Empowering employees with chronic diseases; development of an intervention aimed at job retention and design of a randomised controlled trial

Background  

Persons with a chronic disease are less often employed than healthy persons. If employed, many of them experience problems at work. Therefore, we developed a training programme aimed at job retention. The objective of this paper is to describe this intervention and to present the design of a study to evaluate its effectiveness.     

Factors predictive of response and survival in patients with metastatic colorectal cancer in Taiwan

5-Fluorouracil in combination with leucovorin has been shown to be active in therapeutic trials of metastatic colorectal carcinoma. In this study, we administered these drugs to 72 patients with metastatic colorectal carcinoma. Thirty-six of them without previous exposure to 5-fluorouracil were treated with weekly bolus injections of 5-fluorouracil (425 mg/m2) and leucovorin (25 mg/m2) supplemented with oral levamisole. Another 36 patients with or without prior 5-fluorouracil treatment received 5-fluorouracil 3,000 mg/m2 and leucovorin 300 mg/m2 in a 48-hour continuous infusion every two weeks. Clinical efficacy and toxicity were assessed by WHO criteria. Variables were tested for relations to response and survival by univariate and multivariate analysis. The response rate was 19.4% in weekly bolus arm and 13.9% in biweekly high-dose infusion arm (P = 0.527). Median survivals in the two arms were 18.4 months (weekly) and 21 months (biweekly) respectively (P = 0.708). Gastrointestinal side effects including nausea, vomiting, diarrhea and mucositia were the major toxicities of these regimens. By multivariate analysis, the only factor to influence response rate was the site of metastases (P = 0.009). The only factor to affect survival was performance status of the patient (P = 0.0001). We concluded that the two 5-fluorouracil based regimens are well-tolerated and shown to have a response rate comparable with previous reports of similar regimens in patients with metastatic colorectal cancer. Only liver metastases seemed to have a better response to therapy. Performance status is the most important prognostic factor in patients with metastatic colorectal cancer.      

Langerhans' cell histiocytosis with thyroid involvement masquerading as thyroid carcinoma

A 28-year-old woman was admitted to our Hospital with a chief complaint of progressive gingival swelling and loosening of teeth over about a year. According to past history, she had received total thyroidectomy 2 years previously due to thyromegaly. The thyroidectomy specimen was at first interpreted as 'poorly differentiated carcinoma of the thyroid'. One year ago, she began to be aware of gingival swelling and loosening of teeth. A gum biopsy was taken and the pathologic features were similar to her 'thyroid carcinoma'. Subsequent investigations, including immunohistochemical stain, showed the gum was heavily infiltrated with histiocyte-like Langerhans' cells which were positive for S-100 protein. Ultrastructural examination of the cells under electron microscope revealed many typical intra-cytoplasmic Birbeck granules. Langerhans' cell histiocytosis was diagnosed. Langerhans' cell histiocytosis with thyroid involvement is extremely rare and may run a relatively indolent course. Even on a retrospective examination, it may easily be confused with poorly differentiated carcinoma of the thyroid. We suspect that this error may have been made on other occasions and that the occurrence of this condition may be underreported.      

Histidinaemia: a benign metabolic disorder

Histidinaemia is a relatively common inherited metabolic disorder with an incidence similar to phenylketonuria. This paper reports the long term outcome of patients diagnosed by newborn screening in the north west of England. Between 1966 and 1990, 108 infants were diagnosed as having histidinaemia by a regional neonatal screening programme (incidence 1:11,083). A further five children were detected following diagnosis in a sibling. Of the 113, nine were lost to follow up. Infants diagnosed before 1981 (n = 47) were placed on a low histidine diet (225 mg/kg/d) for an average period of 21 months (SD 4.5). All patients were reviewed regularly, Griffiths developmental quotients (DQ) were assessed at 2 and 4 years, and WISC-R intelligence quotients (IQ) at 8, 12, and 18 years. IQ data were converted to standard deviation scores (IQ SDS) to account for increasing IQ norms with time. Neither DQ nor IQ correlated with plasma histidine at diagnosis or with the mean plasma histidine throughout life. Growth was normal in all patients. There was no apparent benefit from a low histidine diet in early childhood. In contrast to other studies, there was no excess of clinical symptoms. On the basis of these findings, histidinaemia is a benign metabolic disorder that does not require treatment.     

Lingual thyroid gland: sonographic appearance

Thyroid dysgenesis is often manifested by a lingual or sublingual location of the thyroid gland. If radionuclide studies are not readily available or are contraindicated, ultrasound (US) may be used to locate the gland. The US appearance of a lingual thyroid gland and the role of US in the evaluation of suspected thyroid dysgenesis are described.     

HPLC测定益肤霜中红霉素和地塞米松的含量

采用ＨＰＬＣ测定益肤霜中红霉素和地塞米松的含量，控制制剂的质量。色谱条件：固定相为Ｋｒｏｍａｓｉｌ Ｃ１８柱；流动相为乙腈－０．２ｍｏｌ／Ｌ醋酸铵－水，流速０．８ｍｌ／ｍｉｎ；检测波长２１５ｎｍ。以ｃ对峰面积Ａ作直线回归，红霉素在１．５－２４ｇ／Ｌ地塞米松在２０－３００ｍｇ／Ｌ的范围内，其浓度与峰面积呈直线关系。红霉素回收率为９９．６９％；地塞米松的回收率为１００．２８％。本法操作简便，结果准确，     

Quality assessment and assurance in diagnostic imaging. Theoretical and practical considerations and a quality audit of the excretory urogram

Concepts necessary to an understanding of the basics of quality assurance audits are presented. Included are specific examples that bridged theory and practice by applying the protocol to a real-life diagnostic imaging situation. This method meets the present requirements of the Joint Commission of the Accrediation of Hospitals.     

Elektronenmikroskopische Analyse der Mikrogametenentwicklung bei Toxoplasma gondii

Zusammenfassung Die Ausbildung der Mikrogameten bei T. gondii beginnt mit einer Vervielfachung des Gamontenzellkerns. In der Oberfläche des Gamonten treten nacheinander mehrere Vorwölbungen auf, denen sich jeweils ein Zellkern zuordnet. In den Vorwölbungen bilden sich die späteren Perforatorien der Mikrogameten aus, und es werden— ausgehend von je einem Basalkörper — 2 Geißeln gebildet. Der Mikrogamet wächst jetzt gleichsam aus der Oberfläche des Gamonten heraus. Hierbei tritt das große Mitochondrium in engen Kontakt mit dem Zellkern. Der Zellkern streckt sich, und nach Durchtrennung einer letzten Plasmaverbindung liegen die Mikrogameten frei in der parasitophoren Vakuole.Aufgrund verschiedener Bilder sind wir der Auffassung, daß die Mikrogameten von T. gondii — im Gegensatz zu denen anderer Coccidienarten (z. B. E. pragensis, E. nieschulzi, E. perforans) — nicht gleichzeitig, sondern in Gruppen nacheinander entstehen. Es bleibt ein Restkörper zurück. Der Mikrogamet von T. gondii ist, durch die Gestalt des Zellkerns verursacht, sehr breit und stark abgeflacht. Das Mitochondrium ist vom tubulären Typ; die Tubuli liegen nicht in Reihen, sondern ungeordnet im Mitochondrium. Neben den 2 Geißeln lassen sich Reste einer rudimentären dritten erkennen. Im Perforatorium sind 16 oder mehr sehr kurze Mikrotubuli in einer Reihe, dicht oberhalb einer stark osmiophilen Platte angelegt. Ihre Funktion ist zur Zeit noch nicht geklärt.

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Electron microscopical studies on the microgametogeny of Toxoplasma gondii

Summary The micorgametogony of T. gondii is investigated electronmicroscopically. The formation of the gametes begins with a multiplication of the gametocyte nucleus. The surface of the gametocyte develops many protuberances and a single cell nucleus migrates into each. Within the protuberances later to become the perforatoria of the microgamete, two flagella develop from each basal body. The protuberance then grows and buds off to form the microgamete. During this process the large mitochondrion migrates into closer contact with the nucleus. The nucleus elongates and when the last plasma connection is severed the microgamete lies free in the vacuole surrounding the parasite.On the bases of the different structures observed, we suppose that the microgametes of T. gondii develop in groups, one after the other, in contrast to other Coccidia, e.g. E. pragensis, E. nieschulzi, E. perforans where they develop simultaneously. In T. gondii a residual body remains and, because of the form of the nucleus, the microgamete is wide and flat. The mitochondrion is of the tubular type; the tubules ramifying rather than lying in rows. Next to the two flagella rudimentary remains of a third can be found. In the perforatorium 16 or more very short microtubuli lie packed together on top of a strongly osmophilic plate but their function has not yet been determined.

     

Prekallikrein-Kallikrein conversion rate as a predictor of contrast material catastrophies

An in vitro is described that attempts to detect patients with a potential for adverse systemic reactions to contrast material. This test involves measuring the rate of conversion of prekallikrein to kallikrein under certain standard conditions. In a preliminary retrospective study, the test could be used to identify such patients with a sensitivity of 88%, a specificity of 82%, and a predictive value of 79%.