Follow-up in women with breast cancer: the patients' perspective.

We surveyed the opinions of patients on routine follow-up for early breast cancer to assess their satisfaction with current breast cancer follow-up arrangements, establish the issues that are important to patients in this setting and to assess their opinions on different models of care in breast cancer follow-up. A self-completion questionnaire was issued to 134 women attending an outpatient breast cancer follow-up clinic at a central teaching hospital in Glasgow. Most women (84%) considered follow-up 'important' and 90% were satisfied with current follow-up practice. Almost all patients (91%) were content with both the current frequency and duration of their appointments. Risk of recurrence and effects of treatment were considered the most important topics for discussion. Two-thirds of patients felt it was important to see the same member of staff at each follow-up appointment. The majority (64%) would have been satisfied with a nurse-led system of follow-up, whereas only 38% would be happy with General Practitioner-led care. Although patients are generally satisfied with current follow-up arrangements, most would accept the involvement of specialist nurses in conjunction with a consultant.

Problems associated with ultrasonography of the canine ovary around the time of ovulation.

Real-time B-mode ultrasound imaging was carried out, using a scanner of moderate quality, on 40 fresh bitch cadavers to identify the presence of ovaries and significant ovarian structures. The results indicated that accurate identification of the ovaries depended on the presence of significant follicles or corpora lutea (CL). The findings were verified at post-mortem examination. The study was continued by scanning 35 live bitches using three different scanning units of increasingly improved quality to show that the process of ovulation could be assessed with reasonable accuracy with improved quality of equipment, although the exact fate of the follicle could not be imaged. The results were judged against assays for blood circulating progesterone. A final group of seven live bitches were scanned with a high-grade scanner using an annular phased-array transducer to attempt to image the process of ovulation. The non-echogenic follicle disappeared and was replaced by the CL that was hypoechoic with respect to surrounding tissue, thus allowing accurate assessment of the time of ovulation. This was confirmed by progesterone assay.

Acute phase proteins in canine pregnancy (Canis familiaris).

An acute phase response has been identified during mid-gestation in bitches by determination of the serum C-reactive protein (CRP) concentration. In four pregnant bitches, a large increase in CRP during mid-gestation was followed by a second increase after parturition. In three pregnant bitches, a similar increase was observed during mid-gestation but the second (post parturition) increase was not detected. In two pregnant bitches only a small rise was observed in mid-gestation. No increase in CRP was observed in the serum of two bitches that were not mated following oestrus or in the serum of two bitches that were mated but did not become pregnant. One bitch was diagnosed as pregnant by palpation but did not produce a litter and did not have a mid-gestation increase in CRP. However, this animal did show an acute phase response shortly after oestrus.

Molecular biological methods for monitoring oocyte maturation and in vitro fertilization in bitches.

Oocytes were collected from ovaries of bitches, at various stages of the oestrous cycle, after routine sterilization. Cumulus-enclosed oocytes were cultured for 0-72 h in a modified M-199 medium containing 10% oestrous bitch serum and 20 micrograms oestradiol ml-1. For oocytes surrounded by two or more layers of cumulus cells, an increase in the expression of mRNA transcripts for zona pellucida glycoprotein 3 (ZP3) was seen and reached peak levels after 48 h culture in vitro. Histological assessment showed that 39% of these oocytes had extruded their first polar body after 24 h culture in vitro. When these in vitro matured oocytes were transferred to oviduct cell monolayers and inseminated with fresh dog spermatozoa in Medium-199 supplemented with 10% fetal calf serum and 50 mg gentamicin sulfate ml-1, penetration of the zona pellucida started 1 h after insemination for oocytes that had been cultured for 48 and 72 h. At 12 h after insemination both male and female pronuclei were seen in 37.5% and 20% of the oocytes incubated for 48 and 72 h, respectively. No further development was seen.

Effects of medroxyprogesterone acetate or gonadotrophin-releasing hormone agonist on suppression of spermatogenesis in the dog (Canis familiaris).

Medroxyprogesterone acetate (MPA) was administered as a depot injection to two adult male dogs. One was injected with 75 mg as a depot injection once a month for 2 months and the other with 50 mg at 2-weekly intervals for 1 month, followed by 100 mg at 2-weekly intervals for a further 2 months. Two other male beagles were given gonadotrophin-releasing hormone (GnRH) agonists (nafarelin derivative no. 49947 and nafarelin acetate) at a dose of 50 micrograms day-1 for either 22 or 23 days. The profiles of luteinizing hormone (LH) and testosterone were monitored before and during the treatment periods, and changes in the dogs' testes, epididymides and prostate glands were determined post mortem. In the MPA-treated animals, LH was suppressed for only very brief periods. In contrast, in the dogs treated with GnRH agonist, LH and testosterone concentrations were suppressed for most of the treatment period. In the MPA-treated animals, histological changes were seen mainly in the head of the epididymis, and in the acrosome region of the spermatozoa still present in this region of the male reproductive tract. The acrosome, instead of being closely applied to the sperm head, was in contact only in the most anterior areas, with the remainder forming a fan-like projection, indicating increasing detachment from the sperm head. In the dogs treated with GnRH agonist there was clear evidence of cessation of normal spermatogenesis in most of the seminiferous tubules. Changes in the histology of the head of the epididymis were similar to (but more profound than) those found in the dogs treated with MPA. Seminal changes were demonstrated in ejaculates collected during the latter stages of the treatment period.

Observations on the treatment and diagnosis of open pyometra in the bitch (Canis familiaris).

Eight bitches presenting with vaginal discharges were diagnosed as having open pyometra, as assessed by ultrasonographic, radiographic, haematological and clinical investigation. Plasma progesterone was assessed before treatment with prostaglandin F2 alpha (Dinoprost) and three of the bitches had low concentrations. Each bitch was given multiple injections of PGF2 alpha and monitored during and after treatment. All bitches had basal progesterone concentrations after treatment and the uterine diameters were markedly reduced by that time. One bitch has subsequently produced a litter of seven pups. Five of six bitches that were subjected to ovariohysterectomy 1-2 months later had normal uteri, although one had caseated areas in the uterine wall.

Comparison of endocrine changes and ultrasound as means of identifying ovulation in the bitch.

Twenty bitches were monitored through pro-oestrus and oestrus using both circulating plasma hormone levels and ultrasonic examination of the ovaries. Using luteinising hormone (LH) as being the generally accepted optimum indicator of the day of ovulation, comparisons were made of the accuracy of progesterone and ultrasound to identify ovulation. Progesterone agreed with LH in 12 of 20 bitches and was within one day in seven of the other eight. Ultrasound was less accurate in that only four of the 16 estimates agreed, with a further six being within one day. However, if only the bitches which were examined by ultrasound with the latest equipment were included, while only three of 11 coincided, six of the remaining eight were within one day of the LH estimated ovulation. It is concluded that, at present, of the rapid assessments, the measurement of plasma progesterone is a better estimator of ovulation than ultrasound.

Ovulation, fertilization and early embryonic development in the bitch (Canis familiaris).

Using circulating plasma hormone estimations, ovulation was monitored in bitches. The results obtained indicate that the timing of ovulation bears little relationship to alterations in sexual behaviour. The bitches were killed and reproductive tracts were removed at various intervals after ovulation and ova or embryos were recovered. The embryo stages were assessed visually and some were investigated histologically. Embryonic development, to early blastocyst stage, took place within the oviducts during the first 12 days after ovulation and there was a marked increase in size between the early and late blastocyst. A culture system using cells from the uterine tube supported the development of one 1-cell embryo to the morula stage.

A comparison of two techniques for the synchronisation of oestrus in dairy heifers.

Seventy-four heifers in four separate breeding groups were allocated into two treatment groups for oestrus synchronisation. Group 1 was given a combination of an initial injection of norgestomet and oestradiol valerate together with a norgestomet ear implant left in place for nine days. Group 2 was given two injections of the synthetic prostaglandin luprostiol 10 days apart. The animals in group 1 were artificially inseminated once 48 hours after the removal of the implant and those in group 2 were inseminated once 72 hours after the second injection of luprostiol. Subsequently any returns were rebred by either AI or natural service. There was no significant difference between the numbers of animals in the two treatment groups which were diagnosed pregnant 33 to 35 days after insemination, although the implant treatment gave a higher overall proportion of pregnancies (70 per cent, 51 per cent). It also gave significantly smaller numbers of 'open' days over the whole of the breeding period. A study of individual animals by progesterone assay and investigation of ovarian structures by real-time ultrasound showed that some of them had unusual progesterone profiles but nevertheless became pregnant. It would appear that a corpus luteum may be responsive to prostaglandins even though it is secreting only a low level of progesterone.

Insemination of beagle bitches with frozen semen.

Behaviour, vaginal cytology and plasma progesterone concentrations were monitored during oestrus in a group of 6 beagle bitches before intrauterine insemination with frozen semen. At intervals after insemination, the reproductive tracts were examined for evidence of conception, which occurred in 5 of the bitches. One pregnant bitch had received treatment with stilboestrol before insemination.

Control of breeding in the mare.

Six mares were studied over a period of two years under varying conditions of lighting from total darkness to normal ambient lighting. The mares continued to cycle during the winter under natural lighting and also when kept in total darkness. Circulating melatonin, progesterone and oestrogen concentrations were determined and related to clinical changes in the reproductive tract.

Plasma prolactin concentrations in non-pregnant mares at different times of the year and in relation to events in the cycle.

Plasma prolactin concentrations were measured in mares using an homologous radioimmunoassay. An annual rhythm in plasma prolactin was found, with concentrations higher during the summer than during the winter. In addition to this seasonal pattern, occasional high concentrations of prolactin were seen when concentrations were otherwise basal. Blood samples taken from mares during an oestrous cycle in October-November showed that prolactin values were basal for most of the cycle, with a marked rise in prolactin shortly before the onset of oestrus. This prolactin peak was associated with an increase in the size of the largest follicle, and with a peak of PGFM in some mares, but did not appear to be related to the LH surge. In oestrous cycles in March and May-June, there was a wide variation in the baseline of prolactin secretion, in accordance with the seasonal pattern already mentioned. However, the peak of prolactin seen around oestrus in October-November was less obvious in March and May-June. Post-partum mares showed a high but irregular profile of prolactin concentrations with no clear-cut pattern in relation to the oestrous cycle.

Plasma prolactin concentrations and cyclic activity in pony mares during parturition and early lactation.

Five pony mares were blood sampled during late pregnancy, foaling and early lactation. An homologous assay for horse prolactin was used to measure plasma prolactin concentrations in these samples. Regular estimates of cyclic activity were also made. Plasma prolactin concentrations rose markedly in the last week of pregnancy and remained high although variable in early lactation, before declining to basal levels by 1-2 months post partum. All mares showed a post-partum oestrus 7.0 +/- 0.9 days after parturition. One mare whose foal died shortly after birth showed a rapid decline in plasma prolactin values after death of the foal and an early oestrous period (4 days after parturition). The pattern of prolactin changes reported for the mare are in agreement with those reported for other mammalian species.

Assessment of oviduct potency in the cow.

A test of oviduct patency was developed, based on instillation of dye to the uterine horn through a two-way catheter. In 23 cows, two cases of bilateral and five cases of unilateral blockage were detected. Of 69 cow genital tracts collected from an abattoir, nine of 138 oviducts (7 per cent) did not permit the passage of dye. Fourteen of the remaining oviducts were found to blocked using a suspension of 80 micrometer pollen grains. This suggested that some animals showing patency to the dye test in vivo may in fact have abnormalities of the oviduct sufficient to prevent the passage of the ovum. In five cows, superovulation and embryo recovery were carried out as an investigation of oviduct patency and function. Although in one of the five cows, subsequently found to have a blocked oviduct, no embryos were recovered, ambiguous results were obtained in the other animals. The unpredictable response to superovulation may limit the application of this latter technique in investigation of oviduct patency and function.