Breast imaging today and tomorrow.

As the new millennium approaches, there is still no proven cure for breast cancer. There is hope, however, that emerging new technologies will afford the clinician early detection strategies for their patients in the coming years. Film-screen mammography continues to provide the most reliable and accurate tool for breast imaging. Agencies such as the American Cancer Society and the American College of Radiology recommend yearly screening for all patients after the age of 40. The triad of mammography, proficient clinical breast examination, and breast self-examination are reviewed. Benefits and limitations of newer modalities are presented, as well as an overview of the nurse practitioner role. Included are various educational resources for both the professional and the patient. Additionally, the Breast imaging Reporting and Data System system of mammographic interpretation is incorporated.

Issues in breast imaging.

Until there is a cure for breast cancer, clinicians must focus their attention on current modalities of early detection that can accurately diagnose the early stage of the disease. Mammography continues to be the most reliable and accurate tool for breast imaging although controversy continues to obscure the issue of appropriate mammographic screening for women 40-49 years of age. Agencies such as the American Cancer Society and the American College of Radiology recommend year screening for women older than 40 years of age. Patient risk factors should be examined thoroughly in making individual decisions regarding breast screening. Additionally, the historic perspective of mammography and new technologies emerging in improved breast imaging are presented. The radiologist's interpretation of mammography and the role of the primary care provider are also reviewed.

Insulin omission in women with IDDM.

OBJECTIVE: To describe the extent of intentional insulin omission in an outpatient population of women with insulin-dependent diabetes mellitus (IDDM) and examine its relationship to disordered eating, attitudes toward diabetes, other psychosocial factors, long-term complications, and glycemic control. RESEARCH DESIGN AND METHODS: Before their routinely scheduled clinic appointments, female IDDM patients who were 13-60 years of age completed a self-report survey (final n = 341). The survey included standardized questionnaires assessing disordered eating attitudes and behaviors, psychological functioning (general distress, diabetes-specific distress, and hypoglycemic fear), attitudes toward diabetes, and self-care behaviors. All subjects were assessed for glycosylated hemoglobin within 30 days of survey completion. Long-term complications were determined through chart review. RESULTS: Approximately 31% of the subject sample, representing women of all ages, reported intentional insulin omission, but only 8.8% reported frequent omission. Compared with non-omitters, omitters reported more disordered eating, greater psychological distress (general and diabetes-specific), more hypoglycemic fear, poorer regimen adherence, and greater fears concerning improved diabetes management (which may lead to weight gain). Omitters evidenced poorer glycemic control, more diabetes-related hospitalizations, and higher rates of retinopathy and neuropathy. Multivariate examination revealed only two variables that independently predicted omission: diabetes-specific distress and fear of improved glycemic control ("because I will gain weight"). Of the omitters, approximately half reported omitting insulin for weight-management purposes (weight-related omitters). These subjects evidenced significantly greater psychological distress, poorer regimen adherence (including more frequent omission), poorer glycemic control, and higher rates of complications than did non-weight-related omitters as well as non-omitters. Non-weight-related omitters tended to fall between weight-related omitters and non-omitters on most measures of psychological functioning, adherence, and glycemic control. CONCLUSIONS: These findings suggest that insulin omission is common, that it is not limited to younger women, and that the medical consequences of omission, especially frequent omission, may be severe. Although a strong association between omission and disordered eating was observed, these data suggest that this link may be complicated by important diabetes-specific factors. Patients preoccupied with eating and weight concerns may also become emotionally overwhelmed by diabetes and/or fearful of normoglycemia (and the associated weight-related consequences), thus reinforcing the desire to omit insulin and maintain elevated blood glucose levels.

Family environment and glycemic control: a four-year prospective study of children and adolescents with insulin-dependent diabetes mellitus.

An onset cohort of children and adolescents with insulin-dependent diabetes mellitus (IDDM) and their parents were studied. Aspects of family environment were evaluated at study inception, and their influence on the initial level of, and change in, glycemic control over 4 years was examined. Family measures of expressiveness, cohesiveness, and conflict were linked to differences in the longitudinal pattern of glycemic control. In particular, the encouragement to act openly and express feelings directly (expressiveness) seemed to ameliorate deterioration of glycemic control over time in both boys and girls. Boys were especially sensitive to variations in family cohesiveness and conflict; those from more cohesive and less conflicted families showed less deterioration in glycemic control. This study demonstrated the important influence of family psychosocial factors present at diabetes onset on glycemic control in children and adolescents over the first 4 years of IDDM.

Binding of [3H]12-O-tetradecanoylphorbol-13-acetate to intact human peripheral blood lymphocytes.

Our studies indicate that tritiated 12-O-tetradecanoylphorbol-13-acetate ([3H]TPA) produced by the reduction of the C-20 aldehyde with sodium [3H]borohydride is recognized by the same cellular site as is unlabeled 12-O-tetradecanoylphorbol-13-acetate (TPA). None of the concentrations of TPA used in these studies had an effect on the cell number and viability of human peripheral blood lymphocytes (HPBL) when incubated up to 1 hr at temperatures of 37 and 4 degrees as compared to untreated controls. [3H]TPA was not significantly metabolized by these cells after 1 hr at 37 degrees. Examination of the binding of [3H]TPA with simultaneous examination of uptake of tritiated thymidine ([3H]dThd) in parallel cultures demonstrated a close correlation between the apparent binding constant (0.94 X 10(8) M-1) and the activation constant for TPA stimulation of [3H]-dThd incorporation (0.95 X 10(-8) M). Binding of [3H]TPA was examined in two experimental conditions in which TPA-induced mitogenesis was inhibited: (a) preincubation of HPBL at 37 degrees for 24 hr causes a decrease of [3H]dThd uptake of 50% and an apparent loss of binding sites for [3H]TPA; and (b) glucocorticoid inhibition of [3H]dThd uptake in HPBL by 50%, however, did not reduce [3H]TPA binding. Our data suggest that cellular receptors either at the membrane or in the cytoplasm exist for TPA in HPBL. Alterations in binding of TPA to these receptors may account for the decrease in mitogenic response in preincubation experiments.