The Risk of a Shod and Unshod Horse Kick to Create Orbital Fractures in Equine Cadaveric Skulls.

Objective:  The aim of this study was to compare the potential of an unshod and shod hoof to cause an orbital fracture in the event of a kick.

Materials And Methods:  Thirty-four equine cadaveric orbitae were exposed to a steel or horn impactor in a dropping test set-up. An impactor velocity of 7 m/s was used for both materials.

Spatio-chemical characterization of a polymer blend by magnetic resonance force microscopy.

Magnetic resonance force microscopy (MRFM) is a promising method to obtain magnetic resonance images with nanometer resolution. One of the factors currently limiting its application to compounds with strong and possibly time-dependent dipolar couplings is the imperfect efficiency of the adiabatic inversion sweeps and the concomitant loss in the signal to noise ratio. We describe significant improvements to previous MRFM excitation schemes.

Automated NMR assignment of protein side chain resonances using automated projection spectroscopy (APSY).

This paper describes an automated method for sequence-specific NMR assignment of the aliphatic resonances of protein side chains in small- and medium-sized globular proteins in aqueous solution. The method requires the recording of a five-dimensional (5D) automated projection spectroscopy (APSY-) NMR experiment and the subsequent analysis of the APSY peak list with the algorithm ALASCA (Algorithm for local and linear assignment of side chains from APSY data). The 5D APSY-HC(CC-TOCSY)CONH experiment yields 5D chemical shift correlations of aliphatic side chain C-H moieties with the backbone atoms H(N), N, and C'.

[Pain in tumor patients: assessment and pain drug therapy].

This review gives an overview over the diagnostic and pharmacological approach to pain in cancer patients. The work-up and the pharmaceutical treatment is detailed and several important points in the use of opiates are highlighted.

[Prevalence and therapy of vascular risk factors in hospitalized type 2 diabetic patients].

Type 2 diabetes mellitus is often associated with other risk factors for atherosclerotic disease, resulting in a marked increase in cardiovascular events and deaths. Combined treatment of hyperglycaemia, dyslipidaemia and hypertension significantly decreases the frequency and severity of diabetic microvascular and macrovascular complications. In a prospective cohort study including 356 type 2 diabetic patients (= 14% of all in-patients during a 6 months' period) the prevalence and treatment of cardiovascular risk factors were determined.

[Castleman disease].

Background: The term "Castleman's disease" (angiofollicular lymph node hyperplasia) comprises a heterogeneous clinicopathologic entity among lymphoproliferative disorders.

Case Report: We present a rare case with retroperitoneal manifestations, and discuss several aspects of diagnosis, differential diagnosis, the clinical course and therapy of the disease. Finally, we summarize the actual knowledge about the pathogenesis of Castleman's disease.

[Sulfasalazine-induced pulmonary infiltrates and Legionella pneumonia].

After 2 weeks' treatment with sulfasalazine (SASP) and mesalazine enema, a 32-year-old female with recently diagnosed ulcerative colitis developed bilateral pulmonary infiltrates with peripheral eosinophilia. Both drugs were discontinued. In view of a high-positive antibody titre (1:4096) against Legionella pneumophila serogroups 1-5, legionnaires' disease was assumed and empirical antilegionella therapy with macrolid antibiotic was started.

[Recent development in the treatment of lung cancer: from the point of view of the medical oncologist].

After a short introduction to recent developments in the field of tobacco control, the non-surgical treatment of small cell and non-small cell lung cancer is summarised with special reference to practical aspects. The promising results obtained with newer cytostatic agents are reviewed. In small cell lung cancer, modern chemotherapy prolongs survival five-fold to an average of one year and 5-10% of all patients achieve long-term disease-free survival.

[A multitude of therapeutic possibilities--from the viewpoint of the clinician].

Modern medicine offers to patients and physicians an ever increasing multitude of diagnostic and therapeutic possibilities. Depending upon the individual viewpoint of the patient and the caregivers there may be different opinions about the "right" choice. This article reviews some of the potential problems and conflicts, which may arise from multiple diagnostic and therapeutic options.

[New cytostatic drugs--indications and costs].

In the last decade six new chemotherapeutic agents including the vinca alcaloid vinorelbine, the taxanes paclitaxel and docetaxel, the antimetabolite gemcitabine and the two topoisomerase I-inhibitors irinotecan and topotecan were shown to be active in several phase II- and randomized phase III-trials. This article reviews their mode of action, their efficacy, their side effects and their indications. Their state of registration and reimbursement by insurance companies in Switzerland are summarized.

Hereditary persistence of alpha-fetoprotein. Case report and review of the literature.

Persistently elevated alpha-fetoprotein (AFP) levels of 24 to 30 micrograms/ml (normal < 10 micrograms/ml) were found in a 38-year-old healthy man. Subsequently, AFP was found to be elevated in another five out of 13 family members within three generations. The pedigree is consistent with an autosomal dominant inheritance pattern.

Neuropharmacology of emesis and its relevance to anti-emetic therapy. Consensus and controversies.

Recent great advances in the neuropharmacology of the emetic pathways have led to better therapy and improved insight into pathophysiological processes in patients undergoing chemo- and radiotherapy. This article gives an overview of the area, outlines current controversies and makes recommendations for future clinical studies.

Initial prognostic factors in small-cell lung cancer patients predicting quality of life during chemotherapy. Swiss Group for Clinical Cancer Research (SAKK).

The question of whether initial prognostic factors in small-cell lung cancer patients have a predictive value for patients' quality of life (QL) during chemotherapy is addressed in the context of a randomised clinical trial comparing early and late alternating chemotherapy (SAKK protocol 15/84). The relative impact of initial tumour stage and performance status, previous weight loss, sex and age on patient-rated QL was analysed over six chemotherapy cycles in 124-130 patients (according to available QL data) with more than 400 questionnaires. Fatigue/malaise, personal functioning, emotional and general well-being were prospectively selected as QL indicators.

[Therapists' coping with his own abilities].

This review summarizes some of our current knowledge on the burn-out syndrome and details factors contributing to the high rate of emotional melt-down in health professionals. Possible coping strategies are detailed, and some personal thoughts how to prevent emotional exhaustion are given.

Early versus late alternating chemotherapy in small-cell lung cancer. Swiss Group for Clinical Cancer Research (SAKK).

Background: From 1984 to 1989, the Swiss Group for Clinical Cancer Research (SAKK) performed a randomized phase III trial comparing early versus late alternating chemotherapy in patients with small-cell lung cancer.

Patients And Methods: 406 eligible patients were entered into the trial. Regimen A consisted of PAV (cisPlatin, Adriamycin, VP 16-213, and Regimen B of CyMOC (Cyclophosphamide, Methotrexate, Oncovin, CCNU).

Quality versus quantity of life in the treatment of patients with advanced small-cell lung cancer? A randomized phase III comparison of weekly carboplatin and teniposide versus cisplatin, adriamycin, etoposide alternating with cyclophosphamide, methotrexate, vincristine and lomustine. Swiss Group for Clinical Cancer Research (SAKK).

Background: Based on a promising pilot study with weekly carboplatin and teniposide (CBDCA/VM) the Swiss Group for Clinical Cancer Research (SAKK) performed a randomised phase III trial in patients with extensive-disease small-cell lung cancer aimed at the development of an effective palliative treatment with low subjective toxicity.

Patients And Methods: From September 1989 to September 1991 patients were randomised to a weekly regimen of CBDCA/VM or to our 'standard chemotherapy' of cisplatin, adriamycin and etoposide alternating with cyclophosphamide, methotrexate, vincristine and lomustine (PAV-CyMOC).

Results: The trial was closed before the planned accrual of 140 evaluable patients due to a significant survival difference shown by an interim analysis.

Combined-modality treatment of small-cell lung cancer: randomized comparison of three induction chemotherapies followed by maintenance chemotherapy with or without radiotherapy to the chest. Swiss Group for Clinical Cancer Research (SAKK).

Background: From 1980 to 1983 the Swiss Group for Clinical Cancer Research (SAKK) performed a randomised phase III trial in patients with small-cell lung cancer with the objective of improving the results of induction chemotherapy and defining the role of consolidating chest irradiation.

Patients And Methods: Patients were initially randomised to induction arms AVP (adriamycin, etoposide and cisplatin given every four weeks for four cycles), EVA (cyclophosphamide, etoposide and adriamycin given every four weeks for four cycles) or MOC/AVP (methotrexate, vincristine, cyclophosphamide alternating with adriamycin, etoposide and cisplatin given for two cycles). All patients received prophylactic cranial irradiation with 30 Gy, and after four months of induction chemotherapy were randomized to maintenance chemotherapy with or without consolidating chest irradiation.

Ondansetron plus dexamethasone is superior to ondansetron alone in the prevention of emesis in chemotherapy-naive and previously treated patients. Swiss Group for Clinical Cancer Research (SAKK).

Background: This prospective, randomized, double-blind study assessed whether the addition of dexamethasone to ondansetron leads to improved control of chemotherapy--induced emesis, both in patients undergoing their first course of highly emetogenic chemotherapy and in chemotherapy-pretreated patients refractory to standard anti-emetics.

Patients And Methods: Patients were randomized to receive either 20 mg dexamethasone as an intravenous infusion or placebo plus ondansetron 8 mg 15 minutes prior to and 4 and 8 hours after the administration of chemotherapy. According to the randomisation code patients received from day 2 to day 5 either ondansetron 8 mg p.

Effect of thoracic radiotherapy on mortality in limited small cell lung cancer. A meta-analysis of 13 randomized trials among 2,140 patients.

This meta-analysis was designed to evaluate the hypothesis that thoracic radiotherapy contributes to a moderate increase in overall survival in limited small-cell lung cancer. We collected individual data on all patients enrolled before December 1988 in randomized trials comparing chemotherapy alone with chemotherapy combined with thoracic radiotherapy. The study included 13 trials and 2140 patients with limited disease.

What makes for successful TQM in the NHS?

A three-year evaluation of total quality management (TQM) at NHS demonstration sites shows there are clear factors which predict successful implementation of TQM. The intention is to raise awareness at both TQM and non-TQM sites of the need to have a structured, pre-planned approach to TQM, based on a thorough understanding of alternative approaches.