Derrick J. Beech

Alcohol and drug use in victims of life-threatening trauma.

OBJECTIVE Alcohol and drug use has been implicated as a contributing factor to all types of trauma. This investigation seeks to determine the prevalence of alcohol and drug use in patients who are victims of life-threatening injuries and the association of alcohol and drug use with intentional trauma. METHODS The Medical Center of Louisiana at New Orleans (Charity Campus) trauma registry was used to identify patients sustaining life-threatening injuries that presented to our American College of Surgeons Level 1 trauma center over a 6-month period. Serum ethanol levels and urine toxicology were assessed at initial presentation for all patients. RESULTS A total of 557 patients were evaluated. Seventy percent (n = 319) of tested patients (n = 450) had positive serum ethanol and/or urine toxicology results. Male gender (75% vs. 55%; p < 0.001) was associated with positive screens; ethnicity was not. No difference in hospital days or mortality was seen between positive and negative screens. Victims of intentional trauma showed a higher percent of positive screens (80% vs. 63%; p < 0.005). CONCLUSION These data suggest that alcohol and drug use is associated with life-threatening injury, especially intentional injury. Prevention of substance abuse is essential for the prevention of trauma.

Hepatitis B and C infections among homeless adolescents.

&NA; The lifestyle of homeless adolescents places them at high risk for contracting serious illnesses. This study sought to determine the hepatitis status and predictors of hepatitis infection among 150 homeless adolescents. Each participant took a psychosocial survey and provided a venous blood sample. Most respondents (95%) had engaged in sexual intercourse; approximately 36% indicated they had exchanged sex for food, shelter, or drugs. Youth reported a high rate of consistent condom use, however, 22% tested positive for hepatitis B or C. Homeless youth should be considered a high‐risk group for hepatitis B or C virus infection. As hepatitis B vaccination programs have been targeted at school‐based youth, most homeless youth are missed by these efforts. Targeted programs are needed to immunize this high‐risk group.

Education of medical students in clinical breast examination during surgical clerkship.

BACKGROUND Medical student training in clinical breast examination is deficient at most medical schools. The use of silicone breast models may allow the education of abnormal and normal findings. This study examines the efficacy of silicone breast models to educate medical students in clinical breast examinations during their third-year surgical rotation. METHODS Medical students were randomly selected to participate in formalized training sessions in clinical breast examination or as a control group. Presession and postsession testing with silicone breast models were performed. True positives (masses that were present and documented by the student) and false positives (masses that were not present but were documented by the student) were recorded. RESULTS Medical students undergoing the training sessions demonstrated improved true positive scores (2.2 to 2.8; P <0.05) as well as improved false positive scores (3.0 to 2.0; P = 0.30) and total scores (-0.8 to 0.8; P = 0.07). Students who documented an increase in the number of breast examinations during their rotations had statistically lower false positive scores. CONCLUSIONS Students after formalized clinical breast examination sessions do improve their ability to detect breast masses, although they continue to detect masses that are not present. Experience of actual breast examinations during their surgical rotations may refine their clinical skills.

Socioeconomic Factors, not Ethnicity, Predict Breast Self-Examination

Abstract: The American Cancer Society has recommended monthly breast self‐examinations (BSEs) to aid in the early detection of breast cancer. Compliance with BSE recommendations has been shown to be decreased in certain ethnic groups. This investigation evaluates relevant variables involved in BSE compliance in an urban breast cancer screening center. A survey over a 1‐year period (June 1996–June 1997) was given to all patients on their initial visit to the Breast Health Center at Tulane University Medical Center. Demographic and socioeconomic factors associated with the compliance of BSE were explored. The overall rate of BSE was relatively high at 80%. There was no difference between ethnic groups in rates of BSE (Caucasians 21% versus African Americans 20%). Statistically significant variables associated with BSE noncompliance were high school education (did not complete high school 16% versus completed high school 33%; p < 0.0004), employment status (employed 16% versus unemployed 31%; p < 0.0004), and marital status (married 15% versus single/divorced 22%; p < 0.05). While the majority of women in our study practiced BSE and ethnicity did not predict BSE, several socioeconomic factors were predictive of BSE compliance. Efforts to increase community outreach to lower socioeconomic patients as well as efforts to ensure proficient BSE techniques by patients may help detect early breast cancer.

Training in clinical breast examination as part of a general surgery core curriculum.

BACKGROUND Early detection of breast cancer relies on a multidisciplinary approach that includes patient breast self-examination, radiographic studies, and clinical breast examination (CBE). This study was undertaken to assess the value of formal CBE instruction by the surgery department using solicone breast models. METHODS Thirty students were randomized in their first week of junior surgical clerkship to undergo or forgo a one-hour CBE retraining session. They were subsequently evaluated on technical competence and the ability to detect masses in an opaque silicone breast model. These skills were reassessed one month later. RESULTS The students who underwent the teaching session performed significantly better than the control group in both the early (scores 1.23 vs 2.67, p < 0.05) and the late (scores 0.15 vs 2.14, p < 0.05) testing sessions. CONCLUSIONS These data suggest significant improvement in CBE in students receiving formalized instruction. Further evaluation is needed prior to incorporation of this technique into the surgery core curriculum.

296. Effective Suppression of Breast Cancer by Downregulation of VEGF Signaling

Blocking tumor angiogenesis may be an effective approach to suppress tumor metastasis. Vascular endothelial growth factor (VEGF) plays a pivotal role in tumor angiogenesis. The degree of tumor malignancy correlates with the expression of VEGF and the inverse expression of tumor suppressor gene p16. To examine whether p16 decreases VEGF gene expression and inhibits tumor angiogenesis and metastasis in breast cancer cells, human breast cancer cell line MDA-MB-231, MCF-7 and mouse breast cancer cell line JygMC(A) were used as models for studies. To facilitate induction of p16 expression, a replication-defective recombinant adenovirus expressing human wild-type p16 (AdRSVp16) has been generated. Our study showed that adenoviral-mediated p16 expression downregulated VEGF expression and VEGF receptor activation in breast cancer cells. AdRSVp16 inhibited in vitro cell growth of MDA-MB-231, MCF-7 and JygMC(A) at 50.4%, 58.3% and 38.5%, respectively, attenuated in vivo angiogenesis induced by MDA-MB-231 cells in Matrigel plug assay and in a dorsal air sac model, and had a 53% reduction of metastases of JygMC(A) in nude mice after subcutaneous injection when compared to control group. In addition, the effects of p16 on expression of proliferation marker PCNA, neovascularization marker CD31 and apoptosis inside the tumors were also analyzed. These results demonstrate that p16 downregulates VEGF gene expression, inhibits angiogenesis, and suppresses tumor growth and metastasis in breast cancer cells. This study suggests that viral vector-based p16 gene therapy may have clinical potentials to suppress breast cancer growth and metastasis.

Physicians‐in‐Training Recommendations for Prophylactic Bilateral Mastectomies

Abstract:  The decision to recommend bilateral prophylactic mastectomy (PBM), one treatment modality used to reduce the development of breast carcinoma, may be influenced by physician bias. This investigation tested the hypothesis that there are physician‐in‐training biases in recommendations of PBM. All second‐year medical students, general surgical residents, and internal medicine residents at our institution participated in a survey in which they were asked at what percent risk of developing breast carcinoma the physicians‐in‐training would recommend PBM for 1) their patients, 2) themselves, and 3) their significant others, as applicable. A total of 198 physicians‐in‐training responded. Univariate analysis demonstrated an association between both the type of physician‐in‐training (p < 0.03) and gender (p < 0.004) with the percent risk for which respondents would recommend PBM. However, with multivariate analysis, only gender was associated with percent risk (p < 0.05). Physicians‐in‐training also chose PBM at a lower risk for their significant others than for themselves (67.5% versus 57.2%; p < 0.02). Respondents also chose PBM at a similar risk for themselves or significant others as for their patients (r = 0.83, r = 0.98; p < 0.001). This investigation suggests that males (compared to females) are more likely to recommend PBM for the prevention of breast cancer.