Quality of life as subjective experience: Reframing of perception in patients with colon cancer undergoing radical resection with or without adjuvant chemotherapy

Purpose and background: We examined whether patients with colon cancer undergoing surgery with or without adjuvant chemotherapy change the internal standards on which they base their quality-of-life (QL) estimation, and, if they do so, whether this reframing alters interpretation of QL findings. These questions were addressed within a randomized clinical trial of the Swiss Group for Clinical Cancer Research (SAKK 40/93). Patients and methods: After radical resection of adenocar-cinoma of the colon (pT1-4pN>0M0 and pT3-4pN0M0) and perioperative chemotherapy, patients were randomized to three treatment arms: observation only (A), 5-FU 450 rag/m2plus Levamisol (B), or 5-FU 600 mg/m2 (C). QL was measured by linear analogue self-assessment indicators. Patients estimated their pre-surgery QL both before surgery and retrospectively thereafter, and their pre-adjuvant QL both at the beginning of randomly assigned chemotherapy or observation and retrospectively about two months later. Thereafter, current QL was assessed. Paired t-tests were used to test the hypotheses of no change. Results: Overall, 187 patients with at least one pair of corresponding questionnaires were analyzed. Patients estimated their pre-surgery QL after surgery significantly lower than before and their pre-adjuvant QL under treatment or observation also lower than at the beginning. In the adjuvant phase, in contradiction to our hypothesis, chemotherapy had almost no impact on these changes attributed to reframing. Conventionally assessed changes indicated an improvement in QL. Patients with treatment C reported less improvement in functional performance than those with B or those under observation (P = 0.04). Patients with treatment B indicated a greater worsening in nausea/vomiting than those with C, whereas patients with observation only showed an improvement (P = 0.0009). After adjustment of current QL scores under treatment or observation to patients' retrospective estimation, the treatment effects were diluted but the overall improvement was substantially amplified in most QL indicators. Conclusions: Patients with colon cancer substantially re-frame their perception in estimating QL both under radical resection and under adjuvant chemotherapy or observation. This effect is an integral part of patients' adaptation to disease and treatment. An understanding of this phenomenon is of particular relevance for patient care. Its role in evaluating QL endpoints in clinical trials needs further investigatio

Spondylodiscitis as the first manifestation of Whipple's disease -a removal worker with chronic low back pain

Whipple's disease is a rare systemic infectious disease caused by the actinobacterium Tropheryma whipplei. Spondylodiscitis is an extremely rare manifestation of the infection and has previously been described in only three case reports. We present a 55-year-old man with persistent lumbago and signs of systemic illness, but without any gastrointestinal symptoms or arthralgia. The signal response in the lumbar spine in magnetic resonance tomography, both native and after intravenous gadolinium administration, was compatible with spondylodiscitis at the L4/L5 level. Culture of a specimen obtained by radiographically guided disc puncture and repeated blood cultures remained sterile. Tropheryma whipplei was detected by PCR amplification in material obtained from the disc specimen, from a biopsy of the terminal ileum and from the stool. The histology of duodenum, terminal ileum, colon and disc material was normal and, in particular, showed no PAS-positive inclusions in macrophages. Long-term antibiotic treatment with sulphamethoxazole and trimethoprim was successful, with marked improvement of the low back pain and normalisation of the systemic inflammatory signs. The possibility of Whipple's disease must be suspected in the case of a ‘culture-negative' spondylodiscitis even if there are no gastrointestinal symptoms and no arthralgia presen

Cryptococcus gattii Meningoencephalitis in an Immunocompetent Person 13 Months after Exposure

Abstract : A 53-year old immunocompetent Swiss female is described who developed severe meningoencephalitis due to infection with Cryptococcus gattii 13 months following exposure on Vancouver Island, Canada. Diagnosis was based on cerebrospinal fluid (CSF) examination, i.e., positive India-ink staining, positive latex particle agglutination, and positive culture. Species identification was performed by growth on L-canavanine-glycine-bromthymol blue medium and by sequencing of the intergenic and internal transcribed spacer regions of the rRNA genes. After initial therapy with fluconazole by which the patient did not improve, therapy was changed to amphotericin B and flucytosine and later to high-dose fluconazole and amphotericin B. Despite long-term treatment and external drainage of the CSF, the patient's condition improved only slowly. The patient was discharged after 132 days of hospitalizatio

Comparación in vitro de la resistencia compresiva de dos cementos resinosos en coronas metal-cerámicas reparadas con incrustaciones cerámicas

Se han propuesto diversas técnicas para restaurar la integridad de la corona sin la necesidad de retirarla de la boca. Uno de los factores más importantes que influyen en la adhesión entre dos sustratos cerámicos es el tipo de cemento. El objetivo del presente trabajo fue evaluar in vitro la resistencia de las incrustaciones cerámicas cementadas en coronas metal cerámicas fracturadas a fuerzas tangenciales, fijas sobre patrones metálicos (cromo-níquel) de un canino superior izquierdo. Por tal motivo se confeccionaron 20 coronas metal-cerámicas, divididas en dos grupos de 10. Se talló la cara distal de las coronas sin exponer el metal simulando una fractura, y se elaboró incrustaciones cerámicas. En el grupo 1 se cementó con RelyX U100®, y el grupo 2 con Multilink N®. Ambos grupos fueron sometidos a la prueba de ensayo en la maquina universal AMSLER, modelo K-2000 NP. Los resultados no muestran diferencias estadísticamente significativas, sin embargo el grupo 2 obtuvo mayores valores de resistencia

A randomized double-blind trial to compare the clinical efficacy of granisetron with metoclopramide, both combined with dexamethasone in the prophylaxis of chemotherapy-induced delayed emesis

Background: The prophylactic use of 5-HT3 receptor antagonists (setrons), after the first 24 h (acute phase) of exposure to emetic chemotherapy, to decrease the incidence of ‘delayed phase' emesis increases costs. We designed a study to evaluate the efficacy of a setron (granisetron) in the delayed phase, compared with metoclopramide, each combined with a corticosteroid. Patients and methods: Patients on their first course of single-day emetic chemotherapy (cisplatin, carboplatin, doxorubicin, cyclophosphamide and others) received granisetron 2 mg p.o. and dexamethasone 8 mg p.o. on day 1, followed for 5 days by dexamethasone 4 mg p.o. od combined with either metoclopramide 20 mg p.o. tds or granisetron 1 mg bd in a double-blinded double-dummy protocol. Patients evaluated the results using a diary card. Randomization was stratified by institution, sex, emetic chemotherapy naïve versus previous, alcohol consumption and platinum versus non-platinum regimen. Results: 131 evaluable patients received granisetron in the delayed phase, and 127 received metoclopramide. Control of acute emesis in both arms was similar (86% granisetron; 85% metoclopramide). The 35 patients experiencing acute emesis had poor control in the delayed phase, with only four granisetron and three metoclopramide patients having no or mild nausea and no vomiting. Conclusions: In daily practice, a combination of oral dexamethasone and oral granisetron achieves an extremely high control of acute emesis (86% protection). Our data suggest that routine prescription of setrons for delayed phase control is not advisable as it increases costs without any benefit for the majority of patients. Delayed emesis in the rare patients with acute phase emesis remains an unsolved proble

A Systematic Search for Structure-Activity Relationships of Skin Contact Sensitizers: Methodology

A computerized resource for the systematic evaluation of the structure-activity relationships and other aspects of contact allergens is described. This resource consists of a data base of results of contact dermatitis tests and a structural classification scheme for contact allergens that is called a Structure-Activity (S/A) Tree. The data base now contains approximately 2200 test results extracted from the journal Contact Dermatitis (1975–1982) and is continually being expanded. The S/A Tree is being developed to provide an index to structure-activity relationships of contact allergens; 63 structural groups are currently indexed. Analyses of benzoquinones and gallic acid esters are presented as examples of the potential application of this resource to such problems as the identification of potential cross-reactants, appropriate test concentrations and vehicles, and the reliability of available test results

Colapso posterior de mordida: etiología, diagnóstico diferencial y tratamiento

El propósito de esta revisión de reportes de caso y de la literatura es informar al odontólogo general y especialista sobre un correcto significado del diagnóstico del colapso posterior de mordida, y por ende su tratamiento, ya que al tener múltiples conceptos guiará a diferentes enfoques, lo cual resulta confuso. Esta situación clínica implica una pérdida de la dentición en el sector posterior lo que conlleva a una sobrecarga anterior, este signo en algunos casos lleva a perder la correcta oclusión. Existen otras posibles causas para este desorden de la oclusión, como la enfermedad periodontal, alteraciones en forma y función de labios y lengua, así como maloclusiones y hábitos parafuncionales. La variedad del diagnóstico diferencial se ejemplifica con 4 casos clínicos. Finalmente, se da una guía del manejo clínico del odontólogo con respecto a esta alteración

Optimización de la retención de una prótesis total superior a través de un atache magnético colocado en una exostosis palatina

RESUMENLa retención, soporte y estabilidad de una prótesis total superior está dada básicamente por el reborde edéntulo y extensión Aunque algunos autores consideran a la retención como la propiedad menos importante en unadentadura completa, se sabe que es un factor condicionante para el confort psicológico del paciente, ya que evita episodios incómodos de desalojamiento de la misma durante la función.El presente caso clínico describe el tratamiento de una paciente edéntula total superior y parcial inferior con compromiso severo de los tejidos residuales de soporte, quien presentaba una exostosis palatina donde se colocó un implante corto para aumentar la retención a través de un atache magnético, logrando de ésta manera mejorar considerablemente las propiedades protésicas

5-Fluorouracil as protracted continuous intravenous infusion can be added to full-dose docetaxel (Taxotere®)-cisplatin in advanced gastric carcinoma: a phase I-II trial

Background: A phase I-II multicenter trial was conducted to define the maximum tolerated dose (MTD) according to tolerance and toxicity (primary objective), as well as to describe the clinical activity, in terms of response and survival (secondary objectives), of a combination of 5-fluorouracil (5-FU) in protracted continuous intravenous infusion (p.i.v.) with docetaxel and cisplatin for patients with advanced gastric cancer. Patients and methods: Patients with measurable unresectable and/or metastatic gastric carcinoma, World Health Organization performance status ≤1, normal hematological and renal functions, adequate hepatic function and not pretreated for advanced disease by chemotherapy, received up to eight cycles of a combination of docetaxel on day 1, cisplatin on day 1 and 5-FU p.i.v. on days 1-14 (TCF) every 3 weeks, which was escalated up to the MTD, defined by the occurrence of dose-limiting toxicity in two patients in one dose level. Results: Fifty-two patients were accrued and treated (43 in the phase I part of the trial and nine additional at the recommended dose level). A median of five cycles/patient was given. The recommended dose of TCF was docetaxel 85 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1 and 5-FU p.i.v. 300 mg/m2/day on days 1-14. Grade ≥3 toxicities were neutropenia 79%, alopecia 46%, fatigue 23%, mucositis 10%, diarrhea 19%, nausea/vomiting 13%, neurological 4% and palmar-plantar 2%. Ten non-fatal febrile neutropenia episodes were recorded in eight patients. There were no treatment-related deaths. Among 41 patients with measurable disease (79%), we observed one complete and 20 partial responses for an overall intent-to-treat response rate of 51% (95% confidence interval 35-67%). Five patients (20%) had stable disease for ≥12 weeks (four cycles). The median overall survival was 9.3 months. Conclusions: 5-FU p.i.v. at 300 mg/m2/day for 2 weeks out of three could be safely added to the docetaxel-cisplatin (TC) combination, but the dose of docetaxel had to be reduced to 75 mg/m2 in a subsequent phase II trial. This drug regimen seems to be very active in advanced gastric cancer. Comparison with both TC and ECF in a randomized SAKK trial is ongoin