Menstrual cycle and timing of breast surgery in premenopausal node-positive breast cancer: Results of the International Breast Cancer Study Group (IBCSG) Trial VI

Purpose: It has been postulated that breast cancer surgery performedduring the follicular phase of the menstrual cycle is associated with pooreroutcome.Patients and methods: We tested this hypothesis by evaluatingdisease-free survival (DFS) for 1033 premenopausal patients who receiveddefinitive surgery either during the follicular phase (n = 358) or theluteal phase (n = 675). All patients were enrolled in a randomized trialconducted between July 1986 and April 1993. All had node positive breastcancer and randomization was stratified by estrogen receptor (ER) status.All patients received at least three cycles of adjuvant cyclophosphamide,methotrexate, and 5-fluorouracil (CMF). The median follow-up was 60 months.Results: Patients who underwent definitive surgery for breast cancer inthe follicular phase had a slightly worse disease-free survival than thoseoperated on during the luteal phase (five-year DFS percentage: 53%versus 58%; hazard ratio, 1.13; 95% confidence interval (CI),0.94–1.38; P = 0.20). The effect was significantly greater for thesubpopulation of 300 patients with ER-negative primaries (P = 0.02interaction effect; five-year DFS percentages 42% vs. 59%;hazard ratio 1.60; 95% CI, 1.12–2.25; P = 0.008). The effect oftiming of surgery diminished for analyses based on lesser surgicalprocedures, e.g., excisional biopsies. In particular, no effect of timingwas observed for fine needle aspiration procedures.Conclusions: Surgical procedures which are more extensive than a fineneedle aspiration biopsy might be associated with worse prognosis if conductedduring the follicular phase of the menstrual cycle. This phenomenon was seenpredominantly for high risk breast cancer with low levels or no estrogenreceptors in the primary tumor.     

Patients' perceptions of outcomes of a Canadian hospitalization

Notes that with health care reform moving at tremendous speed throughout Canada, a great deal of interest in outcomes research has been generated. States that the research team consisted of 17 professional practice leaders from eight disciplines. Proposes, through the research, to identify from the perspective of former patients what results they hoped to achieve prior to discharge from hospital and what facilitated and hindered them in achieving these results. Reports that a representative sample was selected for the study. Forty-one former patients each participated in up to two focus groups, with a total of 16 focus groups conducted. Hierarchical analysis revealed themes that fell within the framework of structure, process and outcomes. The findings will assist in ensuring that more appropriate and effective care is offered to patients by a variety of disciplines.     

Longitudinal changes in adult fat-free mass: influence of body weight

BACKGROUND: Almost all of the data on changes in body composition during aging are cross-sectional in nature. These show that fat-free mass (FFM) declines with age. OBJECTIVE: The goal was to analyze results of assays done in the author's laboratory of the FFM of normal adults studied at intervals for >/=2 decades to ascertain longitudinal changes. DESIGN: (40)K counting was used to estimate FFM in adult university personnel (15 men, 5 women) over periods ranging from 21 to 38 y. No advice was given about diet or exercise. RESULTS: There was considerable variation in the change of FFM over time. Some subjects lost FFM as the years went by, whereas others actually gained FFM. Analysis of the data showed that change in body weight was a prime factor in determining the magnitude and direction of the FFM change (R(2) = 0.54). Adults who maintained their weight lost an average of 1.5 kg FFM per decade and so gained an equal amount of fat; those who lost weight lost even more FFM, whereas those who gained weight either gained FFM or lost it more slowly than the others. Data from the literature confirmed this trend. CONCLUSIONS: FFM loss is not inevitable during adulthood-at least up to age 81 y, the oldest age yet studied. The magnitude and direction of the FFM change, be it positive or negative, is strongly influenced by change in body weight.     

Changing domains in the management process. Radiographers as managers in the NHS

Examines a group of radiographers developing management roles within the backdrop of a changing NHS. A comparative study of 25 Scottish and English radiographer managers were interviewed using semi-structured interviews. Interviews were based on a number of issues associated with moving from a clinical professional to a clinical manager and were analysed using domain theory. The interviews formed a number of emerging themes, which included management, professionalism, management style, conflicts between the role of both manager and professional, and role change. Radiographer managers are forming new "hybrid" manager roles, which have been developing within a changing NHS. A definite tension was seen in this role change. This transition was not easy for this group of radiographer managers. However, they have shown resilience in undertaking both operational and strategic management decisions, while using their clinical background to inform their decision making.     

Naming names

Name-based reporting of AIDS diagnoses, mandatory in the U.S. since 1982, generates profound concern among advocacy, civil rights, and consumer communities who argue that it discourages people from obtaining testing. The use of unique identifier numbers, particularly those with encryption capabilities, is a reasonable alternative to name-based reporting. Because it lowers the risk of testing avoidance, unique identifier-based reporting is seen as an effective data collection tool. A number of unique identifier systems now exist for HIV and/or CD4 data reporting in Maryland, Oregon, Washington, and Philadelphia. Unique identifier systems have lower duplication rates than name-based reporting.     

Paediatric medulloblastoma: Atypical CT features at presentation in the SIOP II trial

Summary A review of cranial CT studies of 233 patients for the Second Medulloblastoma Trial of the International Society of Paediatric Oncology showed typical CT appearances in only 30% of patients. The varied appearances encountered are described with particular emphasis on atypical CT features.A shorter version of this paper was published in the Proceedings of the XIV Symposium Neuroradiologicum (Neuroradiology (1991) 33 [Suppl]: 516–517)     

An individual patient-based meta-analysis of tamoxifen versus ovarian ablation as first line endocrine therapy for premenopausal women with metastatic breast cancer

Increased dietary fat intake and rate of breastepithelial cell proliferation have each been associated withthe development of breast cancer. The goal ofthis study was to measure the effect ofa low fat, high carbohydrate diet on therate of breast epithelial cell proliferation in womenat high risk for breast cancer. Women wererecruited from the intervention and control groups ofa randomized low fat dietary intervention trial, breastepithelial cells were obtained by fine needle aspiration,and cell proliferation was assessed in these samplesusing immunofluorescent detection of Ki-67 and PCNA. Theeffects of needle size and study group oncell yield and cytologic features of the cellswere also examined. Fifty three women (20 inthe intervention group and 33 in the controlgroup) underwent the biopsy procedure. Slides from 38subjects were stained for Ki-67 and from 14subjects for PCNA. No cell proliferation (fluorescence) wasdetected for either Ki-67 or PCNA in anyof the slides. Epithelial cell yield and numberof stromal fragments were greater with a largerneedle size. Numbers of stromal fragments and bipolarnaked nuclei were greater in the low fatas compared to the control group but nodifferences in epithelial cell yield were observed betweenthe two groups. This study confirms that fineneedle aspiration biopsy is a feasible method ofobtaining epithelial cells from women without discrete breastmasses, but suggests that cell proliferation cannot beassessed using Ki-67 and PCNA in such samples.     

Enzyme supplementation of dry and wet wheat-based feeds for broiler chickens: performance and gut responses

To test whether the improvements in digestive efficiency due to either wetting of the food or inclusion of enzymes are accompanied by the same changes in gut function, foods with a high content of wheat were fed to broiler chicks from 1-42 d old. Twenty-four birds were caged individually while a further sixty-four were in group pens in experiments of 2 x 2 factorial design with two levels of enzyme (0 or 1 g/kg, designed for wheat) and two levels of water addition (0 and 1300 g/kg). Food intake and live-weight gain were significantly increased by wet feeding (from 89.3 to 153.4 g/d and from 39.7 to 65.4 g/d respectively), the differences increasing with age, while the enzyme had no significant effect (120.5 and 122.2 g/d and 51.9 and 53.1g/week respectively). The viscosity of digesta was greatly reduced both by wetting (from 4.40 to 2.64 kPa. s) and enzyme (from 4.47 to 2.57 kPa. s) but there was a significant interaction with age in which the viscosity was low throughout in the wet only, enzyme only and wet + enzyme treatments but declined with age from a very high level in the dry, no enzyme treatment (11.5 kPa. s at 14 d). While wetting increased weight and length of digestive tract and thickness of some parts of the gut, enzyme had no significant effect, tending to reduce gut wall thickness. Crypt cell proliferation rate (CCPR) was significantly reduced by wet feeding (from 39.4 to 28.7 cells/crypt per 2 h) and by enzyme supplementation (from 38.9 to 29.2 cells/crypt per 2 h). Therefore, while both wetting and enzyme addition to the food reduced digesta viscosity and CCPR to a similar extent, the former had marked stimulatory effects on food intake and weight gain while the latter had little effect. The mode of action of wet feeding is therefore deduced to be not primarily through its effects on viscosity and CCPR.     

Influences on participation in a community-based colorectal neoplasia screening program by virtual colonoscopy in Australia

Objective : To determine the effect of certain personal and health behaviour characteristics on participation in a community-based colorectal neoplasia (CRN) screening program using virtual colonoscopy.
Methods : The study population comprised randomly selected subjects from the State electoral roll; screening by virtual colonoscopy was offered through letter of invitation. For non-responders, a further invitation was sent a month later. Non-response after a further month led to subjects being considered non-participants. Non-participants were contacted by letter to complete a structured questionnaire; participants completed a similar questionnaire immediately after their screening virtual colonoscopy.
Results : Discussing the invitation to screening with someone else increased the likelihood of participation by 63% (prevalence ratio 1.63, 95% CI 1.38–1.93); knowing someone with cancer increased the likelihood of participation by 23% (PR 1.23, 95% CI 1.07–1.42). Among participants who discussed screening with another individual, the spouse was the most common (71%). Subjects who were single were less likely to participate (PR 0.79, 95% CI 0.67–0.94). The strongest reported influence for participation was information provided in the letter of invitation (29.8%). The most common reasons for non-participation were lack of time and perceived good health.
Conclusions and Implications : This study suggests that a simple strategy to facilitate participation is to encourage subjects to discuss screening with others; further, to recognise that this may be most difficult for those who are single. Information provided to subjects prior to screening positively contributes to participation.     

Spontaneous resolution of a unilateral cataract in an infant.

We report a case of unilateral cataract with a posterior located central opacity greater than 3 mm in diameter, which resolved without surgical intervention in an otherwise healthy child.