Review of a transplantectomy series.

INTRODUCTION: Renal transplant nephrectomy is a complex process carried out in various situations of renal graft failure. The objective of the study was to describe the experience in our center and to evaluate the safety and efficacy in performing transplantectomies. MATERIAL AND METHODS: This is a retrospective study of 70 transplantectomies performed at our center from 1995 to 2013. Multiple variables related to complications (according to Clavien classification) and mortality as the cause of nephrectomy, surgical technique, or urgent or elective surgery were analyzed. RESULTS: Seventy transplantectomies from a total of 996 transplantations were performed at our center. The mean age was 46.2 years, with 47 men. The most frequent cause of nephrectomy was chronic rejection graft intolerance of 58.5%; 75.7% of the surgical technique was subcapsular. The indication was scheduled at 78.57% (n = 55). Serious complications, defined as Clavien >III (excluded deaths, Clavien V), occurred in 21.43% (n = 15). There were 8 deaths, 6 of which were associated with the clinical severity of patients with urgent indication. The analysis unvariate transplantectomies scheduled group revealed no factor associated with increased morbidity and mortality. CONCLUSIONS: In referral centers, nephrectomy is safe and effective in the treatment of complications of renal graft surgical technique. The increased morbidity and mortality of the procedure depends mainly on the indication and clinical condition of the patient, severity increasing in situations where urgent nephrectomy is performed.

The Internet in oncology nursing.

OBJECTIVES: To explore the implications of the internet for oncology nursing practice, education, and research. DATA SOURCES: Published articles, texts, research studies, review articles, and online documents pertaining to the internet. CONCLUSIONS: The internet has influenced nearly every aspect of society. As the worldwide communications infrastructure strengthens, access devices become affordable, and more countries contribute content in their native language, this technology becomes a truly global phenomenon. This affords oncology nursing a voice that extends beyond the community support group to millions of internet users. IMPLICATIONS FOR NURSING PRACTICE: Internet access, quality of information, and privacy of data transmitted are among the greatest challenges that face oncology nurses who integrate this technology into practice.

Details on demand: consumers, cancer information, and the Internet.

An increasing number of patients and their families have Internet access and use it to make sense of their cancer experience. Search engines and subject guides take Internet users to cancer-related Web sites that contain information of varying quality and accuracy. Several organizations have attempted to create evaluation tools for cancer information on the Internet. They are, for the most part, untested, but they can serve as a practical guide for coaching patients and family members on the use of the Internet. Evaluating Internet information with guidelines, dealing with Internet-savvy patients and families, and the use of e-mail in clinical practice are discussed.

Interstitial tandem duplication of 6p: a case with partial trisomy (6)(p12p21.3).

A de novo interstitial tandem duplication of 6p12p21.3 was observed in a 7-month-old boy with growth retardation, psychomotor delay and craniofacial, brain, limb, and genital anomalies. Fluorescent in situ hybridization using a chromosome 6 paint probe demonstrated that the extra material belonged to chromosome 6. Although it has been suggested that 6p25 is the critical band involved in the expression of the phenotype of 6p duplication, comparison of the clinical findings of this case with those from the literature cases showed strong similarities.

Improving oncology nursing practice through understanding and exploring the Internet.

PURPOSE/OBJECTIVES: To provide an overview of the evolution of computer technology, a brief history of the Internet, and guidelines for searching the Internet. DATA SOURCES: Literature, electronic online sources, and personal experience. DATA SYNTHESIS: Vast collections of resources are available on the Internet that can enhance many aspects of oncology nursing practice. These resources are stored on computers, rarely published as print documents, and only available to those oncology nurses who learn to navigate the Internet. IMPLICATIONS FOR NURSING PRACTICE: Specific Internet-based oncology nursing resources can enhance clinical practice, improve education, and facilitate oncology nursing research. CONCLUSIONS: Because a significant number of valuable resources are available on the Internet, it is critical that oncology nurses understand it, be aware of the resources, and have the skills to access the appropriate information.

The impact of the national information infrastructure on distance education and the changing role of the nurse.

PURPOSE/OBJECTIVES: To describe a new opportunity for learning--distance education--that is available to oncology nurses and the role of the nurse educator in the distance-learning environment. DATA SOURCES: Literature and electronic information. DATA SYNTHESIS: Distance learning is a new option for oncology nurses that is based on the assumption that the student is motivated to grasp new ideas and will pursue studies with autonomy and honesty. This article reviews the principals of distance learning, its advantages, and the role of the nurse educator in this new learning environment. CONCLUSIONS: Electronic networks are providing oncology nurses with the opportunity to share information and collaborate with colleagues throughout the world. This same technology supports the opportunity for distance education. Oncology nurses have numerous opportunities to participate in distance learning, both as learners and as nurse educators, and the advantages of this new learning environment are numerous. IMPLICATIONS FOR NURSING PRACTICE: Opportunities now exist for formal education (both undergraduate and graduate) and continuing education for oncology nurses via distance learning. Oncology nurses need to treat technology as a friend and use distance learning to cultivate life-long learning.

Effect of ABVD chemotherapy with and without mantle or mediastinal irradiation on pulmonary function and symptoms in early-stage Hodgkin's disease.

PURPOSE: To evaluate the effect of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy alone and of ABVD with mantle or mediastinal irradiation (RT) on the pulmonary function of patients with early-stage Hodgkin's disease. PATIENTS AND METHODS: Between 1989 and 1993, 60 patients with clinical stage I to IIIA HD enrolled onto randomized trials at Memorial Sloan-Kettering Cancer Center (MSKCC) underwent prospective evaluation of pulmonary function. All patients received six cycles of ABVD, and 30 patients received mantle or mediastinal RT. Pulmonary function tests (PFTs) and symptom evaluation were conducted before, during, and after completion of chemotherapy and RT, and at various intervals thereafter. The median follow-up time was 30 months. RESULTS: During chemotherapy, symptoms of cough and dyspnea on exertion developed in 32 of 60 patients (53%) and declines in pulmonary function occurred in 22 of 60 patients (37%). Discontinuation of bleomycin was necessary in 14 of 60 patients (23%). Following chemotherapy, there was a significant decline in median forced vital capacity (FVC) and diffusing capacity of carbon monoxide (DLCO). In patients who received mantle or mediastinal RT, there was a further decline in FVC following radiation therapy. At the most recent follow-up evaluation, five of 29 patients (18%) who received ABVD alone and nine of 30 (30%) who received ABVD and RT reported persistent mild pulmonary symptoms (P = .36), which did not significantly affect normal daily activity. CONCLUSION: ABVD chemotherapy induced acute pulmonary toxicity that required bleomycin dose modification in a substantial number of patients. The addition of RT resulted in a further decrease in FVC; however, this did not significantly affect the functional status of patients.

A teaching booklet for patients receiving mantle field irradiation.

PURPOSE/OBJECTIVES: To design a booklet for use in educating patients with Hodgkin's disease about mantle field irradiation. DATA SOURCES: Published articles, book chapters, and clinical experience. DATA SYNTHESIS: Information about the actual mantle field irradiation treatment and its acute side effects, self-care measures, and late effects are included in the booklet, along with a self quiz. CONCLUSIONS: Feedback from patients and staff is positive. Early detection of and intervention for herpes zoster infection has improved. IMPLICATIONS FOR NURSING PRACTICE: The booklet can be used in conjunction with other teaching tools for radiation therapy and skin care and as a written reference for patients and staff.

A phase I clinical trial of a combination of mitoxantrone, 5-fluorouracil, and high-dose leucovorin given on a day 1 and day 8 schedule to patients with metastatic breast cancer.

In a Phase I-II clinical trial, 19 ambulatory women with metastatic breast cancer were treated with a combination of mitoxantrone, 5-fluorouracil, and leucovorin (MFL). The planned schedule of mitoxantrone intravenously (i.v.) on day 1 with 5FU and leucovorin (days 1, 8, and 15) was better tolerated on a day 1 and day 8 schedule. Dose-limiting toxicity was found to be granulocytopenia with very little subjective toxicity encountered. Platelet toxicity and more profound granulocyte toxicity appeared to occur in patients with liver metastases. Since most patients did not have easily measurable disease, a response rate could not be determined, although at least four patients had probable antitumor responses. We conclude that doses of M (7.5 mg/m2 i.v. day 1) and 375 mg/m2 days 1 and 8 of F and L should be the starting doses for Phase II trials on this treatment schedule and should be well tolerated subjectively. Dose escalation and deescalation schemata should be included in a Phase II study design, recognizing that some patients may not encounter toxicity at these doses, while patients with liver metastases may develop inordinate toxicity.

A multicentre study to assess long-term use of fluticasone propionate aqueous nasal spray in comparison with beclomethasone dipropionate aqueous nasal spray in the treatment of perennial rhinitis.

Two hundred and fifty-one patients, aged 16 years and over, with perennial rhinitis were recruited to this multicentre, randomized, double-blind, parallel group study. One hundred and fifty-nine patients received fluticasone propionate (200 micrograms) aqueous nasal spray (FPANS) twice daily, and 83 patients received beclomethasone dipropionate (200 micrograms) aqueous nasal spray (BDPANS) twice daily; treatment randomization being 2:1, respectively, in order to increase the number of patients in the FPANS group as FPANS was the drug under study. After 1 year of treatment, nasal blockage (p = 0.002), nasal discharge (p = 0.002) and eye watering/irritation (p = 0.048) were significantly improved in patients treated with FPANS twice daily, compared to patients treated with BDPANS twice daily. The symptom grades for nasal itching (p = 0.052) were improved in the FPANS group, but just failed to attain statistical significance at the 5% level. The symptom grades for sneezing tended to be better for the FPANS group, but the difference was not statistically significant. Assessment of changes in the findings during nasal examination (rhinoscopy) and in haematological, biochemical and urinary parameters, and measurements of plasma cortisol levels during the one year of treatment with the study drugs, showed that there were no clinically significant differences between the two treatment groups and that the study drugs were equally well tolerated. This study indicates that long-term use of FPANS provides better relief than BDPANS for most of the symptoms of perennial rhinitis.

Negative modulation of Escherichia coli NAD kinase by NADPH and NADH.

NAD kinase was purified 93-fold from Escherichia coli. The enzyme was found to have a pH optimum of 7.2 and an apparent Km for NAD+, ATP, and Mg2+ of 1.9, 2.1, and 4.1 mM, respectively. Several compounds including quinolinic acid, nicotinic acid, nicotinamide, nicotinamide mononucleotide, AMP, ADP, and NADP+ did not affect NAD kinase activity. The enzyme was not affected by changes in the adenylate energy charge. In contrast, both NADH and NADPH were potent negative modulators of the enzyme, since their presence at micromolar concentrations resulted in a pronounced sigmoidal NAD+ saturation curve. In addition, the presence of a range of concentrations of the reduced nucleotides resulted in an increase of the Hill slope (nH) to 1.7 to 2.0 with NADH and to 1.8 to 2.1 with NADPH, suggesting that NAD kinase is an allosteric enzyme. These results indicate that NAD kinase activity is regulated by the availability of ATP, NAD+, and Mg2+ and, more significantly, by changes in the NADP+/NADPH and NAD+/NADH ratios. Thus, NAD kinase probably plays a role in the regulation of NADP turnover and pool size in E. coli.