Radioactive Seed Localization Program for Patients With Nonpalpable Breast Lesions.

Without early diagnosis and treatment, many lives are lost to breast cancer. Increased breast cancer awareness has facilitated research to guide health care providers toward improving patient outcomes. Research in diagnostic and treatment modalities has expanded to focus on improving the quality of life for patients with breast cancer who are living longer than expected. Providers can offer patients with nonpalpable breast lesions new screening techniques and improved treatment options, including radioactive seed localization lumpectomy. This treatment offers patients the potential for decreased tumor re-excision for positive margins near the surgical site, a lower volume of excised breast tissue, decreased operative time, convenient surgical scheduling, and less pain. Additionally, radioactive seed localization lumpectomy can improve patient and staff member satisfaction.

Re-evaluation of carotid duplex for visual complaints: who really needs to be studied?

Amaurosis fugax (AF), Hollenhorst plaques, central retinal artery occlusion (CRAO), and nonspecific visual symptoms are all reasons for patient referral for carotid artery evaluation. This study reviews the management of patients with visual signs or symptoms based on their clinical presentation, carotid duplex results, follow-up data, and outcome. We performed a retrospective review of all patients presenting to the Vascular Surgery Clinic between June 1996 and December 2001 for carotid duplex scanning because of the indication of a visual disturbance. A total of 3560 carotid duplex examinations were performed during the study period; 98 were performed for a visual complaint or finding. A total of 11.1% of group 1 (Hollenhorst plaques), 22.2% in group 2 (CRAO), 45% in group 3 (AF), and 9.8% in group 4 (nonspecific visual symptoms) had significant carotid disease and underwent carotid endarterectomy. No patient who underwent screening carotid duplex and did not have surgically correctable disease developed significant carotid disease or symptoms from carotid disease during the study period. Hollenhorst plaques, CRAO, and nonspecific visual complaints are a poor predictor of significant carotid stenosis, while AF had a significantly higher rate of surgically correctable carotid stenosis. Patients with visual signs or symptoms need an initial screening carotid duplex examination. If this does not show surgically correctable disease, patients do not need to return for further examinations unless another indication arises.

Progesterone inhibits human infragenicular arterial smooth muscle cell proliferation induced by high glucose and insulin concentrations.

INTRODUCTION: Diabetes mellitus is a significant risk factor for atherosclerotic peripheral vascular disease. Hyperglycemia and hyperinsulinemia, as encountered in patients with type II diabetes, have been shown to stimulate vascular smooth muscle cell (VSMC) proliferation, a paramount feature in atherosclerosis. Female sex hormones, such as estrogen, have been suggested to inhibit VSMC proliferation. However, the role of progesterone, particularly in patients with diabetes mellitus, has not been examined. Therefore, we studied the effect of progesterone on VSMCs exposed to various concentrations of glucose and insulin. METHODS: Human infragenicular VSMCs isolated from the tibial arteries of five male patients with diabetes undergoing lower extremity amputation were used. Immunocytochemical studies with confocal microscopy were performed for progesterone receptor identification in these VSMCs. Cells were grown to subconfluence, followed by exposure to deprived media with various glucose (100 and 200 mg/dL) and insulin (no insulin and 100 ng/mL) concentrations. Cells were then additionally exposed to physiologic progesterone (10 ng/mL, progesterone group) and compared with a no-progesterone group. Cell count and methyl-(3)H-thymidine incorporation were used to determine cellular proliferation. Cell count with hemocytometry was performed on day 6. DNA synthesis as reflected through methyl-(3)H-thymidine incorporation was measured at 24 hours. RESULTS: Immunocytochemical studies with confocal microscopy showed cytosolic progesterone receptors. The no-progesterone group showed a significant rise in cell count (P <.05) at all concentrations of glucose or insulin compared with the control group containing 100 mg/dL glucose concentration. The no-progesterone group also showed a significant rise in thymidine incorporation (P <.05) in the 100 mg/dL glucose-100 ng/mL insulin group and the 200 mg/dL glucose-100 ng/mL insulin group compared with the 100 mg/dL glucose group. In the cell count studies, progesterone significantly inhibited cellular proliferation in several settings. All cell groups cultured with insulin or an elevated glucose concentration showed a significant (P <.05) antiproliferative effect when exposed to progesterone. With thymidine incorporation, progesterone showed a similar antiproliferative effect in cells stimulated with glucose or insulin. CONCLUSION: Significant reductions in cell proliferation as determined with both cell count and thymidine incorporation suggest that progesterone is an inhibitor of VSMC proliferation induced by our in vitro models of hyperglycemia and hyperinsulinemia. Therefore, progesterone may have a protective role against the atherosclerotic changes associated with type II diabetes.