ABSTRACT
BACKGROUND: PET/CT investigation with 18F-fluorodeoxyglucose (FDG) has a high sensitivity (89 - 100 %) and good specificity (79 - 95 %) for the diagnosis of NSCLC. Currently, it is mainly used in preoperative staging. This leads in approximately 15 % of these cases to the diagnosis of metastatic disease that was neither clinically suspected nor seen in previously performed conventional imaging. We hypothesised that including these cases in the palliative stage IV group would have an influence on overall survival. AIM: The aim of this study was to compare the overall survival (OS) of patients with stage IV NSCLC who underwent FDG-PET/CT staging with patients in whom conventional imaging procedures were performed. METHODS: We analysed the OS of all stage IV NSCLC patients diagnosed in our clinic in 2009 (n = 254), 96/254 (38 %) patients were staged with PET/CT and 158/254 (62 %) with conventional imaging (CT group). Survival data were compared by Kaplan-Meier statistics. RESULTS: Patients in the PET/CT group were younger (65 ± 11) than in the CT group (68 ± 10 years; p = 0.008). The median OS of all patients was 246 (range: 217 - 275) days; 338 (range: 247 - 429) days in the PET/CT group and 207 (range: 161 - 253) days in the CT group (p = 0.001), stating a difference of 131 days (4.4 months) in median OS. CONCLUSION: The use of FDG-PET/CT staging mainly in the preoperative setting leads to stage migration of patients with a better prognosis into the worst stage (IV) and thus longer survival within this subgroup. This survival benefit is unrelated to treatment and needs to be addressed in future studies.
Subject(s)
Carcinoma, Non-Small-Cell Lung/mortality , Carcinoma, Non-Small-Cell Lung/pathology , Fluorodeoxyglucose F18 , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Positron-Emission Tomography/statistics & numerical data , Tomography, X-Ray Computed/statistics & numerical data , Adult , Aged , Aged, 80 and over , Female , Germany/epidemiology , Humans , Male , Middle Aged , Neoplasm Staging , Prevalence , Radiopharmaceuticals , Reproducibility of Results , Risk Assessment , Risk Factors , Sensitivity and Specificity , Survival Analysis , Survival RateABSTRACT
BACKGROUND: The National Eye Institute Visual Function Questionnaire (NEI-VFQ) is not sufficient to assess vision-related quality of life in patients with vision impairments caused by neuroophthalmic deficits. The neuroophthalmic supplement to the NEI-VFQ is currently only available in an English version. The supplement was translated into German and three items concerning visual field loss were added. MATERIAL AND METHODS: NEI-VFQ and supplement data were collected from 62 pre- and postchiasmatic patients with visual field defects and from 245 healthy reference persons. NEI-VFQ and supplement were psychometrically tested and validated. Relations between visual field variables and vision-related quality of life were assessed. RESULTS: The patient group showed diminished quality of life in 10 NEI-VFQ subscales and in eight supplement items when compared to age-matched healthy controls. Correlations between supplement and visual field diagnostic variables demonstrate moderate relations between visual field loss and deterioration of vision-related quality of life. A Cronbach's α of 0.81 for the supplement can be increased to 0.92 in combination with the NEI-VFQ, the sole application of the NEI-VFQ generates an alpha of 0.93 in this sample. A factor analysis reveals four factors that cover the 13 items capturing the following issues: 'severity/problems due to the visual field defect", "unusual eyelid appearances", "blurry vision/double vision" and "diverse vision of both eyes"; 72 % of the variance can be explained by these four factors. CONCLUSION: The German translation of the neuroophthalmic supplement to the NEI-VFQ captures additional vision-specific problems beyond the sole NEI-VFQ that are often reported by patients with vision impairments after brain damage. Although the relevance of some items can be questioned, nevertheless the supplement qualifies for an enhanced outline of subjective vision impairments that are not included in the previous NEI-VFQ.
Subject(s)
Optic Nerve Diseases/epidemiology , Quality of Life , Sickness Impact Profile , Surveys and Questionnaires , Vision Disorders/epidemiology , Visual Field Tests/methods , Visual Field Tests/statistics & numerical data , Adult , Aged , Aged, 80 and over , Comorbidity , Data Interpretation, Statistical , Female , Germany/epidemiology , Humans , Male , Middle Aged , Optic Chiasm/injuries , Optic Nerve Diseases/psychology , Prevalence , Reproducibility of Results , Risk Assessment , Risk Factors , Sensitivity and Specificity , Vision Disorders/psychologyABSTRACT
Two groups of tinnitus patients (n=93) were recruited, one of which was treated with standard infusion therapy and further acute medical intervention, while the other obtained an additional psychotherapeutic intervention. Questionnaires and interviews were taken at beginning of the treatment, and 9 days and 3 years after treatment. The accompanying psychotherapeutic intervention consisted primarily of client-centered counseling, guided relaxation techniques from clinical hypnosis, and some standard and tinnitus-related methods for a better coping with stress. After 9 days, both treatment groups showed significant improvement in several psychological characteristics. However, there was no evidence for the superiority of the combined treatment with psychological intervention. Psychotherapeutic treatment accompanying the acute medical treatment probably shows better effectiveness in an ambulant setting with both patients and medical healthcare professionals rating it as 'very helpful'. This pilot study has contributed initial results for the integrated treatment of the acute tinnitus and has helped in the development of further therapeutic strategies as well as an evidence based concept for further evaluation. This study received one of the two scientific first prizes of the "German Tinnitus League".
Subject(s)
Hydroxyethyl Starch Derivatives/administration & dosage , Nafronyl/administration & dosage , Pentoxifylline/administration & dosage , Psychotherapy , Somatoform Disorders/therapy , Tinnitus/therapy , Vasodilator Agents/administration & dosage , Adaptation, Psychological , Adult , Cognitive Behavioral Therapy , Combined Modality Therapy , Cortisone/administration & dosage , Drug Administration Schedule , Drug Therapy, Combination , Female , Humans , Infusions, Intravenous , Male , Middle Aged , Patient Admission , Person-Centered Psychotherapy , Personality Inventory , Relaxation Therapy , Sick Role , Somatoform Disorders/psychology , Surveys and Questionnaires , Tinnitus/psychologyABSTRACT
The therapeutic effect of applying photic stimulation was evaluated in a sample of 17 patients with chronic tinnitus. The employed optical stimulation technique triggers the activity of brain waves and induces deep relaxation characterized by increased EEG activity in the theta and delta spectrum. The expected therapeutic effect beyond relaxation was a decrease in subjective tinnitus distress and further improvements in well-being. All patients received ten applications of photic stimulation, each lasting 30 min. Every application markedly increased the peripheral blood circulation, thus indicating a relaxation effect. The emotional and cognitive impairments as well as the subjective tinnitus distress significantly decreased during treatment while sleep disturbances showed a tendency towards improvement. Overall, tinnitus distress markedly decreased and general well-being improved. The photic stimulation technique is proposed as a relief for tinnitus patients who do not respond to conventional relaxation techniques.
