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In patients with an advanced disease or a terminal illness, it may become necessary to institute parenteral opioid therapy either on a temporary basis (for acute breakthrough pain) or permanently. Continuous intravenous or subcutaneous opioid infusions have been the mainstay of parenteral opioid therapy for oncologic pain. Patient-controlled analgesia (PCA) now offers an alternative modality, and Drs. Bruera and Ripamonti review the current status of this relatively new technique. Is there any evidence to suggest the superiority of one modality over the other for the treatment of oncologic pain?

The Van Nuys Prognostic Index (VNPI) is, in many ways, the best current approach for classifying patients with ductal carcinoma in situ (DCIS) according to their risk of local recurrence after breast-conserving therapy. However, this index has very important limitations.

Apoptosis is a mode of cell death that is currently of intense research interest in developmental and cancer biology. For more than 40 years, radiobiologists have been aware of cells in irradiated specimens that display the

Patient-controlled analgesia (PCA) is a relatively new technique in which patients are able to self-administer small doses of opioid analgesics when needed. Many different devices are available for opioid infusion, including

BETHESDA, Md--A federal advisory committee has recommended continuing the use of AZT (zidovudine) in HIV-infected pregnant women to prevent them from passing the virus on to their newborns. The group also urged the US Public Health Service to thoroughly reassess its guidelines for the use of AZT in pregnant women.

ROYAL OAK, Mich-Interstitial implants that deliver radiation therapy to the tumor bed alone after lumpectomy have been well tolerated with no significant acute or late toxicity in the first 50 patients in a Michigan study. In addition, with three years' median follow-up, no patients have recurred locally or distantly.

A major gene essential for controlling the synthesis of hereditary material and cell proliferation is also critically involved in determining the extent of malignant growth of cancer cells, reports a study published in a recent issue of the Proceedings of

Steven T. Rosen, MD, FACP, director of the Robert H. Lurie Cancer Center of Northwestern University, announced that the Center has been awarded a 4-year competitive renewal of its Cancer Center Support Grant (CCSG) from the National

For years, doctors have looked at tissue biopsies and spotted unusual cells that seem to have early signs of cancer. The problem is that, until recently, doctors have never had the right tools to extract the cells from the tissue, leaving them with no

WASHINGTON--A new survey of pharmaceutical and biotechnology companies by the Pharmaceutical Research and Manufacturers of America (PhRMA) has identified 122 drugs and vaccines in testing to prevent HIV infection or to treat AIDS and AIDS-related diseases. These drugs are in addition to the 42 medications already approved and on the market in the United States.

PITTSBURGH-Although not designed specifically to answer the question, NSABP B-15 and B-16 provide no evidence that delay in radiation therapy, to allow administration of adjuvant chemotherapy, increases the risk of ipsilateral breast cancer recurrence in node-positive patients undergoing breast-conserving surgery. E.P. Mamounas, MD, presented the updated results of these two trials at a general session of the San Antonio meeting. Dr. Mamounas is with the NSABP at the University of Pittsburgh, and is also medical director of the Mount Sinai Center for Breast Health, Beachwood, Ohio.

WASHINGTON--President Clin-ton calls his new national AIDS strategy an important milestone in the history of efforts to end the pandemic that has killed more than 343,000 Americans since 1981. "In the 15 years of this epidemic, we have never had such a unified strategy," the President said. "These goals will guide our work in the coming term and, more specifically, in the coming year."

CHICAGO--A percutaneous breast biopsy method that uses a thin rotating blade to snip off tissue and a vacuum element to withdraw pathological samples is proving to be three times more accurate and two times faster than core needle biopsy, said Roger J. Jackman, MD, of the Department of Diagnostic Radiology, Palo Alto Medical Clinic, Calif, at the annual meeting of the Radiological Society of North America (RSNA).

CHICAGO--Although ultrasound has been the primary imaging technique used in the assessment of the prostate gland for potential malignancy, it has been secondary to PSA assays and the digital rectal examination as a screening technique because "the cost-benefit ratio is too low to warrant its use," Matthew D. Rifkin, MD, said at the annual meeting of the Radiological Society of North America. New technological refinements of sonographic equipment, however, may allow a bigger role for ultrasound in prostate cancer in the future, said Dr. Rifkin, chair of the Department of Radiology, Albany Medical College, NY.

WASHINGTON--Managed care seems a topic certain to generate bipartisan attention during the 105th Congress, with several bills already introduced and others on the way.

BETHESDA, Md--The NIH Consensus Development Conference was unanimous in its decision not to recommend routine screening mammography for women aged 40 to 49, saying that the evidence to date does not show that any possible benefits outweigh potential risks.

Raising the normal retirement age in the United States to age 70 could save the federal government billions of dollars each year and help shore up the ailing Social Security trust fund over the long term, according to two university researchers.

Scientists are discovering the proteins that control the way human DNA copies itself, a breakthrough that may lead to new treatments for cancer or heart disease.

RARITAN, NJ--Procrit (Epoetin alfa) has received marketing clearance by the FDA for use in reducing the need for allogeneic blood transfusions in anemic patients scheduled to undergo elective noncardiac, nonvascular surgery. Patients should be at high risk for perioperative transfusion with significant, anticipated blood loss. Procrit is not indicated for anemic patients who are willing to donate autologous blood.

Recombinant human interleukin-11 (IL-11 [Neumega]) stimulates platelet production and inhibits inflammation in clinical studies in cancer patients, according to research presented at a symposium held last summer in New York City. The potential

CHICAGO--According to the clinical literature, men with a prostate-specific antigen density (PSAD) level less than 0.15 ng/mL do not need ultrasound-guided biopsy because the PSAD is considered normal or reflects only a benign process.

CHICAGO--Positron emission tomography (PET) has excellent potential as a screening test for spotting axillary lymph node metastases in women with newly diagnosed, early-stage breast cancer, thereby sparing many women from unnecessary lymph node dissection, Lee Adler, MD, of Case Western Reserve University, said at the Radiological Society of North America meeting.

TOLEDO, Ohio-Researchers at the Medical College of Ohio have treated a series of breast-conservation patients with intraoperative electron beam radiation to the tumor bed, in conjunction with a course of 45 to 50 Gy of external beam radiation.

WASHINGTON--State legislators from nine states announced they will introduce the Managed Care Consumer Protection Act when their respective legislatures convene this year. Legislators in others states may also introduce the "model" bill, drafted by a bipartisan group of state legislators. The drafting panel said it sought to avoid piecemeal attempts to resolve conflicts between consumers and managed care plans by drafting a comprehensive, uniform bill.

In November 1992, residents of Massachusetts approved a ballot petition (Question 1) that increased the tax on each pack of cigarettes from 26¢ to 51¢ beginning January 1, 1993, and requested that the legislature spend the proceeds on tobacco

BETHESDA, Md--In a move designed to increase the pool of patients available for clinical trials, the National Cancer Institute has forged an agreement with the Department of Veterans Affairs that will increase the ability of veterans to enroll in phase I, II, and III studies.

DALLAS--Breast implant excision or exchange offers a unique cancer screening opportunity in breasts frequently difficult to check manually or radiologically, William Shaw, MD, said at the American Society of Plastic and Reconstructive Surgeons annual meeting.

The familial aggregation of cancer has piqued the curiosity of physicians for more than two millennia. Most explanations for this aggregation were based upon environmental hypotheses, such as diet, solar radiation, habit patterns, and cultural practices, as well as occupational exposures. On rare occasions, ancients and now, more frequently, contemporaries have suggested that genetics might provide an important causal explanation for familial cancer.

Physicians can expect to see more requests for medical records by companies offering viatical settlements to terminally ill or chronically ill patients who meet certain criteria as certified by their physicians. The viatical industry, which has been marketing its services primarily to AIDS patients through gay publications and networks, is maturing as a result of new federal legislation granting tax-free status to the proceeds and as viatical companies expand their marketing efforts to the population at large.

SAN ANTONIO--Bisphosphon-ates are indicated in patients with established bone metastases from breast cancer or myeloma, to reduce skeletal complications, Alexander H.G. Paterson, MD, said at a minisymposium held in conjunction with the San Antonio Breast Cancer Symposium.