Protein restriction in chronic renal failure

The aim of the study was to investigate the effect of a protein restricted diet on renal function and growth of children with chronic renal failure. In a multicentre prospective study 56 children (aged 2-18 years) with chronic renal failure were randomly assigned to the protein restricted (0.8-1.1 g/kg/day) or the control group. All children were followed up by the same paediatrician and dietitian. After a follow up period of three years there was no significant difference in glomerular filtration rate between children on a protein restricted diet and children of the control group. There was no significant difference in weight with respect to height and height SD score between the protein restricted and the control group. Compliance with the protein restricted diet, as indicated by the prospective diet diaries and the serum urea:creatinine ratio, was good. This study shows that children with chronic renal failure do not benefit from a protein restricted diet.     

Rude awakenings

A new nurse recently complained in a national nursing publication that her manager, a 22-year veteran, refers to her staff as"dodos," "dipsticks" and "resident idiots." The vexed grad wanted to know whether she had to put up with this verbal abuse. It's amazing that she even had to ask. The Los Angeles Times reports that rudeness is epidemic in America, as "embedded in the workplace culture as time cards, fluorescent lighting and computers." EMTs and paramedics are prime targets. You endure it from patients, their families, bystanders, coworkers, managers, ED staffers and cops. You no doubt take a deep breath, hold your tongue and prepare to move on to the next call. But what if you're mad as hell and don't want to take it anymore? On the following pages, experts share their experiences and offer communication strategies. So, hurry up! Turn the page! (Oops. We apologize for being rude...)     

Hearing loss after platinum treatment is irreversible in noncranial irradiated childhood cancer survivors

Cisplatin and carboplatin are effective antineoplastic agents. They are also considered to be potentially highly ototoxic. To date, no long-term follow-up data from well-documented cohorts with substantial numbers of childhood cancer survivors (CCS) with platinum-related hearing loss are available. Therefore, in this study, we studied the reversibility of ototoxicity from discontinuation of treatment onwards in a national cohort of platinum-treated survivors with hearing loss at the end of cancer treatment. Of the 168 CCS with follow-up audiograms, we longitudinally evaluated the course of hearing function in 61 CCS who showed hearing impairment at discontinuation of treatment according to the Münster criteria (>20 dB at ≥4–8 kHz). Survivors were treated with platinum (median total cumulative dose cisplatin: 480 mg/m² and median total cumulative dose carboplatin: 2520 mg/m²). Median follow-up time was 5.5 years (range: 1.0–28.8 years). The results showed that none of these survivors revealed improvement of hearing function even till 28.8 years after discontinuation of treatment (grade <2b during long-term follow-up). An increase in hearing loss with two or three Münster degrees was observed in five of 61 survivors after 1.6–19.6 years. Overall, this indicates that ototoxicity after platinum treatment may be irreversible and that longitudinal clinical audiological monitoring and care is required in long-term survivors of childhood cancer on a large scale.     

Multi-quadrant biopsy technique improves diagnostic ability in large heterogeneous renal masses. Abel EJ,Heckman JE,Hinshaw L,Best S,Lubner M,Jarrard DF,Downs TM,Nakada SY,Lee FT Jr,Huang W,Ziemlewicz T.J Urol. 2015 Oct;194(4):886-91. [Epub 2015 Mar 30]. doi: 10.1016/j.juro.2015.03.106.

Purpose

Percutaneous biopsy obtained from a single location is prone to sampling error in large heterogeneous renal masses, leading to nondiagnostic results or failure to detect poor prognostic features. We evaluated the accuracy of percutaneous biopsy for large renal masses using a modified multi-quadrant technique vs. a standard biopsy technique.

Heterogeneity in renal cell carcinoma

Introduction

In recent years, molecular characterization of renal cell carcinoma has facilitated the identification of driver genes, specific molecular pathways, and characterization of the tumor microenvironment, which has led to a better understanding of the disease. This comprehension has revolutionized the treatment for patients with metastatic disease, but despite these advancements many patients will develop resistance leading to treatment failure. A primary cause of this resistance and subsequent treatment failure is tumor heterogeneity. We reviewed the literature on the mechanisms of tumor heterogeneity and its clinical implications.

The concept of sustainable chemistry: Key drivers for the transition towards sustainable development

To achieve and safeguard the chemicals management “2020 goal” of least possible adverse effects, we need broad and global transformation to a sustainable chemistry, which can provide the most adequate solutions contributing to sustainable development as set out in the Agenda 2030. As a basis for effective progress, a common understanding is required of sustainable chemistry, of its scope, characteristic elements, and specific objectives, as well are guidelines requisite for influencing the speed and direction of this complex and encompassing transformation. This article aims at stimulating this transition process towards a sustainable chemical sector by proposing “100 words for sustainable chemistry”, objectives and guiding principles as well as actions steps towards the further implementation of sustainable chemistry.     

Improved diagnosis of "nondelineated" thyroid nodules by oblique scintillation scanning and echography.

The scan of the thyroid gland in oblique projections has enabled us to visualize 11 "cold" thyroid nodules which were not delineated on a traditional anterior view among 825 patients studied in a 2-yr period. Accurate localization of the nodule in the oblique projection facilitated accurate placement of the transducer for echography. The combination of the isotope imaging studies and ultrasound then permitted one to differentiate solid and cystic "cold" nodules. Diagnosis and choice of therapy are therefore enhanced by the addition of oblique views, when needed, and echography.     

Phase II study of carboplatin in recurrent ovarian cancer: severe hematologic toxicity in previously treated patients

Summary Carboplatin (CBDCA) is a second-generation cisplatin analog that has shown activity in early clinical trials. Its spectrum of toxicity is quantitatively and qualitatively different from that of the parent compound. Between November 1984 and September 1986 we conducted a phase II trial of CBDCA in 46 women with epithelial ovarian cancer. All patients had undergone at least one prior chemotherapy regimen; 41 (89%) had previously received cisplatin (mean cumulative dose, 540 mg/m²). The CBDCA dose was based on renal function and was injected i. v. once every 4 weeks. Patients were stratified on the basis of baseline creatinine clearance: those with a baseline creatinine clearance of 60 ml/min received 400 mg/m² CBDCA; those with a creatinine clearance between 30 and 60 ml/min received an initial dose calculated according to a previously published formula [2, 3] that corrected for renal insufficiency and projected nadir platelet counts of 75,000/mm³. Of 41 evaluable patients, 6 (15%) had an objective response [2 complete responses (CRs); 4 partial responses (PRs)]; 5 of the 6 responders had previously responded to cisplatin treatment. No responses were observed in 12 patients who had not responded to prior cisplatin therapy. Significant hematologic toxicity was seen. Of 18 patients with a creatinine clearance of 60 ml/min (dose, 400 mg/m²), 6 had nadir platelet counts of <25,000/mm³, 4 with symptomatic bleeding. Of the 21 evaluable patients for whom the dose-modification formula was applied, 10 had nadir platelet counts of <75,000/mm³; 5 had counts of <50,000/mm³. CBDCA has activity even in patients who have previously undergone extensive cisplatin therapy; however, its toxicity is variable and thrombocytopenia is dose-limiting. We did not confirm the ability of the above-mentioned formula to calculate the CBDCA dose and accurately predict the nadir platelet count for all patients. Other factors, such as prior radiotherapy, may also be important in the dosing of CBDCA in pretreated patients.Supported in part by a grant from Bristol Myers Company Pharmaceutical Research and Development Division, CRU CA 16087 and CRU-96.N. Colombo is the recipient of a fellowship from the American Italian Foundation for Cancer Research.     

Combined esophageal and gastric ph-metry in healthy volunteers influence of cable through les and effect of misoprostol

In order to evaluate whether combined esophageal and gastric pH-metry is feasible without interference due to the transcardial cable, four 24-hr ambulatory esophageal pH-metries were carried out in seven healthy volunteers in a randomized order. In two studies only one glass electrode was used. It was placed 5 cm above the lower esophageal sphincter. In the two other studies an additional electrode was placed in the corpus region 10 cm below the lower esophageal sphincter. In order to obtain a wide range of pH values, misoprostol (400 g) was given at 9am and 9:15pm in two studies. In the two other studies placebo was given. Misoprostol exerted only a weak and short-lasting effect on gastric acidity. The four measuring conditions did not differ with respect to medians of esophageal reflux time and duration of single reflux episodes, Kendall's coefficient of concordance yielded a high reproducibility for both variables (P < 0.0025). Thus, combined esophageal and gastric pH-metry is feasible and highly reproducible.This work was supported by Swiss National Foundation grant 3.827.0.86 and by Deutsche Forschungsgemeinschaft grant Em 36/1-3.     

Nursing and men's health. Some critical considerations

This article addresses issues concerning the relationships among nursing, a nascent "men's health" movement, and the established "women's health" movement. Suggestions are made in regard to the potential positive contributions of a men's health movement that recognizes masculinity as a social reality while aiding men with health problems from a holistic nursing perspective.