ObjectiveTo evaluate surgical treatment delay disparities by race/ethnic group in a group of breast cancer patients treated in the New York region.DesignCohort study.SettingTwo affiliated hospitals in the New York region.ParticipantsPatients admitted at two affiliated hospitals in the New York region for breast cancer treatment during 2007–2011.Main outcome measureTime to receiving first surgery for breast cancer, defined as the time in days between initial diagnosis (biopsy) and definitive surgical treatment (lumpectomy or mastectomy). Predicted time to first surgery by race group was also analysed using a multivariate linear regression model with adjustments made for several demographic and clinical factors.ResultsTotally, 3071 patients who were first treated with surgery were identified. Racial background was classified as White, African American or Asian/other. Overall median time to surgery was 28 days: 28 days in whites, and 34 and 29 days in African Americans and Asian/others, respectively (p = 0.032). Multivariate analyses showed that only African Americans, not Asian/others, had significantly increased surgical delay compared to whites (p = 0.019).ConclusionsThis study demonstrates significant racial differences in surgical delay in a group of breast cancer patients treated in the New York region. These differences may reflect tacit attitudes of medical providers or processes insensitive to patient educational needs. Additional studies may improve our understanding of this delay.
Aortic laceration during laparoscopic procedures is a rare but well-known complication with a high mortality rate. Thus far, few cases which were recognized and treated successfully have been reported in the literature; the exact incidence is not known. Such a complication occurred after an elective laparoscopic sterilization in a 35-year-old woman. The situation was recognized early and successfully treated. The common complications of laparoscopy are usually of a minor nature but a few are life threatening. This case illustrates the need for emphasis on the prevention of complications and the appropriate course of action in the event of their occurrence.
Creatine kinase (CK, EC 2.7.3.2) activity in the serum of a patient with metastatic carcinoma migrated as two distinct bands cathodal to the origin and to CK-3 on agarose gel electrophoresis. The more cathodal isoenzyme (CKm-2) is of high molecular mass, is precipitated by ammonium sulfate at 30% of saturation, and is not retarded by Sephadex G-100. Treatment with urea at a concentration of 6 mol/L caused CKm-2 to elute with proteins of lower molecular mass on a G-100 column and shifted the electrophoretic migration to a position just cathodal to the origin (CKm-1). Antibody to CK-1 and CK-2 did not affect the activity of either CKm-1 or CKm-2. Similarities between these cathodal bands of CK activity and mitochondrial CK suggest the mitochondrial origin of these isoenzymes. These cathodal CK isoenzymes reacted unpredictably with different commercial reagent systems for determination of CK activity in serum or in agarose gel.
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