Acute myocardial infarction occurrence: environmental links - Baku 2003-2005 data.

BACKGROUND: Despite substantial progress in modern preventive and clinical cardiology, acute myocardial infarction (AMI) remains a central acute cardiac event. The aim of this study was to check the basic daily environmental-physical conditions accompanying the occurrence of AMIs in a specific geographic area: Baku, Azerbaijan. MATERIAL/METHODS: AMIs registered in the Baku area by 21 first-aid stations (n=4919) during 2003-2005 were compared with daily geomagnetic activity (GMA) levels (I(0)-IV(0)) and cosmic ray activity (CRA), described by neutron (imp/min) and solar activity. The same comparison was made for pre-admission fatal AMIs (n=440). The cosmophysical data came from space science centers in the USA, Russia, and Finland. RESULTS: AMI morbidity followed a daily distribution according to GMA, mostly on quiet (I(0)) GMA days. A monthly comparison showed inverse relationships with solar activity and GMA and correlation with CRA. The daily clinical parameters of AMI correlated with CRA. Despite the daily rise in AMI mortality on days with the highest GMA, the days with the lowest GMA and higher CRA were predominant for AMI occurrence and pre-admission mortality. One of the possible predisposing factors can be life-threatening arrhythmia. CONCLUSIONS: The monthly number of AMIs was inversely related to monthly solar activity and correlated with CRA-neutron activity. Pre-admission AMI mortality was inversely linked with GMA. Daily AMI pre-admission mortality rose with concomitant GMA; low-GMA and higher-neutron-activity AMIs occurred much more frequently and were more strongly related to the number of fatal pre-admission AMIs. The clinical course of AMI was linked with CRA level.

Postoperative loco-regional radiation therapy for breast cancer patients with four or more involved lymph nodes or extracapsular extension.

BACKGROUND: Post-mastectomy loco-regional radiation to the chest wall and draining lymphatics, combined with adjuvant chemotherapy and hormonal therapy, significantly improve survival in patients with node-positive breast cancer. However, the actual benefit of post-mastectomy radiotherapy and the desired extent of treatment are still debatable. OBJECTIVES: To examine the effect of postoperative loco-regional radiotherapy on local and regional recurrence and survival in breast cancer patients with four or more involved lymph nodes or extracapsular tumor extension. METHODS: This controlled clinical trial included 258 breast cancer patients with four or more involved nodes or ECE. Eighty-nine patients in the control group had modified radical mastectomy and received adjuvant chemotherapy with melphalan and 5FU, but no radiation therapy. The 169 patients in the study group (87 with MRM and 82 with lumpectomy and axillary dissection) received various adjuvant chemotherapy regimes and radiation therapy to the chest wall/breast, supraclavicular region and full axilla. RESULTS: With an average follow-up of more than 5 years, loco-regional radiation significantly reduced local and regional disease recurrence. The median disease-free survival was significantly longer in radiated patients (59.2 months and 63.3 months in the MRM and L+AXLND groups, respectively, vs. 28.4 months in the control group; P < 0.01). There was no difference in the rate of systemic recurrence and overall survival. The median overall survival was 71.2 and 67.5 months in the study groups (MRM and L+AXLND, respectively) and 70.5 months in the control group (P = 0.856). CONCLUSIONS: Radiotherapy to the breast/chest wall and to the draining lymphatics, in addition to surgery and adjuvant therapy, significantly reduced the risk of local and regional recurrence in high risk breast cancer patients with four or more involved lymph nodes or ECE.