INTRODUCTION: To evaluate the utilization of genetic testing after the implementation of a comprehensive multidisciplinary breast cancer care (cMDC) program: ALL breast cancer cases undergo a mandated, standardized/structured review of treatment options and ongoing care (including clinical trial opportunities). METHODS: A retrospective chart review of 542 patients newly diagnosed with invasive breast cancer one year prior to and after the incorporation of a cMDC program was performed for primary outcome: rate of overall appropriate genetic referrals as defined by age, family history, triple negative status, and personal history. Secondary outcomes: compliance and equity in genetic referrals across demographics (race, insurance type and hospital site). SPSS was used for multivariate analysis, ( P <.05). RESULTS: There were 123 pre-cMDC and 419 cMDC patients. A positive pathologic genetic mutation was seen in 2.2% of patients. Comparison of pre-cMDC and cMDC patients yielded a significant increase in appropriate genetic referrals (34.1%–41.8%), a decrease in withholding genetic referral when indicated (59.3%–21.7%) and an increase in inappropriate referrals (1.9%–11.7%) respectively ( P =.001). Amongst both study arms Caucasians were more compliant genetic appointment compared to their African American counterparts (pre-cMDC P =.011, cMDC P =.016). African Americans in the cMDC group demonstrated an 11% increase in attendance compared to a 1% decrease noted among Caucasians in the cMDC group. Genetic referrals were equally offered appropriately before and after the implementation of the MDC across race, insurance type and location. CONCLUSION: Utilizing a cMDC approach to breast cancer care may help increase appropriate utilization of genetics, reach more African-Americans and identify those with pathologic mutations.
The objective of this work was to determine whether normothermic global cardiac ischemia in a porcine model was associated with a change in the density (Bmax) of voltage-dependent calcium channels in myocardial sarcolemmal membranes. Pigs were anesthetized, a thoracotomy was performed, and samples were taken of the left and right ventricles from control and ischemic hearts. Dihydropyridine-binding sites were quantified using [(3) H]isradipine, and 5 prime-nucleotidase activity was measured by the liberation of inorganic phosphate from adenosine monophosphate. B (max) and dissociation constants and 5 prime-nucleotidase activity for control and ischemic tissues, respectively, were compared by using Student's t-test for unpaired samples. After normothermic global ischemia, the Bmax of [(3) H]isradipine binding increased in the left ventricle by 81% (299% +/- 1.7% to 540% +/- 11% fmoles/mg, P < 0.01) and in the right ventricle by 33% (387% +/- 9.9% to 515% +/- 38% fmoles/mg, P < 0.01) compared with control. 5 prime-nucleotidase activity increased by 48% in the left ventricle and by 96% in the right ventricle (p < 0.05). Fifteen minutes of normothermic ischemia in the pig is associated with marked sarcolemmal abnormalities, including increases in specific dihydropyridine binding and 5 prime-nucleotidase activity, which reflect global changes in membrane function, which might contribute to the increase in myoplasmic calcium during ischemia. (Anesth Analg 1997;84:972-5)
Abstract In a family at risk for Langer mesomelic dwarfism, we document the onset of disproportionate growth in the second trimester by sonographic biometry. Midt‐trimester pathologic correlation of this condition demonstrates primary changes in the growthplate in the regions of proliferating cartilage and hypertrophic and degenerative chondrocytes.
The objective of this work was to determine whether normothermic global cardiac ischemia in a porcine model was associated with a change in the density (Bmax) of voltage-dependent calcium channels in myocardial sarcolemmal membranes. Pigs were anesthetized, a thoracotomy was performed, and samples were taken of the left and right ventricles from control and ischemic hearts. Dihydropyridine-binding sites were quantified using [(3) H]isradipine, and 5 prime-nucleotidase activity was measured by the liberation of inorganic phosphate from adenosine monophosphate. B (max) and dissociation constants and 5 prime-nucleotidase activity for control and ischemic tissues, respectively, were compared by using Student's t-test for unpaired samples. After normothermic global ischemia, the Bmax of [(3) H]isradipine binding increased in the left ventricle by 81% (299% +/- 1.7% to 540% +/- 11% fmoles/mg, P < 0.01) and in the right ventricle by 33% (387% +/- 9.9% to 515% +/- 38% fmoles/mg, P < 0.01) compared with control. 5 prime-nucleotidase activity increased by 48% in the left ventricle and by 96% in the right ventricle (p < 0.05). Fifteen minutes of normothermic ischemia in the pig is associated with marked sarcolemmal abnormalities, including increases in specific dihydropyridine binding and 5 prime-nucleotidase activity, which reflect global changes in membrane function, which might contribute to the increase in myoplasmic calcium during ischemia. (Anesth Analg 1997;84:972-5)
