A Descriptive, Longitudinal Study of Quality of Life and Perceived Health Needs in Patients With Head and Neck Cancer.

Patients with head and neck cancer have numerous concerns and symptoms in the first year of posttreatment survivorship and are especially vulnerable at the end of treatment and 1 month posttreatment. This article shares the findings of a descriptive, longitudinal study of health-related quality of life (HRQOL) in patients with head and neck cancer from the beginning of treatment through 12 months posttreatment. The primary objective of this study was to describe the symptom experience and health needs of patients receiving radiation for head and neck cancer to support the establishment of an advanced practitioner (AP) clinic for head and neck cancer survivors. Significant findings in this study showed HRQOL at the end of treatment was significantly lower than baseline (p < .001). Low scores persisted through 1 month, with gradual recovery by 12 months. Fatigue and anxiety had the highest mean scores, yet anxiety improved with time, whereas fatigue did not. Positive human papillomavirus status was statistically associated with higher anxiety. Socioeconomic status negatively impacted HRQOL. Themes of perceived health needs were managing oral symptoms, returning to a normal life, and regaining energy. The AP in oncology can play a pivotal role in providing comprehensive assessment, symptom management, health education, and supportive counseling in this population throughout treatment and survivorship.

Phase I/II trial of all-trans retinoic acid and tamoxifen in patients with advanced breast cancer.

Because tamoxifen and all-trans-retinoic acid (ATRA) have additive antitumor effects in preclinical systems, we performed a Phase I/II clinical trial of this combination in patients with advanced breast cancer. Patients with potentially hormone-responsive advanced breast cancer were enrolled. All received 20 mg of tamoxifen by mouth daily. Consecutive cohorts of 3-6 patients were treated on odd-numbered weeks with ATRA at doses of 70, 110, 150, 190, or 230 mg/m2/day. Twenty-six patients were entered in this trial; 25 were evaluable. A dose of 230 mg/m2 ATRA produced unacceptable headache and dermatological toxicity, but doses < or = 190 mg/m2 were tolerable. Two of 7 patients with measurable disease responded. Seven of 18 patients with evaluable, nonmeasurable disease achieved disease stability for more than 6 months. Plasma AUCs on day 1 of successive weeks of treatment were stable over time. A nonsignificant decrease in serum insulin-like growth factor I levels was noted during treatment, but this trend was similar to that observed in three "control" patients treated with tamoxifen alone. When given with daily tamoxifen, the maximum tolerated dose of ATRA that could be given on alternate weeks was 190 mg/m2/day. This schedule of ATRA resulted in repeated periods of exposure to potentially therapeutic concentrations of ATRA. Declines in the serum insulin-like growth factor I concentrations observed in patients treated with tamoxifen and ATRA were similar to those observed in patients treated with tamoxifen alone. Objective responses were observed, some in patients who had previously progressed while receiving tamoxifen, suggesting that further studies would be of interest.

Successful thrombolysis of an occluded modified Blalock shunt three days after operation.

A 10-day-old boy with pulmonary atresia received a right-sided aortopulmonary polytetrafluoroethylene shunt. Three days after the operation he became cyanotic and was reintubated. Shunt occlusion was confirmed with angiography. Recombinant tissue plasminogen activator was given locally into the proximal end of the shunt. The thrombus was completely resolved after 2 days. When administration of recombinant tissue plasminogen activator was stopped, heparin infusion was started for 5 days. Shunt patency was demonstrated by angiography at 3 months postoperatively.

CP43', the isiA gene product, functions as an excitation energy dissipator in the cyanobacterium Synechococcus sp. PCC 7942.

Under conditions of iron deficiency certain cyanobacteria induce a chlorophyll (Chl)-binding protein, CP43', which is encoded by the isiA gene. We have previously suggested that CP43' functions as a nonradiative dissipator of light energy. To further substantiate its functional role an isiA overexpression construct was introduced into the genome of a cyanobacterium Synechococcus sp. PCC 7942 (giving isiAoe cells). The presence of functional CP43' in isiAoe cells was confirmed by Western blot as well as by the presence of a characteristic blueshift of the red Chl a absorption peak and a notable increase in the 77 K fluorescence peak at 685 nm. Compared to wild-type cells isiAoe cells, with induced CP43', had both smaller functional antenna size and decreased yields of room temperature Chl fluorescence at various light irradiances. These observations strongly suggest that isiAoe cells, with induced CP43', have an increased capacity for dissipating light energy as heat. In agreement with this hypothesis isiAoe cells were also more resistant to photoinhibition of photosynthesis than wild-type cells. Based on these results we have further strengthened the hypothesis that CP43' functions as a nonradiative dissipator of light energy, thus protecting photosystem II from excessive excitation under iron-deficient conditions.

Percutaneous nephrostomy in infants and children.

RATIONALE AND OBJECTIVES: The purpose of this study was to review the authors' experience with percutaneous nephrostomy during an 11-year period, paying special attention to indications and outcomes. MATERIAL AND METHODS: The records of 71 percutaneous nephrostomy procedures performed on 59 children at the authors' institution from January 1987 through December 1997 were retrospectively reviewed. In these children, ultrasonography was used for puncture and fluoroscopy for catheter insertion. Local anesthesia with sedation was used and later replaced by general anesthesia. Loop-end catheters were employed. The smallest patient weighed 1,200 g, and the mean patient age was 3.4 years. RESULTS: The mean duration of drainage was 60 days, and the longest time was 11 months. Indications were mainly obstructions, with congenital obstruction (n = 28) and postoperative obstruction (n = 26) being the most common. Obstructive pyelitis, malignancy, stone, renal cystic disease, trauma, and neurogenic bladder disturbance were also indications. No complications such as loss of the kidney, serious infection, or hemorrhage of clinical importance were observed. Obstruction was successfully relieved in all patients, but 12 kidneys and five hemikidneys did not recover function and were eventually removed. CONCLUSION: The percutaneous nephrostomy procedure is a safe technique that can be used successfully for short- and longterm drainage in all children, even in small infants and those with solitary kidneys, and is a valuable adjunct to surgery.

Bilaterality in slipped upper femoral epiphysis.

The frequency of slipping and osteoarthritis of the contralateral hip was recorded in 260 patients with slipped upper femoral epiphysis between 1910 and 1960. Twenty-three of these patients (9%) had primary bilateral slipping, 32 (12%) had a contralateral slip diagnosed later during adolescence and a further 104 (40%) had signs of contralateral slipping at follow-up 16 to 66 years later, giving a total of 159 cases (61%) with bilateral slips. Of the 104 slippings diagnosed at follow-up, 25% showed osteoarthritis. It is concluded that, with a slipped epiphysis, prophylactic contralateral pinning should be performed to avoid slipping and to reduce the risk of osteoarthritis.

Embolization of hepatic hemangiomas in infants.

A small number of cavernous liver hemangiomas in infants cause serious symptoms, requiring active treatment. We report two newborns with giant liver hemangiomas, treated by intra-arterial embolization. The babies presented at 2 - 8 days after birth with tachypnoea and cardiac dilation. A giant liver hemangioma located in the right liver lobe in one infant and in the left liver lobe in the other was found at ultrasonography and computed tomography. Dilated liver veins indicated abnormal shunting of the blood through the hemangiomas. Because of progress of symptoms superselective embolization of the arteries feeding the hemangiomas and arising from the celiac trunk was performed with a mixture of Lipoidol and Histoacryl. A decrease of tachypnoea and of heart volume was noted after embolization. In one infant surgery was necessary due to gastrointestinal bleeding. The intra-arterial embolization is a valuable method for the treatment of newborns with symptomatic cavernous liver hemangiomas.

Nursing management of patients receiving biological therapy.

OBJECTIVE: To provide an overview of the most common toxic effects associated with biotherapy and strategies for effective patient management, predominantly in the outpatient setting. DATA SOURCES: Review articles and book chapters related to nursing care of patients receiving biotherapy. CONCLUSIONS: Biological response modifiers can produce several toxic effects that may have a significant impact on the patient's quality of life. Additionally, biotherapy is being delivered more frequently in the ambulatory and home care settings. IMPLICATIONS FOR NURSING PRACTICE: As the role of biotherapy expands in the treatment of cancer, oncology nurses must be attuned to the special needs of patients receiving this therapy. Nurses must be knowledgeable of not only symptom management but reimbursement and managed care issues as well.

Hernia of the lung: case report and literature review.

Hernia of the lung is an uncommonly encountered clinical entity. The majority of reported hernias are acquired traumatic thoracic hernias. A case report of an acquired spontaneous lung hernia is presented. A literature review of the classification, diagnosis, treatment and current incidence is discussed.

Multifocal sclerotic BCG spondylitis in a 13-year-old girl.

A case is reported of multifocal BCG osteomyelitis in a 13-year-old girl. The lesions in the skull, ribs and in several vertebrae were mainly sclerotic and healed with antituberculotic therapy. The case is unusual because of the late onset, sclerotic changes, and involvement of the spine.

Emergency pacing and subsequent permanent pacemaker implantation in a premature infant of 1770 g with a follow-up of 6 years.

We report successful emergency pacing followed by permanent pacemaker implantation due to complete block in an otherwise healthy premature infant of 1,770 g. Via the umbilical vein a temporary bipolar pacing lead was placed in the right ventricle. The lack of spontaneous improvement warranted implantation of a permanent pacemaker system at the age of 2 weeks. Via a transatrial approach an endocardial unipolar screw-in lead was placed in the right ventricle and connected to a pulse generator implanted subcutaneously. During the follow-up period of 6 years the child has been doing well with his VVI-R pacemaker operating at rates between 80 and 160 pulses/minute at a chronic stimulation threshold below 0.9 V at 0.37 msec.

Esophageal scintigraphy: a comparison with esophagoscopy.

Fifty consecutive patients with different esophageal symptoms were investigated with esophageal endoscopy, transit scintigraphy, and gastroesophageal (GE) scintigraphy with extra-abdominal compression. Scintigraphic findings were abnormal in 27 of those 31 patients (87%) who were classified as abnormal at endoscopy. A prolonged transit time was the commonest finding, but hiatal hernia and GE reflux were also found. However, the scintigraphic procedure showed abnormalities in 6 of 19 (31%) who were classified as normal at endoscopy. Esophageal scintigraphy is recommended as a screening test before endoscopy is decided on.

Slipped capital femoral epiphysis in southern Sweden. Long-term result with closed reduction and hip plaster spica.

Seventy-two patients treated with closed reduction and hip spica for slipped capital femoral epiphysis (physiolysis colli femoris; PCF) were evaluated by questionnaire 25 to 66 years after primary treatment. Fifty-seven cases were examined with the use of clinical and radiographic methods. Pain and restricted hip function were obvious in most patients. In 25 of 72, an operation had been done in adult life for coxarthrosis. In a previously investigated group of PCF patients not actively treated, only two of 49 had had surgical treatment of coxarthrosis. Thus the results of closed reduction and hip spica are unfavorable, compared with those of nontreated cases. The results suggest a harmful influence of both reduction and hip spica.

Transluminal balloon dilation of ureteral stricture in a child. A case report.

A 12-year-old girl complained of left flank pain 4 months after the onset of symptoms of polyarthritis nodosa with hypertension, multiple neuritis and impaired renal function. Intravenous pyelography (IVP) revealed no stone. Several months later the flank pain recurred, and IVP now showed a calcified stone midway in the left ureter. Ureterolithotomy was performed, and a 3 cm long stone embedded in the mucosa was removed. Two months postoperatively IVP showed severe ureteric obstruction due to stenosis at the level of the incision. Dilation of the stricture was accomplished with a 4 mm balloon, and further dilation 2 weeks later with a 6 mm balloon. A third dilation was performed with a 4 mm balloon. At examination 3 months later the girl was free from symptoms and IVP with forced diuresis was normal, as were the findings after 6 more months. Transluminal balloon dilation of postoperative ureteral strictures in children should be considered as an alternative to surgery.