Louisiana health and nutrition survey.

The objective of this project was to conduct a survey to estimate the current prevalence of high-risk dietary, occupational, and other lifestyle factors in subgroups of the Louisiana population by age, sex, race, and geographic region. A probability sample of adult Louisiana residents was selected using a 3-stage cluster design identical to that used in the Louisiana Behavioral Risk Factor Surveillance System. The reduced version of the Health Habits and History Questionnaire developed by Block et al at the National Cancer Institute was administered by telephone. The survey results are presented and discussed.

Peripherally inserted central catheters: resistance to removal: a rare complication.

Peripherally inserted central catheters that resist removal occur in 8 of 829 catheters (0.965%). Several causes may be responsible as the reason for this phenomenon, such as infectious process, fibrin formation, and endothelial thrombosis. This article describes venospasm as confirmed by ultrasound as the cause. Removal in all but one catheter was completed in approximately 1 hour with gentle pulling, taped tension, and warm soaks for 20 minutes. Tourniquet application and gentle traction were employed. If unsuccessful, the tourniquet was removed and warm soaks reapplied. One catheter did not respond to this recommended treatment and was stuck for six days. Treatment of catheter embolus is outlined should the catheter be inadvertently broken during the removal process.

Characteristics of local recurrence following lumpectomy for breast cancer.

We report the clinical characteristics and treatment of local breast relapse in our breast cancer patients who were initially managed with breast conservation surgery (lumpectomy) alone. A retrospective study was conducted of 366 patients who were treated since 1977. The clinical, pathological, and treatment data regarding the primary tumor and the recurrences (91) were reviewed. The actuarial rate of local breast relapse in this group was 31% at 10 years. Breast relapse was significantly less in those patients 65 years old or greater. Acceptable treatment of the breast relapse included total mastectomy or repeat lumpectomy plus radiotherapy. Most relapses were small and occurred in the same area as the original tumor and had similar histology and estrogen and progesterone receptor values. About one-third of patients will have isolated relapses after conservation surgery alone, but in the older age group, isolated breast relapse occurs less frequently. The recurrences are usually surgically resectable, and acceptable results can be achieved with salvage surgery.

Total mastectomy is not always mandatory for the treatment of recurrent breast cancer after lumpectomy alone.

To determine the treatment that offered the best local control for isolated local recurrences of breast cancer after lumpectomy without radiotherapy, the authors reviewed 355 patients initially treated by lumpectomy (with or without axillary dissection) without radiotherapy. Local breast cancer recurred in 79 patients. They underwent either repeat partial mastectomy (PM) or completion total mastectomy (TM). Twenty-four patients (5 TM, 19 PM) received radiotherapy. Local control was defined as the absence of further recurrence of breast or chest-wall cancer. The 19 patients treated with repeat PM and radiotherapy had an actuarial local control rate of 82% at 5 years. Those treated with TM (28 patients) [corrected] or TM plus radiation (5 patients) had rates of local control of 60% and 52% respectively. Although there were no significant differences between the TM and PM plus radiotherapy groups, the 27 patients who had a repeat PM without radiotherapy had a significantly lower rate of local control (32%, p < 0.005). Treatment of recurrent breast cancer with PM and radiotherapy is a viable alternative to TM for enhancing local control. Repeat PM alone gave much poorer results. The authors conclude that local cancer recurrences after lumpectomy alone do not necessarily require TM and can often be treated with repeat excision and radiotherapy.

Tonometry comparison: Goldmann versus Tono-Pen.

Tono-Pen and Goldmann tonometers were compared in 152 eyes of healthy subjects (Group A) and 69 eyes of patients after intraocular procedures (Group B). In Group A, the readings from both the tonometers showed no statistically significant difference in the 0 to 15mmHg range. However, the Tono-Pen values were lower in eyes with intraocular pressures between 16 and 30mmHg (P less than .0001). This questions the reliability of Tono-Pen as an adequate screening instrument. The correlation between the two instruments was acceptable in Group B (r = .89), indicating that the Tono-Pen may be used cautiously to determine intraocular pressure in postoperative patients.