Differentiating inflammatory breast cancer from acute mastitis.

Inflammatory breast cancer is a devastating disease with an extremely high rate of morbidity and mortality. Differentiating this disease from acute mastitis may be difficult on initial diagnosis. The expeditious diagnosis and treatment of inflammatory breast cancer has important ramifications for the patient's prognosis. Unfortunately, no clear guidelines are available to help the primary care physician differentiate between acute mastitis and inflammatory breast cancer. We present our recommendations and guidelines for a diagnostic approach to this problem. Inflammatory breast cancer typically occurs in older women, while acute mastitis usually affects younger, lactating women. If a trial of antibiotics does not decrease the signs and symptoms in the inflamed breast, inflammatory breast cancer must be considered, especially in older, nonlactating women.

Measuring self-reported comfort with general family practice skills during a required third-year family practice clerkship.

BACKGROUND: To judge the effectiveness of a new required third-year family practice (FP) clerkship, we designed a 20-item FP comfort assessment (FPCA) to measure students' self-reported comfort with a wide range of FP skills. This report examines the behavior and characteristics of the FPCA. METHODS: During the 1990-91 academic year, 179 students who completed the FP clerkship were asked to complete the FPCA on the first and last days of the clerkship. RESULTS: Factor analysis of responses yielded four factors that explained 66.4% of the total variance: relationships and values, history and physical, diagnosis and management, and preventive medicine. After adjustment, internal consistency for each factor ranged from .77 to .89. All postclerkship factor scores were significantly greater than preclerkship factor scores, indicating that the FPCA performed as expected. All postclerkship factor scores and two of the change scores correlated significantly with the students' overall clerkship grade, indicating concurrent validity. CONCLUSION: The FPCA is a reliable and valid measure of student comfort with patient-centered FP skills.

Age-related change in P3 amplitude as a function of predictable and unpredictable rare events.

The auditory event-related potentials (ERP's) of young, middle-aged and elderly subjects were measured over Fz, Pz, C3 and C4 in two different rare tone conditions. In the fixed condition, the rare tone occurred predictably, every fourth stimulus. In the random condition, the rare tone was presented unpredictably, with 1:4 probability. Large amplitude late positive waves (P3's) of middle aged subjects (N = 22) were present in the random condition at all placements, but absent in the fixed condition. Elderly subjects (N = 23) responded identically to both rare tone conditions at all placements. Young subjects (N = 7) had large amplitude P3 responses to both random and fixed conditions at all placements except Pz. Over Pz, young subjects had patterns similar to middle-aged subjects, with large P3's to the random rare tone but not the fixed rare tone. Elderly subjects may not differentiate the two conditions, either because they have less efficient memory, or because they primarily attend to the global probability of rare tone occurrence. The results with young subjects suggest that recent memory processes involved in discriminating rare tone conditions initially develop over the posterior (Pz) areas.

Organization of projections from the superior colliculus to the thalamic lateral posterior nucleus in the rat.

Injections of horseradish peroxidase into the lateral posterior nucleus (LP) of the rat thalamus resulted in retrograde labeling of neurons in the superior colliculus (SC). Approximately 80% of the labeled cells occurred in the stratum opticum and 20% in the stratum griseum superficiale. The system of projections is organized such that medial parts of SC project to dorsal LP and lateral parts of SC project to ventral LP.