Orchidectomy following failure of antiandrogen monotherapy in patients with metastatic prostate cancer

OBJECTIVE

Patients with metastatic prostate cancer who are initially treated by oral antiandrogens and then have progressive disease may be offered surgical castration as a second-line treatment. Twenty-eight such patients were reviewed to determine the outcome in terms of secondary PSA response, symptomatic relief and disease-specific survival.

MATERIALS AND METHODS

Retrospective chart-based review of patients undergoing bilateral scrotal orchidectomy after failure of antiandrogen monotherapy.

RESULTS

Patients who had a >50% reduction in PSA at 12 weeks' postorchidectomy had significantly greater duration of PSA response and disease-specific survival. 64% of patients who had bone pain prior to orchidectomy had some relief of symptoms postoperatively. No prognostic indicators of improved survival were identified.

CONCLUSION

Orchidectomy as a secondary hormonal treatment following relapse on antiandrogens does produce a response in terms of PSA level and symptoms in some patients.

The advanced pedi-bag program: a hospital-EMS partnership to implement prehospital training, equipment, and protocols

OBJECTIVE

The Advanced Pedi-Bag Program is a partnership between a trauma center and a county-wide EMS agency (LCEMS) with three major goals: 1) train all LCEMS paramedics in the American Heart Association's Pediatric Advanced Life Support (PALS), 2) stock each Life Squad with a specific bag containing the equipment necessary to treat both basic and advanced pediatric emergencies, and 3) develop treatment protocols for pediatric patients.

DESIGN

Descriptive study.

SETTING

LCEMS serves a population of 450,000. Pediatric runs account for 800 to 1,200 LCEMS runs per year.

RESULTS

The LCEMS Medical Director established and facilitated mandatory PALS training of 180 paramedics. A committee of emergency/pediatric/trauma professionals developed and distributed 40 bags with a comprehensive inventory of basic and advanced pediatric supplies and equipment to all LCEMS Life Squads upon completion of PALS training. Protocols were developed that integrate the use of the bag's contents.

CONCLUSION

This partnership between a trauma center and an EMS agency resulted in improved training of county paramedics, Life Squads that have an Advanced Pedi-Bag with specific equipment and supplies to manage pediatric emergencies, and pediatric protocols that support the use of this equipment. Paramedics benefit from advanced training opportunities and patients benefit from improved prehospital care.

Stable integration of large (>100 kb) PAC constructs in HaCaT keratinocytes using an integrin-targeting peptide delivery system

Transfer of large DNA constructs in gene therapy studies is being recognised for its importance in maintaining the natural genomic environment of the gene of interest and providing tissue-specific regulation and control. However, methods used to deliver such constructs have been poorly studied. We used a receptor-mediated, integrin-targeting transfection system enhanced by liposomes, to deliver a 110 kb PAC (P1-based artificial chromosome) to HaCaT keratinocytes. The PAC contained the collagen VII locus, an EGFP (enhanced green fluorescent protein) reporter gene and the puromycin resistance gene (pac) to allow selection of stably transfected cells. Analysis of puromycin resistant and EGFP-expressing colonies by Western blot showed that collagen VII production increased dramatically after transfection, indicating successful transfer of a large fully functional genomic locus. Fluorescent in situ hybridisation (FISH) and Southern blot analysis revealed that the PAC had integrated as at least one copy per cell. EGFP expression has persisted for 35 weeks, suggesting stable transgene expression. We conclude that the integrin-targeting peptide method of gene delivery is an effective means of stably delivering large DNA constructs to human keratinocytes and could be of benefit for genomic gene therapy approaches.

A comparison of parent and adolescent reports describing the health-related quality of life of adolescents treated for cancer

Our objectives were to compare adolescent and parent ratings of the health-related quality of life (HRQL) of adolescents treated for cancer, to compare the HRQL of adolescents who were on treatment vs. the HRQL of those who were off treatment following their diagnosis with cancer and to assess the HRQL of adolescents who were at different points of time following their diagnosis with cancer. The HRQL of 70 adolescents (aged 10 to 18 years) consecutively attending the Women's and Children's Hospital Oncology Clinic in South Australia was assessed by means of standard questionnaires. Parents completed the Child Health Questionnaire, the Functional Status II(R) Questionnaire and the Impact-on-Family Scale. Adolescents completed the self-report version of the Child Health Questionnaire. In general, there was good agreement between parent and adolescent reports. However, parents of adolescents receiving active treatment for cancer reported that their illness was having a greater impact on the adolescents' physical functioning than was reported by the adolescents. The psycho-social functioning of adolescents in single-parent families was reported also by parents to be worse than that of adolescents in 2-parent families. The physical functioning of adolescents had only a weak relationship with parental status but a significant relationship with treatment status. Despite generally good agreement between parent and adolescent reports describing the HRQL of adolescents treated for cancer, it cannot be assumed that reports from parents are always an accurate reflection of the views of the adolescents. Studies examining the influence of independent factors on adolescents' HRQL must take into account differences in reports from these 2 informants and the possibility that key independent variables have differing relationships with the various domains which comprise adolescents' HRQL.

Evidence of progressive delay of motor development in children with sensorineural hearing loss and concurrent vestibular dysfunction

Gross motor development, and the effect of age, sex and vestibular function on it, was examined in 39 24- to 83-mo.-old children with sensorineural hearing impairment. Repeated testing was completed on 18 children. Delayed gross motor development was evident regardless of age, but only children less than 5 years of age had developmental balance deficits on initial testing. Both gross motor and balance development scores were lower on repeated testing. Furthermore, vestibular function scores facilitated identification of those children with a deficit in balance development as well as those with a progressive delay in motor or balance development. Implications for practice are discussed.

Childhood cancer: a 4-year prospective study of the psychological adjustment of children and parents

PURPOSE

The objective of this 4-year prospective study was to assess the psychological adjustment of children treated for cancer and their parents.

PATIENTS AND METHODS

Children aged 2 to 12 years with cancer diagnosed and their parents and families (n = 39) were assessed immediately after their diagnosis and then annually for the next 4 years. At each assessment, the psychological adjustment of the children and their families was compared with the adjustment of a cohort of children and families in the general community (n = 49).

RESULTS

Immediately after the diagnosis of cancer in the children, the children and their parents had significantly more psychological problems than children and parents in the community. However, at subsequent assessments, there was no difference in the number of psychological problems experienced by children and parents in the two groups.

CONCLUSIONS

In the longer term, the prevalence of psychological problems experienced by children treated for cancer and their parents does not differ from that found in children and parents in the general community. Future research should give greater attention to other aspects of the lives of children treated for cancer and their parents, including their broader health-related quality of life.

Comparative genomic hybridization in pediatric acute lymphoblastic leukemia

Comparative genomic hybridization (CGH) was used to clarify the chromosomal status of 15 patients diagnosed with childhood acute lymphoblastic leukemia (ALL). Bone marrow samples from 10 of the 15 patients were selected because no metaphases were obtained for cytogenetic analysis. Three patients with normal trypsin and giemsa banding (GTG) karyotypes were also studied by CGH to determine whether significant abnormalities might have been missed by banding analysis, and samples from an additional 2 patients with hyperdiploidy were also included. Seven of the 10 patients with failed GTG banding analysis were found to be chromosomally abnormal by CGH; 2 out of 3 patients with normal GTG band karyotypes were abnormal, indicating that the metaphases available for karyotyping were not malignant cells, and that CGH analysis of hyperdiploid samples provided more accurate resolution than karyotyping alone. The prognostic value of chromosomal aberrations detected by CGII and the efficiency of the technique suggest a central role for CGH in routine clinical cytogenetics.

Detailed comparative gene map of rat chromosome 1 with mouse and human genomes and physical mapping of an evolutionary chromosomal breakpoint

We report the localization of 92 new gene-based markers assigned to rat chromosome 1 by linkage or radiation hybrid mapping. The markers were chosen to enrich gene mapping data in a region of the rat chromosome known to contain several of the principal quantitative trait loci in rodent models of human multifactorial disease. The composite map reported here provides map information on a total of 139 known genes, including 80 that have been localized in mouse and 109 that have been localized in human, and integrates the gene-based markers with anonymous microsatellites. The evolutionary breakpoints identifying 16 segments that are homologous regions in the human genome are defined. These data will facilitate genetic and comparative mapping studies and identification of novel candidate genes for the quantitative trait loci that have been localized to the region.

HsRec2/Rad51L1, a protein influencing cell cycle progression, has protein kinase activity

Human Rec2/Rad51L1 is a member of the Rad51 family of proteins. Although recombinase activity, typical of this family, could not be established, its overexpression in mammalian cells has been shown to cause a delay in G1. Moreover, since hsRec2/Rad51L1 has been found to be induced by both ionizing and UV irradiation, it is likely that hsRec2/Rad51L1 is elevated following any DNA damage and causes a G1 delay to allow time for DNA repair to occur. Limited homology with catalytic domains X and XI of protein kinase A suggested that kemptide, an artificial substrate containing one phosphorylatable residue, a serine, might serve as a substrate for hsRec2/Rad51L1. Here, we report that hsRec2/Rad51L1 can phosphorylate kemptide, as well as myelin basic protein, p53, cyclin E, and cdk2, but not a peptide substrate containing tyrosine only. The finding that hsRec2/Rad51L1 exhibits protein kinase activity is a first step toward identifying a mechanism whereby this protein affects the cell cycle.

Longitudinal follow-up of the intellectual and academic functioning of children receiving central nervous system-prophylactic chemotherapy for leukemia: a four-year final report

This longitudinal investigation extends our prospective study of the intellectual and academic functioning of children treated for cancer to 4 years after diagnosis. In the longer term, the children who received central nervous system (CNS) chemotherapy experienced greater neurocognitive deficits, particularly in the area of academic achievement, than did the children who did not receive CNS chemotherapy. Specifically, the CNS chemotherapy-treated children scored lower on academic tests of reading at 3 and 4 years after diagnosis. The results suggest that CNS chemotherapy prophylaxis may adversely effect the development of higher-order mental abilities and cognitive skills during the late-effects period and may also impair academic achievement.

A comparison of troponin T and troponin I as predictors of cardiac events in patients undergoing chronic dialysis at a Veteran's Hospital: a pilot study

OBJECTIVE

The purpose of this study was to prospectively evaluate the usefulness of the cardiac troponins as predictors of subsequent cardiac events in patients with chronic renal failure undergoing dialysis.

BACKGROUND

Cardiac troponin T (cTnT) and I (cTnI) are cardiac markers that are specific for cardiac muscle. They are also excellent prognostic indicators for patients presenting with chest pain. Although cardiac disease is the leading cause of death in dialysis patients, standard methods to diagnose acute coronary syndromes in patients with renal failure are often misleading.

METHODS

A six-month prospective study was done in a university-affiliated Veterans Hospital's dialysis clinic. Forty-nine patients undergoing chronic dialysis with no complaints of chest pain were followed for cardiac events occurring in the six months after cardiac troponin measurements. These included unstable angina, acute myocardial infarction and cardiac death. An additional 83 patients with renal failure but who were not undergoing dialysis were also examined.

RESULTS

Within six months all three dialysis patients with elevated cTnI at entry into the study suffered an adverse complication (specificity and positive predictive value = 100%). Twenty-five patients had cTnT elevated at >0.10 ng/ml (53%). Patients with diabetes were more likely to have elevated troponin T levels (64% vs. 25%, p = 0.01). All six patients developing cardiac events within three months had elevations of cTnT >0.1 ng/ml (sensitivity = 100%). Whereas the specificity of cTnT was only 56% for a near-term cardiac event, the negative predictive value of cTnT using a cutoff of < or = 0.1 ng/ml was 100%. On restratifying patients using a cutoff value of cTnT of >0.2 ng/ml, only nine of 49 dialysis patients (18%) had elevated levels. In patients with renal failure not undergoing dialysis, only three of 83 (4%) had elevated troponin I or T. None of these patients suffered a cardiac event in the next six months.

CONCLUSIONS

This prospective pilot study clearly delineates the troponins as important prognosticators in asymptomatic otherwise "stable" patients on chronic dialysis, especially those with concomitant diabetes mellitus. It also appears that troponins are more likely to be elevated in dialysis patients than other patients with renal failure not on dialysis. The above suggests that the combination of cTnI and cTnT might be very effective in elucidating cardiac risks of patients with renal failure undergoing chronic dialysis.

The polysulfonated compound suramin blocks adsorption and lateral difusion of herpes simplex virus type-1 in vero cells

Several polysulfonate compounds have been shown to have the potential to inhibit the replication of herpesviruses by blocking binding and penetration of the host cell. We analyzed the actions of the polysulfonate compound suramin on the replication of herpes simplex virus type 1 (HSV-1) and compared them with the actions of heparin. We used the expression of a reporter gene (beta-galactosidase) recombined into the latency-associated transcript region of the 17syn+ strain of HSV-1 to quickly evaluate productive cycle activity and have shown that it can be directly correlated with virus replication under the conditions used. We find that suramin, like heparin, blocks the binding of HSV-1 to the cell membrane. Also, suramin efficiently blocks the cell-to-cell spread of the virus; this effect has not been previously reported. Our control experiments demonstrate that heparin also has some effect on intercellular spread of HSV-1 but to a significantly lesser degree than does suramin. We suggest that suramin and related polysulfonate compounds have potential for developing of antiherpes treatments.

Daytime CPAP titration: a viable alternative for patients with severe obstructive sleep apnea

OBJECTIVE

Continuous positive airway pressure (CPAP) is the treatment of choice for patients diagnosed with severe obstructive sleep apnea (OSA). The implementation of CPAP therapy has traditionally been based on full-night titration studies or split-night protocols. This study compared a group of patients who received a regular nocturnal CPAP titration with patients who received a daytime CPAP titration. The objective of the study was to determine if daytime CPAP titration is a viable alternative for the implementation of CPAP treatment in patients with severe OSA.

STUDY DESIGN

Fourteen patients (13 men and one woman) received a daytime CPAP titration (day group). The day group was matched to 18 patients (17 men and one woman) who were titrated under a full-night regular nocturnal study (night group). Eligible patients were those with severe OSA (respiratory event index > 40). The groups were matched by age, sex, and body mass index.

RESULTS

Daytime and nocturnal CPAP titration studies yielded sufficient amounts of rapid eye movement (REM) and non-REM sleep to help determine CPAP settings. Importantly, the diurnal and nocturnal CPAP titrations resulted in comparable therapeutic pressures as well as comparable resolution of sleep-disordered breathing. After 1 week of treatment, the groups exhibited similar CPAP use and comparable improvements in subjective sleepiness as indicated by their increase in sleep/wake activity inventory scores.

CONCLUSIONS

Daytime CPAP titration studies may be a viable alternative for the efficient and expedient implementation of CPAP therapy among some patients with severe OSA.

The perception of sleep as a function of the level of daytime sleepiness among patients with obstructive sleep apnea

Subjective estimates of sleep onset among patients with a variety of sleep disorders have been shown to be inaccurate. This inability in perceiving sleep onset is potentially dangerous for this population, in particular, for individuals who are required to drive long distances or operate heavy machinery as part of their daily activities. This study evaluated the perception of sleep among 237 consecutive patients diagnosed with obstructive sleep apnea. Patients completed an overnight sleep-laboratory evaluation followed by an objective evaluation of sleep propensity. The latter was done using the Multiple Sleep Latency Test (MSLT). Patients with an accurate perception of having slept on the MSLT were found to have shorter sleep latencies when compared with those with an inaccurate perception of their sleep. The results of this study suggest that the rapidity with which sleep is manifested is an important contributor to the accurate perception of sleep.

Analysis of factors influencing kinetics of herpes simplex virus transcription utilizing recombinant virus

The herpes simplex virus type 1 (HSV-1) transcription program is a regulated cascade in which early and late phases of gene expression are separated by viral DNA replication. While promoters controlling expression of transcripts encoding immediate-early proteins contain virus-specific cis-acting elements, these are in the context of cellular promoter elements, and the promoters controlling expression of other viral transcripts contain only cellular cis-acting elements. We had developed and continue to refine a general method for the production of recombinant viruses in which modified promoters can be inserted into nonessential loci within the viral genome through homologous recombination. This approach has been especially useful in defining the features of model promoters of the various kinetic classes. Our work suggests that class-specific differences in promoter architecture are critical factors in the ability of the cellular transcription machinery to form stable preinitiation complexes at various phases of infection and, thus, mediate kinetic class-specific transcription. Early (beta) promoters contain a TATA box and upstream activation elements while sequences downstream of the TATA homology are dispensible for transcription. Late transcripts can be catagorized as either leaky-late (beta gamma) or strict late (gamma) depending on whether they are readily detectable prior to viral DNA replication. Promoters controlling both types are clearly distinct from early ones in that sequences near the transcription start site which resemble consensus mammalian initiator elements are required along with the TATA box and activator elements. Strict late promoters do not contain elements upstream of the TATA box but include what appears to be a class specific element downstream of the transcription start site.

Influence of parental and family adjustment on the later psychological adjustment of children treated for cancer

OBJECTIVE

To examine the relationship between parental adjustment and family adjustment during the period after the children's diagnosis of cancer and the psychological adjustment of children 2 years after their diagnosis.

METHOD

The study used a prospective design. Children aged 2 to 5 years with cancer and their parents and families (n = 38) were assessed immediately after the children's diagnosis and again 2 years after the diagnosis. Path analysis was used to investigate the relationship between parental and family adjustment during the period after diagnosis and the psychological adjustment of the children 2 years after their diagnosis.

RESULTS

Maternal adjustment during the period after the children's cancer was diagnosed had a significant relationship with the children's psychological adjustment 2 years after diagnosis. In contrast, the adjustment of fathers and family adjustment appeared to have a more limited impact on the later psychological adjustment of the children.

CONCLUSION

The level of distress experienced by mothers after the children's diagnosis may have an important influence on the later psychological adjustment of the children. It is possible that this is due to the impact of maternal distress on the capacity of mothers to care for their children during the children's treatment for cancer.

Childhood cancer: a two-year prospective study of the psychological adjustment of children and parents

OBJECTIVE

To follow prospectively the psychological adjustment of young children, parents, and families during the first 2 years after the children's diagnosis of cancer.

METHOD

Children aged 2 to 5 years with cancer diagnoses and their parents and families (n = 38) were assessed immediately after diagnosis, 1 year after diagnosis, and 2 years after diagnosis. At each assessment, the psychological adjustment of the children and their families was compared with the adjustment of a cohort of children and families in the general community (n = 39).

RESULTS

Children with cancer and their parents experienced significantly more emotional distress than children and parents in the community during the period immediately after diagnosis. However, the number of problems experienced by the children with cancer and their parents declined during the first year after the children's diagnosis and stabilized at a level comparable with that found among children and parents in the general community.

CONCLUSION

Although the results are consistent with reports that suggest that in the longer term the prevalence of psychological problems among children with cancer is similar to that found among children in the general community, they also highlight the considerable distress experienced by children and parents during the period immediately after the children's diagnosis.