Migraine and chronic daily headache management: a qualitative study of patients' perceptions

AIM: The aim of the study was to gain insight into the patients' perceptions of migraine and chronic daily headache (CDH) management. METHODS: Thirteen, semi-structured and individual interviews with seven migraine and five CDH patients were carried out and analysed in QSR NUD*IST5, using a grounded theory methodology. RESULTS: The participants described using five areas of management: 1) health care use; 2) medication use; 3) alternative therapies; 4) social support; and 5) lifestyle and self-help. The participants described their expectations, preferences, worries and (dis)satisfaction in relation to these five areas of management. The participants adapted headache management to suit their needs and preferences, making migraine and CDH management highly individual and giving the headache patient a central role within their own care. CONCLUSION: Health care is changing towards a greater involvement of the patients in their own care. Therefore, it is important to increase understanding of the patients' perspective of chronic diseases, including migraine and CDH. The results from this study inform health care professionals of the range of their patients' needs and preferences. This knowledge can be used to shape clinical practice, to develop patient education programmes and to further research efforts into issues that are important to the headache patient.     

Survival of cervical cancer patients in selected regions of Poland in 1990-1996, in relation to some prognostic factors

To evaluate whether cervical cancer patients in selected regions of Poland show similar 5-year survival rates and if they are different from European average and, also, to evaluate the effect of selected prognostic factors. The analysis based on a cohort of 1386 cervical cancer cases identified by population-based Cancer Registries collecting data from Kieleckie and Opolskie voivodships and from the City of Warsaw in 1990-96. These data become complete by adding information from medical records. The 5-year relative survival rates were calculated using the life tables method, and, a multivariant regression analysis was applied for evaluation of prognostic factors. The regions differed significantly in stage distribution (p<0.001), however, they were similar in age groups and histological diagnosis. The age-standardized relative 5-year overall survival rate was 52.2%, and was among lowest rates in Europe. The rate in Kieleckie was 60.7%; in Opolskie--43.3%, and in Warsaw--51.9%. The rates for Stage I in those regions were comparable at over 80%, but were different for Stage II and higher stages. The multivariant analysis showed a significant risk increase related to stage advancement (p<0.0001) as well as to the place of living in Opolskie (p=0.02) and to the adenocarcinoma diagnosis (p=0.05). However, the analysis did not confirm the effect of age of diagnosis as a prognostic factor. The overall, age-standardised 5-year relative survival rates of cervical cancer patients are one of the lowest in Europe, though diversified in the regions. They are almost satisfactory and close to European average in Kieleckie where prevention was effective, but poor in the other regions. The low survivals overall are basically due to the unsatisfactory proportion of the early stage of disease. The uneven survivals of patients with Stage II and higher stages of cancer in the selected regions of Poland suggest different standards of treatment.     

Patient size and x-ray transmission in body CT

Physical characteristics were obtained for 196 patients undergoing chest and abdomen computed tomography (CT) examinations. Computed tomography sections for these patients having no evident pathology were analyzed to determine patient dimensions (AP and lateral), together with the average attenuation coefficient. Patient weights ranged from approximately 3 kg to about 120 kg. For chest CT, the mean Hounsfield unit (HU) fell from about -120 HU for newborns to about -300 HU for adults. For abdominal CT, the mean HU for children and normal-sized adults was about 20 HU, but decreased to below -50 HU for adults weighing more than 100 kg. The effective photon energy and percent energy fluence transmitted through a given patient size and composition was calculated for representative x-ray spectra at 80, 100, 120, and 140 kV tube potentials. A 70-kg adult scanned at 120 kVp transmits 2.6% of the energy fluence for chest and 0.7% for abdomen CT examinations. Reducing the patient size to 10 kg increases transmission by an order of magnitude. For 70 kg patients, effective energies in body CT range from approximately 50 keV at 80 kVp to approximately 67 keV at 140 kVp; increasing patient size from 10 to 120 kg resulted in an increase in effective photon energy of approximately 4 keV. The x-ray transmission data and effective photon energy data can be used to determine CT image noise and image contrast, respectively, and information on patient size and composition can be used to determine patient doses.     

Autoantibodies to Annexin XI-A and Other Autoantigens in the Diagnosis of Breast Cancer

We report on the identification of autoantigens commonly recognized by sera from patients with breast cancer. We selected ten sera from patients with invasive ductal carcinoma (IDC) of the breast with high titer IgG autoantibodies for biopanning of a T7 phage breast cancer cDNA display library. A high throughput method involved the assembly of 938 T7 phages encoding potential breast cancer autoantigens. Microarrays of positive phages were probed with sera from 90 patients with breast cancer [15 patients with ductal carcinoma in situ (DCIS) and 75 patients with IDC of the breast], with 51 non-cancer control sera and with sera from 21 patients with systemic autoimmune diseases. A 12-phage breast cancer predictor group was constructed with phage inserts recognized by sera from patients with breast cancer and not by non-cancer or autoimmune control sera (P < 0.0001). Several autoantigens including annexin XI-A, the p80 subunit of the Ku antigen, ribosomal protein S6, and other unknown autoantigens could significantly discriminate between breast cancer and non-cancer control sera. Biopanning with three different sera led to the cloning of partial cDNA sequences identical to annexin XI-A. IgG autoantibodies reacting with the amino acid 41-74 sequence of annexin XI-A were found in 19% of all women with breast cancer but in 60% of sera from women with DCIS of the breast. In addition, partial sequences identical to annexin XI-A, nucleolar protein interacting with the forkhead-associated (FHA) domain of pKi-67, the KIAA1671 gene product, ribosomal protein S6, cyclin K, elongation factor-2, Grb2-associated protein 2, and other unknown proteins could distinguish DCIS from IDC of the breast and appear to be potential biomarkers for the diagnosis of breast cancer.     

CREB deficient mice show inhibition and low activity in novel environments without changes in stress reactivity

The ability to respond to unexpected or novel stimuli is critical for survival. Determining that a stimulus is indeed novel requires memory to ascertain its lack of familiarity. As the long-term synaptic changes involved in memory formation require the cAMP response element binding protein (CREB), we examined the extent to which CREB is involved in responses to novel environments. These environments typically trigger an endocrine stress response. Thus, we measured behavioural and stress hormone responses to three novel and one familiar environment in mice with a targeted disruption of the alpha and delta isoforms of the CREB gene (CREB(alphadelta-) deficient mice). We found CREB(alphadelta-) deficient mice to be less active and more inhibited in the elevated plus maze, open field, and light/dark box, without showing differences in anxiety-like behaviour. This inhibition is unique to novel environments because these mice display a normal phenotype in the home cage, a familiar environment. Although CREB(alphadelta-) deficient mice exhibit altered behaviour in novel environments, they show normal reactivity to mild and moderate stress as both basal and stress levels of corticosterone are similar to those of wild-type controls. This is the first report of CREB(alphadelta-) deficient mice to: (i) show altered behaviour, not related to learning and memory-associated behaviours, upon initial exposure to environments and (ii) serve as an animal model that can dissociate locomotor activity from anxiety-like behaviour in novel environments.     

Phase II trial of infusional cyclophosphamide,idarubicin, and etoposide in poor prognosis non-Hodgkin's lymphoma

The purpose of this study was to determine the complete response (CR) rate, failure-free survival (FFS), and overall survival (OS) of patients with poor-prognosis intermediate-grade non-Hodgkin's lymphoma (NHL) after treatment with cyclophosphamide, idarubicin, and etoposide given as a continuous intravenous infusion (CIVI) over 96 hours (infusional CIE), including patients with relapsed/refractory disease and patients with no prior therapy but at least two poor-risk features by the age-adjusted International Prognostic Index. Forty-two patients with previously untreated NHL (N = 24) or relapsed/refractory (N = 18) NHL received cyclophosphamide (200 mg/m2/d), idarubicin (2.5-3.0 mg/m2/d) and etoposide (60 mg/m2/d) given by a 96-hour CIVI every 3 weeks for a maximum of 8 cycles. All patients also received granulocyte-colony-stimulating factor. CR occurred in 10 of 24 patients (42%; 95% confidence intervals [CI] 22%, 62%) treated with CIE as first-line therapy, and in 3 of 18 patients (17%; 95% CI 20%, 32%) treated with CIE as second-line or greater therapy. One-year FFS and OS were 42% and 64%, respectively, in patients with no prior therapy, and 17% and 56% in patients with prior therapy. Severe (grade III) or life-threatening (grade IV) toxicity included leukopenia (59%), anemia (61%), thrombocytopenia (31%), and infection (10%). Two patients (4%) died due to treatment related infectious complications. It is unlikely that infusional CIE produces a CR rate more than about 60% in poor-risk patients with intermediate-grade NHL when used as first-line therapy, or more than about 30% in patients receiving the regimen as second-line therapy. Substitution of idarubicin for doxorubicin in this setting, therefore, is not associated with an improved response rate.