Problem For Most Patients Research Articles

The effect of cancer stage and treatment modality on quality of life in oropharyngeal cancer

To examine changes in health-related quality of life among oropharyngeal cancer patients by stages and across treatment types among advanced cancer patients. Individual prospective cohort study. All newly diagnosed patients with oropharyngeal cancer treated with curative intent were routinely assessed. The European Organization for Research and Treatment of Cancer (EORTC) both the Main Module quality-of-life questionnaire (QLQ-C30) and the Head and Neck Cancer (HNC) Module (QLQ-H&N35) were administered at diagnosis and 3, 6, and 12 months thereafter. Complete case analysis was used following assessment of missing data. The proportion of patients with clinically significant deterioration (changes of ≥ 10 points) from baseline were calculated for each follow-up time point and compared by stage (I/II vs. III/IV) and then treatment type (chemotherapy and radiotherapy [CRT] vs. surgery and postoperative radiotherapy [S&PORT]). Deterioration in most domains was most frequent for stage III/IV patients at 3 months (both modules), whereas stage I/II patients experienced this at 6 months (QLQ-C30) and 12 months (H&N35). Among stage III/IV patients, this happened at all time points for S&PORT patients (QLQ-C30) versus 12 months for CRT patients (H&N35). The number of patients reporting deterioration was lower for most domains at 12 months compared to earlier periods, although dry mouth remained a problem for most patients (60%-85% across treatment/stage groups). Our preliminary findings suggest that general and disease-specific deterioration is of most concern for stage I/II patients at 6 and 12 months and at 3 months for advanced cancer patients. For stage III/IV patients receiving S&PORT, general deterioration remains a problem after diagnosis, whereas for CRT patients, disease-specific deterioration is of most concern at 12 months.

Eyebrow Reconstruction: Technical Strategies

The eyebrows have a combined linguistic and affective function and play a key role in facial expressions. Eyebrows loss (madarosis) has various etiologies [1, 2] and may cause disfigurement and discomfort. Eyebrow transplantation is the best aesthetically acceptable procedure that is performed to improve the patient’s appearance and self-esteem. Reconstruction techniques using micrografts of various sizes usually yield good results. Transplantation methods vary from physician to physician; some use a 18-21-G needle with stick-and-place, some use implanters, and others use premade incisions with a tiny microblade, such as a 15 Sharpoint, and place the grafts afterward. The success of reconstruction depends on the surgeon’s knowledge of eyebrow anatomy and his or her ability to reproduce the angle and direction of single-hair grafts to achieve natural results [3]. Here we report our successful, easy approach, with more than 90 cases of eyebrow reconstruction by follicular unit transplant (FUT). Eyebrow design is critical [4] and has three key points: symmetry, direction, and angle. We obtained perfect symmetry by drawing the eyebrow on transparent paper, which is then used as a template for the design of a perfectly symmetrical contralateral eyebrow (Fig. 1). The donor hair is the scalp, in the occipital area, where a strip with an appropriate number of bulbs is harvested. Strip harvesting is about 45 to preserve the adjacent bulbs. Extensive dissection of at least a 1-2-cm margin to suture the donor area without tension ensures a good scar. Micrografts are prepared by means of magnification, and each hair graft is transplanted microsurgically into an incision prepared for it by using of a needle bayonet of 18/19 G (Fig. 2a). This needle is extremely handy; it simplifies and speeds up the creation of the microincision. It overcomes the main difficulty of the eyebrow transplant, reproducing the very acute angle between the hair-stem and the skin. Indeed, this needle is inserted with ease at an acute angle, virtually flat to the skin (Fig. 2b), reproducing the correct original anatomy and shortening the operative time. On average, 100-300 follicular unit grafts are transplanted microsurgically (Fig. 3). Patients who have this eyebrow transplantation for both reconstructive and aesthetic reasons (Fig. 3) are generally very satisfied. The presented technique simplifies the precise, oriented placement of single-hair grafts and has been time-tested by the senior author for the last 20 years. The bayonet needle is a novel and simple approach to FUT, with satisfactory results and a very low complication rate. It is safe, effective, minimally invasive, and very handy in allowing rapid movement. Furthermore, it has no additional costs because it is packed on the operating table by a 18/19-G needle. The results of our technique are natural, beautifully shaped, and contoured. The one problem is that the hair will continue to grow, which necessitates trimming the hair monthly. After a few years, hair transplants adapt to the recipient site by a mechanism that we call ‘‘field effect,’’ as in pubic restoration [5] and other ectopic transplants. However, this is a minor problem for most patients because the defect is caused by a disfigurement due to oncological surgery (Fig. 4), radiotherapy (Fig. 5), burns or severe Electronic supplementary material The online version of this article (doi:10.1007/s00266-011-9712-1) contains supplementary material, which is available to authorized users.

Phase I Clinical Study of the Dietary Supplement, Agaricus blazei Murill, in Cancer Patients in Remission

Although many cancer patients use complementary and alternative medicine, including Agaricus blazei Murill (ABM), safety is not yet well understood. Cancer survivors took 1.8, 3.6, or 5.4 g ABM granulated powder (Kyowa Wellness Co., Ltd., Tokyo, Japan) per day orally for 6 months. Adverse events were defined by subjective/objective symptoms and laboratory data according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (NCI-CTCAE v3.0). Seventy-eight patients were assessed for safety of ABM (30/24/24 subjects at 1/2/3 packs per day, resp.). Adverse events were observed in 9 patients (12%). Most were digestive in nature such as nausea and diarrhea, and one patient developed a liver dysfunction-related food allergy, drug lymphocyte product. However, none of these adverse events occurred in a dose-dependent manner. This study shows that ABM does not cause problems in most patients within laboratory parameters at the dosages tested over 6 months. This trial supports previous evidence that the ABM product is generally safe, excluding possible allergic reaction.

Eye and Eyelid Abnormalities Are Common in Patients with Hashimoto's Thyroiditis

Overt ophthalmopathy is presumed to be uncommon in patients with Hashimoto's thyroiditis compared to Graves' disease, where significant eye changes are found in approximately 40% of patients. On the other hand, when observing, more subtle eye changes, particularly upper eyelid retraction (UER) and mild inflammatory signs, may be common in patients with Hashimoto's thyroiditis. We have determined the prevalence and characteristics of eye signs in recently diagnosed patients with Hashimoto's thyroiditis studied prospectively since 2004 till date in Sydney (Australia). We measured serum orbital antibodies in 20 of the patients in enzyme-linked immunosorbent assay. The overall prevalence of eye signs in patients with Hashimoto's thyroiditis was 34%, of whom about a quarter had chronic UER, determined as a margin-reflex distance of >5 mm, as the main sign. There was no correlation between eye signs and cigarette smoking. Overall, there was only a modest correlation between eye signs and positive antibody tests, and 40% of patients with no eye signs at the time of study were antibody positive. Eye changes, in particular UER, are common in patients with Hashimoto's thyroiditis. Since thyroid stimulating hormone-receptor antibodies are not usually associated with Hashimoto's thyroiditis, autoimmune mediated damage of the levator palpebrae superioris (eyelid) muscle cannot be due to these antibodies. Although eyelid abnormalities may be a minor problem for most patients, for some there are major cosmetic implications requiring surgical management.

Diagnostic evaluation of dysphagia

Taking a careful history is vital for the evaluation of dysphagia. The history will yield the likely underlying pathophysiologic process and anatomic site of the problem in most patients, and is crucial for determining whether subsequently detected radiographic or endoscopic 'anomalies' are relevant or incidental. Although the symptoms of pharyngeal dysphagia can be multiple and varied, the typical features of neurogenic pharyngeal dysphagia are highly specific, and can accurately distinguish pharyngeal from esophageal disorders. The history will also dictate whether the next diagnostic procedure should be endoscopy, a barium swallow or esophageal manometry. In some difficult cases, all three diagnostic techniques may need to be performed to establish an accurate diagnosis. Stroke is the most common cause of pharyngeal dysphagia. A videoradiographic swallow study is vital in such cases to determine the extent and timing of aspiration and the severity and mechanics of dysfunction as a prelude to therapy.

Indoor environment and acoustic conditions in two Finnish hospital wards

The aim of this study was to determine the acoustic conditions of two typical Finnish wards. The methods included long‐term noise measurements, building acoustical measurements and questionnaires for patients (N=33) and nurses (N=27). The average sound pressure levels were within 49 and 58 dBA in the corridors, office and patient rooms. Personal noise exposure levels among nurses were within 56 and 70 dBA. The noise was mainly caused by people. Ventilation noise level was 28 dBA. Building acoustic measurements showed reasonable agreement with national directions. Indoor environment was not a problem for most patients. Some disturbance from thermal conditions, dry air and noise was experienced. From daytime noise sources, other patients' snore and groans caused annoyance in some patients. Night‐time sleep was disturbed most by anxiety, pain, noise, thermal conditions and an uncomfortable bed. Patients were, on average, quite satisfied with the overall room conditions. Nurses were more bothered by environmental factors than patients, giving highest annoyance ratings to thermal conditions, air quality and noise. Noises were experienced to cause some distraction when concentrating to work tasks. Sounds of phones ringing were experienced as particularly detrimental. Lack of privacy was the most obvious problem in both staff and patient evaluations.

Ergebnisse der Dekompression beim Engpass-Syndrom des N. tibialis im Tarsaltunnel

Summary Purpose The purpose of this study is to present the current knowledge on the signs/symptoms, the possibility of imaging techniques and neuro-physiologic investigations, the surgical technique as well as our results after surgical treatment of patients suffering from tarsal tunnel syndrome. Material and methods In 75 patients, 77 surgical decompressions of the tarsal tunnel were performed. All patients were treated conservatively for at least 6 months prior to surgical intervention. We performed a la-test (local anaesthesia-test) with 1–2 ml in every patient prior to indicate surgery. The results were evaluated according to pain at rest, pain during walking, weakness, and according to a modified Kitaoke score. Results Followup ranged from 6 to 100 months (average 39 months). Only 43 out of 75 patients were subjectively satisfied and would undergo surgery again. While pain at rest decreased in 53 patients, pain during walking decreased only in 22 cases. Muscle weakness decreased in 6 patients. However, this parameter was not a problem in most patients preoperatively. At the time of followup the Kitaoke score was 44 (range 15 to 75), which also documented the only satisfying results. We found a positive correlation between preoperative duration of complaints and the postoperative time interval of nerve restitution. No correlation was observed between the results of preoperative neurophy-siological investigation and the clinical outcome. Clinical relevance Surgical decompression of the tibial nerve did not lead to good results in any of the cases. Therefore the indications for surgery should be handled with strong restriction.

Assessment of biodegradable controlled release rod systems for pain relief applications

Control of chronic, severe pain is a difficult and important clinical problem for most patients, especially those with cancer. Although current applications are insufficient for a satisfactory solution to this problem, the rate of disease incidence is increasing worldwide, thus making the problem more apparent. Based on this fact, this study was designed with the ultimate goal of formulating a controlled release system of pain relievers, mainly opioids, for the local treatment of pain to achieve satisfactory, fast, and less side effect-related relief and to provide a better life status for chronic pain patients. Two copolymers of a biodegradable polymer poly(L-lactide-coglycolide) (PLGA) were used to prepare an implantable rod type drug release system containing either an analgesic or anesthetic type of pain reliever. In vitro drug release kinetics of these systems were studied. It was observed that release from PLGA 85 : 15 was more zero-order than it was from PLGA 50 :50. A zero-order release rate was obtained for codeine, hydromorphone, and bupivacaine from PLGA (85 :15) rods. They, however, were released from PLGA (50 :50) rods with Higuchi kinetics. The drug solubility was also influential on release rate, as shown by the zero-order morphine release from PLGA (50 :50) rods. Scanning electron micrographs (SEMs) of the monolithic rods revealed erosion of the rods and the removal of drug crystals from the rod structure.

Direct adsorption of lipoproteins from whole blood by DALI apheresis: technique and effects.

Low-density lipoprotein (LDL) apheresis can drastically reduce atherogenic lipoproteins in coronary patients in whom LDL and lipoprotein (a) (Lp[a]) cannot be sufficiently reduced by conservative therapy. LDL and Lp(a) adsorption by polyacrylate/polyacrylamide (DALI) is the simplest procedure for clinical LDL apheresis to date. DALI was first applied in patients in 1994 and introduced into clinical routine in 1996. It is the first LDL-hemoperfusion system, i.e., it adsorbs LDL and Lp(a) directly from whole blood. This markedly simplifies the extracorporeal circuit, the handling of the system, and reduces significantly staff time and, especially at higher blood flow rates, treatment time. Its features are high selectivity and capacity of lipoprotein removal (maximum about 8 g low-density lipoprotein cholesterol per session). Using citrate anticoagulation, good biocompatibility is evidenced by the lack of cell losses, hemolysis, thrombotic events, and complement activation. Some clotting factors of the intrinsic system are also adsorbed. There is significant bradykinin activation that, however, does not cause problems in most patients if angiotensin converting enzyme inhibitor medication is avoided. In a first long-term study, 93% of sessions were uneventful. Major side effects were citrate-induced paresthesias (1.3%) and hypotension (0.8%). To date, more than 25,000 DALI sessions have been performed all over the world.

Treatment of benign ureterointestinal anastomotic strictures with permanent ureteral Wallstent after Camey and Wallace urinary diversion: long-term follow-up.

Ureterointestinal anastomotic stricture follows urinary diversion in 4% to 8% of patients and may lead to a progressive deterioration of renal function. There are problems with all current management techniques: surgical revision, endourologic incision, nephrostomy drainage, external ureteral stents, and dilation with a high-pressure angioplasty balloon. The authors present their long-term results with permanent ureteral Wallstents for the treatment of benign ureterointestinal stricture. Eight patients with 10 strictures were treated by placement of self-expanding permanent indwelling stents via percutaneous nephrostomy between September 1993 and January 1998. The mean age of the group was 59.2 years. Development of strictures occurred a mean of 20.9 months after urinary diversion. There were seven complete and three partial strictures. Of 49 patients treated by the Camey procedure, 7 patients (14%) developed 9 (18%) strictures. Of 28 patients having the Wallace procedure, 1 patient (3.5%) developed one stricture. After recanalization of the distal ureter by a Terumo guidewire and dilation with a high-pressure angioplasty balloon, a Wallstent was placed across the stricture via a percutaneous approach. The endourologic placement of the Wallstent was well tolerated by all patients. The hospital stay averaged 2 days. Seven patients with nine strictures after the Camey procedure are doing well with a follow-up of 7 to 68 months (mean 22.4 months). One major complication was observed in one patient necessitating an additional procedure (lithotripsy) because of stone formation at the lower part of the stent extending into the neobladder in order to maintain patency after 68 months. The other patient, who had a Wallace procedure, is doing well 1 year 8 months afterward. An endourologic ureteral Wallstent approach to ureterointestinal stricture is a successful alternative, providing satisfactory management of the problem in most patients. No complication such as stent migration, hematuria, pain, or recurrent stricture was observed.

Limy Bile and Laparoscopic Cholecystectomy

Objective to determine incidence of ‘limy bile’ in patients undergoing laparoscopic cholecystectomy; to analyze patient characteristics and preoperative imaging modalities in these patients and evaluate surgical treatmentPatients and Methods : a retrospective analysis of 1800 laparoscopic cholecystectomies performed between March 1990 and March 1998 for symptomatic gallbladder disease.Results: Five patients with limy bile (0,27 %) were identified. Four were female and one was male, age varied from 42 to 66. Most patients were symptomatic longtime before presentation. Ultrasound was not able to differentiate between normal gallstones or sludge. In three patients the diagnosis was made before operation, in one patient it was an incidental finding. Surgery in these patients is not more difficult than in any other patient.Conclusion : Limy bile is a rare finding (0,27% in 1800 cholecystectomies). Plain abdominal X-rays mostly suggest the presence of calcium carbonate precipitate in the gallbladder, but ultrasound cannot differentiate between cholelithiasis and limy bile. Laparoscopic resection can be performed without problems in most patients. Preoperative diagnosis of this rare entity is not essential, as it does not alter treatment.

Patient Factors Related to the Presentation of Fatigue Complaints: Results from a Women's General Health Care Practice

ABSTRACT The aim of this study was to examine which patient-related factors predicted: (1) fatigue, (2) the intention to discuss fatigue and (3) the actual discussion of fatigue during consultation with a GP in a women's general health care practice. Patients were asked to complete two questionnaires: one before and one after consultation. The patient-related factors included: social-demographic characteristics; fatigue characteristics; absence of cognitive representations of fatigue; nature of the requests for consultation; and other complaints. Some 74% of the 155 respondents reported fatigue. Compared to the patients that were not fatigued, the fatigued patients were more frequently employed outside the home, had higher levels of general fatigue, and a higher need for emotional support from their doctor. A minority (12%) intended to discuss fatigue during consultation. Of the respondents returning the second questionnaire (n = 107), 22% reported actually discussing their fatigue with the GP while only 11% had intended to do so. In addition to the intention to discuss fatigue during consultation, the following variables related to actually discussing fatigue: living alone, caring for young children, higher levels of general fatigue, absence of cognitions with regard to the duration of the fatigue, and greater psychological, neurological, digestive, and/or musculoskeletal problems as the reason for consultation. Fatigue was found to be the single reason for consultation in only one case. It is concluded that fatigue does not constitute a serious problem for most patients and that discussion of fatigue with the GP tends to depend on the occurrence of other psychological or physical problems and the patient's social context.

Ankle ligament injuries

Acute ankle ligament sprains are common injuries. The majority of these occur during athletic participation in the 15 to 35 year age range. Despite the frequency of the injury, diagnostic and treatment protocols have varied greatly. Lateral ligament complex injuries are by far the most common of the ankle sprains. Lateral ligament injuries typically occur during plantar flexion and inversion, which is the position of maximum stress on the anterotalofibular liagment (ATFL). For this reason, the ATFL is the most commonly torn ligament during an inversion injury. In more severe inversion injuries the calcaneofibular (CFL), posterotalofibular (PTFL) and subtalar ligament can also be injured. Most acute lateral ankle ligament injuries recover quickly with nonoperative management. The treatment program, called "functional treatment," includes application of the RICE principle (rest, ice, compression, and elevation) immediately after the injury, a short period of immobilization and protection with an elastic or inelastic tape or bandage, and early motion exercises followed by early weight bearing and neuromuscular ankle training. Proprioceptive training with a tilt board is commenced as soon as possible, usually after 3 to 4 weeks. The purpose is to improve the balance and neuromuscular control of the ankle. Sequelae after ankle ligament injuries are very common. As much as 10% to 30% of patients with a lateral ligament injury may have chronic symptoms. Symptoms usually include persistent synovitis or tendinitis, ankle stiffness, swelling, and pain, muscle weakness, and frequent giving-way. A well designed physical therapy program with peroneal strengthening and proprioceptive training, along with bracing and/or taping can alleviate instability problems in most patients. For cases of chronic instability that are refractory to bracing and external support, surgical treatment can be explored. If the chronic instability is associated with subtalar instability that is refractory to conservative measures and bracing as outlined above, surgical treatment must address the subtalar joint as well. Subtalar ligament injury and instability are probably more common than appreciated. Definition and diagnosis of this entity are difficult, however. Fortunately, it appears that in the majority of the acute injuries healing occurs with the same functional rehabilitation program as that for lateral ankle ligament sprains. For chronic subtalar instability an intial attempt at functional rehabilitation with ankle proprioceptive training and bracing should be attempted. If this program fails primary repair or reconstruction can be beneficial. Reconstructive procedures must address the subtalar joint. Subtalar instability often occurs in conjunction with talocrural instability, so careful diagnosis is critical in anyone with chronic ankle instability. If either is not addressed, the patient will continue to have problems. Deltoid ligament injuries most often occur in association with ankle fractures. They are rare as isolated injuries. If no fracture is evident on radiographs, particular attention must be paid to the syndesmosis to ensure there is not an associated syndesmosis disruption. True isolated deltoid injuries seem to do well with non-operative functional treatment as for lateral ankle ligament injuries. Deltoid ruptures associated with ankle fractures appear to heal well by addressing the other injuries and allowing the deltoid to heal on its own. It is vital to correct any syndesmosis injury and to obtain correct bony alignment. Syndesmosis injuries can be debilitating if not treated properly. Careful physical exam and interpretation of radiographs is necessary to obtain a correct diagnosis. Partial injuries appear to do well with functional rehabilitation. However, complete tears, if widening is not corrected, can lead to chronic ankle pain and early degenerative changes. Widening of the syndesmosis with a tear of the inferior tibiofibular ligaments is an indication for surgery to place a syndesmosis screw for reduction of the mortise. Protected weight bearing is required for about 6 weeks after surgery, at which time the screw should be removed. A functional rehabilitation program can then begin.

Gastric emptying time in patients with primary hypothyroidism.

Symptoms due to slowing of gastrointestinal motility constitute an important problem in most patients with primary hypothyroidism. The purpose of this study was to calculate gastric emptying time in patients with primary hypothyroidism using a radioisotopic method. Fifteen hypothyroid patients (2 male, 13 female) participated in the study. Mean age was 43 (range 38-50) years. Only patients who had been recently diagnosed and had received no previous therapy were included in the study. Radiological and endoscopic examination of the upper gastrointestinal tract was carried out. Patients with gastric outlet obstruction were excluded. Twelve healthy and euthyroid people with no detectable gastrointestinal pathology were examined as a control group. The mean age of this group was 45 (range 35-55) years. Patients and control group received a semisolid meal containing 1 mCi technetium-99m sulphur colloid and measurements were made from the epigastrium. Mean gastric emptying half-time (t(half)) was 112.13+/-48.96 min in hypothyroid patients and 57.87+/-6.38 min in the control group. Gastric emptying time of the hypothyroid patients was significantly different from the control group (P< 0.001). There was no correlation between gastric emptying time and serum thyroid-stimulating hormone (TSH) levels. We concluded that radioisotopic study is a safe, rapid and reliable method for determining gastric emptying time in patients with primary hypothyroidism.

Mechanisms of action of glucocorticoids in asthma.

"Mechanisms of Action of Glucocorticoids in Asthma." American Journal of Respiratory and Critical Care Medicine, 154(2_pt_2), pp. S21–S27

Controlling the hemodynamic response to laryngoscopy and endotracheal intubation.

The hemodynamic response to the stress of laryngoscopy and endotracheal intubation does not present a problem for most patients. However, patients with cardiovascular or cerebral disease may be at increased risk of morbidity and mortality from the tachycardia and hypertension resulting from this stress. These hemodynamic effects gained notice after the introduction and use of muscle relaxants, such as curare and succinylcholine, for endotracheal intubation at the time of anesthesia induction. A variety of anesthetic techniques and drugs are available to control the hemodynamic response to laryngoscopy and intubation. The method or drug of choice depends on many factors, including the urgency and length of surgery, choice of anesthetic technique, route of administration, medical condition of the patient, and individual preference. The possible solutions number as many as the medications and techniques available and depend on the individual patient and anesthesia care provider. This paper reviews these medications and techniques to guide the clinician in choosing the best methods.

Liver function in patients with pulmonary emphysema due to severe alpha-1-antitrypsin deficiency (Pi ZZ).

Alpha 1-Antitrypsin deficiency predisposes to pulmonary emphysema, liver cirrhosis and hepatocellular carcinoma. Anecdotal evidence and a large autopsy study suggest that severe lung and liver disease rarely coexist in the same subject, but this has not been studied in patients. Therefore we investigated 27 patients with severe alpha 1-deficiency (Pi ZZ) and pulmonary emphysema for signs of liver disease and impaired hepatic function. A subgroup of 7 patients underwent quantitative liver function tests. On physical examination or ultrasonography, cirrhosis or tumor was not suspected in any patient. Conventional liver function tests were completely normal in 17 patients. Elevated serum activities of gamma-glutamyltranspeptidase and/or aminotransferases were seen in 10 patients. In some, the elevation was only marginal and in none more than twice normal. The serum bilirubin concentration and activity of alkaline phosphatase were increased in 1 patient. Serum protein, albumin, fibrinogen, antithrombin III, alpha 1-fetoprotein concentrations, serum activities of cholinesterase and glutamate dehydrogenase, activated partial thromboplastin time and prothrombin time were normal in all patients. The indocyanine green half-life was abnormal only in 1 of 6 patients, suggesting that hepatic blood flow was not impaired in the study group. However, the lidocaine half-life and galactose elimination capacity, parameters of hepatic metabolization, were impaired in 4 and 6 of 7 patients, respectively. We conclude that liver disease or impaired liver function is not a clinically relevant problem in most patients with pulmonary emphysema due to alpha 1-antitrypsin deficiency. But results of quantitative liver function tests, although performed in only a small group of patients, suggest that hepatic metabolization might be impaired even in those patients who present with pulmonary disease.

Malnutrition in cystic fibrosis: A behavioral conceptualization of cause and treatment

The genetic mutation in cystic fibrosis causes a generalised dysfunction of the exocrine system. The subsequent increase in energy needs due to pulmonary infections, increased basal metabolic rate, and malabsorption are not compensated for by increased food intake, hence, malnutrition becomes a problem for most patients. Biological control mechanisms for body energy regulation may be impaired, causing anorexia directly and contributing to learned behaviors which further decrease intake. An interdisciplinary approach to treatment is suggested which would include behavioral, dietary, and medical components. Early and continuous assessment and modification of problematic eating behaviors and related environmental factors along with nutrition education may delay the need for artificial supplementation, and augment their use by increasing oral intake and compliance with procedures. Anxiety due to increasing disease severity may contribute to anorexia and treatment noncompliance. Behavioral training in identification of Stressors and relaxation techniques may be helpful in reducing stress.

Methods of assessment of bowel fu nction in patients with advanced cancer

Constipation is said to be a problem for most patients with advanced cancer. There has been little investigation of constipation in this group perhaps partly because of their frailty and a consequent reluctance to impose burdensome investigations on them. Mean transit time (MTT-S) was measured in 17 patients with advanced cancer admitted to a hospice and was used as a standard to evaluate the use of single stool analysis of transit time (SST) and the standardized estimation of stool form as measures of bowel function in this population. Bowel frequency, stool weight and stool water content were used as additional measures of bowel function. Transit time ranged from four to 12 days, the SST method proving accurate for transit times of 96 hours or less. MTT-S correlated more strongly with mean stool form ( r=0.83) than with any other measure of bowel function. It is suggested that standardized stool form assessment may give clinically useful information about transit time and be of particular value in assessing bowel function in ill patients.

Dietary prevention of coronary artery disease

The prevalence of high serum cholesterol levels and the associated epidemic of coronary artery disease in our society are largely the by-products of a maladaptive diet. Dietary modification is the logical and effective approach to this problem for most patients. In general, dietary therapy consists of a reduction in the intake of saturated fatty acids, cholesterol, and excess calories. Many specific dietary modifications, including increased intake of omega-9 and omega-3 fatty acids and soluble fiber, may also help reduce cholesterol levels and prevent coronary artery disease.