Soft tissue sarcomas: current management and future directions.

This article reviews the current state of diagnosis and treatment of soft tissue sarcomas. Etiology, staging, imaging, tissue sampling, and current treatment are all reviewed using updated references. Current standards for surgical treatment are emphasized and the future directions of treatment addressed.

The effects of race and age on axillary lymph node involvement in breast cancer patients at a Midwestern safety-net hospital.

BACKGROUND: Black and premenopausal patients have been shown to have poorer stage for stage survival than the overall population. The purpose of this study was to define the effects of age and race on axillary lymph node involvement at a Midwestern safety-net hospital. The hypothesis was that black patients under the age of 50 would be found to have increased rates of axillary involvement in breast cancer. METHODS: A retrospective case review was performed of 184 breast cancer patients from 2000 to 2005. Statistical analysis was performed by race and age. Patients under 50 years of age were defined as premenopausal. RESULTS: The overall rate of axillary involvement was 47.8%. Black patients had an overall rate of axillary involvement of 52.9%. However, premenopausal black patients had a 70.8% rate of axillary involvement (P < .05). Premenopausal white patients had a 46.3% rate of axillary involvement. Logistic regression analysis was performed, and premenopausal age and tumor size were found to be independent predictors of positive lymph node status in black patients. CONCLUSION: In our study, premenopausal black patients had a much higher rate of axillary lymph node involvement than any other group. This finding was consistent even when tumor size was taken into account. More research needs to be done to better define this difference and to detect this disease at an earlier stage.

Hemorrhagic shock in the rat: comparison of carotid and femoral cannulation.

BACKGROUND: The reservoir model of rat hemorrhagic shock is widely used. In this model, either the carotid or femoral artery can be cannulated to withdraw blood and measure pressure. In animals undergoing hemorrhage using the carotid approach, we observed seizure activity during the post-shock period, suggesting some degree of brain damage. The hypothesis of the present study is that survival in a model of severe hemorrhagic shock would be higher with femoral cannulation than with carotid cannulation. MATERIALS AND METHODS: All animals (n = 90) were anesthetized with isoflurane using an anesthesia vaporizer while breathing spontaneously. In group 1, the left carotid artery and jugular vein were cannulated; in group 2, the left femoral artery and vein were cannulated. Following a period of hemorrhagic shock (20 to 30 mmHg for 30, 60, or 50-90 min), resuscitation was performed through the venous cannula by giving L-lactated Ringer's (21 mL/kg) and returning the shed blood. RESULTS: In the carotid cannulation group, nearly 50% of the animals had seizures after resuscitation, and most of those animals died following the seizures. The 24-h survival rate in the femoral artery cannulation group was significantly higher than in the carotid artery cannulation group. Femoral cannulated animals had no seizures following reperfusion. CONCLUSIONS: Femoral artery cannulation was associated with considerably better survival than carotid artery cannulation in this rodent model of hemorrhagic shock. The occurrence of seizures in animals undergoing carotid cannulation suggests brain damage from inadequate cerebral perfusion or subsequent reperfusion damage.

Kidney patient care in disasters: emergency planning for patients and dialysis facilities.

The catastrophic 2005 hurricane season alerted Americans to the need for a more effective response to mass casualty incidents. To address the needs of the nephrology community, the Kidney Community Emergency Response Coalition (KCERC) was formed, with representatives from more than 50 governmental agencies and private organizations. After completing phase 1 of its work, the KCERC issued recommendations for patients, dialysis units, and providers. During phase 2, the KCERC will promote implementation of those recommendations. During a disaster, the KCERC will host a daily conference call on which dialysis facilities, the End-Stage Renal Disease Networks, and emergency response officials will coordinate disaster response. Predisaster preparation for kidney patients should stress identification of alternative dialysis facilities, education about the renal emergency diet, and plans for early evacuation from the disaster area and for evacuating with medical documents and medications. Dialysis facilities are required to have a disaster plan; regular revision and rehearsal are essential. Critical issues for dialysis facilities include identification of partner facilities, a robust communications plan that takes into account the limitations of telephones and broadband access, staff shortages in the face of a possible influx of new patients, the delivery of service in the face of compromised utilities (water, power), and the recovery of a dialysis facility that experiences flooding or structural damage. A timeline to safety for dialysis patients can be visualized; if specific tasks are accomplished at each disaster stage, then it is likely that the health of these vulnerable patients can be protected.

Kidney patient care in disasters: lessons from the hurricanes and earthquake of 2005.

The active 2005 hurricane season alerted Americans to the pressing need for a more effective response to mass casualty incidents. The kidney patient community was particularly affected. Ninety-four dialysis facilities in the Gulf Coast states closed for at least 1 wk in the aftermath of Hurricane Katrina, and additional units were affected by evacuation of dialysis patients. Dialysis units along the Gulf Coast were also affected by Hurricanes Rita and Wilma. Existing emergency response plans were inadequate in providing continuity of care for kidney patients. The Kashmir, South Asia, earthquake of October 2005 killed 97,000 individuals. Building collapse was associated with widespread crush injury, and many patients required temporary hemodialysis. Several regions of the United States have the potential for catastrophic earthquakes. The Kidney Community Emergency Response Coalition has recently issued recommendations for patients, dialysis facilities, and providers, with a goal to improve care of kidney patients in future domestic disasters. With suitable planning, the nephrology community can do much to ensure the continuity of medical care for kidney patients in the face of a wide range of possible natural and human-made disasters.