Hypophysectomy for palliation of breast cancer with especial reference to surgical technique

In a series of 19 patients who had hypophysectomy for palliation of cancer of the breast, all had striking relief of pain. Objective evidence of remission of disease was observed in ten patients. The survival time after operation averaged 19.8 months for patients who had remission and 2.1 months for patients who did not. Results were better in patients who had had cancer for a long time before operation than in those who had had the disease a relatively short time. Also it was noted that results were better in patients who had had preoperative response to endocrine therapy than in those who had not. Hence these factors may be considered in selection of patients for hypophysectomy.     

Five-year study of surgical rates in Ontario's counties.

The surgical rates for eight operations (hysterectomy, tonsillectomy/adenoidectomy, cholecystectomy, prostatectomy, appendectomy, mastectomy, colectomy and cesarean section) done in Ontario''s 44 counties from 1973 to 1977 were examined. There was considerable variation among the counties for all the operations studied, although the degree of intercounty variation decreased over the 5 years. Differences in resources (hospital beds and surgeons) explained little of the variation in the rates, but this may be because people crossed county lines for certain operations. Although some counties had consistently high or low rates for individual operations during the 5-year period, only four had consistently high rates for four or more operations, and only five had consistently low rates for four or more. The five counties with teaching health science centres had the highest ratios of specialists and surgeons to population, and, with the exception of one county in 1973, had above-average numbers of hospital beds. Despite the greater resources in these counties, their residents had consistently low rates for cholecystectomy, appendectomy, mastectomy and tonsillectomy/adenoidectomy. However, three of these counties had the highest rates for cesarean section. The variation in the rates is likely due to lack of agreement about indications for surgery or to variation in the use of technology rather than to differences in the incidence or prevalence of disorders.     

Long term treatment of severe obesity: four year follow up of results of combined behavioural modification programme.

A four year programme of treatment for severe obesity combining standard techniques such as behavioural modification, exercise, nutritional advice, and, in addition, readmission of patients who relapse has been developed. One hundred and seven subjects of both sexes were treated. Thirty nine had their jaws fixed from the start. After four years 104 out of 107 subjects were traced; 33 (31%) had left the programme. The mean loss of weight in the remaining 74 subjects was 11.7 kg (range -20 to 55.5): 14 had lost more than 20 kg, 35 had lost 5-20 kg, 17 had lost 0-5 kg, and eight were above their weight before treatment. The rate of dropping out in this study was lower than that generally reported. Our data suggest that combined behavioural modification used as a programme for reducing weight may result in a substantial loss of weight for several years even for severely obese subjects.     

Criteria for the diagnosis of fibroepithelial lesions of the breast with liquid-based cytology

OBJECTIVE: To establish diagnostic criteria for diagnosing and differentiating fibroepithelial lesions of the breast on ThinPrep (Cytyc Corp., Boxborough, Massachusetts, U.S.A.). STUDY DESIGN: Eighty-four fibroepithelial lesions were sampled by ultrasound-guided aspiration biopsy. Based on smears and histologic correlates, there were 55 fibroadenomas, 26 papillary neoplasms and 3 phyllodes tumors. The ThinPrep slides for each sample were reviewed retrospectively and evaluated for specific morphologic and cytologic features. RESULTS: On ThinPrep slides, 95% of the fibroadenomas had a predominance of single myoepithelial nuclei, 89% had staghorn clusters, and 47% had myxoid stroma. Among the papillary neoplasms, 8% had a predominance of single columnar ductal cells, 31% had papillary groups, 23% had vessels, and 27% had collagenous spherulosis. The ThinPrep preparations of the phyllodes tumors showed that 67% had single myoepithelial nuclei, 33% had a predominance of single ductal cells, 67% had staghorn clusters, and 0% had myxoid stroma. A majority of the fibroadenomas and the papillary neoplasms showed mild to moderate ductal epithelial hyperplasia. A majority of the phyllodes tumors showed moderate ductal epithelial hyperplasia. CONCLUSION: Fibroepithelial lesions of the breast can be accurately differentiated using ThinPrep samples based on the evaluation of specific cytologic and morphologic features, including the presence of staghorn clusters, fibromyxoid stroma, vessels, collagenous spherulosis, papillary clusters and predominance of myoepithelial nuclei or columnar cells in the background. However, the degree of ductal epithelial hyperplasia does not aid in the diagnosis.     

Free-flap reconstruction of large defects of the scalp and calvarium

Beyond a certain size, full-thickness defects of scalp are not amenable to local flap repair. Staged distant flaps have now been virtually eliminated by free-flap reconstruction. The authors present 12 patients in whom full-thickness scalp defects with an average area of 275 cm2 were reconstructed utilizing free flaps. Nine patients had corresponding large calvarial defects. Ten patients had reconstruction with free latissimus dorsi muscle flaps and overlying skin grafts, and one patient had reconstruction with a scapular free flap. Of the 12 patients, 8 had extirpative surgery for tumor with immediate reconstruction and the remaining 4 had reconstruction for chronic radionecrosis of the scalp, usually associated with infected osteoradionecrosis of the calvarium. Of this latter group, 2 patients underwent simultaneous acrylic cranioplasty. The technique and results are discussed.     

Lameness and Claw Lesions of the Norwegian Red Dairy Cattle Housed in Free Stalls in Relation to Environment,Parity and Stage of Lactation

Approximately 88% of Norwegian dairy cattle are housed in tie stalls. Free stall housing for all dairy cattle will be implemented within 20 years. This means that the majority of existing stalls will be rebuilt in the near future. Fifty-seven free stall herds of the Norwegian Red breed were randomly selected and 1547 cows and 403 heifers were trimmed by 13 claw trimmers during the late winter and spring of 2002. The claw trimmers had been taught diagnosing and recording of claw lesions. Environment, management- and feeding routines were also recorded. Fifty-three herds had concrete slatted alleys while 4 had solid concrete. Thirty-five herds had concrete as a stall base, while 17 had rubber mats, 2 had wood and 3 had deep litter straw beds. The prevalence of lameness was 1.6% in hind claws. Models for lameness and claw lesions were designed to estimate the influence of different risk factors and to account for the cluster effects within herd and claw trimmer. Detected risk factors for lameness were: parity three and above and narrow cubicles; for heel horn erosions: lactation stage around 5–7 months after calving and solid concrete alleys; for haemorrhages of the white line: lactation stage around 3–5 months after calving and solid concrete alleys; for haemorrhages of the sole: parity one, lactation stage around 5–7 months after calving and short cubicles, for white line fissures: slatted concrete alleys; for asymmetrical claws: parities two and above and for corkscrewed claws: solid concrete alleys. The prevalence of lameness in heifers was low, however 29% had one or more claw lesions. Heifers that were housed in pens or free stalls had more heel-horn erosions, haemorrhages of the sole and white-line fissures than heifers in tie stalls. As new free stalls are being built, it is important to optimise the conditions for claw health.     

After-exercise thermography and prediction of deep vein thrombosis.

A total of 112 patients participated in a prospective study of after-exercise thermography as a screening method for predicting risk of postoperative deep venous thrombosis. The fibrinogen-uptake test was used to detect thrombosis after elective surgery. The incidence of the complication showed no significant difference between patients who had had positive and those who had had negative thermograms. Thermography does not seem to be useful for predicting risk of postoperative thrombosis.     

Mechanism of adaptation in the mandibular condyle of the mouse. An organ culture study

The cranial base and whole mandible of 7-day-old mice were cultured for 1 or 2 weeks in a novel organ culture system that provided an articulating movement for the temporomandibular joints. The mandibles were articulating either in a closed or in an open position to simulate the in vivo mouth-breathing pattern. The reactions of the condylar processes were followed macroscopically and microscopically after osteoid or von Kossa staining. After 1 week of culture, small differences were found in the shape of the condylar processes between the two groups. After 2 weeks, significantly increased growth was observed superiorly in those condyles which had been working in a closed position and posteriorly in the condyles which had been working in an open position. Histologic analysis revealed that after 1 week calcification had proceeded faster in the posterior aspect of the condyles in the mandibles which had been working in a closed position as compared to the mandibles which had been working in an open position, and the difference was even more marked after 2 weeks. In the latter condyles calcification had proceeded markedly in the anterosuperior aspect. Osteoid staining showed that perichondrial mesenchymal cells had differentiated into osteoblasts in the posterior aspect of the condyles in those mandibles which had been working in a closed position. This led to a ceasing of expansive growth in the posterior aspect and thus to a more upwardly directed condylar growth. In mandibles which had been working in the open position to simulate the mouth-breathing pattern in vivo, chondrogenesis and thus expansive growth continued in the posterior aspect, leading to a more posteriorly directed condylar growth.(ABSTRACT TRUNCATED AT 250 WORDS)     

Long-term use of televisions,balls, and mirrors as enrichment for paired and singly caged chimpanzees

The evaluation of environmental enrichment techniques for nonhuman primates over long periods of time has had mixed results. Some studies report rapid habituation to new enrichment items, while others note continued use. We have investigated the use of three different enrichments that had been available to paired and singly caged chimpanzees for several years. Twenty subjects were observed during 200 hr of scan sampling while singly caged and while pair housed. Each subject had a variety of enrichments available and their use of a television, ball, and mirror were recorded. The chimpanzees had previous exposure to all of the items: televisions had been available for a mean of 22.75 months, balls had been available for 55.9 months, and mirrors had been available for 25.9 months. The results indicated that the chimpanzees continued to use the enrichments for small amounts of time (0.27%–1.53% of the observations) even after such prolonged exposure. Television and ball use were significantly higher than mirror use. Housing condition was not a significant factor in the analyses, contrary to expectations. We concluded that several simple enrichment items may be effective in offering variety and choices to the nonhuman primate and can be one element in a comprehensive environmental enhancement plan. © 1996 Wiley-Liss, Inc.     

Oral health and history of respiratory tract infection in frail institutionalised elders

Objectives: The purpose of this study was to look for a relationship between history of respiratory tract infection (RTI) and oral health in very old subjects. Setting and Subjects: 302 frail elders (mean age: 85 years) living in a medical care facility were examined by one dentist. Outcome Measures: The incidence of RTI over 1 year had been recorded along with markers of nutritional status and degree of dependency. The oral examination comprised an evaluation of hygiene, quality of prostheses and the prevalence of caries, periodontal disease and mucosal disorders. Results: One third (33%) of the subjects had experienced at least one episode of RTI and a fifth (19%) had visited the dentist in emergency. The incidence of RTI had been greater among dentate subjects and those who came to the dentist in emergency. The dentate subjects with a history of RTI had higher plaque score (P=0.02). Half (49%) of the subjects had oral disorders that could develop in a dental emergency and these subjects had had a higher risk of RTI (relative risk: 1.9, 95% confidence interval: 1.1–3.9). The presence of selected oral disorders associated with low serum albumin increased the relative risk of having had RTI to 3.2 (1.5–6.7). The association between presence of actual oral health problems and previous experience of RTI was more noticeable in those who had poor general health or were more debilitated. Conclusions: The present study suggests that poor oral hygiene and the presence of potential emergency could be major risk factors for RTI among the frail elderly.     

Medical cost of curing childhood acute lymphoblastic leukaemia

Between 1970 and 1979 acute lymphoblastic leukaemia was diagnosed in 378 children at this hospital. The outcome for the 181 survivors was examined six or more years after diagnosis to assess morbidity in an unselected group of long term survivors. One hundred and thirty seven of the survivors were in first remission and probably cured (group I). Forty four (group II) had had one or more relapses, some of whom, who had isolated extramedullary relapses, also have a good chance of cure.In group I 136 patients had prophylactic cranial or craniospinal irradiation, while patients in group II, in addition to having that treatment, received local testicular (17) or craniospinal radiation (seven) for testicular or central nervous system relapse. Eight had additional prophylactic cranial radiotherapy after bone marrow relapse, and six had total body irradiation before bone marrow transplantation. The incidence of clinically important growth and endocrine morbidity was 20% in group I and 68% in group II. The morbidity in patients in group I was mainly attributable to early pubertal maturation. In group II 30 patients had growth failure, of whom 19 had gonadal failure from testicular or total body irradiation, 14 had growth hormone deficiency after doses of cranial irradiation of over 2400 cGy, and 10 had spinal growth impairment after craniospinal irradiation. Two also had early pubertal maturation. Five out of six patients who received total body irradiation had multiple endocrine deficiency. Neuropsychological sequelae of treatment were seen in 40 (42%) of 96 schoolchildren in group I and in 12 (38%) of 32 schoolchildren in group II. Postinfective sequelae of treatment were found in patients in both groups.These results show that the survivors who were in their first remission had a 42% residual morbidity related to treatment compared with an 82% morbidity in the survivors of one or more relapses who had multiple treatments.     

Increased production of PGI2-like activity by frozen-thawed rat aorta.

The effects of storage conditions, temperature, and time on the ability of the rat thoracic aorta to produce a platelet aggregation inhibitor were investigated. Aortic fragments were incubated in Tris buffer, aliquots of which were then tested for their ability to inhibit ADP-induced human platelet aggregation. The incubation fluid of samples that had been soaked in Tris buffer at 4 degrees C for 24 hours contained no inhibitor activity, whereas the incubation fluid of similar samples that had been kept at 4 degrees C but not soaked in buffer contained comparable inhibitor activity as that of fresh samples. The incubation fluid of samples that had been kept at -20 degrees C or -80 degrees C contained greater inhibitor activity than that of fresh samples, and was maintained in -20 degrees C samples for 7 days, and -80 degrees samples for 28 days. The aortic inhibitor had similar properties as PGI2.     

Study of 8-year-old children with a history of respiratory syncytial virus bronchiolitis in infancy.

Thirty-five children known to have had respiratory syncytial virus bronchiolitis in infancy were examined at the age of 8 and their respiratory function tested. The results were compared with those in 35 controls matched for age, sex, and social class. Although 18 of the children who had had bronchiolitis in infancy had experienced subsequent episodes of wheezing, these were neither severe nor frequent in most cases and had apparently ceased by the age of 8. Nevertheless, the mean exercise bronchial lability of the children who had had bronchiolitis was significantly higher than that of the control children and the mean peak expiratory flow rate at rest significantly lower. Atopy, assessed by family and personal history alone, did not seem to be related to either bronchiolitis or wheezing episodes after bronchiolitis. The parents of the children who had had bronchiolitis smoked significantly more cigarettes during the infant''s first year of life than those of the control children. The results suggest that bronchiolitis and childhood asthma are not closely related. Bronchial hyperreactivity might be inherited independently of atopy, but environmental factors seem the most likely link between severe respiratory infection in infancy and chronic or recurrent respiratory illness in adult life.     

Mothers' experiences of induction

Mothers of a random sample of 2182 legitimate live births were interviewed about their experiences of pregnancy, labour, and delivery. Of these, 24% reported that their labours were induced, and data about this from a subsample of mothers tallied with information obtained through the doctors in charge in 88% of cases. All but 3% of the mothers who were induced perceived some medical reason for the induction. The proportion of inductions in the 24 study areas ranged from 6% to 39%. A relatively small proportion of labours in “teaching” hospitals, small hospitals with less than 100 beds, and GP maternity hospitals were induced, but a comparatively high proportion of private patients had an induction. There was no clear association between induction and the mother''s age or parity. Despite being given more pain relief, those who were induced reported similar intensities of pain during the first and second stages of labour to those whose labour started spontaneously; they also reported that they had “bad pains” for a similar period. The period they had contractions was shorter for the induced than for those starting spontaneously, and the intensity of pain at delivery was rated somewhat less by those who were induced.There was no difference between induced babies and others in the proportion who were held by their mothers immediately after their birth. Two-fifths of the mothers who were induced would have liked more information about induction; and a similar proportion said they had not discussed induction with a doctor, midwife, or nurse during their pregnancy. Only 17% of the mothers who had an induction said they would prefer to be induced if they had another baby. This contrasts with 63% of those who had epidural analgesia who would opt for the same procedure next time, while 83% of those who had had a baby in hospital, and 91% of those having had a home birth, would want their next baby in the same type of place.     

Human perception and awareness of ticks in a South Australian rural community and implications for management of Amblyomma triguttatum triguttatum

The ornate kangaroo tick, Amblyomma triguttatum triguttatum, is invasive on Yorke Peninsula, South Australia. To assess the potential for developing comprehensive management strategies for the species, we mailed 1,000 surveys to Yorke Peninsula residents to investigate community perceptions of ticks, gather information on tick-host ecology, and assess whether or not occupation and length of residence affected whether residents had seen ticks. The response rate was 32%; most respondents (63%) had not seen ticks on Yorke Peninsula. Of those who had (n = 104), 56% had seen ticks on animals, especially lizards (31%) and kangaroos (20%); 50% had seen ticks on humans. Of the 64 respondents who believed places on Yorke Peninsula had many ticks, 56% identified Innes National Park and 75% areas on southern Yorke Peninsula. The likelihood of seeing ticks was not related to occupation. Whether respondents had seen ticks was related to length of residence on Yorke Peninsula (<10 years = 23.6%, 10-30 years = 44.0%, 31-50 years = 47.6%, 51-70 years = 30.9%, 71+ years = 21.4%). The number of respondents who had seen ticks on humans suggests that tick-borne diseases could become a public health issue on Yorke Peninsula. This finding is of particular concern because A. t. triguttatum is implicated in the epidemiology of Q fever in Queensland. Finally, respondents were unaware of the responsibility for tick management, which demonstrates a need for collaboration amongst stakeholders.     

Clinical and Diagnostic Significance of Enteroclysis Through Nasointestinal Decompression Intubation

To study the clinical and diagnostic significance of enteroclysis through nasointestinal decompression intubation, thirty-five patients with small bowel obstruction were enrolled. A nasointestinal catheter of 300 cm was placed through the nasal cavity then pushed to the upper jejunum under X-ray realtime monitoring. The patients underwent intra-small-intestinal suction therapy reducing or relieving the obstruction after 3 days. As the catheter reached the lesions, we conducted selective imaging. Using fluoroscopy, we injected 20–100 ml meglumine diatrizoate 76 % and 50–200 ml air via the decompression suction port to produce a double-contrast radiography. The catheter was then retrieved to the upper jejunum, and the X-ray of the small intestine was obtained. All 35 patients had successful intubations. The decompression treatment resolved symptoms in 20 cases and alleviated symptoms in 15 cases. Ten cases underwent surgery. The images obtained by infusing meglumine diatrizoate through the decompression catheter were of good quality. Among the 35 cases, six were absent of any distinct abnormal signs on the X-ray, 15 had adhesive ileus, four had small bowel tumor (three metastatic tumor, one small bowel cancer), three had Crohn’s disease, three had radiation enteritis (one of the three was mistaken for small bowel metastatic tumor), two had enteric intussusception, one had a polyp in the small intestine, one had ascending colon cancer. The nasointestinal decompression intubation under X-ray monitoring serves a dual function for patients with intestine obstruction, by decompressing the small bowel and examining the small intestinal radiographically. The X-rays can confirm the obstruction and provide guidelines for surgery.     

松墨天牛成虫标本保存及其DNA提取质量比较

【目的】探讨适合DNA提取的天牛成虫标本保存方法。【方法】采用SDS-蛋白酶K消化法对液氮中冷冻保存、无水乙醇-20℃冷冻保存、无水乙醇室温保存和干标本室温保存且保存时间在2年以上的松墨天牛Monochamus alternates Hope成虫标本基因组DNA进行提取,并对不同保存方式提取的DNA样本进行了质量比较和分析。【结果】在上述常见的松墨天牛成虫标本4种保存方式中,以液氮中冷冻保存效果最佳,其次为无水乙醇-20℃冷冻保存,插针干标本室温保藏效果最差。利用昆虫线粒体基因CO I和CO II的通用引物从上述DNA中均能够成功扩增出目的片段,测序结果证实扩增片段符合预期。【结论】液氮和无水乙醇-20℃冷冻保存适合松墨天牛成虫标本长期保存,且不影响后续的PCR扩增和测序。     

Surgical management of the radiated chest wall

Fifty consecutive patients with radiation-related problems of the chest wall were treated between 1976 and 1984. There were 40 women and 10 men with an average age of 54 years (range 26 to 78 years). Twenty-three patients had radiation ulcers alone, 20 had recurrent cancer, and 7 had infected median sternotomy wounds. Thirty-six had skeletal resections and 44 had soft-tissue resections. The skeleton was reconstructed with Prolene mesh in 12 patients and with autogenous rib in 3. Sixty-three muscles were transposed in 43 patients. Twelve omental transpositions were performed (8 for primary treatment and 4 for salvage of a failed muscle flap). Hospitalization averaged 20.2 days. There was one operative death (at 29 days). Partial flap necrosis occurred in 10 patients. Mesh was removed in three patients. There were 14 late deaths, most from recurrent tumor. The remaining patients had well-healed wounds and a generally improved quality of life. We conclude that aggressive resection and reliable reconstruction are critical considerations in the surgical management of this perplexing clinical problem.     

Use of the agar diffusion precipitation test in the diagnosis of hog cholera

The application of the agar diffusion precipitation (ADP) test for diagnosing hog cholera was investigated. The test used as antigen, pancreatic tissue from 272 pigs that had been inoculated with hog cholera virus. The test was positive for 13.5% of the animals that were sick for 4 days or less, 40% of those sick for 5 days, and 77% of those sick for 6 days or more. The test was positive for 13.5% of all animals that had been vaccinated with crystal violet-glycerol hog cholera vaccine and had been sick for at least 6 days after challenge inoculation. Titration of the virus in ADP-test-negative and ADP-test-positive pancreatic suspensions did not show a direct correlation between the infective virus particle and the precipitating antigen.     

Circadian variations in the oxygen-consumption of anterior segments of earthworms

Summary The oxygen-consumption of anterior segments (prostomium plus the first six segments) of earthworms, Lumbricus terrestris L., was measured around midday and in the evening on 25 days of late winter and early spring. The preparations were cut from animals which had lived in complete darkness for at least several days prior to their being studied. Data for 1) anterior pieces with intact suprapharyngeal ganglia (brain), for 2) pieces from which those ganglia had been removed about an hour before the segments were placed in the respirometers, for 3) pieces in which the circumpharyngeal connectives had been severed approximately an hour before measurements were made and for 4) pieces from which the ganglia had been removed 42 hours before recording, are presented in Tables 1 and 2.The average oxygen-consumption of preparations of the first three groups was 22 to 25% greater (p<0.05) in the evening than at noon, i. e., the circadian variation was found whether or not the central nervous system had been manipulated shortly before respiratory rates were determined. However, for the preparations of type 4), the differences between midday and evening rates were less, averaged only 16%, and were not statistically significant. Those findings may indicate that the longterm maintenance of the circadian variation in oxygen-consumption does depend upon nervous mediation or synchronization.