Role of MRI in Breast Cancer Staging: A Case-Based Review.

Breast cancer is the most commonly diagnosed cancer in women in the United States and is also the second leading cause of cancer deaths in women. The five-year survival rate and overall prognosis are largely dependent on the stage at diagnosis. Our article highlights the role of magnetic resonance imaging (MRI) in breast cancer staging and updates to the American Joint Committee on Cancer (AJCC) 8th edition guidelines regarding breast cancer staging that are relevant to radiologists. It provides a case-based approach to emphasize the key findings that the radiologist should report on a breast MRI to aid the clinicians in staging and management.

Double-blind comparison of once-daily bopindolol and atenolol for mild-to-moderate hypertension.

In order to compare the medium term antihypertensive effectiveness and tolerability of atenolol with those of bopindolol (LT 31-200), a new non-selective beta-blocker with slight PAA (partial agonist activity), a randomized double-blind study was performed. Thirty-one outpatients with mild-to-moderate essential hypertension (WHO stage I-II) were enrolled and after a placebo run-in randomly allocated to bopindolol (1 to 4 mg/day) or atenolol (50 to 200 mg/day). The dose was titrated according to the individual pressor responses, and thereafter it was kept constant until the end of the treatment (12 weeks). Both drugs induced statistically significant decreases in SBP, DBP and HR, both in resting conditions and during an ergometric test. Accordingly, most patients achieved the main goal of the therapy, i.e., supDBP less than or equal to 90 mmHg, 11/15 (74%) with bopindolol versus 8/13 (62%) with atenolol. There were no significant differences between the effects of the two compounds. Resting airway resistance (expressed as Peak Expiratory Flow) was not influenced by the treatments. The antihypertensive efficacy was still evident after 12 months in 8 patients who were evaluated for non-comparative long-term effectiveness of bopindolol monotherapy, and improvements in plasma lipid profiles were also observed. Side effects were relatively mild and transient, with two patients in the atenolol group discontinuing therapy (one for inefficacy and one because of undesirable reactions) and one dropped out in the bopindolol group (late evidence of not fulfilling inclusion criteria).(ABSTRACT TRUNCATED AT 250 WORDS)

Bromocriptine for treatment of benign breast disease. A double-blind clinical trial versus placebo.

Over the last few years bromocriptine has been used for treatment of mastodynia and benign breast disease, but with contradictory results. This double-blind clinical trial was performed to determine the efficacy of this prolactin inhibitor as compared with placebo. Subjective discomfort, clinical examination of the breast lesions, echomammography and breast thermography were evaluated before, during and after 3 months of treatment and in a further follow-up. Plasma levels of estradiol, progesterone and prolactin were measured over the same time. Significant reduction of mastodynia and significant improvement of the breast lesions were observed in the group given bromocriptine, though echomammography and breast thermography did not reveal any significant differences between the two groups. Plasma prolactin levels were significantly reduced by bromocriptine administration.

Beta-blockers and psychic stress: a double-blind, placebo-controlled study of bopindolol vs lorazepam and butalbital in surgical patients.

One hundred patients scheduled for surgery participated in a randomized double-blind trial designed to evaluate the effects of acute treatment with two doses of bopindolol (1 mg:BP1;2 mg:BP2) in comparison with those of 2.5 mg lorazepam (LR), 75 mg butalbital (BT) and placebo (PL). Anxiety was evaluated by the STAI X1 questionnaire on the day before surgery, in the late afternoon (time 0: basal) and in the evening (time 1). At the same times patients were requested to play a game of manual skill called "Go Down". The next day, in the morning (time 2), the patients were given the same questionnaire and were asked a series of questions about their sleep and awakening. Mean anxiety scores were significantly increased over basal values at both time 1 and time 2 in the PL and LR groups and at time 2 in the BT group, but neither in the BP1 nor in the BP2 group. The time needed to perform the "Go Down" test was significantly shorter than the basal value for both BP groups and significantly longer for the BT group, while nonsignificant modifications occurred in the PL and LR groups. Positive effects were obtained in patients treated with BP, at both doses, on ease of "falling asleep", number of "night awakenings" and "reawakening mood" while LR and BT were mostly ineffective, except for BT on ease of "falling asleep". It was concluded that a beta-blocker such as bopindolol may be more effective than a benzodiazepine or a barbiturate for the prevention of anxiety symptoms induced by a clearly defined stress situation, such as awaiting a surgical operation.

A single blind comparison of dihydroergotoxine mesilate and clonidine for treatment of hypertensive emergencies.

The effectiveness and safety of dihydroergotoxine mesylate (DHT) and clonidine (CLO) as acute antihypertensive treatments were studied in a single-blind randomized controlled study of 28 patients hospitalized after abrupt increases in mean blood pressure (MAP) to more than 150 mmHg, with concomitant symptoms related to hypertensive status (16 patients). Intravenous infusion of 1.5 mg DHT significantly reduced both systolic (SBP) and diastolic (DBP) blood pressure from 227 +/- 2/128 +/- 2 mmHg to 160 +/- 4/94 +/- 2 mmHg by 1 hour after the onset of infusion (p less than 0.01). In patients given CLO, BP values fell from 221 +/- 3/123 +/- 3 mmHg to 166 +/- 5/95 +/- 3 mmHg after 150 minutes. After that BP values did not change significantly up to 6 hours after both treatments. One hour after the onset of infusion, mean heart-rate (HR) had decreased by 15 beats/min in the DHT group and by 10 beats/min in the CLO-group. Twenty-one per cent of the patients given DHT and 78% of the patients given CLO complained of mild or moderate side-effects. The results of this study showed that DHT is an effective and well tolerated agent for the treatment of hypertensive emergencies and can be used safely even when continuous monitoring of blood pressure cannot be carried out.

Comparison of effects of guanfacine and clonidine on blood pressure, heart rate, urinary catecholamines, and cyclic nucleotides during and after administration to patients with mild to moderate hypertension.

In a random trial, the effects of treatment and withdrawal of guanfacine were compared with those of clonidine in 20 uncomplicated hypertensive patients. Elevated blood pressure returned to normal or responded well in all the patients given either guanfacine once daily or clonidine thrice daily. The pulse rate was reduced comparably by both treatments after 12 weeks, but the effect of guanfacine developed more gradually. Both guanfacine and clonidine significantly inhibited urinary noradrenaline, dopamine, and cyclic nucleotide excretion, while urinary adrenaline levels were unaffected. Side effects occurred earlier during treatment with clonidine. After sudden withdrawal, all the parameters tended to increase gradually in the guanfacine group, reaching base line by days 4-6. In the clonidine group the increase was more rapid, with pretreatment values reached within the 2nd day, and sometimes these values were surpassed. After withdrawal of clonidine all the patients had one or more side effects, most of them occurring within 48 h, while only 60% of the patients in the guanfacine group reported the appearance of unwanted symptoms, on days 3-6. It is concluded that there are close similarities between the effects of guanfacine and clonidine on the parameters evaluated, except for dopamine excretion, which was significantly less affected by guanfacine. Marked differences were found after abrupt withdrawal, with guanfacine less likely to produce the "discontinuation syndrome," probably due to its long half-life.

Effects of pindolol and metoprolol on plasma lipids and lipoproteins.

1 The effects of two beta-adrenoceptor blocking drugs, pindolol and metoprolol, on plasma lipids and lipoproteins were studied in sixteen hypertensive patients (WHO I-I) by a cross-over design, with two active treatment periods of 12 weeks each. 2 Neither pindolol nor metoprolol had any effect on total plasma cholesterol (total-C), triglycerides (TG) or low-density lipoprotein cholesterol (LDL-C). 3 Pindolol significantly increased high-density lipoprotein cholesterol (HDL-C). After metoprolol, HDL-C levels remained similar to those in the placebo period. 4 The ratio of total-C to HDL-C was significantly reduced by pindolol only. 5 Compared with the placebo period, both pindolol and metoprolol significantly reduced heart rate (HR) and systolic (SBP) and diastolic (DBP) blood pressure. The decreases in HR were significantly greater after metoprolol. No differences between the effects of the two drugs on SBP and/or DBP were observed.

[Comparison of the effect of premedication with diazepam and trazodone on anesthesia induced with althesin]. / Valutazioni comparative degli effetti della premedicazione con diazepam e con trazodone sulla narcosi da althesin.

Interference on the part of premedication with diazepam and trazodone with althesin anaesthesia was investigated and compared by means of variance analysis according to Fisher, and the X2c test according to Yates, in 150 patients aged 35-45 yr in three groups of 50 during examination of the uterine cavity. No marked difference between the effects of the two drugs were noted, with two exceptions: 1) trazodone was better able to potentiate the hypnotic action of althesin, so that less was needed for the induction of anaesthesia; 2) patients pretreated wih diazepam displayed a marked increase in postoperative somnolence, this being an expression of the drug's hypnotic effect.