Carcinomas with identical and with different specific antigens

Summary Immunological investigations demonstrated that certain human malignant neoplasms possess similar specific antigenic and immunogenic properties. On the other hand, there are tumors which have qualitatively different specific antigens. The immunological group to which the tumor belongs is not connected with localization of the tumor, its structure or blood group.Presented by Active Member of the AMN SSSR N. N. Zhukov-Verezhnikov     

Infectious diseases and immunological markers associated with patients with non-Hodgkin lymphoma treated with rituximab

Background: The use of rituximab (RTX) is increasing, even in developing countries. It has become the first-line therapy or adjuvant to chemotherapy (CHOP; cyclophosphamide, hydroxydaunorubicin, oncovin and prednisone) for various diseases, including B cell lymphoma and autoimmune diseases.

Aim: We describe the infectious diseases and immunological markers associated with RTX treatment of patients with non-Hodgkin lymphoma (NHL).

Methods: Serum immunoglobulins were determined before and after intravenous immunoglobulin (IVIg) administration. Pneumo-23IgG-specific anti-pneumococcal antibodies were evaluated before and after vaccination. Immunophenotyping and lymphocyte proliferation were determined in the course of the treatment.

Results: Seven patients were followed and median age was 56.0?±?5.0?years (range, 41.9–71.6?years). At baseline, the mean level of IgG was 333.7?±?40.8?and IgM 40.9?±?11.3?mg/dL, respectively; immunoglobulin A and E (IgA and IgE) were under the limit of detection. Two patients had reduced or absent B cells and T cell subsets were at normal levels in five patients. All patients failed to mount an efficient post-vaccination immune response against hepatitis B virus, tetanus, diphtheria and against the 23-valent pneumococcal polysaccharide vaccine. During RTX/CHOP treatment, human-IgG-immunoglobulin (IVIg) therapy was introduced in six patients after recurrent infections, including community-acquired pneumonia (85.7%), chronic sinusitis (85.7%) and gastroenteritis (42.9%).

Conclusion: Poor response against pneumococcal vaccines increases the susceptibility of respiratory diseases in these patients. In patients with NHL treated with RTX, the benefits achieved with IVIg replacement for the control of recurrent infectious diseases is of paramount importance. Clinicians dealing with monoclonal antibodies against cancer therapy, especially RTX, should be aware of the increasing risks for symptomatic induced hypogammaglobulinemia and respiratory infections.     

Tolerance and rebound with zafirlukast in patients with persistent asthma

Background  

The potential for tolerance to develop to zafirlukast, a cysteinyl leukotriene (CysLT) receptor antagonist (LRA) in persistent asthma, has not been specifically examined.     

伊痛舒运用于颈源性头痛的治疗及护理

颈源性头痛好发于中老年或长期处于工作紧张状态的电脑工作及文字工作者,已成为疼痛门诊中的常见病种,其病因较为繁杂.随着对头痛不断研究,越来越多的学者发现,颈部疾病可以导致头痛,颈源性头痛在头痛人群中与偏头痛相近,大约为17.18%[1-2].我科采用伊痛舒及香丹注射液行颈2椎旁神经组滞治疗该病,取得了良好的疗效.现报告如下.     

Coinfection with hepatitis C and B viruses with pre-C mutant

We report on a case of co-infection VHB-VHC with a pre-core mutant, a rare association in the literature. The last consensus conference in march 2002 did not help us so much, since only VHC-VIH co-infection was considered. We report on our therapeutic experience about the treatment and discuss the recent studies aimed to define the function of respective virus in the case of co-infection. In the present case, the VHC infection has been completely cured, but some problems with the VHB infection are still unsolved.     

Sleep in children with autism with and without autistic regression

The purpose of the present investigation was to characterize and compare traditional sleep architecture and non-rapid eye movement (NREM) sleep microstructure in a well-defined cohort of children with regressive and non-regressive autism, and in typically developing children (TD). We hypothesized that children with regressive autism would demonstrate a greater degree of sleep disruption either at a macrostructural or microstructural level and a more problematic sleep as reported by parents. Twenty-two children with non-regressive autism, 18 with regressive autism without comorbid pathologies and 12 with TD, aged 5-10years, underwent standard overnight multi-channel polysomnographic evaluation. Parents completed a structured questionnaire (Childrens' Sleep Habits Questionnaire-CSHQ). The initial hypothesis, that regressed children have more disrupted sleep, was supported by our findings that they scored significantly higher on CSHQ, particularly on bedtime resistance, sleep onset delay, sleep duration and night wakings CSHQ subdomains than non-regressed peers, and both scored more than typically developing controls. Regressive subjects had significantly less efficient sleep, less total sleep time, prolonged sleep latency, prolonged REM latency and more time awake after sleep onset than non-regressive children and the TD group. Regressive children showed lower cyclic alternating pattern (CAP) rates and A1 index in light sleep than non-regressive and TD children. Our findings suggest that, even though no particular differences in sleep architecture were found between the two groups of children with autism, those who experienced regression showed more sleep disorders and a disruption of sleep either from a macro- or from a microstructural viewpoint.     

Allergy screening with Phadiatop® and CAP Phadiatop® in combination with a questionnaire in adults with asthma and rhinitis

The efficiency of the new screening tests for atopy, Phadiatop and CAP Phadiatop, was studied by comparing their results with a clinical diagnosis of atopy in 100 consecutive adults with asthma and/or rhinitis. Further, the diagnostic efficiency of a combination of Phadiatop and a few standardized questions was studied. The Phadiatop was found to have a specificity of 0.98, and a sensitivity of 0.92 and the CAP Phadiatop a specificity of 0.94 and a sensitivity of 0.96. When the Phadiatop was combined with a few questions, a sensitivity of 1.00 was achieved. It is concluded that Phadiatop and CAP Phadiatop have a higher diagnostic precision than other hitherto used methods for screening of atopic allergy. The place of Phadiatop in a diagnostic flow chart is suggested.     

Satisfaction with treatment decision-making and treatment regret among Latinas and non-Latina whites with DCIS

Objective

To examine differences in treatment decision-making participation, satisfaction, and regret among Latinas and non-Latina whites with DCIS.

Methods

Survey of Latina and non-Latina white women diagnosed with DCIS. We assessed women's preferences for involvement in decision-making, primary treatment decision maker, and participatory decision-making. We examined primary outcomes of satisfaction with treatment decision-making and treatment regret by ethnic-language group.

Results

Among 745 participants (349 Latinas, 396 white) Spanish-speaking Latinas (SSL) had the highest mean preference for involvement in decision-making score and the lowest mean participatory decision-making score and were more likely to defer their final treatment decision to their physicians than English-speaking Latinas or whites (26%, 13%, 18%, p < 0.05). SSLs reported lower satisfaction with treatment decision-making (OR 0.4; CI 95%, 0.2–0.8) and expressed more regret than whites (OR 6.2; CI 95%, 3.0–12.4). More participatory decision-making increased the odds of satisfaction (OR 1.5; CI 95%, 1.3–1.8) and decreased the odds of treatment regret (OR 0.8; CI 95%, 0.7–1.0), independent of ethnicity-language.

Conclusion

Language barriers impede the establishment of decision-making partnerships between Latinas and their physicians, and result in less satisfaction with the decision-making process and more treatment regret.

Practice implications

Use of professional interpreters may address communication-related disparities for these women.     

Short-term and long-term survival in patients with alcoholic hepatitis treated with oxandrolone and prednisolone

A cooperative study was conducted to determine the efficacy of 30 days of treatment with either a glucocorticosteroid (prednisolone) or an anabolic steroid (oxandrolone) in moderate or severe alcoholic hepatitis. One hundred thirty-two patients with moderate disease and 131 with severe disease were randomly assigned to one of three treatments: prednisolone, oxandrolone, or placebo. During the 30 days, mortality in the groups receiving steroid therapy was not significantly different from mortality in the placebo group. Thirteen per cent of the moderately ill patients and 29 per cent of the severely ill patients died. Although neither steroid improved short-term survival, oxandrolone therapy was associated with a beneficial effect on long-term survival. This was especially true in patients with moderate disease: among those who survived for one or two months after the start of treatment the conditional six-month death rate was 3.5 per cent after oxandrolone and 19 to 20 per cent after placebo (P = 0.02). No consistent long-term effect was associated with prednisolone therapy.     

Lemierre's Syndrome with Spondylitis and Pulmonary and Gluteal Abscesses Associated with Mycoplasma pneumoniae Pneumonia

Lemierre's syndrome, a systemic anaerobic infection caused by Fusobacterium necrophorum, is characterized by an acute oropharyngeal infection, septic thrombophlebitis of the internal jugular veins, sepsis, and multiple metastatic infections. It commonly leads to pulmonary parenchymal abscesses and occasionally to septic arthritis, osteomyelitis, or liver or spleen abscesses. Reported here is a case of spondylitis and pulmonary and gluteal abscesses that occurred as part of a classic presentation of Lemierre's syndrome. Treatment with imipenem and clindamycin was successful.     

Satisfaction with communication in ICU patients and relatives: comparisons with medical staffs' expectations and the relationship with psychological distress

Objective

To study intensive care unit (ICU) patients’ and relatives’ satisfaction in regard to communication with medical staff (nurses and physicians), perceived support, environmental strain and their psychological distress. Further, to compare this with expectations of the medical staff.

Methods

Cross-sectional study, 4–6 weeks post-ICU discharge. Respondents to the questionnaire were: 255 (63%) patients, 354 (82%) relatives and 145 (74%) medical staff. Degree of satisfaction and distress were measured on a five-point Likert-scale (0 = low to 4 = high).

Results

The mean score for patient satisfaction with communication was 3.0 (95%CI 2.9–3.1) and for relatives 3.4 (3.3–3.5). This was significantly higher than expected by the staff for patients 2.5 (2.4–2.6) and relatives 2.8 (2.7–2.9), both p < 0.001. Relatives’ degree of psychological distress, 2.5 (2.4–2.6) was significantly higher than for patients’, 1.6 (1.5–1.7), but was significantly lower than expected by the staff, 2.9 (2.8–3.0) and 2.7 (2.6–2.8) respectively, both p < 0.001.

Conclusion

Patients and relatives were more satisfied with the communication than expected by the staff. The staff overestimated the patients’ and relatives’ psychological distress. Relatives report more psychological distress symptoms post-ICU discharge compared to the patients.

Practice implications

Medical staff is aware of psychological distress in ICU patients and relatives and effort to reduce this during ICU stay and afterwards should be implemented.     

Onward and upward with MHR

As incoming Editor-in-Chief of MHR, I am delighted to have thisopportunity briefly to set out my stall and let you know howI see the journal developing over the next 3 years. RichardIvell, his associate editors and     

Self-regulation and women with asthma

PURPOSE OF REVIEW: Recent research related to sex and gender role influences on asthma in women is summarized. Implications for enhancing women's self-regulation and ability to manage asthma effectively are discussed. RECENT FINDINGS: Studies in the past year have indicated that asthma is a significant burden on women and emphasized the importance of control, especially during pregnancy. The significance of hormonal variation in symptoms and severity has been noted. An association between weight and asthma has been observed. Evidence suggests that hormonal changes contribute to the asthma prevalence shift from men to women in adolescence. One study showed positive results of focusing on sex-related and gender-related factors in self-regulation education for women. Recent findings imply that enhancing self-regulation and effective management of asthma in women requires attention to sex and gender role influences in clinical counseling and intervention research. SUMMARY: Clinicians may help female patients with asthma by incorporating sex and gender role related considerations into their clinical consultations. Evidence-based asthma education interventions to assist women with their particular asthma management challenges are needed.