Caring for elderly patients who have paranoia

Caring for patients with paranoia presents unique challenges. As increasing numbers of potentially paranoid patients are treated, radiologic technologists must understand techniques that increase patient trust and decrease suspiciousness. Understanding the perceived vulnerability of patients with paranoia and implementing appropriate strategies facilitate trust and are key to providing quality care.

[Prognostic significance of apoptosis inducers/inhibitors in stomach carcinoma with/without adjuvant intraoperative radiotherapy (IORT)]

Several studies have tried to improve the surgical results after resection for gastric cancer by different adjuvant therapy protocols, including intraoperative radiotherapy (IORT). Since 1990 we have performed a randomized, prospective trial comparing surgery alone and surgery plus adjuvant IORT to evaluate the role of adjuvant intraoperative radiotherapy in the treatment of curative resected gastric carcinomas. In the present study, p53, bcl-2 immunoreactivity and DNA fragmentation as a typical marker of apoptosis were determined to investigate the predictive value of apoptosis-related factors and the observed response to radiotherapy. Preliminary data indicate that patients with tumors containing increased numbers of apoptotic tumor cells might derive benefit from adjuvant IORT.

FAS/FAE: impact on children

Alcohol is a teratogen and it can cause lasting birth defects called Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE). FAS is one of the leading causes of mental retardation. FAS/FAE can result in a myriad of behavioral, learning and developmental problems. There are estimates of 12,000 new cases of FAS yearly. The school nurse plays an important advocacy and educational role in helping the child with FAS. Family involvement is important for the child with FAS.

Oscillatory corticothalamic response to somatosensory input

We construct a model of the thalamocortical feedback loop using the Random Neural Network model to provide a theoretical explanation for cortical and thalamic damped rapid (circa 60-100 Hz) oscillations which have been observed in lightly anesthesized rats with somatosensory input Nicolelis (1997). Experimental data corroborates the choice of model parameter settings. Model predictions indicate that positive feedback loops and large signaling delays within cortex significantly determine the oscillatory phenomenon and its duration (i.e. its decay), while positive feedback from cortex to thalamus is needed to exhibit oscillations in thalamus.

[Risk factors and pathogenic microorganisms in patients with insufficient esophagojejunostomy after gastrectomy]

It was the aim of the study to find by retrospective analysis of data from totally gastrectomized patients risk factors for the development of esophago-jejunal anastomotic leakage, that may be avoidable or influenced therapeutically.

PATIENTS AND METHODS

The study design was retrospective involving 838 patients with total gastrectomy for gastric cancer from the years 1973-1993. In 134 cases leakage of the esophago-jejunostomy occurred. The relative risk for the development of leakage associated with individual parameters was determined by comparing the data from 704 patients without leakage to the data from 134 patients presenting with this complication. For a subgroup of 86 patients with anastomotic leakage microbiological data of swabs taken from the anastomoses were available, which were evaluated with respect to potentially pathogenic bacilli.

RESULTS

The overall leakage rate of esophago-jejunal anastomoses was 15.9% (n = 134). The mortality rate during this time period amounted to 14.3%. Leakage was a most highly significant factor for mortality (p = 0.0001). Significant risk factors for leakage of the esophago-jejunostomy were tumors of the cardia, splenectomy, a duration of operating time of more than 5 hours and manual suture technique compared to stapler anastomoses. Tumor unrelated associated disease, tumor stage and a history of other preexisting gastric diseases were not associated with an increased relative risk. At the time of the initial clinical manifestation of leakage the following pathogenic bacilli could be isolated from leaking anastomoses with decreasing incidence: E. coli, S. aureus, Proteus mirabilis, Pseudomonas aeruginosa, Klebsiella pneumoniae a.o. The bacterial spectrum has not changed during the observation period of 20 years.

SUMMARY

With the exception of the choice of suture techniques the identified clinical risk factors cannot be avoided or influenced therapeutically due to a lack of potentially curative treatment alternatives. In contrast potentially pathogenic bacilli associated with leakage can be prevented from coming in contact with anastomoses thereby preventing infection and leakage.

Prognostic value of preoperative serum levels of CEA, CA 19-9 and CA 72-4 in gastric carcinoma

We studied the relevance of CEA, CA 19-9, CA 72-4 and the common classical prognostic factors (age, sex, tumor infiltration, N-classification, staging, grading and Lauren classification) in gastric carcinoma.

PATIENTS AND METHODS

Survival function estimates were calculated according the method to Kaplan-Meier. The patients were separated into two groups according to preoperative marker levels. Fixing specificity at 100% for healthy people, cut off levels were calculated. Survival curve differences were assessed using the log-rank-test. Multivariate Cox proportional hazards regression analysis was performed. The mantel-Haenszel method was used to assess the 2-year survival rate of patients with gastric carcinoma and high versus low levels of tumor-associated antigens adjusted to tumor stages. The study was performed on the frozen sera (stored at -80 degrees C) of 103 patients with histologically proven gastric carcinoma.

RESULTS

The tumor stage (log-rank chi-square = 55.9; P < 0.0001) represents the best prognostic factor besides preoperative values of CA 19-9 (log-rank chi-square = 13.9; P < 0.001) and CEA (log-rank chi-square = 12.2; P < 0.001). CA 72.4 shows a log-rank chi-square of 6.9 (P < 0.01). We found no statistically significant correlation between survival and sex, tumor grade and Lauren classification. The importance of different parameters in providing additional prognostic information was evaluated by multivariate analysis. Only patients after curative surgical intervention (n = 55, R0) were considered. Cox proportional hazards regression analysis yielded an adjusted relative risk of 2.4 in patients with a preoperative CEA concentrations > or = 4 ng/mL vs. < 4 ng/mL, of 2.8 in patients with a preoperative CA 19-9 concentration > or = 60 U/mL vs. < CA 19-9 and of 1.8 for stage III/IV vs. stage I/II (P < 0.05). For CEA the 2-year survival rates in the group of patients with preoperative serum concentrations > or = 4 ng/mL versus < 4 ng/mL and stadium III/IV were 14% versus 29% and in stadium I/II 50% versus 83% (P < 0.05). For CA 19-9 the 2-years survival rates in the group of patients with preoperative serum concentrations > or = 60 U/mL versus < 60 U/mL and stadium III/IV were 14% versus 28% and in stadium I/II 40% versus 83% (P < 0.05).

CONCLUSION

The postoperative R-classification and the tumor stage represent the best prognostic information besides the preoperative values of CA 19-9 or CEA, respectively. The predictive information provided by preoperative CEA and CA 19-9 serum levels is additional to that obtained from other factors investigated.

[Adjuvant intraoperative radiotherapy of stomach carcinoma]

In order to evaluate the role of adjuvant IORT in the treatment of resectable gastric carcinoma, we carried out a randomized trial comparing surgery and surgery+adjuvant IORT. The study included 115 patients within a 74-month period, 51 of them received a single application of 28 Gy to the celiac axis. Patients were comparable with regard to age, sex, tumor stage and operative morbidity. The difference in mean survival time (IORT: 26.9 months vs. non-IORT, 30.8 months) and tumor-related death in the long-term course (mean follow-up period 29.2 months) with 29.4% (15/51) in the IORT-treated patients vs. 31.2% (20/64) in non-irradiated patients did not reach significance.