The management of breakthrough cancer pain--educational needs a European nursing survey.

Poorly managed cancer pain is well known to profoundly impact the patient's daily life and interfere with quality of life. Nurses who cared for patients with cancer from 12 European countries participated in a survey of breakthrough cancer pain practice. The purpose was to investigate how nurses assess breakthrough cancer pain, use of standardised tools, confidence in supporting patients and awareness of medications. Responses from 1241 participants showed country variations. The majority of the sample was female, Germany had the highest proportion of male nurses (21.0%), followed by Greece (15.8%). A significantly larger proportion of nurses with longer experience and more education (78.8%) used a comprehensive definition of breakthrough cancer pain. Significant variations in training were found; 71% of Finnish nurses had received training compared with 6% of Greek nurses. Training and using a standardised assessment tool was associated with a significant increase in the nurses' perceived ability to distinguish between breakthrough and background pain. Nurses in countries with the highest proportion of training were most confident in supporting patients. In conclusion, there still exists problems with effective management of patients' breakthrough cancer pain, continuing inability to define the difference between background and breakthrough cancer pain leads to poor treatment.

Calcified foci at the junction between adrenal cortex and medulla of rhesus monkeys.

The occurrence of calcified foci at the junction of adrenal medulla and cortex in monkeys obtained from toxicity studies during a 10-year period is reported. The survey included reinvestigated adrenal samples from 274 male and 270 female rhesus monkeys and 52 male and 52 female cynomolgus monkeys. The incidence of calcified foci was 46% in male and 45% in female rhesus monkeys, and 6% in male cynomolgus monkeys, while their females did not show the lesion. In male rhesus monkeys, the mean number of foci was 4 for both glands, in females, 2 for the right and 4 for the left one. Initial stages indicated that the lesions develop possibly from focal apoptosis of medulla cells followed by a dystrophic mineralization. No correlation was observed concerning dose groups, test article, study length, testing facility, origin of monkeys, their sex, age, diet or final body weight. The foci of mineralization were dystrophic, species-specific in the rhesus monkey and possibly related to stress. The location of the foci at the cortico-medullary junction, precisely the location of the remnants of the fetal zone, may indicate their origin from this zone.

Long distance image transfer: first results of its use in histopathological diagnosis.

Histopathological images were transferred by use of normal telephone lines between three pathology institutes located in three different cities in the FRG. Images were digitized using a colour TV camera and stored in a special computerized image transmission system. The stored image was transferred and visualized on a (receiver) colour TV screen after dialing the telephone number connected to the receiver image transmission system. An additional telephone dialogue was activated by use of a normal acoustic telephone, and the diagnostic difficulties of the underlying image were discussed. Diagnostic assistance was possible in all transferred cases as well as histopathological diagnosis. Resolution of the images was set at 512 x 512 pixel x 8 bit. Image transfer time was 3.2 min on average. The differences between the original and transferred image were measured by "retransfer" of the original image and by subtracting the two images from each other. No major transfer errors could be measured.

Benign melanoma of the choroid in a beagle: ophthalmological, light and electron microscopical investigations.

A pigmented choroidal tumor was diagnosed in a 13-month-old male beagle. The tumor was observed ophthalmoscopically over a period of seven years. Light and electron microscopical features are those of a benign melanocytic tumor with marked histological similarities to uveal nevus in man.

Fixation-induced cyst-like spaced in the brains of rabbit foetuses.

During teratologic trials, routine investigations of 4261 brains from rabbit foetuses, fixed in Bouin's solution and sectioned by Wilson's free-hand razor blade technique, revealed cyst-like spaces in the brains of 164 foetuses (3.8%). The cyst-like spaces, characterised by the absence of an epithelial or endothelial lining, were usually solitary and occurred mainly in the massa intermedia of the thalamus. The spaces were found almost as ofter in control foetuses as in those from treated animals. On the basis of histologic examination and different fixation techniques, involving a further 1430 foetuses, these cyst-like spaces, previously interpreted as strain specific brain malformations, can be regarded as fixation artefacts.

Carcinogenicity study of lindane in the mouse.

Linadane (gamma-BHC) was investigated for its possible carcinogenic effect on 500 mice (250 males, 250 females) of the Chbi: NMRI (SPF) strain in a study lasting 80 weeks. A substance-related production of tumours was not evident at the dosage levels employed (12.5, 25 and 50 ppm). The tumours found corresponded in type and frequency to those occurring spontaneously in this strain. Electron-microscopical examination of livers, carried our at the same time, provided no evidence of Lindane-induced fine structural hepatocellular alterations.

[Occurrence of spontaneous tumours in the rat strain Chbb: THOM (SPF) (author's transl)]. / Spontan auftretende Tumoren des Rattenstammes Chbb: THOM (SPF)

400 albin rats (200 male, 200 female) of the strain Chbb: THOM (SPF) were investigated for the occurrence of spontaneous tumours over a period of almost three years. On day 750 of the study 78% of the male and 84% of the female animals were still alive. In 295 tumour hosts (73.8%) we discovered a total of 419 tumours. Several primary tumours were observed in 97 animals. The examinations revealed 240 tumours in the male and 179 tumours in the female rats. The highest tumour rate of 34.5% was established for adenomas of the interestial cells of Leydig in the testes. In female animals mammary tumours were the most frequent type of tumour, accounting for 31%. Talking into account the life expectation of the rats as well as the type and frequency of the tumours these results prove the suitability of this strain for carcinogenicity studies.

A contribution to the question of the possible hepatocarcinogenic effects of lindane.

The possible hepatocarcinogenic effect of lindane was studied in an 80-week study using 500 NMRI mice (strain Chbi : NMRI (SPF)). After giving doses of 12.5, 25 and 50 ppm in the food no compound-induced liver tumours were observed. Neither the occurrence of lymphatic leukemia, malignant haemangioendotheliomas, reticulum cell neoplasms nor liver cell adenomas could be related to the administration of the compound. In view of the actual residue level of lindane the probability of carcinogenic risk to man would appear remote.