Occupational Therapy: Still at Work

Many occupational therapists are moving into the field of occupational health and safety. This move is a reflection of the political and economic climate of Australia as well as the changing legislation related to occupational health. Only New South Wales legislation will, however, be examined in this instance. Occupational therapy's move from a medical model to a holistic conceptual basis has also resulted in an increased awareness of primary prevention strategies and health promotion. The workplace-based strategies which occupational therapists can offer the corporate sector are many and varied and reflect the unique contribution to be made by the profession to occupational health and safety.     

Endocrine Profile of 45 Patients with Sertoli Cell Only Syndrome

Endokrines Profil bei 45 Männern mit Sertoli-Zell-Syndrom
Bei 45 Männern mit Sertoli-Zell-Syndrom wurden die Hormonbasiswerte für FSH, LH, Prolaktin und Testosteron mit denen von Klinefelter-Paitenten, Männern mit Oligozoospermie und gesunden, fertilen Männern verglichen. Dabei ergab sich, daß die FSH- und LH-Werte bei Sertoli-Zell-Syndrom signifikant höher lagen als bei Gesunden. Die Erhöhung der Gonadotropine bei Patienten mit Sertoli-Zell-Syndrom was allerdings nicht so hoch und Testosteron nicht so herabgesetzt wie man es bei Klinefelter-Paitenten gefunden hatte. Aus dem Resultat, daß die LH-Werte erhöhte waren, während Testosteron sich im normalen Rahmen bewegte wird die Schlußfolgerung gezogen, daß hier eine kompensierte Dysfunktion der Leydigzellen bei den Patienten mit Sertoli-Zell-Syndrom vorliegt. Für Oligozoo-spermie-Patienten ließ sich keine Differenz der Hormonwerte gegenüber Gesunden feststellen.     

Prognostic value of micrometastases in sentinel lymph nodes of patients with breast carcinoma: a cohort study

Background: The prognostic meaning and thus indication for adjuvanttherapy of lymphogenic micrometastases in breast cancer patientsis still under debate. Patients and methods: From 1999 to 2007, 703 patients with _cT_1–2N₀breast cancer underwent surgery including sentinel lymph nodebiopsy. Examination of sentinel lymph nodes consisted of hematoxylinand eosin and immunohistochemistry staining following serialsectioning of the sentinel node. Patients were divided intofour groups: _pN₀ (n = 423), _pN_1micro (n = 81), _pN_1a (n = 130)and _pN_1b (n = 69). Median follow-up was 40 months. Results: At the end of follow-up, 53 patients had died and 64had recurrent disease. Compared with _pN₀ and following adjustmentfor possible confounders, including adjuvant systemic treatment,overall survival was not significantly different for _pN_1microwhile significantly worse for _pN_1a and _pN_1b {hazard ratio (HR)[95% confidence interval (CI)]: 0.59 [0.14–2.58], 4.31[1.85–10.01], 10.66 [4.04–28.14], respectively}.Likewise, disease-free survival was not significantly differentfor _pN_1micro and worse for _pN_1a and _pN_1b (HR [95% CI]: 1.43[0.67–3.02], 2.79 [1.37–5.66], 7.13 [3.27–15.54],respectively). Distant metastases were more commonly observedin the _pN_1micro than in the _pN₀ group, but still not as commonas in the _pN_1a or _pN_1b group (HR [95% CI]: 4.85 [1.79–13.18],10.34 [3.82–28.00], 23.25 [7.88–68.56], respectively). Conclusion: Although the risk of distant metastases was higherin patients in the _pN_1micro than in the _pN₀ group, no statisticallysignificant differences were observed in overall or disease-freesurvival between _pN₀ and _pN_1micro. Micrometastatic lymph nodeinvolvement in itself should not be an indication for adjuvantchemotherapy in breast cancer patients. Key words: breast cancer, micrometastases, prognosis, sentinel lymph node Received for publication March 11, 2008. Revision received June 25, 2008. Accepted for publication July 1, 2008.