Interventionally implanted port catheter systems for hepatic arterial infusion of chemotherapy in patients with colorectal liver metastases: A phase II-study and historical comparison with the surgical approach

<p>Abstract</p> <p>Background</p> <p>The high complication rates of surgically implanted port catheter systems (SIPCS) represents a major drawback in the treatment of isolated liver neoplasms by hepatic arterial infusion (HAI) of chemotherapy. Interventionally implanted port catheter systems (IIPCS) have evolved into a promising alternative that enable initiation of HAI without laparatomy, but prospective data on this approach are still sparse. Aim of this study was to evaluate the most important technical endpoints associated with the use of IIPCS for the delivery of 5-fluorouracil-based HAI in patients with colorectal liver metastases in a phase 2-study, and to perform a non-randomised comparison with a historical group of patients in which HAI was administered via SIPCS.</p> <p>Methods</p> <p>41 patients with isolated liver metastases of colorectal cancer were enrolled into a phase II-study and provided with IIPCS between 2001 and 2004 (group A). The primary objective of the trial was defined as evaluation of device-related complications and port duration. Results were compared with those observed in a pre-defined historical collective of 40 patients treated with HAI via SIPCS at our institution between 1996 and 2000 (group B).</p> <p>Results</p> <p>Baseline characteristics were balanced between both groups, except for higher proportions of previous palliative pre-treatment and elevated serum alkaline phosphatase in patients of group A. Implantation of port catheters was successful in all patients of group A, whereas two primary failures were observed in group B. The frequency of device-related complications was similar between both groups, but the secondary failure rate was significantly higher with the use of surgical approach (17% vs. 50%, p < 0.01). Mean port duration was significantly longer in the interventional group (19 vs. 14 months, p = 0.01), with 77 vs. 50% of devices functioning at 12 months (p < 0.01). No unexpected complications were observed in both groups.</p> <p>Conclusion</p> <p>HAI via interventionally implanted port catheters can be safely provided to a collective of patients with colorectal liver metastases, including a relevant proportion of preatreated individuals. It appears to offer technical advantages over the surgical approach.</p

Spina bifida at the sacral level: more than minor gait disturbances

Objective: To investigate functional outcome in two groups of children with sacral level paralysis: myelomeningocele (MMC) versus lipomyelomeningocele (LMMC). Additionally both groups were compared with each other and when possible with reference values. Design: Cross-sectional study by means of ( 1) clinical assessment, and ( 2) disability measurement. Setting: Spina bifida outpatient clinic at a university hospital in the Netherlands. Subjects: Sample of 30 children with MMC and 14 with LMMC. Mean age (SD) 6.0 (4.9) and 8.4 ( 4.9) years respectively. Main measures: Muscle strength, ambulation level, motor performance (Bayley Scales of Infant Development (BSID) and Movement Assessment Battery for Children), and the Pediatric Evaluation of Disability Inventory (PEDI). Results: The majority of patients in both groups were normal ambulant, 14/21 (67%) in MMC and 9/14 (64%) in LMMC. Ambulation was strongly associated with muscle strength of hip abductors (odds ratio (OR): 13.5, 95% confidence interval (CI) 2.5 - 73.7), and ankle dorsal-flexor muscles ( OR: 110, 95% CI 8.9 - 135.9). No significant differences were found in lesion and ambulation level. Muscle strength and motor performance were significantly lower in the MMC group than in the LMMC group ( p <0.05). PEDI scores were comparable in both groups. Most problems were noted in mobility skills and caregiver assistance in self-care, especially regarding bladder and bowel management. Conclusions: Gross motor and functional problems were seen in both groups. The MMC group showed more muscle weakness and motor problems. However, in both groups caregiver assistance was needed for a prolonged period, especially regarding bladder and bowel management. These findings need special attention, particularly in children who attend regular schools

Motor performance and disability in Dutch children with haemophilia: a comparison with their healthy peers

We investigated whether haemophilic children who are on prophylactic therapy differ from their healthy peers in terms of motor performance and disability. Thirty-nine children, aged 4-12 years, with moderate (eight) and severe (31) haemophilia were included. Patients with severe haemophilia received primary prophylactic therapy that was individually tailored. The number of target joints, amount of swelling, range of motion, muscular strength and pain were measured, as well as motor skills and disability. The scores were compared to the normal population. No patients had target joints. Normal range of motion in all joints was seen in 97% (38/39) of the patients. Strength of elbow, knee, and ankle muscles were within the normal ranges. Ninety-five percent (37/39) of the patients had normal motor performance. Although 90% of our patients (35/39) had no disabilities in activities of daily living (ADL), 79% (31/39) of them reported that the disease impacted on their lives. Seventy-two percent (28/39) of the patients had pain, and in 21% (6/28) of them this was mainly caused by injections. Restrictions in sports or gymnastics were seen in 56% (22/39) of the patients. Those who indicated that they experienced pain and those who indicated restrictions in sports had a higher chance of experiencing disease impact compared to those who did not have these limitations. There were no significant differences between patients with moderate and severe haemophilia. In general, Dutch children with moderate or severe haemophilia are comparable with their healthy peers with regard to motor performance and ADL. However, a majority of the patients perceive an impact of their disease associated with pain and restrictions in sports

Determinants of functional independence and quality of life in children with spina bifida

Objective: To investigate determinants of functional independence and study which functional abilities were determinants for 'health-related quality of life' in children with myelomeningocele. Design: Cross-sectional study by means of clinical assessment, 'disability' measurement and questionnaires. Uni- and multivariate logistic regression models were used to investigate factors that were determinants for these outcomes. Results were expressed as odds ratios ( OR) and 95% confidence intervals ( 95% CI). Setting: Outpatient spina bifida clinic at a university hospital. Subjects: One hundred and twenty-two children with myelomeningocele. Mean age 7.9; range 1 - 18 years. Main measures: Functional independence as measured by the Pediatric Evaluation of Disability Inventory (PEDI), and quality of life as measured by the Spina Bifida Health Related Quality of Life Questionnaire. Results: Lesion level below L3 ( OR 0.4, 95% CI 0.1 - 1.0), mental status of IQ >= 80 ( OR 4.2, 95% CI 1.2 - 14.9), having no contractures in lower extremities ( OR 3.4, 95% CI 1.3 - 8.8), and having normal strength of knee extensor muscles ( OR 4.1, 95% CI 1.4 - 11.5) were most strongly associated with independence in self-care. Mental status ( OR 16.1, 95% CI 2.8 - 93.9), having no contractures in lower extremities ( OR 1.5, 95% CI 1.4 - 5.3), and normal strength in knee extensors ( OR 11.0, 95% CI 1.3 - 97.0) were the most important determinants for independence in mobility. Concerning functional abilities, being independent with regard to mobility was the most important determinant for 'health-related quality of life' ( OR 5.3, 95% CI 1.6 - 17.4). Conclusions: In children with myelomeningocele, good muscle strength, mental ability and being independent in mobility appeared to be much more important for daily life function and quality of life than other medical indicators of the disorder

Spinal fusion in children with spina bifida:influence on ambulation level and functional abilities

The aim of this study was to determine the influence of spinal fusion on ambulation and functional abilities in children with spina bifida for whom early mobilization was stimulated. Ten children (three males and seven females) with myelomeningocele were prospectively followed. Their mean age at operation was 9.3 years (standard deviation (SD): 2.4). Spinal curvature was measured according to Cobb. Pelvic obliquity and trunk decompensation were measured as well. The ambulation level was scored according to Hoffer, and functional abilities, as well as the amount of caregiver assistance, were documented using the Pediatric Evaluation of Disability Inventory. All patients were assessed before surgery and three times after surgery, with a total follow-up duration of 18 months after surgery. After spinal fusion, magnitude of primary curvature decreased significantly (p=0.002). Pelvic obliquity and trunk decompensation did not change. In spite of less immobilization as compared with other reported experiences, ambulation became difficult in three out of four patients who had been able to ambulate prior to surgery. Functional abilities and amount of caregiver assistance concerning self-care (especially regarding dressing upper and lower body, and self-catheterization) and mobility (especially regarding transfers) showed a nonsignificant trend to deterioration within the first 6 months after surgery, but recovered afterwards. From pre-surgery to 18 months after surgery, functional skills on self-care showed borderline improvement (p=0.07), whereas mobility did not (p=0.2). Mean scores on caregiver assistance improved significantly on self-care (p=0.03), and borderline on mobility (p=0.06), meaning that less caregiver assistance was needed compared with pre-surgery. The complication rate was high (80%). In conclusion, within the first 6 months after spinal fusion, more caregiver assistance is needed in self-care and mobility. It takes about 12 months to recover to pre-surgery level, while small improvement is seen afterwards. After spinal fusion, ambulation often becomes difficult, especially in exercise walkers. These findings are important for health-care professionals, in order to inform and prepare the patients and their parents properly for a planned spinal fusion

O papel da equipe de enfermagem no centro de atenção psicossocial El papel del equipo de enfermería en el centro de atención psicosocial The nursing team role in the psychosocial attention center

Pesquisa qualitativa, exploratória-descritiva, desenvolvida no ano de 2008, em um Centro de Atenção Psicossocial II e ad de um município da região metropolitana de Curitiba. OBJETIVO: conhecer o papel da equipe de enfermagem junto à equipe multidisciplinar do Centro de Atenção Psicossocial. Os sujeitos foram dois enfermeiros e três auxiliares de enfermagem. Os dados foram coletados por meio de entrevista semiestruturada e organizados em categorias temáticas: As especificidades da assistência no Centro de Atenção Psicossocial e O papel da equipe de enfermagem no Centro de Atenção Psicossocial. Os profissionais de enfermagem reconhecem que o CAPS representa avanço na qualidade da assistência em saúde mental ao considerar o tratamento humanizado e as possibilidades de ressocialização em contraposição ao modelo hospitalocêntrico. Entretanto, é preciso considerar que há uma confusão em relação ao seu papel enquanto membro da equipe multiprofissional desse serviço.<br>Pesquisa cualitativa, exploratoria-descriptiva, desarrollada en el año 2008, en un Centro de Atención Psicosocial II y ad de un municipio de la región metropolitana de Curitiba. OBJETIVO: conocer el papel del equipo de Enfermería junto al equipo multidisciplinar del Centro de Atención Psicosocial. Los sujetos fueron dos enfermeros y tres auxiliares de Enfermería. Los datos fueron colectados por medio de una entrevista semi-estructurada y organizados en categorías temáticas: Las especificaciones de la asistencia en el Centro de Atención Psicosocial y El papel del equipo de Enfermería en el Centro de Atención Psicosocial. Los profesionales de Enfermería reconocen que el CAPS representa el progreso en la cualidad de la asistencia en salud mental al considerar el tratamiento humanizado y las posibilidades de resocialización en contraposición al modelo hospitalocéntrico. Es necesario considerar que hay una confusión con relación a su papel en lo que se refiere a los miembros del equipo multiprofesional de ese servicio.<br>Qualitative Descriptive Exploratory Research developed in 2008 at Psychosocial Attention Center II and ad located in Curitiba metropolitan region. OBJECTIVE: understand the nursing team role along with the Psychosocial Attention Center multidisciplinary team. The participants were two Registered Nurses and three Auxiliary Nurses. The data was collected by a semi-structured interview and organized in thematic categories: The Psychosocial Attention Center Assistance Specificities and The Nursing Team Role at the Psychosocial Attention Center. The Nursing professionals recognize that CAPS represents a quality improvement in mental health assistance considering a humanized treatment and resocialization possibilities, as opposed to the hospital-centric model. However, it is necessary to consider there is some confusion in relation to the professional role as a multiprofessional team for this service