Post traumatic paraplegics living in Athens: the impact of pressure sores and UTIs on everyday life activities.

This paper contains the findings of a scientific research which was done on post-traumatic paraplegics who live in the area of Athens. Greece, and measured the impact of pressure sores and UTIs on their everyday life activities. The target population was 127 individuals out of which 98 were observed and interviewed. A semi-structured questionnaire which consisted of two parts used; the first part of the questionnaire included general questions whereas the second contained the Sarno Functional Life Scale (SFLS) which is a tool measuring the level of independence of disabled people. Sixty-two per cent of the population was male. The mean age of the sample population at the time they had the accident which caused the paraplegia was 31.5, while the median was 28.5. The majority of the subjects comes from the lower socioeconomic class. Traffic accidents accounted for the 55% of the occurrences of paraplegia, falls for 37%, surgical complication for 4% and athletic activities for the remaining 4%. Forty-nine percent of the sample had been hospitalised in a rehabilitation centre. However, the multiple regressions used did not reveal any statistically significant relation between the hospitalisation in a rehabilitation centre and the paraplegic's scores in any of the Sarno Functional Life Scale's (SFLS) variables. Instead, the multiple regressions employed yielded paraplegics' scores in the SFLS's everyday life activities that were negatively related to age (P = 0.004) and pressure sores (P = 0.021). The paraplegics' scores on the SFLS's indoors activities are positively related to the years since injury (P = 0.048) and health education on daily fluid consumption (P = 0.003). The scores of the subjects on the SFLS's outdoor activities are positively related to the years of education (P = 0.008), the years since injury (P = 0.011), while are negatively related to pressure sores (P = 0.034) and UTIs (0.044). The subjects' scores on the SFLS variables regarding social relations had a negative relation to sex, (female) (P = 0.0001), age (P = 0.001) and pressure sores (P = 0.019), while they have a positive relation with the years since injury (P = 0.024).

Factors associated with back pain in nursing staff: a survey in Athens, Greece.

Factors associated with self-reported back pain were investigated using questionnaire data on 407 female nurses from a large hospital in Athens, Greece. Factor analysis was used to construct indices of pain and its impact on normal life, and also to summarize work load descriptions. Pain factors were examined in relation to work load and personal characteristics by logistic regression. Statistically significant items, in relation both to pain and impact, were the existence of previous back injury, self-reported headaches and the 'carrying and lifting' factor of work load which principally included moving equipment. Age, height and weight were not associated with back pain. Compared to a similar study by Harber and colleagues in California, United States of America, the factors associated with back pain were quite similar in this study even though the prevalence of back pain was much higher among Greek nurses and their work load was physically much more demanding.

5-Fluorouracil, epirubicin, and mitomycin C versus 5-fluorouracil, epirubicin, mitomycin C, and leucovorin in advanced gastric carcinoma. A randomized trial.

Leucovorin (LV) enhances the activity of 5-fluorouracil (5FU). Based on these data, we performed a randomized trial with 5FU, epirubicin (EPI), mitomycin C(MMC) with/ without LV in advanced gastric cancer (AGC). The purpose of our study was to investigate if the addition of LV improved the response rate of the combination 5FU EPI, MMC (FEM) over FEM. From January 1988 until April 1994, 88 patients with recurrent or metastatic AGC were randomly received 5FU, EPI, MMC with (group A) or without (group B) LV. Between the two arms of the study no difference was noticed in sex, performance status, primary site of tumor, and lymph node metastases. Therapy included group A (5FU 600 mg/m2/day, i.v. bolus, on days 1, 8, 29, 36, and EPI 45 mg/m2/day, i.v. bolus, on days 1 and 29, MMC 10 mg/m2/day, i.v. bolus, on day 1) and group B (the same as group A plus LV 200 mg/m2/day by 2 h intravenous infusion with 5FU intravenous push at midinfusion). No significant difference in response rate was noticed between the two treatment arms; there were two (5%) patients with complete response in group A, and five (12%) in A and 11 (26%) partial responders in group B (p < 0.1). A significantly higher number of patients achieving stable disease was observed in group B; 19 (44%) in comparison to group A 10 (24%) (p < 0.048). There were more patients with progressive disease in group A 25 (59%) than in group B 12 (28%) (p < 0.003) (Table 2). No difference was noted in mean duration of response: group A, 15.8 (6-31) weeks; and group B, 17.6 (6-28) weeks. The mean time to progression was for group A [11.4 (6-35) weeks] and for group B [17.6 (8-33) weeks]. Mean survival was for group A [27.4 (12-59) weeks] and for group B [30.6 (17-53) weeks], for 50% of patients. Causes of death were, for group A, 40 patients from disease progression and two sudden deaths; for group B, causes of death were for 41 patients disease progression and two sudden deaths. There were two patients in group A and one in group B that were not evaluable because they abandoned therapy after the first cycle. Toxicity was increased in group B; anemia, nausea and vomiting, and alopecia (p < 0.055) were more severe in group B, but not statistically different when compared to group A. Neutropenia, thrombocytopenia, mucositis, and fatigue of any grade were significantly more common and severe in group B. Significant dose reductions due to toxicity were required more commonly in group B. We conclude that the response rate was increased in the schedule with the addition of LV, at the cost of increased toxicity and with no difference in survival. A randomized trial comparing FEM-LV with new generation regimens would determine whether the addition of LV qualifies FAM equally active with these.

A randomized trial comparing adjuvant fluorouracil, epirubicin, and mitomycin with no treatment in operable gastric cancer.

Combination chemotherapy (CT) has, in some groups of patients with gastric cancer (GC), who are at a high risk for relapse, resulted in a small but measurable improvement in palliation and patient survival not reaching statistical significance and therefore remaining applicable in an investigational setting. Based on the above data, we studied adjuvant CT with FEM (5-fluorouracil (5-FU), epirubicin, mitomycin C) in a randomized study of patients with completely resected stage III GC and patients with stages T1-3 with a low histologic grade. CT was started 2-3 weeks after surgery. From August 1988 until February 1994, 84 patients with completely resected tumors and lymph nodes were randomized to either group A (FEM) or group B (no treatment). Patients were eligible for randomization if they had a Karnofsky score > 60, no postoperative evidence of residual tumor, and normal cardiac, hepatic and renal functions. Forty-two patients were randomized to each group, with no significant differences regarding: age distribution, group A 53 years (41-65), group B 57 years (35-66); sex, group A 32/10, group B 25/17 (men/women); site of primary tumor, group A 22/20, group B 25/17 (pylorus/antrum); histologic grade, group A 0/19/23, group B 0/25/17 (grades I/II/III); lymph node metastases, group A 30, group B 32, and surgical procedure, group A 33/9/6, group B 35/7/9 (total gastrectomy/partial gastrectomy/splenectomy). Group A received 5-FU 600 mg/m2/day i.v. on days 1, 8, 29 and 36, epirubicin 45 mg/m2/day i.v. on days 1 and 29, and mitomycin C 10 mg/m2 i.v. on day 1. The schedule was repeated every 56 days for 3 cycles. Group B received no treatment odd was only subjected to the regular follow-up. At the last follow-up at 66 months, 27/42 patients in group A (64%) had relapsed or died, compared to 34/42 patients in group B (81%). The differences in the relapse and the disease-free and the overall survival rates were not statistically significant. Only the subgroup of patients with histologic grade III tumors receiving adjuvant FEM demonstrated a trend towards improved survival (p = 0.085). Main therapy-related toxicities for the treatment group were grade I-II anemia, neutropenia, and throbocytopenia in 16, 45, and 22% of patients, respectively, and grade I-II nausea and vomiting in 29% of patients. Based on the present findings and those of previous studies, even if one considers the difference reaching statistical significance in the latter for histologic grade III tumors, it becomes evident that with current therapeutic modalities adjuvant therapy has no established role in the management of resectable GC. Studies of new-generation regimens, such as FAMTX (5-FU, Adriamycin and methotrexate) as well as ELF (etoposide, Leucoverin, and 5-FU), should be conducted in the adjuvant therapy setting with a nontherapy control group, in order to clarify the issue of adjuvant CT in resectable GC.

Occupational low-back pain in nursing staff in a Greek hospital.

The prevalence of occupational low-back pain was investigated in 407 female nurses in a large tertiary health care unit in Athens, Greece. Work-related back pain within the previous 2 weeks was reported by 63% of respondents and within the previous 6 months by 67%. Prevalence was higher (66% in the previous 2 weeks) in the wards with physically heavy duties than in the rest (52%, P = 0.003), but all grades of nursing staff were affected equally. The specific factors which claimed to be responsible for causing back pain included moving heavy items (36%), lifting patients onto trolleys (32%) or in bed (29%), helping patients out of bed (24%) and bending to lift objects from the floor (24%). Absence from work because of back pain in the previous 2 weeks was reported by 28% of the sample.

[Determinative factors in nosocomial pneumonia in patients with mechanical ventilation in the respiratory care unit]. / Prosdioristikoi paragontes tes epiptoses tes nosokomeiakes pneumonias se arrostous me mechanike anapnoe sten anapneustike monada entatikes therapeias.

We studied risk factors for nosocomial pneumonia in 192 intubated patients. Nosocomial pneumonia was diagnosed in 50 (26%) of the 192 patients. The patients receiving mechanical ventilation and the ventilators were colonised with Gram negative bacteria, mainly Actinetobacter and Pseudomonas. The duration of mechanical ventilation and the bacterail colonization of ventilators were associated with the development of pneumonia.

Natural history and prognosis of recurrent breast cancer.

Patterns of recurrent disease were analysed in 603 patients with breast cancer. The time of onset, frequency of recurrence, and survival after recurrence were not influenced by age or menopausal state. While survival after local recurrence was longer than survival after distant metastasis, the time to onset of local and distant disease followed an identical pattern, indicating that local recurrence should be regarded as a manifestation of systemic disease. Postoperative radiotherapy did not affect the time of onset of local recurrence. We suggest that patients with local recurrence should receive both systemic and local treatment and that controlled trials of chemotherapeutic agents in these patients might be valuable in finding the most effective drug combinations to be used as adjuvant treatment after mastectomy.