Adrenal dysfunction in critical illness: a clinical entity that requires treatment?

Corticosteroids are of key importance in controlling the immune system and in the maintenance of cardiovascular function. Thus, an adequate function of the adrenal cortex is essential for survival in critical illness. There is growing evidence that adrenocortical function can become impaired during critical illness, because of deleterious effects of cytokines, leading to a state of relative adrenal dysfunction.

Diagnosis and management of laryngopharyngeal reflux disease.

Purpose Of Review: Laryngopharyngeal reflux remains a controversial subject for both diagnosis as well as treatment. Nevertheless, there is increasing clinical and experimental evidence to suggest that it is associated with many nonspecific otolaryngological symptoms.

Recent Findings: Twenty-four hour dual probe pH tests fail to prove or exclude laryngopharyngeal reflux because of insufficient specificity and sensitivity.

Primary pancreatic and renal non-Hodgkin's lymphoma: CT and MR findings.

Primary malignant non-Hodgkin's lymphoma of the pancreas or the kidney is uncommon. We describe a case of primary non-Hodgkin's lymphoma of the pancreas consisting of 3 masses and causing acute pancreatitis, combined with a primary non-Hodgkin's lymphoma of the left kidney, without the presence of abdominal lymphadenopathies. Our case report is documented with CT as well as MR images.

Clinical trials report on ongoing trials in lung cancer.

This review summarises major studies that are underway in the treatment of lung cancer in the world. A large number of small Phase I and II trials are being performed, in particular including new cytotoxic agents. This review focuses on randomised Phase III trials, and those mainly conducted by large co-operative groups.

Mucosal vulval lichen planus: outcome, clinical and laboratory features.

Background: Mucosal lichen planus of the vulva is a rare but increasingly recognized condition. It has potentially severe complications such as fusion of the labia and vagina; the risk of developing squamous cell carcinoma (SCC) may be increased. An association between hepatitis B and C infection and skin or oral lichen planus appears to exist in certain geographical areas.

Percutaneous placement of marking coils before stereotactic radiation therapy of malignant lung lesions.

Purpose: To evaluate a technique for implantation of radiopaque markers in lung nodules as an aid in extracranial stereotactic radiation therapy.

Materials And Methods: An implantation technique was developed for marking intrapulmonary lung lesions by introducing a vascular coil through a coaxial needle in or near the target tumor. The markers were placed percutaneously through 15- or 20-gauge coaxial needles in 41 lesions (25 patients) under computed tomographic fluoroscopic guidance.

The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature.

Purpose: The purpose of this meta-analysis was to determine the additional value of neoadjuvant, concurrent, and/or adjuvant chemotherapy to radiation in the treatment of locally advanced nasopharyngeal carcinoma (NPC) with regard to the overall survival (OS) and the incidence of local-regional recurrences (LRR) and distant metastases (DM).

Patients And Methods: To be eligible, full published studies had to deal with biopsy-proven NPC and have patients randomly assigned to receive conventional radiotherapy (66 to 70 Gy in 7 weeks) or radiotherapy combined with chemotherapy.

Results: Ten randomized clinical studies were identified, including 2,450 patients.

Sonography of the normal ulnar nerve at Guyon's canal and of the common peroneal nerve dorsal to the fibular head.

Purpose: This study was conducted to evaluate the ability of sonography to visualize the ulnar nerve at Guyon's canal and the common peroneal nerve dorsal to the fibular head and to test for correlations between nerve measurements and subject characteristics.

Methods: We used a 5-12-MHz linear-array transducer in sonographic evaluation of 15 healthy adult volunteers. We evaluated the correlations between nerve diameters and surface areas and subject body mass index and height.

Care of a patient with acute leukemia based on a Dutch specialized model of oncology nursing.

Within the University Hospital Vrije Universiteit autologous and allogenic SCT are practiced. The hematology ward has 18 beds 3 of which are isolation rooms with laminar airflow and six day-care beds. In a year about 20 allogeneic and some 50 autologous SCT take place.

Validation of the portable VmaxST system for oxygen-uptake measurement.

The aim of this study was to validate the accuracy of a new type of portable gas-analysis system (Sensormedics VmaxST) for the measurement of oxygen-uptake at expenditure levels that are reached during walking in patients with movement disorders. The criterion method was the Douglas Bag (DB) method, which is considered to be the gold standard. Accuracy evaluations were made in two trials, randomly using the VmaxST (ST) and the Douglas Bag method.

Respiratory chain complex V deficiency due to a mutation in the assembly gene ATP12.

In patients with mitochondrial encephalomyopathies an increasing number of causative gene defects have been detected. The number of identified pathogenic mitochondrial DNA mutations has largely increased over the past 15 years. Recently, much attention has turned to the investigation of nuclear oxidative phosphorylation (OXPHOS) gene defects.

The presence of high-risk HPV combined with specific p53 and p16INK4a expression patterns points to high-risk HPV as the main causative agent for adenocarcinoma in situ and adenocarcinoma of the cervix.

Adenocarcinoma in situ (ACIS) and adenocarcinoma (AdCA) of the cervix are frequently missed in population-based screening programmes. Adding high-risk HPV (hrHPV) testing to cervical cancer screening might improve the detection rate of ACIS and AdCA. Since the exact proportion of AdCAs of the cervix that can be attributed to hrHPV infection is still a matter of debate, a comprehensive study was performed of hrHPV presence in ACIS and AdCA of the cervix.

Reducing inter-observer variation in thyroid volume calculation using a new formula and technique.

Objective: Ultrasound (US) measurement of thyroid volume is used in diagnosis and follow-up of patients with thyroid disease. We assessed a new formula and technique for thyroid volume calculation, based on an automatically continuous trace transverse surface area (aTSA) calculation, to ascertain where this technique could reduce inter-observer variation.

Methods: Three observers with a different level of US expertise, using a 12-5 MHz linear transducer, examined 25 volunteers.

Neurotrophic factors in prostate and prostatic cancer.

Recent progress in growth factor research has led to a reexamination of the involvement of neurotrophic factors outside their classical domain of the nervous system. These last few years have seen a substantial accumulation of data concerning Nerve Growth Factor (NGF)'s prevalence within the prostate. NGF and its receptors were reported from the normal prostatic tissue, benign hyperplasia and prostatic cancer.

Comparison of quantitative competitive PCR with LightCycler-based PCR for measuring Epstein-Barr virus DNA load in clinical specimens.

The aim of this study was to develop a LightCycler-based real-time PCR assay for monitoring the Epstein-Barr virus (EBV) DNA load in unfractionated whole blood. This assay was compared with quantitative competitive PCR (Q-PCR) for EBV. The LightCycler-based assay was highly sensitive and reproducible when quantifying plasmid DNA in either the presence or absence of healthy donor blood DNA.

Role of Epstein-Barr virus DNA load monitoring in prevention and early detection of post-transplant lymphoproliferative disease.

Posttransplant lymphoproliferative disease (PTLD) is a severe and life-threatening complication after stem cell or solid-organ transplantation, virtually always associated with presence of Epstein-Barr virus (EBV) in the proliferating cells. PTLD is probably caused by the iatrogenically impaired T-cell response allowing outgrowth of EBV-positive B-cells. Quantitative EBV DNA load monitoring is a minimally invasive technique increasingly recognized as a valuable tool in posttransplant patient management.

How effective is a clerkship as a learning environment?

To assess the educational quality of a traditional clerkship, a questionnaire was administered to 28 students at the end of their 10-week surgical clerkship. The questionnaire contained 116 items on learning objectives, patient problems encountered by students, clinical skills performed, feedback received and amounts of time spent on various activities. The students indicated that they had adequate ability to correctly analyse and manage patient problems.

Cheilitis granulomatosa: overview of 13 patients with long-term follow-up--results of management.

Background: Cheilitis granulomatosa, often regarded as a subtype of orofacial granulomatosis, is characterized by recurrent or persistent swelling of one or both lips. Classically, a non-necrotizing granulomatous inflammation is seen at histologic examination. Although a relationship has been proposed between Melkersson-Rosenthal syndrome (and the monosymptomatic form, cheilitis granulomatosa) and Crohn's disease on the basis of the orofacial swelling and similar histology, several studies of Melkersson-Rosenthal syndrome have not found an association with Crohn's disease.

Measuring perceived activity limitations in lower extremity Complex Regional Pain Syndrome type 1 (CRPS I): test-retest reliability of two questionnaires.

Objective: To assess the test-retest reliability of two questionnaires for measuring activity limitations in patients with Complex Regional Pain Syndrome type 1 (CRPS I) of the lower extremity.

Design: Patients filled out the Walking Stairs Questionnaire and the Questionnaire Rising and Sitting Down twice during a one-week period.

Setting: Outpatient pain clinic of a university hospital.

Development and implementation of the Rehabilitation Activities Profile for children: impact on the rehabilitation team.

Objective: To describe the changes in functioning of the rehabilitation team induced by the Rehabilitation Activities Profile for children (Children's RAP), an instrument designed to improve interdisciplinary communication in paediatric rehabilitation.

Design: Multiple case-study design.

Subjects: Seven paediatric rehabilitation teams.

Gemcitabine-radiotherapy in patients with locally advanced pancreatic cancer.

A feasibility study was performed to assess the toxicity and efficacy of a combination of gemcitabine-radiotherapy in patients with locally advanced pancreatic cancer (LAPC). 24 patients (15 females and 9 males) with measurable LAPC were included; the median age of the patients was 63 years (range 39-74 years). The performance status ranged from 0 to 2.

Pemetrexed as a single agent in the therapy of advanced lung cancer.

Pemetrexed is a multitargeted antifolate with activity as a single agent against non-small cell lung cancer at a recommended dose of 500 mg/m(2) as a 10-minute infusion every 21 days. The response rate in untreated patients with stage IIIB/IV disease is from 18% to 23%. It is also active in the second-line setting in patients progressing after pretreatment with a number of drugs or after a very short treatment-free interval.

Effect of duration of upper- and lower-extremity rehabilitation sessions and walking speed on recovery of interlimb coordination in hemiplegic gait.

Background And Purpose: The effects of different durations of rehabilitation sessions for the upper extremities (UEs) and lower extremities (LEs) on the recovery of interlimb coordination in hemiplegic gait in patients who have had a stroke were investigated.

Subjects And Methods: Fifty-three subjects who had strokes involving their middle cerebral arteries were assigned to rehabilitation programs with (1) an emphasis on the LEs, (2) an emphasis on the paretic UE, or (3) a condition in which the paretic arm (UE) and leg (LE) were immobilized with an inflatable pressure splint (control treatment). The 3 treatment regimens were applied for 30 minutes, 5 days a week, during the first 20 weeks after onset of stroke.