selection of the appropriate guiding catheter is a critical early decision. Changing guiding catheters may be the most expeditious way to solve a "difficult case." The various options for deep engagement of the guiding catheter into the coronary orifice to gain power for crossing resistant lesions have been examined and the potential risks enumerated. The operator must be willing carefully to chart a course to avoid vessel occlusion, pressure damping, dye trapping, intimal damage, and dissection. Sudden disengagement of the guiding catheter from the coronary and vessel spasm must be prevented. Selective use of the "balloon traction maneuver," if judiciously applied, may lead to higher success rates. Guiding catheters and balloons will continue to evolve and hopefully become easier to use. The continued development of smaller deflated balloon profiles with slippery surfaces and better power transmission characteristics will undoubtedly make the vigorous techniques mentioned above less necessary to master in the future.