Changes in the intestinal mucosal cell populations of German shepherd dogs fed diets containing different protein sources.

Sixteen German Shepherd Dogs from 4 litters were IgA-deficient on the basis of at least 1 of 2 serum IgA determinations, and all had small intestinal bacterial overgrowth, as documented by quantitated small intestinal bacterial culture in another study. These dogs were fed 2 diets that differed principally in their protein source (chicken vs beef, milk, and wheat). All dogs were fed each diet for 2 weeks before the study began. Next, all dogs were fed the chicken-based diet for 2 months. Then, half the dogs (group 1) were randomly assigned to continue eating the chicken-based diet, while the other half (group 2) ate a diet containing beef, milk, and wheat proteins. The small intestine was biopsied at the beginning of the study and after dogs had eaten the assigned diet for 2 and 4 months. At 2 months, group-2 dogs had more colonic mucosal mast cells, but this difference did not persist at 4 months. At the end of the study (ie, 4 months), although all dogs were clinically normal, group-2 dogs had significantly (P = 0.010) decreased numbers of jejunal villus plasma cells. However, these histologic changes were not considered clinically important. There were no significant differences in blood eosinophil counts, serum trypsin-like immunoreactivity, or cobalamin, folate, or IgA concentration. Clinical differences were not detected between the 2 groups, before or after the study. Changes were seen in serum IgM and IgG concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical interventions that can improve quality of life for older cancer patients.

Up until the last several decades, surgeons have of necessity focused on survival as the first priority of cancer treatment, and quality of life has been a secondary issue. Now, very radical surgical procedures are less often necessary, because early diagnosis and smaller tumors are more common, and because radiotherapy and chemotherapy have been shown to be as or more effective than extensive surgical resections for many large cancers. Therefore, surgeons can select treatment options that maximize quality of life without increasing the risk of treatment failure. Older patients respond to surgical cancer treatment in much the same way as younger adults, and can benefit greatly from this flexible therapeutic approach. Solid tumors for which treatment options are discussed in this paper include cancer of the breast, rectum, prostate, oral cavity, melanoma, and soft tissue sarcoma.

Cancer control and the older person. Prevention and detection in older persons.

Older persons are appropriate targets for a range of prevention and early detection interventions, however, greater emphasis should be given to structuring the delivery of prevention and detection services to the special needs of this population. This may require research and program development to reach older persons in the most effective and cost-effective manner. The American Cancer Society and other program efforts must accommodate the heterogeneity and special needs of segments of the older population. Racial and cultural minorities, impoverished persons, the cognitively impaired, and the physically impaired are four groups requiring special attention. Early detection guidelines specific to older persons should be developed.

An outbreak of infectious conjunctivitis spread by microscopes.

Among the potential occupational hazards of microscope use is the transmission of infectious agents among employees. We report a large (145 cases) and costly (+647,000) epidemic of viral conjunctivitis in a microelectronics factory. Spread of the illness appeared to be through sharing of microscopes among employees. Routine handwashing instructions and safety glasses failed to prevent spread of the epidemic. Mandatory screening prior to work and temporary plant shut-down were finally successful. We discuss efforts to control this outbreak and make recommendations to prevent similar epidemics in other workplaces.

Determinants of physicians' preferences for alternative treatments in women with early breast cancer.

To learn about factors, that influence a physician's decision making, a mail survey was conducted asking physicians about their preferences for radical mastectomy vs. local excision plus irradiation, and for adjuvant chemotherapy vs. no adjuvant treatment for two hypothetical women with operable, clinical stage I breast cancer - one 35 years old and the other 60 years old. Two hundred and sixty-one physicians from varied specialties in Connecticut and Massachusetts returned the questionnaire. Approximately half of the respondents would accept either mastectomy or limited surgery plus radiation therapy for either patient. Adjuvant chemotherapy was recommended by 97% of respondents for the younger patient and by 66% for the older patient. Several factors appeared to be related to therapeutic preferences. An individual physician's attitude towards patient involvement in decision making was the most important predictor of surgical preference for both the patients, whereas the role of specialty (i.e., surgeons vs. other providers) was more important for the surgical management of the older patient. For the decision involving adjuvant chemotherapy, specialty, hospital size, and presence of radiotherapy equipment on site were important predictors. Factors other than survival (such as disease-free interval and cosmetic results) were viewed as important standards of effectiveness by some physicians.

Electrocoagulation for intraoral cancer.

Electrocoagulation of 58 intraoral lesions (1 to 6.5 cm in diameter) resulted in a three-year absolute disease-free survival rate of 59% (34/58). During the 20-year study, 43 (74%) of the 58 patients were cured. Though an initial 28% local failure rate was observed, 31% (5/16) of these patients were subsequently cured by a second electrocoagulation. Electrocoagulation has distinct advantages over conventional surgery and irradiation. Relatively little tissue beyond the tumor is coagulated. Such tissue sparing allows better postoperative function and cosmesis. The deleterious effects of irradiation, including the serious "dry-mouth" syndrome, are avoided. These treatment results are competitive with those of conventional surgery and irradiation. The limited field treated, the tissue conservation, the minimal morbidity, and the cost-effectiveness should make electrocoagulation a real consideration in treating selected invasive intraoral tumors. Ideally suited for electrocoagulation are those patients whose lesions are small, easily visualized, mobile, and well differentiated.

Occupational hazards to hospital personnel.

Hospital personnel are subject to various occupational hazards. Awareness of these risks, compliance with basic preventive measures, and adequate resources for interventions are essential components of an occupational health program. Physical, chemical, and radiation hazards; important infectious risks; and psychosocial problems prevalent in hospital workers are reviewed. A rational approach to managing and preventing these problems is offered.

The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients treated by primary radiation therapy.

The extent of the surgical resection necessary for breast cancer patients treated by primary radiation therapy is unknown. A simple gross excision of the tumor provides the best cosmetic result, but a wide local resection may be important to prevent local recurrence in some patients. In order to identify patients who are not adequately treated by gross excision of the tumor and radiation therapy, we performed a retrospective clinical-pathologic review of 221 treated women with infiltrating duct carcinoma. There were 53 cases in which the excision specimen showed a constellation of three pathologic features: prominent intraductal carcinoma in the tumor, intraductal carcinoma in the grossly-normal adjacent tissue, and poorly-differentiated nuclei. These cases had a 37% risk of a local recurrence at 6 years compared to eight per cent for all other cases (p less than 0.0001). In cases with all three features, the use of a supplemental dose of radiation to the primary site did not significantly reduce the risk of a local recurrence. Local recurrence at 6 years was 34% in cases with all three features, who received supplemental local radiation, compared to 49% in cases not receiving a supplemental dose (p = 0.28). Survival was also worse for patients with all three features compared to other cases (69% vs. 90% at 6 years, p = 0.002). These results indicate that patients with all three pathologic features have a high risk of local recurrence following gross excision of the tumor and radiation therapy. If primary radiation therapy is selected for these patients, they should first undergo a re-excision of the tumor site in order to be certain that areas of extensive intraductal carcinoma have been adequately resected. Patients whose tumors do not show all three features are adequately treated by gross excision of the tumor prior to radiation therapy.