Advanced Cancer in Young Adults (YAs): Living in a Liminal Space

Young adults (YAs), defined as individuals between the ages of 18 and 39 years, experience unique challenges when diagnosed with advanced cancer. Using the social constructivist grounded theory approach, we aimed to develop a theoretical understanding of how YAs live day to day with their diagnosis. A sample of 25 YAs (aged 22-39 years) with advanced cancer from across Canada participated in semi-structured interviews. Findings illustrate that the YAs described day-to-day life as an oscillating experience swinging between two opposing disease outcomes: (1) hoping for a cure and (2) facing the possibility of premature death. Oscillating between these potential outcomes was characterized as living in a liminal space wherein participants were unsure how to live from one day to the next. The participants oscillated at various rates, with different factors influencing the rate of oscillation, including inconsistent and poor messaging from their oncologists or treatment team, progression or regression of their cancer, and changes in their physical functioning and mental health. These findings provide a theoretical framework for designing interventions to help YAs adapt to their circumstance.

Feasibility of a Keratin-Based Topical Cream for Radiation Dermatitis in Patients with Head and Neck Cancer: Results of a Randomized Pilot Study

PURPOSE/OBJECTIVE(S)

Acute radiation dermatitis (RD) is a frequent toxicity associated with radiotherapy (RT) for head and neck cancer (HNC). KeraStat Cream (KC), an emulsion-based wound dressing that acts as a protective barrier that promotes the healing of minor skin wounds and partial-thickness burns, has not yet been studied in patients receiving RT for HNC.

MATERIALS/METHODS

This randomized, open-label pilot study enrolled patients with HNC planned to receive definitive or postoperative RT to a total dose of at least 60 Gy. The study excluded patients with a history of prior RT, use of topical corticosteroids, scleroderma, lupus, or treatment with anti-EGFR therapy. Eligible patients were randomized to KC or routine skin care (RSC, patient choice of a variety of commercially available topical creams/lotions), applied at least twice daily during and for 1 month after RT. Assessments were performed at baseline, weekly during RT, and 1-month after RT. The primary outcome was adherence to the prescribed skin care regimen (at least 10 applications per week of treatment, starting at week 2). Secondary outcomes were the incidence rates of clinician-rated and patient-reported dermatitis (CTCAE and PRO-CTCAE grades 2+) and the Dermatologic Life Quality Index (DLQI, range 0-30 with a higher number indicating worse skin-related quality of life) at the last assessment before radiotherapy completion (end-RT).

RESULTS

Of 29 patients enrolled, 24 (n = 12 in each group) were randomized and completed the study. Most patients had stage III-IV disease (17, 71%), and the most common primary site was the oropharynx (n = 11, 46%), followed by the oral cavity (n = 7), larynx (n = 5), and sinonasal (n = 1). The median RT dose was 68 Gy (range 60-70), median skin V60 was 37.2 cc (range 1.5-107.6), and median skin V70 was 0 cc (range 0-24.9), with no differences between groups. The bilateral neck was treated in most patients (n = 19, 79%), primary site treated in 3 and unilateral neck treated in 2 patients. Most patients received concurrent chemotherapy (n = 18, 75%). Complete adherence to assigned skin care was observed in 7/12 (58%) patients in the RSC group vs. 10/12 (83%) patients in the KC group (p = 0.65). Nearly all patient-weeks were adherent: 64/67 patients in the KC group and 61/68 patients in the RSC group (p = 0.20). Incidence rates of G2+ RD were similar between the KC and RSC groups: CTCAE, 9/12 vs. 7/12 (p = 0.67); PRO-CTCAE, 10/12 vs. 8/12 (p = 0.64). When measured at end-RT, mean RD scores were similar between the KC and RSC groups: CTCAE, 1.4 vs. 1.8 (p = 0.30); PRO-CTCAE, 2.0 vs. 2.0 (p = 1); DLQI (4.8 vs. 4.6, p = 0.92). Repeated measures analysis showed no difference between arms for CTCAE (p = 0.72), PRO-CTCAE (p = 0.96), or DLQI (p = 0.78).

CONCLUSION

A randomized study of KC vs. RSC is feasible with good adherence to assigned skin care, particularly in the KC group. Future randomized trials are warranted to investigate the efficacy of this novel topical approach to RD during radiotherapy for HNC.

Supporting People and Their Caregivers Living with Advanced Cancer: From Individual Experience to a National Interdisciplinary Program

OBJECTIVES

To discuss the unmet needs of patients living with advanced cancer and their caregivers and to review strategies, including collaborating with community and non-profit organizations, to help improve the experience of living with, and beyond, advanced cancer.

DATA SOURCES

Published articles, first person experience (SB), community organization input, and survey data (Canadian Cancer Society).

CONCLUSION

People living with advanced cancer face significant challenges, including persistent physical symptoms and psychosocial concerns, difficulties with coordination of care, and possible lack of available resources and supports if the person is no longer being followed by cancer health care professionals. More research is required to better understand the needs of patients and their caregivers living with advanced cancer. Existing resources and supports may be inadequate for this population, and delineation of the unique needs of this population may lead to tailored care plans and, ultimately, an improved experience for patients and caregivers alike.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses are ideally suited to care for this population to help elucidate their unique unmet needs and collaborate with patients and other clinicians to develop interventions to address such unmet needs. Oncology nurses can liaise with community organizations to identify sources of support and resources for patients and their loved ones and advocate for improved care for patients affected by advanced cancer.

Return to Everyday Activity in the Community and Home: a feasibility study for a lifestyle intervention to sit less, move more, and be strong

BACKGROUND

Many interventions designed to meet physical activity guideline recommendations focus on a single component (e.g., walking), to the detriment of other elements of a healthy lifestyle, such as reducing prolonged sitting and doing balance and strength exercises (i.e., bundled multiple behaviors). Adopting these multiple health behaviors within daily life routines may facilitate uptake and support longer-term behavior change. We tested feasibility for a three-part lifestyle intervention to support older women to sit less, move more, and complete balance and strength exercises.

METHODS

We used a convergent parallel mixed-methods, single-arm study design to test feasibility for a 6-week lifestyle intervention: Return to Everyday Activities in the Community and Home (REACH). We collected information at baseline, 3 and 6 weeks (final), and 6 months (follow-up) using questionnaires, semi-structured interviews, and performance-based measures. We describe three key elements: (1) implementation factors such as recruitment, retention, program delivery, and adherence; (2) participants' acceptability and experience with the program; and (3) health outcomes, including participants' global mobility, activity, and perceptions of their physical activity identity, and habit strength for (i) physical activity, (ii) breaking up sitting time, and (iii) balance and strength exercises.

RESULTS

We were able to recruit enough participants in the allotted time to conduct one cycle of the REACH group-based program. There were 10 community-dwelling women, median (p25, p75) age 61 (57.5, 71) years, who completed the study. The program was feasible to deliver, with high attendance (mean 5/6 sessions) and positive overall ratings (8/10). Participants rated session content and length high, and educational materials as highly acceptable and understandable. Although participants were active walkers at baseline, few were breaking up prolonged sitting or participating in any balance and strength exercises. At final and follow-up assessments, participants reported developing habits for all three health behaviors, without diminishing physical activity.

CONCLUSION

These results show acceptability of the program and its materials, and feasibility for bundling multiple health behaviors within the REACH program. It also provides confirmation to advance to testing feasibility of this three-part lifestyle intervention with older, less active, adults.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier, NCT02786394; May 18, 2016.

Are serum cortisol levels a reliable indicator of wellbeing in the tammar wallaby, Macropus eugenii?

Serum corticosteroid levels were measured in six female tammar wallabies (Macropus eugenii) at Macquarie University, NSW, Australia, to assess their reliability as indicators of wellbeing in this species. Animals were challenged with a change in conditions over the course of approximately 3 weeks, comprising (i) isolation and movement; (ii) altered feeding routine, in order to impose a disturbance to homeostasis ("stress"). Blood samples were collected five times during the study period, and analysed for corticosteroid concentration and a number of haematological and biochemical measures. The use of enzyme immunoassay for the measurement of corticosteroids in marsupial serum was validated. We found that there was no significant change in serum corticosteroid concentrations in response to either of the changed conditions suggesting that serum corticosteroid concentrations are not reflective of a change in wellbeing. Cortisol was the dominant serum corticosteroid, with concentrations up to 50 times higher than corticosterone. Significant differences were observed in aspartate amino-transferase, alanine amino-transferase, haemoglobin, total erythrocyte count and mean corpuscular haemoglobin concentration over the period of study. However, no significant correlations emerged to justify any of these measures, or serum corticosteroid levels, as reliable indicators of compromised wellbeing in the tammar wallaby.

Carrier screening for Canavan disease in Australia

This study reports, for the first time, the carrier frequency of Canavan disease in the Ashkenazi Jewish population in Australia, and the identification of a novel mutation in the ASPA gene.

The frequency of founder mutations in the BRCA1, BRCA2, and APC genes in Australian Ashkenazi Jews: implications for the generality of U.S. population data

BACKGROUND

Several studies have shown that Ashkenazi Jews in the United States and Israel have a high prevalence of the founder mutations BRCA1 185delAG, BRCA1 5382insC, BRCA2 6174delT, and APC I1307K at frequencies of 1.0--1.1%, 0.2--0.3%, 0.6--1.4%, and 6.1--7.0%, respectively. The objective of this study was to compare the prevalence of these alleles in the Australian Jewish population with that of U.S. Jews. Australian Jews have a different history of migration, with less opportunity for changes in allele frequency due to conversion or intermarriage with non-Jewish Australians. The results obtained therefore can be used to assess whether U.S. data can be generalized to other Jewish populations. SUBJECTS AND METHODS. Subject samples were ascertained through a screening program for Tay-Sachs disease as part of a community-based screening program in New South Wales and Victoria. DNA extracted from 1200 deidentified blood samples was tested using amplification refractory mutation system polymerase chain reaction.

RESULTS

The allele frequencies found were as follows: BRCA1 185delAG 1.25% (95% confidence interval [CI], 0.62--1.88%), BRCA1 5382insC 0.25% (95% CI, 0--0.53%), BRCA2 6174delT 1.08% (95% CI, 0.50--1.67%), and APC I1307K 8.67% (95% CI, 7.07--10.26%). The prevalence of breast carcinoma predisposition alleles therefore is greater than 2.5% in Australian Ashkenazim.

CONCLUSIONS

There were no significant differences between the allele frequencies in Australian Ashkenazim and those identified in other studies with similar ascertainment strategies, despite the different migration patterns of Australian Jews. This suggests the broad applicability of the U.S. and Israeli data, not only to Australian Ashkenazim, but also to Ashkenazi communities throughout the world.

Plasma fibrinogen and other cardiovascular disease risk factors and cataract

PURPOSE

To determine whether associations exist between cataract and established cardiovascular risk factors (other than smoking) - hypertension, body mass index, serum lipids and plasma fibrinogen.

METHODS

The Blue Mountains Eye Study is a large (n=3654) population-based cross-sectional study conducted among people aged 49-97 years residing in the Blue Mountains, a region west of Sydney, Australia. Risk factor data were collected using standardised clinical procedures. Lens photographs were taken and graded for presence and severity of cortical, nuclear, and posterior subcapsular cataracts.

RESULTS

Cortical cataract was associated with a history of myocardial infarction, higher plasma fibrinogen, and higher serum cholesterol. Nuclear cataract was associated with a higher platelet count but hypertension was associated with lower prevalence of nuclear cataract. Posterior subcapsular cataract was associated with higher plasma fibrinogen and lower body mass index. Some of these associations appeared to be stronger in women than in men: fibrinogen and cortical cataract and body mass index and posterior subcapsular cataract.

CONCLUSIONS

Several risk factors for cardiovascular disease are associated with presence of cataract, perhaps explaining the observation in several studies that people with cataract have increased mortality rates. The possibility of strong associations between plasma fibrinogen and cataract merits further epidemiological and laboratory research.

Diabetes in an older Australian population

PURPOSE

To describe the prevalence of self-reported diabetes and undiagnosed diabetes using new fasting plasma glucose (FPG) criteria, and vascular associations with diabetes history in a representative sample of older Australians attending the population-based Blue Mountains Eye Study.

METHODS

3654 people aged 49 years or older, representing 88% of permanent residents in two postcode areas west of Sydney, underwent a detailed medical and eye examination. This included history of diabetes, vascular events and vascular risk factors. Fasting pathology tests, including glucose, were obtained for 88% of these subjects.

RESULTS

A diabetes history was given by 217 people (5.9%), including 7.0% of men and 5.2% of women. Elevated FPG (> or = 7.0 mmol/l) was found in a further 66 people (2.2% of persons who had FPG performed) and Impaired Fasting Glucose (FPG > or = 6.1 mmol/l and < 7.0 mmol/l) was found in a further 127 people (4.2%). History of diabetes was associated with an increased prevalence of obesity, elevated mean blood pressure and serum triglycerides, and lower mean serum cholesterol and HDL-cholesterol. Statistically significant associations were found between diabetes history and history of angina, acute myocardial infarction, stroke, gout and thyroid disease, after adjusting for age and sex using logistic regression. The vascular relationships with diabetes were stronger among people who currently smoked.

CONCLUSIONS

This study has found similar diabetes prevalence to recently published Australian National Health Survey findings. Strong cross-sectional associations between diabetes history and vascular events and increased prevalence of vascular risk factors among older subjects with diabetes emphasise the need to address vascular risk factors in this group.

Sonographic features of ovarian remnants

Ovarian remnants occur after a portion of ovarian tissue is left behind unintentionally after oophorectomy. The ovarian remnant may be functional and cystic, producing pelvic pain and, in some patients, extrinsic compression of the distal ureter. Ovarian remnants frequently are associated with adhesions from previous pelvic surgery for endometriosis or pelvic inflammatory disease. Ovarian remnants also may be included within pelvic peritoneal inclusion cysts. In this retrospective study, the sonographic features of ovarian remnants in 10 patients with surgical proof or clinical follow-up data are described. Most ovarian remnants were simple cysts (seven of 10), three had multiple septations, and six had a rim of presumably ovarian tissue with arterial and venous flow. Three patients with ovarian remnant masses that were aspirated had symptomatic relief without recurrence. In one patient, guided aspiration was unsuccessful, probably owing to the presence of organized hemorrhage within the mass. Extrinsic compression of the distal ureter was observed in one patient, who was treated with gonadotropin releasing hormone agonist (Lupron). The sonographic findings of a completely cystic or multiseptated pelvic mass with a rim of vascularized solid tissue in a postoophorectomy patient, although such cases are rare, suggest the diagnosis of an ovarian remnant. If the diagnosis can be established with a high degree of certainty, sonographically guided aspiration may be attempted in an effort to provide symptomatic relief. Otherwise, sonography is useful in serial assessment of these masses in patients receiving medical treatment.

Hematological indices in an older population sample: derivation of healthy reference values

Factors affecting hematological values were explored, and healthy reference values were estimated from a cross-sectional survey of a population (n = 4433), ages 49 years or more, residing permanently in a defined geographic region. Nursing home residents were excluded. Details of medication use and medical history were obtained by interview, and participants were asked to return after an overnight fast for blood sampling. The participation rate was 82.4%, of whom 88.4% provided a fasting blood sample. Hemoglobin, hematocrit, and erythrocyte counts were higher in men, whereas platelet counts were higher in women. Statistical associations between each hematological index and smoking, alcohol intake, use of certain drugs, chronic disease, and high creatinine values were tested by unpaired t-tests. Separate reference groups were defined for each hematological index by excluding subjects with any of the factors found to be of importance. The resulting reference values are particularly appropriate for evaluating hematological test results in older individuals.

A pilot study on the percutaneous absorption of microfine titanium dioxide from sunscreens

Many Australians are being advised to apply microfine titanium dioxide sunscreen daily from the cradle to the grave. However, there is a surprising lack of data on the percutaneous absorption of microfine titanium dioxide. A prospective pilot study was conducted to analyse the percutaneous absorption of microfine titanium dioxide from sunscreens. Selected patients scheduled to have skin surgery, applied titanium dioxide sunscreen to the skin daily for 2-6 weeks prior to their operation. After excision, the stratum corneum of the sample was stripped and the titanium concentration of the remaining epidermis and dermis was measured by inductively coupled plasma-mass spectrometry. The results from this pilot study showed that levels of titanium in the epidermis and dermis of subjects who applied microfine titanium dioxide to their skin were higher than the levels of titanium found in controls. Studies with larger cohorts are necessary to establish if this absorption is statistically significant.

Using Shewhart p control charts of external quality-assurance program data to monitor analytical performance of a clinical chemistry laboratory

We have investigated the application of Shewhart's p control charts in our external quality-assurance program to monitor the long-term performance of our laboratory's analytical quality. The p control charts have been able to detect long-term changes in our laboratory's analytical performance that would have been difficult to detect by more-conventional techniques. We have explored methods for interpreting these charts as well as some of their limitations, which include minimum subgroup size and dependence on constant specification limits. These charts may be not only a simple method for the long-term monitoring of analytical performance of a laboratory, but also of use to the organizers of external quality-assurance programs.

Using Shewhart p control charts of external quality-assurance program data to monitor analytical performance of a clinical chemistry laboratory

We have investigated the application of Shewhart's p control charts in our external quality-assurance program to monitor the long-term performance of our laboratory's analytical quality. The p control charts have been able to detect long-term changes in our laboratory's analytical performance that would have been difficult to detect by more-conventional techniques. We have explored methods for interpreting these charts as well as some of their limitations, which include minimum subgroup size and dependence on constant specification limits. These charts may be not only a simple method for the long-term monitoring of analytical performance of a laboratory, but also of use to the organizers of external quality-assurance programs.

Error rates in Australian chemical pathology laboratories

OBJECTIVE

To measure transcription and analytical errors made by Australian chemical pathology laboratories.

DESIGN

Retrospective data collection covering the period 1 November 1993 to 1 April 1994.

SETTING AND PARTICIPANTS

Fourteen pathology laboratories in five Australian States (seven in the public sector, and seven in the private sector).

MAIN OUTCOME MEASURES

Error rates in transcribing information from request forms to computer record systems, and laboratory performance on chemical analysis.

RESULTS

Pathology laboratories had a transcription-error rate of up to 39% and an error rate of up to 26% for analytical results. The worst-performing laboratory had errors (of patient identification or results of analysis) in 46% of requests. The three best-performing laboratories achieved 85% error-free reporting, with one achieving 95%.

CONCLUSIONS

Error rates in Australian pathology laboratories vary widely, but may be as high as 46% for all specimens in some laboratories. The types of errors reported were under the control of the laboratory, and would affect the accuracy of reported pathology test results, with potential adverse outcomes for patient care and inefficient use of health-care resources. There is a need to establish broader quality assurance programs and performance requirements to reduce these types of error.

The Tay-Sachs disease prevention program in Australia: Sydney pilot study

OBJECTIVES

To determine the frequency of heterozygous carriers of the Tay-Sachs disease gene in an asymptomatic Ashkenazi Jewish population and to compare the acceptability of different community testing strategies.

DESIGN

Pilot survey of carrier rates and community attitudes.

SETTING

Sydney, February 1993 to November 1994.

PARTICIPANTS

147 self- or medically referred people of Ashkenazi Jewish origin were tested. Jewish religious, medical and community organisations and leaders were consulted.

OUTCOMES

Prevalence of HEXA mutations, client and community preference for different testing and reporting strategies.

RESULTS

Frequency of heterozygous carriers was 1 in 18, with a relative frequency of the three major allelic variants similar to that in overseas studies. Most subjects were medically referred and preferred individual reporting of their carrier status. Community representatives had serious reservations about this strategy and few orthodox Jews participated in the study. An alternative strategy was developed for future testing.

CONCLUSIONS

Frequency of heterozygous carriers of the Tay-Sachs disease gene was higher than found among Ashkenazi Jews in other countries, possibly because of ascertainment bias. A testing strategy with medical referral and individual reporting of carrier status may not be appropriate for all the community at risk and a modified strategy is necessary.

Application of CQI tools to the reduction in risk of needlestick injury

OBJECTIVE

To reduce the risk of needlestick injuries to laboratory workers.

DESIGN

Continuous Quality Improvement (CQI) tools were applied to data collected on the number of blood gas syringes that arrived in the laboratory with needles still attached and to the reasons for these occurrences.

SETTING

A clinical chemistry department within a 900-bed tertiary referral university teaching hospital.

PARTICIPANTS

Clinical chemistry laboratory staff and medical staff responsible for sending syringes with needles still attached.

INTERVENTIONS

Changing to a preheparinized blood gas syringe that included a syringe cap within the packaging.

RESULTS

Fivefold reduction in the number of syringes arriving in the laboratory with needles still attached.

CONCLUSION

The risk of needlestick injury to laboratory workers can be reduced by provision to clinical staff of preheparinized blood gas syringes that include a syringe cap within the packaging. The techniques to CQI provide powerful tools for the identification, solving, and monitoring of safety-related issues within the healthcare environment.

Applying the Australian Quality Awards criteria to a clinical chemistry department

National quality award schemes can provide a detailed self-assessment process enabling an organization to assess its current position and to highlight opportunities for further improvement along the road to implementing best practice. This article describes how the Australian Quality Awards were used to guide the intermediate stages of implementation and to integrate some advanced stages of implementation of total quality management within a clinical chemistry department.

Ageing and the pursuit of slimness: dietary restraint and weight satisfaction in elderly women

Dieting and body dissatisfaction are highly prevalent amongst young women. In this study, dietary restraint, disinhibited eating, eating attitudes and body satisfaction were compared in elderly (ES) and young (YS) normal weight women. Dietary restraint and eating attitudes were similar across age groups. Differences between current body weight and desired body weight were equivalent for both age groups (ES, M = 10.8, SEM = 1.8 lb; YS, M = 11.3, SEM = 1.2 lb), although young women (Body Shape Questionnaire, BSQ, M = 78.5, SEM = 5.8) reported significantly greater dissatisfaction with their bodies than the elderly (BSQ, M = 61.7, SEM = 2.9). Of the elderly who had dieted, the majority had dieted five times or less, had started dieting between the ages of 40 and 50 years, and very few had dieted in their teens or twenties (< 8 per cent). Despite normal weight status, desire to lose weight and attempts to achieve this are experienced by young and old alike.

Taming the supplies and inventory process at Westmead Hospital

In July 1991, a team within the Clinical Chemistry Department at Westmead Hospital used control charts and other statistical tools to analyze the supplies and inventory process. No single major problem was discovered. Instead, the team found many small problems causing delays and inefficiencies in the process. By developing and implementing multiple solutions, the team was able to streamline the process and reduce the number of principal suppliers.

RESULTS

The number of principal suppliers was reduced by two-thirds. The average number of "urgent" orders, which add extra steps to the purchasing process, was reduced by three-quarters. The mean turnaround time for common clinical chemistry laboratory tests improved by 8%.

The ovarian remnant syndrome and ureteral obstruction: medical management

The ovarian remnant syndrome represents the development of symptoms due to residual ovarian tissue after bilateral salpingo-oophorectomy. Treatment generally consists of surgical resection but recurrence after resection is common. A case is reported in which a postoperative recurrent ovarian remnant was successfully managed by using a luteinizing hormone-releasing hormone agonist. In addition, this report includes a survey of gynecologists to determine the frequency of this syndrome and of ureteral involvement.

Decremental motor responses to repetitive nerve stimulation in ALS

Repetitive nerve stimulation (RNS) of the trapezius muscle at slow rates was performed on 192 patients with amyotrophic lateral sclerosis (ALS). Fifty-six patients (29%) showed classical neuromuscular decrement of 10-43% (mean 16.8%) while 44 patients (23%) had a borderline decrement of 5-9%. The trapezius was significantly more sensitive in revealing the defect than the distal hypothenar muscles. In 30 patients followed serially, the decremental response remained constant or increased with time. However, 25% of patients continued to show no decrement in spite of progression of disease. No statistical correlation was found between decrement and clinical severity, disease staging, or disease progression. The finding that at least 50% of ALS patients show some degree of decrement on RNS of the trapezius muscle suggests that functional alterations of the neuromuscular junction accompany this disease.

Reduction of errors in laboratory test reports using continuous quality improvement techniques

The techniques of continuous quality improvement have been applied to the problem of wrongly addressed clinical laboratory test reports. Over a 6-month period, flow charts of the process of producing test reports were created, the error rates of incorrectly addressed test reports were established, and the root causes of these errors were identified and progressively removed. A 17-fold sustained reduction in the rate of incorrectly addressed test reports was achieved with faster turnaround time, no significant expenditure of funds, and no changes in staff, equipment, or the laboratory information system.

Familial hypobetalipoproteinaemia: a rare presentation to the lipid clinic

OBJECTIVE

To report a case of familial hypobetalipoproteinaemia in a woman who presented after the incidental finding of marked hypocholesterolaemia during laboratory tests.

CLINICAL FEATURES

An asymptomatic 37-year-old Lebanese woman presented to the lipid clinic with a serum total cholesterol concentration of 1.1 mmol/L, high density lipoprotein (HDL) cholesterol of 1.0 mmol/L, and triglycerides of 0.28 mmol/L. No secondary cause for the hypocholesterolaemia was established. INVESTIGATION AND OUTCOME: Her serum apolipoprotein B (apo B) levels were markedly reduced at 0.07 g/L. Except for one daughter (IV-4), all other family members including her husband (her first cousin) had apo B levels about 25% of normal. Daughter IV-4 had undetectable apo B levels. Family studies confirmed an autosomal dominant pattern of inheritance consistent with familial hypobetalipoproteinaemia.

CONCLUSION

Familial hypobetalipoproteinaemia is a rare condition that should be considered in the differential diagnosis of hypocholesterolaemia. Absence of clinical features, autosomal dominant pattern of inheritance, and reduced apo B levels suggest the diagnosis.

Chorea and ballism

Chorea and ballism are hyperkinetic movement disorders which can be caused by a variety of conditions including metabolic abnormalities, neurodegenerative and immunologic disorders, as well as structural lesions. In addition, paroxysmal dyskinesias may be associated with chorea. Chorea is increasingly recognized as a symptom of a variety of different conditions. The pathophysiologic mechanisms underlying choreic disorders, however, need further elucidation.

Embryogenesis and plant regeneration from isolated microspores of Brassica rapa L. ssp. Oleifera

Conditions favourable to embryogenesis from isolated microspores of Brassica rapa L. ssp. oleifera (canola quality) were identified. A population with enhanced responsiveness for microspore embryogenesis (C200) was synthesized by crossing individual plants showing microspore embryogenic potential. For optimal microspore embryogenesis, buds (2-3mm in length, containing mid-late uninucieate microspores) were collected from older plants (2 months old) and microspores isolated and washed in iron-free B5 medium. NLN medium with its iron content reduced to half was beneficial for initial microspore culture. An elevated temperature(33-35°C) during the first day of culture, followed by maintenance at 25°C resulted in dozens of embryos from each isolation (about 100 buds). Seeds were obtained from plants regenerated from microsporederived embryos after colchicine treatment.