Silicone implants and the inhibition of cancer.

The safety of augmentation mammaplasty and its relationship to breast cancer has been a much debated topic. The authors previously showed a decreased incidence of breast cancer in rats who had received silicone implants 2 weeks before carcinogen stimulation. The present study was designed to determine (1) whether this protective effect is influenced by the location of the implant, and (2) whether tumor incidence could also be altered in spontaneous mammary tumor-forming animals, the C3H/OuJ mice. (1) A total of 110 rats received either a silicone implant or a sham operation in one of three locations: inframammary region, dorsum, or intraperitoneal cavity. Methylnitrosoured (MNU) injections occurred 14 days after implantation. Animals were examined weekly for tumor growth and were killed 250 days after MNU injection. Animals with silicone implants beneath the mammary gland had a statistically significant lower incidence of breast cancer formation (11.5 percent) compared with both dorsally implanted animals (45.8 percent) and sham controls (64 percent). (2) Sixty C3H/OuJ mice underwent implantation of either a silicone implant, free silicone gel, silicone sheet, or a sham operation. At 50 weeks of age, after weekly examinations, the animals were killed. The cancer incidence in mice with silicone implants was 17 percent compared with 50 percent found in sham controls. Exposure to a silicone prosthesis at an early age does not seem to increase tumor incidence and may even have a locally protective effect against breast cancer formation.

A placebo-controlled trial of selegiline (L-deprenyl) in the treatment of tardive dyskinesia.

The goal of this study was to determine whether selegiline (L-deprenyl), a selective monoamine oxidase B inhibitor and antioxidant, would improve neuroleptic-induced tardive dyskinesia (TD). Thirty-three patients with TD were randomly assigned to selegiline 10 mg/day or placebo for 6 weeks and were assessed at baseline and at weeks 1, 2, 4, and 6 for TD, parkinsonism, akathisia, depression, and positive and negative symptoms. Examinations for TD were videotaped and scored by a rater unaware of the temporal sequence of examination. Twenty-eight subjects completed at least 1 week of treatment; all five dropouts were receiving selegiline. When baseline score and gender were controlled, the group receiving selegiline displayed significantly less improvement of TD compared with the placebo group. The two treatment groups did not differ in any other outcome measure. Selegiline was less effective than placebo in reducing symptoms of TD over a 6-week trial. This may be the result of the dopamine agonist effects associated with selegiline.

Survival after a second episode of toxic epidermal necrolysis.

Toxic epidermal necrolysis resulting from severe hypersensitivity to medication has a reported mortality of up to 66%. A patient surviving two episodes with more than a 50% skin loss is unprecedented in the medical literature. Mortality has been associated with many factors, including delayed reepithelialization, persistent skin slough, coagulopathy, severe hypoproteinemia, and sepsis. It may be possible to decrease morbidity and mortality by preventing the shearing of epidermis, thereby limiting the denuded areas. This case report describes the successful management of our patient's second episode of toxic epidermal necrolysis. The treatment of this patient in our specialized burn center consisted of careful fluid and electrolyte management, nutritional support, standard topical antimicrobials, and new modalities of local wound management.