Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life.

PURPOSE: Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type. METHODS: We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤3.0 cm and lymph node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 "not at all" to 5 "all the time") and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors. RESULTS: Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up. CONCLUSIONS: Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.

Comparison of peanut meal and soybean meal as protein supplements for laying hens.

Peanut protein is severely limiting in threonine and has been used to create threonine deficiency in animals. The availability of purified threonine at low cost raises the possibility of economically using peanut meal (PNM) and threonine combinations in poultry diets. An experiment was conducted to compare corn and PNM based diets to corn and soybean meal (SBM) based diets at three protein levels (16, 18.5, and 21%) in diets for 22-to-34-wk-old commercial Leghorns. Birds were housed two per cage with four cages per replicate and six replicates per treatment. Feed consumption, egg production, and feed per dozen eggs were almost identical for PNM (93.8 g/hen per d, 92.2 eggs per 100 hens/d, and 1.22 kg/dozen) and SBM (93.7 g/hen per d, 92.2 eggs per 100 hens/d, and 1.22 kg/dozen). Dietary protein level had no consistent effect on any of these parameters but did significantly improve body weight gains and egg weights (1.2 to 2.5 g/egg). PNM-fed hens laid slightly smaller eggs during the first 6 wk (P<0.05), but there were no egg size differences during the last 6 wk of the experiment (P>0.14). PNM-fed hens laid eggs with better interior quality at 26 and 30 wk of age. After 2 wk of storage, Haugh units remained better for eggs from hens fed PNM than SBM when kept refrigerated (4 degrees C; P<0.05) or at room temperature (20 degrees C; P<0.10). Egg specific gravity was slightly lower for hens fed PNM. It is concluded that PNM is an excellent ingredient for laying hen diets.

Power of two methods for the estimation of bone ash of broilers.

An experiment was conducted to compare two common methods of estimating bone ash from growing broiler chicks (A = autoclaving; B = boiling/extracting). Ross x Ross 1-d-old broiler chicks were fed a corn-soy, phosphorus-deficient diet (22.7% CP, 1% calcium, 0.22% non-phytate phosphorus), with 0, 750, 1,500, 3,000, or 6,000 units of phytase (FTU) to produce bones with a range of ash. The methods were compared with bones from chicks at 7, 14, and 21 d of age. Left legs were used for method B, and right legs were used for method A. Data was analyzed by the general linear models procedure of SAS software, and differences between means were detected using the Duncan's new multiple range test at the 0.05 level. Variance estimates were the mean square errors (from SAS outputs). Sample sizes needed to detect a 2% difference in bone ash were calculated using the method of Zar. The addition of 6,000 FTU/kg increased tibia ash from 26 to 37%, 29 to 41%, and 33 to 43% on Days 7, 14 and 21, respectively (method B). With bones from 7-d-old chicks, the same number of samples was necessary to detect a 2% difference using methods A and B. With bones from 14- and 21-d-old chicks, approximately 50 and 150% more samples were necessary, respectively, using method A. The autoclaving method is less labor-intensive and requires no toxic solvents, but for older birds, many more samples or replications are needed to detect the same treatment differences.

Ondansetron is a better prophylactic antiemetic than droperidol for tonsillectomy in children.

Both intravenous ondansetron (OND) and droperidol (DROP) have been observed to reduce vomiting after tonsillectomy in children. This randomized, double-blind investigation compared the effect of OND and DROP on vomiting after outpatient tonsillectomy in 276 healthy children age 2-12 yr. All subjects received a standardized anaesthetic, which consisted of induction with either propofol or halothane/N2O, vecuronium 0.1 mg x kg(-1) on an as needed basis, maintenance with halothane/N2O, midazolam and codeine, and reversal of neuromuscular blockade with neostigmine and atropine on an as needed basis. Subjects were given either OND 150 micrograms x kg(-1) or DROP 50 micrograms x kg(-1)iv after induction of anaesthesia. Rescue antiemetics in the hospital were administered to patients who vomited X 2 and X 4, respectively. Postoperative pain was treated with morphine, codeine and/or acetaminophen. For 24 hr following surgery, emesis was recorded by nursing staff while subjects were in the hospital, and by parents following discharge from hospital. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. The frequency of in-hospital emesis was 16% in the OND-patients and 30% in the DROP-group, P <0.05. The OND-subjects required fewer rescue antiemetics, 5% vs 13%, P <0.05. The overall incidence of emesis was 45% in the OND-group and 57% in the DROP-group, P <0.05. In conclusion, ondansetron was a superior prophylactic antiemetic for tonsillectomy in children when compared to droperidol.

Oral ondansetron decreases vomiting after tonsillectomy in children.

Vomiting is a common, unpleasant aftermath of tonsillectomy in children. Intraoperative intravenous ondansetron (OND) reduces vomiting after this operation. Our double-blind, placebo-controlled, randomized investigation studied the effect of the oral form of OND on vomiting after outpatient tonsillectomy in children. We studied 233 healthy children age 2-14 yr undergoing elective tonsillectomy. Subjects were given placebo (PLAC) or OND 0.1 mg.kg-1 rounded off to the nearest 2 mg one hr before surgery. Anaesthesia was induced with either propofol or halothane/N2O. Vecuronium 0.1 mg.kg-1 was administered at the discretion of the anaesthetist. Anaesthesia was maintained with halothane/N2O, 50 micrograms.kg-1 midazolam iv and 1-1.5 mg.kg-1 codeine im. At the end of surgery, residual neuromuscular blockade was reversed with neostigmine and atropine. All episodes of in-hospital emesis were recorded by nursing staff. Rescue antiemetics in the hospital were 1 mg.kg-1 dimenhydrinate iv for vomiting x 2 and 50 micrograms.kg-1 droperidol iv for vomiting x 4. Parents kept a diary of emesis after discharge. Postoperative pain was treated with morphine, codeine and/or acetaminophen. The two groups were similar with respect to demographic data, induction technique and anaesthesia time. Oral OND (n = 109) reduced postoperative emesis from 54% to 39%, P < 0.05. This effect was most dramatic in-hospital, where 10% of the OND-patients and 30% of the PLAC-group vomited, P < 0.05. The OND-subjects required fewer rescue antiemetics, 7% vs 17%, P < 0.05. In conclusion, oral ondansetron decreased the incidence of vomiting after outpatient tonsillectomy in children.

Methicillin-resistant Staphylococcus aureus: a descriptive analysis on veterans.

Concern over complications of a potentially large outbreak of methicillin-resistant Staphylococcus aureus (MRSA) prompted intensive monitoring and establishment of effective communication lines between infection control practitioners, nurses, physicians, and microbiology personnel. From October, 1986, through September, 1987, 77 patients at the Veterans Administration Medical Center in Oklahoma City had MRSA. Charts were available for review on 63 of these patients. When those with charts available were reviewed, 41 patients had nosocomial (NC) and 22 had community-acquired (CA) MRSA. Of the 41 NC patients, 34 were infected (of which 17 died during hospitalization) and 7 colonized (3 died). Of the 22 CA patients, 15 were infected (4 died) and 7 colonized (2 died). Length of stay was NC-infected, mean 51.8 days; NC-colonized, 38.9 days; CA-infected, 14.9 days; and CA-colonized, 16.1 days. This study shows the importance of NC MRSA, especially as it relates to hospital costs and care of many extended stay patients.

Antiallergic properties of SQ 13,847, an orally effective agent. II. Activity in vitro.

SQ 13,847, a pyrazolo[1,5-c]quinazoline with potent oral antiallergic activity in the rat, was compared with its principal oxidative metabolite, SQ 12,903, for ability to block the release of histamine from the rat mast cell in vitro. SQ 12,903, at concentrations in the range of 0.3 to 2 micrometer, produced 50% inhibition of histamine release reactions triggered by dextran, antirat immunoglobulin (Ig) E or polymyxin B, whereas SQ 13,847 concentration of 100 micrometer or greater were required to produce equivalent inhibitory effects. The greater potency of SQ 12,903 relative to that of SQ 13,847, both in vitro and in passive cutaneous anaphylaxis via the intravenous route, together with the structural similarity of SQ 13,847 is prodrug, requiring oxidation to SQ 12,903 for expression of maximum antiallergic activity. SQ 12,903, disodium cromoglycate and doxantrazole displayed similar time-dependent inhibition and cross-tachyphylaxis, suggesting that all three antiallergic agents block mast cell degranulation via a common mechanism.

Enhancement of abnormality in gamma images using Kohonen filters.

A new method of processing digital images consists of a numerical filter which suppresses normal features producing an enhancement of the abnormality. The resulting filtered image aids the observer in the recognition of the abnormality. The filter is developed from verified normal images in the computer memory. The enhancement of pathologic accumulations with respect to surrounding activity was improved on the average by a factor of 2.6 for 13 lateral brain images.

Evaluation of blood filters: dynamics of platelets and platelet aggregates.

Microaggregates of platelets have been found in stored blood and in extracorporeal circulation systems and the potential microembolism of these particles intensely studied. Four currently available filters were studied for their filtration effectiveness of induced platelet microaggregates and for the removal of normal platelets from blood collected in acid citrate dextrose or heparin. Dacron wool filtration significantly (P less than 0.001) reduced aggregates in 13 to 80 mu sizes to a level similar to that in normal blood. In general, as filtration effectiveness increased so did the elimination of normal platelets.