A novel treatment of childhood lymphoblastic non-Hodgkin's lymphoma: early and intermittent use of teniposide plus cytarabine

We treated 24 children and adolescents with stage III or IV lymphoblastic non-Hodgkin's lymphoma, using a protocol designed for patients with poor-prognosis acute lymphoblastic leukemia (ALL). Early therapy consisted of teniposide plus cytarabine administered before and immediately after prednisone, vincristine, and asparaginase. The two- drug combination was also given intermittently with continuous 6- mercaptopurine and methotrexate during the first year of continuation chemotherapy. Periodic intrathecal methotrexate and delayed cranial irradiation were used to prevent central nervous system involvement. Anthracycline compounds, alkylating agents, high-dose methotrexate, and involved-field irradiation were not used in any phase of treatment. Twenty-two (96%) of the 23 evaluable patients achieved complete remission. With a median follow-up of 2 1/2 years, only four patients have relapsed; the remainder have been disease-free for eight months to more than five years. The projected four-year continuous complete remission rate is 73% for all patients and 79% for the 19 with mediastinal involvement at diagnosis. These results demonstrate that use of teniposide plus cytarabine with an otherwise conventional plan of ALL therapy is an effective approach to the treatment of childhood lymphoblastic lymphoma.     

Improving day and night sleep problems in infants by changing day time sleep rhythm: a single group before and after study

This study explores the duration and timing of day time waking periods required for sleep disturbed infants to improve day and night sleep. Seventy-nine sleep disturbed outpatients with day and night sleep problems were investigated before and two weeks after a brief sleep intervention. Data were collected by interviewing parents on their infants’ day and night sleep patterns. Besides instructing the parents on night sleep regulation, they were advised to regulate day sleep. After the intervention, duration of day and night sleep increased and frequency of night waking decreased. The mean duration of the first waking period in the morning did not change, but the range decreased. The mean duration of the last waking period in the evening increased. The frequency of short and irregular day naps and the need for assistance in falling asleep decreased after the intervention. It is recommended that the last waking before night sleep is lengthened to reduce day and night sleep problems.     

Single‐port surgery: Current applications and limitations

Introduction: In an attempt to further enhance the benefits of cosmesis and reduced morbidity of minimally invasive surgery, single‐port (incision) laparoscopic surgery (SPS) has emerged as a bridge between conventional laparoscopy and natural orifice transluminal endoscopic surgery. As the expertise and instrumentation required are an extension of standard laparoscopic techniques, SPS has been adapted for a variety of procedures and specialties in a short span of time. Discussion: In this article, we discuss the various SPS techniques, as well as the new devices and instrumentation available for facilitating SPS. We also review current applications reported for SPS in various surgical specialties. We present a comprehensive review of the potential benefits, limitations and risks of these novel techniques. Conclusion: Initial reports have demonstrated the technical feasibility and safety of SPS for a wide range of surgical applications. With specialized instrumentation and refinement of technique, its role will increase in coming years. Future work is necessary to improve existing instrumentation, to increase clinical experience and to assess the benefits of this surgical approach.     

Women in chronic pain: sense of control and encounters with health professionals

An evolving theory on "women's sense of control while in chronic pain and the results of the quality of their encounters with health professionals" is introduced in this article. According to the theory, the main challenge of women in chronic pain is to maintain a sense of control of self and the pain to avoid demoralization, which is seen as a potential threat for all women in chronic pain. To retain a sense of control, women are challenged to learn to live with the pain and cope with the unpredictability and incurability of the pain. They are challenged to find meaning in their suffering, to create personal space, and to be self-protective as well as to keep a positive self-image and self-esteem while trying to live a "normal" life in dignity in spite of the pain and warding off isolation and demoralization. Health professionals are seen as potentially powerful people in the lives of women in chronic pain. Empowerment or disempowerment from them greatly influences whether women in chronic pain are demoralized or not.     

Can reproductive pattern explain better survival of women with lung cancer?

We examined whether women's survival from lung cancer is influenced by hormonal factors associated with reproductive events. In all 4235 women and 4797 men born on 1 January 1935 or later with lung cancer diagnosed in 1978-1999 were identified in the Danish Cancer Registry and followed up to 31 December 2002 by linkage to the Central Population Registry. Cox regression analysis was used to estimate hazard rate ratios (HRs), and survival probabilities were calculated. Both nulliparous women and men without children had worse prognoses than those with children (women: HR 1.14; CI 1.03-1.26; men: HR 1.24; CI 1.15-1.34). The 5-year survival rate of nulliparous women with adenocarcinoma was 20.3%, while that for parous women was 20.5%; the corresponding rates for men were 13.0% and 16.6%. The number of children affected the risk for death in both sexes, indicating that the finding is not due to hormonal factors but to unmeasured elements such as socio-economic status or lifestyle factors related to parenthood.     

Polymorphisms in genes involved in xenobiotic metabolism and lung cancer risk under the age of 60 years. A pooled study of lung cancer patients in Denmark and Norway

The genetic susceptibility hypothesis has been used to explain why only a minority of smokers develop lung cancer. Only few studies have studied the role of polymorphisms in phase-I and II metabolizing genes, among young lung cancer patients. We have pooled the individual data of three studies from Denmark and Norway, including 320 patients diagnosed with non-small cell lung cancer at age 59 or below, and 618 age and gender matched controls. A questionnaire was used to determine relevant demographic and lifestyle characteristics, and polymorphisms in following genotypes were determined GSTM1, GSTM3, GSTP1, GSTT1, GPX1, MPO, NQO1 and NAT2. Based on the literature, the alleles of the genotypes were categorised as high- or low-risk alleles. No individual effect of the genotypes was found on the risk of lung cancer. Given a smoking exposure, the presence of high-risk alleles (or phenotypes) was generally found to increase the risk of lung cancer, although the effect modification did not reach statistical significance. A pattern of stronger protective effect was observed in carriers of more than one allele associated with lower risk of lung cancer, and a higher risk of lung cancer in carriers of one or more alleles associated with higher risk of lung cancer, but the results did not reach statistical significance. The effect modification was generally strongest at lower levels of smoking.     

The better sleep better well‐being programme: Educating and training community healthcare nurses in developing interventions for families of infants with moderate sleep problems: a pilot study

The main aim of this pilot study was to evaluate the benefit of the Better Sleep Better Well‐being (BSBW) educational and training intervention programme regarding infants sleep problems for Community Health Care (CHC) nurses, on their perceptions on their family nursing practice skills and on their job demand, control and support. There were 6 CHC nurses who participated in the BSBW programme, and 26 nurses in the comparison group. The programme consisted of 4 sessions (8 hours per session) of lectures on the aetiology of infants sleep problems as well as on evidence‐based and family relational practices and on 20 sessions of clinical cases, scenarios, discussions and reflections. The main finding indicated that the nurses in the intervention group reported significantly higher family nursing practices skills compared to the nurses in the comparison group. The findings are promising, since they offered additional resources to the CHC nurses, in their clinical practices.     

Conditional survival of patients with the four major histologic subgroups of lung cancer in Denmark.

PURPOSE: The survival probability of patients with lung cancer is usually based on the extent of disease as assessed at the time of diagnosis. The discouraging 5-year survival is often reported (< 10%) without taking into account changes in the survival probability as time advances from diagnosis. PATIENTS AND METHODS: Conditional survival estimates by sex, age, extent of disease, and histology were estimated for patients diagnosed with lung cancer in Denmark from 1943 to 1997. Survival probabilities were calculated by the Kaplan-Meier method, and cumulative survival estimates were used to derive conditional survival estimates. RESULTS: For every additional year survived, the probability of surviving the next 5 years increases from 33% (men) and 36% (women) after the first year, to 60% (men) and 67% (women) who have survived 5 years. The 5-year survival probability of patients younger than 49 years who had survived the first year was 33%, and increased to 81% after the fifth year. Corresponding estimates for 60- to 69-year-old patients were 23% and 52%. The conditional survival differed greatly among patients with localized and regional disease (29% and 10%, respectively) in the first year, but converged with time (52% and 47%, respectively) after 5 years. The conditional survival is similar in patients with squamous cell carcinoma, adenocarcinoma, and large-cell carcinoma, but is markedly lower in patients with small-cell carcinoma. CONCLUSION: For patients who have survived more than 1 year, the conditional survival probability provides a more accurate estimate of survival as compared with the conventional observed survival rates.