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An abstract of the study "Arrhythmogenicity of Chronic Dobutamine Infusions in End Stage Congestive Heart Failure Patients Receiving Oral Amiodaron," by E. Tsagalou and colleagues is presented.

Mass spectrometric characterization of the surfactant protein A (SP-A) receptor 210 (SP-R210) led to the identification of myosin (Myo) XVIIIA and nonmuscle myosin IIA. Antibodies generated against the unique C-terminal tail of MyoXVIIIA revealed that MyoXVIIIA, MyoIIA, and SP-R210 have overlapping tissue distribution, all being highly expressed in myeloid cells, bone marrow, spleen, lymph nodes, and lung. Western blot analysis of COS-1 cells stably transfected with either MyoXVIIIA or MyoIIA indicated that SP-R210 antibodies recognize MyoXVIIIA. Furthermore, MyoXVIIIA but not MyoIIA localized to the surface of COS-1 cells, and most importantly, expression of MyoXVIIIA in COS-1 cells conferred SP-A binding. Western analysis of recombinant MyoXVIIIA domains expressed in bacteria mapped the epitopes of previously derived SP-R210 antibodies to the neck region of MyoXVIIIA. Antibodies raised against the neck domain of MyoXVIIIA blocked the binding of SP-A to macrophages. Together, these findings indicate that MyoXVIIIA constitutes a novel receptor for SP-A. [ABSTRACT FROM AUTHOR]

Prolonged labor can lead to infection, fetal distress, asphyxia, and life-threatening harm to both the mother and the baby. Surfactant protein A (SP-A) was shown to contribute to the maintenance of pregnancy and timing of term labor. SP-A modulates the stoichiometric expression of the SP-R210 L and SP-R210 S isoforms of the SP-R210 receptor on alveolar macrophages (AMs). Lack of SP-R210 L dysregulates macrophage inflammatory responses. We asked whether SP-A alters normal and inflammation-induced parturition through SP-R210 using SP-A- and SP-R210 L -deficient mice. Labor and delivery of time-pregnant mice were monitored in real time using a time-lapse infrared camera. Intrauterine injection with either vehicle or Escherichia coli lipopolysaccharide (LPS) on embryonic (E) day 18.5 post coitus was used to assess the effect of gene disruption in chorioamnionitis-induced labor. We report that either lack of SP-A or disruption of SP-R210 L delays parturition by 0.40 and 0.55 days compared with controls, respectively. LPS induced labor at 0.60, 1.01, 0.40, 1.00, and 1.31 days earlier than PBS controls in wild type (WT), SP-A-deficient, littermate controls, heterozygous, and homozygous SP-R210 L -deficient mice, respectively. Lack of SP-A reduced litter size in PBS-treated mice, whereas the total number of pups delivered was similar in all LPS-treated mice. The number of live pups, however, was significantly reduced by 50%-70% in SP-A and SP-R210 L -deficient mice compared with controls. Differences in gestational length were not associated with intrauterine growth restriction. The present findings support the novel concept that the SP-A/SP-R210 pathway modulates timely labor and delivery and supports fetal lung barrier integrity during fetal-to-neonatal transition in term pregnancy. NEW & NOTEWORTHY To our knowledge, this study is the first to report that SP-A prevents delay of labor and inflammation-induced stillbirth through the receptor SP-R210 L .

Aim: Procalcitonin (PCT) is variably used in clinical practice to identify infectious processes. This study investigated whether PCT level in pleural fluids could predict the infectious complications in the chests of patients undergoing lobectomy., Patients and Methods: Thirty-four patients undergoing lobectomy for lung cancer were enrolled. PCT levels were measured in serum (S-PCT) and pleural effusion (PF-PCT) on consecutive postoperative days (PODs). The patients were grouped according to the development of chest infectious complications (atelectasis/pneumonia, postoperative infected pleural effusion/empyema/infected space, prolonged air leak >5 days with evidence of infection, lung torsion, and lung infarction). Multivariate analysis was performed to identify if S-PCT or PF-PCT and on which PODs were predictive of chest infectious complications. Receiver operating characteristic (ROC) analysis was further performed to identify cutoff values., Results: Eleven patients experienced infectious complications within a median of 4 days (range 3-5 days) postoperatively. S-PCT and PF-PCT in non-complicated patients did not significantly increase postoperatively and followed a decreasing course. Only PF-PCT was significantly increased in complicated patients from POD1; the level peaked on POD4, as did that of S-PCT. PF-PCT on POD2 and 3 and S-PCT on POD3 independently predicted chest infectious complications. ROC analysis showed that PF-PCT > 0.88 ng/dL on POD2 was the most sensitive predictor of such complications (area under the ROC curve [AUC]: 0.979, sensitivity 85%/specificity 91%, p  < .001) compared to S-PCT POD3 and PF-PCT POD3., Conclusion: Compared to PCT concentrations in serum, those in pleural fluids were more sensitive and predicted chest infectious complications earlier in patients undergoing lobectomy.

Persistent high levels of proinflammatory and Th1 responses contribute to cerebral malaria (CM). Suppression of inflammatory responses and promotion of Th2 responses prevent pathogenesis. IL-4 commonly promotes Th2 responses and inhibits inflammatory and Th1 responses. Therefore, IL-4 is widely considered as a beneficial cytokine via its Th2-promoting role that is predicted to provide protection against severe malaria by inhibiting inflammatory responses. However, IL-4 may also induce inflammatory responses, as the result of IL-4 action depends on the timing and levels of its production and the tissue environment in which it is produced. Recently, we showed that dendritic cells (DCs) produce IL-4 early during malaria infection in response to a parasite protein and that this IL-4 response may contribute to severe malaria. However, the mechanism by which IL-4 produced by DCs contributing to lethal malaria is unknown. Using Plasmodium berghei ANKA-infected C57BL/6 mice, a CM model, we show here that mice lacking IL-4Rα only in CD8α + DCs are protected against CM pathogenesis and survive, whereas WT mice develop CM and die. Compared with WT mice, mice lacking IL-4Rα in CD11c + or CD8α + DCs showed reduced inflammatory responses leading to decreased Th1 and cytotoxic CD8 + T cell responses, lower infiltration of CD8 + T cells to the brain, and negligible brain pathology. The novel results presented here reveal a paradoxical role of IL-4Rα signaling in CM pathogenesis that promotes CD8α + DC-mediated inflammatory responses that generate damaging Th1 and cytotoxic CD8 + T cell responses., Competing Interests: Conflict of interest The authors declare that they have no conflicts of interest with the contents of this article., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim of study: We aimed to investigate whether the difference in pleural pressures (Δ P ) is wider among patients who develop a residual pneumothorax after chest tube removal following lung resection surgery. Materials and methods: Ninety-eight patients who underwent lung resection were included in the study over a period of 12 months. The Δ P prior to chest tube removal in patients who developed a residual pneumothorax after chest tube removal was compared with that of patients who did not develop this complication. The receiver operating characteristic (ROC) curve analysis was performed to identify cutoff values of Δ P for the prediction of residual pneumothorax. Logistic regression analysis was used to formulate a prediction model for the occurrence of residual pneumothorax based on Δ P . Results: Thirteen patients who developed a residual pneumothorax were compared with 85 patients without this complication. The Δ P in the residual pneumothorax group was significantly higher (10.8 versus 4.2 cm H 2 O, p  < 0.01). The Δ P in patients who required intervention was also significantly higher (14.8 versus 4.2 cm H 2 O, p  < 0.01). A Δ P cutoff value of 8 cm H 2 O was predictive of the occurrence of residual pneumothorax (sensitivity 85.6%, specificity 84.6%) and a value of 12 cm H 2 O was predictive of intervention (sensitivity 84%, specificity 85%). Increasing Δ P was an independent predictor of the occurrence of residual pneumothorax ( p  = 0.008) on the multivariate logistic regression model. Conclusion: Patients with wide Δ P before chest drain removal may be complicated with residual pneumothorax.

Inhaled granulocyte/macrophage colony-stimulating factor (GM-CSF) shows promise as a therapeutic to treat viral and bacterial pneumonia, but no mouse model of inhaled GM-CSF has been described. We sought to 1 ) develop a mouse model of aerosolized recombinant mouse GM-CSF administration and 2 ) investigate the protection conferred by inhaled GM-CSF during influenza A virus (IAV) infection against secondary bacterial infection with pneumococcus. To assess lower respiratory tract delivery of aerosolized therapeutics, mice were exposed to aerosolized fluorescein (FITC)-labeled dextran noninvasively via an aerosolization tower or invasively using a rodent ventilator. The efficiency of delivery to the lower respiratory tracts of mice was 0.01% noninvasively compared with 0.3% invasively. The airway pharmacokinetics of inhaled GM-CSF fit a two-compartment model with a terminal phase half-life of 1.3 h. To test if lower respiratory tract levels were sufficient for biological effect, mice were infected intranasally with IAV, treated with aerosolized recombinant mouse GM-CSF, and then secondarily infected with Streptococcus pneumoniae . Inhaled GM-CSF conferred a significant survival benefit to mice against secondary challenge with S. pneumoniae ( P < 0.05). Inhaled GM-CSF did not reduce airway or lung parenchymal bacterial growth but significantly reduced the incidence of S. pneumoniae bacteremia ( P < 0.01). However, GM-CSF overexpression during influenza virus infection did not affect lung epithelial permeability to FITC-dextran ingress into the bloodstream. Therefore, the mechanism of protection conferred by inhaled GM-CSF appears to be locally mediated improved lung antibacterial resistance to systemic bacteremia during IAV infection.

Inflammatory lung diseases affect men and women disproportionately, suggesting that fluctuations of circulating hormone levels mediate inflammatory responses. Studies have shown that ozone exposure contributes to lung injury and impairment of innate immunity with differential effects in men and women. Here, we hypothesized that 17β-estradiol enhances inflammation and airway hyperresponsiveness (AHR), triggered by ozone exposure, in the female lung. We performed gonadectomy and hormone treatment (17β-estradiol, 2 wk) in C57BL/6J female and male mice and exposed animals to 1 ppm of ozone or filtered air for 3 h. Twenty-four hours later, we tested lung function, inflammatory gene expression, and changes in bronchoalveolar lavage fluid (BALF). We found increased AHR and expression of inflammatory genes after ozone exposure. These changes were higher in females and were affected by gonadectomy and 17β-estradiol treatment in a sex-specific manner. Gonadectomized male mice displayed higher AHR and inflammatory gene expression than controls exposed to ozone; 17β-estradiol treatment did not affect this response. In females, ovariectomy reduced ozone-induced AHR, which was restored by 17β-estradiol treatment. Ozone exposure also increased BALF lipocalin-2, which was reduced in both male and female gonadectomized mice. Treatment with 17β-estradiol increased lipocalin-2 levels in females but lowered them in males. Gonadectomy also reduced ozone-induced expression of lung IL-6 and macrophage inflammatory protein-3 in females, which was restored by treatment with 17β-estradiol. Together, these results indicate that 17β-estradiol increases ozone-induced inflammation and AHR in females but not in males. Future studies examining diseases associated with air pollution exposure should consider the patient's sex and hormonal status.

The type 2 immune response controls helminth infection and maintains tissue homeostasis but can lead to allergy and fibrosis if not adequately regulated. We have discovered local tissue-specific amplifiers of type 2-mediated macrophage activation. In the lung, surfactant protein A (SP-A) enhanced interleukin-4 (IL-4)-dependent macrophage proliferation and activation, accelerating parasite clearance and reducing pulmonary injury after infection with a lung-migrating helminth. In the peritoneal cavity and liver, C1q enhancement of type 2 macrophage activation was required for liver repair after bacterial infection, but resulted in fibrosis after peritoneal dialysis. IL-4 drives production of these structurally related defense collagens, SP-A and C1q, and the expression of their receptor, myosin 18A. These findings reveal the existence within different tissues of an amplification system needed for local type 2 responses., (Copyright © 2017, American Association for the Advancement of Science.)

The post-pneumonectomy syndrome is a rare complication consisting of rotation and herniation of the mediastinal structures, the remaining lung and the respective bronchi, into the contralateral hemithorax. This situation may produce symptomatic airway obstruction and varies in its presentation and severity. We describe one case of right and one of left pneumonectomy syndrome as well as one case of post-lobectomy syndrome. We review the literature on the pathophysiology, the clinical, radiological and bronchoscopic characteristics of this rare entity and discuss all available therapeutic alternatives.

Brucellosis is a zoonotic infection primarily affecting the reticuoendothelial system: spleen, liver and bone marrow. Despite the fact that multisystem infection in brucellosis is usually reported, pulmonary involvement is considered to be very rare. We report four cases (three male and one female, farm workers) of pulmonary brucellosis who presented with signs and symptoms of lower respiratory infection. All of them underwent thorough clinical examination and laboratory tests before the diagnosis of pulmonary brucellosis was confirmed. All patients were hospitalized for at least eight days and given appropriate antibiotic therapy. Follow up after 12-24 months showed no lasting effects from the infection and laboratory tests were found within the normal limits.

Large multinodular goiters, obvious to the naked eye, are rarely confronted by clinicians nowadays; yet they do have a place in the differential diagnosis of the neck masses. Due to the fact that 80% of the neck masses in adults are related to malignancy, the later should be ruled out.

Sex differences in the incidence of respiratory diseases have been reported. Women are more susceptible to inflammatory lung disease induced by air pollution and show worse adverse pulmonary health outcomes than men. However, the mechanisms underlying these differences remain unknown. In the present study, we hypothesized that sex differences in the expression of lung inflammatory mediators affect sex-specific immune responses to environmental toxicants. We focused on the effects of ground-level ozone, a major air pollutant, in the expression and regulation of lung immunity genes. We exposed adult male and female mice to 2 ppm of ozone or filtered air (control) for 3 h. We compared mRNA levels of 84 inflammatory genes in lungs harvested 4 h postexposure using a PCR array. We also evaluated changes in lung histology and bronchoalveolar lavage fluid cell counts and protein content at 24 and 72 h postexposure. Our results revealed sex differences in lung inflammation triggered by ozone exposure and in the expression of genes involved in acute phase and inflammatory responses. Major sex differences were found in the expression of neutrophil-attracting chemokines (Ccl20, Cxcl5, and Cxcl2), the proinflammatory cytokine interleukin-6, and oxidative stress-related enzymes (Ptgs2, Nos2). In addition, the phosphorylation of STAT3, known to mediate IL-6-related immune responses, was significantly higher in ozone-exposed mice. Together, our observations suggest that a differential regulation of the lung immune response could be implicated in the observed increased susceptibility to adverse health effects from ozone observed in women vs. men., (Copyright © 2015 the American Physiological Society.)

Mycoplasmosis is a frequent causative microbial agent of community-acquired pneumonia and has been linked to exacerbation of chronic obstructive pulmonary disease. The macrophage class A scavenger receptor (SRA) facilitates the clearance of noxious particles, oxidants, and infectious organisms by alveolar macrophages. We examined wildtype and SRA(-/-) mice, housed in either individually ventilated or static filter-top cages that were cycled with fresh bedding every 14 d, as a model of gene-environment interaction on the outcome of pulmonary Mycoplasma pulmonis infection. Intracage NH3 gas measurements were recorded daily prior to infection. Mice were intranasally infected with 1 × 10(7) cfu M. pulmonis UAB CT and evaluated at 3, 7, and 14 d after inoculation. Wildtype mice cleared 99.5% of pulmonary M. pulmonis by 3 d after infection but remained chronically infected through the study. SRA (-/-) mice were chronically infected with 40-fold higher mycoplasma numbers than were wildtype mice. M. pulmonis caused a chronic mixed inflammatory response that was accompanied with high levels of IL1β, KC, MCP1, and TNFα in SRA(-/-) mice, whereas pulmonary inflammation in WT mice was represented by a monocytosis with elevation of IL1β. Housing had a prominent influence on the severity and persistence of mycoplasmosis in SRA(-/-) mice. SRA(-/-) mice housed in static cages had an improved recovery and significant changes in surfactant proteins SPA and SPD compared with baseline levels. These results indicate that SRA is required to prevent chronic mycoplasma infection of the lung. Furthermore, environmental conditions may exacerbate chronic inflammation in M. pulmonis-infected SRA(-/-) mice.

Objectives: The pleural membrane of the lower pleural cavity has a greater ability to recycle fluid than the pleural membrane of the upper pleural cavity. During lobectomy, the visceral pleura is removed with the lobe, whereas the parietal pleura is traumatized during manipulation. This study investigates variations of the drainage according to the type of lobectomy and its relation to effusion-related complications., Methods: Data of upper and lower lobectomy patients were compared with those of wedge resection patients. All patients were suctioned until totally dry before closure, and one chest tube was left in the hemithorax. The amount of fluid drained per day, the duration of drainage, the length of hospital stay and the morbidity were noted. Student's paired t-test and Mann-Whitney U-test were used for comparison; P < 0.05 was defined as statistically significant., Results: Patients after lower lobectomy had more fluid drained when compared with patients after upper lobectomy or wedge resection on the first (636 ± 90, 268 ± 75 and 225 ± 62 ml, respectively; P = 0.002) and second postoperative day (464 ± 94, 237 ± 90 and 220 ± 62 ml, respectively; P = 0.046). The drainage tube was removed earlier in patients with upper lobectomy procedures than in patients with lower lobectomy procedures (4.6 ± 0.9 vs 8.1 ± 1.4 days; P = 0.014). Effusion-related complications developed in lower lobectomies with a higher output from the second postoperative day., Conclusions: A larger amount of fluid is drained after removal of the lower lobes, possibly because the important fluid-recycling ability of the lower parts of the cavity is malfunctioning. Early drainage tube removal after lower lobectomy may be reconsidered when taking into account the possibility of effusion-related complications.

Alveolar type II epithelial or other pulmonary cells secrete GM-CSF that regulates surfactant catabolism and mucosal host defense through its capacity to modulate the maturation and activation of alveolar macrophages. GM-CSF enhances expression of scavenger receptors MARCO and SR-A. The alveolar macrophage SP-R210 receptor binds the surfactant collectin SP-A mediating clearance of respiratory pathogens. The current study determined the effects of epithelial-derived GM-CSF in host resistance to influenza A pneumonia. The results demonstrate that GM-CSF enhanced resistance to infection with 1.9×10(4) ffc of the mouse-adapted influenza A/Puerto Rico/8/34 (PR8) H1N1 strain, as indicated by significant differences in mortality and mean survival of GM-CSF-deficient (GM(-/-)) mice compared to GM(-/-) mice in which GM-CSF is expressed at increased levels. Protective effects of GM-CSF were observed both in mice with constitutive and inducible GM-CSF expression under the control of the pulmonary-specific SFTPC or SCGB1A1 promoters, respectively. Mice that continuously secrete high levels of GM-CSF developed desquamative interstitial pneumonia that impaired long-term recovery from influenza. Conditional expression of optimal GM-CSF levels at the time of infection, however, resulted in alveolar macrophage proliferation and focal lymphocytic inflammation of distal airways. GM-CSF enhanced alveolar macrophage activity as indicated by increased expression of SP-R210 and CD11c. Infection of mice lacking the GM-CSF-regulated SR-A and MARCO receptors revealed that MARCO decreases resistance to influenza in association with increased levels of SP-R210 in MARCO(-/-) alveolar macrophages. In conclusion, GM-CSF enhances early host resistance to influenza. Targeting of MARCO may reinforce GM-CSF-mediated host defense against pathogenic influenza., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Rationale: Alveolar macrophages contribute to host defenses against influenza in animal models. Enhancing alveolar macrophage function may contribute to protection against influenza., Objectives: To determine if increased expression of granulocyte/macrophage colony-stimulating factor (GM-CSF) in the lung increases resistance to influenza., Methods: Wild-type mice and transgenic mice that expressed GM-CSF in the lung were infected with influenza virus, and lung pathology, weight loss, and mortality were measured. We also administered GM-CSF to the lungs of wild-type mice that were infected with influenza virus., Measurements and Main Results: Wild-type mice all died after infection with different strains of influenza virus, but all transgenic mice expressing GM-CSF in the lungs survived. The latter also had greatly reduced weight loss and lung injury, and showed histologic evidence of a rapid host inflammatory response that controlled infection. The resistance of transgenic mice to influenza was abrogated by elimination of alveolar phagocytes, but not by depletion of T cells, B cells, or neutrophils. Transgenic mice had far more alveolar macrophages than did wild-type mice, and they were more resistant to influenza-induced apoptosis. Delivery of intranasal GM-CSF to wild-type mice also conferred resistance to influenza., Conclusions: GM-CSF confers resistance to influenza by enhancing innate immune mechanisms that depend on alveolar macrophages. Pulmonary delivery of this cytokine has the potential to reduce the morbidity and mortality due to influenza virus.

Objective - This study aimed to assess the reliability of an adaptation of the Harvard Trauma Questionnaire for use in epidemiological investigations of adolescents' exposure to violence and related post-traumatic stress disorder (PTSD) symptoms. Method - The exposure items of the Harvard Trauma Questionnaire were adapted for the South African context. The symptoms scale was left intact. Self-report questionnaires were administered on two occasions to 104 students in four high schools in Cape Town, South Africa. Test-retest reliability was assessed using Cohen's kappa (k) and observed agreement, as well as a concordance correlation coefficient for the symptoms scale. Cronbach's alpha was used to assess internal consistency of the symptoms scale. Results - All but one item showed at least fair test-retest reliability. Cronbach's alpha for the symptoms scale was 0.92, and the concordance correlation coefficient between the total symptoms score at time 1 and time 2 was 0.64 (95% CI = 0.51-0.74). Conclusions - Results suggest that the instrument may be sufficiently reliable for use in epidemiological studies of adolescent populations, although this sample is limited in several key respects. Further studies should investigate reliability in broader samples, as well as examining validity.

Objective - This study aimed to assess the reliability of the Beck Depression Inventory (BDI) and the Self-Rating Anxiety Scale for epidemiological investigations of adolescents' symptoms. Method - Self-report questionnaires were administered on two occasions to 104 students in four private high schools in Cape Town, South Africa. Test-retest reliability was assessed using Cohen's kappa and observed agreement. Internal consistency of each scale was assessed using Cronbach's alpha. Resuls - All items of the BDI and all but four of the Self-Rating Anxiety Scale had at least fair Kappa scores. The remaining four items of the Self-Rating Anxiety Scale had reasonable observed agreement and reflect more transient states that are likely to change between administrations. Conclusions - The results give encouraging indication that these instruments may be reliable in developing contexts. However, the study is limited by a sample that is small and not sufficiently representative of the broader South African population. Future studies should include larger and more representative samples, in order to explore item bias in different race and gender subgroups. Validity also needs investigation.

Objectives: This study aimed to establish prevalence of adolescents' exposure to violence and related symptoms in the South African context and to explore relationships between exposure and symptoms., Setting: Four high schools in Cape Town, South Africa., Methods: Self report questionnaires were administered to 104 students. Types of violence explored included: witnessing or being a victim of violence perpetrated by someone known to the child or in the home and witnessing or being a victim of violence perpetrated by a stranger. The Harvard Trauma Scale, Beck Depression Inventory, and Zung Self-Rating Anxiety Scale were used to assess potentially related symptoms., Results: The majority of children had been exposed to at least one type of violence, and exposure to the one type of violence was related to the other type. Symptoms of post-traumatic stress disorder and depression appear to be related to most types of exposure to violence, but anxiety symptoms only to exposure to violence perpetrated by someone known to the child or in the home., Conclusions: Rates of exposure to violence, and related symptoms, were unacceptably high. Symptoms were associated with exposure to violence.

Background and Objectives: Patients with gastric lymphoma treated by chemotherapy or radiation therapy are at high risk of developing complications, most commonly perforation or bleeding. In any case of upper gastrointestinal tract bleeding during conservative treatment for gastric lymphoma, thorough investigation is required to exclude other causes of hemorrhage which could be managed appropriately. When the source of bleeding is the tumor, the only effective measure is resection of the stomach, a very dangerous operation in these poor-risk patients., Methods: We treated 3 consecutive patients with life-threatening gastric bleeding from lymphoma treated by chemotherapy., Results: We successfully controlled the hemorrhage by surgical devascularization., Conclusion: Devascularization of the involved part of the stomach is safe and effective.

In an attempt to clarify the controversial issues related to prognosis and therapeutic aspects of phyllodes tumors (PT), we retrospectively reviewed all cases of PT treated in our hospital during the last fifteen years. Re-examining the pathology material we found 84 cases, while thirteen more cases which had been initially classified as fibroadenomas with areas of phyllodes tumor were rejected from the analysis because they were classified as fibroadenomas. Based on the criteria proposed by Azzopardi and Salvadori and adopted by WHO, we found 55 benign PT (65.14%), 14 borderline PT (16.6%), and 15 malignant PT (17.8%). The median age of the patients with benign PT was 34 years, compared to 46.5 years for those with borderline tumors and 52 years for those with malignant. The median size of benign tumors was 3 cm, 9.5 cm for borderline, and 7.25 cm for malignant. Out of 55 patients with benign PTs, 37 underwent wide local excision and the remaining 18, with small tumors, underwent enucleation. In this group of patients, there was no recurrence after a median interval of 6.65 years. Eleven patients with borderline PT underwent wide local excision and three mastectomy; one immediately after an incomplete PT excision and the remaining two 8 months and 2 years later due to a locally recurrent PT (the last one proven histologically in the permanent biopsy of the recurrence to be malignant). Twelve patients with malignant PT underwent mastectomy, either during the same operation or following the results of the permanent section biopsy. Three more patients with malignant PT underwent wide local excision. The size of the tumor in these patients was relatively small and the pathology report indicated clear margins with normal breast tissue surrounding the tumor. One patient with 8 cm diameter malignant PT, who underwent mastectomy, passed away sixteen months later from widely spread metastases. Applying the criteria of Azzopardi and Salvadori, each case of PT can be managed successfully avoiding unnecessary mastectomies.

Objectives: To investigate to what extent local children exposed to community violence develop post-traumatic stress disorder (PTSD), whether the symptom profile is typical or atypical, and how detection can be improved., Design: A cross-sectional study of two samples of children with a high risk of past exposure to violence., Setting and Subjects: Sixty Xhosa-speaking children aged 10-16 years; 30 from the Children's Home which serves Khayelitsha, and 30 from a school in a violent area of Khayelitsha., Outcome Measures: A shortened version of the Survey of Exposure to Community Violence (SECV) was administered to determine exposure to violence. Structured questionnaires and a clinical assessment were used to elicit symptoms and make psychiatric diagnoses., Results: All 60 children reported exposure to indirect violence, 57 (95%) had witnessed violence, and 34 (56%) had experienced violence themselves. Twenty-four (40%) met the criteria for on or more DSM-III-R diagnoses and 13 (21.7%) met the criteria for PTSD., Conclusions: Community violence places children at a high risk of developing serious psychiatric disorders and many children develop PTSD. None of the children in the school sample had received intervention prior to the study, pointing towards an urgent need for increased community and professional awareness of children at risk.

Objectives: This study aimed to evaluate the effectiveness of a 12-week intervention programme for conduct-disordered boys aged 10-16 years., Design: A descriptive study comparing a group of boys who participated in an intervention programme with a non-participant group., Setting: All the participants were resident in Khayelitsha and the programme was conducted at Empilweni, a community mental health project in Site C, Khayelitsha., Subjects: Nine of the 15 boys who were referred to Empilweni for serious conduct problems participated in the intervention; the remaining 6 were non-participants., Outcome Measures: The New York Teacher Rating Scale (NYTRS) and selected modules of the Diagnostic Interview Schedule for Children (DISC) were administered before and immediately after the treatment programme, and again after a 6-month interval., Results: Six months after the intervention, the treatment group showed a significant reduction in defiance, physical and delinquent aggression, as well as additional conduct problems. The non-treatment group only showed a significant reduction in defiance., Conclusions: The study results suggest that short-term community-based group therapy may be effective in treating delinquent behaviour among boys in an informal settlement. The feasibility of promoting such interventions as part of national violence prevention programmes requires serious consideration.