Comparison of the systemic and intratumoral effects of tamoxifen and the aromatase inhibitor vorozole in postmenopausal patients with primary breast cancer.

PURPOSE: To determine biologic differences, if any, between presurgical endocrine treatment with an aromatase inhibitor (vorozole) and tamoxifen in patients with postmenopausal primary breast cancer. PATIENTS AND METHODS: Randomization was to 12 weeks of 2.5 mg of vorozole per day or 20 mg of tamoxifen per day, both orally. Clinical response was assessed monthly together with serum sex hormone binding globulin (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogens (E1, E2, and E1S), lipids, insulin-like growth factor-1 (IGF-1), and bone metabolites (CrossLaps CTx). Tissue samples for Ki67, apoptotic index (AI), estrogen receptor, and progesterone receptor were collected at 0, 2, and 12 weeks. RESULTS: Ki67 fell by 58% and 43% (means) at 2 weeks in the vorozole and tamoxifen patients, respectively (P =.13). In the vorozole group, the correlations of proportional changes in Ki67 at 2 weeks with tumor volume changes and clinical response at 12 weeks were not significant (P =.09) and marginally significant (P =.04), respectively. Serum lipids did not differ between groups. Serum levels of EI, E2, and E1S were suppressed markedly by vorozole, whereas levels of SHBG increased and LH and FSH fell significantly with tamoxifen. IGF-1 levels fell significantly with tamoxifen (P =.001) compared with the nonsignificant rise with vorozole. Twelve-week CTx values fell by 19% with tamoxifen (P =.006) and rose by 11% with vorozole (P =.15). CONCLUSION: The correlation with vorozole of Ki67 with volume and clinical response supports this as an intermediate marker. The nonsignificant effects on bone and lipid metabolism by the aromatase inhibitor may be important to consider for adjuvant and potential prevention strategies.     

Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals

Background  

Theories of behavior change indicate that an analysis of barriers to change is helpful when trying to influence professional practice. The aim of this study was to assess the perceived barriers to practice change by eliciting nurses' opinions with regard to barriers to, and facilitators of, implementation of a Fall Prevention clinical practice guideline in five acute care hospitals in Singapore.     

A contact detection system for identifying individual animals in groups

The system described has been in use for a period of three years to study voluntary consumption of alcohol for individual monkeys. In some experiments it has been used to monitor consumption 24 hr per day over a period of two months.     

Cholelithiasis: A clinical and dietary survey

Cholelithiasis among male and female patients at the Royal Melbourne Hospital was studied, and the incidence of the disease in relation to various clinical and dietary factors is discussed. The patients are distinguished by sex and country of origin, a distinction being made between patients born in Australia and those born in southern Europe and now living in Australia. Appropriate control groups were also studied.

It was shown that the incidence of cholelithiasis is higher in women than in men (3·0% as opposed to 0·7% in the Melbourne Hospital group), and higher among patients born in southern Europe than in Australia. A correlation was also established between marriage and the disease, and, in women, between having had children and the disease.

The dietary investigations showed that in Australia those patients with cholelithiasis were fatter than the control patients. Equally well there seemed to be a strong family tendency to develop gallstones. No association was found between cholelithiasis and blood grouping.

In the comparison of the southern European group and the Australian-born group it was shown that the former group had a higher incidence of the disease (9·3% as opposed to 2·3%), and that the overall incidence of cholelithiasis increased with age in men and was constant in women. However, when taken separately, the incidence in Australian female patients did increase with age, the higher proportion of women from southern Europe with the disease where the incidence was, in fact, evenly distributed in all age groups, accounting for this apparent constancy. It was also shown that a woman born in southern Europe increased the risk to herself of developing gallstones within two to five years of moving to Australia, and the contributory factors are discussed.

     

Control of scabies, skin sores and haematuria in children in the Solomon Islands: another role for ivermectin

OBJECTIVE: To assess the effects of a 3-year programme aimed at controlling scabies on five small lagoon islands in the Solomon Islands by monitoring scabies, skin sores, streptococcal skin contamination, serology and haematuria in the island children. METHODS: Control was achieved by treating almost all residents of each island once or twice within 2 weeks with ivermectin (160-250 microg/kg), except for children who weighed less than 15 kg and pregnant women, for whom 5% permethrin cream was used. Reintroduction of scabies was controlled by treating returning residents and visitors, whether or not they had evident scabies. FINDINGS: Prevalence of scabies dropped from 25% to less than 1% (P < 0.001); prevalence of sores from 40% to 21% (P < 0.001); streptococcal contamination of the fingers in those with and without sores decreased significantly (P = 0.02 and 0.047, respectively) and anti-DNase B levels decreased (P = 0.002). Both the proportion of children with haematuria and its mean level fell (P = 0.002 and P < 0.001, respectively). No adverse effects of the treatments were seen. CONCLUSION: The results show that ivermectin is an effective and practical agent in the control of scabies and that control reduces the occurrence of streptococcal skin disease and possible signs of renal damage in children. Integrating community-based control of scabies and streptococcal skin disease with planned programmes for controlling filariasis and intestinal nematodes could be both practical and produce great health benefits.