Improvement In General Symptoms Research Articles

Type-D personality exerts a stable, adverse effect on vital exhaustion in PCI patients treated with paclitaxel-eluting stents

Objective Vital exhaustion is associated with the pathogenesis of cardiovascular disease (CVD), but its prevalence after percutaneous coronary intervention (PCI) with drug-eluting stent implantation, as well as the impact of personality on exhaustion, is not known. In PCI patients, we examined (a) the prevalence of exhaustion, (b) the impact of type-D personality on exhaustion over time, and (c) the clinical significance of type-D personality compared with gender and age as predictors of exhaustion. Methods Consecutive patients ( n=419) with stable or unstable angina treated with PCI with drug-eluting stent implantation completed the Type-D Scale (DS14) at baseline and the Maastricht Questionnaire (which assesses exhaustion) at baseline and at 1 year. Results Of all patients, 53% were exhausted at baseline and at 1 year, with 41% experiencing chronic symptoms. Type-D patients [ F(1, 417)=98.688; P<.001] had significantly higher exhaustion levels than non type-D patients both at the time of the index PCI and at 1 year. There was a general improvement in symptoms of exhaustion over time [ F(1, 417)=5.005; P=.03], but type-D exerted a stable effect on exhaustion ( P=.06). In multivariable analysis, type-D (OR=3.53; 95% CI=1.88–6.64) remained an independent predictor of exhaustion at 1 year, adjusting for demographic and clinical risk factors and exhaustion at baseline. The impact of type-D on exhaustion was large compared with a small effect for gender and age, as measured by Cohen's effect size index. Conclusions Symptoms of exhaustion were still highly prevalent in PCI patients 1 year post-PCI despite treatment with the latest technique in interventional cardiology. Type-D exerted a large and stable effect on exhaustion compared with that of gender and age. CVD research and clinical practice may benefit by adopting a personality approach in order to identify high-risk patients.

Quality-of-Life Considerations in Patients with Advanced Lung Cancer: Effect of Topotecan on Symptom Palliation and Quality of Life

Key goals in the treatment of lung cancer are to improve both survival and quality of life (QOL). While formal techniques are frequently used to evaluate survival and response, such rigor is used less often in assessing the impact of treatment on quality of life. Many patients with lung cancer are elderly and have complex medical histories and a myriad of comorbidities. In these patients, with limited survival expectations, symptom palliation, quality of life, and convenience of therapy are especially important end points. Indeed, clinical trials are now incorporating symptom scores and QOL outcomes in their designs (now combined as "patient reported outcomes" or PROs). Moreover, symptom palliation correlates well with QOL and survival duration, providing further rationale for therapy selection based on these parameters. The potential palliative and QOL benefits of chemotherapy have been investigated for several agents in lung cancer trials. Of these, topotecan (Hycamtin; GlaxoSmithKline; Philadelphia, PA) is the best characterized in relapsed small cell lung cancer (SCLC). In a phase III trial of topotecan versus cyclophosphamide, doxorubicin (Adriamycin; Bedford Laboratories; Bedford, OH), and vincristine (Oncovin; Eli Lilly and Company; Indianapolis, IN) (CAV) in patients with recurrent SCLC, topotecan was associated with statistically significant (p < 0.05) improvements in general symptoms (e.g., fatigue and interference with daily activity) and disease-specific symptoms (e.g., dyspnea and hoarseness). Moreover, the introduction of oral therapies, such as oral topotecan, may increase the convenience of therapy by reducing the time needed for therapy and the need for frequent venipuncture. This review summarizes the role of chemotherapy in symptom palliation, with an emphasis on the impact of topotecan therapy on symptom parameters in patients with relapsed SCLC and the emerging role of oral therapy in this setting.

RIFAXIMIN IN ABDOMINAL BLOATING AND FLATULENCE TRIAL (RAFT)

Purpose: Functional GI disorders represent the bulk of outpatient practice in gastroenterology. Although many treatment options are available, the subjective response rate of patients remains sub-optimal. The aim of this study is to assess the efficacy of rifaximin, a non-absorbable antibiotic, in relieving functional symptoms such as bloating and flatulence. Methods: This randomized double-blind placebo-controlled trial included three phases of 10 days each: phase 1 for baseline symptom recording, phase 2, the actual treatment phase, and phase 3 for post-treatment symptom recording. Recruitment was done through community advertisements. Patients were randomized into group A (rifaximin 400 mg BID for 10 days) and B (placebo). The primary end point was the subjective feeling of general symptom improvement at the end of each phase. A symptom score consisting of abdominal pain, bloating, change in bowel habits, feeling of incomplete evacuation, and urgency was calculated for each phase using a patient symptom diary. Lactulose hydrogen breath test (LHBT) was conducted at the beginning of phase 1 and at the end of phase 3. Results: 103 patients were included (52 in group A and 51 in group B). Baseline characteristics were comparable. Symptom duration was 1.98 ± 1.38 years and 2.07 ± 1.19 years in groups A and B respectively. At the end of phase 2, a subjective feeling of symptom relief was reported by 21/52 (40.4%) in group A versus 11/51 (21.6%) in group B (p = 0.03). Similarly, 16/52 (30.8%) in group A and 6/51 (11.8%) in group B reported a decrease in their symptomatology at the end of phase 3 (p = 0.02). The mean symptom scores dropped significantly from 112.27 ± 9.38 to 106.42 ± 12.08 for group A (p <0.01) but not in group B. There was no difference between baseline hydrogen excretion in both groups. LHBT values dropped in the overall rifaximin group but this change was not statistically significant when compared to the placebo group. However, within the rifaximin group, LHBT results amongst responders dropped significantly from baseline and correlated with symptom relief (p = 0.04). Conclusions: This trial shows that rifaximin is effective in reducing symptoms of abdominal bloating and flatulence. Symptom relief correlated with a drop in LHBT values in the treatment arm. Further studies are needed to evaluate the efficacy of long-term or cyclic use of rifaximin in this patient population.

Pretreatment Quality of Life of Inoperable Non-Small Cell Lung Cancer Patients Referred for Primary Radiotherapy

This study examined the association between the most important prognostic factors in non-small cell lung carcinoma (NSCLC) and self-reported pretreatment quality of life (QoL) and the impact of the presence, severity and changes in respiratory symptoms on general symptoms and QoL. The study included 262 patients. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-LC13 were used to assess symptoms and QoL before radiotherapy. Patients with inoperable NSCLC showed major differences in self-reported QoL as a function of clinical prognostic factors. A significant association was found between World Health Organization (WHO) performance status and QoL but not other prognostic factors. Dyspnoea was the only respiratory symptom associated significantly with general symptoms, physical and psychosocial functioning and QoL. Furthermore, changes in dyspnoea were associated significantly with changes in physical and role functioning, global QoL and fatigue as assessed 6 weeks after radiotherapy. These results indicate that palliation of dyspnoea may have a significant beneficial effect on QoL and that palliation of other respiratory symptoms is not necessarily associated with improvement of general symptoms, physical and psychological functioning or global QoL.

Lipid-lowering for lower limb atherosclerosis.

Raised lipid levels, including cholesterol, are important risk factors in the development of lower limb arterial disease (atherosclerosis). The objective of this review was to assess the effects of lipid lowering therapy in patients with lower limb atherosclerosis. The reviewers searched the Cochrane Peripheral Vascular Diseases Group trials register, Embase, reference lists of relevant articles, and contacted trial investigators in Europe and pharmaceutical companies. Randomised trials of lipid-lowering therapy in patients with lower limb atherosclerosis. The main outcomes were mortality, non-fatal events, direct tests of disease progression, indirect measurements of disease, and subjective measures. Two reviewers extracted data and assessed trial quality independently. The reviewers contacted investigators to obtain information needed for the review that could not be found in published reports. There were nine eligible trials, but two were excluded because of poor methodology. The seven remaining trials involved a total of 698 participants from seven different countries. Men and women participated in all but one trial and were generally middle aged to elderly. The follow-up period varied from four months to three years. The overall quality of the included trials was high. The trials were heterogeneous in terms of inclusion criteria, type of drugs used and outcomes measured. Lipid-lowering therapy produced a marked but non-significant reduction in mortality (odds ratio 0.21, 95% confidence interval 0. 03 to 1.17), but little change in non-fatal events (odds ratio 1.21, 95% confidence interval 0.80 to 1.83). In two trials there was a significant overall reduction in disease progression on angiogram (odds ratio 0.47, 95% confidence interval 0.29 to 0.77). The changes in ankle brachial pressure index and walking distance were inconsistent, although trials showed a general improvement in symptoms that could not be combined in a meta-analysis. Side effects were generally mild, with the exceptions of liver toxicity produced by betapyridil and the adverse effect of probucol on lipoprotein profile. Lipid-lowering therapy may be useful in preventing deterioration of underlying disease and alleviating symptoms. These results cannot determine whether one lipid-lowering regimen is better than another.

Treatment of the eosinophilia-myalgia syndrome

The eosinophilia-myalgia syndrome (EMS) is a unique entity associated with products that contain l-tryptophan (L-trp). Studies of the underlying etiopathogenic processes are underway. EMS is a distinct syndrome, but shares features with eosinophilic fasciitis and other variants of systemic sclerosis. A wide spectrum of clinical manifestations has been described, but there is no consensus regarding treatment. We report the clinical and laboratory features of 12 patients. All were treated with nonsteroidal antiinflammatory drugs (NSAIDs) and analgesics with transient or minimal effect. Two received d-penicillamine (DP) and colchicine, with minimal improvement; one had no response to azathioprine (AZA). Eleven received corticosteroids and had improvement of general symptoms, arthralgias, arthritis, myalgias, skin changes, eosinophilia, and leukocytosis. Nevertheless, all but the latter two findings recurred when corticosteroids were tapered. Seven patients who were unresponsive to the former treatments received low-dose pulse oral methotrexate. Six exhibited continued improvement after a mean follow-up of 4.5 months, with good drug tolerance. Corticosteroids were tapered and, in some instances, discontinued without relapse or complications. One patient improved but later died of aspiration pneumonia. We conclude that methotrexate (MTX) is a therapeutic alternative for patients with severe or refractory EMS.

Evaluation of a psychological treatment programme for climacteric women

A psychological assessment and treatment programme designed for a group of climacteric women with severe and varied psychological complaints and symptoms is described and evaluated. All the women were currently experiencing stressful psychosocial difficulties within their life situation. The treatment programme comprised an educational, a counselling and a behavioural component. By the end of the sixth session of therapy, most women showed a significant improvement in their main complaint, accompanied by improvements in general symptoms and personal adjustment. Two-thirds considered that they had benefited substantially from treatment. The outcome of the treatment was considered to be encouraging in what might otherwise be considered a potentially unresponsive group of women.

Effects of hemodilution on O2 transport in high-altitude polycythemia.

A native of the Peruvian Andes (4,250 m) was studied before and after isovolemic hemodilution of the hematocrit from 62 to 42%. O2 transport was studied with newly developed catheters in the radial and pulmonary arteries. These catheters allowed continuous measurement of arteriovenous O2 content and intermittent cardiac output by thermodilution. During exercise tests, breath-by-breath gas exchange measurements also allowed cardiac output to be calculated by the O2-Fick technique. A complex series of interrelated physiological changes occurred in response to hemodilution. These included increased ventilation, increased arterial and mixed venous PO2, increased cardiac output (both heart rate and stroke volume), and improved ventilation-flow match. The general improvement in symptoms that followed hemodilution correlated well with increased anaerobic threshold and mixed venous PO2 during exercise.

A Clinical Study of Fuji-Bitol in Patients operated on for Paranasal Sinusitis

Fuji-Bitol (composed of 13 kinds of medicinal herbs) was administered for 4 to 15 weeks to 35 patients who have been operated on for chronic sinusitis in our hospital.The result was effective in 32 patients and slightly effective in 3. The rate of effectiveness was 91.4%.Compared with the effect on the patients we have treated with antiphlogistics or proteolytic enzymes in other studies, Fuji-Bitol was considered to be a more effective drug for the improvement of general symptoms than antiphlogistics or proteolytic enzymes.