bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dying from cancer: the views of bereaved family and friends about the experiences of terminally ill patients
Authors: Addington-Hall JM , MacDonald LD , Anderson HR , Freeling P. 
Published: November 2007

Objective: To investigate current experiences of dying cancer patients and to identify areas where improvements in care are needed. Design: Interviews with principal carers eight weeks after the death of cancer patients who had been routinely notified by hospital staff and had entered a district wide trial of a new service for terminally ill cancer patients. Setting: An inner London health district. Subjects: Eighty carers of cancer patients who died between 1987 and 1989. Results: Anorexia, breathlessness, pain, insomnia and depression were all experienced by over 50% of patients in the last week of life. Twenty per cent of patients in pain were reported to have had no effective treatment. Carers of patients dying at home were significantly more likely to feel that the place of death had been right for the patient (97% versus 53%) than carers of patients dying in hospital. Half (36) of carers were dissatisfied with hospital care: the main reason given was that nurses were too busy to provide adequate care (24). Thirty-nine per cent of carers were dissatisfied with information they received from the hospital and eight had wanted to know more about the timing of death. Twenty-seven per cent of 64 carers who had had contact with the general practitioner during the final illness were dissatisfied with care provided by the GP. Twenty per cent of 56 carers who had had contact with district nurses were dissatisfied because of the lack of continuity of care or because nurses appeared rushed. Twenty-nine per cent had had a home help and 10% had had meals on wheels. Fifty-two per cent of carers needing equipment to help them nurse the patient, and 15% of carers who had needed help during the night, had been unable to obtain such help without difficulty, if at all. Implications: More attention should be paid to ensuring that good symptom control is achieved for all patients. More support from general practitioners, community nursing and social services is needed to enable patients to remain at home when desired. Improvements are needed in the care provided for dying patients on acute wards.
Laser therapy in the palliation of dysphagia in oesophageal malignancy
Authors: Lewis-Jones CM , Sturgess R. , Ellershaw JE 
Published: November 2007

Dysphagia is a distressing symptom commonly found in patients with oesophageal malignancy. Endoscopic laser therapy, in isolation or in conjunction with other treatments, can offer effective palliation. The procedure is outlined together with discussion of the advantages and complications of this technique.
A population-based study of the coverage of cancer patients by hospice services
Authors: Hunt Roger , McCaul Kieran 
Published: November 2007

The aims were to determine the proportion of terminal cancer patients in South Australia who had involvement with a programme of hospice care, to identify the predictors of hospice involvement, and to consider the influence of hospice services, along with other variables, on the place of death. A file of patients of the State's hospice services who died in 1990 was compiled and linked to the population-based Central Cancer Register. We found that 1561 (56%) of the 2800 cancer patients who died in 1990 had care from a hospice service. Patients were less likely to be involved with a hospice service if they were 80 years or older, lived in a rural region, or had a haematological malignancy, and more likely to have hospice care it they had a survival time of more than six months, or were born in the UK or Europe. Patients of hospice services were more likely than other patients to die at home or in an inpatient hospice, and less likely to die in a nursing home or private hospital. A range of other factors were also found to be associated with place of death. We conclude that there has been a rapid acceptance of hospice care in South Australia, with a majority of the target population of cancer patients covered by services. Epidemiological research methods are useful for identifying gaps in the provision of care, and for determining the impact of various factors on where people die. This research is, therefore, important for the formulation and evaluation of policy for the delivery of terminal care.
A comparison of hospice and hospital care for people who die: views of the surviving spouse
Authors: Seale Clive , Kelly Moira 
Published: November 2007

To compare the quality of inpatient care for dying people in St Christopher's Hospice, London and nearby hospitals in 1994 and make comparisons with earlier studies of the same setting, interviews were undertaken with spouses of people who had died from cancer in these settings, matched by age and sex. The subjects comprised 66 people who had died in 1994, 33 of whom had died in the hospice, 33 in local hospitals. The mean age was 70.2, 61 % were male. The hospice group were more likely to know that they were dying and less likely to be admitted as emergencies. Treatment for pain, breathlessness and nausea from both sources provided relief in almost all cases. Most information about the illness was given by hospital doctors before hospice care occurred. Where it occurred, communication by hospice staff was judged better than that by hospital doctors. Staff in hospitals were more likely to be judged 'very busy'. Hospice respondents were less likely to want improvements, and more likely to judge the institution as being 'like a family'. Earlier studies had shown a trend for symptom control to have improved in hospitals but for difference in the psychosocial climate to favour the hospice. By 1994, this latter difference was still obtained. We stress the role of hospital staff and general practitioners in helping patients accept a terminal prognosis, so that better-planned care can proceed. The busy public atmosphere of some hospital wards may not be conducive to the good care of dying people.
The incidence of suicide in palliative care patients
Authors: Grzybowska Pola , Finlay Ilora 
Published: November 2007

Anecdotal reports from hospices show a low incidence of suicide, yet depression is increased in cancer patients, and the likelihood of suicide is increased in depressed patients. Suicide would be expected to be more common in terminally ill patients. A postal survey was undertaken of 43 palliative care units. They were asked to report the number of suicides, parasuicides and the total number of referrals for the five-year period from 1990 to 1994. Thirty-four units replied (79%). Complete data were available from 24 (56%) units. Total referrals were 72 633 in the five-year period. Nine units (38%) had one or more suicides, with a total of 21 suicides reported. Sixteen units (67%) had one or more attempted suicides (total 37). There are implications in the study both for direct patient care, but also data collection, staff support and training.
The Long-Term Clinical Outcome of 56 Patients with Biopsy-Proven Lupus Nephritis Followed at a Single Center
Authors: Derksen Ronald H.W.M. , Hené Ronald J. , Kater Louis 
Published: November 2007

We retrospectively evaluated the clinical outcome of 45 female and 11 male patients with biopsy-proven lupus nephritis, followed at our hospital between February 1974 and February 1990. In the majority signs of nephritis were present at the time systemic lupus erythematosus was diagnosed (range: —42-156 months) and the median time from onset of nephritis to biopsy was 2 months. The median follow-up from the time of the biopsy was 53.5 months (range: 2-192), the median age at biopsy 25 years and the median serum creatinine level 1.2 mg/dl. Initial renal biopsies had the following histopathological classes according to the World Health Organization criteria (n): I (2); II (10); III (10); IV (28); V (5); VI (1). Over the study period active episodes were treated with high-dose oral prednisone alone or combined with intravenous nitrogen mustard and oral chlorambucil (1974-75), azathioprine (1978-86), cyclophosphamide (1986-90) and/or plasma-exchange (1976-84). These strategies were based on literature data or multicenter studies in which we participated. Eight patients developed end-stage renal disease (ESRD) (median: 47 months post-biopsy; range: 20-120). In these, initial biopsies showed class IV in seven, and class V in one. Confounded risk factors for ESRD were class IV biopsy, male gender and serum creatinine level above 1.4 mg/dl. The calculated proportion without ESRD 5 years post-biopsy was 87% (95% confidence limits: 98-76%), and at 10 years 70% (95% confidence limits: 90-49%). Five patients (11.2%) died; causes of death were cerebrovascular accident (n = 2), cerebral lupus (n = 2) and S. aureus sepsis (n = I). Twelve (21.4%) patients had localized herpes zoster infection; six (10.7%) had a salmonella sepsis.
Antiganglioside Antibodies in Patients with Neuropsychiatric Systemic Lupus Erythematosus
Authors: Pereira  , Yoshinari Natalino H. , De Oliveira Ricardo M. , Cossermelli Wilson 
Published: November 2007

Antiganglioside antibodies (AGA) were determined in sera and cerebrospinal fluids (CSF) from 50 systemic lupus erythematosus (SLE) patients, and age-matched normal controls. The SLE patients were subdivided according to the type of clinical manifestation into two groups: neuropsychiatric SLE and active SLE without neuropsychiatric manifestation. The presence of these antibodies showed a significant correlation between IgG AGA in the CSF and IgM AGA in the serum and neuropsychiatric SLE. Fifteen patients had this antibody in the CSF without detectable levels in the serum. No correlation was seen between anti cardiolipin antibodies in the serum or CSF and neuropsychiatric SLE. The present work suggests that antibodies against gangliosides may be a marker for neuro psychiatric SLE and that intrathecal antibody production can result in the development of this manifestation.
HLA Antigens and Complement C4 Allotypes in Patients with Chronic Biologically False Positive (CBFP) Seroreactions for Syphilis: A Follow-Up Study of SLE Patients and CBFP Reactors
Authors: Stephansson E.A. , Koskimies S. , Lokki M.-L. 
Published: November 2007

We report a follow-up of our previous study of HLA markers in 118 unrelated patients: 49 with definite systemic lupus erythematosus (SLE) (group 1), 32 with definite or probable SLE and chronic biologically false positive (CBFP) seroreactions for syphilis (group 2), and 37 CBFP reactors (group 3). Definite SLE was confirmed in 28 (90.3%) of the patients in group 2, equally in HLA B8- and HLA B7-positive patients. Three of the CBFP reactors developed SLE, two (40%) out of five HLA B8-positive as compared to one (6.6%) out of 15 HLA By-positive CBFP reactors (P = 0.07). Fourteen patients died (groups 1 and 2). Eight of the 24 HLA B8-positive patients died in contrast to one of the 20 HLA B7-positive patients (P < 0.02). Of the CBFP reactors, 70.9% had complement C4 null alleles as compared to 47.9% in controls (P = 0.05) and 50% had C4A null alleles as compared to 17.8% in controls (P < 0.05). C4B null alleles were found in 28.6% (28.6% in controls, P is not significant). The null alleles for C4A were not solely in a linkage disequilibrium with the HLA B8 DR3 haplotype. CBFP reactors with C4A null alleles had a higher risk of developing SLE, lupus-like disease or symptoms such as photosensitivity, cutaneous vasculitis and/or autoantibodies than did those with no C4A null alleles (P < 0.02).
Immune Ablation with Stem-Cell Rescue: A Possible Cure for Systemic Lupus Erythematosus?
Authors: Marmont Alberto M. 
Published: November 2007

The impressive prolongation of survival has been the most important progress made in clinical systemic lupus erythematosus (SLE). Quality of life has also greatly improved, including pregnancy. However, persisting disease and therapy-related morbidity outcomes justify new approaches, different from the usual long-term palliative immunosuppression. Haematopoietic stem cells (HSCs) from healthy histocompatible mice are capable of curing murine SLE after eradication of the original HSCs with total body irradiation. Syngeneic and even autologous HSCs are also capable of curing induced experimental autoimmune diseases such as adjuvant arthritis and experimental allergic encephalomyelitis. In man allogeneic bone-marrow transplantation (BMT) is becoming progressively safer, but cannot yet be offered to SLE patients. However, syngeneic transplants from twins non-concordant for the disease would be justified. Conditioning with high-dose cyclophosphamide followed by autologous HSC rescue, from the marrow and/or from the peripheral blood, may already be regarded as a powerful immunosuppressive procedure for selected cases of SLE and other severe autoimmune diseases. Autologous transplant procedures are not saddled with the immunologic problems of allo-BMT. Although eradication of SLE may not be achieved by auto-BMT, minimal residual immunologic disease can be suppressed or controlled, and long-term self-maintained remissions may be expected.
Antiphospholipid Antibody: Future Developments
Authors: Lockshin Michael D. 
Published: November 2007

In September 1991, an NIH workshop on molecular and biological aspects of antiphospholipid antibodies (aPL) identified questions for future studies: are the antibodies defined by the ELISA and by the lupus anticoagulant tests the same? Is aPL directly responsible for disease? What is the antigen? What drives the production of aPL? What is the role of β2-glycoprotein I? What accounts for patient heterogeneity? Can a satisfactory animal model be developed? The NIH workshop did not address important clinical questions, including those of pathogenesis and treatment. In 1994 many of these questions have at least partial answers. β2-glycoprotein I appears to be an obligatory component of the antigen, abnonnal coagulation is the probable central pathogenic event and animal models now exist. There are still critical unknowns that define a future research agenda: the genetics of the aPL syndrome, the relationship of aPL to SLE and mechanisms of pathogenesis (including why clotting is episodic and what is the cellular or anatomical location of the initial injury). Despite a decade of clinical studies, risk prediction for defined patient groups is only now beginning to be studied. There are still almost no randomized, prospective, controlled treatment trials on any aspect of the syndrome nor are there definitive answers regarding which among antiplatelet, anticoagulant or antithrombin therapies is superior, what is the role of immunosuppressive therapy and what experimental therapies might be introduced. The molecular biology of the antigen-antibody interaction will soon be fully understood, then the cellular and the organism biology. Definitive treatment interventions may await this understanding but adequate therapies are available at this time to conduct important and effective prospective clinical trials.
Role of Genetic Factors in Drug-Related Autoimmunity
Authors: Adams Louis E. , Mongey Anne-Barbara 
Published: November 2007

Although there is evidence to suggest that genetic factors play a major role in the pathogenesis of many of the rheumatic diseases, far less is known of their role in the induction and expression of human autoimmunity resulting from long-term exposure to drugs, chemicals and environmental agents. Pharmacogenetic factors represent an important source of interindividual variation in response to drugs; most research to date has focused on genetic polymorphism of drug metabolism via N-acetylation, S-methylation or cytochrome P-450-catalyzed oxidation. In drug-related autoimmunity, there is limited evidence that the host's genetic background plays a major role beyond the expression of autoantibodies. More recent prospective studies have concentrated on the association of MHC-genes in the expression of autoimmunity and the susceptibility of patients to develop drug-related clinical syndromes.
Appearance of systemic lupus erythematosus after thymectomy: four case reports and review of the literature
Authors: Mevorach Dror , Perrot Serge , Buchanan Neil MM , Khamashta Munther , Laoussadi Sadek , Hughes Graham RV , Menkes Charles Joel 
Published: November 2007

The appearance of systemic lupus erythematosus (SLE) after thymectomy (or thymomectomy) is presented in four patients together with a comparative review of additional reports found in a Medline search for the years 1966-94 in the English and French literature. Fourteen women and two men of average age of 39 years (range 11-66 years) at presentation, developed SLE after thymectomy (11 patients) or thymomectomy (five patients). Half developed SLE within 3 years after surgery (range 3 months to 18 years). The most common SLE manifestation was polyarthritis occurring in 15 of 16 patients either at presentation or during the first year. Other frequent manifestations included skin rashes, fever, cytopenias and pleuritis. Two rare manifesta tions of SLE, optic neuritis and transverse myelitis, were reported in two patients. Thymic hormone activity was measured in one patient and was undetectable compared with normal controls. HLA studies in eight patients showed the combination of A1, B8 in four. In conclusion, the appearance of SLE after thymectomy or thymomectomy appears to be more than a coincidence. It may provide insights into the pathogenesis of SLE.
Association of anticardiolipin antibodies and abnormal nailfold capillaroscopy in patients with systemic lupus erythematosus
Authors: Bongard Olivier , Bounameaux Henri , Miescher Peter-Anton , De Moerloose Philippe 
Published: November 2007

Anticardiolipin antibodies (aCL) are found in about 40-50% of patients suffering from systemic lupus erythematosus (SLE) and their presence carries an increased risk of thromboembolism. Since there is a high prevalence of nailfold capillary abnormalities in patients with SLE, we studied the relationship between aCL and skin microcirculatory changes or vascular symptoms in 51 consecutive patients with SLE (49 women, 2 men, 34.8 ± 13.7 years). Twenty-two patients (43.1 %) had positive aCL (IgG 22 (5-60) GPL; IgM 5 (3-16.5) MPL; median titre and range) and 12 (54.5%) of them had abnormal capilloscopic findings. By contrast, among the 29 patients without aCL, only six (20.7%) had an abnormal capillaroscopy (P = 0.027). There was no correlation between either aCL or capillaroscopy and Raynaud's phenomenon. These results show a relationship between aCL and nailfold capillary changes in patients with SLE, suggesting a direct damage of the vascular endothelium by aCL.
Lack of association between the MHC linked OTF3 gene and systemic lupus erythematosus
Authors: Pablos JL , Carreira PE , Gomez-Reino JJ 
Published: November 2007

The objective of this study was to investigate whether an octamer transcription factor gene ( OTF3) located within the MHC region of chromosome 6 is involved in determining susceptibility to systemic lupus erythematosus (SLE) in a Spanish population. An OTF3 HindIII polymorphism was characterized by restriction fragment length polymorphism analysis of polymerase chain reaction amplified genomic DNA in 69 patients with SLE and 60 controls. No differences in the OTF3 allelic or genotypic distribution between healthy controls and patients with SLE were found. In the group of patients with diffuse proliferative glomerulonephritis, where we have previously detected the strongest MHC association, we did not observe OTF3 linkage either. In conclusion, the OTF3 gene does not appear to be associated with SLE in the Spanish population. This might be due to the distance of the gene from the HLA class II-III region where more relevant autoimmune-related genes are located.
Fluctuations of antibody to ribosomal P proteins correlate with appearance and remission of nephritis in SLE
Authors: Martin AL , Reichlin M. 
Published: November 2007

Antibodies to ribosomal P proteins are found in widely variable proportions (up to 42%) of patients with SLE depending on the ethnic background of the patient population. Neuropsychiatric disease was first recognized to have increased prevalence with anti-P and more recently liver and renal disease. We describe four patients with SLE and circumscribed episodes of nephritis of relatively short duration. In two patients, antibodies to ribosomal P protein were the only specificity detected at the time of appearance of active nephritis; and in the other two patients, the appearance and disappearance of anti-ribosomal P was simultaneously found with similar fluctuations in anti- dsDNA titers. Anti-ribosomal P antibodies were measured by Western blot and a P peptide-specific ELISA. These data raise the possibility for a pathogenic role for anti-ribosomal P antibodies in lupus nephritis.
Heart rate variability and cardiac autonomic function in systemic lupus erythematosus
Authors: Lagana' B. , Tubani L. , Maffeo N. , Vella C. , Makk E. , Baratta L. , Bonomo L. 
Published: November 2007

The cardiac autonomic function was evaluated in 23 patients with Systemic Lupus Erythe matosus (SLE) without clinical expression of dysautonomia and in 14 healthy volunteer subjects as a control group, by analysis of Heart Rate Variability (HRV) from 24 h ambula tory electrocardiography. All the patients were taking corticosteroids and 10 of them also Ciclosporin A (CsA). The following parameters of HRV were performed: Time domain: standard deviation of the RR intervals average (SDNN) and percentage of RR adjacent intervals differing from each other more than 50 msec (pNN50). Frequency domain: low frequencies (LF) and high frequencies (HF). Significant lower values were detected in SLE patients vs controls: SDNN = 69.40 vs 127.72; pNN50 = 16.44 vs 25.95; LF = 8.34 vs 34.97; HF = 3.21 vs 12.18. The incidence of autonomic dysfunction in our SLE population evaluated by considering intervals of nor mality is approximately 78% for SDNN; 17% for pNN50; 91% for LF and, finally, 56% for HF. The analysis of HRV may be a valuable technique in the study of the incidence of dysautonomia for these patients.
Valvular heart disease in primary antiphospholipid syndrome (PAPS): clinical and morphological findings
Authors: García-Torres R. , Amigo M-C. , de la Rosa A. , Morón A. , Reyes PA 
Published: November 2007

Purpose. To describe clinically and pathologically the valvular lesion of the primary anti phospholipid syndrome (PAPS). Patients and Methods. We studied six patients with PAPS and valvulopathy. Four of them died and had autopsy and two had valvular replacement. The study comprised 18 heart valves, 16 from autopsy and two, one mitral and one aortic, resected at surgery. Results. Murmurs and echocardiographic findings kept correlation with gross pathology. Abnormalities were found in one or more valves in all patients including two of five aortic, two of five mitral, one of four pulmonary and two of four tricuspid. Co-existence of new and old lesions was observed. Pathologic findings included intravalvular thrombosis with focal necrosis and hemorrhage, vascular proliferation, mild histiocytic/fibroblastic infiltration, laminated and verrucous fibrin deposits, laminated and/or nodular fibrosis, and focal calcifi cation. Conclusion. The PAPS valvular lesion consists mainly of superficial or intravalvular fibrin deposits and its subsequent organization: vascular proliferation, fibroblast influx, fibrosis and calcification. This results in valve thickening, fusion and rigidity leading to functional abnormalities. Inflammation is not a prominent feature of this lesion.