Elderly women with breast cancer often die due to other causes regardless of primary endocrine therapy or primary surgical therapy.

Survival and cause of death was investigated for Primary Surgical Therapy (PST) and Primary Endocrine Therapy (PET). Of women aged ≥75 years 113 patients received PET, 233 patients underwent PST. PST gave better survival, although this group was younger (p < 0.001). During follow-up the percentage of deaths due to breast cancer was similar and stable in both groups. Increased age was associated with a higher risk on death due to other causes (HR 1.11; CI 1.07-1.14), not on death due to breast cancer (HR 0.94; CI 0.87-1.01). The association of type of treatment and death due to breast cancer was not different between both groups in univariate analyses (HR 0.78; CI 0.44-1.39). In the multivariate model this non-significance remained after correcting for tumor size and age (HR 0.68; CI 0.33-1.42). Treatment should not be based merely on surgical treatment. PET may be an acceptable alternative.

Developmental changes in semantic verbal fluency: analyses of word productivity as a function of time, clustering, and switching.

We investigated age-related improvement in semantic category verbal fluency (VF) in 309 Dutch schoolchildren attending first to ninth grade. Quantitative analyses of number of correct responses as a function of time as well as qualitative analyses of clustering and switching were conducted. Overall, Dutch VF task performance, i.e., number of correct responses over 60 seconds, was not established before mid-adolescence. This is in line with previously published studies, using VF number of correct responses over 60 seconds as the main outcome measure and examining VF task performance across other cultures and languages (e.g., Italian, French, Hebrew). Next, mean cluster size, a measure of lexico-semantic knowledge, was not established until at least grade 3. In contrast, performance on the VF outcome measures "number of switches/clusters" was established at least 4 years later. Qualitative and quantitative Design Fluency (DF) outcome measures support the notion that the numbers of switches/clusters are valid measures of higher order cognitive functions, such as strategy use and cognitive flexibility. In line of this, VF number of correct responses during 16-60 seconds, a measure of controlled information processing, is established at least 2 years later (i.e., grades 7-8) than number of correct responses during the first 15 seconds time slide, a measure of automatic processing. Finally, environment, i.e., the level of parental education, primarily affected automatic and lexico-semantic knowledge. No effects of sex on VF performance were found. These data suggest that the alternative scoring methods of VF tasks can be used to acquire knowledge on development of lower and higher order cognitive functions in healthy children and the influence of the environment on it.

Video assisted thoracoscopic surgery (VATS) for pneumothorax: a reason for unscheduled surgery?

Timing of urgent surgery, with full schedules and the businesslike attitude of operating room management, can lead to animated discussions, affecting quality of care and job satisfaction. No publication appears to address the timing of definitive care for a stable, spontaneous, pneumothorax (SP) by unscheduled, or urgent, video assisted thoracoscopic surgery (VATS). We reviewed the literature and describe our series of 38 patients with SP and VATS. Of 185 patients with SP, 38 were presented for VATS. Of these 29% were unscheduled. Average time between diagnosis of SP and VATS was 11 days, with four days between decision for VATS and its execution. Post-operative antibiotics were prescribed to 37% of patients. There was a correlation between chest drain time in situ and infective signs (p = 0.001, rho = 0.654) as well as proven infections (p = 0.05, rho = 0.386), but not between for scheduled and unscheduled procedures. In conclusion, our case series and review did not identify reasons why VATS for SP should be performed as an urgent procedure, though we support more rapid planning.

Symptomatic nonunion of a distal phalanx fracture: treatment with a percutaneous compression screw.

Fractures of the distal phalanx caused by crush injuries occur frequently but rarely result in nonunions. This article describes 2 patients with a symptomatic hypertrophic nonunion after a fracture of the waist of the distal phalanx of the thumb. Following the general principles of nonunion treatment, both patients were successfully treated with a single compression screw inserted by a minimally invasive approach.

Differential development of learning strategies on a Pictorial Verbal Learning Test (PVLT) in primary-school children.

The aim of this study was to test the hypothesis that developmental differences exist in the use of learning strategies in primary school children. Serial and subjective clustering in a multitrial Pictorial Verbal Learning Test (PVLT) were compared in 79 children aged 6-12. Correlation analyses indicated that serial clustering yielded better performance when information was presented on the initial trials of the test. Subjective clustering was superior when information was presented repeatedly, i.e., after three or more trials. Analyses of variance indicated that subjective clustering was used more often in older children with repeated presentations. On the other hand, there was no increase in the use of serial clustering with age and with repeated presentations. The findings imply that training in the use of proper strategies could have benefit for children who use an inefficient learning strategy and/or have a learning problem. In addition, they point to the importance of the factor "age" in relation to the way information is presented to children.

The involvement of the agriculture industry and government in animal disease emergencies and the funding of compensation in western Europe.

In Western Europe, the control and eradication of contagious animal diseases have always been subject to government legislation. In the event of an outbreak, the principal policy is 'stamping-out' (depopulation) of the infected herd. The owner of the herd is usually awarded financial compensation. The authors provide an overview of the involvement of the agriculture industry and government in animal disease emergencies and the funding of compensation in Western Europe. In particular, developments within the European Union are described, as illustrated by a case study in the Netherlands. The economic consequences of a widespread epidemic of classical swine fever (hog cholera) in the Netherlands in 1997 are described. Evaluation of the epidemic demonstrated that special emphasis needs to be placed on factors such as the high-risk period, animal movement, the attitude of farmers towards risk and the structure of compensation. Epidemic disease insurance schemes are considered to be a possible alternative in alleviating certain financial losses caused by disease outbreaks.

Care of the family of the ICU patient.

A nurse working in intensive care may easily forget the first impact this environment makes and therefore may unintentionally overlook a family's needs. It is hoped that this article will help nurses recognize the importance of easing stress within the family as well as provide the tools to meet the needs of each family whose loved one enters an intensive care unit.

[Role of the veterinarian in safeguarding the quality of foods of animal origin (author's transl)]. / Taak van de dierenarts bij de kwaliteitsbewaking van voedingsmiddelen van dierlijke oorsprong.

The Minister van Agriculture and Fisheries will adopt policy measures regarding products of animal origin designed to promote the interests of producers and consumers in the fairest possible manner. For the veterinary inspector who has always been closely concerned in the production of these commodities, the result will be that his duties acquire a broader perspective.

[The use of drugs in animal breeding, viewed in the light of the quality of the finished animal product (author's transl)]. / Het gebruik van medicijnen in de dierveredelingssector, gezien in het licht van de kwaliteit van het dierlijke eindprodukt.

In view of the export of foods of animal origin by the Netherlands, it is essential: --to provide guarantees that these finished products shall be free from veterinary drug residues or that any residues shall not be in excess of fixed tolerance levels; --also to adjust legislation concerning the permissibility and use of veterinary drugs and feed additives to factors stimulating the transfer to finished animal products. Adequate methods of investigation will have to be developed; --to perform adequate tests for residues of groups of veterinary drugs on inspecting finished products of animal origin. When these residues are in excess of permissible levels, stock farmers should be prosecuted for possible improper use and the product in question should be condemned; --closely to follow developments in countries to which these products are being exported and to base policies on these developments; --to achieve a high degree of harmonization between legislation concerning veterinary drugs and criteria of investigation.