Biological response modifiers in the management of patients with breast cancer

Summary Despite impressive progress in understanding the biology of breast cancer, mechanisms of host defense, and the pathophysiology of the metastatic process, this burgeoning fact bank has made little impact on the management of patients with breast cancer. There are many interesting ideas for improved diagnosis and therapy in various stages of development, but few have actually translated into improved survival of patients with breast cancer. Potentially useful biological agents include cytokines, monoclonal antibodies, immunotoxins, vaccines, and adoptive cellular therapies. Therapies targetting growth factor receptors and the cellular machinery required for metastasis may become useful, especially when used in combination with other cytotoxic agents. Colony-stimulating factors may allow a test of the hypothesis that augmented dose-intensity of cytotoxic chemotherapy will cure more patients. Though we are not yet sure precisely how to use all of these new tools, there can be little doubt that their application will make a significant impact on the management of patients with breast cancer and other malignancies in the next decade.     

Henoch Sch?nlein nephritis

Glomerulonephritis is the main determinant of mortality in the Henoch Sch?nlein syndrome. We report a prospective study on 17 patients with the Henoch Sch?nlein nephritis who underwent a renal biopsy during a 12-year period. Three patients have developed end-stage renal failure, 13 are alive with normal renal function and one was lost to follow-up. We recommend that patients with Henoch Sch?nlein nephritis be followed up, with urinalysis and assessment of renal function, for at least five years.     

Pain related to tracheal suctioning in awake acutely and critically ill adults: a descriptive study.

The purpose of this secondary data analysis of findings from a larger procedural pain study was to examine several factors related to pain during tracheal suctioning. In addition to tracheal suctioning, other procedures studied included turning, wound drain removal, femoral catheter removal, placement of a central venous catheter, and wound dressing change. A total of 755 patients underwent the tracheal suctioning procedure that was performed primarily in intensive care units (93%). A 0-10 numeric rating scale, a behavioural observation tool, and a modified McGill Pain Questionnaire-Short Form were used for pain assessment. Pain intensity scores were significantly greater during the tracheal suctioning procedure (M=3.96, S.D.=3.3) than prior to (M=2.14, S.D.=2.8) or after (M=1.98, S.D.=2.7) tracheal suctioning. Few patients received analgesics prior to or during the procedure. Surgical, younger, and non-white patients reported higher pain intensities. Although mean pain intensity during tracheal suctioning was mild, almost the half of the patients reported moderate-to-severe pain. Individualized pain management must be performed by healthcare providers in order to respond to patients' needs as they undergo painful procedures such as tracheal suctioning.     

Interaction of duration of homelessness and gender on adolescent sexual health indicators.

PURPOSE: The purpose of this analysis was to determine the effects of duration of homelessness and gender on personal and social resources, cognitive-perceptual factors, and sexual health behaviors among homeless youth. DESIGN: Cross-sectional analysis of data collected at baseline from 461 homeless adolescents who participated in a sexual health intervention study was done. METHOD: Data were collected via laptop computers from homeless adolescents (mean age=19.52+1.91 years) in both comparison and intervention groups before the initiation of the intervention. FINDINGS: Significant interaction effects were found for personal and social resources F (4, 426)=2.83, p<.05. Male participants who had been homeless<6 months had significantly higher scores on social connectedness than did male participants who were homeless>1 year. Univariate analysis of variance (ANOVA) indicated that both boys and girls who had been homeless>1 year had greater AIDS knowledge, F (1, 441)=7.91, p<.01, reported significantly more sexual risk-taking behaviors, F (1, 396)=9.93, p<.05, and engaged in fewer safe-sex behaviors, F (1, 396)=12.05, p<.05, than did those who had been homeless<6 months. Univariate ANOVA indicated that female participants had significantly lower levels of perceived health status, F (1, 429)=12.08, p<.01, significantly greater sexual self-care behaviors, F (1, 396)=16.29, p<.01, and significantly higher levels of assertive communication F (1, 396)=4.03, p<.05 than did male participants, regardless of duration of homelessness. CONCLUSIONS: The duration of homelessness and gender has both direct and interaction effects on cognitive-perceptual and behavioral outcomes associated with sexual health. CLINICAL RELEVANCE: Nurses and other healthcare providers working with homeless youth recognize the need to develop brief interventions that address health-risk behaviors. Findings from this study indicate that gender-specific interventions should be provided to youth soon after they become homeless.     

A survey of treatment modalities for convergence insufficiency.

BACKGROUND: Convergence insufficiency (CI) is a common and distinct binocular vision disorder. However, there is a lack of consensus regarding the treatment most appropriate for Cl. Possible treatment modalities include base-in prism, pencil pushup therapy (PPT), reading glasses, home-based vision therapy/orthoptics (HBVT), and office-based vision therapy/orthoptics (OBVT). The purpose of this study was to investigate the care process for Cl by surveying eyecare professionals regarding the most common treatment modalities used by both optometrists and ophthalmologists across the United States. METHODS: Surveys requesting doctors to indicate which treatment(s) they prescribed and believed to be most effective for symptomatic CI patients were mailed to 863 optometrists and 863 ophthalmologists in the United States. RESULTS: Fifty-eight percent of the optometrists responded to the survey; the most common treatment prescribed was PPT (36%) followed by HBVT (22%) and OBVT (16%). For the ophthalmologists (who had a 23% response rate), the most common treatment prescribed was PPT (50%) followed by HBVT (21 %) and base-in prism (10%). CONCLUSIONS: This survey suggests that most eyecare practitioners prescribe PPT as the initial treatment for CI.     

Morphine pharmacokinetics in early infancy

The pharmacokinetics of morphine in ten infants less than or equal to 10 weeks of age who were receiving morphine infusions were determined. Infants 1-4 days of age (newborns) showed longer elimination half-lives than the older infants (6.8 vs. 3.9 h). Clearance in the newborns is less than one-half that found in older infants (6.3 vs. 23.8 ml X min-1 X kg-1). The combination of lower clearance and longer elimination half-life in newborns (0-7 days) may well explain a prolonged duration of action for morphine in very young infants, but other etiologies are needed to explain the respiratory sensitivity believed to persist in older infants.