Response shift due to diagnosis and primary treatment of localized prostate cancer: a then-test and a vignette study

Aim Whether a prostate cancer diagnosis induces response shift has not been established so far. Therefore, we assessed response shift in men who were diagnosed with localized prostate cancer. Patients and methods Out of 3,892 men who completed a questionnaire before screening, 82 were subsequently diagnosed with prostate cancer. Response shift was assessed in 52 (response 63%) by the then-test (EuroQol self-rating of health, Short-Form 36 mental health and vitality) and a novel method: rating of vignettes relating to side effects of prostate cancer treatment (urinary, bowel and erectile dysfunction). Three then-tests were conducted: two referencing pre-diagnosis (measured pre- and post-treatment), and one referencing pre-treatment (measured post-treatment). Results Then-test scores of pre-diagnosis health were significantly higher than original scores, indicating a more positive judgement in retrospect. Then-test scores of pre-treatment health were lower than original scores. Especially the vignette on erectile dysfunction was rated less bad after diagnosis versus before (P < 0.001, moderate effect size). Conclusions We found evidence for response shift in men who were diagnosed with prostate cancer. Men evaluated urinary, bowel, and erectile dysfunction as less bad after they had become patients who can expect to experience these side effects. The rating of vignettes is a promising additional technique to assess response shift.     

Buruli ulcer

Buruli ulcer (Mycobacterium ulcerans) is an emerging disease. The mode of transmission is still unknown. Mycobacterium ulcerans has been detected (by polymerase chain reaction) in water and water insects. Extensive surgery is still the main treatment. Recognition and excision - of the early nodular stage - is effective. The toxin, a polyketide, causes immunosuppression with potent inhibition of monocytes, T cells and nuclear factor kappa-B activation.     

PRELIMINARY STUDY OF OMENTUM TRANSPOSITION TO BRAIN FOR TREATMENT OF ALZHEIMER＇ S DISEASE

Objective To learn the effect of omemtum transposition to the brain of patients with Alzheimer＇s disease. Methods Ten consecutive patients, aged 58 - 81 years old, underwent graft of their elongated pedicled omentum onto their left frontal-temperal-parietal cerebral cortex. Those patients, who had more than five years of dementia with low mini mental-state examination （MMSE） scores of 2 -15, were diagnosed by a neurologist. All subjects underwent single photon evoked computer tomography （SPECT） pre- and post-operatively. SPECT results were analyzed semi-quantitatively by calculation of the left/right radioactivity counts symmetry index （Si）. The patients were followed up to one year. The outcome was evaluated by the neurologist with a modified scale of activities of daily living （mADL） as well as the MMSE. Results Three months following the surgery, the Si of SPECT increased from （ 98. 7 ＋ 1.9） % to （ 103. 9 ＋ 2.3 ） % （ P = 0. 0307）. The neurological and neuropsychological testing scores increased insignificantly during the follow-up period. By the one year, the MMSE score rose from 8. 7 ＋1. 4 to10. 7 ＋1. 8 （ P 〉 0. 05 ） , while the mADL from13. 3 ＋1. 8 to16. 9 ＋ 2. 0 （ P 〉 0. 05 ） . One of the patients suffered a heart attack, two had epileptic episodes postoperatively. Conclusion We believe that omental transposition to the brain augments cerebral blood flow, which might be helpful to decelerate the processing of Alzheimer＇s disease. However, it is still a potentially risky procedure for the elderly.     

Myelopoiesis in immunologically classified subgroups of childhood acute lymphocytic leukemia

Soft agar culture studies of 43 immunologically characterized patients with childhood acute lymphocytic leukemia (ALL) are presented. The immunologic subsets studied include “null”-cell, pre-B-cell, and T-cell leukemias. Abnormal myelopoiesis, including high peripheral blood and low marrow, colony-forming cell numbers, low colony-stimulating activity, and normal maturation of colony-forming cells in vitro was noted in each group as previously described for immunologically uncharacterized ALL. We conclude that immunologic subsets of childhood lymphoblastic leukemia cause similar abnormalities of myelopoiesis. Lack of differences in growth characteristics among immunologic subsets of ALL make it impossible to use this tissue culture technique in sub-classification of these leukemic disorders.