Angiotensin II (Ang II) AT1 receptors are involved in the regulation of the stress response. In adult male rats, acute restraint increased AT1A mRNA in paraventricular nucleus. Repeated restraint increased AT1A mRNA and AT1 binding in paraventricular nucleus and AT1 binding in subfornical organ and median eminence. AT1B and AT2 receptors were not expressed in brain areas involved in the stress response. Acute restraint increased anterior pituitary AT1A mRNA and AT1 binding and decreased AT1B mRNA. During repeated restraint, the increase in AT1A mRNA in the anterior pituitary was maintained, but AT1B mRNA and AT1 binding returned to normal levels. In adrenal zona glomerulosa, AT1B mRNA, AT1 binding, AT2 mRNA and AT2 binding decreased during acute restraint. Receptor mRNA and binding returned to normal after repeated stress, with the exception of rebound increase in adrenal zona glomerulosa AT2 mRNA. In adrenal medulla, AT1A mRNA increased and AT2 mRNA decreased during acute restraint. AT1A mRNA remained increased during repeated restraint, while alterations in AT2 mRNA were no longer present. Expression of AT1A, AT1B and AT2 receptors in the hypothalamic-pituitary-adrenal axis is tissue specific and is different in acute and repeated stress. Increased brain, pituitary and adrenomedullary AT1A receptor expression correlates with hypothalamic-pituitary-adrenal axis stimulation, supporting the hypothesis of Ang II, through selective AT1A receptor stimulation, as an important determinant of the acute and repeated stress response. Decreased adrenal zona glomerulosa and anterior pituitary AT1B receptors during acute stress can be interpreted as compensatory to increased stimulation by Ang II. There may be additional roles for adrenal AT2 receptors during acute stress, possibly related to interaction or cross-talk with AT1 receptors.
The incidence of breast cancer is increasing each year. Concomitantly, cosmetic breast augmentation has become the second most often performed cosmetic surgical procedure. As the augmented patient population ages, an increasing number of breast cancer cases among previously augmented women can be anticipated. The surgical treatment of these patients is controversial, with several questions remaining unanswered. Is breast conservation therapy feasible in this patient population and can these patients retain their implants? A retrospective review of all breast cancer patients with a history of previous augmentation mammaplasty who were treated at the Revlon/UCLA Breast Center between 1991 and 2001 was performed. During the study period, 58 patients were treated. Thirty patients (52 percent) were treated with a modified radical mastectomy with implant removal. Twenty-eight patients (48 percent) underwent breast conservation therapy, which consisted of lumpectomy, axillary lymph node dissection, and radiotherapy. Twenty-two of the patients who underwent breast conservation therapy initially retained their implants. Eleven of those 22 patients (50 percent) ultimately required completion mastectomies with implant removal because of implant complications (two patients), local recurrences (five patients), or the inability to obtain negative margins (four patients). Nine additional patients experienced complications resulting from their implants, including contracture, erosion, pain, and rupture. The data illustrate that breast conservation therapy with maintenance of the implant is not ideal for the majority of augmented patients. Breast conservation therapy with explantation and mastopexy might be appropriate for rare patients with large volumes of native breast tissue. Mastectomy with immediate reconstruction might be a more suitable choice for these patients.
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