Is good ‘quality of life’ possible at the end of life? An explorative study of the experiences of a group of cancer patients in two different care culturesINFORMATION POINT:Factor analysis

The purpose of this paper was to explore how a group of gravely ill patients, cared for in different care cultures, assessed their quality of life during their last month of life. The study material comprised quality of life assessments from 47 cancer patients, completed during their last month of life. Two quality of life questionnaires, the EORTC QLQ-C30 and a psychosocial well-being questionnaire, were used. The data were treated in accordance with instructions for the respective questionnaires, and the results are presented primarily as means, mostly at the group level. Assessments from patients in two different care cultures, care-orientated and cure-orientated, were compared. The results show that despite having an assessed lower quality of life in many dimensions than people in general, several patients experienced happiness and satisfaction during their last month of life. 'Cognitive functioning' and 'emotional functioning' were the dimensions that differed least from those of the general population, and 'physical functioning', 'role functioning' and 'global health status/quality of life' differed the most. 'Fatigue' showed the highest mean for the symptom scales/items. There was a tendency for those cared for in the cure-orientated care culture to report more symptoms than those in the care-orientated care culture. An exception to this was 'pain', which was reported more often by those in the care-orientated care culture. The implications of the results are discussed from different angles. The significance of knowledge concerning how patients experience their quality of life is also discussed with respect to the care and the planning of care for dying patients.     

Detection of carbamyl phosphate synthetase 1 deficiency using duodenal biopsy samples

The activity of urea cycle enzymes was assayed in duodenal biopsy specimens obtained from a female infant who presented with neonatal hyperammonaemia. All enzyme levels were normal except N-acetyl glutamate-dependent carbamyl phosphate synthetase 1 (CPS1) which was half the mean activity in normal control specimens. A similar deficiency of CPS1 was also shown in duodenal specimens from the patient's mother who became slightly symptomatic after relatively high protein meals and during pregnancy, and had spontaneously modified her diet to one with protein restriction. The patient is growing normally on a dietary regimen similar to that spontaneously adopted by her mother. Urea cycle enzyme activity in the duodenal biopsy material from the controls was similar to that found in the normal human liver and appears to have distinct advantages as a means of assaying for urea cycle defects in patients with hyperammonaemia and their relatives.     

Clinical and immunological aspects of food allergy in childhood. I. Estimation of IgG, IgA and IgE antibodies to food antigens in children with food allergy and atopic dermatitis

Sixtynine children with case histories of food intolerance and 30 food tolerant children with atopic dermatitis have been investigated regarding serum IgE levels and IgE-, IgG, and IgA-antibodies to some common foods. Children with food intolerance had significantly higher IgE levels and to a larger extent specific IgE antibodies to the tested allergens. IgE antibodies to cow's milk were found in 71% of the children with histories of cow's milk allergy but occurred also in similar titers in 27% of milk tolerant children with other food allergies. IgE antibodies to egg-white occurred in 88% of egg allergies, but low and moderate titers were also found in 17% of children without food intolerance. However, all children with high titers had symptoms of egg allergy. IgE antibodies to the fish allergen were only found in fish allergic children while IgE antibodies to the fish allergen were only found in fish allergic children while IgE antibodies to soy-bean and green peas were found less consistently. The level of serum IgA antibodies to milk was similar in both groups. The IgG antibody titers to all tested food antigens seemed to parallel the IgE antibody titer to the same food. It was not possible to correlate the IgG antibody titers to symptoms.     

Effect of HCG on plasma levels of estrogens and progesterone during the luteal phase of the menstrual cycle in rhesus monkeys (Macaca mulatta). Stimulation of sex steroid production in Rhesus monkeys

To study the plasma patterns of estrogen and progesterone under gonadotropic stimulation simulating early pregnancy, 4 normal female rhesus monkeys (Macaca mulatta) were injected intramuscularly with 50-250 IU of human chorionic gonadotropin (HCG) for 5-10 days during the luteal phase of their menstrual cycle. Plasma levels of estrogen and progesterone were measured by radioimmunoassay of blood samples taken before and after the HCG injections. The exogenous HCG was found to prolong the life span of the corpus luteum and extended the length of the luteal phase in direct relation to the length of HCG treatment. Within 6 hours after the first HCG injection, a 10-fold increase in plasma progesterone was found in all 4 monkeys, and plasma progesterone levels remained comparatively high for 4-5 days after the first injection. The plasma levels of estrone and estradiol were significantly higher than pretreatment levels and normal luteal phase levels during and after HCG injection, with estrone predominating over estradiol levels. It is concluded that HCG injections in the luteal phase stimulate estrogen and progesterone production, with progesterone increasing before estrogen, but with the increased estrogen levels being maintained for longer periods of time.     

The value of a statistical life: theoretical and empirical evidence

The value of a statistical life is an important concept in health and environmental economics. This paper provides definitions of the value of a statistical life, and considers single-period and life cycle models. It shows how the value of a statistical life can be measured simply in empirical studies, and addresses the important age profile issue. Available empirical evidence is briefly presented, and recent studies are included that use meta-analysis to determine which variables are appropriate to explain the variance of estimates of the value of statistical life.     

Experimental acute sinusitis in rabbits. Energy metabolism in sinus mucosa and secretion

In previous studies, sinus secretions have been analysed concerning pO2, pCO2 and pH. In this study the energy metabolism in the maxillary sinus mucosa and secretion was studied in 33 New Zealand White rabbits. In freeze-dried samples, glucose and lactate were analysed by enzymatic assays and ATP by HPLC. In the purulent sinusitis, lactate concentration in the mucosa was 5.67 mmol X kg-1 w.w. and significantly higher than in the control sinus. Also in the non-purulent sinusitis, lactate was increased in the mucosa. The lactate concentrations in the secretion were 9.8 and 8.4 mmol X kg-1 w.w. in purulent and non-purulent secretions respectively and are probably the result of a diffusion from the mucosal cells and of leukocyte metabolism. A reduced ATP content, with increases in ADP and AMP, in the sinus mucosa of the purulent sinusitis suggests a relative energy depletion which could result in impaired epithelial function.     

Renal parenchymal volume during and after acute pyelonephritis measured by ultrasonography.

A total of 47 children with acute pyelonephritis were investigated using water delay ultrasonographic equipment (Octoson) for determination of renal parenchymal volume by the stepped section technique. Thirty two patients were repeatedly investigated every to every other week up to seven weeks. Median renal parenchymal volume during acute pyelonephritis of the right kidney was 2.70 cm3/kg body weight and of the left kidney 3.10 cm3/kg; this was significantly larger than the volume of control kidneys, which was 1.82 and 2.07 cm3/kg, respectively. The most enlarged kidneys were found among the youngest children. A significant successive decrease in renal size was found during the first four to five weeks after the acute pyelonephritis. Because of enlargement of the kidneys during acute pyelonephritis we suggest that the first renal size determination to be used for following renal growth should be performed after at least four to six weeks.