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PubMed1998

The effects of perphenazine and bromocriptine on follicular dynamics and endocrine profiles in anestrous pony mares.

Nineteen anestrous pony mares were used in a project designed to determine the effects of altered prolactin concentrations on follicular dynamics and endocrine profiles during spring transition. The dopamine antagonist, perphenazine, was administered daily to mares (0.375 mg/kg body weight) in Group A (n = 6), while Group B mares (n = 7) received 0.08 mg/kg metabolic weight (kg75) dopamine agonist, 2-bromo-ergocriptine, intramuscularly twice daily. Mares in Group C (n = 6) received 0.08 mg/kg75, i.m., saline twice daily. Treatment began January 20, 1994, and continued until ovulation occurred. Mares were teased 3 times weakly with an intact stallion. The ovaries of the ponies were palpated and imaged weekly using an ultrasonic B-mode unit with a 5 Mhz intrarectal transducer until they either exhibited estrual behavior and had at least a 20-mm follicle, or had at least a 25-mm follicle with no signs of estrus. At this time, ovaries were palpated and imaged 4 times weekly. Blood samples were obtained immediately prior to ultrasonic imaging for measurement of prolactin, FSH and estradiol-17 beta. Perphenazine treatment advanced the spring transitional period and subsequent ovulation by approximately 30 d. Group A exhibited the onset of estrual behavior earlier (P < 0.01) than control mares. In addition, Group A mares developed large follicles (> 30 mm) earlier (P < 0.01) than Group B mares, with least square means for Groups A and B of 47.0 +/- 8.8 vs 88.1 +/- 8.2 d, respectively. Control mares developed 30-mm follicles intermediate to Groups A and B at 67.3 +/- 8.8 d. Bromocriptine decreased (P < 0.05) plasma prolactin levels throughout the study, while perphenazine had no significant overall effect. However, perphenazine treatment did increase (P < 0.05) mean plasma prolactin concentrations from Day 31 to 60 of treatment. There were no differences in mean plasma FSH or estradiol-17 beta between treatment groups. We concluded that daily perphenazine treatment hastened the growth of follicles and subsequent ovulation while bromocriptine treatment appeared to delay the growth of preovulatory size follicles without affecting the time of ovulation.

Anestrus↗
PubMed1977

Treatment of cryptorchidism by intranasal synthetic luteinising-hormone releasing hormone. Results of a collaborative double-blind study.

The effect of intranasal luteinising-hormone releasing hormone (L.H.R.H.) in 84 boys with unilateral or bilateral cryptorchidism was evaluated in a double-blind controlled trial. Boys with retractile testes were not studied. L.H.R.H. caused no side-effects; plasma antibodies to L.H.R.H. were never demonstrated. Four weeks' therapy with intranasal L.H.R.H. administered in six doses daily (1.2 mg/day) led to complete descent in 38% of a total of 61 testes, an improved position in 28%, and no response in 19%; 15% of testes were never palpated. After placebo the position of 25% of testes was improved; there was no response in 75% of a total of 51 testes. The success-rate seemed to be independent of age, but was related to the initial testicular position, with complete descent in only 11% of testes not previously palpated compared with 48% of testes found in the inguinal region.

Administration, Intranasal↗
PubMed1992

Vibrissal roughness discrimination is barrelcortex-dependent.

We have investigated the contribution of the neocortical vibrissal representation within the posterior medial barrel subfield (PMBSF) to the high performance levels obtained by rats in a complex roughness discrimination task mediated by vibrissal inputs. Nine binocularly occluded rats were trained in a two-choice roughness discrimination until they obtained the 85% correct response criteria. Subsequently, the PMBSF was localized by electrophysiological recordings and bilaterally ablated. The locus and extent of the cortical lesions were confirmed by histological analysis after additional training and testing. There was no evidence of task retention after the cortical lesion and barrelless rats were unable to obtain prelesion discriminative performance levels when stimulation was restricted solely to vibrissal cues. After extensive postlesion training, four of these rats were allowed to palpate the discriminanda with their forepaws. Under these conditions rats rapidly reached the 85% correct criterion once again. The present results indicate that the PMBSF is essential for complex tactile discrimination when sensory information is obtained through the vibrissae by active palpation. This deficit is specific for the vibrissal system, the PMBSF is not essential to solve the same tactile discrimination task when the source of the somatosensory information is provided by other non-vibrissal cutaneous sensory receptors.

Animals↗
PubMed2002

Risk factors for stillbirths in two swine farms in the south of Brazil.

We evaluated stillbirth risk factors in two commercial swine farms of the Rio Grande do Sul State (south of Brazil). The study was conducted during 1 month in Farm A and during 2 months in Farm B, both during 1999. Data for all farrowings that occurred during the study period were recorded (101 for Farm A and 373 for Farm B), without interference in the farm management. In Farm A, 39% of all litters born during the period of interest had stillborn piglets and the stillborn risk for piglets was 12%. In Farm B, 25% of all litters had stillborn piglets whereas the stillborn risk was 2%. Variables considered as potential risk factors for stillbirths were: parity (1, 2-3, 4+); breed (purebred or crossbred); sow body-condition (normal or fat); use of oxytocin during parturition (yes or no); obstetric intervention through vaginal palpation (yes or no); farrowing duration (<4 or > or =4h); mummified fetuses (yes or no); total litter size (<12 or > or =12 piglets); and litter birth weight (<11 or > or =11kg). All stillborn piglets had their classification validated by necropsy. In multivariable logistic-regressions, the cases were the litters having at least one stillborn piglet. In Farm A, litters having at least 12 pigs and in which oxytocin was used during the parturition had 20.8-times-higher odds of stillborn occurrence. In Farm B, litters from sows having parity > or =4 had 2.2-times-higher odds of stillborn occurrence than litters from parity 2 to 3 females, litters having > or =12 pigs had 2.0-times-higher odds of a stillborn piglet than smaller litters and farrowings in which vaginal palpation was performed had 8.0-times-higher odds. Farrowing room management to minimize stillborn risk should target higher-parity females, large litters and optimization of practices of obstetric interventions.

Animal Husbandry↗
PubMed2003

An economic risk assessment of the management of pregnant feedlot heifers in the USA.

Pregnant heifers are undesirable in the feedyard. We applied simulation modeling to a partial-budget model to compare alternative strategies for managing pregnant heifers in feedyards. The model was developed with input costs (cattle, preventive medical care, morbidity, mortality, treatments, and performance), input benefits (sales of poorly performing heifers, baby calves, open (non-pregnant) heifers, recently calved heifers, and pregnant heifers), and net returns as the output. Predicted mean net returns for feeding either open heifers or aborted heifers were greater than $ 100 (live-basis sales) to $ 200 (rail-basis sales) higher than for pregnant heifers. However, there was substantial variability in net returns for all three types of heifers. Net returns were compared among three decision choices made upon arrival of the cattle at the feedyard: (1) palpate all heifers and inject with abortifacient only those pregnant (PALABT), (2) inject all heifers with abortifacient without determining pregnancy status (ABTALL), and (3) do not palpate or administer abortifacient to any of the heifers (NOTHING). Predicted returns for PALABT and ABTALL were equivalent when estimated pregnancy prevalence was 43% (median net returns=$44.92 and $ 50.46, respectively). For heifer lots with pregnancy prevalences </=36%, PALABT yielded higher net returns than ABTALL but the opposite was true when the pregnancy prevalence was >/=49%. Net returns for PALABT and NOTHING were equivalent when the estimated prevalence of pregnancy was 2% on a live-basis sales (median net return=$50.05) and approximately 0.9% on a rail-basis sales (median net returns=$58.36 (PALABT) and $ 58.30 (NOTHING)) (with PALABT yielding positive net returns at the higher pregnancy prevalences). NOTHING yielded a positive net return relative to PALABT when the pregnancy prevalence was <1.5% (live-basis sales) and <0.5% (rail-basis sales).

Animal Husbandry↗
PubMed1988

Accuracy of blood pressure measurements made aboard helicopters.

Hemodynamically unstable patients will benefit from therapy to control their blood pressure only if this pressure can be determined with accuracy. We compared the accuracy of arterial blood pressure measurements taken aboard helicopters by palpation with a Doppler device and with an oscillometric device. Twenty critically ill patients who required an intra-arterial line had simultaneous blood pressures taken invasively and with one or more of the nonivasive techniques. A total of 222 comparisons was made. Error measurements are reported as mean +/- standard deviation; a high standard deviation implies inaccuracy in individual noninvasive measurements. Mean palpation error was 19 +/- 22 torr, mean Doppler error was 8 +/- 17 torr, mean oscillometric systolic error was 0 +/- 33 torr, and mean oscillometric mean blood pressure measurement error was 10 +/- 15 torr. A blood pressure undetectable by noninvasive means was no guarantee of a low arterial pressure: four patients with arterial systolic pressures from 45 to 138 torr had nonpalpable pulses; three patients had systolic pressures between 98 and 143 torr that were not detectable with the Doppler device; and two patients had systolic pressures of 70 and 110 torr that were undetectable by the oscillometric device. We conclude that aboard helicopters some ill patients cannot have accurate noninvasive measurement of their arterial blood pressure made with present technology. Relying on inaccurate blood pressure measurements may lead to therapeutic mishaps.

Aircraft↗
PubMed2000

Effects of latency and rate on bone formation in a porcine mandibular distraction model.

PURPOSE: Long treatment protocols currently limit the application of distraction osteogenesis (DO). The purpose of this study was to develop a porcine model for DO and to define the effects of latency and distraction rate on bone formation. MATERIALS AND METHODS: Distractors were placed through submandibular incisions. For analysis of latency, mandibular osteotomies were distracted after 0 (n = 3) or 4 (n = 2) days at a rate of 1 mm/d (7 days) with 14 days fixation. For analysis of rate, osteotomies were distracted at 1 mm (n = 4), 2 mm (n = 4), or 4 mm (n = 4) per day to produce a 12-mm gap with 24 days fixation. DO wounds were assessed in vivo with bimanual palpation to detect mobility across the gap. Harvested specimens were evaluated by gross appearance and bimanual palpation. Standardized radiographic techniques were used to estimate bone density. RESULTS: During DO, animals showed normal activity. There were no infections, and no distractors were removed prematurely. Clinical and radiographic evaluation of the groups that underwent distraction after 0- or 4-day latency showed equivalent healing. In the comparison of distraction rates, stability was greatest in the group distracted at 1 mm/d. CONCLUSIONS: A porcine model for mandibular DO has been developed in which mandibular lengthening was successfully performed without latency and at a rate of 1 mm/d. The relationships among latency, gap size, rate, and duration of fixation are poorly understood and can be defined with relevant animal models.

Animals↗
PubMed2000

Tumor necrosis factor-alpha in synovial fluid and plasma from patients with chronic connective tissue disease and its relation to temporomandibular joint pain.

PURPOSE: The purpose of this study was to determine the level of tumor necrosis factor-alpha (TNF-alpha) in the temporomandibular joint (TMJ) synovial fluid (SF-TNF-alpha) and blood plasma (P-TNF-alpha) of patients with chronic inflammatory connective tissue disease and investigate its relation to TMJ pain, hyperalgesia, and allodynia. PATIENTS AND METHODS: Twenty-four patients with a diagnosis of chronic inflammatory connective tissue disease and TMJ pain were included in the study. Visual analog scale, tenderness of the TMJ, and pain at mandibular movements were registered, and the pressure pain threshold and pressure pain tolerance levels were measured. TMJ synovial fluid samples and blood plasma were analyzed for TNF-alpha and the levels related to TMJ pain, hyperalgesia, and allodynia. RESULTS: TNF-alpha was present in the TMJ synovial fluid of 8 of 24 patients at levels significantly exceeding those in plasma at the same visit. The presence of SF-TNF-alpha showed a significant positive correlation to TMJ pain at maximum voluntary mouth opening and tenderness to posterior palpation of the TMJ. CONCLUSION: Local production of TNF-alpha occurs in the TMJ synovium of patients with chronic inflammatory connective tissue disease. Pain on mandibular movement and tenderness on posterior palpation (allodynia) of the TMJ is related to the level of SF-TNF-alpha.

Arthralgia↗
PubMed2003

A study of pelvic ligament strength.

OBJECTIVES: To measure the strength at tearing of pelvic ligaments used in the cure of prolapse and urinary incontinence. MATERIAL AND METHODS: We performed our measurements on pelvis ligaments from cadaveric specimens. We dissected 29 human female pelvis cadavers of which storage conditions differed. Ten were frozen, 10 fresh and 9 were stored in formalin. In each cadaver we dissected pre-vertebral ligaments at promontory and right and left symmetrical ligaments. These were the iliopectineal, sacrospinous and arcus tendineus of pelvic fascia. A subjective clinical evaluation of the ligament properties was performed by visual observation as well as finger palpation. Ligaments were classified into three groups. Group A contained high quality ligaments, in terms of thickness and apparent strength following finger palpation. Ligaments of doubtful quality were classified in group B and low apparent quality ligaments in group C. Then the ligaments were stitched by a suture taking the entire ligament and a force was applied on the vagina axis until tearing. The device used for strength measurement during traction was a SAMSON type force gauge, model EASY, serial number SMS-R-ES 300N manufactured by Andilog that was developed for the purpose of our study. Measurements were given in Newton (N). RESULTS: There was a great variability in the values obtained at tearing with minimal values at around 20N and maximal values at 200N. Individually measured, ligament strength varied between individuals, and for the same patient between the type of ligaments and the side. The pre-vertebral ligament was on average the strongest. There was no significant difference according to the storage condition except for the pre-vertebral ligament in formalin cadavers. For bilateral ligaments, there was no difference between the left and right side. The iliopectineal ligament was statistically significantly stronger than the sacrospinous and arcus tendineus of pelvic fascia. There was a correlation between subjective evaluation and objective strength measurements. DISCUSSION: No papers have been published on the strength of pelvic ligaments at tearing. These are however routinely used in the cure of prolapse and urinary incontinence. Our results show that there is a great variability in strength between individuals, and for a same patient between the types of ligaments and side. These observations could explain some of the surgical intervention failures and demonstrate the importance of per-operative strength evaluation. Per-operative subjective evaluation of strength is related to objective measurements and could be used to determine the type of ligaments to be used for surgical suspension. Freezing does not damage pre-vertebral ligament strength and further studies are required to evaluate elasticity of pelvic ligaments.

Biomechanical Phenomena↗
PubMed2002

Randomized controlled trial of botulinum toxin A for chronic myogenous orofacial pain.

The purpose of this study was to determine whether botulinum toxin A (BTX-A) was efficacious for the treatment of chronic moderate to severe jaw muscle pain in females. This was a randomized double-blind, placebo-controlled crossover trial of BTX-A. Twenty five units injected into each temporalis muscle and 50 U injected into each masseter muscle using three sites per muscle with 0.2 cm(3) per site. Data were collected at baseline, 8, 16, 24 weeks, with crossover occurring at 16 weeks. Primary outcome variables were pain intensity and unpleasantness, measured by horizontal visual analog scale (VAS). Secondary outcome variables were maximum interincisal opening without and irrespective of pain, muscle palpation tenderness (12 points), and four general questions. Fifteen female patients were enrolled (18-45 years), but only ten completed the trial. Of those who finished, no statistically significant difference was found in pain intensity (P=0.10), unpleasantness (P=0.40), palpation muscle tenderness (P=0.91), or the three general questions (P=0.64, P=0.66, P=0.67). Statistical significance was achieved for maximum opening without pain (P=0.02) and irrespective of pain (P=0.005) with the BTX-A arm having a relative decreased opening. No statistically significant difference was observed in any outcome measures except maximum opening, which showed BTX-A patient opening less wide than placebo. The results do not support the use of BTX-A in the treatment of moderate to severe jaw muscle pain in this patient population.

Adolescent↗
PubMed1997

Pain in spasmodic torticollis.

Spasmodic torticollis (cervical dystonia) is frequently a painful condition but little is known of the characteristics of the pain. We assessed 39 patients with spasmodic torticollis for the presence or absence, location, and quality of pain, as well as its correlation to postural abnormality. Muscle tenderness was evaluated by manual palpation and pressure algometry. Measurements were made on muscles either actively maintaining or opposing abnormal head posture, as well as on muscles not contributing to it. Control measurements were made in 18 healthy subjects. Two-thirds of patients reported continuous or intermittent recurrent pain. Pain was reported widespread and diffuse over the neck and shoulders, with some radiation, predominantly on the side toward which the head was twisted. There were no differences between study groups when compared for pressure algometry and only moderate differences when compared for manual palpation. No correlation was found between the severity of motor signs and pain. Degenerative changes seen on X-rays were similar in painful and pain-free patients. These findings suggest that pain associated with spasmodic torticollis does not arise in muscles alone, and we hypothesise that central mechanisms are also involved.

Adult↗
PubMed1997

Effect of intravenous sodium amytal on cutaneous sensory abnormalities, spontaneous pain and algometric pain pressure thresholds in neuropathic pain patients: a placebo-controlled study. II.

This study investigated the behaviour exhibited by 17 neuropathic pain patients (almost half of whom had documented neurological injury) with diffuse pain and extraterritorial sensory, sudomotor and vasomotor abnormalities, under the influence of intravenous administration of saline-controlled sodium amytal (SA), a medium action barbiturate. After SA (but not after normal saline) infusion, there was a dramatic and selective reduction of allodynia (touch-evoked pain) in all patients displaying this phenomenon, while pin prick and cold hypo- or hyperalgesia, as well as algometric pressure thresholds of the symptomatic limb (as a measurement of deep pain) were minimally changed in most patients. Spontaneous subjective pain was reduced substantially but not totally. The patients were able (once allodynia was eliminated) to recognize a deep-seated pain of which they were unaware before, evoked by firm but gentle palpation of the limb. Sympathetic blocks and A-fibre ischemic blocks in several patients and spinal stimulation in one patient produced effects identical to those observed during SA administration. The deep pain component was maintained despite elimination of allodynia even under stages of sleep induced by SA, at which time the patients would withdraw only the symptomatic limb upon firm but gentle palpation. We argue that neuropathic pain patients have two separate pain components, a cutaneous one (touch-evoked pain or allodynia) mediated by large fibres as a product of central sensitization, and a deep pain component mediated via nociceptors, which can be easily discriminated during systemic administration of SA.

Adult↗
PubMed2002

Dose response in prostate cancer with 8-12 years' follow-up.

PURPOSE: This communication reports the long-term results of the original group of prostate cancer patients who participated in the first prospective Fox Chase Cancer Center radiation dose escalation study for which 8-12 years of follow-up is now available. METHODS AND MATERIALS: Between March 1, 1989 and October 31, 1992, 232 patients with clinically localized prostate cancer received three-dimensional conformal radiotherapy only at Fox Chase Cancer Center in a prospective dose-escalation study. Of these patients, 229 were assessable. The 8-, 10-, and 12-year actuarial rates of biochemical control (biochemically no evidence of disease [bNED]), freedom from distant metastasis (FDM), and morbidity were calculated. The Cox proportional hazards model was used to assess multivariately the predictors of bNED control and FDM, including pretreatment prostate-specific antigen (PSA) level (continuous), tumor stage (T1/T2a vs. T2b/T3), Gleason score (2-6 vs. 7-10), and radiation dose (continuous). The median total dose for all patients was 74 Gy (range 67-81). The median follow-up for living patients was 110 months (range 89-147). bNED control was defined using the American Society for Therapeutic Radiology and Oncology consensus definition. RESULTS: The actuarial bNED control for all patients included in this series was 55% at 5 years, 48% at 10 years, and 48% at 12 years. Patients with pretreatment PSA levels of 10-20 ng/mL had statistically significant differences (19% vs. 31% vs. 84%, p = 0.0003) in bNED control when stratified by dose (<71.5, 71.5-75.6, and > 75.6 Gy, respectively) on univariate analysis. For the 229 patients with follow-up, 124 (54%) were clinically and biochemically without evidence of disease. Sixty-nine patients were alive at the time of last follow-up, and 55 patients were dead of intercurrent disease. On multivariate analysis, radiation dose was a statistically significant predictor of bNED control for all patients and for unfavorable patients with a pretreatment PSA <10 ng/mL. For the patients with a pretreatment PSA level of 10-20 ng/mL, the radiation dose was a statistically significant predictor across all groups. No radiation dose response was seen for those patients with a pretreatment PSA level >20 ng/mL, although large numbers of patients are required to demonstrate a difference. The radiation dose, Gleason score, and palpation T stage were significant predictors for the entire patient set, as well as for those with pretreatment PSA levels between 10 and 20 ng/mL. The FDM rate for all patients included in this series was 89%, 83%, and 83% at 5, 10, and 12 years, respectively. For patients with pretreatment PSA levels <10 ng/mL, all four covariates (radiation dose, Gleason score, pretreatment PSA, and palpation T stage) were significant predictors of distance metastasis. Using the Radiation Therapy Oncology Group morbidity scale, no difference was noted in the frequency of Grade 2 and 3 genitourinary and Grade 3 gastrointestinal morbidity when patients in this data set were stratified by radiation dose. However, a significant increase occurred in Grade 2 gastrointestinal complications as the radiation dose increased. CONCLUSION: The long-term results of the original Fox Chase radiation dose escalation study with >9 years of median follow-up confirm the existence of a dose response for both bNED control and FDM. The dose response in prostate cancer is real, and the absence of biochemical recurrence after 8 years demonstrates the lack of late failure and suggests cure.

Actuarial Analysis↗
PubMed2003

Does short-term androgen deprivation substitute for radiation dose in the treatment of high-risk prostate cancer?

PURPOSE: Randomized trials have corroborated the clinical benefit of adding androgen deprivation (AD) to radiotherapy (RT) in the treatment of high-risk prostate cancer. Another competing strategy is to escalate the RT dose using three-dimensional conformal RT (3D-CRT). In this analysis, we asked whether the addition of short-term AD (STAD) ( 20 ng/mL, Gleason score 8-10, or T3-4) prostate cancer is an effective substitute for dose escalation. METHODS AND MATERIALS: Between March 1, 1990 and November 30, 1998, 296 high-risk prostate cancer patients were treated with 3D-CRT alone (n = 206) or in combination with STAD (n = 90). The patient characteristics were median age 68 years, median follow-up 58 months, pretreatment initial prostate-specific antigen 21.8 ng/mL, RT dose 75 Gy, STAD duration 3 months, and time off STAD 64 months. The impact of STAD with respect to dose was examined using univariate analysis for dose ranges of <75 Gy and >or=75 Gy. Stepwise Cox proportional hazards regression multivariate analysis was performed to determine independent correlates of freedom from biochemical failure (bNED), freedom from distant metastasis (FDM), and overall survival. In a separate matched-pair analysis (n = 44 per group), those treated to <75 Gy + STAD (Group A) were compared with those who received >or=75 Gy alone (Group B). RESULTS: On univariate analysis, the addition of STAD had no impact on bNED, FDM, or overall survival in either dose group. On multivariate analysis, initial prostate-specific antigen level, palpation T stage, and RT dose were significant correlates of bNED. For FDM and overall survival, the significant covariates were palpation T stage and Gleason score, respectively. Finally, in matched-pair analysis, the higher RT dose group had a significantly greater bNED rate at 5 years (Group A 35% vs. Group B 57%, p = 0.0190). CONCLUSION: Our data suggest that STAD, as used here (median 3 months), is not a substitute for RT dose in the treatment of high-risk prostate cancer. RT dose is an essential element in the treatment of high-risk prostate cancer.

Aged↗
PubMed1998

Is there an increased risk of second primaries following prostate irradiation?

PURPOSE: To assess the risk of developing a second primary cancer following prostate irradiation compared to the underlying risk in patients with prostate cancer. METHODS AND MATERIALS: The baseline rate of secondary cancers following prostate cancer was obtained from a study of 18,135 patients from the Connecticut Tumor Registry, of whom only 12.5% received radiotherapy. These patients, with a mean age of 72 and a mean follow-up of 3.9 years, were compared to a cohort of 543 patients (median age 70) with similar follow-up (median 3.9 years), all of whom were treated with definitive radiotherapy at Fox Chase Cancer Center. The possible association between various covariates (age, dose, palpation stage, field size, Gleason score, pretreatment PSA) and the development of a secondary cancer was assessed. RESULTS: 1,053 of 18,135 patients (5.8%) in the Connecticut Tumor Registry developed a second primary cancer compared with 31 of 543 (5.7%) patients treated with prostate radiation (p = 0.99). Although this risk increases gradually over time, it is not significantly different, at any time period, between the two groups of patients. Of the 31 secondary primaries in the irradiated group, 82% had a history of tobacco and/or alcohol use. Only melanomas were significantly increased compared to the expected rate in an age-matched population (p < 0.001). Five of the 31 secondary cancers occurred within the radiation field (four bladder, one colon), four within 3 years and only one occurred 9 years after radiotherapy. No association was found between age (<70 vs. > or =70 and as a continuous variable), dose (<74 vs. > or =74 Gy), palpation stage ( or =T2C), field size (prostate vs. pelvic), radiation technique (conventional vs. conformal), Gleason score (2-6 vs. 7-10), or pretreatment PSA (<15 vs. > or =15 and as a continuous variable) and the risk of developing a second primary. Although a lower radiation dose (as a continuous variable) correlated with an increased risk of developing a secondary cancer (p = 0.04), this phenomenon is likely due to differences in follow-up time. CONCLUSION: Up to at least 10 years, there is no increased risk of developing a second primary cancer following prostate irradiation compared to the baseline rate from prostate cancer itself. This risk is not higher in younger patients with localized disease (<T2C), who often must choose between surgery and radiation. The vast majority of secondary cancers occurred outside of the radiation field (84%) and/or within 3 years of radiotherapy (97%), suggesting they were not caused by radiation. Most of these patients had lifestyles with predisposing risk factors. Patients with prostate cancer manifested a significantly increased risk of developing melanomas, suggesting that they may benefit from patient education and skin screening examinations.

Aged↗
PubMed1997

Efficiency of the OVATEC unit for estrus detection and calf sex control in beef cows.

Seventy five spring calving Gelbvieh and Angus cows were utilized over a three year period to evaluate the usefulness of the OVATEC intravaginal probe for indicating the onset of estrus and providing the possibility to influence the sex of the offspring by choosing a breeding time in relation to critical changes in cervical mucus conductivity. Cows were randomly assigned by breed each year into one of four treatments: (1) probed and inseminated when impedance values declined, creating conditions expected to favor X-bearing sperm and with it an increase in the conception of females (PF); (2) probed and inseminated when impedance values were rebounding, expected to favor Y-bearing sperms and with it an increase in the conception of males (PB); (3) standing estrus (AI); or (4) natural service by bull (NS). Cows grazed or were fed hay from tall fescue-legume pastures. Lutalyse was used to synchronize estrus in a two injection scheme. Vaginal probe readings were taken at first injection, second injection and every 12 h thereafter for 6 days. Visual observations for estrus were obtained for PF, PB and AI every 12 h postsecond injection. Rectal palpations of ovaries were obtained at standing heat in all but NS treatments. In cycling cows, probe readings increased prediction of estrus onset (P < 0.10) compared to visual observations and were similar (P > 0.95) to rectal palpations in all probed cows. PF cows delivered heifer calves at greater rates (P < 0.025) than all other treatments whereas PB cows delivered bulls at greater rates (P < 0.05) than all other treatments. Heifer to bull ratios were not different (P > 0.95) for AI or NS treatments. The results of this study indicate that the potential exists for increasing female offspring conceptions utilizing cervical mucus conductivity as a gauge for insemination times.

Administration, Intravaginal↗
PubMed1998

The clinical features of rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive damage of synovial-lined joints and variable extra-articular manifestations. Tendon and bursal involvement are frequent and often clinically dominant in early disease. RA can affect any joint, but it is usually found in metacarpophalangeal, proximal interphalangeal and metatarsophalangeal joints, as well as in the wrists and knee. Articular and periarticular manifestations include joint swelling and tenderness to palpation, with morning stiffness and severe motion impairment in the involved joints. The clinical presentation of RA varies, but an insidious onset of pain with symmetric swelling of small joints is the most frequent finding. RA onset is acute or subacute in about 25% of patients, but its patterns of presentation also include palindromic onset, monoarticular presentation (both slow and acute forms), extra-articular synovitis (tenosynovitis, bursitis), polymyalgic-like onset, and general symptoms (malaise, fatigue, weight loss, fever). The palindromic onset is characterized by recurrent episodes of oligoarthritis with no residual radiologic damage, while the polymyalgic-like onset may be clinically indistinguishable from polymyalgia rheumatica in elderly subjects. RA is characteristically a symmetric erosive disease. Although any joint, including the cricoarytenoid joint, can be affected, the distal interphalangeal, the sacroiliac, and the lumbar spine joints are rarely involved. The clinical features of synovitis are particularly apparent in the morning. Morning stiffness in and around the joints, lasting at least 1 h before maximal improvement is a typical sign of RA. It is a subjective sign and the patient needs to be carefully informed as to the difference between pain and stiffness. Morning stiffness duration is related to disease activity. Hand involvement is the typical early manifestation of rheumatoid arthritis. Synovitis involving the metacarpophalangeal, proximal interphalangeal and wrist joints causes a characteristic tender swelling on palpation with early severe motion impairment and no radiologic evidence of bone damage. Fatigue, feveret, weight loss, and malaise are frequent clinical signs which can be associated with variable manifestations of extra-articular involvement such as rheumatoid nodules, vasculitis, hematologic abnormalities, Felty's syndrome, and visceral involvement. Although there is no laboratory test to exclude or prove the diagnosis of rheumatoid arthritis, several laboratory abnormalities can be detected. Abnormal values of the tests for evaluation of systemic inflammation are the most typical humoral features of RA. These include: erythrocyte sedimentation rate, acute phase proteins and plasma viscosity. Erythrocyte sedimentation rate and C-reactive protein provide the best information about the acute phase response. The C-reactive protein is strictly correlated with clinical assessment and radiographic changes. Plain film radiography is the standard investigation to assess the extent of anatomic changes in rheumatoid arthritis patients. The radiographic features of the hand joints in early disease are characterized by soft tissue swelling and mild juxtaarticular osteoporosis. In the the past 10 years, ultrasonography has gained acceptance for studying joint, tendon and bursal involvement in RA. It may improve the early clinical assessment and the follow-up of these patients, showing such details as synovial thickening even within finger joints. Other imaging techniques, such as magnetic resonance, computed tomography and scintigraphy may provide useful information about both the features and the extent for anatomic damage in selected rheumatoid arthritis patients. The natural history of the disease is poorly defined; its clinical course is fluctuating and the prognosis unpredictable. RA is an epidemiologically relevant cause of disability. An adequate early treatment of RA may alter the diseas

Arthritis, Rheumatoid↗
PubMed2003

A prospective study of the value of axillary node sampling in addition to sentinel lymph node biopsy in patients with breast cancer.

AIMS: Limitations of sentinel lymph node biopsy (SLNB) include the occurrence of false negative (FN) results and the need to further treat SLNB positive axillae. The aims of this study were to: (1) compare the accuracy of SLNB alone to a combined SLNB and axillary sampling procedure (SLNB+AS). (2) evaluate if the additional AS could identify those SLNB positive cases with no further disease in the axilla. METHODS: Sixty-seven combined SLNB+AS procedures were performed prospectively in 66 patients, followed by Level II axillary dissection. Additionally sampled nodes were recorded if they were clinically suspicious or not at intra-operative palpation. RESULTS: The FN rate for SLNB alone was 14.3%, whilst that for SLNB+AS was reduced to 3.6%. However, the benefit of additional sampling was only seen in those cases with tumours >/=3 cm and clinically suspicious nodes (n=12). Of 12 cases with a positive SLN but negative AS, 4 (30%) were found to have disease elsewhere in the axilla. CONCLUSION: SLNB is inaccurate in the presence of suspicious nodes found at operation and careful palpation and sampling of these nodes is recommended, especially with larger tumours. In SLNB positive patients, AS is unreliable in predicting those patients with no further disease in the axilla.

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