Psychoneuroendocrinological and immunological parameters in cancer patients: Involvement of stress and depression

Plasma noradrenaline (NA), adrenaline (A), dopamine (DA), platelet serotonin (pS), free serotonin (fS), cortisol (CRT), growth hormone (GH), peripheral blood lymphocytes (lymph), lymphocyte subpopulations (LSS) and CD4/CD8 ratio were serially assessed in 50 non-medicated, advanced cancer patients (spontaneous evolution) and in age- and sex-paired controls. Clonidine tests and psychiatric evaluations were also serially performed. Patients showing long symptomless periods had all normal values except for raised pS, whereas those who remained free of symptoms for only a short time had raised NA, A and CRT, plus lowered pS values. Further increases in NA, A and CRT, plus additional increases in DA and fS, occurred during exacerbation periods, during which times reductions in lymph, LSS and NK also were observed. Patients in terminal stages showed maximal decreases of all neurotransmitters and immunological parameters; only DA and fS remained raised. Psychiatric interviews performed simultaneously with the clonidine tests revealed a low incidence of moderate depression during symptomless periods and no depression during exacerbation periods. Several significant positive and negative correlations between neurotransmitters and immunological parameters were found during exacerbation periods. Pain, although not intense, and other symptoms required occasional administration of low doses of non-opiate analgesics.     

An update on infective endocarditis of dental origin.

OBJECTIVES: The aim of this study was to analyse the prevalence of dental treatment and oral infections related to the development of infective endocarditis (IE). METHODS: A retrospective study of 103 cases of IE diagnosed from 1997 to 1999 was conducted in Galicia, Spain. RESULTS: According to the Duke's endocarditis criteria (1994), 87 cases (84.5%) were considered definite IE. A presumed oral portal of entry was recorded in 12 patients (13.7%). Oral infections were held responsible in six cases while the remaining six had received dental treatment in the previous three months (three tooth extractions, one scaling, one cleaning, one fillings). In eight cases of IE (66.6%) typical oral pathogenic microflora was identified, with Streptococcus viridans being the most frequent. In four patients no previous cardiac disease was recorded. CONCLUSIONS: These results suggest that prevalence and characteristics of IE cases of dental origin did not change significantly in the last decades. The need for increased oral hygiene and improved dental care should be emphasized on preventing IE of dental origin. Continued education of physicians and dentists on the importance of the knowledge of current prophylactic protocols should also be considered.     

Perforation of a Benign Gastric Ulcer into the Subdiaphragmatic Aorta

A patient in whom a benign gastric ulcer perforated into the subdiaphragmatic aorta is reported. This is the second such case to be documented and the first to be reported in the English literature. Previous gastroesophageal surgery, regional radiation therapy, ulcerogenic medications, and endocrinopathies seem to be contributing factors to the potential of benign gastric and esophageal ulcers to perforate into the pericardium, left atrium, left ventricle thoracic or abdominal aorta. This complication is almost always lethal. It is concluded that peptic disease in patients with these contributing factors warrants aggressive treatment.     

Microtiter method for MIC testing with spherule-endospore-phase Coccidioides immitis.

A method was developed for susceptibility testing with spherule-endospore-phase Coccidioides immitis by using a microtiter format. Isolated endospores were used to inoculate wells containing modified Converse medium with various concentrations of azole or nikkomycin antifungal substances which then were sealed with an acetate film. The plate was incubated at 37 degrees C with shaking for 96 h, after which the control wells had visible turbidity and endpoints were discernible. Microscopic examination revealed that both control and treatment wells maintained cells predominantly in the spherule-endospore phase of growth.     

Roux-en-Y hepaticojejunostomy with subcutaneous access and the use of gianturco stents for the management of biliary tract strictures

The need to control recurrent biliary strictures implies the practice of repeated major surgical procedures. The hepaticojejunostomy with subcutaneous jejunal access (Chen's procedure) allows the permanent option of a non-operative management of recurrent biliary tract anastomosis complications. Through the subcutaneous jejunal access, the application of a Gianturco metallic prosthesis is permitted and the correction of biliary-intestinal anastomosis strictures with non-operative methods is possible. This report is a review of a series of 20 patients treated with the Chen procedure, of whom 3 patients also had implantation of Gianturco stents via hepaticojejunostomy with subcutaneous access.

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Resumen La necesidad de controlar la recurrencia de las estrecheces biliares implica la práctica de repetidos procedimientos quirúrigicos. Sin embargo, la hepático-yeyunostomía con acceso yeyunal subcutáneo (Procedimiento de Chen), provee una vía permanentemente disponible para el manejo de las complicaciones recurrentes en la anastomosis bilio-entérica.La colocación de una prótesis metálica de Gianturco para controlar la estrechez recurrente de la anastomosis es una alternativa favorable y posible de realizar por este medio. Este artículo presenta nuestra serie de 20 pacientes tratados con el procedimiento de chen en tres de los cuales colocamos una protesis de Gianturco a través del acceso subcutaneo de la hepaticoyeyunostomia.

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Résumé Le traitement des sténoses biliares implique souvent des procédures chirurgicales majeures itératives. L'intervention de Chen, c'est-à-dire l'anastomose hépaticojéjunale avec anse de jéjunostomie potentielle (en Y) en position sous-cutanée permet un accès à l'anastomose pour traiter de façon non-opératoire les complications et les récidives des anastomoses biliodigestives en case de besoin. Il est possible de passer à travers cette anse (soit avec une dissection à minima, soit en percutanée) une prothèse métallique de Gianturco pour traiter de façon non-opératoire les sténoses des anastomoses biliodigestives. Cet article est une revue des 20 patients traités par l'intervention de Chen, parmi lesquels trois ont eu une prothèse de Gianturco insérée par voie transcutanée jusqu'à l'anastomose hépaticojéjunale. transcutanée de l'hépatojéjunostomie.

     

Gallbladder cancer: An analysis of a series of 139 patients with invasion restricted to the subserosal layer

The goal was to study our experience in the management of a series of patients with a potentially curative subserosal gallbladder cancer who were prospectively treated by the authors. Between April 1988 and July 2004, 139 patients were enrolled in our prospective database. Of the above, 120 were operated on with an open procedure and the rest with laparoscopic surgery. In only eight patients was the diagnosis suspected before the cholecystectomy. The majority of tumors were adenocarcinoma. Six patients had an epidermoid tumor, and one had a carcinosarcoma. Of the patients, 74 underwent reoperation, while in 55 (70.2%) it was possible to perform an extended cholecystectomy with a curative aim. Operative mortality was 0%, and operative morbidity was 16%. Lymph node metastases were found in 10 (18.8%), while in 7 (13.2%) the liver was involved. The overall survival rate was 67.7%, while in those who underwent resection, the survival rate was 77%. Through the use of a multivariate analysis, the presence of lymph node metastasis was found to be an independent factor with respect to prognosis. The feasibility of performing an extended cholecystectomy in patients with gallbladder cancer and invasion of the subserosal layer allows for a good survival rate. The presence of lymph node metastases represents the main poor prognosis factor, and some type of adjuvant therapy should be studied in this particular group. Presented at the 2005 Spring Surgical Week, Fort Lauderdale, Florida, April 13–19, 2005. Supported by the generosity of the German Clinic, Santiago, Chile.     

Development of a health habits scale

The present study is based on the assumption that health habits assessment can make a significant contribution to our understanding of physical and psychological well-being. Thus, the purpose of this study was to develop an easily administered, conceptually sound, and psychometrically adequate health habits scale for use in nursing and health research. A self-report scale consisting of 5 positive health items and 5 negative items was administered initially to a sample of more than 1500 American adults. Subsamples of this group were used in various psychometric evaluations of the scale. A second sample of more than 700 college and noncollege adults also completed the new health habits scale and a number of additional inventories thought to be related conceptually to the new scale. In general, the health scale showed high content validity, good agreement between self- and other-ratings, strong test-retest reliability, and consistent evidence of concurrent and divergent validity. The strengths of the scale are its inclusion of both disease-preventive and health-promoting behaviors, its brevity, and its psychometric development.     

Defects in embryonic hindbrain development and fetal resorption resulting from vitamin A deficiency in the rat are prevented by feeding pharmacological levels of all-trans-retinoic acid

Vitamin A is required for reproduction and normal embryonic development. We have determined that all-trans-retinoic acid (atRA) can support development of the mammalian embryo to parturition in vitamin A-deficient (VAD) rats. At embryonic day (E) 0.5, VAD dams were fed purified diets containing either 12 μg of atRA per g of diet (230 μg per rat per day) or 250 μg of atRA per g of diet (4.5 mg per rat per day) or were fed the purified diet supplemented with a source of retinol (100 units of retinyl palmitate per day). An additional group was fed both 250 μg of atRA per g of diet in combination with retinyl palmitate. Embryonic survival to E12.5 was similar for all groups. However, embryonic development in the group fed 12 μg of atRA per g of diet was grossly abnormal. The most notable defects were in the region of the hindbrain, which included a loss of posterior cranial nerves (IX, X, XI, and XII) and postotic pharyngeal arches as well as the presence of ectopic otic vesicles and a swollen anterior cardinal vein. All embryonic abnormalities at E12.5 were prevented by feeding pharmacological amounts of atRA (250 μg/g diet) or by supplementation with retinyl palmitate. Embryos from VAD dams receiving 12 μg of atRA per g of diet were resorbed by E18.5, whereas those in the group fed 250 μg of atRA per g of diet survived to parturition but died shortly thereafter. Equivalent results were obtained by using commercial grade atRA or atRA that had been purified to eliminate any potential contamination by neutral retinoids, such as retinol. Thus, 250 μg of atRA per g of diet fed to VAD dams (≈4.5 mg per rat per day) can prevent the death of embryos at midgestation and prevents the early embryonic abnormalities that arise when VAD dams are fed insufficient amounts of atRA.