Epistaxis in people with hereditary haemorrhagic telangiectasia: surgical management and psychological impact.

From the emergency management of acute epistaxis to the surgical procedures for chronic epistaxis, this article covers the options available to control the archetypal symptom of hereditary haemorrhagic telangiectasia while exploring the psychological effect such a disease has on the patient.

Sacituzumab govitecan: antibody-drug conjugate in triple-negative breast cancer and other solid tumors.

Patients with metastatic triple-negative breast cancer (mTNBC) that has progressed on first-line therapy have a poor prognosis with limited therapeutic options. Sacituzumab govitecan (SG) is a novel antibody-drug conjugate (ADC) that has shown promising efficacy in mTNBC. SG is comprised of SN-38, the active metabolite of irinotecan, conjugated via a hydrolyzable linker to the humanized RS7 antibody targeting trophoblast cell surface antigen 2 (Trop-2), a glycoprotein that is expressed at high levels in many epithelial solid tumors. It has received breakthrough therapy status by the U.S. Food and Drug Administration (FDA) for the treatment of patients with pretreated mTNBC. In this review, we summarize available data regarding the pharmacology, pharmacokinetics, safety and efficacy of SG and describe ongoing and future clinical studies investigating this agent.

Effects of cost metric on cost-effectiveness of protected-area network design in urban landscapes.

A common goal in conservation planning is to acquire areas that are critical to realizing biodiversity goals in the most cost-effective manner. The way monetary acquisition costs are represented in such planning is an understudied but vital component to realizing cost efficiencies. We sought to design a protected-area network within a forested urban region that would protect 17 birds of conservation concern. We compared the total costs and spatial structure of the optimal protected-area networks produced using three acquisition-cost surrogates (area, agricultural land value, and tax-assessed land value). Using the tax-assessed land values there was a 73% and 78% cost savings relative to networks derived using area or agricultural land value, respectively. This cost reduction was due to the considerable heterogeneity in acquisition costs revealed in tax-assessed land values, especially for small land parcels, and the corresponding ability of the optimization algorithm to identify lower-cost parcels for inclusion that had equal value to our target species. Tax-assessed land values also reflected the strong spatial differences in acquisition costs (US$0.33/m(2)-$55/m(2)) and thus allowed the algorithm to avoid inclusion of high-cost parcels when possible. Our results add to a nascent but growing literature that suggests conservation planners must consider the cost surrogate they use when designing protected-area networks. We suggest that choosing cost surrogates that capture spatial- and size-dependent heterogeneity in acquisition costs may be relevant to establishing protected areas in urbanizing ecosystems.

Informing women about their breast cancer risks: truth and consequences.

We assessed the extent to which informing women about their risk for breast cancer affected their perceived 10-year and lifetime risks for getting breast cancer, their emotional reactions toward getting breast cancer, and their intentions to get mammograms. In a pre- to posttest design, 121 women were given their 10-year risk of getting breast cancer with or without being compared with women their age and race at lowest risk. Women's perceptions of their 10-year risks became more congruent (i.e., more accurate) with their actual risk. Participants were more accurate when they received their own risk without being compared with women at lowest risk. Women who received only their own risk estimate reported being at lower risk than other women. Overall, women reported that obtaining their 10-year risk estimate either did not affect or increased their intentions to get mammograms. These results suggest that giving women their individual risk of getting breast cancer improves accuracy while also enhancing their feelings that they are at lower risk than other women. Counter to many theories of health behavior, reducing women's perceived risk of breast cancer did not lower their intentions to get mammograms. Implications for the communication of breast cancer risk are discussed.

Testing different formats for communicating colorectal cancer risk.

This study assessed the extent to which different formats of informing men and women age 50 and over of the risks of colorectal cancer (CRC) affected their perceptions of their absolute and comparative (self versus other) 10-year and lifetime risks; emotional reactions about getting CRC; and screening intentions. Forty-four men and 78 women received information about the absolute lifetime risk of getting CRC. In addition, participants either did or did not receive information about (1) lifetime risk of getting CRC compared with other cancers, and (2) risk factors for CRC (age and polyps). Participants who received risk factors information were more likely to increase their perceived absolute 10-year and lifetime risks of getting CRC compared with participants who did not receive risk factors information. In addition, participants who received risk factors information were more likely to believe age was related to getting CRC and felt at greater risk for having polyps compared with participants who did not receive this information. None of the experimental conditions affected how worried, anxious, and fearful participants felt about getting CRC, nor did they affect screening intentions. Independent of experimental condition, participants tended to increase their intentions to get screened for CRC in the next year or two. Intention to be screened was more pronounced among participants who had been screened via a fecal occult blood test (FOBT) or sigmoidoscopy (SIG). Implications for the design of interventions involving the communication of CRC risks are discussed.

[Peritoneography for identification of non palpable herniation]. / Die Peritoneographie zum Nachweis nicht tastbarer Hernien.

Peritoneography with trijodic contrast medium is a simple but very effective method to identify non palpable herniations causing inguinal pain of unknown origin. It is also very useful for early detection of recurrent herniations after surgery as well as for diagnosis of non palpable umbilical herniations in adipose patients, and for demonstration of herniastions of the abdominal wall after trauma. Technique of investigation and radiological symptoms are described following experience with 154 outpatients. In 25% of these patients during clinical investigation no herniation was found.