Breast lymphoma: favorable prognosis after treatment with standard combination chemotherapy.

PURPOSE: This paper is to determine the clinicopathological features and outcome of patients with breast lymphoma seen at a single institution. PATIENTS AND METHODS: We have reviewed data on 14 patients with breast lymphoma seen at our institution from 1990 to 2003. RESULTS: All patients were female, with a median age of 47.6 years. Diffuse large B-cell lymphoma (DLBCL) was observed in 9 cases, while follicular, Burkitt's, small lymphocytic, MALT and T-cell lymphoma were observed in 1 case each. 5 patients (35.7%) had stage IE disease, 6 patients (42.9%) had stage IIE disease and 3 patients (21.4%) had stage IV disease. Standard CHOP with or without rituximab was given to all patients with aggressive breast lymphoma (n = 10), while 1 patient with Burkitt's lymphoma received a CHOP-based regimen. The 3-year actuarial survival estimate among all 11 patients with aggressive breast lymphoma was 73%. Among those with localized disease, the estimated 3-year survival was 90%. The actuarial 3-year overall survival (OS) estimate for the entire cohort of 14 patients was 76.9%. CONCLUSION: Our results indicate that breast lymphoma is not associated with an inferior outcome when treated with standard CHOP-based chemotherapy.

The impact of smoking status on the behavior and survival outcome of patients with advanced non-small cell lung cancer: a retrospective analysis.

STUDY OBJECTIVES: There are fundamental differences in characteristics between smokers and nonsmokers with non-small cell lung cancer (NSCLC). We aim to study the impact of smoking status on the behavior of the disease, and to identify differences in outcome between the two groups. DESIGN: A retrospective analysis was done of patients with NSCLC seen during the period from January 1999 to August 2002. Clinical characteristics, survival outcome, and response to treatment were reviewed and compared between the smokers and nonsmokers. SETTING: Department of Medical Oncology, National Cancer Center. RESULTS: Of 317 patients analyzed, 117 patients (36.3%) were nonsmokers. Among the nonsmokers, 74.5% had adenocarcinoma and 73.9% were women. The smokers had poorer performance status, reported more weight loss, and had a higher mean age at diagnosis of almost 8 years than nonsmokers. One hundred eighty-seven patients (59%) had died as of December 31, 2002. The nonsmokers had a longer median survival, although this was not statistically significant. There were no statistically significant differences in survival and response to chemotherapy between the two groups after adjusting for known prognostic factors. CONCLUSIONS: Despite the known differences in mutational spectra and clinical characteristics between smokers and nonsmokers with NSCLC, no differences in terms of response to chemotherapy and survival outcome were observed. This could imply that this disease is equally aggressive in these two groups. More research is needed to further delineate and characterize the differences between these two etiologically different forms of NSCLC.

Randomized trial of prolonged low-dose versus conventional-dose indomethacin for treating patent ductus arteriosus in very low birth weight infants.

OBJECTIVE: Indomethacin is used for closing the patent ductus arteriosus in premature infants. Prolonged low-dose indomethacin given over 6 days could potentially improve closure rates because ductal constriction is maintained long enough for more effective anatomic closure. We compared the efficacy of this regimen to conventional dosing in a cohort of very low birth weight infants. METHODS: In a 2-arm clinical trial, 140 infants were randomized to either conventional dose (0.2 mg/kg/dose every 12 hours for 3 doses) or prolonged low-dose indomethacin (0.1 mg/kg/dose daily for 6 doses). The primary outcome measure was ductal closure rate, and the secondary outcomes were the need for a second course of treatment, surgical ligation rates, and side effects. RESULTS: Ductal closure after 1 course of indomethacin was similar between the 2 groups: 68% for the conventional dose group and 72% for the prolonged low dose (mean difference -4%; 95% confidence interval: -19% to 11%). The incidence of transient oliguria was higher in the conventional dose group, 31% versus 9%. There was a trend toward more necrotizing enterocolitis in the prolonged low-dose group, 7.0% versus 1.4%. CONCLUSIONS: There was no difference in efficacy between the 2 dosing regimens. In view of this and with its higher incidence of necrotizing enterocolitis, we do not recommend using prolonged low-dose indomethacin for closing the patent ductus arteriosus in very low birth weight infants.

Agreement between Scheimpflug photography and A-scan ultrasonography in anterior segment ocular measurements in children.

PURPOSE: The Scheimpflug principle, as a method of performing biometry on the anterior segment, has not been widely used in the clinical setting compared with ultrasonography. The purpose of this study was to examine the agreement in anterior chamber length and lens thickness measurements between A-scan ultrasonography and Scheimpflug photography. METHODS: A total of 252 children aged between 6 and 12 years participated in this study. All subjects had instillation of cycloplegic eye drops before measurement. Scheimpflug photography and A-scan ultrasonography were performed in this sequence on the same day. The anterior segment length on the Scheimpflug images was taken as the axial corneal thickness added to the anterior chamber depth. A-scan ultrasonography was performed by placing the probe on the corneas after topical anesthesia. Differences were obtained by subtracting the A-scan ultrasonography measurements from the Scheimpflug measurements. Data were analyzed using difference vs. mean plots. RESULTS: For anterior chamber length, the mean difference between the two methods was -0.03 +/- 0.16 mm, with 95% limits of agreement of -0.35 to +0.30 mm. However, Scheimpflug readings were greater than that of ultrasonography for smaller measurements, and the opposite was true for larger measurements. For lens thickness, the mean difference was -0.2 +/- 0.10 mm, with 95% limits of agreement of -0.40 to +0.00 mm. For the measurement of lens thickness, adding a correction factor of 0.2 mm to Scheimpflug's readings should replace that of A-scan readings reasonably well. CONCLUSIONS: The readings obtained from these two methods of biometry must be used with the knowledge of the instruments. We discuss the possible reasons for the difference in readings obtained using these two instruments.

A multiple regression approach to study optical components of myopia in Singapore school children.

PURPOSE: Previous studies on the optical components of childhood myopia adjusted only for age and gender or reported only the change of individual components with time. We perform a study to assess the association of the optical components of the eye contributing to the degree of myopia by building a statistical model which can better assess the individual effects of each optical component. METHODS: Children 6-12 years old with myopia of -1 to -6 D were used in this study. Autokeratometry was performed to determine the mean corneal power in two perpendicular meridia. Ultrasonography was used to determine the vitreous chamber depth (VCD). Ultrasonography and Scheimflug biometry were used to determine lens thickness (LT) and anterior chamber depth. A stepwise multiple linear regression was used to determine statistically significant independent variables that explain the variation in the mean spherical equivalent of the left eye. The independent variables investigated were anterior chamber length, LT, VCD, mean corneal power, age and gender. The first regression model used measurements of anterior chamber depth and LT from ultrasonography, while the second model used measurements from Scheimflug photography. Statistical significance was set at p < 0.05. RESULTS: Both statistical models have the same significant independent variables - VCD, LT and gender, with similar estimates. In both models, VCD was found to have the strongest partial association with mean spherical equivalent, followed by gender and LT. A more myopic refractive error was associated with (1) a longer eye, (2) an increased LT, and (3) female gender. CONCLUSIONS: Myopia was associated with a longer vitreous chamber. This remained the primary determinant of myopia in Chinese children after consideration of other optical components. The effect of gender and LT on myopia requires further study. These results are in agreement with multiple regression analyses in Singapore adults.