A rapid food screener to assess fat and fruit and vegetable intake.

BACKGROUND: The U.S. Preventive Services Task Force recommends that Americans lower dietary fat and cholesterol intake and increase fiber and fruit/vegetables to reduce prevalence of heart disease, cancer, stroke, hypertension, obesity, and non-insulin-dependent diabetes mellitus in the United States. To provide preventive services to all, a rapid, inexpensive, and valid method of assessing dietary intake is needed. METHODS: We used a one-page food intake screener based on national nutrition data. Respondents can complete and score the screener in a few minutes and can receive immediate, brief feedback. Two hundred adults self-administered the food screener. We compared fat, fiber, and fruit/vegetable intake estimates derived from the screener with estimates from a full-length, 100-item validated questionnaire. RESULTS: The screener was effective in identifying persons with high-fat intake, or low-fruit/vegetable intake. We found correlations of 0.6-0.7 (p<0. 0001) for total fat, saturated fat, cholesterol, and fruit/vegetable intake. The screener could identify persons with high percentages of calories from fat, total fat, saturated fat, or cholesterol, and persons with low intakes of vitamin C, fiber, or potassium. CONCLUSIONS: This screener is a useful tool for quickly monitoring patients' diets. The health care provider can use it as a prelude to brief counseling or as the first stage of triage. Persons who score poorly can be referred for more extensive evaluation by low-cost paper-and-pencil methods. Those who still have poor scores at the second stage ultimately can be referred for in-person counseling.

Diagnostic ability of different human milk fat globule antigens in breast cancer.

Human mammary epithelial antigens (HME-Ags) are released into the circulation by breast tumors and not by normal breast tissue (Proc. Natl. Acad. Sci. USA 74: 582-586, 1977). This characteristic made them valuable, together with other breast cancer related antigens later identified, to develop immunoassays useful in the follow-up of breast cancer. Assays for these antigens in serum have less than complete sensitivity and partial specificity, and as a result of this have not been totally successful in studying the relapsing breast cancer patient. In the present work, correlations are made among 3 assays available for breast cancer disease follow-up. They detect HME-Ags, CEA, and the heavy molecular weight mucin of the human milk fat globule (HMFG). Values for sensitivity and specificity for the 3 assays were obtained from approximately 300 samples of patients whose clinical diagnosis at the time of blood drawing was rigorously established. A small but definite advantage in sensitivity is demonstrated for the HME-Ags assay over the other two. A similar advantage is also demonstrated in the sequential follow-up of breast cancer patients, where HME-Ags respond more rapidly in most instances to changes in tumor burden. Further, the ability of increases in levels of these assays to predict relapse was studied in 15 patients who relapsed. HME-Ags demonstrated a predictive value of 73%, while CEA and the heavy molecular weight mucin remained at 47%. The present study exemplifies the search for novel antigens (Ags) with maximal ability to detect breast cancer relapse and with improved sensitivity to monitor tumor burden changes. Here, assays for different antigens to be compared are tested in the same serum samples obtained from carefully staged patients. The results suggest a role as breast cancer markers for antigens of lower molecular weight than the epithelial mucin-like components studied previously.

Management and supportive care of ambulatory cancer patients.

Ambulatory cancer care rather than prolonged hospital care is becoming increasingly more common. The total care of patients requires both psychological and medical support to meet the varied problems of cancer. A coordinated home care program is presented utilizing a team of health care professionals who, using video instructions, teach family, friends and patients ways to improve their health through nutrition, exercise and body care. Psychological aspects of cancer are reviewed, and suggestions on how to improve coping skills are presented. Through planning, understanding, a caring medical team and a supportive family, successful ambulatory care can be provided to the cancer patient thereby helping him/her to live with cancer.

Mycosis fungoides of the mastoid, middle ear, and CNS. Literature review of mycosis fungoides of the CNS.

Facial nerve paralysis developed in a man with tumor-stage mycosis fungoides (MF). Mastoidectomy disclosed that MF had involved the mastoid and middle ear. Meningeal lymphoma, confirmed by the finding of Sézary cells in the CSF, was subsequently established. Autopsy disclosed MF lymphoma in the leptomeninges, medulla, spinal cord, and cranial nerves. A unique feature was the formation of a communicating hydrocephalus. Case reports of 23 patients with MF of the CNS, including 21 autopsies, are reviewed. Practically all had tumor-stage or erythrodermic MF. Atypical mononuclear cells were found ante mortem in the CSF in eight patients. In contrast to other CNS lymphomas, bone marrow involvement was uncommon. Cranial, especially facial, nerve paralyses were often premonitory signs of meningeal lymphomas. Patients with MF having such symptoms should have cytologic examination of the CSF.

Adjuvant immunotherapy of high risk stage I melanoma with transfer factor.

Following conventional surgical management, 100 patients with high risk Stage I melanoma were treated with transfer factor to reduce the incidence of disease recurrence. All patients had primary lesions invasive to Clark's level III or deeper and exceeding 1.0 mm in measured thickness. Ninety-six patients are available for analysis at 15 to 67 months (median: 30 months) after diagnosis. Nine patients have had a recurrence of disease (treatment failure), and one has died. Actuarial non-failure rate is 90%, and survival rate is 99% at five years. A nonrandomized but contemporary control group of 46 patients displaying comparable risk factors was treated with surgery alone. The non-failure rate of this group is 63%, and the survival rate is 69%, data consistent with the results of several published studies. These results suggest that transfer factor immunotherapy may be a valuable adjunct in the treatment of patients with high risk Stage I melanoma.

Pulmonary hyalinizing granulomas in a patient with malignant lymphoma, with development nine years later of multiple myeloma and systemic amyloidosis.

In our patient, multiple bilateral nodular pulmonary densities appeared on a chest x-ray at the time of diagnosis of stage IV diffuse lymphocytic lymphoma. After localized radiation therapy, the patient received no further systemic therapy. The pulmonary nodules slowly became larger and more numerous. Nine years later the patient developed proven multiple myeloma. Pulmonary hyalinizing granulomas have not heretofore been associated with proven lymphoreticular neoplasia, although this has long been suspected. The occurrence of two B-cell tumors at different points in time associated with systemic amyloidosis is an extremely rare event. The authors discuss the possibility that these conditions represent an abnormality in a common cell of origin with differing expression over time. Coincidence, however, remains a likely explanation for the different immunopathies that occurred in our patient.

The challenge of nutritional maintenance in cancer patients.

Weight loss and cachexia frequently accompany malignant disease and its treatment. Semistarvation is common in patients in hospital and in patients with cancer as well. Adequate nutrition is essential in treatment of malignant conditions. Patients and families as well as the medical community should use a comprehensive approach to improving the caloric and protein intake of patients who are still able to benefit from oral intake and further therapy.

Priapism and multiple myeloma. Successful treatment with plasmapheresis.

Priapism was associated with multiple myeloma and hyperviscosity in a sixty-year-old black male. Plasmapheresis treatment of the hyperviscosity corrected his priapism, and chemotherapy for the underlying multiple myeloma prevented the recurrence of priapism after a chronic intermittent history of seventeen years.

Multiple myeloma. Clinical correlation of immunoglobulin changes with therapy. A report of 23 cases.

Twenty-three patients with multiple myeloma were studied. They were grouped according to their clinical response and changes in myeloma globulin in the serum or urine while under chemotherapy. Sixteen responded favorably with clinical improvement and marked reduction in the respective M-globulins. Four did not respond and showed progression of disease, and three had short-lived clinical response with essentially unchanged myeloma-globulin values. Patients with renal insufficiency showed simultaneous improvement of uremia and M-globulins in response to chemotherapy. Three patients had solitary plasmacytomas when first seen, and dissemination occurred later in one. Combination of alkylating agents with steroids appeared to give faster, longer-lasting and more satisfactory clinical remissions, although the bone marrow may remain essentially unchanged. Radiation therapy was the most effective agent against localized pain (without altering the M-globulin) when used alone. Twenty-two of the 23 patients already had a significant decrease in IgM at the time multiple myeloma was diagnosed. A diminution in IgM can be considered of diagnostic significance although the mechanism for this reduction is not known. It has been felt to involve a feed-back mechanism, where one immunoglobulin elevation results in a subsequent diminution in the other immunoglobulins.