An analysis of gender differences in treatment and outcome of periampullary tumours in Sweden – A national cohort study

BackgroundLittle is known of possible gender differences in treatment of periampullary tumours and outcome after pancreatoduodenectomy (PD), and the aim of this study was therefore to investigate any variances from national multicentre perspective.MethodsData from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients diagnosed with a periampullary tumour from 2012 throughout 2017 was collected. The material was analysed in two groups, men and women, for palliative treatment and curative intended resection.ResultsA total of 5677 patients were included, 2906 (51%) men and 2771 (49%) women. Women were older than men, 72 (65–78) years vs. 70 (64–76), p < 0.001. A lesser proportion of women were planned for resection (1131 (41%) vs. 1288 (44%), p = 0.008), but after adjusting for age and tumour location no difference was seen. Postoperative morbidity was equal, but women had significantly better long-term survival than men. The survival was equal for palliative men and women.ConclusionNo gender bias could be established when analysing treatment for periampullary tumours in Sweden, even though less women were offered surgery. Data suggest that even though women were older they tolerate surgery well and hence offering PD at a higher age for women could be suggested.     

Postmenopausal craniofacial hyperhidrosis treated with botulinum toxin type B

Hyperhidrosis can seriously impair patients’ quality of life. Medical history, including heredity and hyperhidrosis during youth, as well as current age and time elapsed since menopause, is important to consider when distinguishing between postmenopausal hyperhidrosis and vasomotor symptoms to enable adequate treatment. This report concerns a subgroup of eight postmenopausal patients participating in a randomized controlled trial regarding botulinum toxin (Btx) type B treatment in craniofacial hyperhidrosis. Even though the sample size is small and the enrolment is not yet completed, the promising data collected hitherto are interesting to present in advance because this subtype of craniofacial hyperhidrosis is often underrecognized and challenging to treat. Patients were randomized to receive Btx type B or placebo. Measurements were performed before treatment and 3 ± 1 weeks after. The Dermatology Life Quality Index (DLQI) score was improved for all patients after Btx type B treatment (n = 3) with a median decrease of 9 points (90% median improvement). The placebo group (n = 5) had a median increase of 2 points (–18% median decline). When the same group (n = 5) received Btx type B (open) the DLQI score decreased with a median of 7 points compared with baseline (91% median improvement). Treatment‐related adverse events were temporary and did not prevent improvement of life quality. Furthermore, background data evaluation uncovered interesting findings regarding vasomotor symptoms in relation to postmenopausal hyperhidrosis. In conclusion, the results indicated that Btx type B seems to be a safe and effective treatment in postmenopausal craniofacial hyperhidrosis. Further research is encouraged.     

Patients’ perceptions of palliative care: adaptation of the Quality from the Patient’s Perspective instrument for use in palliative care,and description of patients’ perceptions of care received

Background

Globally, the number of people who die with dementia is increasing. The importance of a palliative approach in the care of people with dementia is recognised and there are national polices to enhance current care. In the UK implementation of these polices is promoted by the National Institute for Health and Care Excellence (NICE) Dementia Quality Standards (QS). Since publication of the QS new care interventions have been developed.

Aim

To explore critically the current international research evidence on effect available to inform NICE Dementia QS relevant to end of life (EOL) care.

Design

We used systematic review methods to seek the research evidence for three statements within the Dementia QS. These are those that recommend: (1) a case management approach, (2) discussing and consideration of making a statement about future care (SFC) and (3) a palliative care assessment (PCA). We included evaluative studies of relevant interventions that used a comparative design, such as trials and cohort studies, and measured EOL care outcomes for persons dying with moderate to severe dementia. Our primary outcome of interest was whether the intervention led to a measurable impact on wellbeing for the person with dementia and their family. We assessed included studies for quality using a scale by Higginson and colleagues (2002) for assessment of quality of studies in palliative care, and two authors undertook key review processes. Data sources included Cinahl, Embase, and PsychINFO from 2001 to August 2014. Our search strategy included free text and medical subject headings relevant to population and recommended care.

Results

We found seven studies evaluating a care intervention; four assessed SFC, three PCA. None assessed case management. Studies were of weak design; all used retrospective data and relied on others for precise record keeping and for accurate recall of events. There was limited overlap in outcome measurements. Overall reported benefits were mixed.

Conclusions

Quality statements relevant to EOL care are useful to advance practice however they have a limited evidence base. High quality empirical work is needed to establish that the recommendations in these statements are best practice.

     

Work-related hand eczema in atopics

549 individuals with severe (group 1), 406 with moderate (group 2) atopic dermatitis in childhood, 222 with respiratory allergy but no atopic dermatitis in childhood (group 3), and 199 without personal or family atopy (group 4) were studied as to occupational health symptoms due to hand eczema. In groups 1, 2 and 4, there was a slightly significant difference (P less than 0.05) between the frequency of hand eczema in individuals with and without occupational exposure to chemicals, water, soil or wear (friction). Despite no such work, 55% in group 1 and 44% in group 2 had developed hand eczema. About 1/4 of the atopics in extreme risk occupations, such as ladies' hairdressers and nursing assistants, had not developed hand eczema. Altogether, 9% in groups 1 and 2 and 3% in group 4 had changed their jobs due to hand eczema, the majority from work with to work without exposure to chemicals, water, soil or wear. Social factors had usually contributed to the change. The healing rate after taking up a new occupation was 15% in group 1, 36% in group 2 and 67% (4 out of 6) in group 4. The majority of the patients whose eczema had not healed had improved in their new occupations. It is claimed that medical reasons for change of occupation should be carefully weighed against social reasons.     

Hand eczema among hard-metal workers

Seven hundred seventy-six of 800 workers in a hard-metal factory were investigated. The prevalence of hand eczema and irritant reactions of the hands was 10% and 15% respectively. Of 1,006 workers who had left the industry during the previous ten years, 87 had had hand eczema. The cumulative incidence of hand eczema for these ten years was estimated to be 17%. Fifty-two percent of the hand eczemas and 67% of the irritant reactions started during the first year of work. The majority of both the hand eczemas and the irritant reactions first appeared in grinding activities. Wet grinding and oil grinding entailed the highest risks of hand eczema. Hand eczema was significantly more common in individuals with an atopic background. Eighteen percent of the individuals with present or previous hand eczema had positive patch-test reactions. Positive patch tests were equally common among individuals with irritant reactions and those with normal skin.     

Increased serum levels of antibodies to Epstein-Barr virus in adults with history of atopic dermatitis

Serum antibodies to Epstein-Barr virus (EBV), varicella-zoster (VZV) and herpes simplex virus (HSV) were determined in 140 patients with active or healed atopic dermatitis (AD) and 48 control individuals. Antibody titers against EBV were significantly higher in AD patients than in the controls irrespective of whether the AD was active or healed at the time of blood sampling. No difference in EBV antibody titers were observed between AD patients with asthma and/or hay fever and those without such additional atopic manifestations. There was no correlation between EBV antibody titers and serum IgE levels. The frequency of seropositivity and the magnitude of antibody titers against VZV and HSV in AD patients were not significantly different from the controls. Increase in EBV antibody titers may reflect basic immunoregulatory disturbances in AD but it is also possible that EBV may play a role in the pathogenesis of atopic disease.     

Skin disease and contact sensitivity in house painters using water-based paints, glues and putties

A dermatologic investigation of 202 construction painters included patch testing with the TRUE Test™ standard series and ingredients of water-based paints, glues and putties (painters' series). 32 painters had current eczema and 16 had a history of previous eczema. Of these, 16 and 9, respectively, had current and previous histories of hand eczema. Irritant reactions on the hands, characterized by dry, erythematous finely fissured skin, which healed within a few days of skin rest, were found in 18 painters. 8 painters presented dry, fissured finger tips and finger sides. The total group of painters had 25 allergic reactions to the TRUE Test™ standard series and 11 to the painters' series. 11 test reactions were found to be related to present or previous hand eczema: 4 cases reacted to nickel, cobalt, colophony or N-octyl-isothiazolinone; 2 each to p-tertbutylphenol-formaldehyde resin and benzisothiazolinone (BIT); and 3 to Cl + Me-isothiazolinone, 5 painters were sensitive to BIT without clinical symptoms of skin disease. Hand eczema is no more common among construction painters who work with water-based paints, glues and putties, than in an average population. There are, however, special risks of sensitization and eczema in a construction painter's work that should be considered on employment.