Role of interstitial brachytherapy in oral and oropharyngeal carcinoma: Reflection of a series of 1344 patients treated at the time of initial presentation

Our study focuses on a series of 1344 cases of carcinoma of the oral cavity and oropharynx treated between 1973 and 1992. Brachytherapy was always performed with iridium 192, either alone or in combination with external-beam irradiation or with surgery for the treatment of the primary tumor. For the oral cavity, we studied 565 cases of mobile tongue. The local control and overall survival rates, respectively, at 5 years are as follows: for T1, 92% and 70%; for T2, 62% and 42%; and for T3, 50% and 29%. For the subgroup T1T2N0, there was a better prognosis for treatment by brachytherapy of the primary lesion alone (p < 0.0001). Two hundred seven cases of floor-of-mouth carcinoma have been reported. The T3T4 patients were not considered surgical candidates. The local control and overall survival rates, respectively, at 5 years are as follows: for T1, 97% and 71%; for T2, 72% and 42%; and for T3, 51% and 35%. Ninety-seven patients were treated by postoperative brachytherapy. These were patients for whom the margins after surgery were positive or narrow. A technique termed the modified bridge is described for lesions located in the mandible. Carcinomas of the buccal mucosa are rare in our country; only 42 cases were treated in this comparison of two techniques, and the overall survival rate was 48%. Epidermoid carcinomas of the oropharynx have nearly always been treated by a combination of external-beam irradiation and brachytherapy because of the bilateral node risk. Seventy-two patients with epidermoid cancers of the base of the tongue had an overall survival rate of 44%. The tonsil, soft palate, and pillars benefited from the use of the loop technique of brachytherapy combined with external-beam irradiation. Three hundred sixty-one patients were treated. Among these patients were two groups with different prognoses. Patients with tonsil, soft palate, and posterior pillar carcinomas had a local control rate of 84% and an overall survival rate of 57%. Conversely, the anterior pillar and the pharyngoglossal sulcus have a local control rate of only 65% and an overall survival rate of 38%.Statistical analysis revealed the prognostic factors for local control. The complications were classified into four grades: minor (20%), moderate (9%), major (4%), or inducing death (0.2%). The bone complications of grade 2 or 3 are more frequent for the floor of the mouth than for other locations. (Otolaryngol Head Neck Surg 1996:115:519-26.)     

Prevention and treatment of diabetic nephropathy with blood pressure lowering drugs

Summary: Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria (>300 mg/24 h), a relentless decline in glomerular filtration rate (GFR), and raised arterial blood pressure. the prevalence of abnormal elevated albumin excretion rate (>30 mg/24 h) is approximately 40% in insulin-dependent (IDDM) and non-insulin-dependent (NIDDM) patients. Diabetes has become the leading cause of end-stage renal failure in the United States of America and Japan and it remains the second leading cause in Europe. Patients suffering from diabetic nephropathy have an enormous increase in morbidity and mortality from cardiovascular disease in addition to renal death. Elevated blood pressure is an early and frequent phenomenon and furthermore accelerates the course of diabetic nephropathy. Studies in humans suggest that angiotensin-converting enzyme (ACE) inhibitors postpone and may even prevent progression to clinical overt diabetic nephropathy in normotensive IDDM and NIDDM patients with persistent microalbuminuria. Conventional antihypertensive therapy and ACE inhibition usually combined with a diuretic reduces albuminuria and postpones renal insufficiency in hypertensive IDDM patients with overt nephropathy. A more beneficial effect on the rate of decline in glomerular filtration rate has been demonstrated by ACE inhibitors compared to conventional antihypertensive treatment in IDDM patients with diabetic nephropathy and reduced kidney function (serum creatinine >133 mmol/L). These findings suggest that ACE inhibition causes renal protection (i.e. a beneficial effect on kidney function [structure] above and beyond what would be expected from blood pressure lowering effect alone). Finally, it should be stressed that ACE inhibition and conventional antihypertensive treatment postpone end-stage renal failure and improve survival in diabetic nephropathy.     

New hydroxamate inhibitors of neurotensin-degrading enzymes Synthesis and enzyme active-site recognition

Selective and mixed inhibitors of the three zinc metallopeptidases that degrade neurotensin (NT), e.g. endopeptidase 24-16 (EC 3.4.24.16), endopeptidase 24-11 (EC 3.4.24.11 or neutral endopeptidase, NEP) and endopeptidase 24-15 (EC 3.4.24.15), and leucine-aminopeptidase (type IV-S), that degrades the NT-related peptides, Neuromedin N (NN), are of great interest. On the structural basis of compound JMV 390-1 (N-[3-[(hydroxyamino)carbonyl]-I-oxo-2(R)-benzylpropyl]-L-isoleucyl-L-leucine), which was a full inhibitor of the major NT degrading enzymes, several hydroxamate inhibitors corresponding to the general formula HONHCO-CH₂-CH(CH₂-C₆H₅)CO-X-Y-OH (with X-Y = dipeptide) have been synthesized. Compound 7a (X-Y = Ile-Ala) was nearly 40-times more potent in inhibiting EC 24-16 than NEP and more than 800-times more potent than EC 24-15, with an IC₅₀ (12 nM) almost equivalent to that of compound JMV 390-1. Therefore, this compound is an interesting selective inhibitor of EC 24-16, and should be an interesting probe to explore the physiological involvement of EC 24-16 in the metabolism of neurotensin. © Munksgaard 1996.     

Lupus Erythematosus-Like Lesions by Voriconazole in an Infant with Chronic Granulomatous Disease

Abstract:  We report the first case of lupus-like lesions in an infant with chronic granulomatous disease during the treatment with voriconazole for chronic invasive aspergillosis. The lesions disappeared with termination of the treatment.     

Midwives' supervisory styles and leadership role as experienced by Norwegian mothers in the context of a fear of childbirth

LYBERG A. & SEVERINSSON E. (2010) Journal of Nursing Management 18, 391–399
Midwives' supervisory styles and leadership role as experienced by Norwegian mothers in the context of a fear of childbirth Aim The aim of the present study was to describe the midwives’ supervisory style and leadership role as experienced by pregnant women and new mothers in the context of a fear of childbirth. Background A service led by midwives can influence the quality of care. Methods The sample consisted of 13 mothers. Data were interpreted by means of qualitative content analysis. Results The findings revealed that the midwives’ supervisory styles were related to their ability to create a trusting and caring relationship, demonstrate problem-solving capacity, and showing willingness, preparedness and courage to support the women. The midwives’ leadership role was described as involving a crucial set of professional management skills and techniques. Conclusion The findings have strengthened the argument for the provision of continuity of care to women who are afraid of childbirth. Further studies should focus more specifically on the implementation of research in practice. Implication for nursing management It is necessary for midwives to demonstrate leadership in order to develop practice, predict challenges and changes, provide different care delivery models and acquire an evidence base for care. This also demands systematic supervision to improve care outcomes.     

Caregivers' job satisfaction and empowerment before and after an intervention focused on caregiver empowerment

engström m., wadensten b. & häggström e. (2010) Journal of Nursing Management   18, 14–23
Caregivers' job satisfaction and empowerment before and after an intervention focused on caregiver empowerment
Aims  To evaluate a training programme aimed at strengthening caregivers' self-esteem and empowering them, and also to study correlations between psychological empowerment and job satisfaction.
Background  Structural and psychological empowerment have received increased attention in nursing management, yet few intervention studies on this topic, based on theoretical assumptions, have been conducted in elderly care.
Method  Data on self-assessed psychological empowerment and job satisfaction were collected in an intervention ( n  = 14) and a comparison group ( n  = 32), before and after the intervention.
Results  When compared over time in the respective groups, there were significant improvements in the intervention group regarding the factor criticism (job satisfaction scale). There were no statistically significant differences in the comparison group. Total empowerment and all factors of empowerment correlated positively with total job satisfaction. Six out of eight factors of job satisfaction correlated positively with total empowerment.
Conclusions  Caregivers' perception of criticism can improve through an intervention aimed at strengthening their self-esteem and empowering them.
Implications for nursing management  Intervention focused on psychological empowerment and especially caregivers' communication skills seems to be beneficial for caregivers. Recommendations are to increase the programme's length and scope and to include all staff at the unit. However, these recommendations need to be studied further.     

Differences in β-adrenergic receptor density and adenylate cyclase activity between normal and leukaemic leukocytes

Abstract. An identical class of high-affinity binding sites for the ¹²⁵I-labelled β-adrenergic antagonist hydroxybenzylpindolol, was identified on intact human normal and leukaemic peripheral blood leukocytes. On normal unfractionated lymphocytes, polymorphonuclear leukocytes, and monocytes, receptor density did not differ significantly (1200–1400 receptors per cell; P > 0.3), but it was higher on B- than on T-lymphocytes ( P < 005). In leukaemia, monocytic blast cells expressed highest receptor numbers, whereas very low receptor density was seen on the pathologic B-cells from chronic lymphocytic leukaemia. Among normal leukocytes, adenylate cyclase activation by hormones (isoproterenol, prostaglandin E₁, histamine) and sodium fluoride was strongest in plasma membranes from monocytes, but very weak in polymorphonuclear leukocytes either due to uncoupling of hormone receptors from adenylate cyclase or to low catalytic activity. In T-cells, enzyme activity was significantly lower than in B-cells. Loss of adenylate cyclase sensitivity to hormones and fluoride occurred in leukaemic cells from chronic and acute lymphocytic leukaemia.     

How to apply results from randomized trials and systematic reviews to individual patient care

A clinician may apply the results from randomized controlled trials and population‐based cohort studies to the management of an individual patient to determine whether the patient will achieve more benefit than harm from the intervention. From the data the clinician should determine what are the benefits and harms of the intervention, whether there are any variations in the relative treatment effect, whether the treatment effect varies with different baseline risks of disease in untreated patients, what are the predicted reductions in absolute risk of disease for individuals and whether the benefits outweigh the risks for their patient. If the patient is at a low risk of the outcome, the harms of therapy may not justify its use to prevent or treat the disease. However, if the patient is at a high risk of developing the outcome, he or she is likely to gain more benefit than harm from the therapy.     

Autoimmune pulmonary alveolar proteinosis: Treatment options in year 2013

Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of a periodic acid Schiff (PAS)‐positive eosinophilic material in the distal airways. For decades, the standard treatment of PAP has been whole lung lavage (WLL), where large quantities of saline are instilled into the lungs to remove the proteinaceous material. However, not all patients respond to this treatment. Thus, new treatment modalities, such as subcutaneous or inhaled granulocyte macrophage colony‐stimulating factor (GM‐CSF), and the CD20 antibody rituximab and plasmapheresis, have been investigated. Based on the current literature, a stepwise treatment plan is suggested starting with WLL, continuing to inhaled GM‐CSF, and then to rituximab if the former treatment regimes are unsuccessful.     

A Novel Glycine Mutation in the Col7a1 Gene Leading to Dominant Dystrophic Epidermolysis Bullosa with Intra-Familial Phenotypical Heterogeneity

Abstract:   Dystrophic epidermolysis bullosa (DEB) represents a group of inherited skin disorders characterized by sublamina densa blister formation. We resent the case of a 16-year old girl with DEB, who had a 10-year-history of recurrent pruritic skin lesions. Despite misleading biopsy results, the correct diagnosis was suspected by examination of other family members. Finally, mutational analysis revealed a novel glycine substitution mutation in the COL7A1 gene in three affected family members.