Quality of life: how is it measured and defined?

Quality of life is an abstract concept which encompasses an individual's perceived level of physical, psychological, and social well-being. It is a highly subjective phenomenon, mediated by one's personal and cultural values and beliefs, self-concept, goals, and life experiences. Some studies have demonstrated that an individual's quality of life may be influenced negatively by a diagnosis of cancer and/or the sequelae of treatment. Concerns about quality of life issues may affect a patient's choice of treatment options or compliance with treatment regimens. Although there is no universally agreed-upon instrument to measure quality of life, researchers are increasingly utilizing multidimensional patient self-assessment tools in lieu of physician-rated performance status scales. Recent advances in detection and treatment may improve quality of life for patients with urologic malignancies. Cancer treatment which extends quantity while maintaining or improving quality of life is the mandate of care for the future.     

Chronic persistent cough and gastro-oesophageal reflux.

Chronic cough persisting for two months or more that remains unexplained after extensive investigations is a common clinical problem. The purpose of this study was to determine whether such cough is associated with otherwise asymptomatic gastro-oesophageal reflux. Thirteen patients with chronic persistent cough that was unexplained after a standard diagnostic assessment were identified. All were non-smokers. The mean (SE) duration of cough was 17.8 (8.0) months. Ten had never had reflux symptoms and three had had mild symptoms only after the onset of the cough. All the patients completed standardised cough diary cards for eight weeks and underwent 24 hour ambulatory oesophageal pH monitoring. A reflux episode was defined as a fall in oesophageal pH to below 4.0. Nine control subjects were matched for age, lung function, and body mass index. The patients experienced significantly more episodes of reflux per 24 hours than the controls (115.8 (SE 31.7) versus 4.7 (1.4) and longer reflux episodes (15.5 (5.8) versus 1.7 (0.5) minutes), and the oesophageal pH was below 4.0 considerably longer (84.5 (20.2) versus 3.8 (1.3) minutes). Cough occurred simultaneously with 13% (2.2%) of reflux episodes and within five minutes in another 35% (5.8%) of episodes, whereas gastro-oesophageal reflux occurred simultaneously with 78% (5.5%) of cough episodes and within five minutes in another 12% (2.3%) of episodes. It is concluded that chronic persistent cough that remains unexplained after a standard diagnostic assessment is associated with otherwise asymptomatic gastro-oesophageal reflux. It is suggested that a self perpetuating mechanism may exist whereby acid reflux causes cough via a local neuronal oesophageal-tracheo-bronchial reflex, and the cough in turn amplifies reflux via increased transdiaphragmatic pressure or by inducing transient lower oesophageal sphincter relaxation. Further study of this mechanism and the role of specific antireflux treatment in chronic persistent cough is warranted.     

Long term study of the effect of sodium cromoglycate on non-specific bronchial hyperresponsiveness.

A double blind, crossover study was undertaken to determine whether non-specific hyperresponsiveness in subjects with asthma was reduced by long term treatment with sodium cromoglycate and, if so, whether this was related to change in lung function. Forty four adult asthmatic subjects (41 atopic, three non-atopic) entered the one year study at intervals staggered over six months. After a baseline period to ensure that asthma control was stable subjects entered the treatment period, during which they inhaled sodium cromoglycate 20 mg four times daily or matching placebo four times daily for 16 weeks each, in random order. Response was assessed at four weekly intervals by measurement of lung function and histamine inhalation tests, from which the provocative concentration of histamine causing a 20% fall in FEV1 (PC20H) was calculated. The assessment included daily symptom score, morning and evening Airflow-meter readings and treatment; mean values for each treatment period and also for the final four weeks of each period were compared. There were no significant differences between placebo and sodium cromoglycate treatment for PC20H, FEV1, morning or evening flow meter readings, bronchodilator usage, or symptom scores for the group as a whole, for the 16 week period or for the final four weeks of each period. Thirteen subjects showed better morning and evening flow meter readings while taking sodium cromoglycate than while taking placebo and eight better readings with placebo than with sodium cromoglycate (p less than 0.05). Improvement in lung function did not correlate with baseline lung function or baseline PC20H, or with features of atopy. These results suggest that long term sodium cromoglycate treatment does not alter non-specific bronchial responsiveness in adult asthmatic subjects.     

Peripheral aneurysms

Peripheral atherosclerotic aneurysms occur primarily in elderly men. Major complications are arterial thromboembolism with ischemia of the limb and, rarely, rupture of the aneurysm. Vascular reconstruction is associated with a low mortality, and operation is recommended. These aneurysms are often associated with arterial ectasia at other locations. The presence of peripheral atherosclerotic aneurysms always requires a search for other peripheral aneurysms, particularly in the abdominal aorta.     

Sound levels from personal cassette players

Techniques have been devised whereby the levels at which users of personal cassette players listen to tape-recorded sounds through lightweight headphones may be measured and expressed in terms of free-field equivalent continuous A-weighted sound pressure levels. Data have been obtained on over 60 users of such devices who variously listened, in laboratory and field conditions, to music and speech against quiet and noisy backgrounds. The results have been interpreted in terms of noise exposure. Comparison with damage risk criteria indicates that 5% of the sample are listening in such a manner that habitual use would constitute a damage risk to hearing.     

Hemolytic warm IgM autoagglutinins in autoimmune hemolytic anemia

The authors report a patient with fulminant autoimmune hemolytic anemia due to a rare warm IgM autoagglutinin more reactive at 37 degrees C than at lower temperatures and secondary to systemic lupus erythematosis. The patient's clinical course and the serologic and immunochemical characteristics of the antibody are described, including the possibility that transfusions of small amounts of incompatible red cells may have contributed to the hemolysis. The consequences of using the initial serologic test results as the basis for therapy are discussed.