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PURPOSE: The resident as teaching assistant (TA) in the operating room is an important role in the maturation of surgical trainees. One concern in the current 80-hour workweek era is that current senior residents (SRs) are unprepared to serve as TAs, potentially leading to higher complication rates and a significant increase in the length of operations. The aim of this study was to analyze whether SRs serving as TAs during laparoscopic cholecystectomy (LC) resulted in an adverse effect on complication rates in the 80-hour workweek era. METHODS: A retrospective review was conducted of 1668 LC performed at 2 affiliated general surgery teaching hospitals from 2003 through 2007. Teaching hospital A was a public teaching hospital where junior residents (JR) performed the LC with a scrubbed SR as TA under faculty supervision. Teaching hospital B was a community-based affiliate hospital where the JR performed LC with only scrubbed faculty supervision. Operative case duration, JR level, patient gender/age, operative indication, final pathology, and complication data were gathered and univariate and multivariate analyses were performed. RESULTS: Despite a higher rate of acute cholecystitis in the TA hospital, LC-associated complications occurred at similar rates with and without SR as TA. The rate of biliary injury was also the same in both hospitals. On multivariable analysis, only male gender was associated with complications (odds ratio = 1.7; p = 0.004). CONCLUSIONS: In the 80-hour resident workweek era, SRs acting as TAs during LC is not associated with increased total complications or an increased rate of biliary injury.

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Ligand-targeted liposomes have the potential to increase the therapeutic efficacy of antineoplastic agents. Recently, a combinatorial approach to the preparation of ligand-targeted liposomes has been developed, termed the post-insertion technique, which will facilitate the production of targeted liposomes. In this paper, Stealth immunoliposomes (SIL) coupled to anti-CD19 made by either a conventional coupling technique (SIL[anti-CD19]), or by the post-insertion technique (PIL[anti-CD19], were compared with respect to their in vitro binding and cytotoxicity and their ability to improve in vivo survival in tumor-bearing mice. The in vitro binding and uptake of PIL[anti-CD19] by CD19-expressing, B-cell lymphoma (Namalwa) cells was similar to that of SIL[anti-CD19] and both were significantly higher than binding of non-targeted liposomes (SL). In addition, no significant differences were found between the respective in vitro cytotoxicities of doxorubicin-loaded PIL[anti-CD19] or SIL[anti-CD19], or in their in vivo therapeutic efficacy in a murine model of human B-lymphoma. Overall, the results demonstrate that the post-insertion technique is a simple, flexible and effective means for preparing targeted liposomal drugs for clinical applications.

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We have developed a method for producing sterically stabilized immunoliposomal drugs (SIL) readily applicable to a 'mix and match' combinatorial approach for the simple manufacture of a variety of ligand-targeted liposomal drugs. Ligands coupled to the terminus of polyethylene glycol (PEG) in micelles formed from PEG-lipid derivatives (mPEG2000-DSPE) could be transferred into preformed, drug-containing liposomes from the micelles in a temperature- and time-dependent manner. Antibody densities up to 100 microg antibody/micromol of phospholipid, and up to 3 mol% of mPEG2000-DSPE, could be simultaneously transferred from the ligand-coupled micelles into the liposomal outer monolayer with negligible drug leakage from liposomes during transfer and good stability in human plasma. Transfer of anti-CD19 into SIL resulted in a three-fold increase in binding of these liposomes to CD19+ human B cell lymphoma cells.

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There has been very little research exploring the relationships among perceptions of, and concern about, getting breast cancer and interest in genetic testing for breast cancer among African-American women with and without a family history of breast cancer. This study explored these issues among 130 and 136 African-American women with and without a family history of breast cancer, respectively. Women with a family history reported having greater perceived breast cancer risks and concerns than women without a family history of breast cancer. Knowledge of breast cancer risk factors was very poor and correlated weakly with perceptions of risk and concern. In attributional analyses, acknowledging one's family history status was the strongest predictor of perceived risk only among women with a family history. Women with a family history of breast cancer expressed greater interest in genetic testing for breast cancer susceptibility than women without a family history, although interest in testing was high overall. Increasing perceptions of breast cancer risks and concerns were related to a greater interest in genetic testing, and this relationship was not moderated by family history status. Attributions of risk and knowledge of breast cancer risk factors generally were not related to interest in testing. Overall, these results suggest that: (a) African-American women with a family history are more concerned about and do recognize their greater risk of breast cancer; (b) knowledge of risk factors and attributions of risk are not directly related to interest in genetic testing; and (c) concerns, rather than beliefs about one's risk, are more powerfully related to interest in genetic testing, independent of family history status.

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A patient with papulonecrotic tuberculid had a pruritic papular eruption associated with constitutional symptoms. The eruption flared whenever the patient received low doses of prednisone to control symptoms of temporal arteritis. A cervical lymph node biopsy specimen demonstrated acid-fast bacilli, and Mycobacterium bovis grew on the cultures. The eruption cleared completely with antituberculous therapy. This case demonstrated the clinicopathologic findings compatible with a diagnosis of papulonecrotic tuberculid. Skepticism regarding the existence of papulonecrotic tuberculid is probably a result of the current decreased prevalence of untreated tuberculosis, and the subsequently increased rarity of this entity.

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Over 700 patients were screened by patch testing for sensitivity to the components of a vehicle tray from July 1974 through June 1976 at the Mayo Clinic. A modified version of the vehicle tray originally suggested by Fisher et al. (1971) was used, containing 14 substances commonly found in vehicles. Patches were applied for 24 rather than the usual 48 hours. Our percentage of reactivity compares favorably with the 48-h application method, thus demonstrating the efficacy of this time-saving technique. The method and usefulness of determining a percentage of irritancy are discussed. This was found to be a valuable tool in assessing false-positive reactions among our percentage of reactivity. Four irritants were demonstrated: phenylmercuric acetate (0.05% pet.), sodium lauryl sulfate (1% aq), thimerosal (0.1% aq) and hexachlorophene (1% pet.).

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