Quality of life in chronic lymphocytic leukemia: an international survey of 1482 patients

Although a diagnosis of chronic lymphocytic leukemia (CLL) can have a profound effect on the quality of life (QOL), few studies have objectively measured the QOL of CLL patients or compared it to the general population. We conducted an international, web-based survey of patients with CLL using standardized instruments with published population norms to evaluate fatigue and QOL. Co-morbid health conditions were assessed using the Charlson Co-Morbidity Index. Between June and October 2006, 1482 patients with CLL responded to the survey. The physical, social/family, functional, and overall QOL scores of CLL patients were similar to or better than published population norms. In contrast, the emotional well-being scores of CLL patients were dramatically lower than that of both the general population (P < 0.001) and patients with other types of cancer (P < 0.001). QOL scores were lower among individuals with advanced stage disease (all P < 0.05). Factors associated with lower overall QOL on multivariate analysis included older age, greater fatigue, severity of co-morbid health conditions, and current treatment. CLL has a profound impact on QOL at all disease stages. The effects of CLL on QOL appear to differ from that of other malignancies with a more marked impact on emotional QOL. Research identifying efficacious psycho-oncologic support interventions for patients with CLL is needed.     

Ischemic preconditioning prevents free radical production and mitochondrial depolarization in small-for-size rat liver grafts

BACKGROUND: Ischemic preconditioning (IP) renders tissues more tolerant to subsequent longer episodes of ischemia. This study tested whether IP attenuates injury of small-for-size liver grafts by preventing free radical production and mitochondrial dysfunction. METHODS: IP was induced by clamping the portal vein and hepatic artery for 9 min. Livers were harvested 5 min after releasing the clamp. Mitochondrial polarization and cell death were assessed by intravital confocal/multiphoton microscopy of rhodamine 123 (Rh123) and propidium iodide. Free radicals were trapped with alpha-(4-pyridyl 1-oxide)-N-tert-butylnitrone and measured using electron spin resonance. RESULTS: After quarter-size liver transplantation, alanine aminotransferase, serum bilirubin, necrosis, and apoptosis all increased. IP blocked these increases by more than 58%. 5-Bromo-2'-deoxyuridine labeling and increases of graft weight were only approximately 3% and 0.2% in quarter-size grafts without IP, respectively, but increased to 32% and 60% in ischemic-preconditioned grafts, indicating better liver regeneration. Eighteen hours after implantation, viable cells with depolarized mitochondria in quarter-size grafts were 15 per high power field, and dead cells were less than 1 per high power field, indicating that depolarization preceded necrosis. A free radical adduct signal was detected in bile from quarter-size grafts. IP decreased this free radical formation and prevented mitochondrial depolarization. IP did not increase heat shock proteins 10, 27, 32, 60, 70, 72, 75 and Cu/Zn-superoxide dismutase (SOD) but increased heat shock protein-90, a chaperone that facilitates protein import into mitochondria, and mitochondrial Mn-SOD. CONCLUSION: Taken together, IP decreases injury and improves regeneration of small-for-size liver grafts, possibly by increasing mitochondrial Mn-SOD, thus protecting against free radical production and mitochondrial dysfunction.     

The effects of Toradol on postoperative intimal hyperplasia in a rat carotid endarterectomy model: laboratory research

Carotid endarterectomy (CEA) and more recently carotid artery stenting are the treatments of choice for atherosclerotic disease of the extracranial carotid arteries; however, early restenosis caused by neointimal hyperplasia confounds surgical therapy. Oxidative stress has been implicated in the progression of intimal hyperplasia. The authors hypothesized that ketorolac tromethamine (Toradol), a nonsteroidal antiinflammatory drug that is a potent cyclooxygenase inhibitor, would decrease oxidative stress and thereby reduce intimal hyperplasia in a rat CEA model. Twenty-nine male Sprague-Dawley rats underwent CEA and were divided into 3 treatment groups as follows: (1) control (placebo), (2) 7.5 mg/kg Toradol, and (3) 10 mg/kg Toradol. Toradol treatment began 2 days before CEA and continued for 2 weeks. Two weeks after endarterectomy, carotid arteries were fixed, harvested, and examined for platelet activity (platelet reactive units), oxidative stress (malondialdehyde and glutathione), and intimal hyperplasia (measured as percentage of luminal stenosis). Platelet activity, malondialdehyde and glutathione, and intimal hyperplasia were all significantly lowered in both 7.5- and 10-mg/kg doses of Toradol versus control. Toradol given daily beginning 2 days before CEA and ending 2 weeks after the procedure was effective at significantly reducing platelet activity, oxidative stress, and intimal hyperplasia development in the rat without any increase in bleeding. Although the mechanism of action of this reduction is not completely understood, one possible explanation may be through the inhibition of reactive oxygen species production.     

Fungal endophytes: an untapped source of biocatalysts

Horizontally transmitted endophytes are an ecological group of fungi that infect living plant tissues and survive in them without causing any disease symptoms. Even as facets of the endophyte-plant symbiotic relationship are being uncovered, there is an increasing appreciation of the different growth substrates exploited by endophytes and the vast repertoire of secreted enzymes of these fungi. These attributes exemplify the striking biodiversity of fungal endophytes and should motivate bioprospecting these organisms to identify novel biocatalysts that might help address challenges in medicine, food security, energy production and environmental quality.     

Arterial complications of thoracic outlet syndrome

Objective: Arterial vascular complications resulting from thoracic outlet compression, although rare, can be substantial and potentially limb threatening. These complications are due to compressions at the thoracic outlet, the treatment of which continues to be a dilemma. The objective of the present study was to review our experience with this problem with particular reference to its management. Methods: We performed a retrospective study of 12 years and retrieved data from the medical records department of Nizam’s Institute of Medical Sciences, Hyderabad, India. A retrospective review identified 35 patients (age range 15–50 years). In 31 patients, the vasculopathy was caused by a cervical rib, soft tissue anomalies (n = 31), and an elongated transverse process (n = 4). Evaluation included assessment with colour duplex and arteriography with positional maneuvers. Thirty‐two patients presented with a fixed pulse deficit, 22 patients had palpable mass and 15 patients had distal embolization. Results: In 31 patients with cervical rib, the rib was excised via a supraclavicular approach, Scalenectomy was performed and the arterial pathology was repaired on its merit, usually by a vein graft replacement or bypass. The elongated process was excised in the other four patients. Twelve patients required thrombectomy of the distal arteries and a bypass procedure (with a vein/prosthetic graft) was performed in 14 patients. Dorsal sympathectomy, as an adjunct, was carried out in 10 patients. In view of their advanced distal disease, four patients were given prostaglandin therapy. Short‐term follow up of 2 years showed good results. Conclusion: Our results show that simple excision of the cervical rib with scalenectomy via supraclavicular approach, together with arterial reconstruction (if required) is adequate for arterial vascular complications resulting from thoracic outlet compression. Patients with severe distal disease may require other adjunct procedures like dorsal sympathectomy or prostaglandin infusions along with proximal reconstruction.     

Microvascular reconstruction of the upper extremity with the rectus abdominis muscle

Large soft-tissue defects of the upper extremity are difficult to reconstruct. Defects in 21 patients (15–75 years old) were treated by free tissue transfer of the rectus abdominis muscle. The defects were the result of trauma or resection of tumor and measured more than 15 × 15 cm. The muscle was transferred on the inferior epigastric pedicle and covered with a skin graft within 48 hours. All transfers were successful, and early soft-tissue healing occurred. This procedure offers the advantages of easy positioning, large donor vessels, and a highly vascular soft tissue reconstruction. The long-term functional and cosmetic results have been excellent. © 1994 Wiley-Liss, Inc.     

Why Are There Differences in the Perceived Safety of Office-Based Surgery?

BACKGROUND: Office-based surgery has become an important method of health-care delivery, but there is controversy about its safety and which practitioners should perform it. Several states have already or are preparing to enact legislation regulating office-based surgery. OBJECTIVE: The objective was to discuss recent literature pertaining to the safety of office surgery and to discuss reasons why there are perceived differences in its safety. METHODS: The pertinent literature is reviewed. Results. The majority of studies suggest that office surgery is safe. A recent study that found to the contrary may have methodologic flaws. CONCLUSION: The medical and legislative community should seek to scientifically examine office surgery. Overregulation or loss of office surgery would have a tremendous impact on the management of skin cancers and the delivery of quality cosmetic and laser surgery.