Risk of breast cancer in relation to the use of rauwolfia alkaloids.

In a case-control study of 1881 women with breast cancer and 1523 controls with benign conditions, 65 cases (3.5%) and 64 controls (4.2%) reported having used a drug that contained rauwolfia, giving a rate ratio estimate of 0.8 (95% confidence interval, 0.5-1.1). Use that ended more than a year previously was negatively associated with breast cancer (rate ratio, 0.5; 95% confidence interval, 0.2-0.9). The risk of breast cancer did not vary significantly according to duration of use. Nor did it vary within strata of varying base-line risk, such as age at first pregnancy. The data suggest that rauwolfia alkaloids do not increase the risk of breast cancer.

Correlation between initial and long-term responses of spontaneous pet animal tumors to heat and radiation or radiation alone.

Most early-phase testing of new therapeutic modalities involves analysis of initial tumor response as opposed to estimation of long-term response. In this study, the validity of initial response rates to predict long-term responses was examined for tumors treated with radiotherapy alone compared with heat combined with radiotherapy. A total of 130 pet animals with either squamous cell carcinomas, melanomas, fibrosarcomas, mammary adenocarcinomas, or mast cell sarcomas were randomized to receive either radiation alone (XRT) or heat + radiation (delta + XRT). Responses to treatment were evaluated by response rates and response duration. The complete response (CR) rates were consistently higher for delta + XRT than for XRT across different histology groups. The combined therapy led to prolonged tumor response in all histological subgroups except melanomas, which had a longer response duration when treated with XRT alone (p = 0.043). This was in spite of a relatively high CR rate in that group (100% versus 12.5% for delta + XRT and XRT, respectively). In contrast, while no significant improvement in CR rate was observed for dermal squamous cell carcinomas treated with delta + XRT (XRT = 52.9%; delta + XRT = 68.8%), a significant improvement in response duration was noted (p = 0.002). These are two examples where CR rate did not predict long-term response. When all histological subgroups were combined (except melanomas), the CR rate was higher (p less than 0.001), and response duration was prolonged (p = 0.031) for delta + XRT compared to XRT alone.

Lack of relation of oral clefts to diazepam use during pregnancy.

The hypothesis that in utero exposure to diazepam increases the risk of oral-cleft anomalies was evaluated in a case-control study, in which 445 infants with cleft lip with or without cleft palate and 166 with cleft palate without cleft lip (cleft palate alone) were compared with 2498 control infants having other birth defects. For exposure to diazepam during lunar months 1 through 4 relative to no exposure during pregnancy, the estimated relative risks were 1.0 for cleft lip with or without cleft palate (95 per cent confidence interval, 0.5 to 2.1) and 0.8 for cleft palate alone (0.3 to 2.7). After control for all identified potential confounding factors, the corresponding estimates were 0.8 (0.4 to 1.7) and 0.8 (0.2 to 2.5), respectively. The findings were unchanged when maternal suspicion that diazepam might be a teratogen was taken into account. The data suggest that first-trimester exposure to diazepam does not materially affect the risk of cleft lip with or without cleft palate or of cleft palate alone.

A comparison of mortality and charges in two differently staffed intensive care units.

All patients entering the two differently staffed adult intensive care units (ICUs) of Baystate Medical Center were studied for a three-month period. In one unit, patients were cared for by medical and surgical resident teams specifically assigned to the ICU, who were supervised by private and teaching ICU attending physicians; patients admitted to the other ICU were cared for entirely by private physicians. Significantly lower hospital mortality rates were observed in the resident-staffed ICU for three categories of patients. Median charges for the two groups of ICU patients were either the same or higher for the resident-staffed ICU when controlling for levels of condition and treatment variables.