%0 Journal Article
%A de Groot, Hugo
%J Tijdschr Diergeneeskd
%D 2007 May
%N 10
%P 398-9
%T [Moribund cattle]
%V 132
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17578232

%0 Journal Article
%C Department of Immunology & Rheumatology, Mixed Unit Hospices Civils de Lyon-BioMerieux, E. Herriot Hospital, 69437 Lyon Cedex 03, France
%A Zhou, Y
%A Toh, ML
%A Zrioual, S
%A Miossec, P
%J Cytokine
%D 2007 Jul
%T IL-17A versus IL-17F induced intracellular signal transduction pathways and modulation by IL-17RA and IL-17RC RNA interference in AGS gastric adenocarcinoma cells
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17644350
%X Inflammatory processes are implicated in gastric cancer development. In contrast, the role of inflammation and proinflammatory cytokines in established cancer remains to be clarified. We investigated the contribution of IL-17A versus IL-17F-mediated intracellular signalling pathways in human gastric adenocarcinoma AGS cells. IL-8 secretion was evaluated by ELISA, mitogen-activated protein kinase (MAPK)(4) by Western blotting, and activator protein 1(AP-1) and nuclear factor kappa B (NFkappaB) by TransAM transcription factor assay or qRT-PCR. IL-17RA and IL-17RC inhibition were achieved by small interfering RNA (siRNA). IL-17A significantly induced activation of all three MAPK (ERK, p38 and JNK) and downstream transcription factors AP-1 and p65 NFkappaB. IL-17F was less potent but induced a significant activation of p65 NFkappaB. Consistently, IL-17A was more potent to induce IL-8 secretion than IL-17F. Inhibition of either IL-17RA or IL-17RC expression via siRNA led to near complete abrogation of IL-17A-mediated c-Jun and p65 activation. These data suggest that in gastric cancer, absence of either IL-17RA or IL-17RC can inhibit IL-17 responsiveness. Conversely, downstream of IL-17R binding, IL-17A and IL-17F induce key signal transduction pathways implicated in inflammation and carcinogenesis. IL-17A, and possibly IL-17F, may contribute to amplification and persistence of inflammatory processes implicated in inflammation-associated cancer

%0 Journal Article
%C Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
%A Zeliadt, Steven B
%A Penson, David F
%J Pharmacoeconomics
%D 2007 
%N 4
%P 309-27
%T Pharmacoeconomics of available treatment options for metastatic prostate cancer
%V 25
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17402804
%X The resources devoted to managing metastatic prostate cancer are enormous, yet little attention has been given to directly measuring the economic consequences of treatment alternatives. The purpose of this article was to evaluate the pharmacoeconomics of available treatments for metastatic prostate cancer, including hormone-sensitive disease, androgen-independent prostate cancer and locally advanced/progressive disease. We identified 58 articles addressing economic issues related to metastatic prostate cancer. Treatment alternatives with considerably different costs are available in many areas of disease management, most notably, medical androgen deprivation therapy (ADT) versus surgical castration; combined androgen blockage (CAB) versus monotherapy for initial treatment of hormone-sensitive disease; as well as bisphosphonates and bone-targeted radioisotopes for palliation. The few available pharmacoeconomic studies indicate that the additional costs are not supported by clear and compelling evidence of differences in survival or quality-of-life (QOL) outcomes. Our review revealed that authors often use considerably different assumptions about efficacy and survival outcomes in their analyses, which may be due to the inconsistency of available clinical evidence. Although there have been many clinical trials comparing various therapies, we identified only three trials that included economic assessments. Thus, few sources of economic data are available and most pharmacoeconomic studies rely on information mined from indirect sources. We note that, while there has been considerable enthusiasm about the role of docetaxel regimens in the past 2 years, no study has yet examined the costs of these therapies. Survival remains poor for metastatic disease, thus QOL is the primary consideration for many therapies. However, QOL for treatment of metastatic disease is poorly measured and, in most analyses, the impact of therapy on QOL was inferred based on speculation by the authors. Given the large cost burdens of these treatments, it is essential that we more fully understand the true QOL gains potentially offered by more expensive therapies. The economic studies of advanced prostate cancer highlight several aspects of clinical care that are filled with considerable uncertainty and remain guided by forces other than optimal resource allocation. It is essential that we address the weaknesses in our understanding of the economic consequences of therapies for prostate cancer, and find ways to include economic information into the process of determining optimal therapy

%0 Journal Article
%C Service de Dermatologie, Hopital Habib Thameur - Tunis
%A Zakraoui, Hela
%A Fenniche, Samy
%A Chekili, Salma
%A Benmously, Rym
%A Marrak, Hayet
%A Mokhtar, Insaf
%A Zakraoui, Leith
%J Tunis Med
%D 2007 Jun
%N 6
%P 532-4
%T [Paraneoplastic digital necrosis: a case report]
%V 85
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17644912
%X BACKGROUND: Digital necrosis is a frequent vascular disease. Its very often reflects arterial disorders of macro or mirocirculation. Paraneoplastic digital necrosis is rare, however. AIM: Report a new case of paraneoplastic digital necrosis CASE: Our patient was a 62-year old diabetic female patient with a history of total thyroid ablation at 50 year old. She presented with bilateral digital necrosis of the second, third and fourth fingers. During her recovery, we have found a biological inflammatory syndrome and abdominal echography revealed a metastatic liver. Radiological investigations in search for the primitive tumour were negative. The patient was referred to a specialized center for a palliative chemotherapy. CONCLUSION: Etiologies of digital necrosis are various, mainly iatrogen, professional, toxic, atheroma or systemic disease. In case of no evident cause, explorations should be gone to detect underlying malignancies

%0 Journal Article
%C Dana-Farber Cancer Institute, Boston, USA
%A Wright, Alexi A
%A Katz, Ingrid T
%J N Engl J Med
%D 2007 Jul
%N 4
%P 324-7
%T Letting go of the rope--aggressive treatment, hospice care, and open access
%V 357
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17652646

%0 Journal Article
%C Center for Applied Research on Aging and Health, Thomas Jefferson University, Edison Building, suite 500, 130 South 9th Street, Philadelphia, PA 19106, USA
%A Winter, L
%A Parker, B
%J Soc Sci Med
%D 2007 Jul
%T Current health and preferences for life-prolonging treatments: An application of prospect theory to end-of-life decision making
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17655996
%X As a substantial body of research attests, the acceptability of life-prolonging treatment (e.g., tube feeding) tends to be greater among people in worse health than among healthier ones. Because a decision for or against a life-prolonging treatment represents a choice between two prospects-life (usually in poor health) and death-we propose a decision model, Prospect Theory, as a theoretical account of this phenomenon. Prospect Theory postulates that pairs of distant prospects are less distinguishable than pairs of closer ones. Thus, to healthy individuals, the prospects of death and life in poor health would both be remote, and therefore, the distinction between them, small. To less healthy individuals, however, the difference between the same pairs of prospects would appear greater, and therefore, life-prolonging treatment may be more acceptable. In a cross-sectional study of 304 community-dwelling people, aged 60 years and over in the Philadelphia area, USA, preferences for 4 life-prolonging treatments in 9 health scenarios were examined in relation to participants' current health, operationalized as number of deficits in physical functioning. As predicted, less healthy people expressed stronger preferences for all life-prolonging treatments compared with healthier ones, with differences greatest in the worse-health scenarios. Preferences also varied by health scenario, with any treatment preferred in the better health scenarios. Treatment preferences did not differ by type of treatment, depressed mood or any demographic characteristic except race, with African-Americans expressing stronger treatment preferences. Implications for advance care planning are discussed

%0 Journal Article
%C Mercy Hospice, Auckland. derekwillis35@hotmail.com
%A Willis, Derek
%J N Z Med J
%D 2007 
%N 1258
%P U2631
%T No privacy in death
%V 120
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653249

%0 Journal Article
%C Department of Mental Health Sciences, Royal Free and University College Medical School, and St Joseph's Hospice, London NW3 2PF, UK
%A Walsh, Kiri
%A Jones, Louise
%A Tookman, Adrian
%A Mason, Christina
%A McLoughlin, Joanne
%A Blizard, Robert
%A King, Michael
%J Br J Psychiatry
%D 2007 Feb
%P 142-7
%T Reducing emotional distress in people caring for patients receiving specialist palliative care. Randomised trial
%V 190
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17267931
%X BACKGROUND: Caring for relatives with advanced cancer may cause psychological and physical ill health. AIMS: To evaluate the effectiveness of increased support for distressed, informal carers of patients receiving palliative care. METHOD: The sample was composed of 271 informal carers who scored over 5 on the 28-item General Health Questionnaire (GHQ-28). The intervention comprised six weekly visits by a trained advisor. Primary outcome was carer distress (GHQ-28) at 4-week, 9-week and 12-week follow-up. Secondary outcomes were carer strain and quality of life, satisfaction with care, and bereavement outcome. RESULTS: Scores on the GHQ-28 fell below the threshold of 5/6 in a third of participants in each trial arm at any follow-up point. Mean scores in the intervention group were lower at all time points but these differences were not significant. No difference was observed in secondary outcomes. Carers receiving the intervention reported qualitative benefit. CONCLUSIONS: The intervention might have been too brief, and ongoing help might have had accruing benefits. Alternatively, informal carers of patients with cancer may already receive considerable input and the advisor's help gave little additional advantage; or caring for a dying relative is extremely stressful and no amount of support is going to make it much better

%0 Journal Article
%C Service de Neurologie A and EDMUS Coordinating Center, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France. sandra.vukusic@chu-lyon.fr
%A Vukusic, Sandra
%A Confavreux, Christian
%J Curr Opin Neurol
%D 2007 Jun
%N 3
%P 269-74
%T Natural history of multiple sclerosis: risk factors and prognostic indicators
%V 20
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17495619
%X PURPOSE OF REVIEW: To highlight progress in the description of the natural course and prognosis of multiple sclerosis. RECENT FINDINGS: The general evolution of multiple sclerosis is now well known at the level of patient groups. Characteristics of relapses early in the disease and the occurrence of a progressive phase seemed to be the most reliable prognostic factors. Recent works suggest that the progressive phase in multiple sclerosis could be an age-dependent, degenerative process, independent of previous relapses, and that the initial course of the disease does not substantially influence age at disability milestones. By contrast, a younger age at disease onset strongly correlates with a younger age when reaching disability landmarks, confirming that even if it takes longer for younger patients to accumulate irreversible disability, they are disabled at a younger age than patients with later onset. Multiple sclerosis might be considered as one disease with different clinical phenotypes, rather than an entity encompassing several distinct diseases. SUMMARY: Overall course and prognosis in multiple sclerosis is most likely to be related to age and the occurrence of the progressive phase of the disease, rather than to relapses or other clinical parameters. Individual prognosis remains hazardous

%0 Journal Article
%C Hospices Civils de Lyon, Departement d'imagerie digestive, Hopital E. Herriot, Lyon, France
%A Viremouneix, L
%A Monneuse, O
%A Gautier, G
%A Gruner, L
%A Giorgi, R
%A Allaouchiche, B
%A Pilleul, F
%J J Magn Reson Imaging
%D 2007 Jul
%N 2
%P 331-338
%T Prospective evaluation of nonenhanced MR imaging in acute pancreatitis
%V 26
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17654731
%X PURPOSE: To compare the value of nonenhanced (NE) magnetic resonance imaging (MRI) (NE-MRI) with contrast-enhanced (CE) computed tomography (CT) (CE-CT) scan in assessing acute pancreatitis (AP) and in evaluating the severity index (SI) with clinical outcome. MATERIALS AND METHODS: Patients with AP were prospectively investigated by CE-CT scan and NE-MRI on admission. MRI was performed with fat-saturated T1-weighted imaging, T2-weighted imaging, and MR cholangiopancreatography (MRCP). Balthazar's grading system was used to evaluate the NE-MRI severity index (CTSI, MRISI) and it was compared to the clinical outcome. RESULTS: A total of 90 patients (median age = 55 years) were included in the study. AP was of biliary etiology in 37 patients (41%). On admission, AP was assessed as grade III by CTSI in four patients (4%), whereas 19 patients were classified grade III by MRISI. The coefficient correlation between CTSI and MRISI was good, with r = 0.6 (P < 0.001). Considering CE-CT scan as the gold standard, sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of NE-MRI for detecting severe AP based on imaging criteria were 100%, 82.6%, 100%, and 21%, respectively. NE-MRI discriminates normal pancreatic parenchyma from edema and necrosis with a correlation between morbidity (P < 0.008). CONCLUSION: NE-MRI seems to be a reliable method of staging AP severity in comparison to CE-CT scan. J. Magn. Reson. Imaging 2007;26:331-338. (c) 2007 Wiley-Liss, Inc

%0 Journal Article
%C Department of Cardiac Surgery, Children's Hospital Boston, Boston, Massachusetts 02115, USA
%A Vida, Vladimiro L
%A Bacha, Emile A
%A Larrazabal, Alesandro
%A Gauvreau, Kimberly
%A Thiagaragan, Ravi
%A Fynn-Thompson, Francis
%A Pigula, Frank A
%A Mayer, John E Jr
%A del Nido, Pedro J
%A Tworetzky, Wayne
%A Lock, James E
%A Marshall, Audrey C
%J Ann Thorac Surg
%D 2007 Aug
%N 2
%P 581-5; discussion 586
%T Hypoplastic left heart syndrome with intact or highly restrictive atrial septum: surgical experience from a single center
%V 84
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17643639
%X BACKGROUND: The presence of an intact or highly restrictive atrial septum (I/HRAS) has long been recognized as a predictor of poor outcome among patients with hypoplastic left heart syndrome (HLHS), although the rarity of this condition has precluded conclusive study. The purpose of this review is to summarize recent surgical outcomes for these patients at our center and to identify predictors. METHODS: We retrospectively identified all neonates with a diagnosis of HLHS and I/HRAS who underwent stage I palliation at Children's Hospital Boston between January 2001 and December 2006. Chart review enabled analysis of patient and procedural variables. RESULTS: All 32 patients underwent left atrial decompression in utero or postnatally before surgery. Fourteen patients (44%) underwent fetal intervention, either atrial septoplasty (n = 9) or aortic valvuloplasty (n = 5). Twenty-nine of the 32 patients had postnatal left atrial hypertension and underwent transcatheter atrial septoplasty as neonates before surgery; 3 did not require postnatal atrial septoplasty after successful fetal atrial septoplasty. After stage I, hospital survival was 69% (22 of 32). Need for shunt revision (p = 0.02) and for extracorporeal membrane oxygenation use (p < 0.001) were associated with hospital mortality. Survival at 6 months was 69% for patients who had fetal intervention, and 38% for those who were treated only postnatally (p = 0.2). CONCLUSIONS: Surgical outcome for patients with HLHS and I/HRAS continues to improve. Prenatal decompression of the left atrium may be associated with greater hospital survival. Proposed effects of fetal intervention on lung pathology and longer-term survival are subjects for future study in this unique group of patients

%0 Journal Article
%C Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Karolinska Institute Stockholm, Sweden; Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institute Stockholm, Sweden; Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
%A Valdimarsdottir, U
%A Kreicbergs, U
%A Hauksdottir, A
%A Hunt, H
%A Onelov, E
%A Henter, JI
%A Steineck, G
%J Lancet Oncol
%D 2007 Jul
%T Parents' intellectual and emotional awareness of their child's impending death to cancer: a population-based long-term follow-up study
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17644038
%X BACKGROUND: We aimed to study care-related determinants of when parents gain awareness of their child's impending death to cancer, and whether the duration of this awareness affects the parents' long-term morbidity. METHODS: Between August 2001 and October 2001, 449 of 561 (80%) parents who had lost a child due to any malignancy in Sweden between Jan 1, 1992, and Dec 31, 1997 (identified on the Swedish Causes of Death Register), answered a 365-item postal questionnaire designed to ascertain when, before the child's actual death, they had become intellectually and emotionally aware of the child's impending death (awareness time). The primary endpoints were intellectual awareness time (defined as time between intellectual realisation that a disease is fatal and the actual time of death) and emotional awareness time (defined as time between emotional realisation that a disease is fatal and the actual time of death). Parents' awareness of less than 24 h was referred to as a short awareness time. FINDINGS: 436 parents answered the question about intellectual awareness and 433 parents answered the question about emotional awareness. 112 parents (26%) reported a short intellectual awareness time and 195 parents (45%) reported a short emotional awareness time. The risk of having short intellectual awareness time was increased if parents had absence of information on their child's fatal condition (mothers relative risk [RR] 3.6 [95% CI 2.3-5.5]; fathers 2.9 [1.8-4.5]) and if curative treatment was used towards the end of life (mothers 4.1 [2.6-6.5]; fathers 2.7 [1.7-4.2]). The risk of short emotional awareness time was increased if parents had absence of information indicating the child would die (mothers 1.5 [1.1-2.0]; fathers 1.8 [1.3-2.5]) and absence of talks about death with the other parent (mothers 1.5 [1.1-2.0]; fathers 1.7 [1.2-2.2]). Compared with fathers who had longer emotional awareness time, fathers with short emotional awareness time had an increased risk of depression (adjusted RR 1.8 [1.0-3.3]) and absence from employment due to sick leave or early retirement (RR 8.5 [1.1-67.8]) at follow-up. This difference was not noted for mothers. INTERPRETATION: Health-care professionals can influence parents' intellectual and emotional awareness of a child's impending death due to cancer. Short emotional awareness increases the risk of long-term depression in bereaved fathers

%0 Journal Article
%A Thompson, Katherine H
%A Orvig, Chris
%J Chem Soc Rev
%D 2006 Jun
%N 6
%P 499
%T Editorial: lanthanide compounds for therapeutic and diagnostic applications
%V 35
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16729143
%X The medical applications of lanthanides are diverse: MRI contrast agents, hypophosphatemic agents for kidney dialysis patients, luminescent probes in cell studies, and for palliation of bone pain in osteosarcoma

%0 Journal Article
%C Department of Medical Oncology, University Medical Center, Utrecht
%A Teunissen, S C C M
%A de Graeff, A
%A Voest, E E
%A de Haes, J C J M
%J Palliat Med
%D 2007 Jun
%N 4
%P 341-6
%T Are anxiety and depressed mood related to physical symptom burden? A study in hospitalized advanced cancer patients
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656411
%X BACKGROUND : Anxiety and depressed mood are common symptoms in hospitalized advanced cancer patients. It is often presumed that anxiety and depression affect the occurrence and experience of physical symptoms. PURPOSE : To analyse the relation between anxiety, depressed mood and the presence and intensity of physical symptoms. Patients and methods : Anxiety and depressed mood were assessed in a hospitalized advanced cancer population (n = 79) primarily by the Hospital Anxiety and Depression Scale (HADS), and also by a single-item question ;Are you anxious and/or depressed?' and by the Edmonton Symptom Assessment System (ESAS). Physical symptoms were assessed by a semi-structured interview and by the ESAS. RESULTS : Thirty-four percent of the patients reported anxiety, 56% depressed mood and 29% both, as assessed by the HADS. The correlations between HADS, the single-item question and the ESAS were low. No association was found between anxiety or depressed mood and the presence of physical symptoms. Patients who were anxious or depressed had higher ESAS scores for insomnia and drowsiness; scores for pain, anorexia, asthenia, nausea and dyspnea were independent of anxiety and/or depressed mood. CONCLUSION : The relationship between anxiety, depressed mood and the presence and intensity of physical symptoms in hospitalized advanced cancer patients is very limited. Palliative Medicine 2007; 21: 341-346

%0 Journal Article
%C Division of General Internal Medicine, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: mueller.pauls@mayo.edu)
%A Swetz, Keith M
%A Crowley, Mary Eliot
%A Hook, Christopher
%A Mueller, Paul S
%J Mayo Clin Proc
%D 2007 Jun
%N 6
%P 686-91
%T Report of 255 clinical ethics consultations and review of the literature
%V 82
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17550748
%X OBJECTIVE: To review clinical ethics consultations at a tertiary care academic medical center. METHODS: We retrospectively reviewed all ethics consultations (and associated patient medical records) conducted at the Mayo Clinic in Rochester, Minn, between April 6, 1995, and December 31, 2005. RESULTS: Of the 255 consultations, 101 (40%) reviewed intensive care unit care, 103 (40%) involved patients who died during hospitalization, and 174 (68%) were requested by physicians. The most common primary diagnoses of the patients involved were malignancy (18%, n=47), neurologic disease (18%, n=47), and cardiovascular disease (17%, n=43). Most cases involved multiple issues: patient competency and decision-making capacity (82%, n=208), staff member disagreement with care plans (76%, n=195), end-of-life and quality-of-life issues (60%, n=154), and goals of care and futility (54%, n=138). Withholding or withdrawing measures was the focus of 132 (52%) of the consultations. We also identified previously published reports of ethics consultations and compared the findings of those reports with ours. CONCLUSIONS: Despite advances in medicine, the nature of ethical dilemmas remains relatively unchanged. Issues of communication, family conflict, and futility continue to give rise to ethical quandaries

%0 Journal Article
%C Department of Medical Oncology, St Georg Vorsorge- und Rehabilitationskliniken, Kurhausplatz 1, 79862, Hochenschwand, Germany
%A Strobel, ES
%A Feyer, P
%A Steingraber, M
%A Schmitt-Graff, A
%A Kohl, PK
%J J Cancer Res Clin Oncol
%D 2007 Jul
%T An unusual case of Merkel cell carcinoma
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653576
%X PURPOSE: Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine tumor of the skin mainly found in elderly white patients. Due to its poor prognosis with distant metastases in up to 33% and local recurrence in 25-33% and a 5 year disease-specific survival of 64% (1-2) its early diagnosis and appropriate treatment is mandatory. METHODS: The study is an exceptional clinical case of a patient with a large inoperable MCC unable to be treated according to treatment guidelines due to her old age. We review the literature addressing treatment options. RESULTS: The patient was treated with palliative definitive radiotherapy to her large MCC of the left lower leg. She showed a rapid clinical response to four palliative radiation doses of 7 Gy each, necrosis of tumor mass and persistent clearing at a follow-up of 32 weeks. Our patient was very unusual in terms of her extensive MCC and her rapid and complete response to palliative radiotherapy lasting for 6 months at present. CONCLUSIONS: As MCC is an aggressive tumor, best survival is achieved with early diagnosis in a localized stage and prompt adequate surgery and further stage-adjusted treatment. Thus, the differential diagnosis of MCC should not be dismissed in a reddish nodule on the leg, and every excision should be submitted to pathology. In accordance with the literature we demonstrate here that definitive radiotherapy is an effective treatment option for inoperable MCC, which in this individual patient produced necrosis of the extensive tumor mass after only four palliative doses

%0 Journal Article
%C 1TARGOS Molecular Pathology GmbH, Kassel, Germany
%A Stoss, O
%A Werther, M
%A Zielinski, D
%A Middel, P
%A Jost, N
%A Ruschoff, J
%A Henkel, T
%A Albers, P
%J Prostate Cancer Prostatic Dis
%D 2007 Jul
%T Transcriptional profiling of transurethral resection samples provides insight into molecular mechanisms of hormone refractory prostate cancer
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646850
%X The molecular mechanisms for hormone-resistant prostate cancer progression still remain elusive, mainly due to the limited availability of corresponding tissue. As transurethral resection (TUR) is a common palliative therapy for patients with hormone refractory prostate cancer (HRPC) who have subvesical obstruction, we aimed to demonstrate that TUR samples can be used to identify significantly affected biological pathways during the switch to HRPC using oligonucleotide microarray analysis. Among the most significantly deregulated pathways in HRPC, we observed an induction of oxidative phosphorylation and a repression of cytoskeletal components.Prostate Cancer and Prostatic Diseases advance online publication, 24 July 2007; doi:10.1038/sj.pcan.4501001

%0 Journal Article
%C Lancaster University, Lancashire
%A Stevens, T
%A Payne, Sa
%A Burton, C
%A Addington-Hall, J
%A Jones, A
%J Palliat Med
%D 2007 Jun
%N 4
%P 323-31
%T Palliative care in stroke: a critical review of the literature
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656409
%X The aim of this literature review was to identify the palliative care needs of stroke patients. Stroke results in high levels of mortality and morbidity, yet very little is known about the nature and extent of palliative care services that are available to this patient group, and the ways in which such services could be delivered. A critical review of the international literature found only seven papers that attempted to identify the palliative care needs of patients diagnosed with stroke. The results of the review showed that the preferences of stroke patients and their families in relation to palliative care services are largely unknown. The review also indicated the paucity of data in regard to the distinction between provision of palliative care services for patients who die in the acute phase of stroke and for those patients who die later. Establishing reliable assessments of need are central to designing and implementing effective interventions and further research is required in this area. Further data on how the input of palliative care experts and expertise could be of benefit to patients, and the most effective ways these inputs could be targeted and delivered is required. Palliative Medicine 2007; 21: 323-331

%0 Journal Article
%C rsteinbrook@attglobal.net
%A Steinbrook, Robert
%J N Engl J Med
%D 2007 Jul
%N 3
%P 209-13
%T Organ donation after cardiac death
%V 357
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17634455

%0 Journal Article
%C Department of Surgery, Division of Pediatric Surgery, Stanford University Medical Center, Lucile Packard Children's Hospital, Stanford, CA, USA
%A Slater, Bethany
%A Rangel, Shawn
%A Ramamoorthy, Chandra
%A Abrajano, Claire
%A Albanese, Craig T
%J J Pediatr Surg
%D 2007 Jun
%N 6
%P 1118-21
%T Outcomes after laparoscopic surgery in neonates with hypoplastic heart left heart syndrome
%V 42
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17560232
%X BACKGROUND/PURPOSE: Laparoscopy has advanced the care of children for a variety of pediatric surgical diseases. However, complication rates for laparoscopic interventions in neonates with hypoplastic left heart syndrome (HLHS) have not been well described. The purpose of this study is to present the largest reported series of laparoscopic surgery performed in patients with HLHS. METHODS: We conducted a single-institution, retrospective chart review for all neonates with HLHS who underwent a laparoscopic procedure from September 2002 to March 2005. Data regarding patient characteristics, intraoperative monitoring, previous cardiac surgery, perioperative complications, and postoperative mortality were assessed. RESULTS: Twelve patients with HLHS underwent a total of 13 operations during the study period (8 combined Nissen fundoplication and gastrostomy tubes, 3 isolated gastrostomy tubes, 1 Ladd procedure, and 1 combined Nissen fundoplication and gastrocutaneous fistula closure). All cases were completed laparoscopically. Patients had undergone palliative cardiac surgery but were not completely corrected; therefore, they were cyanotic. Perioperative complications were observed in 6 patients (3 gastrostomy tube site infections, 1 small bowel obstruction, 1 postoperative sepsis, and 1 urinary tract infection). There was no mortality in this series. CONCLUSIONS: From this experience, it appears that laparoscopy can be performed safely and with satisfactory outcomes in patients with HLHS. However, a multidisciplinary approach, including the availability of a skilled and experienced cardiac anesthesia team, is believed to be critical to optimize outcomes in these critically ill children

%0 Journal Article
%C Division of Radiation Oncology, National Naval Medical Center, Bethesda, MD
%A Shrivastava, Vikas
%A Christensen, Rebecca
%A Poggi, Matthew M
%J Clin Genitourin Cancer
%D 2007 Jun
%N 5
%P 341-3
%T Prostate cancer metastatic to the external auditory canals
%V 5
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17645833
%X A 58-year-old white man with prostate-specific antigen (PSA) level of 6 ng/mL, a Gleason score of 6 (3+3), and T2a adenocarcinoma of the prostate underwent prostatectomy. On review of the pathology, the specimen contained a Gleason score of 8 (3+5) with other high-risk features. The patient had a persistently elevated postoperative PSA level and was placed on total androgen blockade. The PSA continued to increase, and the patient developed bone-only metastatic disease. The patient was treated with palliative external-beam radiation and samarium. Six months later, he presented with bilateral hearing loss and was found to have pathologic and radiographic evidence of metastatic prostate cancer to the external auditory canals. This was an unusual late finding. The patient died shortly afterward before completing palliative treatment to the area

%0 Journal Article
%C St Richard's Hospice, Worcester. headofeducation@strichards.org.uk
%A Shaw, Susan
%A Meek, Fraser
%A Bucknall, Rachel
%J Nurs Stand
%D 2007 Jun
%N 40
%P 35-8
%T A framework for providing evidence-based palliative care
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17601235
%X The development of a new inpatient hospice unit provided a valuable opportunity to consider ways in which nursing care is defined and documented. Three values which the authors felt should underpin nursing practice in the service were identified. This article outlines these values and describes the documentation framework that was adopted

%0 Journal Article
%C Department of Cardiac Surgery, Ludwig Maximilians University, Munich, Germany. Daniel.Schmauss@med.uni-muenchen.de
%A Schmauss, D
%A Kaczmarek, I
%A Sachweh, J
%A Kozlik-Feldmann, R
%A Sodian, R
%A Deutsch, M A
%A Reichart, B
%A Daebritz, S H
%J Heart Surg Forum
%D 2007 
%N 4
%P E331-3
%T Successful single lung fontan operation in 2 children: case reports
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17599886
%X We report on 2 children, aged 3 and 4 years, with single ventricle physiology who underwent Fontan operation in the presence of a single right lung successfully with good midterm outcome. Therefore, the absence of one lung is not a contraindication for a Fontan palliation in selected patients with optimal hemodynamics

%0 Journal Article
%C Department of Cardiology, Children's Hospital Boston, Boston, Mass 02115, USA. mark.scheurer@cardio.chboston.org
%A Scheurer, Mark A
%A Hill, Elizabeth G
%A Vasuki, Nagavardhan
%A Maurer, Scott
%A Graham, Eric M
%A Bandisode, Varsha
%A Shirali, Girish S
%A Atz, Andrew M
%A Bradley, Scott M
%J J Thorac Cardiovasc Surg
%D 2007 Jul
%N 1
%P 82-9, 89.e1-2
%T Survival after bidirectional cavopulmonary anastomosis: analysis of preoperative risk factors
%V 134
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17599490
%X OBJECTIVE: Prognostic factors for survival after bidirectional cavopulmonary anastomosis for functionally single ventricle are not well defined. We analyzed preoperative hemodynamic and echocardiographic data to determine risk factors for death or transplantation at least 1 year after bidirectional cavopulmonary anastomosis. METHODS: Data for all patients who underwent bidirectional cavopulmonary anastomosis before 5 years of age at our institution from September 1995 through June 2005 were analyzed. Available preoperative echocardiograms and catheterizations were reviewed. Survivors were compared with those who died or underwent transplantation. Bivariable associations between demographic and clinical risk factors and survival status (alive without transplantation vs dead or transplanted) were assessed with Wilcoxon rank sum test and chi2 or Fisher exact tests. Survival functions were constructed with Kaplan-Meier estimates, and event times compared between subgroups with log-rank tests. Cox proportional hazard modeling was used for multivariable modeling of risk of death or transplantation. RESULTS: One hundred sixty-seven patients underwent bidirectional cavopulmonary anastomosis with hemi-Fontan (n = 62) or bidirectional Glenn (n = 105) operations. Three patients died before discharge, 11 died later, and 1 has undergone transplantation. Freedom from death or transplantation after bidirectional cavopulmonary anastomosis was 96% at 1 year and 89% at 5 years. Multivariable analysis of preoperative variables showed atrioventricular valve regurgitation to be an independent risk factor for death or transplantation (hazard ratio 2.8, 95% confidence interval 1.1-7.1, P = .02). CONCLUSION: Although survival after bidirectional cavopulmonary anastomosis is high, preoperative atrioventricular valve regurgitation is an important risk factor for death or transplantation

%0 Journal Article
%C Service de Chirurgie Orthopedique et de Traumatologie du Sport, CHU de Grenoble, Hopital Sud, 38130 Echirolles
%A Saragaglia, D
%A Rubens-Duval, B
%A Chaussard, C
%J Rev Chir Orthop Reparatrice Appar Mot
%D 2007 Jun
%N 4
%P 351-6
%T [Computer-assisted combined femoral and tibial osteotomy for severe genu varum: early results in 16 patients.]
%V 93
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646816
%X PURPOSE OF THE STUDY: The aim of this work was to assess radiographic outcome after double femoral and tibial osteotomy for severe genu varum. Among 197 computer-assisted osteotomies performed in our department between August 2001 and February 2006, 16 (8.1%) were double level osteotomies.MATERIAL AND METHODS: Five women and nine men, mean age 51.19+/-11.15 years (range 20-63 years) underwent surgery (both sides for two men). The right side was involved in nine cases, the left in seven. Inclusion criteria were genu varum>10 degrees and/or a mechanical femur angle >=90 degrees in a context of a varus tibial mechanical axis. Exclusion criteria were a femoral mechanical angle at 90 degrees and a tibial mechanical angle>88 degrees . Using the modified Ahlback classification, the knees were: grade 2 (n=1), grade 3 (n=9), grade 4 (n=4) and grade 5 (n=1). One patient did not present osteoarthritic degradation but a particularly unaesthetic deformity. The radiological femorotibial mechanical angle (HKA) measured preoperatively was on average 168.44 degrees ±2.42 degrees (range 164 degrees -173 degrees ). The average preoperative femoral mechanical angle was 87.38 degrees ±2.45 degrees (range 81 degrees -90 degrees ) and the mechanical tibial angle was 84.5 degrees ±2.19 degrees (range 80 degrees -88 degrees ). The main preoperative objective was to obtain a mechanical femorotibial angle of 182 degrees ±2 degrees without an oblique joint space giving a tibial mechanical angle of 90+/-2 degrees ). All operations were computer-assisted using the Orthopilottrade mark navigation system. After acquisition of the mechanical axis, the closed wedge lateral distal femoral osteotomy was performed first to achieve the desired femoral correction. The open wedge proximal medial tibial osteotomy was then performed to obtain the planned femorotibial mechanical axis. A control goniometry in the weight bearing position was obtained three months postoperatively.RESULTS: There were no complications. The mean preoperative computer-measured HKA was 168.63 degrees ±2.22 degrees (range 164 degrees -173 degrees ), i.e. an angle corresponding perfectly with the preoperative goniometry. After the osteotomies, the mean computer-measured mechanical angle was 183 degrees ±0.94 degrees (range 181 degrees -184 degrees ). Three months after the operation, the weight-bearing goniometry gave a mean HKA angle at 181.25 degrees ±1.84 degrees (range 177 degrees -184 degrees ). The mean femoral mechanical angle was 93.13 degrees ±2.25 degrees (range 89 degrees -97 degrees ) and the mean tibial mechanical angle was 90.31 degrees ±1.20 degrees (range 88 degrees -92 degrees ). The preoperative objective was achieved in 14 of the 16 patients (87.5%). The two failures were undercorrections (177 degrees and 179 degrees ). Joint spaces were not oblique on the x-rays.DISCUSSION: Tibial osteotomy is an excellent method for the treatment of osteoarthritic genu varum. However, in patients with very severe deformity, femoral varus is also involved so that the overcorrection necessary to achieve a good result (3-6 degrees valgus) could often produce an oblique joint space corresponding to excessive tibial valgus. Since osteotomy is generally considered as a palliative measure before later implantation of a total prosthesis, an oblique joint surface would compromise the success of the subsequent surgery. Double-level osteotomy is a way to avoid this problem, keeping in mind that the risk of over or under correction is not negligible for this difficult operation. We used our experience with computer-assisted navigation for total knee arthroplasty and for tibial osteotomy to prepare this technique for double-level osteotomy.CONCLUSION: Computer-assisted double-level osteotomy is a reliable, accurate and reproducible method for the treatment of severe genu varum. The two failures observed in this series were within a tolerable range (177 degrees and 179 degrees ). The use of a navigation procedure simplifies a technique which in general requires skillful application to achieve the preoperative objective. The development of this technique is important in order to avoid an oblique joint space which can compromise the success of subsequent prosthesis implantation

%0 Journal Article
%C Life Source Services Hospice
%A Salviano, Sandra
%J J Community Health Nurs
%D 2007 Fall
%N 3
%P 201
%T BOOK REVIEW: Palliative & End-of-Life Care-Clinical Practice Guidelines (2nd ed.) by Kim. K. Kuebler, Debra E. Heidrich, & Peg Espers
%V 24
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17650990

%0 Journal Article
%C University of Manchester. karen.luker@manchester.ac.uk
%A Ryan-Woolley, Bernadette M
%A McHugh, Gretl A
%A Luker, Karen A
%J Palliat Med
%D 2007 Jun
%N 4
%P 273-7
%T Prescribing by specialist nurses in cancer and palliative care: results of a national survey
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656402
%X BACKGROUND : This study investigates Macmillan nurses' views on nurse prescribing in cancer and palliative care and explores perceived motivators and barriers to training for and the implementation of this extended nursing role. METHOD : National postal survey of 2252 Macmillan nurses in the UK. RESULTS : A response rate of 70% (1575) was achieved. Eleven percent (168 of 1575) of Macmillan nurses surveyed were trained as extended formulary independent nurse prescribers. Half (88 of 168) of the Macmillan nurses who could prescribe from the extended formulary were prescribing, representing just 6% (88 of 1575) of the sample. Training deficits highlighted included poor organization and insufficient length, depth and specificity of courses (to meet the needs of nurses working in palliative care) and a lack of medical mentorship. Among Macmillan nurses who had not undergone extended formulary independent nurse prescribing training, 25% (335) perceived that prescribing was not part of their specialist nursing role. A further 40% (538) expressed reluctance to undergo training. CONCLUSIONS : A clear lack of enthusiasm amongst specialist nurses in cancer and palliative care to undertake prescribing training was identified. It is noteworthy that half of the Macmillan nurses trained as extended formulary independent nurse prescribers were not prescribing. Since government targets for nurse prescribing are not yet being met, these findings raise important questions concerning whether extended nurse prescribing is likely to be a successful initiative in cancer and palliative care. Palliative Medicine 2007; 21: 273-277

%0 Journal Article
%C Division of Endocrinology and Metabolism, Department of Medicine, Beth Israel Medical Center and Albert Einstein College of Medicine, New York, NY, USA. jrosman@bethisraelny.org
%A Rosman, J
%A Bravo-Vera, R
%A Sheikh, A
%A Gouller, A
%J J Endocrinol Invest
%D 2007 Jun
%N 6
%P 521-4
%T Metastatic insulinoma in an adult patient with underlying nesidioblastosis
%V 30
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646729
%X OBJECTIVE: To report a case of metastatic insulinoma presenting 11 yr after enucleation of an isolated insulinoma, and 5 yr after distal pancreatectomy for nesidioblastosis. METHODS: We present the clinical, laboratory, radiological and pathological findings in a 34 yr-old-man with recurrent hypoglycemia. The pertinent literature is reviewed. RESULTS: A 34- yr-old man presented in 1992 with symptoms of recurrent hypoglycemia. Laboratory and imaging findings were consistent with insulinoma. After enucleation of the tumor, his symptoms resolved. In 1998 hypoglycemia recurred and biochemical work-up was consistent with endogenous hyperinsulinism. Imaging for recurrent or metastatic insulinoma revealed no mass. He underwent a distal pancreatectomy and pathology revealed islet cell hyperplasia, or nesidioblastosis. However, the patient reported minimal symptomatic improvement. He was started on diazoxide but was poorly compliant and ate frequently to avoid hypoglycemic symptoms. In 2003 he presented with hypoglycemia-induced seizure activity. Imaging showed hepatic and pulmonary lesions, but no pancreatic mass. An octreotide scan revealed increased hepatic uptake and fine needle aspiration of a liver lesion confirmed metastatic insulinoma. Arterial-stimulation venous sampling revealed increased insulin output from the liver and normal insulin output from the pancreas. After failure of medical therapy, radiofrequency ablation of hepatic lesions was performed with subsequent improvement in clinical symptoms. The patient was discharged on a low dose of dexamethasone. CONCLUSION: Although this patient had nesidioblastosis, his recurrent hyperinsulinism was most likely secondary to metastatic insulinoma. Radiofrequency ablation was successfully used for palliative purposes in managing metastatic insulinoma refractory to medical therapy

%0 Journal Article
%C Palliative Medicine, Sperrin Lakeland Trust, Tyrone County Hospital, Omagh, Co. Tyrone BT79 0AP, Northern Ireland. frobinson@slt.n
%A Robinson, Frances
%A Cupples, Margaret
%A Corrigan, Mairead
%J Palliat Med
%D 2007 Jun
%N 4
%P 305-12
%T Implementing a resuscitation policy for patients at the end of life in an acute hospital setting: qualitative study
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656407
%X OBJECTIVE : To explore attitudes and experiences of doctors and nurses regarding cardiopulmonary resuscitation for patients with end stage illness in an acute hospital. Design : Qualitative study; thematic analysis of two audio-taped focus groups and four semi-structured interviews. SETTING : Acute district hospital, Northern Ireland. PARTICIPANTS : Seven nurses and nine doctors; varying nationality, gender and years of professional experience; involved in cardiopulmonary resuscitation decision-making. RESULTS : Participants reported different interpretations of resuscitation policy and of what do not attempt to resuscitate (DNAR) decisions meant in relation to practical care for patients. This confusion in translating policy into practice contributed to communication difficulties in initiating, documenting and implementing cardiopulmonary resuscitation decisions. Participants were aware of how clinical conditions could change and reported uncertainty in determining end stage illness; they expressed fears of potential consequences of DNAR decisions for patients' care. The more disease-centred approach of doctors to patients' management, compared to nurses' more patient-centred approach, contributed to inter-professional conflict within teams. Doctors identified training needs in applying resuscitation policy and ethical principles in ;real life' and nurses identified a need for ongoing professional support, which was perceived as being less available to junior doctors. Personal relationships between staff and patients, cultural reluctance to address sensitive issues and local community expectations of relatives being involved in decisions added to policy implementation difficulties. CONCLUSIONS : The findings indicate a need for ongoing staff support and training in applying resuscitation policy to decisions for patients with end stage illness in an acute hospital. They support suggestions that reviews of local resuscitation policy and of national guidelines should be undertaken with openness and honesty regarding the goals, opportunities and difficulties involved in trying to deliver good end of life care in local settings. Palliative Medicine 2007; 21 : 305-312

%0 Journal Article
%C Division of Endocrinology, Nemours Children's Clinic, Jacksonville, FL; School of Nursing, University of North Florida, Jacksonville, FL
%A Rini, Annie
%A Loriz, Lillia
%J J Pediatr Nurs
%D 2007 Aug
%N 4
%P 272-82
%T Anticipatory mourning in parents with a child who dies while hospitalized
%V 22
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17645955
%X Even when prognosis is poor and death appears imminent, care of the dying child typically focuses on achieving cure. Parents are often ill-prepared to cope with the grief they experience as their child is dying. Anticipatory mourning allows time to begin grief work prior to the death of a loved one. An exploratory design was used to answer questions in focused semistructured interviews to determine the presence and the role of anticipatory mourning, and to describe the themes expressed by parents. Parents' descriptions of their experiences surrounding the death of their child reveal an environment and a health care team that are often ill-prepared to deal with the impending death of a child. Also described are instances that reflect a compassionate process that positively affects the experience while facilitating appropriate grief work. Offered are recommendations for health care professionals that may assist parents in coping with the death of their child

%0 Journal Article
%C Department of Palliative Medicine RWTH Aachen University Aachen Email: LRadbruch@ukaachen.de
%A Radbruch, Lukas
%A Foley, Kathleen
%A De Lima, Liliana
%A Praill, David
%A Furst, Carl Johan
%J Palliat Med
%D 2007 Jun
%N 4
%P 269-71
%T The Budapest Commitments: setting the goals A joint initiative by the European Association for Palliative Care, the International Association for Hospice and Palliative Care and Help the Hospices
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656401

%0 Journal Article
%C Ardgowan Hospice, Greenock
%A Rachel, Thorp
%A Welsh, John
%J Practitioner
%D 2007 Mar
%N 1692
%P 75-81
%T Achieving optimum pain control in terminally ill patients at home
%V 251
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17441490

%0 Journal Article
%C Hospices Civils de Lyon, Universite Claude Bernard Lyon 1, Lyon, France
%A Pradat, P
%A Tillmann, H L
%A Sauleda, S
%A Braconier, J-H
%A Saracco, G
%A Thursz, M
%A Goldin, R
%A Winkler, R
%A Alberti, A
%A Esteban, J-I
%A Hadziyannis, S
%A Rizzetto, M
%A Thomas, H
%A Manns, M P
%A Trepo, C
%J J Viral Hepat
%D 2007 Aug
%N 8
%P 556-63
%T Long-term follow-up of the hepatitis C HENCORE cohort: response to therapy and occurrence of liver-related complications
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17650289
%X The aims of the study were to verify the long-term effect of time on viral clearance in hepatitis C virus (HCV) patients and to find out factors possibly associated with disease progression. A total of 1641 patients recruited from eight European centres in 1996-1997 were re-analysed 5-7 years after inclusion. The occurrence of decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver transplantation was analysed in relation to different host and viral factors. Ninety-three per cent of the HCV patients who had cleared the virus (spontaneously or after antiviral therapy) remained HCV-RNA-negative during follow up and may be considered as 'cured'. Among patients who were sustained responders at inclusion, 2.3% developed liver complications during follow up, and 31% of non-responders did. Advanced age at infection and presence of the human leucocyte antigen (HLA) DRB1*1201-3 allele were possibly associated with a higher rate of progression to decompensated cirrhosis or HCC. Decompensated cirrhosis might be further associated with male gender, non-response to previous therapy, and lack of HLA DRB1*1301 allele, whereas HCC seems to be associated with the presence of the HLA DQ02 allele. Long-term follow up of HCV patients indicates that virological response persists over time and is associated with a very low incidence of liver complications. Advanced age at inclusion, advanced age at infection, viral genotype 1, non-response to previous therapy and possibly some specific HLA alleles are factors independently associated with a faster rate of progression towards liver complications. The large proportion of patients lost to follow up stresses the need for a strengthened and optimized management of HCV patients

%0 Journal Article
%C Sue Ryder Care St. John's Hospice, Moggerhanger, Bedfordshire, MK44 3RJ, UK. paul.perkins@suerydercare.org
%A Perkins, Paul
%A Jordan, Alice
%A Prentice, Wendy
%A Regnard, Claud
%J Palliat Med
%D 2007 Jun
%N 4
%P 355-6
%T Copying letters to patients: a survey of patients and GPs views
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656413

%0 Journal Article
%C Pediatric and Congenital Cardiac Surgery Unit, Centro Gallucci, University of Padua Medical School, Padua, Italy
%A Padalino, Massimo A
%A Speggiorin, Simone
%A Rizzoli, Giulio
%A Crupi, Giancarlo
%A Vida, Vladimiro L
%A Bernabei, Massimo
%A Gargiulo, Gaetano
%A Giamberti, Alessandro
%A Santoro, Francesco
%A Vosa, Carlo
%A Pacileo, Giuseppe
%A Calabro, Raffaele
%A Daliento, Luciano
%A Stellin, Giovanni
%J J Thorac Cardiovasc Surg
%D 2007 Jul
%N 1
%P 106-13, 113.e1-9
%T Midterm results of surgical intervention for congenital heart disease in adults: an Italian multicenter study
%V 134
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17599494
%X OBJECTIVE: We have analyzed, in a clinical multicenter study, the effect of cardiac surgery in adults with congenital heart disease in Italy. METHODS: We collected clinical data from 856 patients aged 19 years or older who underwent surgical intervention from January 1, 2000, to December 31, 2004. Patients were divided into 3 surgical groups: group 1, palliation (3.1%); group 2, repair (69.7%); and group 3, reoperation (27.4%). RESULTS: Preoperatively, 34.6% of patients were in New York Heart Association class I, 48.4% were in class II, 14.2% were in class III, and 2.8% were in class IV. Sinus rhythm was present in 83%. There were 1179 procedures performed in 856 patients (1.37 procedures per patient), with a hospital mortality of 3.1%. Overall mean intensive care unit stay was 2.3 days (range, 1-102 days). Major complications were reported in 247 (28.8%) patients, and postoperative arrhythmias were the most frequent. At a mean follow-up of 22 months (range, 1 month-5.5 years; completeness, 87%), late death occurred in 5 (0.5%) patients. New York Heart Association class was I in 79.3%, II in 17.6%, and III in 2.9%, and only 1 (0.11%) patient was in class IV. Overall survival estimates are 82.6%, 98.9%, and 91.8% at 5 years for groups 1, 2, and 3, respectively. Freedom from adverse events at 5 years is 91% for acyanotic patients versus 63.9% for preoperative cyanotic patients (P < .0001). CONCLUSIONS: Surgical intervention for congenital heart disease in adults is a safe and low-risk treatment. However, patients presenting with preoperative cyanosis show a higher incidence of late adverse events and complications

%0 Journal Article
%C School of Nursing, The University of Western Ontario, ON, Canada
%A Oudshoorn, Abram
%A Ward-Griffin, Catherine
%A McWilliam, Carol
%J J Clin Nurs
%D 2007 Aug
%N 8
%P 1435-43
%T Client-nurse relationships in home-based palliative care: a critical analysis of power relations
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17655531
%X Aim. To elicit an in-depth understanding of the sources of power and how power is exercised within client-nurse relationships in home-based palliative care. Background. As in all social relations, power is present within client-nurse relationships. Although much research has focused on interpersonal relationships in nursing, the concept of power within the client-nurse relationship in palliative care settings has not been extensively investigated. Methods. Applying a critical lens, secondary qualitative data analysis was conducted. Seventeen nurse and 16 client transcripts from a primary study were selected for secondary data analysis. These 33 transcripts afforded theme saturation, which allowed for both commonalities and differences to be identified. Data analysis involved analytic coding. Results. Study findings help make explicit the underlying power present in the context of home-based palliative care and how this power is used and potentially abused. In analysing the sources and exercise of power, the linkage between macro and micro levels of power is made explicit, as nurses functioned within a hierarchy of power. The findings suggest that educational/occupational status continues to be a source of power for nurses within the relationship. However, nurses also experience powerlessness within the home care context. For clients, being able to control one's own life is a source of power, but this power is over-shadowed by the powerlessness experienced in relationships with nurses. The exercise of power by clients and nurses creates experiences of both liberation and domination. Conclusions. Nurses who are willing to reflect on and change those disempowering aspects of the client-nurse relationship, including a harmful hierarchy, will ultimately be successful in the health promotion of clients in home-based palliative care. Additionally, it should be recognized that nurses work within a specific health system context and, therefore, their practice is influenced by policies and funding models implemented at various levels of the health care system. Relevance to clinical practice. The insights gained through this investigation may assist nurses and other health professionals in reflecting on and improving practices and policies within home-based palliative care and within home care in general

%0 Journal Article
%C Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
%A Onelov, Erik
%A Steineck, Gunnar
%A Nyberg, Ullakarin
%A Hauksdottir, Arna
%A Kreicbergs, Ulrika
%A Henningsohn, Lars
%A Bergmark, Karin
%A Valdimarsdottir, Unnur
%J Acta Oncol
%D 2007 
%N 6
%P 810-6
%T Measuring anxiety and depression in the oncology setting using visual-digital scales
%V 46
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653905
%X We investigated the feasibility of using single-item visual-digital scales for measuring anxiety and depression for research purposes within the oncology and palliative care setting. Data were retrieved from five nationwide postal questionnaires comprising 3030 individuals (response rate 76%): cancer patients, widows/parents who had lost their husband/child to cancer and population controls. All questionnaires contained the Center for Epidemiological Studies Depression scale (CES-D) and Spielberger's State-Trait Anxiety Inventory (STAI-T) as well as seven-point Visual-Digital Scales (VDS) assessing anxiety and depression. Each stepwise increased score on the VDS-depression provided a statistically significant increase in the mean score on CES-D (Spearman's r=0.582). The VDS-anxiety correlated with mean scores on STAI-T (Spearman's r=0.493), however, not all stepwise increased scores on the VDS-anxiety gave a statistically significant increase on the STAI-T. Positive- and negative predictive values were 51% and 91% for VDS-depression and 64% and 80% for VDS-anxiety. Missing data for STAI-T were 7% and 9% for CES-D; the corresponding figures were 2% for the VDS-depression and 3% for VDS-anxiety. With low attrition and agreement with psychometric scales, the Visual-Digital Scales are a feasible alternative for research in the oncology setting. However, the high negative predictive value and the low positive predictive value suggest that the visual- digital scales mainly detect the absence of the symptoms

%0 Journal Article
%C Department of Palliative Medicine, Marshfield Clinic, Marshfield, WI 54449, USA. okon.tomasz@marshfieldclinic.org
%A Okon, Tomasz
%J Pain Physician
%D 2007 May
%N 3
%P 493-500
%T Ketamine: an introduction for the pain and palliative medicine physician
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17525784
%X A history of an escalating chronic intractable pain in a patient with cryoglobulinemia, vasculitis, and severe cutaneous ulcerations is presented. A strategy of progressive, multi-agent, N-methyl-D-aspartate-receptor (NMDA-R) blockade that resulted in adequate pain control and a three-fold reduction in opioid consumption is described. Diagnostic process of neuropathic pain and the role of NMDA-R in the development of hyperalgesia are briefly reviewed. Thereafter, existing clinical literature describing the use of Ketamine, a major NMDA-R antagonist for management of malignant pain, is reviewed. Lastly, evidence-based original protocol for intravenous adjuvant Ketamine analgesia for severe cancer pain is presented

%0 Journal Article
%A Nikolaou, Chara
%A Vassiliou, Vassilios
%A Pangali, Maria
%A Kardamakis, Dimitrios M
%J J Am Geriatr Soc
%D 2007 Jun
%N 6
%P 958-9
%T Cost of medication requirement during radiotherapy: implications for an elderly oncological population
%V 55
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537102

%0 Journal Article
%C Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114. camunroe@partners.org
%A Munroe, Craig A
%A Sirdofsky, Michael D
%A Kuru, Tunay
%A Anderson, Eric D
%J Respir Care
%D 2007 Aug
%N 8
%P 996-9
%T End-of-Life Decision Making in 42 Patients With Amyotrophic Lateral Sclerosis
%V 52
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17650354
%X OBJECTIVE: To determine when end-of-life issues were discussed with patients afflicted with amyotrophic lateral sclerosis (ALS). METHODS: This was a retrospective analysis of ALS patients referred to the neuromuscular clinic at Georgetown University Hospital. Patients were seen by a pulmonologist and a neurologist at the initial diagnosis or referral, and every 2-3 months thereafter. End-of-life discussions were addressed at each visit. Other variables recorded included the amount of time afflicted with ALS, serial pulmonary function test results, and the subjective level of bulbar dysfunction. RESULTS: We saw 43 patients (age range 39-94 y) between June 1999 and September 2004. One patient was on a ventilator at the initial visit, and was therefore excluded from the study. Discussion about the patients' end-of-life care preferences were initiated at the first pulmonary visit with 40 patients. With 2 patients, end-of-life decisions were discussed at the second office visit. Twenty-five patients chose do-not-resuscitate and do-not-intubate (DNR/DNI) orders after the initial end-of-life discussion with the pulmonologist. Five other patients chose DNR/DNI orders during subsequent clinic visits. Four patients were still undecided at their last clinic visit. Six patients were lost to follow-up before a decision was made. Two patients requested full ventilatory support. Both the forced vital capacity and the level of bulbar dysfunction were not statistically different between the patients who chose DNR/DNI and the patients who were either undecided or requested full ventilatory support. CONCLUSIONS: Decisions about end-of-life care are often delayed in patients with ALS. These patients' final decisions seem to be independent of their level of respiratory insufficiency or bulbar function, and most related to the physician addressing end-of-life care decisions in a timely manner

%0 Journal Article
%C andreas@mueller-cyran.de
%A Muller-Cyran, A
%J Anaesthesist
%D 2007 Mar
%N 3
%P 283-4
%T [Beyond all words. First aid for the grieving and traumatised]
%V 56
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17279345
%X The limits of the "language of (in) medicine" emerge more clearly when demanding situations occur. The confrontation with death is an experience which leads to speechlessness because the limitations of language coincide with a limitation of medicine. A qualified psychosocial support can, however, make a contribution in that the bereaved can be turned into mourners. With this in the background the demand for doctors to have a basic psychosocial competence is not an extravagent desire but a component of prevention

%0 Journal Article
%C Department of Plastic & Reconstructive Surgery, Addenbrooke's Hospital NHS Foundation Trust, Cambridge, UK. marc@moncrieff.net
%A Moncrieff, Marc D
%A Hamilton, Stuart A
%A Lamberty, George H
%A Malata, Charles M
%A Hardy, David G
%A Macfarlane, Robert
%A Moffat, David A
%J J Plast Reconstr Aesthet Surg
%D 2007 
%N 6
%P 607-14
%T Reconstructive options after temporal bone resection for squamous cell carcinoma
%V 60
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17485047
%X Squamous cell carcinoma (SCC) of the temporal bone is a rare, aggressive and highly malignant tumour that requires specialised, multidisciplinary surgery for its treatment. Reconstruction of the defect is as crucial as the tumour ablation in terms of mortality and postoperative morbidity. METHODS: The experience of the East Anglian Skull Base Surgery Service from 1982 to 2004 in managing 42 consecutive patients (22 females; age range 37-80 years) undergoing extended and lateral temporal bone resection for SCC is presented. RESULTS: The overall 5-year survival was 31.0% (median follow up: 97 months) when both curative and palliative procedures were included. On multivariate analysis, the favourable prognostic factors were male sex, well-differentiated tumours and stage N(0) neck. The reconstructions in 38 patients were analysed. The majority (24/38) had free tissue transfer reconstructions and most of these were radial forearm free flaps. Later in the series, other free flap types such as anterolateral thigh flaps and lateral arm flaps were employed. Pedicled myocutaneous flaps and local flaps were also used. CONCLUSIONS: This paper analyses the outcomes of the various reconstructions and discusses the evolution of their care in our unit. The information obtained from the review of our data is extrapolated to offer guidance on the choice of reconstructive option in these patients

%0 Journal Article
%C Department of Surgery, The University of Chicago, 5841 South Maryland Avenue, Mail Code 5031, Chicago, Illinois, 60637, USA
%A Mezhir, James J
%A Melis, Marcovalerio
%A Headley, Ryan C
%A Pai, Rish K
%A Posner, Mitchell C
%A Kaplan, Edwin L
%J J Hepatobiliary Pancreat Surg
%D 2007 
%N 4
%P 410-3
%T Successful palliation of hypercalcemia secondary to metastatic parathyroid cancer: an unusual indication for hepatic resection
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653642
%X Primary carcinoma of the parathyroid gland is a rare disease. It is often diagnosed after recurrence of hyperparathyroidism following resection for presumed adenomatous disease. Local and distant recurrence is high and aggressive resection is advocated. Patients with parathyroid cancer are frequently plagued by severe hypercalcemia, which is often refractory to medical therapy. Herein we describe the case of a patient with metastatic parathyroid cancer localized to the liver. The patient was treated with a palliative hepatic resection for the management of persistent and refractory hypercalcemia. Intraoperative parathyroid hormone levels were utilized as an adjunct to determine successful metastatectomy. Our case highlights the importance of an aggressive approach to patients with metastatic parathyroid cancer, as well as the utility of intraoperative parathyroid hormone levels to confirm successful extirpation of disease

%0 Journal Article
%C Children's Hospital of Michigan, Detroit, Michigan 48201, USA. kmeert@med.wayne.edu
%A Meert, Kathleen L
%A Eggly, Susan
%A Pollack, Murray
%A Anand, K J S
%A Zimmerman, Jerry
%A Carcillo, Joseph
%A Newth, Christopher J L
%A Dean, J Michael
%A Willson, Douglas F
%A Nicholson, Carol
%J J Pediatr
%D 2007 Jul
%N 1
%P 50-5, 55.e1-2
%T Parents' perspectives regarding a physician-parent conference after their child's death in the pediatric intensive care unit
%V 151
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17586190
%X OBJECTIVE: To investigate parents' perspectives on the desirability, content, and conditions of a physician-parent conference after their child's death in the pediatric intensive care unit (PICU). STUDY DESIGN: Audio-recorded telephone interviews were conducted with 56 parents of 48 children. All children died in the PICU of one of six children's hospitals in the National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) 3 to 12 months before the study. RESULTS: Only seven (13%) parents had a scheduled meeting with any physician to discuss their child's death; 33 (59%) wanted to meet with their child's intensive care physician. Of these, 27 (82%) were willing to return to the hospital to meet. Topics that parents wanted to discuss included the chronology of events leading to PICU admission and death, cause of death, treatment, autopsy, genetic risk, medical documents, withdrawal of life support, ways to help others, bereavement support, and what to tell family. Parents sought reassurance and the opportunity to voice complaints and express gratitude. CONCLUSIONS: Many bereaved parents want to meet with the intensive care physician after their child's death. Parents seek to gain information and emotional support, and to give feedback about their PICU experience

%0 Journal Article
%C Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA
%A McMullan, David Michael
%A Oppido, Guido
%A Davies, Ben
%A Kawahira, Yoichi
%A Cochrane, Andrew Donald
%A d'Udekem d'Acoz, Yves
%A Penny, Daniel J
%A Brizard, Christian P
%J J Thorac Cardiovasc Surg
%D 2007 Jul
%N 1
%P 90-8
%T Surgical strategy for the bicuspid aortic valve: tricuspidization with cusp extension versus pulmonary autograft
%V 134
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17599491
%X OBJECTIVE: The congenitally bicuspid aortic valve is the most common etiologic factor associated with clinically significant aortic stenosis and/or regurgitation in pediatric patients. Beyond infancy, surgical intervention typically involves valve repair with cusp thinning and commissurotomy or valve replacement, primarily with pulmonary autograft in the current era. An aortic valve repair technique using tricuspidization with cusp extension was introduced in 1999. This study compares the midterm clinical outcome in patients undergoing valve repair by tricuspidization with cusp extension with those receiving a pulmonary autograft (Ross). METHODS: A retrospective study was performed on all consecutive patients with symptomatic bicuspid aortic valve disease who underwent tricuspidization with cusp extension or a Ross procedure between 1999 and 2005. In both groups, all patients were at least 1 year of age at time of the operation. RESULTS: During this period, 21 children (median age 12.6 years, range 2.6-18 years) underwent tricuspidization with cusp extension (TCE group) and 25 children (median age 10.2 years, range 11.5 months-20.1 years) underwent the Ross procedure. Prior balloon valvuloplasty was performed in 5 (24%) of the children in the TCE group and 16 (64%) of the children in the Ross group. Prior surgical commissurotomy was performed in 4 (19%) TCE patients and in 9 (36%) Ross patients. During a median follow-up period of 36.4 months (range 2.5 months-7.4 years), 2 (10%) patients in the TCE group required valve-preserving early revision of the repair, 2 (10%) TCE patients required subsequent aortic valve replacement at 16 and 33 months, 1 (4%) Ross patient required subsequent valve repair at 5 years, and 1 (4%) Ross patient underwent cardiac transplantation at 46 months. At 36 months, the actuarial freedom from reintervention on the aortic valve or autograft was 90% in the TCE group, with 11 patients at risk, and 100% in Ross patients, with 13 patients at risk (P = .39); the freedom from moderate valve dysfunction or reintervention was 66% for TCE patients and 95% for Ross patients (P = .07). There were no deaths, and all but 1 Ross patient remain in New York Heart Association class I. CONCLUSIONS: Reintervention rates in patients undergoing tricuspidization with cusp extension or a primary Ross procedure are similar. Valve performance in the TCE group is satisfactory at midterm follow-up, but the Ross repair appears to provide greater stability of valve function. These results suggest that repair with valve tricuspidization and cusp extension provides reliable palliation of the symptomatic bicuspid aortic valve

%0 Journal Article
%C APHP, Cardiologie Pediatrique, Hopital Necker, 75015 Paris
%A Marini, D
%A Pineau, E
%A Avenet, P-L
%A Mollet, A
%A Abadir, S
%A Bonnet, D
%A Sidi, D
%A Agnoletti, G
%A Boudjemline, Y
%J Arch Mal Coeur Vaiss
%D 2007 May
%N 5
%P 386-93
%T [Utilisation of gastric ring systems for pulmonary artery banding: an animal study.]
%V 100
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646762
%X OBJECTIVES: Pulmonary artery banding is often required as a first palliative procedure in infants with congenital heart disease and high pulmonary blood flow or to retrain the left ventricle. The purpose of the study was to demonstrate the safety of a gastric banding system as an adjustable pulmonary artery banding in chronic implantation. METHODS: Five ewes underwent implantation of the banding system around the main pulmonary artery through a left thoracotomy. All had functional evaluation with progressive occlusion and opening of the device every two weeks for a total period of three months. Invasive pressure measurements in the right ventricle and aorta were carried out each time. RESULTS: Devices could be implanted easily. Progressive occlusion and re-opening were possible in all animals during each time point. All animals survived throughout the protocol. Retrieval of the device was achieved in all animals. In one, it was challenging because of the presence of a fibrotic reaction around the device. It died because of pulmonary artery perforation before the sacrifice. At autopsy, microscopic examination showed no signs of myocardial fibrosis. CONCLUSIONS: In animals, gastric banding system is a safe and effective implantable device to adjust pulmonary artery diameter over a prolonged period of time. This new device may be a valuable alternative to the repeated conventional pulmonary artery banding needed for ventricular retraining in humans

%0 Journal Article
%C Centre de reference "Malformations cardiaques Congenitales Complexes-M3C", Universite Paris-V, Necker-Enfants Malades, AP-HP, Paris
%A Maltret, A
%A Moura, C
%A Le, Bidois J
%A Fermont, L
%A Bajolle, F
%A Stos, B
%A Azancot, A
%A Bonnet, D
%J Arch Mal Coeur Vaiss
%D 2007 May
%N 5
%P 411-415
%T [Prognosis of atrioventricular canal in euploid foetus without abnormality of atrial situs.]
%V 100
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646766
%X Atrioventricular septal defects are commonly diagnosed during fetal life. Postnatal prognosis of atrioventricular septal defects associated with trisomy 21 and with heterotaxia sequences are relatively well known. However, predicting postnatal outcome in fetus with atrioventricular septal defects and normal chromosome and normal atrial situs remains a challenge. In a series of 141 fetal atrioventricular septal defects, we analyzed 80 fetuses with normal karyotype. Twenty-seven had an abnormal atrial situs. One fetus was lost for follow-up. Finally, 52 fetuses were included in the study. Termination of pregnancy was performed in 18 cases (34%). Six fetuses died in utero (18% of ongoing pregnancies). Twenty eight infants were born alive, 2 of them were lost for follow-up right after birth and 3 live born infants died postanatally (11%). Postoperative mortality was 3/15 (20%). Complete repair was proceed for 13 infants, palliative repair for 2; and 8 infants didn't have surgery at the end of follow-up because of partial or intermediate atrioventricular septal defect. The only factor significantly associated with poor outcome was the small size of the left ventricle. Isolated atrioventricular septal defects are of poor cardiac prognosis particularly when associated with left heart obstructions

%0 Journal Article
%C R. Maia Guimaraes, President, International Association of Gerontology and Geriatrics
%A Maia Guimaraes, R
%J J Nutr Health Aging
%D 2007 Sep-Oct
%N 5
%P 419-20
%T News from the IAGG : The Virtual College of Gerontology and Geriatrics
%V 11
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17657363
%X The image we all share of a college is always full of beautiful buildings, a magnificent library and gardens. However the foundation of the Royal Academy lies in an "invisible college" of natural philosophers who began meeting in 1640 to discuss the ideas of Francis Bacon. Another remarkable invisible college was that of provincial professionals who used to meet every month in and around Birmingham, England, on the Monday nearest the full moon, when there was most light to travel home by. That was the Lunar Society, a gathering place for scientists, inventors and natural philosophers, which existed from 1765 until 1813. History tells us that many of those who travelled under the moonlight were prominent scientists such as Erasmus Darwin, botanist, grandfather of Charles; Joseph Priestley, who discovered oxygen; James Watt inventor of condensing and rotary steam engines, and William Withering, medical doctor and botanist who discovered the medical properties of foxglove (digitalis) to treat heart diseases. These meetings did not take place inside a college in Cambridge or Oxford, but rather in the English countryside. Those meetings were a rare opportunity for sharing information and to spread new ideas and technologies. An invisible college in a rural area, near the full moon! Nearly two hundred years elapsed and mankind doesn't need to wait for the light of the full moon to travel, notwithstanding the need for sharing and disseminating information remains as important as it was in the countryside around Birmingham in the XVIII century. Socialization of knowledge remains an important human value. The access to the most important libraries and scientific publications can be reached by simply touching a computer key. It is time for information and scientific publications in the field of Gerontology and Geriatrics to be collected in a web site under the romantic name of Virtual College. No buildings or gardens, just information and knowledge. A college that will be available anywhere in the world, and whose importance will be greater for those who could not sit in a library or classroom of a real college, such as the medieval University of Salamanca in Spain or a new university such as the University of Brasilia in Brazil. Gerontology is a boat searching for better winds and more experienced helmsmen. Information on ageing available in the internet is a mix of truth and lies, reality and dreams, science and charlatanism. A Google search will find more than 135,000 pages for gerovital in the web, none with scientific data related to its use as anti-aging medicine. There are more anti-aging pages than pages dedicated to gerontology and geriatrics. Scientific publications are not free from this contamination. Gerontophobia is a potent stimulant for charlatanism and scientific farce or buffoonery. The light arising from a video display should illuminate science and education in the same way moonlight did for the Lunar Society attendants. The Virtual College of Gerontology and Geriatrics (VCGG) will be integrated to the International Association of Gerontology and Geriatrics website (www.iagg.com.br). Registration will be free. The college will have 3 basic areas: a lecture room, a hall of great names and an open forum. The lecture room will offer several lectures in power point and video presentations concerning the most important themes in Gerontology and Geriatrics. We expect to get collaboration from all major names in Gerontology and Geriatrics to address the scientific areas of their expertise, and of course the IAGG standpoint on major issues like anti-age therapy, vitalism, end of life, older people in intensive care units, retirement policies, and social problems of older people. Anyone in the world will have ready access to up-to-date information in Gerontology and Geriatrics. Classes will be not too long, focusing in the fundamental and practical approach. The hall of great names intends to honour all those who have made or rather are still making important contributions to Gerontology and Geriatrics. This is a new field of science that needs to write its own history. All those working in Gerontology and Geriatrics must be aware of the contribution of Simone du Beauvoir, Marjorie Warren, Pierre Vellas, JH Sheldon, Leonard Hayflick, James Fries, Alois Alzheimer, Lucien Brull and many others. The virtual college will accept nominations made by scientific societies, universities or any institution devoted to Gerontology and Geriatrics. The open forum resembles the invisible college meetings. There will be different group discussions on several subjects. Any one can propose a theme for discussion and open a group. It is expected that the open forum can attract the main researchers in each field to exchange ideas and to help young researchers or students. The open forum will help the organizing committees of the IAGG congresses to identify themes that must be included in the scientific program and also people who should be invited to discuss them. We will stimulate the discussion of controversial themes such as compression of morbidity, prolongevity, posthumanitism versus anti-posthumanitism, and end of life. The proposition of a Virtual College is a great challenge. It requires a solid technical background and a group of enthusiastic people to organize and handle it. A Chancellor will direct the college with the help of three coordinators. Bruno Vellas, the President-elect of IAGG was appointed the Chancellor. His partners in this scientific and educational challenge will be Yves Rolland, from Toulouse, coordinator of the Lecture Room, Martha Pelaez, former Pan American Health Organization regional advisor on aging and health, coordinator of the Hall of Great Names. Toni Antonucci from the University of Michigan will be in charge of the Open Forum. The technical support will come from the IAGG Secretariat in Rio de Janeiro. In the first stage the VCGG will have the areas already mentioned, but the identification of demand for academic information will mobilize us for searching educational institutions to help us to offer academic degree courses for those who have no other way of obtaining a qualification in Gerontology and Geriatrics. A Master Degree Program is not out of our dreams. The internet can be a source of enlightenment, information and amusement. The VCGG proposes to be a real college, since we all know what remains in our lives from the time we were students are not the buildings and gardens, but the gratitude for having had the chance to learn more about life and living

%0 Journal Article
%C Current affiliations: Division of Gastroenterology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo (I.M.), Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Tokyo (H.I.), Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto (Y.M.), Japan
%A Maetani, I
%A Isayama, H
%A Mizumoto, Y
%J Gastrointest Endosc
%D 2007 Aug
%N 2
%P 355-360
%T Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study
%V 66
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17643712
%X BACKGROUND: Through-the-scope (TTS) stents facilitate palliative enteral stent placement. However, most TTS stents are braided, a characteristic that has been associated with significant foreshortening and relatively frequent migration. OBJECTIVES: To evaluate clinical experience with a new woven enteral stent in the treatment of gastric outlet obstruction. DESIGN: From January 2005 to August 2006, patients with unresectable malignant gastric outlet obstruction were offered stent placement with a new woven stent. SETTING: Three referral hospitals in Japan. PATIENTS: Thirty-seven consecutive patients with malignant gastric outlet obstruction. INTERVENTIONS: A newly designed enteral stent was placed by using the TTS placement technique. MAIN OUTCOME MEASUREMENTS: Palliation efficacy and safety of the new stents. RESULTS: Stent placement was successful in 36 of 37 patients (technical success, 97%). Thirty-four patients were able to tolerate oral intake without obstructive symptoms (clinical success, 94.4%). Complications occurred in 16.2% of patients, comprising 2 cases of primary stent dysfunction, 1 perforation, 1 GI bleeding, 1 stent obstruction, and 1 biliary stent dysfunction. No migration was seen during the median follow-up period of 68 days. LIMITATIONS: Small sample size and relatively brief follow-up. CONCLUSIONS: A newly developed enteral stent with higher flexibility and less foreshortening offers comparable clinical outcome to existing stents and a lower frequency of complications, including migration

%0 Journal Article
%C Department of Surgery, James Cook University Hospital, Middlesborough, Cleveland, UK
%A Macafee, DA
%A Whynes, DK
%A Scholefield, JH
%J Colorectal Dis
%D 2007 Jul
%T Risk-stratified intensive follow up for treated colorectal cancer - realistic and cost saving?
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17645572
%X Objective Intensive follow-up post surgery for colorectal cancer (CRC) is thought to improve long-term survival principally through the earlier detection of recurrent disease. This paper aims to calculate the additional resource and cost implications of intensive follow up post-CRC resection, examine the possibility of risk-stratifying this follow up to those at highest risk of recurrence and investigating the impact that population screening might have on the future cost and outcomes of follow up. Method Two follow-up regimens were constructed: the 'standard' follow-up protocol used the principles of the British Society of Gastroenterology (BSG) guidelines whilst the 'intensive' follow-up protocol used the most intensive arm of the follow up after colorectal surgery (FACS) trial. Using ONS data, the number of CRC diagnosed in a given year was calculated for 2003 and projected for 2016 based on the population of England and Wales. The resource requirements and costs of follow up over a 5-year period were then calculated for the two time periods. Risk stratifying entry to follow up and the introduction of population CRC screening were then considered. Results For the 2003 cohort, an intensive follow-up program would detect 853 additional resectable recurrences over 5 years with 795 fewer subjects requiring palliative care. An additional 26 302 outpatient appointments, 181 352 CEA tests and 79 695 CT scans over 5 years would be required to achieve this. The cost of investigating subjects who would never develop detectable recurrences was pound15.6 million. The cost per additional resectable recurrence was pound18 077, a figure also found for a nonscreened population in 2016. An identical intensive follow-up policy with biennial FOBT screening in 2016 saw the cost per additional resectable recurrence rise to pound36 255. Conclusion Intensive follow up will detect considerably more resectable recurrences but at considerable cost and it is unclear if such follow up will be achievable in an already over-stretched NHS. If population-based CRC screening increases the number of Dukes A cancers this may offer the possibility of risk-stratifying future follow up to those at highest risk of recurrence; minimizing tests on those who will never have recurrent disease and better utilizing our scarce resources

%0 Journal Article
%C DepartmentS of Surgery, University Hospital in Pilsen, Czech Republic
%A Liska, V
%A Holubec, L
%A Treska, V
%A Skalicky, T
%A Sutnar, A
%A Topolcan, O
%A Kormunda, S
%A Finek, J
%J Anticancer Res
%D 2007 Jul-Aug
%N 4A
%P 1887-91
%T Tumor markers as useful predictors of survival rate after exploratory laparotomy for liver malignancies
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17649789
%X BACKGROUND: Tumor markers are used for the prediction of relapse and in determining the effect of postoperative or post-oncological therapy as a standard component of follow-up. Metastatic processes of the liver and primary malignancies of the liver and gall bladder are very common in the European population. The aim of this study was to demonstrate the behaviour of malignancy in patients who have not undergone surgical therapy and to study serum levels of the monitored tumor markers in relation to the life expectancy of these patients. PATIENTS AND METHODS: The Log-rank test and Wilcoxon test were used for statistical evaluation. Survival was computed using the Kaplan-Meier method. Serum levels of the tumor markers conventionally used in clinical practice in patients with gastrointestinal tumors (CEA, CA19-9, C724) and the markers of the proliferation activity in malignancy (TK, TPA, TPS) were studied. RESULTS: One hundred and nine patients who underwent exploratory laparotomy without any surgical therapy between September 1999 and June 2005 were studied. For patients with a serum level of CEA, CA19-9 and CA72-4 that was higher than the calculated cut-off hazard ratios of early death were respectively 3-, 5- and 9-fold higher than for patients with serum levels of the same tumor markers below the calculated cut-off. Preoperative serum levels of proliferative tumor markers (TK, TPA and TPS) were not statistically significant for the prediction of early death. CONCLUSION: The results of the pilot study suggest the importance of tumor markers for the prediction of the short-term survival rate. These markers could be used to supplement classic clinical, laboratory and radiodiagnostic parameters. It would be very helpful for the planning of palliative oncological therapy for patients with liver malignancies who cannot be treated by surgical therapy

%0 Journal Article
%C Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK
%A Lee, Myeong Soo
%A Chen, Kevin W
%A Sancier, Kenneth M
%A Ernst, Edzard
%J Acta Oncol
%D 2007 
%N 6
%P 717-22
%T Qigong for cancer treatment: A systematic review of controlled clinical trials
%V 46
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653892
%X Qigong is a mind-body integrative exercise or intervention from traditional Chinese medicine used to prevent and cure ailments, to improve health and energy levels through regular practice. The aim of this systematic review is to summarize and critically evaluate the effectiveness of qigong used as a stand-alone or additional therapy in cancer care. We have searched the literature using the following databases from their respective inceptions through November 2006: MEDLINE, AMED, British Nursing Index, CINAHL, EMBASE, PsycInfo, The Cochrane Library 2006, Issue 4, four Korean Medical Databases, Qigong and Energy Medicine Database from Qigong Institute and four Chinese Databases. Randomised and non-randomised clinical trials including patients with cancer or past experience of cancer receiving single or combined qigong interventions were included. All clinical endpoints were considered. The methodological quality of the trials was assessed using the Jadad score. Nine studies met our inclusion criteria (four were randomised trials and five were non-randomised studies). Eight of these trials tested internal qigong and one trial did not reported details. The methodological quality of these studies varies greatly and was generally poor. All trials related to palliative/supportive cancer care and none to qigong as a curative treatment. Two trials suggested effectiveness in prolonging life of cancer patients and one failed to do so. We conclude that the effectiveness of qigong in cancer care is not yet supported by the evidence from rigorous clinical trials

%0 Journal Article
%C Current affiliations: Department of Internal Medicine (J.H.L., D.H.K., J.Y.K., S.M.L., D.H.K., C.W.P., H.S.C., G.H.K., T.O.K., J.H., G.A.S., M.C.), Department of Radiology (S.K., C.W.K., J.W.L.), Pusan National University College of Medicine, Busan, Korea
%A Lee, Jung Hyun
%A Kang, Dae Hwan
%A Kim, Ji Young
%A Lee, Sun Mi
%A Kim, Do Hoon
%A Park, Chan Won
%A Cho, Hwal Suk
%A Kim, Gwang Ha
%A Kim, Tae Oh
%A Heo, Jeong
%A Song, Geun Am
%A Cho, Mong
%A Kim, Suk
%A Kim, Chang Won
%A Lee, Jun Woo
%J Gastrointest Endosc
%D 2007 Aug
%N 2
%P 364-9
%T Endoscopic bilateral metal stent placement for advanced hilar cholangiocarcinoma: a pilot study of a newly designed Y stent
%V 66
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17643714
%X BACKGROUND: Although endoscopic stent placement is now generally accepted as a palliative method of treatment in unresectable hilar cholangiocarcinoma, exclusively endoscopic placement of bilateral metal stents has been considered very difficult and complex. OBJECTIVE: To evaluate the technical and clinical efficacy of endoscopic placement of dual, newly designed stents in a Y configuration. DESIGN: Prospective, uncontrolled, single center. SETTING: Tertiary referral university hospital. PATIENTS: Ten patients with unresectable hilar cholangiocarcinoma of Bismuth type II or higher. INTERVENTIONS: For bilateral metal stent placement, a biliary Y stent with central wide-open mesh was used exclusively at first. A second stent was placed into the contralateral hepatic duct through the central open mesh of the Y stent. MAIN OUTCOME MEASUREMENT: Technical success, functional success, early complications, and short-term clinical outcome. RESULTS: Technical success was achieved in 8 of 10 patients (80%). Among 8 patients in whom bilateral stents were successfully placed by endoscopy, functional success was 100%, the early complication rate was 0%, and the stent occlusion rate was 25%. The median stent patency period was 217 days. LIMITATIONS: Small number of patients, uncontrolled study, short-term follow-up period. CONCLUSIONS: We described a technique for endoscopic bilateral metal stent placement by using the newly designed Y stent for advanced hilar cholangiocarcinoma that resulted in a high success rate of 80%

%0 Journal Article
%C Department of Paediatrics, Queen Elizabeth Central Hospital, Malawi, , vicky.lavy@virgin.net
%A Lavy, Vicky
%J Palliat Med
%D 2007 Jun
%N 4
%P 333-9
%T Presenting symptoms and signs in children referred for palliative care in Malawi
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656410
%X A study of 95 children referred for palliative care was carried out at Queen Elizabeth Central Hospital in southern Malawi, to determine the prevalence of different symptoms and signs. Seventy-seven percent of the children had HIV, 17% had cancer and 6% had a variety of other diagnoses. The commonest symptoms spontaneously presented by patients and carers were pain (27%) cough (22%) and diarrhoea (18%). Pain was significantly more common among children with cancer than those with HIV/AIDS. Cough, diarrhoea and mouth sores were significantly more common in those with HIV/AIDS. Many symptoms were not volunteered initially, but were revealed on direct questioning. This uncovered that 84% had a history of weight loss, 56% had fever and 51% had mouth sores. The commonest physical signs were wasting (76%), lymphadenopathy (40%) and oral candida (40%). Forty-seven percent of children with HIV had either lost their mother or had a mother who was sick. The wide range of physical symptoms and frequency of sickness or death in the children's mothers demonstrates the need for palliative care to be holistic, addressing the manifold physical, emotional and social problems associated with chronic and terminal illness. Palliative Medicine 2007; 21 : 333-339

%0 Journal Article
%C Division of Cardiology, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
%A Kukar, Atul
%A Sherrid, Mark V
%A Ehlert, Frederick A
%J Anadolu Kardiyol Derg
%D 2006 Dec
%P 49-54
%T Pacing in obstructive hypertrophic cardiomyopathy: a therapeutic option?
%V 6 Suppl 2
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17162271
%X Hypertrophic cardiomyopathy (HCM) is a heterogeneous disease of cardiac muscle which can present with myriad functional and clinical manifestations. When symptoms and left ventricular outflow gradients are present, it is primarily treated with pharmacologic agents. For refractory patients, dual chamber pacing has been proposed; by altering timing and site of cardiac electrical activation, the hemodynamic abnormalities in HCM may be modified. Results of non-randomized and randomized trials have shown an average gradient reduction of 50%. However, pressure gradient reduction within the left ventricular outflow tract (LVOT) has not translated into improved objective functional measurements, even though subjective parameters may improve. Dual chamber pacing cannot be recommended as primary treatment for obstruction except in a subset of patients who are elderly or have significant comorbidities that preclude surgery. However, many patients will now receive implantable cardioverter-defibrillators (ICD) which will include both right atrial and right ventricular leads. This will allow DDD pacing which may be utilized for symptom palliation. Future investigations will determine if alternate forms of pacing, including left atrial or left ventricular pacing, may improve objective measures in these patients

%0 Journal Article
%C Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. krystal@phy.duke.edu
%A Krystal, Andrew
%A Fava, Maurizio
%A Rubens, Robert
%A Wessel, Thomas
%A Caron, Judy
%A Wilson, Phebe
%A Roth, Thomas
%A McCall, W Vaughn
%J J Clin Sleep Med
%D 2007 Feb
%N 1
%P 48-55
%T Evaluation of eszopiclone discontinuation after cotherapy with fluoxetine for insomnia with coexisting depression
%V 3
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17557453
%X BACKGROUND: Insomnia and major depressive disorder (MDD) may coexist. This study evaluated hypnotic discontinuation effects following an 8-week placebo-controlled study of eszopiclone/fluoxetine cotherapy in patients with insomnia and comorbid MDD. METHODS: Patients meeting DSM-IV criteria for MDD and insomnia received fluoxetine each morning for 8 weeks and were randomized to concomitant treatment with nightly eszopiclone 3 mg (cotherapy) or placebo (monotherapy). Thereafter, patients received 2 weeks of continued fluoxetine plus single-blind placebo. RESULTS: Incidence rates of central nervous system (CNS) and potentially CNS-related adverse events (AEs) during the run-out period were similar between treatment groups (8.8% with monotherapy vs 9.8% with cotherapy), and there was no evidence of benzodiazepine withdrawal AEs. Physician-assessed Clinical Global Impression improvements in depressive symptoms were maintained after eszopiclone discontinuation. Improvements in 17-item Hamilton-Depression Rating Scale (HAMD-17) scores with cotherapy versus monotherapy seen at Week 8 (p = .0004) were maintained at Week 10 (p < .0001) and significantly higher depression response and remission rates were observed after cotherapy at Week 10 (p < .02). Patients discontinued from eszopiclone maintained improvements in SL (sleep latency), WASO (wake after sleep onset), and TST (total sleep time) during the 2 weeks following discontinuation (p < .05). CONCLUSIONS: In this study, eszopiclone discontinuation did not result in significant CNS or benzodiazepine withdrawal AEs, rebound insomnia, or rebound depression; and improvements in sleep and depressive symptoms were maintained

%0 Journal Article
%C Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, CA, The Netherlands. e.j.o.kompanje@erasmusmc.nl
%A Kompanje, Erwin J O
%J Intensive Care Med
%D 2006 Dec
%N 12
%P 2067-9
%T Care for the dying in intensive care in The Netherlands
%V 32
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17058070

%0 Journal Article
%C Department of Thoracic and Cardiovascular Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. ckc@uab.edu
%A Knott-Craig, Christopher J
%A Goldberg, Steven P
%A Overholt, Edward D
%A Colvin, Edward V
%A Kirklin, James K
%J Ann Thorac Surg
%D 2007 Aug
%N 2
%P 587-92; discussion 592-3
%T Repair of neonates and young infants with Ebstein's anomaly and related disorders
%V 84
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17643640
%X BACKGROUND: Severely symptomatic neonates and young infants with Ebstein's anomaly usually die without surgical intervention. The relative risks and benefits of single-ventricle palliation versus a two-ventricle repair are uncertain. In a recent series, 69% early survival with single-ventricle palliation was reported in 16 neonates with Ebstein's anomaly. Our institutional bias has been to do a two-ventricle repair in all such patients. METHODS: We reviewed our entire surgical experience with a two-ventricle repair in the severely symptomatic neonate (n = 22) and young infant (n = 5). The indications for operation were ventilator dependence, severe cardiac failure, prostaglandin-dependent circulation, and gross cardiomegaly. RESULTS: Between 1994 and 2006, 27 consecutive patients with Ebstein's anomaly underwent operation. Associated comorbidities included anatomic or functional pulmonary atresia (n = 18), ventricular septal defects (n = 3), small left ventricle (n = 3), hypoplastic branch pulmonary arteries (n = 3), previous cardiac surgery (n = 4), significant intracranial hemorrhage (n = 3), hepatic necrosis and renal insufficiency (n = 3), and malignant tachyarrhythmias (n = 4). Operations consisted of tricuspid valve repair (n = 23) or valve replacement (n = 2), Blalock-Taussig shunt only (n = 1), and bilateral pulmonary arterioplasty with bidirectional Glenn (n = 1). Hospital survival was 74%, and there have been no late deaths during a median follow-up period of 5.4 years (range, 0.2 to 12 years). Three patients required tricuspid valve replacement during the follow-up period. Late arrhythmia requiring medication is present in 1 patient. All patients are currently in New York Heart Association functional class I. CONCLUSIONS: Two-ventricle repair currently has similar early survival compared with single-ventricle palliation. The advantages of a better physiologic repair can be anticipated for a longer follow-up period

%0 Journal Article
%C Internal Unit and Centre of Clinical and Experimental Diagnosis and Therapy, ZeTDT GmbH, Hamburg, Germany. Prof.Klapdor@t-online.de
%A Klapdor, R
%A Bahlo, M
%A Babinsky, A
%A Brenzinger, M L
%J Anticancer Res
%D 2007 Jul-Aug
%N 4A
%P 1789-94
%T Reflections on treatment strategies for palliative chemotherapy of pancreatic cancer
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17649774
%X Following our concept of efficacy-orientated sequential polychemotherapy, we report on the results of palliative chemotherapy in 69 patients suffering from exocrine pancreatic cancer, admitted to our unit in 2004. Evaluation of tumor response was mainly based on the serum courses of the tumor markers CA 19-9 and CEA; in addition, the modern imaging methods CT or MRT, including MRCP and MR-angiography, were performed bi-monthly. The median survival of the 69 patients (65% metastasized stages) was 16 months. The median survival increased with the number of effective treatment sequences, for the whole group from 5 to 10 and 23 months in relation to 0, 1 and > 1 effective sequences respectively. The results support our concept of EOSPC in pancreatic cancer patients, compared to clinical studies following protocols with only 1 treatment sequence and median survival rates of no more than 6-9 months. Compared to the efficacy-orientated sequential polychemotherapy (EOSPC) concept, which does not exclude but also allows the inclusion of clinical trials for further evaluation of new drugs or drug combinations, the common practice looking for survival in studies following protocols with only 1 treatment sequence might represent a negative predictive factor with respect to overall survival, as can be demonstrated by a comparison of our data with relevant recent literature. Our results further indicate that the interest of the clinicians and companies should not be focused only on first-line therapies, but also on 2nd- and 3rd-line strategies, as in our patients a second- and third-line therapy could be started in 73% and 68% of the patients respectively

%0 Journal Article
%C Current affiliations: Departments of Radiology (J.H.K., H.-Y.S., J.H.S., E.C.), Internal Medicine (T.W.K., H.-Y.J., G.H.L., S.K.L., M.-H.K., M.-H.R., Y.-K.K.), and Surgery (B.S.K., J.H.Y.). Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
%A Kim, JH
%A Song, HY
%A Shin, JH
%A Choi, E
%A Kim, TW
%A Jung, HY
%A Lee, GH
%A Lee, SK
%A Kim, MH
%A Ryu, MH
%A Kang, YK
%A Kim, BS
%A Yook, JH
%J Gastrointest Endosc
%D 2007 Aug
%N 2
%P 256-264
%T Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients
%V 66
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17643698
%X BACKGROUND: Metallic stents are a therapeutic option for patients with malignant GI obstruction. OBJECTIVE: Our purpose was to evaluate the clinical effectiveness of a self-expandable metallic stent in 213 patients with malignant gastroduodenal obstruction and to identify prognostic factors associated with clinical outcomes. DESIGN: Prospective cohort study. SETTING: Single tertiary referral university hospital. PATIENTS: Two hundred thirteen consecutive patients with symptomatic malignant gastric outlet or duodenal obstruction from 2001 to 2005. INTERVENTIONS: Placement of a self-expandable metallic stent. MAIN OUTCOME MEASUREMENTS: Prospective data collection focused on technical and clinical success, complications, and prognostic factors associated with stent patency. RESULTS: Technical and clinical success were achieved in 94% and 94% of the patients, respectively, and the complication rate was 21%. The median and mean survival periods were 99 (95% CI, 78-121) and 159 days (95% CI, 116-203). The median and mean stent patency periods were 270 (95% CI, 234-413) and 324 days (95% CI, 128-412). With use of the multivariate Cox proportional hazard model, chemotherapy after stent placement (odds ratio, 0.19; 95% CI, 0.08-0.46; P < .001) was significantly associated with an increase in the maintenance of stent patency. LIMITATIONS: Single-center experience and the lack of a control group. CONCLUSIONS: Placement of a self-expandable metallic stent is clinically effective in patients with unresectable gastric outlet or duodenal obstruction. Chemotherapy after stent placement, albeit associated with increased migration rates, is associated with an increase in the maintenance of stent patency

%0 Journal Article
%C Myton Hospice, Warwick, UK
%A Kay, S
%A Husbands, E
%A Antrobus, J H
%A Munday, D
%J Palliat Med
%D 2007 Jun
%N 4
%P 279-84
%T Provision for advanced pain management techniques in adult palliative care: a national survey of anaesthetic pain specialists
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656403
%X INTRODUCTION : It is estimated that 8% of cancer patients could benefit from advanced pain management techniques; some 12 000 patients per year in the UK. In 2002, Linklater et al. surveyed palliative medicine consultants to assess their access and attitude to such techniques, finding under-utilization with a lack of formal arrangements for referral. We report a survey of pain specialist anaesthetists on the same topic. METHOD : Postal questionnaire survey of lead anaesthetists in UK pain clinics. RESULTS : 106 responses were received from 170 questionnaires sent (62%). Referral rates from palliative medicine to pain clinics were low; only 31% of respondents received more than 12 per year. Joint consulting arrangements were rare, but were associated with more referrals. Only 25% of anaesthetists' job plans had time allocated for palliative medicine referrals, but where present this correlated positively with referrals received (P <0.002). Total interventions were estimated at less than 1000 per year. DISCUSSION : There is evidence of under-referral of patients for advanced pain management procedures with a lack of integrated services. Palliative Medicine 2007; 21 : 279-284

%0 Journal Article
%C Department of Cardiothoracic Surgery, Christchurch Public Hospital, Christchurch
%A Kathiravel, Yaso
%A Westwood, David
%A Macemon, Jeff
%A Singh, Harsh
%J N Z Med J
%D 2007 
%N 1257
%P U2609
%T An international surgical collaboration for the management of pulmonary artery sarcoma: a New Zealand experience
%V 120
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17632599
%X We present the case of a 73-year-old man with a pulmonary artery sarcoma successfully treated as a result of an international surgical collaboration. The tumour was initially deemed to be unresectable due to a lack of local expertise managing cardiac malignancies. Since the patient was unable to travel to a specialist centre in the United States, he was initially offered only palliative therapy. However, two surgeons with experience of treating malignant cardiac tumours travelled to New Zealand specifically to perform a potentially curative resection of his tumour. This case suggests that there should be an emphasis placed on the development of internationally acceptable protocols for the treatment of rare conditions and improved local access to overseas surgical expertise

%0 Journal Article
%C Division of Radiation Oncology, Department of Radiology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
%A Karasawa, Kumiko
%A Hirowatari, Hisako
%A Izawa, Hiromi
%A Furuya, Tomohisa
%A Takada, Takahiro
%A Ito, Kana
%A Saito, Anneyuko
%A Kurokawa, Chie
%A Ozawa, Shuichi
%J Gan To Kagaku Ryoho
%D 2007 Jun
%N 6
%P 853-7
%T [The role of radiotherapy in breast cancer]
%V 34
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17565246
%X Radiotherapy has been widely used in breast cancer in many situations. These are breast irradiation of breast conserving therapy,post mastectomy regional irradiation,irradiation for regional lymph nodes recurrence,breast irradiation of inoperable locally advanced cases,palliative irradiation of brain metastasis,bone metastasis and so on. The relationship among radiotherapy,surgery and systemic therapy has to be considered in those situations.In breast conserving therapy, the usefulness of breast irradiation is well established. Otherwise, a local controllability depend on a grade of residual tumor cell has not been understand. The authors conducted the survey of 941 cases of positive surgical margins and found that doses more than 60 Gy has a tendency for better local control in post menopausal cases. To reduce patient's burden,3 weeks short course irradiation (Canadian protocol) or accelerated partial breast irradiation have been introduced in breast irradiation. A subgroup which has no need to irradiate to conserving breast had not been identified. The timing between postoperative chemotherapy and irradiation is another point that has to be considered. To reduce distant metastasis,chemotherapy first has been considered better. As for post mastectomy regional irradiation, improvement of local and systemic control has been widely known these days. A timing of systemic therapy and irradiation is a point has to consider. In inoperable or far advanced T 4 tumors, breast irradiation with concurrent chemotherapy must be considered in stead of surgery. We have to know a big shortage in Japanese cancer treatment situation that we have few radiation oncologists or medical physicists in Japan. We have to educate those specialists to catch up with increasing cancer patients

%0 Journal Article
%C Department of Surgical Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India
%A Kapoor, Vinay K
%J J Hepatobiliary Pancreat Surg
%D 2007 
%N 4
%P 366-73
%T Advanced gallbladder cancer: Indian "middle path"
%V 14
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653634
%X Gallbladder cancer (GBC) is common in northern India. The western world has a pessimisctic attitude towards GBC resulting in inadequate management of even early GBC. At the other extreme is the Japanese aggressivism with high mortality but very few actual long-term survivors. The Indian surgeons have adopted a Buddhist "middle path" - aggressive surgical approach for "less advanced" GBC and non-surgical palliative approach for "more advanced" GBC. We rely heavily on staging laparoscopy to detect metastatic deposits on liver, peritoneum and omentum, and upper gastrointestinal endoscopy (UGIE) to detect duodenal infiltration which indicates unresectability as we do not perform pancreatico-duodenectomy for GBC. Our favoured procedure is extended cholecystectomy (EC) which includes a 2 cm nonanatomical wedge of liver in the GB bed and the lymph nodes in hepatoduodenal ligament, behind the duodenum and head of pancreas and along the hepatic artery to the right of celiac axis. EC can achieve R0 resection in patients with T1-T2 and T3 (fundus/body - hepatic bed type) disease. For T3 (neck - hepatic hilum type) and T4 disease major hepatic resection is required. In selected patients with nodally advanced GBC, a non-curative simple cholecystectomy with post-operative chemoradiotherapy may improve survival. GBC is an "Indian disease" and Indian surgeons have to be prepared to accept the "challenge" of GBC

%0 Journal Article
%C Aachen University, Aachen
%A Junger, S
%A Pestinger, M
%A Elsner, F
%A Krumm, N
%A Radbruch, L
%J Palliat Med
%D 2007 Jun
%N 4
%P 347-54
%T Criteria for successful multiprofessional cooperation in palliative care teams
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656412
%X INTRODUCTION : Team work is considered a central component of palliative care. Within this comparatively young field of medicine, the emergence of new institutions (eg, palliative care units) highlights the challenge of establishing a completely new team. METHODS : This study focuses on the factors, which enhance both the success and outcome criteria of good team work from the perception of team members in a palliative care unit. The palliative care team at the University Hospital of Aachen (n = 19) was interviewed 1 year after the unit's startup by the means of semistructured interviews. Interview texts were analysed using qualitative content analysis. RESULTS : Factors crucial to cooperation in the team members' views were close communication, team philosophy, good interpersonal relationships, high team commitment, autonomy and the ability to deal with death and dying. Moreover, close communication was by far the most frequently mentioned criteria for cooperation. Team performance, good coordination of workflow and mutual trust underpin the evaluation of efficient team work. Inefficient team work is associated with the absence of clear goals, tasks and role delegation, as well as a lack of team commitment. Conclusion : In a new team, close communication is particularly important for staff as they reorientate themselves to the dynamics of a new peer group. The results confirm the overwhelming importance of clarity, commitment and close, positive exchange among team members for succesful team work. Pallative Medicine 2007; 21: 347-354

%0 Journal Article
%C Department of Gastroenterology and Hepatology, Erasmus MC/University Medical Center Rotterdam, The Netherlands. s.jeurnink@erasmusmc.nl <s.jeurnink@erasmusmc.nl>
%A Jeurnink, Suzanne M
%A van Eijck, Casper H J
%A Steyerberg, Ewout W
%A Kuipers, Ernst J
%A Siersema, Peter D
%J BMC Gastroenterol
%D 2007 
%P 18
%T Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review
%V 7
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17559659
%X BACKGROUND: Gastrojejunostomy (GJJ) is the most commonly used palliative treatment modality for malignant gastric outlet obstruction. Recently, stent placement has been introduced as an alternative treatment. We reviewed the available literature on stent placement and GJJ for gastric outlet obstruction, with regard to medical effects and costs. METHODS: A systematic review of the literature was performed by searching PubMed for the period January 1996 and January 2006. A total of 44 publications on GJJ and stents was identified and reported results on medical effects and costs were pooled and evaluated. Results from randomized and comparative studies were used for calculating odds ratios (OR) to compare differences between the two treatment modalities. RESULTS: In 2 randomized trials, stent placement was compared with GJJ (with 27 and 18 patients in each trial). In 6 comparative studies, stent placement was compared with GJJ. Thirty-six series evaluated either stent placement or GJJ. A total of 1046 patients received a duodenal stent and 297 patients underwent GJJ. No differences between stent placement and gastrojejunostomy were found in technical success (96% vs. 100%), early and late major complications 7% vs. 6% and 18% vs. 17%, respectively) and persisting symptoms (8% vs. 9%). Initial clinical success was higher after stent placement (89% vs. 72%). Minor complications were less frequently seen after stent placement in the patient series (9% vs. 33%), however the pooled analysis showed no differences (OR: 0.75, p = 0.8). Recurrent obstructive symptoms were more common after stent placement (18% vs. 1%). Hospital stay was prolonged after GJJ compared to stent placement (13 days vs. 7 days). The mean survival was 105 days after stent placement and 164 days after GJJ. CONCLUSION: These results suggest that stent placement may be associated with more favorable results in patients with a relatively short life expectancy, while GJJ is preferable in patients with a more prolonged prognosis. The paucity of evidence from large randomized trials may however have influenced the results and therefore a trial of sufficient size is needed to determine which palliative treatment modality is optimal in (sub)groups of patients with malignant gastric outlet obstruction

%0 Journal Article
%C University of Pennsylvania, School of Medicine, Philadelphia, PA, USA. ailbawi@mail.med.upenn.edu
%A Ilbawi, Andre M
%A Spicer, Diane E
%A Bharati, Saroja
%A Cook, Andrew
%A Anderson, Robert H
%J J Thorac Cardiovasc Surg
%D 2007 Jul
%N 1
%P 99-105
%T Morphologic study of the ascending aorta and aortic arch in hypoplastic left hearts: surgical implications
%V 134
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17599493
%X OBJECTIVES: The ascending aorta and aortic arch in patients with hypoplasia of the left heart are hypoplastic as a result of diminished blood flow. In this study, the presence and degree of obstruction owing to areas of narrowing or infolding within the diminutive aorta are quantified, and their surgical significance is discussed. METHODS: Ninety-six specimens with hypoplasia of the left heart were studied and measurements were taken at specified sites to evaluate areas of narrowing. Quantitative assessments of infoldings and their contribution to obstruction of flow are made. RESULTS: Narrowing of the distal ascending aorta was found in 60 (62.5%) specimens, with a decrease in circumference of the distal ascending aorta (0.72 ± 1.06 mm) present when compared with its midpoint (P < .05). Tissue infolding at the orifice of the brachiocephalic artery and its junction with the distal ascending aorta was observed in 56 (58.3%) hearts, with major infolding in 29 (30.2%) and minor infolding in 27 (28.5%). Tissue infolding at this site correlated with a smaller ascending aorta (P < .001) but not with narrowing in the distal ascending aorta (P = .53). Ductal coarctations were detected in 77 (81.1%) specimens. Their presence correlated with a smaller diameter of the ascending aorta (P < .05), and their severity correlated with the presence of aortic and mitral valvular atresia (P < .05). CONCLUSIONS: Important areas of obstruction in the ascending aorta in patients with hypoplasia of the left heart were found, and their pathogenesis is discussed. The findings highlight the importance of incorporating the ascending aorta into the aortic reconstruction at the time of initial palliation for patients with hypoplasia of the left heart

%0 Journal Article
%C Department of Nursing Science, Maastricht University, University Hospital of Maastricht, The Netherlands
%A Huizing, Anna R
%A Berghmans, Ron L P
%A Widdershoven, Guy A M
%A Verhey, Frans R J
%J Int J Geriatr Psychiatry
%D 2006 Sep
%N 9
%P 869-75
%T Do caregivers' experiences correspond with the concerns raised in the literature? Ethical issues relating to anti-dementia drugs
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16955453
%X BACKGROUND: The use of Cholinesterase inhibitors (ChE-Is) has raised debate in the literature on the ethical issues of drug treatment in dementia patients. These issues concern the quality of life of dementia patients and the process of decision-making regarding the use of ChE-Is. We interviewed caregivers of patients with dementia, focussing on issues of quality of life and the process of decision-making regarding the use of anti-dementia drugs. AIM: The aim of this article is to explore whether the ethical concerns raised in the literature are actually in line with experiences in the daily practice of dementia care. METHODS: Qualitative data that have been collected by semi-structured interviews with 12 caregivers of patients who (had) used ChE-Is. RESULTS: The results seem to indicate that theoretical considerations should be modified in the light of the reported experiences of caregivers. For example, problematic consequences of an early diagnosis and the creation of unreasonable hope did not appear in the study. Also problems concerning the rising awareness of cognitive decline were not found. CONCLUSION: In the interest of an ongoing ethical debate on the development and use of anti-dementia drugs it is important to further specify theoretical issues and to conduct empirical research into the practice of decision making and to get more insight in the perspectives of the patients using anti-dementia medicines themselves

%0 Journal Article
%C Departments of Oncology, University Hospital and Medical Faculty Pilsen, Charles University Prague, Czech Republic. holubec@fnplzen.cz
%A Holubec, L Jr
%A Topolcan, O
%A Finek, J
%A Salvet, J
%A Svoboda, T
%A Svobodova, S
%A Mrazkova, P
%A Ludvikova, M
%J Anticancer Res
%D 2007 Jul-Aug
%N 4A
%P 1883-6
%T Dynamic monitoring of cardio-specific markers and markers of thyroid gland function in cancer patients--a pilot study
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17649788
%X BACKGROUND: With the increased effectiveness of anticancer therapy, much more attention is being paid to the monitoring of the side-effects of chemotherapy, which often constitute a limiting factor in anticancer therapy. In this pilot study, the results of our monitoring of changes in cardio-specific markers and thyroid gland parameters in patients with colorectal carcinoma in the course of adjuvant and palliative chemotherapy are presented. PATIENTS AND METHODS: A total of 42 patients with colorectal carcinoma were monitored (median age 52 years, range 34-82 years); in these patients a post-operative adjuvant or palliative chemotherapy was applied (de Gramont's or FOLFIRI regimen). In all of these patients, the cardio-specific markers brain natriuretic peptide (BNP) and troponin I were assessed, as well as markers of thyroid gland function, TSH and FT4. RESULTS: In the course of chemotherapy, more than half of the patients showed laboratory signs of coronary ischemia; in 6 of these (14%) coronary ischemia was manifested with troponin I levels above 0.3 microg/L. Twenty patients (48%) had laboratory signs of heart failure in the course of adjuvant or palliative chemotherapy. A more frequent incidence of elevated cardio-specific enzymes was observed in continual regimens than in bolus application of fluorouracil. Reduced TSH values were observed in the course of chemotherapy in 9 patients (21%), without changes in FT4 values. An increase in TSH values was observed in 4 patients (10%), again without changes in FT4 values. CONCLUSION: The pilot study demonstrated that in patients undergoing treatment for colorectal carcinoma by adjuvant or palliative chemotherapy on the basis of 5-fluorouracil, it is advisable to check for possible cardiotoxicity and simultaneously to monitor thyroid gland functions. This systematic monitoring may improve the quality of life in cancer patients

%0 Journal Article
%C St. Jude Children's Research Hospital, Memphis, Tennessee, pam.hinds@stjude.org
%A Hinds, Pamela S
%A Burghen, Elizabeth A
%A Pritchard, Michele
%J West J Nurs Res
%D 2007 Jun
%N 4
%P 448-65
%T Conducting End-of-Life Studies in Pediatric Oncology
%V 29
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17538126
%X Improving our ability to prevent or diminish suffering in dying children and adolescents and their families is dependent on the completion of high-quality pediatric end-of-life studies. The purpose of this article is to provide useful evidence-based strategies that have been used to implement and complete clinically useful pediatric end-of-life studies in oncology. The article describes specific peer-review and methodological challenges and links those to evidence-based solutions. The challenges and solutions described in this article are from eight end-of-life studies involving pediatric oncology patients. It is hoped that the solutions described here will benefit others in their efforts to implement pediatric end-of-life studies so that clinically useful findings will result and will improve the care of dying children and adolescents

%0 Journal Article
%C Department of Palliative Care, Policy and Rehabilitation, King's College London, London SE5 9RJ
%A Higginson, Irene J
%A Hall, S
%J BMJ
%D 2007 Jul
%N 7612
%P 167-8
%T Rediscovering dignity at the bedside
%V 335
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656508

%0 Journal Article
%C AdnaGen AG, D-30853 Langenhagen, Germany
%A Hauch, Siegfried
%A Zimmermann, Silke
%A Lankiewicz, Silke
%A Zieglschmid, Veit
%A Bocher, Oliver
%A Albert, Winfried Hans
%J Anticancer Res
%D 2007 May-Jun
%N 3A
%P 1337-41
%T The clinical significance of circulating tumour cells in breast cancer and colorectal cancer patients
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17593628
%X BACKGROUND: Circulating tumour cells (CTC) in the blood of cancer patients indicate disease progression. Their presence reflects a relapse or metastasising process since CTC survive only a short time in the circulation. MATERIALS AND METHODS: Test systems developed by AdnaGen have been used for the sensitive and specific analysis of CTC. RESULTS: Case reports of 2 breast cancer patients demonstrate the successful detection of CTC for therapy monitoring purposes. The disappearance of CTC reflects therapy success. The patient that responded towards therapy was characterized by the disappearance of CTC from the first therapeutic unit (TU) onwards. In contrast, CTC remained detectable in the other patient during the whole therapy pointing to only limited therapeutic efficacy and a progressive disease. Furthermore, systematic changes in the expression profile of CTC in colorectal patients at different stages of disease could be observed. Whereas EGFR was expressed in 90% of the patients with CTC during primary disease the expression level decreased to 15% in CTC of metastatic patients. On the other hand the expression of CEA was low in CTC found after primary surgery (15%) and dominant in CTC of metastatic patients (80%). CONCLUSION: The analysis of CTC is a useful tool for therapy monitoring of breast cancer and colorectal cancer patients in the adjuvant and palliative situation. The molecular profiling of CTC may be used to identify therapeutic targets such as HER2 or EGFR for personalised treatment that is likely to have an important impact on the therapeutic efficacy of drugs like Herceptin or Erbitux

%0 Journal Article
%C Dept. of Surgery, Palliative Care Team, Akita City Hospital
%A Hashizume, Takahiro
%A Tomiyasu, Shiro
%A Yomiya, Kinomi
%A Yoshimoto, Tetsusuke
%A Harada, Akiko
%A Matoba, Motohiro
%J Gan To Kagaku Ryoho
%D 2007 Jun
%N 6
%P 897-902
%T [Validity of recommended minimum dose of prior morphine to initiate transdermal fentanyl patch in prescribing information - multicenter survey of on prescriptions by palliative care specialists in Japan]
%V 34
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17570968
%X For initiating the minimum-size (0.25 microg/hour) transdermal fentanyl patch (TDF), 45 mg a day of oral morphine is the recommended minimum dose (RMD) in Japan according to the prescribing information. However, little is known about the validity of the RMD, and we can presume there are many cases where clinicians are inclined to initiate the minimum-size TDF at the early stage contrary to the RMD due to the high morbidity rate of digestive system cancer in Japan. In order to verify the validity of the RMD, we collected 71 retrospective cases where the minimum-size TDF was initiated against the restriction of RMD. The prior morphine (or equivalent doses of other opioids) was prescribed by palliative care specialists at 5 facilities which belong to Symptom Control Research Group (SCORE-G). Then, the side effects and pain control from the 1st to the 4th day were analyzed. The mean age of subjects was 68, and the main reason for initiating TDF therapy was gastrointestinal symptoms (63.4%). The frequency of side effects such as somnolence, nausea, vomiting and constipation did not show a significant correlation with the prior opioid dose.However,severe dyspnea and respiration depression were documented in two patients, and the above rate was three times higher than the nationwide result of the same side effects (0.9 8%). According to the Numeric Rating Scale (from 0: no pain to 10: the worst pain), the pain intensity decreased from 6.6 on the 1st day to 2.8 on the 2nd day, 3.3 on the 3rd day, and 2.9 (p < 0.001) on the 4th day. We conclude that, although introducing the minimum-size TDF against the RMD served to decrease the pain intensity,it raised the side effects on the respiratory system even when prescribed by palliative care specialists. Therefore,the RMD regulation is valid for general practitioners from a medical safety standpoint

%0 Journal Article
%C Department of Child and Adolescent Psychiatry, University of Rostock, Rostock, Germany. frank.haessler@med.uni-rostock.de
%A Haessler, Frank
%A Glaser, Thomas
%A Beneke, Manfred
%A Pap, Akos F
%A Bodenschatz, Ralf
%A Reis, Olaf
%J Br J Psychiatry
%D 2007 May
%P 447-8
%T Zuclopenthixol in adults with intellectual disabilities and aggressive behaviours: discontinuation study
%V 190
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17470962
%X We investigated the effects of zuclopenthixol on aggressive behaviour in patients with intellectual disabilities by randomly withdrawing it after a 6-week period of open treatment. Of the 49 patients responding to the treatment, 39 took part in a randomised withdrawal trial. The placebo subgroup (n=20) showed more aggressive behaviour as indicated by outcomes observed by external raters on the Modified Overt Aggression Scale than did the continuing subgroup (n=19). The results indicate that discontinuation of zuclopenthixolin this population leads to an increase in aggressive behaviour

%0 Journal Article
%C Georgetown University Medical Center, Washington, DC, Veterans Administration Hospital, Baltimore, MD
%A Giordano, James
%A Gomez, Carlos F
%A Harrison, Charles
%J Pain Physician
%D 2007 May
%N 3
%P 395-8
%T On the potential role for interventional pain management in palliative care
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17525775

%0 Journal Article
%C Genitourinary Oncology Service, Department of Medicine, and Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center (GAG, MJM); Department of Medicine, Joan and Sanford E. Weill College of Medicine of Cornell University (GAG, MJM), New York, New York
%A Gignac, GA
%A Morris, MJ
%A Hussain, M
%J J Urol
%D 2007 Jul
%T Castration Resistant, Taxane Naive Metastatic Prostate Cancer: Current Clinical Approaches and Future Directions
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17644121
%X PURPOSE: With the wide use of prostate specific antigen to detect response and disease progression resistance to androgen deprivation is being detected at an increasingly earlier stage. We focused on the current management and novel investigational strategies for the chemonaive patient population with castration resistant metastatic disease. MATERIALS AND METHODS: We reviewed standard and investigational hormonal, chemotherapeutic, biological and immune based strategies for patients with castration resistant metastatic prostate cancer who have not yet received taxane based chemotherapy. RESULTS: Our understanding of the natural history of this group of patients is evolving. A variety of standard and experimental treatment options are available for this group of patients. Manipulating the androgen receptor signaling axis, targeting antiapoptotic pathways, using antiangiogenic strategies, harnessing the immune system and optimizing docetaxel based regimens and novel cytotoxic agents are under investigation. CONCLUSIONS: Multiple agents currently under development offer a promise of palliation and prolongation of survival above and beyond that of docetaxel. In the absence of guidance from randomized trials with regard to chemotherapy timing, and considering the modest effects of docetaxel on survival, decisions regarding choice of therapy (standard chemotherapy or experimental therapies) must be based on careful consideration of the functional status of each individual, presence of symptoms, comorbidities and overall therapeutic objectives

%0 Journal Article
%C Division of General Medicine and Primary Care at Brigham and Women's Hospital, Boston, USA
%A Gazelle, Gail
%J N Engl J Med
%D 2007 Jul
%N 4
%P 321-4
%T Understanding hospice--an underutilized option for life's final chapter
%V 357
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17652645

%0 Journal Article
%C Department of Evaluation & Rehabilitation, Shoham Geriatric Medical Center, Pardes Hana, Israel. dorong@shoham.health.gov.il
%A Garfinkel, Doron
%A Zur-Gil, Sarah
%A Ben-Israel, Joshua
%J Isr Med Assoc J
%D 2007 Jun
%N 6
%P 430-4
%T The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people
%V 9
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17642388
%X BACKGROUND: The extent of medical and financial problems of polypharmacy in the elderly is disturbing, particularly in nursing homes and nursing departments. OBJECTIVES: To improve drug therapy and minimize drug intake in nursing departments. METHODS: We introduced a geriatric-palliative approach and methodology to combat the problem of polypharmacy. The study group comprised 119 disabled patients in six geriatric nursing departments; the control group included 71 patients of comparable age, gender and co-morbidities in the same wards. After 12 months, we assessed whether any change in medications affected the death rate, referrals to acute care facility, and costs. RESULTS: A total of 332 different drugs were discontinued in 119 patients (average of 2.8 drugs per patient) and was not associated with significant adverse effects. The overall rate of drug discontinuation failure was 18% of all patients and 10% of all drugs. The 1 year mortality rate was 45% in the control group but only 21% in the study group (P < 0.001, chi-square test). The patients' annual referral rate to acute care facilities was 30% in the control group but only 11.8% in the study group (P < 0.002). The intervention was associated with a substantial decrease in the cost of drugs. CONCLUSIONS: Application of the geriatric-palliative methodology in the disabled elderly enables simultaneous discontinuation of several medications and yields a number of benefits: reduction in mortality rates and referrals to acute care facilities, lower costs, and improved quality of living

%0 Journal Article
%C Division of Gastrointestinal Oncology & Digestive Endoscopy, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577 Japan. nofuse@east.ncc.go.jp
%A Fuse, Nozomu
%A Doi, Toshihiko
%A Ohtsu, Atsushi
%A Takeuchi, Satoshi
%A Kojima, Takashi
%A Taku, Keisei
%A Tahara, Makoto
%A Muto, Manabu
%A Asaka, Masahiro
%A Yoshida, Shigeaki
%J Jpn J Clin Oncol
%D 2007 Jun
%N 6
%P 434-9
%T Feasibility of Oxaliplatin and Infusional Fluorouracil/Leucovorin (FOLFOX4) for Japanese Patients with Unresectable Metastatic Colorectal Cancer
%V 37
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656481
%X BACKGROUND: A combination of oxaliplatin and infusional fluorouracil/leucovorin (FOLFOX4) is one of the standard regimens for palliative and adjuvant chemotherapy for colorectal cancer. However, the feasibility of FOLFOX4 for Japanese patients has not been determined. We conducted this prospective study to evaluate the feasibility of FOLFOX4. METHODS: Previously treated or untreated patients with unresectable metastatic colorectal cancer were enrolled. The primary endpoint was the rate of completion which was defined as completion of the first 4 cycles with relative dose-intensity of oxaliplatin of 80% or higher. RESULTS: Of the 32 enrolled patients, 31 received FOLFOX4. Twenty-four patients (75%) had received prior chemotherapy. The rate of completion of the first four cycles was 87% (27/31; 95% CI, 70.2-96.4%). With the median number of cycles of nine (range, 1-26), grade 3 or 4 hematological toxicity and non-hematological toxicity were seen in 12 (39%) and 5 (16%) patients, respectively. Grade 1 or 2 sensory neuropathy was seen in 28 patients (90%), but no grade 3 or 4 neuropathy was seen. Grade 1 or 2 allergic reaction was seen in five patients (16%). One patient developed fatal interstitial pneumonitis and died of respiratory failure. Objective response rate was 28.6% (6/21; 95% CI, 11.3-52.2%) in the patients with measurable lesions. Median progression-free survival was 6.5 months (95% CI, 4.6-8.5 months) in all patients. CONCLUSIONS: The completion rate of the first four cycles was as high as expected with manageable toxicity, although fatal pneumonitis developed in one case. FOLFOX4 is feasible for Japanese patients

%0 Journal Article
%C Nursing Research and Development, Belfast City Hospital, Belfast, BT9 7AB. Donna.fitzsimons@bch.n
%A Fitzsimons, D
%A Mullan, D
%A Wilson, J S
%A Conway, B
%A Corcoran, B
%A Dempster, M
%A Gamble, J
%A Stewart, C
%A Rafferty, S
%A McMahon, M
%A Macmahon, J
%A Mulholland, P
%A Stockdale, P
%A Chew, E
%A Hanna, L
%A Brown, J
%A Ferguson, G
%A Fogarty, D
%J Palliat Med
%D 2007 Jun
%N 4
%P 313-22
%T The challenge of patients' unmet palliative care needs in the final stages of chronic illness
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656408
%X BACKGROUND : There is consensus in the literature that the end of life care for patients with chronic illness is suboptimal, but research on the specific needs of this population is limited. AIM : This study aimed to use a mixed methodology and case study approach to explore the palliative care needs of patients with a non-cancer diagnosis from the perspectives of the patient, their significant other and the clinical team responsible for their care. Patients (n = 18) had a diagnosis of either end-stage heart failure, renal failure or respiratory disease. METHODS : The Short Form 36 and Hospital and Anxiety and Depression Questionnaire were completed by all patients. Unstructured interviews were (n = 35) were conducted separately with each patient and then their significant other. These were followed by a focus group discussion (n = 18) with the multiprofessional clinical team. Quantitative data were analysed using simple descriptive statistics and simple descriptive statistics. All qualitative data were taped, transcribed and analysed using Colaizzi's approach to qualitative analysis. FINDINGS : Deteriorating health status was the central theme derived from this analysis. It led to decreased independence, social isolation and family burden. These problems were mitigated by the limited resources at the individual's disposal and the availability of support from hospital and community services. Generally resources and support were perceived as lacking. All participants in this study expressed concerns regarding the patients' future and some patients described feelings of depression or acceptance of the inevitability of imminent death. CONCLUSION : Patients dying from chronic illness in this study had many concerns and unmet clinical needs. Care teams were frustrated by the lack of resources available to them and admitted they were ill-equipped to provide for the individual's holistic needs. Some clinicians described difficulty in talking openly with the patient and family regarding the palliative nature of their treatment. An earlier and more effective implementation of the palliative care approach is necessary if the needs of patients in the final stages of chronic illness are to be adequately addressed. Palliative Medicine 2007; 21 : 313-322

%0 Journal Article
%C School of Health Science, University of Wales Swansea, Swansea, UK
%A Fitzsimmons, Deborah
%J J Clin Nurs
%D 2007 Aug
%N 8
%P 1583-4
%T Commentary on Jocham HR et al. (2006) Quality of life in palliative care cancer patients: a literature review. Journal of Clinical Nursing 15, 1188-1195
%V 16
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17655548

%0 Journal Article
%C Nordic School of Public Health (NHV), Gothenburg, Sweden. soctf@kalundborg.dk
%A Fisker, Tove
%A Strandmark, Margaretha
%J Scand J Caring Sci
%D 2007 Jun
%N 2
%P 274-81
%T Experiences of surviving spouse of terminally ill spouse: a phenomenological study of an altruistic perspective
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17559447
%X The aim of the study was to illuminate the experiences of surviving relatives in connection with their care at home of terminally ill, dying spouses, followed by an outline of the need for palliative assistance by the district nurse. Qualitative interviews with eight surviving relatives have been analysed on the basis of the phenomenological method. The essence of these phenomena was the loving promise to the terminally ill and dying spouse in which the shared grief, structural disintegration and powerlessness, lifelines and supporters and viable grief appeared. This promise consisted of that dying spouse will be able to stay at home during the illness and his or her desire to die at home. It was given during uncomfortable hospitalization and springing from the spouse's desire for autonomy and integrity at the end of his or her life. In keeping the promise, the surviving spouse became altruistic, neglecting his or her own primary needs in the unselfish fulfilment of the needs of the terminally ill spouse. The surviving spouse grieved in lonely isolation characterized by stress and an ethical dilemma in connection with breaching the promise. Light was shed on the professional palliative care with the surviving spouse's lacking verbalization of grief and powerlessness, regardless of whether expert professional palliation or insufficient professional palliation was provided. In that way the findings of the study showed the necessity for professional involvement in the decision concerning palliation at home, including identification of the resources of the primary caregiver

%0 Journal Article
%C Radiation Oncology Unit, Department of Medical and Surgical Sciences, University of Turin, Ospedale S. Giovanni Battista, Torino, Italy
%A Filippi, AR
%A Franco, P
%A Marinone, C
%A Tarella, C
%A Ricardi, U
%J Am J Hematol
%D 2007 Jul
%T Treatment options in skeletal localizations of hairy cell leukemia: A systematic review on the role of radiation therapy
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17654508
%X Skeletal localizations are a rare complication in hairy cell leukaemia patients, with an extimated incidence of 3%. These lesions, mainly osteolytic, can occur at various sites and are almost always symptomatic. Localized radiation therapy (RT) has been extensively used as effective palliative treatment in such cases, with different total doses and fractionation schedules. In this article, a systematic review of all reported cases with osseous complications is presented, to underline the role of RT and to define the most appropriate approach in this subset of patients. Am. J. Hematol., 2007. (c) 2007 Wiley-Liss, Inc

%0 Journal Article
%A Dyer, Owen
%J BMJ
%D 2007 Jul
%N 7610
%P 67
%T Doctor cleared of act "tantamount to euthanasia"
%V 335
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17626938

%0 Journal Article
%A Dyer, Clare
%J BMJ
%D 2007 Jul
%N 7611
%P 119
%T Judge will not intervene as dying woman denied life support
%V 335
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17641332

%0 Journal Article
%C Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull, HU 3 2J2, UK
%A Drew, Philip
%A Posnett, John
%A Rusling, Louise
%J Int Wound J
%D 2007 Jun
%N 2
%P 149-55
%T The cost of wound care for a local population in England
%V 4
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17651229
%X The objective of this study is to estimate the cost of wound care in a local population of approximately 590 000 using results from a wound care audit carried out in Hull and the East Riding of Yorkshire as a basis. Full results of the audit will be published separately. An audit in June 2005 provided information on patients with wounds and on their treatment. This was combined with representative National Health Service unit costs to produce an estimate of the total cost of wound care in 2005-2006. In all, 1644 patients had a total of 2300 wounds (1.44 per patient). Most (74.1%) were treated in the community by district nurses, 21.2% were treated in hospital and 4.8% were treated in residential or hospice care. More than one in four hospital inpatients (26.8%) had a wound. Median duration was 6-12 weeks. Twenty-four per cent had their wound for 6 months or more, and almost 16% of patients had remained unhealed for a year or longer. One in eight wounds (12.8%) were reported as showing signs of infection. The estimated cost of wound care in 2005-2006 was pound15 million to pound18 million ( pound2.5 million to pound3.1 million per 100 000 population). Caring for patients with wounds required the equivalent of 88.5 full-time nurses and up to 87 hospital beds. Wounds are a significant source of cost to patients as well as the health care system. The most important determinant of cost appears to be wound complications which require hospitalisation or which delay hospital discharge. Reducing costs requires a systematic focus on effective and timely diagnosis, on ensuring treatment is appropriate to the cause and condition of the wound and on active measures to prevent complications and wound-related hospitalisation. These results should be generalisable to other similar populations in the UK and elsewhere

%0 Journal Article
%C Centre Livet, Hopital de la Croix Rousse, Hospices Civils de Lyon, 8, rue de Margnolles, 69300 Caluire
%A Dojcinovic, S
%A Ait Si Selmi, T
%A Servien, E
%A Verdonk, P C M
%A Neyret, P
%J Rev Chir Orthop Reparatrice Appar Mot
%D 2007 Jun
%N 4
%P 364-72
%T [A comparison of all-polyethylene and metal-backed tibial components in total knee arthroplasty.]
%V 93
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646818
%X PURPOSE OF THE STUDY: The purpose of our study was to compare the clinical, functional and radiological results of two types of tibial components for the same total knee prosthesis (posterior stabilized HLS), all-polyethylene (group A) and metal-backed (group B), in order to answer the following question: does use of an all-polyethylene piece affect mid-term outcome of total knee arthroplasty (TKA)?MATERIAL AND METHODS: This was a retrospective comparative analysis of a single-center non-randomized consecutive series of 169 patients with an all-polyethylene posterior stabilized cemented gliding TKA. This series was matched with another retrospective series of 169 posterior stabilized cemented TKA with a metal-backed tibial piece. Matching factors were age, gender, etiology, and follow-up. The two series were extracted from our database which included all patients who underwent surgery for a TKA in the same institution (Lyon Civil Hospices) performed by one of the authors (PN) or under his responsibility between 1987 and 1996 for group A (all-poly) and between 1987 and 1997 for group B (metal-backed). Mean follow-up was 66 months. The IKS scores and radiological findings were recorded.RESULTS: In group A, 96% of patients were satisfied, 93% in group B. The IKS knee score for group A was 89 ± 10.8 and 88.3 ± 11.9 for group B. The function score was 68 ± 23.7 in group A and 71 ± 24 in group B. Mean flexion was 113 degrees for both groups. Non-progressive lucent lines were noted in 27 cases in group A and 23 in group B. Revision TKA was performed for 18 knees in group A, including six with implant replacement (three of them for infection). In group B, there were ten revisions, seven with implant replacement including one with infection and three without implant replacement. The 10-year survival was 94.5% in group A and 93.64% in group B. There was no significant difference in the function and knee scores, the presence of lucent lines, and the number of implant replacements between group A and group B (p>0.05).DISCUSSION: This study was unable to demonstrate any superiority in clinical and radiological results for TKA between the all-polyethylene and metal-backed options at five years follow-up

%0 Journal Article
%C Center for Eating Disorders Ursula, P.O. Box 422, 2260 AK Leidschendam, The Netherlands
%A Dingemans, AE
%A Spinhoven, P
%A van, Furth EF
%J Behav Res Ther
%D 2007 Jun
%T Predictors and mediators of treatment outcome in patients with binge eating disorder
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17643390
%X A randomized controlled trial (N=52) was conducted comparing cognitive-behavioral therapy with a waiting list control group to identify mediators and predictors of treatment outcome. Reduction of weight concerns mediated abstinence of binge eating at post-treatment. Abstinence was marginally mediated by changes in eating and shape concerns, depressive symptoms and global severity of general psychopathology. Neither treatment outcome nor status at 1-year follow-up could be predicted by severity of eating disorder, comorbid psychopathology or maladaptive core beliefs at baseline or at post-treatment. The only predictor for abstinence at both post-treatment and 1-year follow-up was the coping style palliative reacting: higher scores predicted less favorable outcomes. Lower expression of emotions at post-treatment predicted more reduction of eating disorder psychopathology at follow-up. No other patient characteristics allowing treatment-patient matching could be identified

%0 Journal Article
%C Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
%A Dev, R
%A Del, Fabbro E
%A Bruera, E
%J Cancer
%D 2007 Jul
%T Association between megestrol acetate treatment and symptomatic adrenal insufficiency with hypogonadism in male patients with cancer
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17647248
%X Patients with advanced cancer may develop cachexia, which is often treated with megestrol acetate (MA). In addition to thromboembolic disease, MA may cause symptomatic suppression of the hypothalamic pituitary adrenal axis. In male patients with cancer, treatment with MA may also suppress the gonadal axis, resulting in symptomatic androgen deficiency. Three cases are presented to highlight the symptomatic burden of adrenal insufficiency and hypogonadism. Clinicians need an increased awareness of the complication of adrenal insufficiency secondary to MA treatment and a low threshold to test for adrenal and gonadal dysfunction in symptomatic male patients with advanced cancer. Cancer 2007. (c) 2007 American Cancer Society

%0 Journal Article
%C End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
%A De Gendt, Cindy
%A Bilsen, Johan
%A Vander Stichele, Robert
%A Van Den Noortgate, Nele
%A Lambert, Margareta
%A Deliens, Luc
%J J Adv Nurs
%D 2007 Feb
%N 4
%P 404-9
%T Nurses' involvement in 'do not resuscitate' decisions on acute elder care wards
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17291204
%X Aim. This paper reports the involvement of nurses in 'do not resuscitate' decision-making on acute elder care wards and their adherence to such decisions in the case of an actual cardiopulmonary arrest. Background. Previous literature showed that nurses are involved in half or less than half of 'do not resuscitate' decisions in hospitals, but their involvement in this decision-making on acute elder care wards in particular has not been investigated. Method. A questionnaire was sent in 2002 to the head nurses of all acute elder care wards in Flanders, Belgium (n = 94). They were asked whether nurses had been involved in the last 'do not resuscitate' decision-making process on their ward and whether nurses 'never', 'rarely', 'sometimes', 'often' or 'always' started resuscitation in case of cardiopulmonary arrest of patients with 'do not resuscitate' status and of those without. Results. The response rate was 86.2% (n = 81). In 74.7% of the last 'do not resuscitate' decisions on acute elder care wards in Flanders, a nurse was involved in the decision-making process. For patients with 'do not resuscitate' status, 54.3% of respondents reported that cardiopulmonary resuscitation was 'never' started on their ward, 'rarely' on 39.5% and 'sometimes' on 6.2%. For patients without 'do not resuscitate' status, nurses started cardiopulmonary resuscitation 'rarely' or 'sometimes' on 22.2% of all wards, and 'often' or 'always' on 77.8%. Conclusion. To make appropriate 'do not resuscitate' decisions and to avoid rash decision-making in cases of actual cardiopulmonary arrest, nurses should be involved early in 'do not resuscitate' decision-making. If institutional 'do not resuscitate' guidelines were to stress more clearly the important role of nurses in all kinds of end-of-life decisions, this might improve the 'do not resuscitate' decision-making process

%0 Journal Article
%C Department of Palliative Care and Rehabilitation Medicine, M. D. Anderson Cancer Center, Houston, TX
%A Curry, Eardie A 3rd
%A Palla, Shana
%A Hung, Frank
%A Arbuckle, Rebecca
%A Bruera, Eduardo
%J Am J Health Syst Pharm
%D 2007 Aug
%N 15
%P 1619-25
%T Prescribing patterns and purchasing costs of long-acting opioids over nine years at an academic oncology hospital
%V 64
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646565
%X PURPOSE: The prescribing patterns and purchasing costs of long-acting opioids over nine years at an academic oncology hospital were studied. METHODS: Data were collected for doses of transdermal fentanyl, methadone (all routes of administration), and oral sustained-release morphine and oxycodone dispensed for individual inpatient use for the month of October for each year between 1996 and 2004. The dates included in the retrieval were selected to document long-acting opioid use before and after the establishment of the palliative care and rehabilitation medicine department. For each opioid the number of milligrams dispensed daily per patient was determined and converted into a morphine-equivalent daily dose (MEDD). The average wholesale price per dosing unit of each drug during each period studied was obtained from internal databases. Costs were calculated by multiplying the number of units dispensed by the average wholesale price per unit and then normalized to 1996 U.S. dollars. The mean aggregate cost for a single MEDD in a month was determined by multiplying the mean cost per MEDD for each agent by that agent's percent contribution to the total MEDDs dispensed in that month. RESULTS: Long-acting opioid and methadone usage increased from 1996 to 2004. Between 1996 and 2004, the mean cost of a single MEDD dropped from $0.0738 to $0.0330. During the study period, the median daily cost to treat one patient dropped from $5.96 to $2.80. CONCLUSION: Long-acting opioid use increased and cost per MEDD decreased at an academic oncology hospital between 1996 and 2004. The decreased cost of purchasing opioids was attributed to the increased proportional use of methadone

%0 Journal Article
%C Department of Chemistry, University of Pretoria, Pretoria, 0002, South Africa
%A Cukrowski, I
%A Popovic, L
%A Barnard, W
%A Paul, SO
%A van, Rooyen PH
%A Liles, DC
%J Bone
%D 2007 Jun
%T Modeling and spectroscopic studies of bisphosphonate-bone interactions. The Raman, NMR and crystallographic investigations of Ca-HEDP complexes
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17644459
%X Raman spectroscopy was used to study the interactions of bovine bone, hydroxyapatite (HA, as a model of bone) and calcium hydrogen phosphate (CaHPO(4)) with 1-hydroxyethylidene-1,1-diphosphonic acid, CH(3)C(OH)(PO(3)H(2))(2) (HEDP, the oldest known member in the class of bisphosphonates (BPs) that is commonly used as (i) a reference compound for BP activity, a scale of a BP's potency, and (ii) a pain palliative agent). Raman spectra with diminished background fluorescence were obtained using a visible laser line of 514.5 nm. The Raman spectra of the products from the reaction of HEDP with bone, HA and CaHPO(4) could be considered virtually identical. This strongly suggests that CaHPO(4) forms first from the reaction of bone or HA with HEDP (which also acts as a strong acid), upon which free Ca(2+) ions become available for complexation reactions with HEDP. Two complexes were observed using Raman spectroscopy for each of the interactions of HEDP studied here. This shows that HA can be substituted for bone in studies concerned with the interaction of bone with chemical compounds. Also, Raman spectroscopy can be utilized to distinguish between different complexes formed at the solid/solution interface. One of the two complexes has been further characterized using Nuclear Magnetic Resonance (NMR) spectroscopy, as well as single crystal and powder X-ray diffraction (XRD). This complex has been found to be calcium dihydrogen ethane-1-hydroxy-1,1-diphosphonate dihydrate (Ca(CH(3)C(OH)(PO(3)H)(2)).2H(2)O). Molecular modeling of this calcium complex using Gaussian03 software confirmed the assignments of the Raman vibrational bands

%0 Journal Article
%C University Department of Surgery, Royal Infirmary, Glasgow, UK
%A Crumley, AB
%A Stuart, RC
%A McKernan, M
%A McDonald, AC
%A McMillan, DC
%J J Gastroenterol Hepatol
%D 2007 Jul
%T Comparison of an inflammation-based prognostic score (GPS) with performance status (ECOG-ps) in patients receiving palliative chemotherapy for gastroesophageal cancer
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17645468
%X Aim: The aim of the present study was to compare an inflammation-based prognostic score (Glasgow Prognostic Score, GPS) with performance status (ECOG-ps) in patients receiving platinum-based chemotherapy for palliation of gastroesophageal cancer. Methods: Sixty-five patients presenting with gastroesophageal carcinoma to the Royal Infirmary, Glasgow between January 1999 and December 2005 and who received palliative chemotherapy or chemo-radiotherapy were studied. ECOG-ps, C-reactive protein, and albumin were recorded at diagnosis. Patients with both an elevated C-reactive protein (>10 mg/L) and hypoalbuminemia (<35 g/L) were allocated a GPS of 2. Patients in whom only one of these biochemical abnormalities was present were allocated a GPS of 1 and patients with a normal C-reactive protein and albumin were allocated a score of 0. Toxicity was recorded using the Common Toxicity Criteria. Results: The minimum follow up was 14 months. During the follow-up period, 59 (91%) of the patients died. On univariate and multivariate survival analysis, only the GPS (hazard ratios 1.65, 95% CI 1.10-2.47, P < 0.05) was a significant independent predictor of cancer survival. In addition, in comparison with patients with GPS of 0, those patients with a GPS of 1 or 2 required more frequent chemotherapy dose reduction (P < 0.05), were less likely to exhibit a clinical response to treatment (P < 0.05), and had shorter survival (P < 0.05). Conclusion: The presence of a systemic inflammatory response, as evidenced by the GPS, appears to be superior to the subjective assessment of performance status (ECOG-ps) in predicting the response to platinum-based chemotherapy in patients with advanced gastroesophageal cancer

%0 Journal Article
%A Crossman, Michael W
%J J Pediatr
%D 2007 Jul
%N 1
%P 4-5
%T For whom the bell tolls...
%V 151
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17586180

%0 Journal Article
%C Department of Neurosurgery, King's College Hospital, London, UK. matthewcrocker@blueyonder.co.uk
%A Crocker, Matthew
%A Chitnavis, Bhupal
%J Br J Neurosurg
%D 2007 Feb
%N 1
%P 28-31
%T Total thoracic vertebrectomy with anterior and posterior column reconstruction via single posterior approach
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17453771
%X We present two cases of vertebral body tumours presenting with neurological compromise treated with posterior approach vertebrectomy and three-column reconstruction using in situ expandable cage and pedicle screw reconstruction. One was performed in a staged procedure, the second as a single procedure. This approach avoids the requirement, and associated comorbidity, of combined anterior and posterior approaches. Although previously described as appropriate to minimize comorbidity in patients with metastatic spinal disease, we believe this strategy should be considered in any patient requiring three-column resection and stabilization in the thoracic spine

%0 Journal Article
%C North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK
%A Connors, Sonia
%A Graham, Sheila
%A Peel, Tim
%J Palliat Med
%D 2007 Jun
%N 4
%P 285-7
%T An evaluation of a physiotherapy led non-pharmacological breathlessness programme for patients with intrathoracic malignancy
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656404
%X The outcomes of the first 4 years of a physiotherapy led non-pharmacological breathlessness management programme for patients with intrathoracic malignancy are described. Of the 169 patients enrolling, only 14 completed the full 4-week programme. All reported improvements in some parameters measured though these did not reach statistical significance. These patients tended to be fitter, had longer median survival and the mechanism of their breathlessness was not progressive cancer. The 155 patients who did not complete the programme had a short median survival (95 days), and tended to have cancer related breathlessness. Of these, 131 were seen, 85 receiving part of the programme, 15 needing other services and 31 started but died during the programme. Objective post intervention scores could not be made in this group, but anecdotal quotes suggested benefit. In a group whose natural history is a relentless deterioration over a period of months, pre- and post-intervention symptom scoring is difficult to achieve. It is suggested that a qualitative approach might be more sensitive at identifying which aspects of the service are most appropriate. Palliative Medicine 2007; 21: 285-287

%0 Journal Article
%C Hematology Department, Hospices Civils de Lyon and Claude Bernard University, Pierre-Benite, France. bertrand.coiffier@chu-lyon.fr
%A Coiffier, B
%J Oncogene
%D 2007 May
%N 25
%P 3603-13
%T Rituximab therapy in malignant lymphoma
%V 26
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17530014
%X Rituximab is the first monoclonal antibody to have been registered for the treatment of B-cell lymphomas. Randomized studies have demonstrated its activity in follicular lymphoma (FL), mantle cell lymphoma and diffuse large B-cell lymphoma (DLBCL) in untreated or relapsing patients. Non-comparative studies have shown an activity in all other lymphomas. Because of its high activity and low toxicity ratio, rituximab has transformed the outcome of patients with B-cell lymphoma. A combination of rituximab plus chemotherapy, rituximab+cyclophosphamide+doxorubicin+vincristine+prednisolone (R-CHOP), has the highest efficacy ever described with any chemotherapy in DLBCL and FL. Some patients are refractory to rituximab but the precise mechanisms of this refractoriness are not understood

%0 Journal Article
%C Services des Maladies de l'Appareil digestif; Valenciennes
%A Coevoet, Hugues
%A Woelffle, Didier
%A Quinton, Jean Francois
%A Hector, Eacute Ric
%A Bonniere, Xavier
%A Boruchowicz, Arnaud
%J Gastroenterol Clin Biol
%D 2007 Jun
%N 6-7
%P 624-6
%T [Distal pancreatectomy for rectal metastatic adenocarcinoma 6 years after proctectomy.]
%V 31
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646794
%X We report the case of a 77 year old man treated with a distal pancreatectomy for rectal metastatic cancer. Diagnosis was made based on increased CEA levels following excision of the rectal tumor discovered during treatment follow up of liver and pulmonary metastases. Eight months after pancreatectomy the patient was asymptomatic and CEA levels were normal. Pancreatic resection for metastatic colonic adenocarcinoma of the pancreas may be considered in selected patients without extrapancreatic disease. Long-term survival or good palliation may be achieved after surgery

%0 Journal Article
%C University of Oxford and Cape Town Child Welfare
%A Cluver, L
%A Gardner, F
%J AIDS Care
%D 2007 Mar
%N 3
%P 318-25
%T Risk and protective factors for psychological well-being of children orphaned by AIDS in Cape Town: a qualitative study of children and caregivers' perspectives
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17453564
%X By 2020, an estimated 2.3 million South African children will be orphaned by HIV/AIDS (Actuarial Society of South Africa, 2005), but little is known about risk and protective factors for their emotional and behavioural well-being. This qualitative study explores perspectives of affected families. Orphaned children (n = 60), caregivers of orphaned children (n = 42) and social care professionals (n = 20) completed semi-structured interviews and focus groups. Participants were recruited from schools, shelters and welfare services. Findings from multiple sources indicate potential risk and protective factors in a range of dimensions, including bereavement, family functioning, social support, poverty, access to education and perceived stigma. Many factors reflected international literature on children experiencing similar stressors (e.g. non HIV/AIDS-related bereavement). However, this study also identified factors which may be specific to this group, notably stigma, abuse and peer factors. Current research is quantitatively testing associations between these identified factors and psychological outcomes

%0 Journal Article
%C Aged Services Learning & Research Collaboration, Southern Cross University, Coffs Harbour, NSW 2450, Australia. colleen.cartwright@scu.edu.au
%A Cartwright, Colleen
%A Onwuteaka-Philipsen, Bregje D
%A Williams, Gail
%A Faisst, Karin
%A Mortier, Freddy
%A Nilstun, Tore
%A Norup, Michael
%A van der Heide, Agnes
%A Miccinesi, Guido
%J Palliat Med
%D 2007 Jun
%N 4
%P 295-303
%T Physician discussions with terminally ill patients: a cross-national comparison
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656406
%X A major issue in the care of terminally ill patients is communication and information provision. This paper reports the extent to which physicians in Australia, Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland discuss topics relevant to end of life care with terminally ill patients and their relatives (without first informing the patient), and possible associations between physician-specific characteristics and such discussions. Response rates to the postal survey ranged from 39% to 68% (n =10139). Physicians in most of the countries except Italy ;in principle, always' discuss issues related to terminal illness with their patients but not with patients' relatives without first informing the patient, unless the relatives ask. Cross-national differences remained strong after controlling for physician characteristics. The majority of physicians appeared to support the principle of patient-centred care to terminally ill patients, consistent with palliative care philosophy and with the law and/or professional guidelines in most of the countries studied. Palliative Medicine 2007; 21: 295-303

%0 Journal Article
%C Department of Otolaryngology, Head and Neck Surgery, Sudharzkrankenhaus Nordhausen, Nordhausen, Germany. jens.buentzel@shk-ndh.de
%A Buntzel, Jens
%A Bruns, Frank
%A Glatzel, Michael
%A Garayev, Asadulla
%A Mucke, Ralph
%A Kisters, Klaus
%A Schafer, Ulrich
%A Schonekaes, Klaus
%A Micke, Oliver
%J Anticancer Res
%D 2007 Jul-Aug
%N 4A
%P 1941-3
%T Zinc concentrations in serum during head and neck cancer progression
%V 27
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17649800
%X Reduced serum-zinc concentrations are well known as typical laboratory characteristics in advanced head and neck cancer. Our aim was to follow the development of this phenomenon during the disease. PATIENTS AND METHODS: A total of 21 patients were included in this pilot-study (1 female, 20 male). The median age was 64 years, range 43-80 years. The following tumour localizations were registered: 11 larynx, 4 oropharynx, 2 hypopharynx and 4 other. Serum zinc levels were registered at baseline and during the follow-up investigations using flame atomic absorption spectrometry. RESULTS: The median follow-up time was 17 months, range 6-43 months. During the follow-up, 9/21 patients died tumour-dependently, 2 patients were living with cancer, 8 patients showed NED, and a further 2 patients died of non-cancer related causes. The zinc concentration decreased from 0.76 mmol/l (0.48-1.07 mmol/l) to 0.55 mmol/l (0.32-1.01 mmol/l). Nine of 11 patients with cancer developed extremely low serum zinc concentration 4-6 weeks before dying. CONCLUSION: The serum zinc concentration may be a marker for definitive palliative situations in head and neck cancer patients

%0 Journal Article
%C kbuha@maltanet.net
%A Buhagiar, Kurt
%A Cassar, Joseph
%J Turk Psikiyatri Derg
%D 2007 Summer
%N 2
%P 179-83
%T [Methylphenidate augmentation of fluvoxamine for treatment-resistant depression: a case report and review literature]
%V 18
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17566884
%X Methylphenidate and other psychostimulants have received substantial attention for the management of depression in patients with medical co-morbidities as well as for the symptomatic palliation of various neuropsychiatric disorders. Despite having been of little use in the first-line treatment of depressive disorders, some evidence does suggest that they may be of potential benefit as an antidepressant augmentation strategy in patients who fail to respond to stand-alone antidepressant regimens. However, such claims appear to be based entirely on case reports and to date, no appropriate placebo-controlled studies have been carried out on healthy young subjects. We report a case of a woman with refractory depression who successfully responded to methylphenidate augmentation of fluvoxamine. Her clinical picture was dominated by significant biological symptoms, which included apathy, anergia, increased appetite, and somnolence, with marked secondary functional impairment. Several antidepressant treatment modalities were attempted, including electroconvulsive therapy, with little improvement in her symptomatology. Augmentation of fluvoxamine with methylphenidate ultimately brought about a rapid and sustained complete remission of her depression. We will highlight how methylphenidate and other psychostimulants, when used with caution and an appreciation of their potential risk for abuse, may prove to be remarkably effective agents for antidepressant augmentation, including that of partially-effective or ineffective selective serotonin re-uptake inhibitors. Evidence for such use of methylphenidate unfortunately remains largely empirical and adequate placebo-controlled studies are therefore required to support or refute this claim

%0 Journal Article
%C St Columba's Hospice, Edinburgh, UK. dbrown@stcolumbashospice.org.uk
%A Brown, D J F
%A Milroy, R
%A Preston, T
%A McMillan, D C
%J J Clin Pathol
%D 2007 Jun
%N 6
%P 705-8
%T The relationship between an inflammation-based prognostic score (Glasgow Prognostic Score) and changes in serum biochemical variables in patients with advanced lung and gastrointestinal cancer
%V 60
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16644880
%X BACKGROUND: The Glasgow Prognostic Score (GPS), an inflammation-based prognostic score formed from standard thresholds of C reactive protein (CRP) and albumin, has prognostic value in patients with advanced cancer. Little is known about the general biochemical disturbance associated with the systemic inflammatory response in cancer. AIM: To examine the relationship between the GPS and blood biochemistry in patients with advanced lung and gastrointestinal cancer. METHODS: The GPS (albumin <35 g/l = 1 and CRP >10 mg/l = 1 combined to form a prognostic score of 0 (normal) and 1 or 2 (abnormal)) and a variety of biochemical variables were examined in patients (n = 50) with advanced lung or gastrointestinal cancer and in a healthy control group (n = 13). RESULTS: The GPS was normal in all the controls, but abnormal in 78% of the cancer group. Serum levels of sodium, chloride, creatine kinase, zinc and vitamin D were lower in the cancer group (all p<0.01), whereas levels of calcium, copper (both p<0.05), alkaline phosphatase, gamma-glutamyl transferase (both p<0.001) and lactate dehydrogenase (p<0.10) were raised. In the patient group, with increasing GPS, there was a median reduction in Karnofsky Performance Status (25%), haemoglobin (22%), sodium (3%), zinc (15%) and survival (93%, all p<0.05) and a median increase in white cell count (129%), alkaline phosphatase (217%), gamma-glutamyl transferase (371%) and lactate dehydrogenase (130%, all p<0.05). CRP levels were strongly and similarly correlated with alkaline phosphatase and gamma-glutamyl transferase, accounting for more than 25% of the variation in their activities. CONCLUSION: Several correlations were seen between biochemical variables and increasing GPS. In particular, chronic activation of the systemic inflammatory response in cancer was associated with increase in gamma-glutamyl transferase and alkaline phosphatase activity in patients with advanced lung and gastrointestinal cancer

%0 Journal Article
%C Karolinska Pharmacy, Karolinska University Hospital, Danderyd Hospital, Stockholm, Sweden
%A Bremberg, Eva R
%A Rotstein, Samuel
%A Eksborg, Staffan
%J Acta Oncol
%D 2007 
%N 6
%P 735-40
%T Treatment modifications of antineoplastic drugs in an oncology day-care unit
%V 46
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653894
%X The frequency of and reasons for treatment modifications related to prescriptions of antineoplastic drugs and to what extent the modifications are performed in accordance with the local treatment protocol were studied at an oncology day-care unit. Ninety-three patients were treated with antineoplastic drugs at the unit during the study period. Their diagnosis included mainly breast- and gastrointestinal tumours. Thirty-eight treatment modifications in relation to the treatment protocol were observed in 31 of 93 patients (33%). Twenty-five of 31 patients were treated with palliative intention (81%). Two treatment modifications of 38 (5%) were in accordance and 21 modifications (55%) were not in accordance with the local treatment protocol. It was not possible to verify whether the remaining 15 modifications (39%) were according to the protocol. Adverse effects were the most common reason specified in the medical file for treatment modification (8 patients; 26%). The reasons for treatment modification were only documented in the medical file for 11 of 31 patients (35%) and only present on the prescription card delivered to the local pharmacy for one of 31 patients (3%). Drug interactions were not considered according to the medical files for any of the 93 patients who were treated at the unit during the study days, and accordingly, no treatment modifications had been performed due to drug interactions. Liver and/or renal function tests were missing in the medical file for four patients treated with drugs for which these tests are crucial. More emphasis should be put on identifying clinically relevant drug interactions between antineoplastic drugs and the patient's regular drugs and also on specifying the reason for modifications in the medical file and on the prescription cards delivered to the local pharmacy. Increased quality assurance of the local treatment protocols is warranted

%0 Journal Article
%C Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Texas 75390-9063, USA. Daniel.Bowers@utsouthwestern.edu
%A Bowers, Daniel C
%A Gargan, Lynn
%A Weprin, Bradley E
%A Mulne, Arlynn F
%A Elterman, Roy D
%A Munoz, Louis
%A Giller, Cole A
%A Winick, Naomi J
%J J Neurosurg
%D 2007 Jul
%N 1 Suppl
%P 5-10
%T Impact of site of tumor recurrence upon survival for children with recurrent or progressive medulloblastoma
%V 107
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17644914
%X OBJECT: The object of this study was to identify prognostic factors for survival among children with recurrent medulloblastoma. METHODS: Postprogression survival and patient, tumor, and treatment factors were examined in 46 cases of recurrent medulloblastoma (mean age of patients at diagnosis 6.5 years, mean age at progression 8.4 years). Differences were calculated by Kaplan-Meier log-rank analysis. Multivariate analysis was performed using the Cox proportional hazard model. RESULTS: The probability of 5-year survival was 26.3%. Forty-one patients received salvage therapy and five patients received hospice care only. Log-rank analysis showed an association between prolonged patient survival and recurrence limited to the primary site (p = 0.008), initial therapy including the Pediatric Oncology Group (POG) regimen for the treatment of brain tumors in infants ("Baby POG;" p = 0.037), and treatment with radiation therapy (RT) following initial progression (p = 0.015). Cox regression analysis showed a significant association between prolonged survival and only one variable--tumor recurrence restricted to the primary site (p = 0.037). There was no significant association between prolonged survival and any other variables, including patient sex, age at progression, interval from tumor diagnosis to progression, initial tumor stage, and salvage treatment with chemotherapy. Subgroup analysis revealed that site of tumor progression was also prognostic for survival among the subgroup of patients older than 3 years of age at diagnosis who were initially treated with RT and chemotherapy (p = 0.017, log-rank test). CONCLUSIONS: Some children with recurrent medulloblastoma will be long-term survivors, and certain features are associated with likelihood of survival. Patients whose tumors recur at only the primary tumor site have an increased chance of prolonged survival

%0 Journal Article
%C University of Limpopo. South Africa
%A Blignaut, E
%J AIDS Care
%D 2007 Apr
%N 4
%P 532-8
%T Oral health needs of HIV/AIDS orphans in Gauteng, South Africa
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17453594
%X To care for HIV/AIDS orphans will put health and social services in South Africa before a major challenge. Published clinical information on South and Southern African HIV-positive children is limited to hospitalized children. A cross-sectional, prospective study was conducted on a convenience sample of HIV-positive children, living in orphanages in Gauteng, South Africa, in order to determine the oral health needs of the children. Five homes for abandoned/orphaned HIV/AIDS children were visited, 11 caregivers, excluding the nursing sisters (registered nurses), were interviewed to determine their knowledge regarding oral health. An oral examination was performed on 87 children who were not receiving antiretroviral treatment. The caregivers were knowledgeable regarding pseudomembranous candidiasis but all lacked knowledge on oral hygiene procedures and the cariogenic potential of a baby bottle. The mean age of the children ranged between 3.2 and 7 years, with one home having children older than 11 years. Rampant early childhood caries in 19 (21.8%) children was the major finding, with 5 children suffering severe pain from multiple carious teeth. In the hospice section of the homes all 12 children had clinically detectable candidiasis, while in 4 (33.3%) there was an associated bleeding and ulceration of the oral mucosa, impairing their ability to eat. The findings indicate a training need among caregivers regarding the oral health of children and a role for health professionals in preventing oral diseases and reducing suffering

%0 Journal Article
%C mcbishop@unmc.edu
%A Bishop, Marion
%J JAMA
%D 2007 Jul
%N 3
%P 266-8
%T A piece of my mind. Life math
%V 298
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17635878

%0 Journal Article
%C Cecil G. Sheps Center for Health Services Research; Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill; and Department of Geriatrics, Duke University, Durham, North Carolina, USA
%A Biola, Holly
%A Sloane, Philip D
%A Williams, Christianna S
%A Daaleman, Timothy P
%A Williams, Sharon W
%A Zimmerman, Sheryl
%J J Am Geriatr Soc
%D 2007 Jun
%N 6
%P 846-56
%T Physician communication with family caregivers of long-term care residents at the end of life
%V 55
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17537084
%X OBJECTIVES: To assess family perceptions of communication between physicians and family caregivers of individuals who spent their last month of life in long-term care (LTC) and to identify associations between characteristics of the family caregiver, LTC resident, facility, and physician care with these perceptions. DESIGN: Retrospective study of family caregivers of persons who died in LTC. SETTING: Thirty-one nursing homes (NHs) and 94 residential care/assisted living (RC/AL) facilities. PARTICIPANTS: One family caregiver for each of 440 LTC residents who died (response rate 66.0%) was interviewed 6 weeks to 6 months after the death. MEASUREMENTS: Demographic and facility characteristics and seven items rating the perception of family caregivers regarding physician-family caregiver communication at the end of life, aggregated into a summary scale, Family Perception of Physician-Family caregiver Communication (FPPFC) (Cronbach alpha=0.96). RESULTS: Almost half of respondents disagreed that they were kept informed (39.9%), received information about what to expect (49.8%), or understood the doctor (43.1%); the mean FPPFC score (1.73 on a scale from 0 to 3) was slightly above neutral. Linear mixed models showed that family caregivers reporting better FPPFC scores were more likely to have met the physician face to face and to have understood that death was imminent. Daughters and daughters-in-law tended to report poorer communication than other relatives, as did family caregivers of persons who died in NHs than of those who died in RC/AL facilities. CONCLUSION: Efforts to improve physician communication with families of LTC residents may be promoted using face-to-face meetings between the physician and family caregivers, explanation of the patient's prognosis, and timely conveyance of information about health status changes, especially when a patient is actively dying

%0 Journal Article
%C Palliative Care Research Group, University Hospital of Freiburg, Freiburg i. Br., Germany
%A Becker, Gerhild
%A Momm, Felix
%A Gigl, Annemarie
%A Wagner, Brigitte
%A Baumgartner, Johann
%J Wien Klin Wochenschr
%D 2007 
%N 3-4
%P 112-6
%T Competency and educational needs in palliative care
%V 119
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17347860
%X PURPOSE: To explore general practitioners' (GPs') and nurses' self assessment of professional education, competency and educational needs in palliative care. METHODS: All 897 registered GPs and all 933 registered home care nurses in the Province of Styria/Austria were sent postal questionnaires to evaluate their professional training in (i) pain control and symptom management, (ii) handling psychosocial needs and (iii) ability to cope with work-related distress. RESULTS: 61.8% of 546 evaluable respondents felt not at all or not sufficiently prepared for palliative care by their professional education (GPs: 70%, nurses: 50.4%). GPs rated the competency of their professional guild significantly higher and their educational needs significantly lower than nurses (p<0.01). Both, GPs and nurses emphasised a great need for education in the area of neuropsychiatric symptom management. CONCLUSION: Our results provide a detailed analysis of needs and may help to target goals for training seminars in palliative care

%0 Journal Article
%C Service de cardiologie pediatrique, Hopital Necker Enfants Malades 149 rue de Sevres 75743 Paris cedex 15
%A Basquin, A
%A Sidi, D
%A Boudjemline, Y
%J Arch Mal Coeur Vaiss
%D 2007 May
%N 5
%P 474-7
%T [Percutaneous closure of veno-venous fistulae after total cavopulmonary derivation: a case report.]
%V 100
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17646778
%X The authors report the case of a boy with a complex congenital heart malformation with a dextro-isomerism or Ivemark's syndrome. After several palliative procedures, a total cavopulmonary derivation was performed at the age of 11 years with implantation of a fenestrated tube between the inferior vena cava and the right pulmonary artery. The fenestration was closed two years later. At about 15 years of age, progressive systemic desaturation was observed; cardiac catheterisation with angiography showed a large number of intra-hepatic veno-venous collaterals draining into a large left suprahepatic vein which drained into the right atrium connected to the systemic ventricle. The largest fistula was embolised with a 20 mm Amplatzer Duct Occluder and two others with 14x12 and 10x8 Amplatzer Duct Occluders. The saturation rose from 75% to 94%. After 6 months' follow-up, the child is asymptomatic and the systemic saturation is 90%

%0 Journal Article
%C Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
%A Averill, Alyssa J
%A Kasarskis, Edward J
%A Segerstrom, Suzanne C
%J Amyotroph Lateral Scler
%D 2007 Aug
%N 4
%P 243-54
%T Psychological health in patients with amyotrophic lateral sclerosis
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653923
%X Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease with no known effective treatment or cure. Clinicians often expect that ALS patients will experience depression following the diagnosis because ALS is a terminal disease. The objective of the current study was to examine the evidence from the literature on psychological health in ALS patients in order to determine the prevalence and severity of depression in this population. Twenty-eight studies of ALS patients, conducted over the past 20 years, were reviewed and evaluated. The cumulative evidence suggests that clinically significant depression is neither as prevalent nor as severe as might be expected. Methodological limitations that are inherent to the measurement of depression in ALS, including the lack of appropriate instruments, small sample sizes, and reliance on cross-sectional data, have contributed to the wide range of reported results. We conclude that ALS patients are more likely to present with hopelessness and end-of-life concerns than clinically significant depression. It is important to assess a broad range of potential psychological distress early in the course of ALS, rather than focus specifically on depression, because the manner in which patients cope with their disease can affect their longevity

%0 Journal Article
%C Department of Oncology, Central Hospital of Satakunta, Sairaalantie 3, Fin 28500 Pori, Finland. raija.asola@satshp.fi
%A Asola, R
%A Huhtala, H
%A Holli, K
%J Breast Cancer Res Treat
%D 2006 Nov
%N 1
%P 77-82
%T Intensity of diagnostic and treatment activities during the end of life of patients with advanced breast cancer
%V 100
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=16758120
%X The aim of this study was to assess the intensity of diagnostic testing and cancer treatment of 335 women with advanced breast cancer during their last 6 months before death between 1995 and 1998 in the Pirkanmaa and Satakunta health care districts and to compare it to the practice in earlier decades, the 1970s and 1980s. Data for 1990s material were collected from medical records in 30-day periods starting from the patient's death backwards. In this material 46.9% of all laboratory tests and 40% of radiological tests during the last 6 months of life were made during the last 2 months prior to death. In the last month 63.9% of patients continued on endocrine therapy and 19.7% on chemotherapy. Patient symptoms and deterioration in general condition showed the appropriate point to discontinue cancer-related treatment and concentrate on palliation of symptoms to be about 2 months prior to death. Resources devoted to diagnostic investigations and treatment of cancer in terminally ill patients could be better used for their care. This would be more likely to improve patients' quality of life and save resources

%0 Journal Article
%C Department of Health Sciences and The Vardal Institute, The Swedish Institute For Health Sciences, Lund University, SE-221 00 Lund, Sweden. Magdalena.Andersson@med.lu.se
%A Andersson, Magdalena
%A Hallberg, Ingalill R
%A Edberg, Anna-Karin
%J Aging Clin Exp Res
%D 2007 Jun
%N 3
%P 228-39
%T Health care consumption and place of death among old people with public home care or in special accommodation in their last year of life
%V 19
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17607092
%X BACKGROUND AND AIMS: Developing care for older people in the last phase of life requires knowledge about the type and extent of care and factors associated with the place of death. The aim of this study was to examine age, living conditions, dependency, care and service among old people during their last year of life, but also their place of death and factors predicting it. METHODS: The sample (n=1198) was drawn from the care and services part of the Swedish National Study on Ageing and Care (SNAC). Criteria for inclusion were being 75+ years, dying in 2001-2004, and having public care and services at home or in special accommodation. RESULTS: In the last year of life, 82% of persons living at home and 51% living in special accommodation were hospitalized; median stays were 10 and 6.7 days respectively. Those living at home were younger and less dependent in ADL than those living in special accommodation. Those living at home and those having several hospital stays more often died in hospital. In the total sample, more visits to physicians in outpatient care predicted dying in hospital, whereas living in special accommodation and PADL dependency predicted dying outside hospital. CONCLUSIONS: Old people in their last year of life consumed a considerable amount of both municipal care and outpatient and in-hospital medical care, especially those living at home, which in several cases ended with death in hospital

%0 Journal Article
%C Department of Neurology, Umea University Hospital, Umea, Sweden
%A Andersen, Peter Munch
%A Borasio, Gian Domenico
%A Dengler, Reinhard
%A Hardiman, Orla
%A Kollewe, Katja
%A Leigh, Peter Nigel
%A Pradat, Pierre-Francois
%A Silani, Vincenzo
%A Tomik, Barbara
%J Amyotroph Lateral Scler
%D 2007 Aug
%N 4
%P 195-213
%T Good practice in the management of amyotrophic lateral sclerosis: Clinical guidelines. An evidence-based review with good practice points. EALSC Working Group
%V 8
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17653917
%X The evidence base for diagnosis and management of ALS is still weak, and curative therapy is lacking. Nonetheless, early diagnosis and symptomatic therapy can profoundly influence care and quality of life of the patient and relatives, and may increase survival time. This review addresses the current optimal clinical approach to ALS. The literature search is complete to December 2006. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. We conclude that a diagnosis of ALS can be achieved by early examination by an experienced neurologist. The patient should be informed of the diagnosis by the consultant. Following diagnosis, a multi-diciplinary care team should support the patient and relatives. Medication with riluzole should be initiated as early as possible. PEG is associated with improved nutrition and should be inserted early. The operation is hazardous in patients with VC <50%: RIG may be a better alternative. Non-invasive positive pressure ventilation improves survival and quality of life but is underused in Europe. Maintaining the patient's ability to communicate is essential. During the course of the disease, every effort should be made to maintain patient autonomy. Advance directives for palliative end of life care are important and should be discussed early with the patient and relatives if they so wish

%0 Journal Article
%C Department of Surgery and Pathology, Institute of Medical Sciences, Banaras Hindu University Varanasi-221 005, India
%A Agarwal, S
%A Khanna, R
%A Arya, N C
%A Khanna, A K
%J Indian J Dermatol Venereol Leprol
%D 2002 Sep-Oct
%N 5
%P 290-1
%T Malignant eccrine spiradenoma: An unusual presentation
%V 68
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656974
%X An unusual case of a 60-year-woman with a progressively increasing painless, ulcerated plaque-like lesion in her right groin is described. The lesion was associated with multiple satellite nodules involving the right thigh with massive lymphoedema oft he involved limb. Histology established the diagnosis of an eccrine spiradenoma with malignant transformation in a satellite nodule. Wide surgical excision was not possible and the patient was subjected to palliative radiotherapy

%0 Journal Article
%C The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, DK-2400 Copenhagen NV, Denmark. map01@bbh.hosp.dk
%A Aa Petersen, Morten
%A Pedersen, Lise
%A Groenvold, Mogens
%J Palliat Med
%D 2007 Jun
%N 4
%P 289-94
%T Does the agreement of patient and physician assessments of health related quality of life in palliative care depend on patient characteristics?
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656405
%X OBJECTIVE: Using physician assessments of patients' health related quality of life may improve the feasibility of studies in palliative care. However, poor agreement between patients and physicians has been found. We investigated whether subgroups of patients with good agreement existed. Study design and setting: Patient and physician assessments of twelve European Organisation for Research and Treatment of Cancer Quality of Life Care Questionnaire 30 domains were obtained once a week for up to 13 weeks. The association between agreement and patient characteristics at the first assessment (n = 115) was investigated using multivariate logistic regression. Significant associations were verified using the follow-up time-points combined (total n = 263). RESULTS : Significant associations between patient characteristics and agreement were found for most domains. However, few subgroups had good agreement. The evaluations on follow-up data did not confirm the findings of subgroups with good agreement. CONCLUSION: Based on our findings physician assessments cannot be recommended as a substitute for patient self-assessment for any subgroups of palliative care patients. Palliative Medicine 2007; 21: 289-294

%0 Journal Article
%J Palliat Med
%D 2007 Jun
%N 4
%P 356-8
%T Can the use of videos of people who have had a positive experience of hospice help patients to make decisions about admission? Pilot study
%V 21
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17656414

%0 Journal Article
%J Zh Vyssh Nerv Deiat Im I P Pavlova
%D 2007 May-Jun
%N 3
%P 373-9
%T [Recognition of emotions by facial and verbal samples in healthy humans and patients with local brain pathology]
%V 57
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17642380
%X The efficiency of emotion recognition by verbal and facial samples was tested in 81 persons (25 healthy subjects and 56 patients with focal pathology of premotor and temporal areas of brain hemispheres). The involvement of some cortical structures in the recognition of the basic emotional states (joy, anger, grief, and fear) and the neutral state was compared. It was shown that the damage to both right and left hemispheres impaired the recognition of emotional states by not only facial but also verbal samples. Damage to the right premotor area and to the left temporal area impaired the efficiency of the emotion recognition by both kinds of samples to the highest degree

%0 Journal Article
%J Heart Advis
%D 2007 Jun
%N 6
%P 4-5
%T "Stop!" say the experts about antioxidant supplements. New research shows that antioxidant supplements may not only be ineffective--they also may be dangerous. Learn how to protect your heart and limit your risks
%V 10
%W http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&dopt=abstract&list_uids=17654794