Nutritional Aspects of Cancer-Related Fatigue

Fatigue, which may well be the most common experience of patients with cancer, remains underappreciated by health care professionals. Perhaps one reason is that because of its complexity and many components, fatigue is not completely understood. Knowledge of fatigue models, such as the Integrated Fatigue Model of Piper, can help dietitians identify potential causes of fatigue such as activity-rest patterns, and identification can lead dietitians to early intervention. Understanding cancer treatment factors, such as nausea and decreased participation in activities of daily living, that are believed to play a part in fatigue form another level on which dietitians can provide intervention. Through intervention, dietitians, working with patients and other members of the multidisciplinary team, may increase the understanding and appreciation of fatigue as well as provide relief from it. Efforts to maintain nutritional status can decrease or prevent some of the fatigue associated with cancer and its treatment. Therefore, the goal of clinical dietitians who work with a fatigued patient with cancer is to use nutrition management to minimize therapeutic side effects and maximize the patient's nutritional parameters.     

Inhalation Toxicity Study of Formamide in Rats

Formamide is a widely used solvent for the manufacture and processingof plastics, and the possibility for inhalation exposure existsfor workers. To assess the toxicity of repeated inhalation ofsublethal concentrations of formamide, three groups of 10 maleCrl:CD BR rats each were exposed nose-only for 6 hr/day, 5 days/weekfor 2 weeks to design concentrations of 100, 500, or 1500 ppmof formamide vapor in air. A control group of 10 male rats wasexposed simultaneously to air only. At the end of the exposureperiod, blood and urine samples were collected for clinicalanalyses, and 5 rats per group were killed for pathologic examination.The remaining 5 rats per group were retained for a 14-day postexposureobservation (recovery) period and then subjected to the sameclinical and pathologic examinations. Male rats exposed to 1500ppm had significantly depressed body weights and body weightgains during the exposure and recovery periods compared to controls.Clinical pathologic examinations revealed that decreased plateletand/or lymphocyte counts were observed in rats exposed to 500or 1500 ppm of formamide. Pathologic examinations revealed compound-relatedmicroscopic changes in the kidneys of rats exposed to 1500 ppmformamide. Minimal to severe necrosis and regeneration of renaltubular epithelial cells were observed principally in the outerstripe of the outer medulla and in cortical medullary rays.Based upon the hematologic and clinical chemical parametersmeasured, the no-observed-effect exposure concentration forrepeated inhalation of formamide was considered to be 100 ppm,under the conditions of this study. The findings of treatment-relatedmicroscopic lesions in the kidneys as well as increases in meanabsolute kidney weights and kidney-to-body weight ratios reflectthe target organ toxicity.     

Home mechanical ventilation in children: Retrospective survey of a pediatric population

BACKGROUND: Home care support is beneficial for children needing mechanical ventilation, when clinically stable. METHODS: A retrospective analysis was carried out of the long-term home ventilation management of a pediatric population with chronic respiratory failure composed of 20 ventilator-dependent children categorized according to age, diagnosis and ventilation support. Age groups consisted of 10% under 1 year, 30% between 2 and 5 years, 30% between 6 and 12 years, and 30% older than 12 years. Diagnostic categories included myopathic disorder, n = 5; congenital central hypoventilation syndrome, n = 6; chest wall disorder, n = 5; cystic fibrosis, n = 1; pulmonary hypertension, n = 1; and diaphragmatic paralysis, n = 2. RESULTS: Sixty-five percent were ventilated using non-invasive mode (NIMV): eight with nasal mask, five with full-face mask, and two children in NIMV also used negative pressure mode; 35% were ventilated using tracheostomy, one of them also used a diaphragmatic pacer. Seventy percent needed nocturnal ventilatory support, (20% 12-18 h, 10% full-day). A total of 18 children were included in the home care and follow-up program. Two children died: one because of worsening of his chronic disease and one because of septic shock. CONCLUSION: Although home care ventilation is not yet widely diffused, it represents a valid alternative to long hospitalization for children with stable chronic respiratory failure.     

Obesity: Selected Medical Issues

The prevalence of obesity is rising at a very alarming rate in the United States. Estimates are that 27% of American adults are now considered obese, and another 52% are overweight. These individuals are at increased risk of premature mortality and the development of many comorbid illnesses. Numerous factors contribute to this epidemic. The medical treatment of obesity is difficult, but can be successful. Drug therapy and obesity surgery can be effective but more research is needed to improve all of the obesity treatments.     

Review Attention and aphasia: theory,research and clinical implications

Over the past decade, there has been increasing interest in the integrity of attention in adults with aphasia. This review paper examines this issue by first introducing attention theory and associated terminology. Next, the paper summarizes the growing literature which documents that not only may adults with aphasia present with attention deficits, but also that their attention deficits may negatively a ect both their language comprehension and production skills. Lastly, the clinical implications of adopting an attentional model of aphasia are considered with respect to strategies for both the assessment and treatment of adults with aphasia.     

Relationship of brain glutamine and brain neutral amino acid concentrations after portacaval anastomosis in rats

Evidence from several sources suggest that blood-brain transport of the large neutral amino acids (NAA) is abnormal in animals with a portacaval anastomosis (PCA) and in patients with liver cirrhosis and portal-systemic shunting and encephalopathy, but the underlying mechanisms are unknown. After PCA, the concentration of glutamine (Gln) in brain is markedly increased as a by-product of cerebral ammonia detoxification, and the rate of efflux of Gln from brain is also increased. The following studies were undertaken to clarify the relationships among plasma and brain concentrations of NAA after PCA in rats and to examine the relationship of brain Gln concentration to plasma and brain NAA concentrations. After PCA plasma phenylalanine, tyrosine and histidine were elevated and leucine, isoleucine and valine were lowered. In brain, phenylalanine, tyrosine, histidine and methionine were markedly elevated after PCA and their concentrations in brain far exceeded the concentrations in plasma. Analyses of single, partial and multiple correlations of plasma NAA ratios expressed as plasma competitor function (PCF), brain NAA and brain Gln showed significant correlations between PCF nd brain NAA in shunted rats. A better correlation was found between brain NAA and brain Gln. Correlation coefficients obtained from multiple correlation analysis equalled or exceeded those obtained in the partial correlation or in the single correlation, suggesting that the effects of PCF and brain Gln on brain NAA were separate and additive. Gln was shown to compete with other NAA for blood brain transport by inhibiting brain 14C phenylalanine uptake.(ABSTRACT TRUNCATED AT 250 WORDS)