ADAM8 in squamous cell carcinoma of the head and neck: a retrospective study.

BACKGROUND: A disintegrin and metalloproteinase (ADAMs) have been associated with multiple malignancies. ADAMs are involved in cell fusion, cell migration, membrane protein shedding and proteolysis. ADAM8 has been found to be overexpressed in squamous cell carcinomas of the lung. A new study showed that ADAM8 is significantly overexpressed in metastasis of squamous cell carcinomas of the head and neck (HNSCC). METHODS: We determined ADAM8 levels in the serum of 79 HNSCC patients at the time of diagnosis, in 35 patients 3 months after treatment and in 10 patients 1 year after therapy and compared the results to the sera of 31 healthy volunteers. We also constructed tissue microarrays to detect ADAM8 immunohistochemically in 100 patients. The results were correlated with the survival data of the patients to determine the diagnostic and prognostic value. RESULTS: The data demonstrated that patients with high ADAM8 expression in the tumor have worse survival rates. We found that high ADAM8 serum levels correlated with high ADAM8 expression in tumor samples. Soluble ADAM8 levels did not show any prognostic or diagnostic properties. CONCLUSION: In summary ADAM8 expression is a prognostic factor for survival of patients with head and neck squamous cell carcinoma.

Management of sinonasal undifferentiated carcinoma with intracerebral invasion: Clinical experience at a single institution and review of the literature.

Sinonasal undifferentiated carcinoma (SNUC) represents less than 1% of all malignancies. Most of the tumors are diagnosed at an advanced stage, when they have already invaded neighboring tissue structures. We describe the cases of 2 patients with a substantial intracerebral extension of SNUC who were treated at our institution. One was treated with surgery followed by chemoradiotherapy. The other was primarily treated with induction chemotherapy with a combination of docetaxel, cisplatin, and 5-fluorouracil followed by concurrent chemo- and radiotherapy. In view of the rarity of SNUC, no prospective clinical trials have been performed and a gold standard for treatment has not yet been established. Therefore, treatment recommendations are based on level IV evidence. These recommendations are diverse and controversial. In our 2 cases, the patient who was treated with induction chemotherapy had a better outcome. In cases of intracerebral extension, radical surgery is necessary and induction chemotherapy should be considered.

Medication study supports registered nurses' competence for single checking.

In 1999, a review of medication policies and practices for The Geelong Hospital, a Victorian regional acute care hospital, was conducted under the leadership and direction of the Executive Nursing Director. The findings of the review suggested that a study be conducted to examine the safety of single-person (registered nurse division 1) checking of a designated group of medications that had previously been double-checked. The present study was conducted as a descriptive study in adult inpatient units and speciality and midwifery services of The Geelong Hospital, and included the monitoring of medication errors for the designated group of medications under a single-person checking protocol for a 7-month period. A similar number of medication errors were reported when compared with a similar time-frame in which double-person checking was standard practice. At the completion of the study, a convenience sample of 129 nurses from the participating units and services completed questionnaires. The majority of the nurses appreciated the increased autonomy the change to single-person checking of medications provided. They also identified benefits for patients, including that they were able to be more responsive to patient needs.

Allowing the patients to sleep: flexible medication times in an acute hospital.

In 1999, under the leadership and direction of the Director of Clinical Services (Nursing), Roger Napthine, Project Consultant, was commissioned to undertake a review of medication policies and practices for a regional acute-care hospital. This initiative was taken with the view of improving nursing practice and patient care. Recommendations from Napthine's review included the trial in a medical and a surgical unit of a change in the administration of routine morning and evening medication times. A descriptive study that included a convenience sample of 52 patients and 25 registered nurses was conducted in the two units. The findings demonstrated that patients were able to sleep longer. Further, although they tended to wake earlier, their 'in hospital' and 'at home' sleeping patterns were more closely aligned. There was agreement among the nurse participants that the change to flexible medication times allowed patients to sleep longer. However, concerns were raised about the impact of the change on other nursing duties, particularly those performed in the mornings.